Inrc 14

25th INTERNATIONAL NURSING
25th INTERNATIONAL NURSING RESEARCH CONGRESS

RESEARCH CONGRESS
Conference Proceedings
ENHANCED ABSTRACTS
OF ORAL AND POSTER
PRESENTATIONS
24-28 July 2014

Hong Kong
Congress 2014 CP cover.indd 1 7/10/14 11:10 AM

25th International
Nursing Research Congress
Enhanced Abstracts of Oral and Poster

Presentations
Held 24-28 July 2014
Hong Kong
© 2015 by Sigma Theta Tau International 2 ISBN: 9781940446134

Copyright © 2015 by Sigma Theta Tau International
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use here does not imply that you may use them for similar or any other purpose.
The Honor Society of Nursing, Sigma Theta Tau International (STTI) is a nonprofit organization
founded in 1922 whose mission is to support the learning, knowledge, and professional
development of nurses committed to making a difference in health worldwide. Members include
practicing nurses, instructors, researchers, policymakers, entrepreneurs and others. STTI’s 496
chapters are located at 678 institutions of higher education throughout Australia, Botswana,
Brazil, Canada, Colombia, Ghana, Hong Kong, Japan, Kenya, Malawi, Mexico, the Netherlands,
Pakistan, Portugal, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan,
Tanzania, United Kingdom, United States, and Wales. More information about STTI can be
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PDF ISBN: 9781940446134

Glossary
A plenary session is a session in which an invited speaker, usually with a significant
subject matter, presents their work or viewpoint. All attendees attend these general
sessions as they usually begin and end a program of events. Plenary sessions vary in
length from one (1) hour to one and a half (1½) hours and can be accompanied by
PowerPoint presentations, audio and/or video files and other visual aids.
An oral presentation is a brief 15-20 minute individual presentation time moderated by

a volunteer. An effective oral presentation should have an introduction, main body and
conclusion like a short paper and should utilize visual aids such as a PowerPoint
presentation. Oral presentations are divided into different categories based on the
program presented. Categories can include: clinical, leadership, scientific, evidence-
based practice, or research.
A poster presentation is the presentation of research information by an individual or

representatives of research teams at a conference with an academic or professional
focus. The work is peer-reviewed and presented on a large, usually printed placard, bill
or announcement, often illustrated, that is posted to publicize. Exceptions to peer-
reviewed posters include Rising Stars student posters and Sigma Theta Tau
International’s Leadership Institute participant posters.
A symposium is a presentation coordinated by an organizer similar to a panel

discussion and contains at least three (3) presentations concerning a common topic of
interest. Each symposium session is scheduled for 45-75 minutes and allows for
questions at the end of the session. Symposia provide an opportunity to present
research on one topic, often from multiple perspectives, providing a coherent set of
papers for discussion.
A peer-reviewed paper is simply an individual abstract that has been reviewed by at

least three (3) peer-reviewers to determine the eligibility of the submission to be
presented during a program. The determination is made by the peer-reviewer answering
a series of regarding the substance of the abstract and the materials submitted. Scores
from each reviewer are compiled. The average score must be 3.00 on a 5-point Likert
scale in order to quality for presentation. Sigma Theta Tau International enforces a blind
peer-review process, which means that the reviewers do not see the name or institution
of the authors submitting the work. All submissions, with the exception of special
sessions and invited posters are peer-reviewed.
An invited or special session is similar to a symposium in the length of time allotted for
presentation, but is not peer-reviewed. These sessions focus on a specific area, but are
conducted by individuals invited to present the work.

Introduction
The Honor Society of Nursing, Sigma Theta Tau International (STTI) conducted its 25th
International Nursing Research Congress at the Hong Kong Convention and Exhibition
Centre, 24-28 July 2014. More than 800 nurses from around the world gathered at the
congress, which had as its theme “Engaging Colleagues: Improving Global Health
Outcomes.”
These conference proceedings are a collection of abstracts submitted by the authors

and presented at the research congress. To promptly disseminate the information and
ideas, participants submitted descriptive information and abstracts of 1500 words or
less. Each oral and poster presentation abstract was peer-reviewed in a double-blind
process in which three scholars used specific scoring criteria to judge the abstracts in
accordance with the requirements of STTI’s Guidelines for Electronic Abstract
Submission.
The opinions, advice, and information contained in this publication do not necessarily
reflect the views or policies of STTI or its members. The enhanced abstracts provided in
these proceedings were taken directly from authors’ submissions, without alteration.
While all due care was taken in the compilation of these proceedings, STTI does not
warrant that the information is free from errors or omission, or accept any liability in
relation to the quality, accuracy, and currency of the information.

Format for Citing Papers
Author. (Year). Title of paper. In Title of conference proceedings (page numbers). Place
of publication: Publisher.
Example:
Smith, C. C. (2015). Nursing Research and Global Impact. In Engaging Colleagues:
Improving Global Health Outcomes: Proceedings of the 25th International Nursing
Research Congress (pp. xxx-xxx). Indianapolis, IN: Sigma Theta Tau
International.

Table of Contents
Part I: Plenary Sessions ............................................................................................. 57
OPENING PLENARY ............................................................................................................ 57
Evidence-Based Nursing Practice: A Panel Discussion .............................................. 57
PLENARY SESSION 2.......................................................................................................... 58
Engaging Colleagues: Improving Global Health Outcomes ........................................ 58
CLOSING PLENARY ............................................................................................................. 59
The Quest for Excellence in International Nursing Research ..................................... 59
Part II: Special Sessions ............................................................................................. 60
A 02 - SPECIAL SESSION: Fostering Global Citizenship in Nursing Education: The
Role of the United Nations .................................................................................................... 60
B 01 - SPECIAL SESSION: Educational Scholarships .................................................... 61
B 02 - SPECIAL SESSION: Celebrating the Asia Region's Excellence and
Advancements in Research and Scholarship Development ........................................... 62
B 06 - SPECIAL SESSION: Exposing Quality of Life and Deadly Health Disparities:
Using Research to Change Health Care Policy ................................................................ 63
B 07 - SPECIAL SESSION: Global Research Collaborations to Prevent and Respond
to Intimate Partner Violence ................................................................................................. 65
C 01 - SPECIAL SESSION: Women's Health and Sleep Research: A Health Ecology
Exemplar for Dialogue on the Keys to Building a Research Career .............................. 66
C 02 - SPECIAL SESSION: Using the Internet to Reach Teens with Type 1 Diabetes
................................................................................................................................................... 67
C 06 - SPECIAL SESSION: A Life Long Quest in Women's Health through Internet
Research Methodology ......................................................................................................... 68
C 07 - SPECIAL SESSION: A Research Journey: To Boldly Go Forward ................... 69
C 13 - SPECIAL SESSION: International Leadership Opportunities............................. 70
D 01 and J 07 - SPECIAL SESSION: Research Abstracts, Proposals and Grant
Writing: Basics from Start to Finish ..................................................................................... 71
D 02 - SPECIAL SESSION: Reducing HIV Health Disparities Among Hispanics
Through Culturally Tailored Intervention Science ............................................................. 72
D 06 - SPECIAL SESSION: Nurses and Tobacco Control: An Intersection of
Research and Health Care Policy ....................................................................................... 74
D 07 - SPECIAL SESSION: Creating Academic Service Partnerships for Education,
Practice and Research .......................................................................................................... 75

E 01 - SPECIAL SESSION: Transitional Care Using Telehealth: Fewer Emergency
Unplanned Admissions and Improved Quality of Life and Functional Ability ............... 76
E 02 - SPECIAL SESSION: The Resilience in Ilness Model: Dialogue on Applicability
in Other Illness Conditions and Difficult/Traumatic Life Circumstances ........................ 77
E 06 - SPECIAL SESSION: Nurses, Healthcare Processes, Partnerships and Patient
Outcomes ................................................................................................................................ 79
F 01 - SPECIAL SESSION: Global Advisory Panel on the Future of Nursing ............. 80
F 02 - SPECIAL SESSION: WHO Collaborating Centers Advancing Global Nursing
Leadership and Fostering Collaboration ............................................................................ 81
F 06 - SPECIAL SESSION: Sustaining Evidence-Based Nursing Practices for Fall
Prevention in Hospitalized Oncology Patients................................................................... 82
G 01 - SPECIAL SESSION: Helping Patients and Families Enrich the Quality of their
Lives during Cancer ............................................................................................................... 84
G 02 - SPECIAL SESSION: Leadership and Person-Centredness: Time for Change!
................................................................................................................................................... 85
G 06 - SPECIAL SESSION: Towards Improved Safety by Examining the Complexities
of Health Care ......................................................................................................................... 86
G 07 - SPECIAL SESSION: Preventing Complications Associated with Tube
Feedings .................................................................................................................................. 88
H 01 - SPECIAL SESSION: From Evidence to Practice and Policy Making: Promoting
the Health Care Quality of Children with Asthma in Taiwan ........................................... 89
H 02 - SPECIAL SESSION: Global Epidemics of Type 2 Diabetes and Cardiovascular
Disease: Nursing Opportunities for Prevention and Management ................................. 91
H 06 - SPECIAL SESSION: Science Supporting the Practice of Acute/Critical Care
Nursing ..................................................................................................................................... 93
H 07 - SPECIAL SESSION: Interventions to Improve Physical Functioning and
Psychological Adjustment in Advanced Heart Disease ................................................... 94
I 01 - SPECIAL SESSION: The Nurse Faculty Leadership Academy: Outcomes from
Leadership Development Mentoring in Three Domains .................................................. 95
I 02 - SPECIAL SESSION: Structuring Caring Science Data for Operations and
Outcomes. ............................................................................................................................... 96
I 07 - SPECIAL SESSION: Getting Published in Nursing Journals: Strategies for
Success ................................................................................................................................... 97
I 11 - SPECIAL SESSION: Basic Principles and Applications of Community-Based
Participatory Research to Advance Nursing Science in HIV Prevention ...................... 98
J 01 - SPECIAL SESSION: The Geriatric Nursing Leadership Academy: Outcomes
across the Care Continuum .................................................................................................. 99
J 02 - SPECIAL SESSION: Use of Caring Theory in Culture and Context in Scotland
and Cameroon ...................................................................................................................... 100

K 02 - SPECIAL SESSION: Caring Science in Asia ...................................................... 101
K 07 - SPECIAL SESSION: Publishing: A Career Road for You? ............................... 102
L 01 - SPECIAL SESSION: Research Abstracts and Grant Writing: Basic Strategies
for Success............................................................................................................................ 103
L 02 - SPECIAL SESSION: Partnership-Based Health Care: Applying Principles of
Caring to Entire System ...................................................................................................... 104
Part III: Evidence-Based Practice Oral Presentations ............................................ 105
A 12 - Reflective Writing Influencing Evidence-Based Practice ................................... 105
Using Reflective Writing as a Nursing Intervention: Review of the Literature ........ 105
A 12 - Reflective Writing Influencing Evidence-Based Practice ................................... 106
Reflective Journaling: Using a Blog with Undergraduate Senior Practicum Nursing
Students ............................................................................................................................. 106
A 13 - Evaluating Nursing Education ................................................................................ 107
Objective Knowledge Assessment in Nursing Education: An Update on the
Evidence-Based Knowledge Assessment in Nursing (EKAN) Instrument .............. 107
The Utilization of Adult Learning Models to Increase Course Evaluation Scores in a
Historically Poorly Evaluated, Graduate Level, APRN Pharmacology Course ...... 109
Evaluation of the Master Instructor Concept in an Accelerated Baccalaureate
Program ............................................................................................................................. 110
A 14 - Simulation Based Learning Technologies ............................................................ 112
Standardized Patient Simulation for Evidenced-Based Practice with First Semester
BSN Student ..................................................................................................................... 112
A 14 - Simulation Based Learning Technologies ............................................................ 113
Examining the Use of a Digital Clinical Patient in the Online Classroom
Environment ...................................................................................................................... 113
B 12 - Preparing Students as Catalysts for Change ....................................................... 115
The Role of Preparatory Activities in Clinical Education for the Pre-Licensure
Nursing Student ................................................................................................................ 115
Educating Nursing Students as Change Agents: A Case Study .............................. 117
Innovative Community Placements: Enhancing Students Experiences with Diverse
Population.......................................................................................................................... 119
B 13 - Academic Program Development .......................................................................... 121

Development and Implementation of a Team-Based Learning Module: An
Academic Perspective ..................................................................................................... 121
B 13 - Academic Program Development .......................................................................... 123
Designing a Faculty Development Program for the Effective Use of Analytic
Grading Rubrics................................................................................................................ 123
B 14 - Nursing Workforce Collaboration ........................................................................... 125
Activation Planning: Preparing a Workforce for Expansion into a New Healthcare
Facility ................................................................................................................................ 125
Fostering Healthy Work Environments: Diversity and Health Equity Competencies
for Managers ..................................................................................................................... 128
Becoming a Better Interprofessional Practitioner: How Does it Happen; What is the
Impact................................................................................................................................. 130
C 12 - EBP Moving Global Practice .................................................................................. 132
Measuring Endoscopic Performance for Colorectal Cancer Prevention Quality
Improvement in a Gastroenterology Practice .............................................................. 132
Munchausen By Internet: A Netnographical Case Study .......................................... 133
The Impact of Computerized Clinical Decision Support on Diagnostic Accuracy in
Nurse Practitioners........................................................................................................... 134
C 14 - Incivility in Nursing Practice .................................................................................... 136
Bullying and Its Prevention Among a National Sample of Israeli ICU Nurses........ 136
Come In…The Water's Warm: A New Nurse's Induction to a Hostile Environment
............................................................................................................................................. 139
The Pebble Effect: Stopping Incivility in Clinical Environments ................................ 141
D 12 - Leadership in the Clinical Setting .......................................................................... 143
The Ankle Blood Pressure Study: An Exemplar Project of Mentoring, Leadership,
and Collaboration to Promote Nursing Research ....................................................... 143
D 12 - Leadership in the Clinical Setting .......................................................................... 147
Acknowledging and Enabling Point-of-Care Leadership: A Key to Clinical Nursing
Excellence ......................................................................................................................... 147
D 13 - Practices Within Nursing Education ...................................................................... 149
Debunking the Myths about Private Sector Nursing Education ................................ 149

D 13 - Practices Within Nursing Education ...................................................................... 150
Teaching/Learning Strategies to Integrate Genetics and Genomics into
Undergraduate Nursing Education ................................................................................ 150
D 14 - Evidence-Based Practices Affecting Global Women's Health .......................... 151
Implementing the Promotion of Ambulation and Upright Positioning During the First
Stage of Labor .................................................................................................................. 151
Effects of Herbal Tea on Postpartum Sleep Quality ................................................... 154
A Study on Teaching-Learning Methods to Promote Self-Directed Learning for
Women's Health Nursing ................................................................................................ 155
E 12 - Educational Simulation Strategies ......................................................................... 157
Enhancing Nursing Students' Medication Safety Competencies with a Pediatric
Medication Simulation Experience ................................................................................ 157
E 12 - Educational Simulation Strategies ......................................................................... 159
A Comparison of Students' Perception on Effectiveness of Integrating Electronic
Health Records into Simulation in Undergraduate Nursing Program ...................... 159
E 13 - Patient Safety Impacts on Evidence-Based Practice ......................................... 161
Nursing Students' Perceptions of Knowledge and Training during the Medication
Administration Process.................................................................................................... 161
E 13 - Patient Safety Impacts on Evidence-Based Practice ......................................... 164
Nurses' Patient Safety Competencies in Korea .......................................................... 164
E 14 - Using EBP Within the Elderly Population ............................................................. 165
Fall Prevention Algorithm for the Older Adult Population: A DNP Project Utilizing
Evidence-Based Practice and Translational Research .............................................. 165
Factors Affecting the BODE Index of Thai Older Adults with COPD ....................... 167
What Impact Does Pharmacist Led Medication Reconciliation Strategies Have on
Reduction of Medication Errors in the Older Adult? ................................................... 168
F 12 - Patient Education and Treatment Modalities ....................................................... 170
Enhancing Adherence to Treatment for Clients with Serious Mental Illness .......... 170
F 12 - Patient Education and Treatment Modalities ....................................................... 172
A Primary Health Care Campus Drive in Responding to a Research Study of
University Students' Knowledge, Perception Towards Human Papillomavirus (HPV)
Infection and Vaccination, and Acceptance of Vaccination for Themselves:
Comparison Between Males and Fem.......................................................................... 172

F 13 - Diverse Language Challenges Within Nursing Practice ..................................... 174
Beyond the Language Barrier: "See," "Hear," "Speak," "Help Me" .......................... 174
Connections for Learning: An Innovative Program to Support Culturally and
Linguistically Diverse Students ...................................................................................... 175
Validation of a Post-Entry English Language Assessment for Commencing
Undergraduate Nursing Students .................................................................................. 177
F 14 - EBP in the Global Clinical Setting .......................................................................... 179
Collaboration in the Chain of Stroke Care: Stroke After-Care, a Gap to be Closed
............................................................................................................................................. 179
F 14 - EBP in the Global Clinical Setting .......................................................................... 180
Barriers Impacting Rapid Access to Tertiary Care for Time Sensitive Critically Ill
Patients .............................................................................................................................. 180
G 12 - Educational Strategies for Clinical Nursing Education ....................................... 182
A Faculty and BSN Student Care Delivery Model for Patients with Diabetes ........ 182
It Takes a Village: Addressing Health Inequities Via Nurse Practitioner Education
............................................................................................................................................. 186
A Substance Abuse Awareness Seminar for Nursing Students ............................... 188
G 13 - Nursing Educational Strategies ............................................................................. 190
Emergent Care Competence and Its Related Factors Among Junior High and
Elementary School Nurses in Taiwan ........................................................................... 190
G 14 - Nursing Student Centered Learning Strategies .................................................. 193
Evaluating Student Success after a Change in the Teaching/Learning Environment
............................................................................................................................................. 193
Innovative Approaches to Clinical Teaching and Learning: Caring for Clients
Undergoing Perioperative Surgical Experiences by Nursing Students ................... 194
Student Remediation in Nursing Programs: The Evidence, the Gaps, and New
Directions ........................................................................................................................... 196
H 12 - Evidence-Based Practice Implications Within Emergency Care ...................... 197
Ultrasound-Guided Peripheral Intravenous Insertion ................................................. 197
An Evidence-Based Approach for Death Notification ................................................. 199

ED Community Placement Project (EDCPP): Right Service-Right Venue Approach
in Managing ED Frequent Users ................................................................................... 201
H 13 - Global Leadership .................................................................................................... 202
Graduate Students Meet Cinematic Leaders: A Creative Final Project for
Managerial/Leadership Course ...................................................................................... 202
Global Nursing Leadership Collaboration: Chinese Evidence-Based Practice
Immersion Program ......................................................................................................... 203
Leadership is Key to High-Performance Amidst Inevitable Trends of Diversity ..... 204
H 14 - EBP Applied to Chronic Conditions....................................................................... 205
The Effectiveness of Nurse-Led Pre-Operative Assessment Clinics for Patients
Receiving Elective Orthopaedic Surgery: A Systematic Review .............................. 205
Intervention Study on Program Development of the Exercise Adherence for the
Elderly of Musculoskeletal Ambulation Disability Symptom Complex ..................... 207
Evidence-Based Outcomes to Detect Obstructive Sleep Apnea, Identify Co-Existing
Factors, and Compare Characteristics of Patients Discharge Disposition ............. 209
I 12 - Using EBP Within Maternal-Child Health ............................................................... 211
The Effect of Breastfeeding Intervening Program in the Non-Authorized Baby-
Friendly Hospital ............................................................................................................... 211
I 12 - Using EBP Within Maternal-Child Health ............................................................... 213
Reduction of Childhood Obesity via the Web-Based Programs in School-Aged
Children.............................................................................................................................. 213
I 13 - Evidence-Based Practice Solutions ........................................................................ 214
Patient Outcomes from Care Provided by Advanced Practice Nurses in the U.S. 214
I 13 - Evidence-Based Practice Solutions ........................................................................ 216
Translating the DASH Diet into Practice ...................................................................... 216
I 14 - Implementing EBP with Staff.................................................................................... 218
Staff Nurses' Use of Research to Facilitate Evidence-Based Practice ................... 218
The Nethersole Nursing Practice Research Unit: Reflecting on its Successes and
Challenges in Promoting Evidence-Based Practice in Nursing in Hong Kong....... 220

Identifying Entry-Level Nursing Practice Characteristics and Emerging Trends in
the United States through Evidence-Based Research ............................................... 222
J 13 - Evidence-Based Practice Within the Pediatric Population ................................. 225
Child Sex Trafficking in the Health Care Setting: Recommendations for Practice 225
Partnerships in Global Health: Nursing Assessments with School-Age Children in
Belize to Promote Healthy Living ................................................................................... 226
Engaging At-Risk Youth Utilizing the Community Emergency Response Team
(CERT) Training as a Harm Reduction Tool ................................................................ 227
J 14 - Clinical Changes Resulting from Evidence-Based Research ............................ 229
Blood Aspiration during Intramuscular Injection .......................................................... 229
Building an Integrated System of Care Across the Extended Care Continuum with
the LINCT Program (Liaison In Nursing Care Transitions)........................................ 232
Improving Alarm Profile Notifications and Responses ............................................... 234
K 13 - Using Technology to Educate Nurses ................................................................... 235
Computer-Based Training at a Military Medical Center: Understanding Decreased
Participation in Training among Staff and Ways to Improve Completion Rates .... 235
K 13 - Using Technology to Educate Nurses ................................................................... 239
Designing Service Learning Projects for an Online Course in Healthcare Delivery
............................................................................................................................................. 239
K 14 - Global Perspectives on EBP .................................................................................. 241
Translating Practice into Policy: Disaster Nursing and Research in the American
Red Cross.......................................................................................................................... 241
L 13 - Global Pain Management Strategies ..................................................................... 244
Will Introduction of a Pain Assessment Template in an Electronic Medical Record
Result in Improvement of Pain Assessment Documentation in an Outpatient Setting
............................................................................................................................................. 244
L 13 - Global Pain Management Strategies ..................................................................... 246
Comparative Differences in the Perception of Postoperative Pain in Patients and
Nurses ................................................................................................................................ 246
L 14 - Evidence-Based Practice in Nursing ..................................................................... 248
High Quality and Low Cost: Evidence-Based Nursing Workshops in a Large Health
Care Organization ............................................................................................................ 248

An Evidence-Based Approach to Successful Practice Change, the Toolkit:
Implementation of Best Practice Guidelines ................................................................ 249
Evidence-Based Practice and Ways of Knowing ........................................................ 251
M 13 - Best Practices in Long-Term Care Facilities ....................................................... 252
Building a Bridge to Improve Self-Care Independence Among Long-Term Care
Facilities Residents: From the Staff Caregiver Perspective ...................................... 252
Translating Evidence into Practice in the Residential Aged Care Setting: Long Term
Sustainability of the Champions for Skin Integrity Model .......................................... 253
Promoting Resident-Centered Care through the Implementation of Best Practices:
A System-Level Implementation Program.................................................................... 254
M 14 - Evidence-Based Practices Changing Global Practice ....................................... 255
Changing the Face of Health Care in a Global Society, Sustaining EBP in Wound
Care: An International Collaboration in the Philippines.............................................. 255
Triplet Partnering: A Novel Approach to Introducing Evidence-Based Nursing
Practice in China .............................................................................................................. 256
Global Collaboration to Build Nursing Competence in EBP ...................................... 258
N 13 - Ensuring Patient Engagement and Adherence Through Education ................ 260
Effectiveness of Patient Engagement through Population-Focused Health
Education on Health Outcomes ..................................................................................... 260
Infused Telemental Health Home Monitoring: Right Care, Right Time, Right Place
............................................................................................................................................. 262
Oral Chemotherapy Adherence ..................................................................................... 264
Part IV: Research Oral Presentations ...................................................................... 266
A 01 - Ethical Issues in Nursing Practice ......................................................................... 266
Expanding Our Understanding Complex Decision-Making in Emergent, Routine and
Urgent Ethically Challenging Clinical Situations.......................................................... 266
Experience of Ethical Conflict in Advanced Practice Nurses and Nurse Managers
............................................................................................................................................. 267

Ethical Issues in Community Health Nursing in Botswana ........................................ 268
A 03 - Promotion and Lived Experiences of Breastfeeding Mothers ........................... 269
Promoting and Supporting Breastfeeding: A Local Support Group Perspective ... 269
A 03 - Promotion and Lived Experiences of Breastfeeding Mothers ........................... 271
Impact of a Nurse-Driven Breastfeeding Educational Intervention on Maternal-Child
Nurse Knowledge Gain and Patient Satisfaction in a Community Hospital ............ 271
A 04 - Cultural DIfferences in Reproductive Health ........................................................ 272
Understanding Cultural Impacts and the Truth of Taiwanese Women's Request for
Repeat Cesarean Delivery.............................................................................................. 272
A 04 - Cultural DIfferences in Reproductive Health ........................................................ 274
Contraceptive Use Among Low-Income and Ethnic Minority Women Living in Three
Urban Underserved Neighborhoods ............................................................................. 274
A 05 - Nursing Burnout ........................................................................................................ 276
Trait Negative Affectivity: A Predictor of Burnout and Secondary Traumatic Stress
in Nurses in WA ................................................................................................................ 276
Nurse Burnout and Patient Outcomes .......................................................................... 278
Application of Revised Nursing Work Index and the Maslach Burnout Inventory for
Registered Nurses from Public Health Institutions, Sao Paulo, Brazil .................... 279
A 06 - Potential Development Within Nursing Programs ............................................... 282
A National Survey of Faculty Knowledge and Experience with Lesbian, Gay,
Bisexual and Transgender (LGBT) Health and Readiness for Inclusion in Teaching:
Curricular Implications for Baccalaureate Nursing Programs ................................... 282
How Politics Affect the Development and Evolvement of a Nursing Program:
Engaging Colleagues in the Community to Improve Global Health Outcomes...... 283
Development of Educational Program for Vietnamse Nurses Using ADDIE Model
............................................................................................................................................. 285
A 07 - Pediatric Health Promotion ..................................................................................... 287
Validation and Sensitivity Pictorial Pediatric Symptom Checklist ............................. 287
Factors Predicting Resourcefulness in Taiwanese Preadolescents ........................ 288
Non-Urgent Emergency Department Use in an Urban Pediatric Primary Care
Population.......................................................................................................................... 289

A 09 - Global Prevention and Management of Cardiovascular Related Disease ...... 291
Factors and Outcomes Associated with Hypertension Management: A Structural
Model.................................................................................................................................. 291
Effects of Self-Management Education Programme in Improving Self-Efficacy of
Patients with Chronic Obstructive Pulmonary Disease: An Exploratory Trial ........ 293
How Risk Ideology Creates Patient Work in a Secondary Stroke Prevention Clinic:
Findings from an Institutional Ethnography in Canada .............................................. 294
A 10 - Transforming Nursing Through Education and Collaboration ........................... 297
Transforming Healthcare through Educational Diversity: Academic Health Center
Pipeline Project ................................................................................................................. 297
A Systematic Review of the Effectiveness of Knowledge Translation Interventions
to Promote Evidence-Informed Decision Making Among Nurses in Tertiary Care 299
Student and Faculty Collaboration: Revising a Mentorship Model .......................... 302
B 03 - Health Promotion Strategies in the Older Population ......................................... 304
Robotic Pets as Companions for Socially Isolated Older Adults .............................. 304
B 03 - Health Promotion Strategies in the Older Population ......................................... 305
The Significance of Walking Speed in Physical Function Among a Group of
Community Dwelling Older Adults ................................................................................. 305
B 04 - Psychiatric Education and the Nursing Student .................................................. 306
Motivating Nursing Students to Intervene with their Psychiatric Clients who Use
Tobacco ............................................................................................................................. 306
Factors Affecting Assessment of Student Nurses` Clinical Practice: A
Phenomenographic Exploration of the Experiences and Understanding of Mentors
of a Mental Health Service in England.......................................................................... 308
Comparison with the State Level As Well As the Relationship of Stress, Resilience
and Psychological Health Between U.K. and China: A Newest Cross-Sectional
Global Study in Undergraduate Nursing Students ...................................................... 309
B 05 - Health Promotion and Disease Prevention in the Diabetic Patient .................. 311
Factors Associated with Metabolic Syndrome Among Thai Women ....................... 311

Relationships Among Locus of Control, Psychology Status and Glycemic Control in
Type 2 Diabetes ............................................................................................................... 313
The Experiences of Siblings Living with a Child with Type 1 Diabetes ................... 314
B 09 - Global Research in the Acute Care Setting ......................................................... 316
A Case-Control Study on Predictors and Outcomes of Unplanned Extubation in
Mechanically Ventilated Critically Ill Patients ............................................................... 316
Mixed Methods: Ideal for Research in the Emergency Department ........................ 317
Acute Confusion Among the Patients in Surgical Intensive Care Units .................. 318
B 10 - Leadership Within the Nursing Workforce ............................................................ 319
Engaging Interprofessional Colleagues in a Collaborative Community of Faculty
Scholars ............................................................................................................................. 319
B 10 - Leadership Within the Nursing Workforce ............................................................ 320
Understanding Workplace Reciprocity of Emergency Nurses: A Qualitative Study
............................................................................................................................................. 320
C 03 - Health Promotion and DIsease Prevention in the Patient with Cancer ........... 326
Predictors of Exercise Counseling Behaviors of Oncology Nurses to Women with
Breast Cancer Experiencing Treatment-Induced Cancer-Related Fatigue ............ 326
C 03 - Health Promotion and DIsease Prevention in the Patient with Cancer ........... 328
Prevalence of Depression in Patients with Pituitary Tumors: Association of
Depression with Perceived Social Capital.................................................................... 328
C 04 - Impacting Student Behaviors Through Engagement.......................................... 330
Measuring Student Satisfaction and Loyalty: A Waste or a Goldmine? .................. 330
Enhancing Leadership Characteristics in Baccalaureate Nursing Students .......... 331
Growing the Flowers: Preparing Undergraduate Nursing Students for a Community
Healthcare Placement in a Neoliberal Economy......................................................... 332
C 05 - Global Women's Health and Cancer ..................................................................... 334
Transition of Women's Perceptions of Health Status When Diagnosed with Breast
Cancer................................................................................................................................ 334
C 05 - Global Women's Health and Cancer ..................................................................... 335
Insights into the Experiences of Women with Physical Disability in Accessing
Cancer Screening ............................................................................................................ 335
C 09 - Healthcare Education for the Older Adult ............................................................. 336

Cogito Ergo Sum: A Grounded Theory of the Filipino Elderly Transition Experiences
in Third Age Education Program.................................................................................... 336
C 09 - Healthcare Education for the Older Adult ............................................................. 338
"Don't Leave Us Out" Civic Literacy: Older Mexican-American Women and Cervical
Cancer Screening ............................................................................................................ 338
C 10 - At-Risk Behaviors in the Adolescent Population ................................................. 340
Effectiveness of Structured Teaching Programme on Addiction Among Adolescents
............................................................................................................................................. 340
Teen Pregnancy: A Multi Method Community Evaluation ......................................... 342
Improving Global Health Outcomes for Teenage Pregnancy Prevention:
Intervention Programs in the United States, Canada, China and the Philippines . 343
D 03 - Workplace Behaviors Affecting Nursing Engagement ....................................... 345
Workplace Violence Towards Nurses at Private and Government Healthcare
Settings of Karachi Pakistan .......................................................................................... 345
Work Stressors and Perceived Organizational Support on Front Line Nurse
Manager Work Engagement .......................................................................................... 356
When the Postive Attributes of Leadership Become Harmful: A Pre Post-Test
Analysis .............................................................................................................................. 358
D 04 - Care Issues With the Cardiac and Diabetic Patient............................................ 359
An International Comparison of Prevalence and Clinical Efficacy of Using
Telehealth to Support Diabetic Self-Management by Patients with Both Cardiac
Disease and Diabetes ..................................................................................................... 359
D 04 - Care Issues With the Cardiac and Diabetic Patient............................................ 361
Does Diabetes Mellitus Make a Difference in Symptom Presentation of Patients
with Acute Myocardial Infarction? .................................................................................. 361
D 05 - Global Research of Tools to Effect Clinical Change .......................................... 362
A Model Testing on Health Literacy, Knowledge about Vitamin D, and Actual
Behavior in Sunlight Exposure ....................................................................................... 362
Is the Braden Mobility Subscale Alone as Predictive as the Braden Scale? .......... 363
A Study on Reliability and Validity of a Tool for Measuring Foreign Patient
Satisfaction ........................................................................................................................ 364

D 09 - Improving Nursing Student Behavior through Research ................................... 366
Nursing is a Team Sport: Sideline Coaching to Achieve NCLEX-RN Success ..... 366
D 09 - Improving Nursing Student Behavior through Research ................................... 369
Improving the Skills of RN-BSN Students in Maximizing the Use of Data and
Information for Evidence-Based Nursing: Nursing Information Behavior................ 369
D 10 - Patient Safety and Nursing Autonomy .................................................................. 371
Registered Nurse Individual Innovative Behavior and Research Utilization ........... 371
Underlying Factors of Medication Errors at a Tertiary Care Hospital, Pakistan ..... 372
Measurement of Moral Courage .................................................................................... 374
E 03 - Global Nursing Migration ......................................................................................... 375
Managing Migration of Human Resources for Health: The Philippine Perspective375
E 03 - Global Nursing Migration ......................................................................................... 378
Examining Filipinos as Foreign-Educated Nurses in the United States from the
Perspectives of Post-Colonialism .................................................................................. 378
E 04 - Nursing Research in Critical Care ......................................................................... 379
A Qualitative Study of Family Members of ICU Patients Who Require Extensive
Monitoring .......................................................................................................................... 379
Impact of a Smart Phone Application on ICU Family and Provider Satisfaction.... 380
Involving Relatives in ICU Patient Care: The Barriers and Enablers....................... 382
E 05 - Utilizing Multiple Technologies to Influence Nursing .......................................... 384
Radio Frequency Identification Device (RFID) and Real Time Location Systems
(RTLS) Enhance Nursing Care Delivery ...................................................................... 384
E 05 - Utilizing Multiple Technologies to Influence Nursing .......................................... 385
Comparison of Telemedicine to Traditional Face-to-Face Care for Children with
Special Healthcare Needs: Analysis of Cost, Caring, and Family-Centered Care 385
E 09 - Using Simulation Through the Lifespan ................................................................ 387
The Use of a Death Notification Simulation and Readiness for Interprofessional
Learning in Nursing and Social Work Students ........................................................... 387
Baby Boy Jones: Using Technology to Engage Undergraduate Nursing Students in
a Case-Based Learning Activity ..................................................................................... 388

Aging Simulation Program: Improving Nursing Students' Attitudes Toward Caring
for Older People ............................................................................................................... 389
E 10 - Medication Related Research in the Clinical Setting .......................................... 390
Medication Communication during Handovers Involving Nurses in Speciality
Hospital Settings............................................................................................................... 390
A Systematic Review of Non-Pharmacological Management of Heel-Stick Pain in
the Pre-Term Neonates ................................................................................................... 392
Exploration of the Medication Disturbance, Quality of Life and Effectiveness of an
Educational Program on the up to Six Months Follow-Up in Atrial Fibrillation
Patients Under Warfarin Treatment .............................................................................. 394
F 03 - Geriatric Nursing Research ..................................................................................... 396
Determinants of Physical Function Recovery in Elderly during Three Months Post-
Hospitalization................................................................................................................... 396
The Experience of Giving Informed Consent in a Mexican-American Older Adult 399
A Mixed-Methods Study for Evaluating the Effect of a Cultural and Contextual-
Specific Exercise Program on Therapeutic Exercise Adherence of Older People
with Knee Osteoarthritis .................................................................................................. 401
F 04 - Affairs Surrounding End-of-Life .............................................................................. 403
Spirituality as a Predictive Factor for Signing an Organ Donor Card ...................... 403
F 04 - Affairs Surrounding End-of-Life .............................................................................. 404
Post Mortem Nursing Care Effectiveness as Perceived by U.S. Hospital Staff
Nurses ................................................................................................................................ 404
F 05 - Global Issues Within the Nursing Workforce........................................................ 406
Gender Differences in the Interrelationships Among Job Stress, Job Satisfaction,
and Intention to Leave Among Hospital Nurses in Taiwan........................................ 406
Registered Nurses Extended Work Shifts and the Association with Quality of
Nursing Care and Patient Safety: A Cross Sectional Survey in Twelve European
Countries ........................................................................................................................... 407
Does Moonlighting Influence South African Nurses' Intention to Leave Their
Primary Jobs? ................................................................................................................... 409
F 07 - Psychological Care of rthe Patient with Cancer .................................................. 410
The Journey of Fighting Cancer: Chinese Canadians' Experiences ....................... 410

F 07 - Psychological Care of rthe Patient with Cancer .................................................. 411
CAM Use: Change across Cancer Treatment and Impact on Stress, Mood, and
Quality of Life .................................................................................................................... 411
F 10 - Learning Environments and Outcomes ................................................................. 412
Negative Depictions of Nursing and the Clinical Learning Environment in South
African Newspapers: Optimizing the Hidden Curriculum to Teach Values to Student
Nurses ................................................................................................................................ 412
Consensus on Outcomes for a Standardized Preceptor Training Programme in
South Africa ....................................................................................................................... 413
Assessment of Related Learning Experience: Basis for a Proposed Dedicated
Education Unit Model (DEU) .......................................................................................... 415
G 03 - Education Based Simulation .................................................................................. 417
Outcomes of an Evidence-Based Research (EBR) Tool to Teach Online Research
and Critical Thinking Skills .............................................................................................. 417
The Effectiveness of Simulation Using in Nursing Education ................................... 418
Examining the Effects of a Standardized Patient Simulation Experience on Decision
Making, Self Efficacy and Critical Thinking .................................................................. 419
G 04 - Dealing with HIV and Vulnerable Populations..................................................... 421
Motivational Factors and Preferences Regarding Research Participation Among
HIV+ Adults in an Urban Setting .................................................................................... 421
Zero New HIV and TB Infection: Vision Impossible with the Current Management of
LGBTI Students in a Rural-Based University .............................................................. 424
SEPA II: Links from Childhood Abuse to Adult Intimate Partner Violence,
Depression, and Drinking in Hispanic Women ............................................................ 425
G 05 - Health Promotion in the Postpartum Arena ......................................................... 427
The Early Postpartum Experience of Previously Infertile Mothers ........................... 427
Effect of Self-Efficacy Regarding a Smooth Labor on Cesarean Deliveries Among
Primiparas in Taiwan ....................................................................................................... 428

Depression and Social Support Trajectories during One Year Postpartum Among
Marriage-Based Immigrant Mothers in Taiwan ........................................................... 429
G 09 - Healthcare Delivery Among Vulnerable Populations ......................................... 431
Nursing Health Promotion Interventions Needed to Reduce Oral Health Disparities:
The Situation in Israel ...................................................................................................... 431
G 09 - Healthcare Delivery Among Vulnerable Populations ......................................... 434
Health Services or Debt Servicing?: SAPs in the Philippines and the Healthcare
Delivery System................................................................................................................ 434
G 10 - Global Nursing Research: Medication Related Randomized Controlled Trials
................................................................................................................................................. 437
Randomized Controlled Trial of Motivational Interviewing to Improve Medication
Adherence of Heart Failure Patients in Mainland China: A Pilot Study ................... 437
................................................................................................................................................. 439
A RCT of the Effects of Medication Adherence Therapy for People with
Schizophrenia Specturm Disorders ............................................................................... 439
................................................................................................................................................. 441
Examining Usual Care Relating to Medicine Adherence Across Kidney
Transplantation Sites: Implications and Managing Differences in Preparation for a
RCT .................................................................................................................................... 441
H 03 - Clinical Based Simulations ..................................................................................... 443
The National Simulation Study: A Longitudinal, Multi-Site, Randomized, Controlled
Study Examining the Use of Simulation as a Substitute for Clinical Hours ............ 443
H 03 - Clinical Based Simulations ..................................................................................... 445
Training Nurses for Charge Nurse Duties through Simulation.................................. 445
H 04 - Health Promotion and Prevention of HIV/AIDS ................................................... 446
SEPA II: Predictors of Self-Efficacy for HIV Prevention Among Hispanic Women 446
A Comparative Study of HIV Positive African Migrants' Efforts to Gain Health
Services in the U.K. and U.S .......................................................................................... 448
HIV Pilot Program for Chinese College Students: Differences by Gender ............. 450
H 05 - Complementary Global Initiatives for Patient Health .......................................... 452
The Effect of Warm-Water Footbath on Fatigue, Sleep and Quality of Life of Stroke
Patients .............................................................................................................................. 452

Effects of Aromatherapy on Sleep Quality and Emotional Status of Hong Kong
Nursing Students Facing Final Examination: A Randomized Controlled Trail ....... 454
Using Healing Touch to Help Junior Nursing Students with Their Anxiety ............. 456
H 10 - Perceptions: Variations from Patients to Staff ..................................................... 458
Knowledge, Attitudes, and Perceptions of Preeclampsia Among First-Generation
Nigerian Women in the United States ........................................................................... 458
Understanding Hospital Staff Needs and Perceptions in the Provision of Palliative
Care .................................................................................................................................... 459
Who Are the Family Caregivers?: Epidemiologic Research ..................................... 461
I 03 - Global Cuturally Diverse Pediatric Concerns ........................................................ 463
Systematic Evaluation of the Psychometric Properties of Pain Assessment Scales
for Use in Chinese Children: Where Are We? ............................................................. 463
I 03 - Global Cuturally Diverse Pediatric Concerns ........................................................ 465
The Experience of Dysmenorrhea and Its Related Self-Care Behaviors Among
Adolescent Girls ............................................................................................................... 465
I 04 - Diabetic Management and Health Promotion........................................................ 466
The Influence of the Social Determinants of Health on Diabetes Self-Management
in Rural Appalachia .......................................................................................................... 466
I 04 - Diabetic Management and Health Promotion........................................................ 467
Effectiveness of Community-Based Multifaceted Intervention (STOP-DM) Designed
for Korean-Americans with Type 2 DM ......................................................................... 467
I 05 - Cultural and Language Barriers in Nursing............................................................ 469
Navigating Cultural Waters: Experience of Western Patients Being Cared for by
Chinese Nurses in Beijing ............................................................................................... 469
I 06 - Clinically Relevant Global Nursing Education ....................................................... 471
Are Nurses Prepared for a Radiological Disaster?: Assessing the Knowledge of
Nursing Students to Support the Need of Integrating Radiological/Disaster Content
into Nursing Curricula ...................................................................................................... 471
Evidence of Moving on: Education and Evidence-Based Practice .......................... 473
Continuing Education Ensures Competence to Practise and Assures Public Safety
............................................................................................................................................. 474
I 10 - Promoting Health in Multiple Disease Processes ................................................. 476

Differences in Scores on the Midlife Women's Symtom Index Between Women with
and without Cardiovascular Disease ............................................................................. 476
I 10 - Promoting Health in Multiple Disease Processes ................................................. 479
Nursing Services for the Prevention and Control of Non-Communicable Diseases
............................................................................................................................................. 479
J 03 - Health Promotion in the Pediatric Population ....................................................... 483
Factors Associated with Physical Activity in Kindergarten Children ........................ 483
The Family Partners for Health Study: A Randomized Cluster Control Trial for Child
and Parent Weight Management ................................................................................... 486
An Ecological Approach to Understanding Health Promoting Behaviors of Children
from Low-Income Families: A Multi-Level Analysis .................................................... 487
J 04 - Global Research Regarding Undergraduate Nursing Students ........................ 488
Educational Efforts for Enhancing Global Health Competencies Among
Undergraduate Nursing Students in South Korea ...................................................... 488
J 04 - Global Research Regarding Undergraduate Nursing Students ........................ 490
Undergraduate Nursing Students' Beliefs and Readiness to Implement Evidence-
Based Practice.................................................................................................................. 490
J 05 - Inspiring Nurse Leaders ........................................................................................... 492
Executive Perspective on the DNP ............................................................................... 492
For the Love of Nursing: Person-Centred, Ever Changing and Self-Fulfilling.
Nursing-People, Change, Growth.................................................................................. 495
A Program of Nursing Clinical Supervision in Primary Healthcare: Strategies to
Implement .......................................................................................................................... 496
J 06 - Global Women's Health Concerns ......................................................................... 498
Do Nurses Have Worse Pregnancy Outcomes? ......................................................... 498
J 06 - Global Women's Health Concerns ......................................................................... 500
Changing Cultural Beliefs Contributing to Breast Cancer Deaths ............................ 500
J 10 - Exploring Technology to Improve Patient Care.................................................... 502
Exploring Nursing Cost Using Patient Level Data ...................................................... 502
J 10 - Exploring Technology to Improve Patient Care.................................................... 505
Using Social Network Analysis to Depict the Structure of Research Collaborations
............................................................................................................................................. 505
J 11 - Integrating Global Community Mental Health Services ...................................... 507

Integrated Community Mental Health Services (ICMHS): Quality of Life and Patient
Satisfaction ........................................................................................................................ 507
J 11 - Integrating Global Community Mental Health Services ...................................... 509
Implementation, Cultural Acceptability, and Impact of a Mental Health Program for
Haitian Healthcare Workers Developed after the 2010 Earthquake ........................ 509
J 12 - Psychiatric Research in the Pediatric Population ................................................ 511
The Relationship Between ADHD and School Attendance, School Behavior, and
School Performance ........................................................................................................ 511
Factors Affecting the Timing of an Autism Spectrum Diagnosis .............................. 512
Understanding the Families' Needs: Interventions for Family Members of
Adolescents with Disruptive Behavior Disorders ........................................................ 513
K 01 - Global Theoretical Issues in Healthcare ............................................................... 515
Using Diaries to Explore the Lived Experiences of Primary Healthcare Clinic
Nursing Managers in Two South African Provinces ................................................... 515
K 01 - Global Theoretical Issues in Healthcare ............................................................... 517
Psychometric Properties of a Short Version of Effort-Reward Imbalance in Blue-
Collar Workers .................................................................................................................. 517
K 03 - Uses of Complementary and Alternative Medicine ............................................. 518
Use of Honey for Healing Pressure Ulcers: An Integrative Review ......................... 518
Use of Complementary and Alternative Medicine by Nurses in Nepal .................... 521
The Effects of Ballroom Dance on Blood Pressure, Heart Rate, Weight, Waist
Circumference, and Body Mass Index Among Filipino-Americans: A Feasibility
Study .................................................................................................................................. 523
K 04 - Behavioral and Self-Care of the Heart Failure Patient ....................................... 525
Illness Representations and Self-Care Behavior of Patients with Heart Failure .... 525
K 04 - Behavioral and Self-Care of the Heart Failure Patient ....................................... 526
The Effectiveness of a Patient Education Program on Promoting Self-Care in
Patients with Heart Failure.............................................................................................. 526
K 05 - Self-Management of Chronic Illnesses ................................................................. 528
Predictors of Self-Management for Chronic Low Back Pain ..................................... 528
Self-Management in Chronic Illness: From Theory to the Practice.......................... 530

Level and Predictors of Self-Care Behaviors (SCB) Among Educated and
Uneducated Patients with Heart Failure (HF) in Pakistan ......................................... 532
K 06 - Infection Control Through Global Research and Health Promotion ................. 533
A Preliminary Report on the Effectiveness of a Physical Anti-Microbial Dressing in
Preventing Tenckhoff Catheter (TC) Exit Site Infection (ESI) ................................... 533
Successful Institution-Wide Sustained Reduction in Central Line Associated
Bloodstream Infection (CLABSI) Using a Multidisciplinary Approach...................... 536
Clean or Not to Clean: A Comparison of Urine Collection Techniques ................... 539
K 10 - Health Promotion in the Healthcare Industry ....................................................... 540
Migraine Triggered Following Endoscopic Foreheadplasty Surgery ....................... 540
Tobacco Smoke Pollution and Compliance Before and After Passage of a
Comprehensive Statewide Smoke-Free Law .............................................................. 542
The Role of Hypothalamic-Pituitary-Adrenal Axis Responsivity in Accumulative and
Sustained Paclitaxel-Induced Mechanical Hypersensitivity in Male and Female
Rats: A Three-Strain Comparison ................................................................................. 545
K 12 - Nursing Research to Improve Clinical Quailty Strategies .................................. 547
Which Clinical Supervision in Nursing Strategies Nurses Wish to be Implemented in
Their Health Contexts?: Construction and Validation of an Questionnaire ............ 547
K 12 - Nursing Research to Improve Clinical Quailty Strategies .................................. 548
Nursing Preparation of the Caregiver By Continuous Care Teams: Quality
Indicators ........................................................................................................................... 548
L 03 - Global Care of the Dialysis Patient ........................................................................ 551
Living with End-Stage Renal Disease: Perceived Impact of Treatment in a Mexican
Hemodialysis Clinic .......................................................................................................... 551
Age Difference in Adherence to a Renal Therapeutic Regimen: The Perspectives of
Chinese Patients Undergoing Continuous Ambulatory Peritoneal Dialysis ............ 553
Outcomes of a Nurse-Led Case Management Program on Home Exercise Training
for Hemodialysis Patients ............................................................................................... 555
L 04 - Health Promotion and Prevention for the Obese Patient Population ............... 557
Comparison of Family Eating Habits and Activity Practices Among Blacks,
Hispanics, and Filipinos: Implications for Prevention and Control of Overweight and
Obesity ............................................................................................................................... 557

The Association of Inflammation with Obesity and Depressive Symptoms Among
People with Multiple Cardiovascular Disease Risk Factors ...................................... 559
Nurses' Commitment and Motivation to Improved Personal Health: The Role of
Hospital Administration.................................................................................................... 561
L 05 - Family Health Promotion ......................................................................................... 566
The Risk Demographic Predictors of Low Health Promotion Lifestyles in Caregivers
of Children with Disabilities ............................................................................................. 566
Supportive Education and Follow-Up for New Fathers .............................................. 568
Relationship Between Families Perception of Health and Family Support in
Vulnerable Children Care................................................................................................ 570
L 06 - Psychosocial Issues in Family Health ................................................................... 571
Family Reintegration Experiences of Soldiers with Combat-Related Mild Traumatic
Brain Injury ........................................................................................................................ 571
African-American Grandmothers Raising Grandchildren: Results of an Intervention
to Reduce Caregiver Psychological Distress ............................................................... 574
A Reflection on Psychosocial Assessment and Support As a Component of Routine
Holistic Antenatal Care .................................................................................................... 575
L 07 - Utilizing Social Networks in Healthcare ................................................................. 577
Strategies for Data Collection and Analysis Using the Online World: Trials and
Tribulations ........................................................................................................................ 577
Researching with Young People As Participants: Issues in Recruitment ............... 578
Engagement and Emotional Connection with Virtual Communities Among Nursing
Students ............................................................................................................................. 580
L 10 - Staff Related Clinical Nursing Leadership ............................................................ 582
Improving the Experiences of Night Shift Nurses in Australian Regional Public
Hospitals: An Action Research Project ......................................................................... 582
Use of Temporary Nursing Staff and Nosocomial Infections in Intensive Care Units,
a Pilot Study ...................................................................................................................... 584

Nursing Support Workers and Tasks Performed, Delayed or Not Completed ....... 586
L 12 - Care of the Depressed/Suicidal Patient and Family............................................ 588
Individuals Use to Promote Healing after a Suicide Attempt: Action/Interaction
Strategies........................................................................................................................... 588
L 12 - Care of the Depressed/Suicidal Patient and Family............................................ 589
The Factors Associated with the Caregivers of Suicidal Patients Stress, Attitude
and Ability: A Path Analysis ............................................................................................ 589
M 01 - Using Quality to Impact Global Nursing Leadership .......................................... 590
Current Assessments of Quality and Safety Competencies in Registered
Professional Nurses: An Examination of Nurse Leader Perceptions ...................... 590
Nurses' Scope of Practice and the Implication for Quality Nursing Care ................ 593
Leveraging Data to Drive Quality Patient Care: The Value of a Unit-Specific Nursing
Performance Dashboard ................................................................................................. 594
M 02 - Educational Support of New Staff ......................................................................... 596
Research on the Sense of Coherence (SOC) of Newly Graduated Nurses in Japan
within Their First Sixth Month of Employment ............................................................. 596
Peer Support in Research Capacity Development ..................................................... 599
Bridging the Education-Practice Gap: Integration of Current Clinical Practice into
Education on Transitions to Professional Practice ..................................................... 600
M 03 - Global Nursing Leadership Initiatives ................................................................... 602
The Relationships Among Leadership Style, Safety Climate, Emotional labor and
Intention to Stay for Clinical Nursing Staff in Taiwan ................................................. 602
M 03 - Global Nursing Leadership Initiatives ................................................................... 603
Nurses' Perceptions of Ethical Issues in an Academic Hospital Setting ................. 603
M 04 - Using Online Technologies for Education............................................................ 606
Utilizing the Technology Acceptance Model (TAM) for Predicting Usage and
Adoption of an iBook© in Online Graduate Nursing Courses ................................... 606
Using an Online Learning Module to Improve Australian Palliative Care Nurses'
Pain Assessment Competencies and Patients' Reports of Pain .............................. 608

Exploration of Personality Traits of Online and On-Campus Family Nurse
Practitioner Students ....................................................................................................... 611
M 05 - Traumatic Issues in the Pediatric Population ...................................................... 612
Robbing the Cradle: An Analysis of Trends in Infant Abduction in the United States
............................................................................................................................................. 612
Parents Reactions to Multi-Disciplinary Perinatal Palliative Care during Pregnancy
with a Lethal Fetal Diagnosis ......................................................................................... 614
Family Structure; Process of Family Life, Communication Patterns and Prevalence
of Smoking, Alcohol and Illicit Drug Use Among Primary Children .......................... 616
M 06 - Health Promotion in an Aging Society .................................................................. 617
Longitudinal Comparison of ADL Function Between Green House Nursing Home
and Traditional Nursing Home Residents .................................................................... 617
The GREAT Program: Promoting Physical, Psychological and Economic Health in
an Aging Population ......................................................................................................... 619
Health-Related Quality of Life and Its Relationships with Poor Exercise Capacity
and Dyspnea in Thais with COPD ................................................................................. 621
M 07 - Global Health Practices in the Psychiatric Population ....................................... 622
Qualitative Assessment of Answer Letters of Patients with Chronic Fatigue and a
Psychiatric Disorder ......................................................................................................... 622
M 07 - Global Health Practices in the Psychiatric Population ....................................... 623
Caregiver Satisfaction and Its Correlates Among Taiwanese Families Living with
Schizophrenia ................................................................................................................... 623
M 10 - Researching Issues Early in Patient's Life........................................................... 624
Obtaining Required Childhood Vaccinations: The Latino Immigrant Experience .. 624
Safe Sleep Advice to Safe Sleep Action: Pilot of the Pepi-Pod Program in
Indigenous Communities ................................................................................................ 628
Mindfulness Intervention for Perinatal Grief: A Pilot and Feasibility Study in Rural
India .................................................................................................................................... 631
M 12 - Using Research to Promote Outcomes................................................................ 634
Barriers and Facilitators to Utilizing Nursing Research.............................................. 634

The Red Box Strategy for Contact Precautions .......................................................... 635
Building Sustainable Community-Based Participatory Research ............................. 637
N 01 - Global Reflections on Nursing Education ............................................................. 639
Reflecting on International Nursing Programs............................................................. 639
Reflections of Second Year Nursing Students in Australia on Improving Their
Cultural Competence in Relation to Aboriginal and Torres Strait Islander Health . 640
Capacity Building Partnership for Global Nursing ....................................................... 641
N 02 - Exercising the Chronically Ill .................................................................................. 642
The Impact of Yoga Education Among Postmenopausal South Asian Women at
Risk for Cardiovascular Disease: A Family Affair ....................................................... 642
The Effectiveness of Exercise Program for Aerobic Fitness in Adults with Systemic
Lupus Erythematosus: A Systematic Review and Meta-Analysis ............................ 643
Stand up for Health: Using Yoga as a Transitional Platform to Increase Physical
Activity Levels in Sedentary Adults ............................................................................... 644
N 03 - Health Promotion for the Cardiac Patient ............................................................. 646
Sensitivity, Specificity, and Sex Differences in Symptoms of Acute Coronary
Syndrome .......................................................................................................................... 646
Fibromyalgia and Risk of Coronary Heart Disease: A Population-Based Cohort
Study .................................................................................................................................. 647
Factors Associated with Prehospital Delay in Acute Coronary Syndrome, Among
Men and Women in Karachi, Pakistan.......................................................................... 648
N 04 - Nurses' Perceptions from Student Through Clinician......................................... 650
Exploring Registered Nurses' Attitudes Towards Post Graduate Education in
Australia: A Pilot Study .................................................................................................... 650
Nurses' Attitudes Toward Restraint Use in Japanese Hospitals .............................. 652
Nursing Students' Perception of the Clinical Learning Environment in Macao ...... 653
N 05 - Evaluations of Global Nursing Faculty .................................................................. 654

Nurse Teachers' Accounts of Their Perceptions and Practices of Written Feedback
............................................................................................................................................. 654
Evaluation of Teaching Competence in Taiwan Nurse Educators: Presence and
Value .................................................................................................................................. 655
Adapt or Sink: Exploring the Nurse Educator-Student Relationship in Democratic
South Africa ....................................................................................................................... 656
N 06 - Health Promotion in Nursing Practice ................................................................... 658
Engaging Nurses Across Disciplinary, Organizational and Sectoral Boundaries for
the Health of Vulnerable Populations: A Systemic Model of an Unfolding Interface
Nursing Practice in Quebec (Canada) .......................................................................... 658
The Use of Allostatic Load for Health Promotion with New Graduate Nurses in the
U.S. ..................................................................................................................................... 659
Evaluation of a Government Deployment Project for Unemployed Nurses as Input
to Policy and Programmatic Directions ......................................................................... 661
N 07 - Diverse Implications of Nursing Research ........................................................... 663
From CBPR to RCT: Lessons Learned Over 10 years with Interventions in Public
Housing .............................................................................................................................. 663
N 07 - Diverse Implications of Nursing Research ........................................................... 665
An Investigation of the Influence of Fish Oil Supplementation on IL-8: A Possible
Protection Against Preeclampsia ................................................................................... 665
N 10 - Considerations in Global Nursing Education ....................................................... 668
Breaking Bad News: Confronting Interdisciplinary Bias ............................................. 668
N 10 - Considerations in Global Nursing Education ....................................................... 670
A Qualitative Study Exploring the Use of Visual Thinking Strategies with Nursing
Students ............................................................................................................................. 670
N 12 - Culturally Diverse Health Behaviors...................................................................... 673
Chronic Health Conditions and Behaviors Among Persons Entering Maximum
Security Prison.................................................................................................................. 673
N 12 - Culturally Diverse Health Behaviors...................................................................... 674
Engaging Chinese-Americans in Advance Care Planning: A Pilot Study ............... 674
Part V: Evidence-Based Practice Poster Presenations.......................................... 676
EBP PST 1 - Evidence-Based Practice Posters Session 1 ........................................... 676

Improving Neurologic Outcomes of Cardiac Arrest Patients Through Therapeutic
Hypothermia ...................................................................................................................... 676
Assessing Reliability and Validity of the Chinese Version of the Functional
Independence Measure on Stroke Patients................................................................. 678
The Efficacy of Care Model of Group Home for Caring the Elderly with Dementia: A
Systematic Review ........................................................................................................... 680
Sepsis Mortality Reduction Project at Contra Costa Regional Medical Center &
Health Center .................................................................................................................... 682
Beyond Clickers: Enhancing Students' Engagement with the Use of Online Polling
............................................................................................................................................. 684
The Practice of Skill Training for Dialectical Behavior Therapy ................................ 685
A Project of Applying PDCA Cycle to Improve New Nurse Medication Error in
Surgical Ward ................................................................................................................... 687
Effects of Tai Chi Exercises on Adults with Metabolic Syndrome: A Systematic
Review ............................................................................................................................... 688
Psychometric Testing of the Mandarin Chinese Version of the Fatigue Severity
Scale (CFSS) in Patients with Major Depressive Disorder........................................ 689
Effectiveness of the Molloy Bridgeport Observation Scale in Predicting Increased
Intraocular Pressure during da Vinci Robotic Procedures......................................... 691
Development of Fast Track System for Severe Trauma Patients Using Six Sigma
Technique .......................................................................................................................... 693
A Systematic Review on Problem-Solving Training for Community Schizophrenia
Patients .............................................................................................................................. 694
Evidence of Culturally-Tailored Diabetes Management Program for Asian-American
Immigrant Population: A Systematic Literature Review ............................................. 695

Promoting Discharge Planning Satisfaction in the Surgical Ward............................ 698
Development of an Evidence-Based Surgical Decision Making Algorithm for
Bladder Exstrophy Related Continence Procedures .................................................. 699
Lifelong Physical Activity as a Predictor in Exercise Beliefs Among Community-
Dwelling Adult over 55 Years of Age ............................................................................ 701
Improving Health Outcomes for Surgical Patient in Nicaragua: Empowering Nurses
Participating in a Multidisciplinary Cleft Lip and Palate Team Implementing
Evidence-Based Practice Solutions .............................................................................. 702
Perceptions of Aging and Interaction Self-Efficacy with Older Adults Among Nursing
Students through the Intergeneration Service-Learning Program............................ 704
Enhancing the Volume of Psychiatric Home Care Service ....................................... 706
The Effects of an Education Program of Lymphedema for Breast Cancer Patients
............................................................................................................................................. 707
The Effect of Pelvic Floor Biofeedback Training for Urinary Incontinence in Prostate
Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials .................... 708
Clinical Nursing Practice Guideline: Oral Care for Patients with an Artificial Airway
Intubation ........................................................................................................................... 710
An Endotracheal Suctioning Guideline for Adults with an Artificial Airway ............. 711
The Efficacy of Home-Based Walking Exercise on Sleep in Cancer Survivors: A
Meta-Analysis of Randomized Controlled Trials ......................................................... 712
Effects of Advance Care Planning on Knowledge, Behavior and Well Being of Older
People: A Systematic Review Protocol ........................................................................ 713
Parent's Perception of Recommendation of HPV Vaccination for Adolescent
Children.............................................................................................................................. 716

Preoperative Skin Traction in Adults with Hip Fracture: Evidence-Based Practice718
Enhancing the Effectiveness of Chest Physical Therapy By Patients' Personal Care
Assistants in a Respiratory Care Ward ......................................................................... 720
Physical Fitness Exercise vs. Cognitive Behavior Therapy on Reducing the
Depressive Symptoms Among Community-Dwelling Elderly Adults ....................... 721
Impact of Different Types of Oral Care on Oral Mucositis and Quality of Life for
Head and Neck Cancer Patients during Radiotherapy .............................................. 722
The Grounded Theory Research Study Group for Teaching Qualitative Research
Methodology to Postgraduate Psychiatric Nursing Students .................................... 725
Factors Affecting Self-Management Behaviors of Patients with Chronic Obstructive
Pulmonary Disease: A Literature Review ..................................................................... 729
Physiological and Psychosocial Nursing Approaches to Orthopedic Oncology
Patients .............................................................................................................................. 730
A Study on Improving Nursing Instruction for Post Total Knee Replacement
Patients in Orthopedic Ward in Taiwan ........................................................................ 733
EBP PST 3 - Evidence-Based Practice Poster Session 3 ............................................. 734
Development of an Evidence-Based Guideline for Screening and Managing
Depression in Older Adults ............................................................................................. 734
Hot Topics in Nurse Practitioner Clinical Education: An Evidenced-Based Review
............................................................................................................................................. 736
Development of Multilingual Educational Materials for Postpartum Health of
Immigrant Women in South Korea ................................................................................ 738
The Effectiveness of Music Interventions on Reducing Anxiety, Sedative
Requirements, Pain, and Improving Physiological Outcomes and Satisfaction
Among Adult Patients Undergoing Colonoscopy: A Systematic Review Protocol 740

The Experience of Evidence-Based Nursing Implementation at a North Medical
Center in Taiwan .............................................................................................................. 742
Nurses' Knowledge, Attitude, and Implement Confidence Regarding Evidence-
Based Nursing in Taiwan ................................................................................................ 743
The Knowledge and Expectation about the Content of Pediatric Nursing Course in
a Two-Year Nursing College Program and Related Factors in Taiwan .................. 744
A Diabetes Self-Management Education Program Based on the Information-
Motivation-Behavioral Skills Model: Effects on Older Adults with Type 2 Diabetes in
Korea .................................................................................................................................. 746
Allergen Screening and Telephone Coaching Interventions to Prevent School-Age
Children at Risk of Developing Asthma ........................................................................ 748
Meta-Analyses of Epigenetics Risk Factors for Prevention of Hypertension:
Angiotensinogen Human Gene Variations Across Different Race-Ethnicity Groups
............................................................................................................................................. 750
The Adoption and Implementation of the Columbia-Suicide Severity Rating Scale
(C-SSRS) in a Psychiatric Emergency Service: Utilizing Roger's Diffusion of
Innovations Model ............................................................................................................ 751
Spotlight on Practice: Achieving Excellence in Service, Accountability, and
Professional Leadership.................................................................................................. 752
Integrating Genomics into Nursing Education ............................................................. 754
Effects of Instructor Immediacy and Online Course Design in Student Satisfaction
and Successful Course Completion .............................................................................. 756
A Faith-Based Concept Analysis for Nursing Education............................................ 758
Implementation of a Nurse-Driven Foley Catheter Removal Protocol: A Patient
Safety and Quality Improvement Project ...................................................................... 759

Best Practice Guidelines for Uncomplicated Urinary Tract Infections Reduce the
Rates of Antibiotic Resistance: A CE Module for Clinicians...................................... 761
Multi-Faceted Approach to Increase Type 2 Diabetes Mellitus Screening in Children
............................................................................................................................................. 763
Part VI: Research Poster Presentations .................................................................. 764
RSC PST 1 - Research Posters Session 1 ...................................................................... 764
Using the Job Demands-Resource Model to Decrease Burnout of Perioperative
Nurse Managers ............................................................................................................... 764
The Effectiveness of the Over 24 Hours Physical Restraint Indicators ................... 765
The Correlations Between Meridian Energy and Nausea/Vomiting in Lung Cancer
Patients Receiving Chemotherapy ................................................................................ 766
The Survey for Nursing Management Behavior of Diabetes Liaison Nurses in
Guangdong Province ....................................................................................................... 768
The Change of Meridian Energy and Symptoms Among the Breast Cancer Patients
with Chemotherapy .......................................................................................................... 769
Factors Involved in Coping with the Dilemma of Using Physical Restraints on
Elderly People with Dementia: Perspectives from Nurses Who Live with Elderly
Relatives ............................................................................................................................ 770
Experiences of Nurses Working Night Shift in Regional Australian Hospitals: A
Qualitative Case Study .................................................................................................... 773
Electronic Monitoring of Hand Hygiene: Challenges and Methods .......................... 774
A Comparative Study to Assess the Effectiveness of Structured Teaching
Programme on Addiction Among Adolescents in Selected Schools of Salem
District, Tamil Nadu State ............................................................................................... 775
Validity and Reliability of Thai Version of Self-Efficacy for Appropriate Medication
Use Scale Among Thai with Post-Myocardial Infarction ............................................ 777

Outcomes and Medical Utilization for Lung Cancer Patients Undergoing Surgery 779
Application of Propensity Scores to Estimate the Association Between
Cardiovascular Disease and Meridian Energy ............................................................ 781
The Discrimination of Screen Pre-Frailty for Community-Dwelling Elderly People 782
The Effects of Psychological Nursing Intervention Program on Psychological
Distress and Quality of Life in Women with Breast Cancer Undergoing
Chemotherapy .................................................................................................................. 783
A Comparative Analysis of Nursing Students' Knowledge, Attitude, Perception and
Self-Efficacy of Child Abuse and Neglect Cases in the Cross-National Research 788
The Effect of the Burnout on the Negative and Positive Automatic Thought in a
Japanese Nurse ............................................................................................................... 790
Too Anxious to Learn?: Should the Ongoing Debriefing Technique be Amongst the
Best Practices in Simulation? ......................................................................................... 791
A Correlational Study in Older Adults with Metabolic Syndrome.............................. 793
Mental Health Nurses' Attitudes Toward Self-Harm: Curricular Implications of a
Qualitative Study .............................................................................................................. 795
Exploration of the Role of Gastroesophageal Reflux Disease in Chronic Obstructive
Pulmonary Disease Patients: A Nationwide Population-Based Cohort Study ....... 796
The Influence of Clinical Placements on Final Grades in an Undergraduate Nursing
Course: A Comparative Study........................................................................................ 797
The Experiences of Stigma As Described by Taiwanese People Living with
Schizophrenia ................................................................................................................... 798
The Development of Cultural-Specific Caregiver Telephone Coaching Program to
Improve Heart Failure (HF) Home Care ....................................................................... 799

Pilot Study to Describe the Substance Use Experiences of HIV-Positive Young
Black Men Who Have Sex with Men (MSM) Between the Ages of 18-29 in San
Francisco ........................................................................................................................... 801
The Impact of Parent Reaction to Sexual Orientation on Depressive Symptoms and
Sex Risk Among Hispanic Men Who Have Sex with Men ......................................... 804
The Identification of Stimulant Misuse .......................................................................... 806
A Study of Service Quality Perception for Blood Donors........................................... 807
The Incidence and Severity of Musculoskeletal Disorders Among Nurses Working
in Taiwan Medical Center ............................................................................................... 808
Development and Evaluation of the Simulation Learning Effectiveness Inventory 810
Relation of Perception of Career Ladder System, Job Satisfaction, Intention to
Leave Among Perioperative Nurses ............................................................................. 811
A Concept Analysis of Self-Management Behavior and its Implications in Research
and Policy .......................................................................................................................... 813
Preoperative Education and Its Associated Factors Among the Patients with Total
Knee Arthroplasty ............................................................................................................. 814
Factors Contributing to Malnutrition in Patients with Gynecologic Cancer Patients
............................................................................................................................................. 817
Diet, Encoded Memory, Visual Cues, Obesity, and Neuroimaging: The Role of ... 818
Intention of Regular Exercise Among Pregnant Women: Theory of Planned
Behavior ............................................................................................................................. 819
Forewarned is Forearmed: Preparing Nursing Students for Workplace Adversity 820
Development of a New Growth and Development Sectors for the Family System
Unit ..................................................................................................................................... 822

Re-Warming Baby after First Bath: A Non-Randomized Clinical Trial .................... 824
Using Evidence Integrated e-Learning to Enhance the Case Management
Continuing Education for Taiwanese Psychiatric Nurses .......................................... 825
Aggression in South Korean Middle School Students................................................ 827
Exploration of Dutch Intensive Care Nurses' Experience of Planned or Emergent
Change Implementation of an Innovation .................................................................... 829
Effectiveness of Kagayashiki Music Intervention on Depression, Cognition and
Basic Activity Daily Living in the Institutionalized Elderly .......................................... 832
Hypertension, Acculturation, Work-Related Stress, and Psychological Distress
Among Filipino-American Registered Nurses (RNs) and Domestic and Home Care
Workers (DHCWs) ........................................................................................................... 833
Faculty and Organizational Characteristics Associated with Informatics/Health
Information Technology Adoption in DNP Programs.................................................. 835
Quality of Life and Associated Factors in Pregnant Women during the Third
Trimester............................................................................................................................ 836
Adults with Type 1 Diabetes: Lifetime Support and Management ........................... 837
Diabetes Self-Management Practice of Older Koreans Based on AADE-7
(American Association of Diabetes Educatiors 7 Behaviors) Domains ................... 839
Effects of Balneotherapy on Pulmonary Function and Quality of Life in Chronic
Obstructive Pulmonary Disease Patients ..................................................................... 840
Experiences of Preceptors in Dedicated Education Units in the Public Hospital
Environment ...................................................................................................................... 843
Learning Needs of Hospitalized Heart Failure Patients in Singapore...................... 845

Caring Behaviors, Self-Efficacy, and Their Associations with Job Involvement
Among Nurses .................................................................................................................. 847
First-Time Fathers' Experiences during Childbirth in Taiwan.................................... 849
Educating Nursing Students to Recognize and Report Negative Behavior in the
Clinical Setting: A Feasibility Study ............................................................................... 851
Removal of Mechanical Ventilator on a Patient of ALS ............................................. 853
The Factors Influencing the Self-Care and Quality of Life of Patients with Coronary
Artery Disease .................................................................................................................. 854
Effects of Cinenurducation Based on Kolb's Experiential Learning Theory Model for
Understanding Child Growth and Development .......................................................... 855
Self Governance Increases Staff Morale...................................................................... 856
The Risk Factors of Unplanned Endotracheal Extubation in Adult Intensive Care
Unit ..................................................................................................................................... 858
The Effects of E-Health Management for Weight Control and Metabolic Syndrome
Abnormalities in Adolescent Girls .................................................................................. 859
Home Visit Nurse's Thoughts for Complementary and Alternative Medicine (CAM)
in Japan ............................................................................................................................. 861
Successful Strategies for Recruiting Low-Income Minority Group Women in a
Community-Based Health Promotion Program ........................................................... 864
The Effects of an Oral Care Program on Oral Health of Institutionalized Elderly .. 865
Exploration of Factors Influencing Sleeping Quality Among College Nursing
Students in Taiwan .......................................................................................................... 866
Asian-American Midlife Women's Physical Activity and Their Relationships to
Sleep-Related Symptoms ............................................................................................... 867

Utilization of Fall Preventive Sensors and Moral Sensitivity ..................................... 870
Effect of the "SHISEI" Educational
-Cognition Meta Program Aiming at the Low
Back Pain Improvement of the Female New Face Nurses in Japan ....................... 871
Job Demand, Work-Family Conflict and Nurses' Intention to Leave ....................... 872
An Effect of Hands-On Training for Female University Students Using the Model of
Breast on the Knowledge and Techniques of Breast Self Examination .................. 873
Child Rearing Support of Nurses who are Mothers of Pre-School Age Children .. 874
The Carers of People with Dementia in the Sub-Acute Facility: A Qualitative Study
............................................................................................................................................. 876
Effectiveness of Motivational Enhancement Therapy Plus Cognitive Behavior
Therapy on Glycerol Control, Depressive Symptoms, and Health Related Quality of
Life in Diabetic Patients: A Randomized Controlled Trial .......................................... 878
Development of the Japanese Version of the Teaching Style Assessment Scale 879
Efficacy of Mantram Repetition Program on Insomnia in Veterans with
Posttraumatic Stress Disorder ....................................................................................... 881
The Historical Research of Japanese Administrative Policy and Outcome of
Maternal and Child Health Education ........................................................................... 882
Understanding Self-Care Coping Styles in Patients with Chronic Heart Failure.... 884
Relationship Between the Risk Factor of Latex Allergies and Rubber Products in
Daily Use By the Japanese Nursing Students............................................................. 885
Application of Andersen Model to Verify Utilization of Maternal and Child's
Preventive Care Among South-East Asian Immigrant Women in Taiwan: Influence
of Acculturation and Associated Factors ...................................................................... 886

The Centers for Medicare and Medicaid Services' Nonpayment Policy and Nursing
Sensitive Patient Outcomes in the U.S. Hospitals ...................................................... 889
Impact of Marital Coping on Body Image and Sexual Relationship Among Breast
Cancer Survivors .............................................................................................................. 891
Experiences of Vietnamese Marriage Immigrant Women with Pregnancy, Birthing,
and Postpartum Care in Korea ...................................................................................... 893
The Historical Research of Legislative Process of the Eugenic Protection Act and
Maternal and Child Health Administration in Japan.................................................... 896
Relationship Between Social Desirability and Preception of Physical Restraint Use
Among Japanese Nurses................................................................................................ 898
The Knowledge of Blood Pressure Measurement Affecting Medication Adherence
in Patients with Hypertension ......................................................................................... 900
Lifestyle Characteristics Correlated with Daily Life Functions of Patients with Mental
Disorders ........................................................................................................................... 901
"Try Not to Judge:" Mothers of Infants with Neonatal Abstinence Syndrome ........ 903
Dyspnea Management Experiences Among Patients with Chronic Obstructive
Pulmonary Disease: A Qualitative Study...................................................................... 904
How to Improve the Case Report Writing and Review Pass Rates Among Nurses at
One Surgical Ward ........................................................................................................... 907
Prevalence of Obesity in a National Representative Sample of Taiwan Adolescents
............................................................................................................................................. 909
The Effect of Characteristics of Medical Market and Institutions on Staff-Mixing
Level of Long-Term Care Hospitals .............................................................................. 911
Situations Among Novice Nurses and Preceptor: They Cannot be Assertive........ 912

Patients' Lived Experience of Chemotherapy after Mastectomy: A
Phenomenological Study ................................................................................................ 914
Factors Influencing Emotional Labor of Clinical Nursing Staff in Taiwan................ 915
Effects of a Cultural Competence Education Program for Nursing Students in
Taiwan................................................................................................................................ 916
Three Japanese Expert Nurses' Professional Narrative: Reflections on Their
Accumulated Clinical Nursing Experiences Refining Nursing Identity..................... 919
Factors That Influence the Amount of Time Spent on Child Care and Housework by
Fathers until One Month after Child Birth ..................................................................... 921
Health Status, Healthy Lifestyle, Activity, Perception of Health, and Health
Services: Differences Between Baby Boomer Women and Elderly Women in Korea
............................................................................................................................................. 922
Mediating Effect on the Relationship Between Professional Commitment and Intent-
to-Leave Among Hospital Nurses in Taiwan................................................................ 924
Pilot Survey of Nurses' Attitudes and Practice of Developmentally Supportive Care
in NICUs inTaiwan ........................................................................................................... 925
Reliability and Validity of the Chinese Version of the Suicide Caring Competence
Scale (SCCS) for Family Caregivers: Scale Development........................................ 926
Current Status and Issues about Nursing Practice Ability of Nursing Faculty in BSN
Programs in Japan ........................................................................................................... 927
Healthcare Needs Among New Immigrate Spouses in Taiwan ................................ 929
Regional Maternal and Child Health Efforts By Nurses, Local Residents, and Civic
Organizations from 1936 in Japan ................................................................................ 930
Healthcare Needs during Pregnancy, Childbirth, and Childrearing of Chinese
Immigrant Women in Korea ............................................................................................ 931

Relationship of Job Satisfaction and Quality of Life Among Taiwanese Nurses: A
Pilot Study ......................................................................................................................... 933
Clinical Experiences of Standard Precautions Among Nursing Students: Based on
the Theory of Planned Behaviour .................................................................................. 935
Gender Differences in Depression, Life Satisfaction, and Health in Middle-Aged
Koreans.............................................................................................................................. 938
The Association Between Laryngectomized Patients' Quality of Life and Their
Medical Treatment ........................................................................................................... 940
The Effect of Multimedia Education of PCA on Patients' Cognition, Interference of
Life, and Satisfaction ....................................................................................................... 943
The Impact of Personality Traits on Early Job Resignation of Newly Graduated
Nurses ................................................................................................................................ 944
Risk Factors of Thromboembolic Events and the Impact on Survival in Newly
Diagnosed Breast Cancer Patients: An Experience from Taiwan ............................ 946
Using Failure Mode and Effects Analysis (FMEA) to Improve Patient Safety in u-
Health Nursing Service.................................................................................................... 947
Development of Assessment Sheet of Older Adults Who Relocate to a Recovery
Phase Rehabilitation Ward ............................................................................................. 948
Promotion of End-of-Life Care at Home for the Elderly in a Community Setting in
Japan: Results of Qualitative Research ....................................................................... 951
Readmission and Risk Factors Among Community Rehabilitation Users with
Psychiatric Disease in Taiwan ....................................................................................... 954
Variables Affecting the Reporting of the Patient Safety Events................................ 955

Mental Health Trajectories and Related Factors Among Perinatal Taiwanese
Women ............................................................................................................................... 956
Narrative Study in Young Adult Offspring of Parents with Bipolar Disorder ........... 958
The Experiences of Families to Care the Children with Asthma during the
Developmental Transition: A Mixed Method ................................................................ 959
Health and Social Service Utilization and Postpartum Depression Among
Childbearing Chinese New Immigrants in Canada ..................................................... 960
The Effectiveness of Analytical Music Videos Appreciation in Elderly People with
Depressive Mood ............................................................................................................. 962
The Effectiveness of an Educational Intervention of Evidence-Based Nursing on
Nurses' Knowledge, Attitude, and Implement Confidence ........................................ 963
Health Status of Postpartum Women: Bladder Symptoms, Postpartum Depression,
and Physical Activity ........................................................................................................ 964
Changing Southern African Nurses' Roles in Antibiotic Stewardship: An Innovative
Pedagogical Approach .................................................................................................... 966
A Study of the Relationship Between Compassion Fatigue, Somatization, and
Silencing Response Among Hospital Nurses: Focusing on the Mediating Effects of
Silencing Response ......................................................................................................... 968
Mentoring and the Early Career Nurse: A Critical Relationship................................ 970
Nurses' Needs to Competently Care for Transitioning Pediatric-Sized Adult Patients
............................................................................................................................................. 971
Exploration of Undocumented Antenatal Domestic Violence.................................... 973
Depression, Balance, and Cognitive Function in the Elderly That Practice and Do
Not Practice Yoga: A Comparative Study .................................................................... 975

Perception of Healthy Aging Among Elderly with Chronic Disease in Taiwan: A
Qualitative Study .............................................................................................................. 977
Exploring Nurses' Barriers, Attitudes and Related Factors in Reporting Medication
Administration Errors ....................................................................................................... 979
Life Experiences of Donors in Living Donor Liver Transplantation .......................... 981
The Challenge of Caring for Incontinence: The Experience of Family Caregivers of
Stroke Survivors ............................................................................................................... 984
Postpartum Depression in Women in a Postpartum Nursing Center ...................... 985
Beyond the Braden Scale: Effectiveness of a Small Group Educational Program on
Neuro-Nurses' Braden Risk Assessment Scores and Number of Preventative
Nursing Interventions ....................................................................................................... 987
The Effects on Caring Behavior of Nursing Students with Different Phases of
Clinical Practice in a 5-Year Junior College in Southern Taiwan ............................. 988
Biobehavioral Consequences of Chronic Social Defeat: A Model of Extreme Stress
in Male and Female Rats ................................................................................................ 990
Factors Related Obesity Among Korean Workers By Occupational Type.............. 993
Implementation of the Prevention of Mother to Child Transmission (PMTCT) of HIV
Program: An Integrative Literature Review .................................................................. 995
Nursing Model for Japanese Oriental Medicine in Japan .......................................... 998
RSC PST 3 - Research Posters Session 3 .................................................................... 1001
Experiences of Patients and Nurses Regarding the Use of Electronic Informed
Consent............................................................................................................................ 1001
Characteristics and Quality of Gait in Older Adults living in Saltillo, Coahuila,
Mexico and Lima, Peru.................................................................................................. 1002

Factors Related to Social Support and Communication Methods for Psychological
and Social Adjustment in Japanese Laryngectomized Individuals: A Study of a Self-
Help Group ...................................................................................................................... 1003
Pelvic Inclination Angle and Autonomic Nervous Activity While Seated in a
Wheelchair: Using the Seated Posture Measurement Method ............................... 1006
The Influence of Participation in Self-Help Groups on Laryngectomized Patients
........................................................................................................................................... 1009
Dietary Environment Assessed Using Visual Measurements of Different Seated
Wheelchair Postures...................................................................................................... 1011
The Relationships Between Patients' Physical, Psychological Distress and the
Family Caregiver Burden in Hospitalized Gastrointestinal Cancer Patients......... 1014
Effects of Activity Program in Prevention of Functional Decline Among Hospitalized
Elderly: A Pilot Study ..................................................................................................... 1016
Logistic Regression for Predicting Early Postpartum Depressive Symptoms in
Japanese First-Time Mothers Aged 35 and Over ..................................................... 1017
College Students' Attitude Toward the Elderly with Dementia in Japan: A
Comparison Between Nursing and Non-Nursing Students ..................................... 1020
The Relationships Between Fatigue, Depression and Quality of Life Among
Depression Outpatients ................................................................................................. 1022
The Project of Improving the Rate of Access Site Bleeding after Femoral Artery
Cardiac Catheterization ................................................................................................. 1023
The Association Between Obesity and Asthma in Children .................................... 1025
Hope and Learned Resourcefulness Among Parents of Disabled Children ......... 1026
Measured Noise Levels in the Hospital with Correlating Patient Perception........ 1027

The Effectiveness of Acupressure in the Quality of Sleep of the Head and Neck
Cancer Patients Receiving Chemotherapy: The Application of Rogers' Theory . 1029
Avoiding Litigation: Legal-Based Mediation Education for Nurses ........................ 1031
Sparks Code-Blue Ability Questionnaire of Novice Nurses in the ICU .................. 1033
Quality of Life Among Family Caregivers for Stroke Patients Discharged from
Hospital within Six Months in Northern Taiwan ......................................................... 1034
Health Perspectives and Lifestyle Issues of First-year Nursing Students: As
Revealed Through a Seminar in Health Self-Management..................................... 1036
“Back to School”: An Educational Collaboration and Tool for School Nurses and
Their Patients with Chronic Headache and School Absence.................................. 1038
The Relationship Between Percieved Self-Efficacy and Postpartum Self-Care
Behaviors in Adolescent Mothers ................................................................................ 1041
Spouse Support, Family Support Influencing Maternal Role Attainment in
Adolescent Mothers ....................................................................................................... 1042
Effects of Telephone-Based Support Group Program for Family Caregivers of
Elders ............................................................................................................................... 1043
Medication Adherence Intention and Health Status Among People with
Osteoarthritis in Korea: Pilot Study for Development of Medication Adherence
Program ........................................................................................................................... 1044
The Effectiveness of Supportive Nursing Care in Sleep Quality of Patients with
Heart Failure ................................................................................................................... 1045
Knowledge, Attitude, and Rejecting Use Behavior of Trans-Fatty Acid Among
Children............................................................................................................................ 1046
What is the Impact of Progressive Mobility on a Medical Cardiology Ward in a
Tertiary Hospital in Saudi Arabia? ............................................................................... 1047

Views of Women Regarding Infant Feeding Practices of HIV Exposed Children in
Vhembe District, Limpopo Province South Africa ..................................................... 1049
Ineffective Peripheral Tissue Perfusion: Construct Validation Using Rasch Analysis
........................................................................................................................................... 1050
Self-Care Related Factors in Patients with Heart Failure ........................................ 1052
Disaster Preparedness of Mothers Raising Preschool Children: Lessons from the
Great East Japan Earthquake ...................................................................................... 1053
A Comparison of Health Promoting Behavior and Quality of Life Among Early Stage
of CKD and Healthy Adults in Taiwan ......................................................................... 1054
Effectiveness of a Trans-Theoretical Model-Based Stage-Matched Intervention to
Promote Lifestyle Modification Among Chronic Kidney Disease in Taiwan ......... 1055
IMRT-Induced Acute Fatigue in Patients with Head and Neck Cancer: A
Prospective Study .......................................................................................................... 1057
Influences of Women's Childbirth Experiences Related to Husband's Supports for
during Childbirth and Attitudes Toward Husband's Childbirth Presence............... 1060
Transnational Care: Perceptions of Filipino Nurses Working in Japanese Hospitals
Under the Japan-Philippine Economic Partnership Agreement (JPEPA) ............. 1062
The Relationship Between Executive Dysfunction and Instrumental Activities of
Daily Living in Early-Stage Dementia.......................................................................... 1063
The Influence of Helping Relationships from Significant Others on Healthy Lifestyle
Among Patients with Chronic Kidney Disease .......................................................... 1066
An Evaluation of Motivators for Colonoscopy Screening Compliance .................. 1068
Parenting Stress, Social Support, Re-Birth Intention of Mother with Infant or Child
........................................................................................................................................... 1069

Using Field Theory to Explore the Resourcefulness of Patients with Depression1071
The Self-Concept of Shizoprenia ................................................................................. 1072
The Effect of a Community-Based Fitness and Aerobic Exercise Program for Older
Adults: A Randomized, Controlled Trial...................................................................... 1075
Weight Gain in Breast Cancer Survivors .................................................................... 1077
Exploring Significant Others Provide Helping Relationship for Mid-Adulthood
Diagnosed with Early-Stage Chronic Kidney Disease ............................................. 1078
Personal Weight Beliefs Predictive of Eating Behavior Patterns and Actual Weight
in Young African-American Women ............................................................................ 1080
Prevalence of Colorectal Cancer in Psychiatric Patients: the Preliminary Results of
Colorectal Cancer Screen ............................................................................................. 1082
The Role of Substance Abuse in the Lives of Childhood Trauma Survivors ........ 1083
Correlation Between Food Allergy Response Capabilities of Mothers Who Raise
Children with Food Allergy and the Quality of Life .................................................... 1084
The Preliminary Study of Family Resilience and Its Correlates Among Cancer
Parents ............................................................................................................................. 1086
Adolescent Mothers' Experiences With Decision Making During Labor and Birth
........................................................................................................................................... 1087
Difference of Knowledge and Attitude about Human Papillomavirus in Male and
Female College Students.............................................................................................. 1090
Correlations Between Psychological Symptoms and Quality of Life in Resident
Elderly: A Regional Hospital in Taiwan ....................................................................... 1092

The Effects of Communication Skills, Compassion Satisfaction, Compassion
Fatigue on Burnout Among Staff of Long-Term Care Insurance in National Health
Insurance Corporation in Korea ................................................................................... 1095
Outcomes of Reciving Service-Learning Activities Among Elders Living in a Long-
Term Care Facility .......................................................................................................... 1097
Risk Factors and Outcomes Associated with Initial Use of Inappropriate Indwelling
Urinary Catheters Among Hospitalized Elderly Patients.......................................... 1098
Application of Root Cause Analysis to Improve the Safety of Patients: A Case
Study of Adverse Event ................................................................................................. 1099
The Effects of a Dash Diet-Based Nutritional Intervention Program for Elderly
Women's Bone Health ................................................................................................... 1100
On the Use of Count Model to Predict Falls in Community-Dwelling Elderly: Using
Klosa (Korean Longitudinal Study of Ageing) Data .................................................. 1103
Physical and Psychological Care of Breast Cancer Patients Receiving Chemical
Therapy ............................................................................................................................ 1105
Effects of Self-Regulated Exercise Maintenance Program (SR-EMP) on Cognitive
and Behavioral Changes and Musculoskeletal Health of Elderly Women with
Osteoporosis ................................................................................................................... 1106
The Development of Educational Tool to Support Disease Management Nurses for
Preventing the Recurrence of Brain Infarction .......................................................... 1109
Epigenetic Risk Factors in Women with Breast Cancer: A Family Case-Control
Study ................................................................................................................................ 1111
Telling It like It Is: The Lived Experience of Young People with Type 1 Diabetes in
Rural Australia ................................................................................................................ 1113
Part VII: Invited Posters .......................................................................................... 1115
RSG STR - Rising Stars of Scholarship and Research Invited Student Posters ..... 1115
Postpartum Urinary Retention and Contributing Factors in Taiwanese Women . 1115

Musculoskeletal Pain in Newly Diagnosed Type 2 Diabetics in Taiwan ............... 1116
A Nurse-Led, Evidence-Based Stroke Self-Management Program for Community-
Residing Stroke Survivors: Development and Design ............................................. 1119
Methods of Developing and Evaluating an Acupressure Protocol for Managing
Agitation in Dementia .................................................................................................... 1120
Part VIII: Research Symposia ................................................................................. 1123
A 11 - Face-to-Face to Email to HELPP Zone App: Delivering Intervention in Intimate
Partner Violence ................................................................................................................. 1123
Face-to-Face to Email to HELPP Zone App: Delivering Intervention in Intimate
Partner Violence ............................................................................................................. 1123
Text Messaging Information for Survivors of Intimate Partner Violence ............... 1123
The HELPP Zone App for Survivors of IPV ............................................................... 1124
B 11 - The Asian Women’s Health Research Network: A Showcase of Studies by the
Korean Side......................................................................................................................... 1126
Effects of Shift Work Change on Occupational Stress in South Korean Female
Nurses .............................................................................................................................. 1126
Predictors of Depression among Midlife Women in South Korea .......................... 1126
Does Social Activity Decrease the Depression in the Elderly?: An Analysis of a
Population-Based Study in South Korea .................................................................... 1127
C 11 - Establishing and Maintaining International Research Collaboration: Processes,
Outcomes, and Exemplars ............................................................................................... 1129
Experiences, Benefits, and Challenges of Initiating and Maintaining International
Research Collaborations ............................................................................................... 1129
Cross-Cultural Comparison of the Haase Resilience in Illness Scale: Psychometric
Properties Testing .......................................................................................................... 1130
Experience of Taiwanese Mothers of Children Completing Cancer Treatments . 1131
D 11 - More Than Vital Signs: Reframing nurses’ Recognition and Response to
Clinical Deterioration.......................................................................................................... 1132
Development of the Barriers to Nurses' Use of Physical Assessment Scale ....... 1132
Factors Influencing Nursing Assessment Practices ................................................. 1132
Exploring Patient Assessment Practices in the Acute Hospital Environment: An
Ethnography .................................................................................................................... 1133
E 07 - Workplace Behaviors Affecting Patient Safety: Role of Nurses and Physicians
as Partners in Change ....................................................................................................... 1135
Disruptive Behavior and its Effects on Workplace Safety: What Can Nurse Leaders
Do? ................................................................................................................................... 1135

Disruptive Behavior Between Physicians and Nurses: The Role of the Physician
Leader .............................................................................................................................. 1135
Disruptive Behavior Between Physicians and Nurses: Building the Interdisciplinary
Toolkit for Change .......................................................................................................... 1137
E 11 - Empirically-Based Bystander Education Programmes to Prevent Dating
Violence in University Students: Lessons from U.S. and Hong Kong Experience .. 1138
Friends Helping Friends: A Peer-Based Programme in Responding to Dating
Violence in U.S. .............................................................................................................. 1138
Dating Café Ambassadors Programme: A Bystander Education Programme to
Prevent Dating Violence in Hong Kong ...................................................................... 1138
Am I Responsible to Help Peers in Abusive Dating Relationships?: Learning from a
Qualitative Study ............................................................................................................ 1139
F 09 - A Place at the Table: Voices of Nursing at the UN, Bringing the Voice of the UN
to Nurses ............................................................................................................................. 1141
On the Ground and from Afar: STTI & Global Nursing Organization Representatives
to UN NGO community: A Place at the Table ........................................................... 1141
Sustaining Global and Local Nursing Voice at the United Nations ........................ 1141
Youth UN Representatives: Emerging Roles for Youth at the UN ......................... 1142
F 11 - Practical Interventions to Improve Adherence ................................................... 1144
Review of the Predictors of Medication Non-Adherence and Adherence ............. 1144
A Review of the Patterns, Predictors, and Interventions to Improve Adherence . 1144
Strategies for Improving Adherence............................................................................ 1145
G 11 - Challenges in the Context of Self-Care and Family Caregivers ..................... 1146
Self-Management on Chronic Diseases ..................................................................... 1146
Critical Factors on Autonomy Reconstruction after Self-Care Dependency......... 1146
Family Vulnerability ........................................................................................................ 1147
Educacional Tool to Improve Caregiver Role ............................................................ 1147
H 09 - Working with Communities to Address Obesity Across the Lifespan ............ 1149
Establishing the Reliability and Validity of HeartSmartKids Cardiovascular Risk
Assessment for Children 2-18 Years .......................................................................... 1149
The Relationship of Maternal BMI and Child Body Size, Home Environment, and
Food in Low-Income Minority Women and Children Participating in a Child Obesity
Primary and Secondary Prevention Project ............................................................... 1149
Cultural Relevance of the Healthy Choices Intervention Program ......................... 1150
Overweight and Obesity in Young Children: A Critical Period for Intervention .... 1151
H 11 - ICU Diary: Supporting the Intensive Care Patients Transition from the ICU 1153
ICU Diary: Mind the Gap ............................................................................................... 1153

The Emergence and Evolution of the Intensive Care Patient Diary....................... 1153
ICU Diaries Reduce Post Traumatic Stress Disorder after Critical IIllness in Patients
and Family Members ..................................................................................................... 1154
ICU Diaries: The Journey to Psychological Recovery for Critically Ill Patient's
Family Members ............................................................................................................. 1155
I 09 - Utilization of Nursing Classification Systems for the Depiction of the Nursing
Process in Electronic Patient Records in Order to Improve Evidence-Based Nursing
............................................................................................................................................... 1157
Aims of Utilization Nursing Process Data in Electronic Patient Records .............. 1157
Illustration of Aims for Utilization Nursing Process Data in Electronic Patient
Records with the Aid of the European Nursing Care Pathways (ENP) ................. 1158
Requirements of Nursing Classification Systems for an Useful Application in
Electronic Data Records ............................................................................................... 1158
J 09 - New Evidence-Based Practice Competencies for Practicing Nurses and
Advanced Practice Nurses: From Development to Real World Implementation ..... 1160
The Development of New Evidence-Based Practice Competencies for Practicing
Registered Nurses and Advanced Practice Nurses ................................................. 1160
Partnering with Healthcare Organizations to Pilot the Implementation of EBP
Competencies ................................................................................................................. 1160
Integration of EBP Competencies Exemplar: The Interdisciplinary Policy and
Procedure Committee Experience............................................................................... 1161
K 09 - Improving Health Outcomes in Haiti through Nursing Education ................... 1163
Collaborating Globally to Transform Haiti's Healthcare ........................................... 1163
Fill in the Blank...The Experience of a Nurse Educator in Haiti .............................. 1163
Empowering Nursing Students at the Faculté des Sciences Infirmières de Léogane
(FSIL) to Promote Evidence-Based Practice in Haiti................................................ 1164
K 11 - Translating Interventions to Practice: Dissemination and Implementation
Research Methods ............................................................................................................. 1166
Research Designs for Dissemination and Implementation...................................... 1166
Putting Evidence into Practice: Dissemination and Implementation of a Cervical
Cancer Prevention Project in Ethiopia ........................................................................ 1167
Dissemination and Implementation Studies: The Statistician/Methodologist's Role
and Responsibilities ....................................................................................................... 1167
L 09 - Factors Influencing Overweight and Healthy Lifestyles in Adolescents:
Supporting Evidence to Guide Effective Interventions ................................................. 1169
Sleep and Adolescent Obesity: Results from the Creating Opportunities for
Personal Empowerment (COPE) Randomized Controlled Trial ............................. 1169
Differences in BMI, Self-Concept and Perceived Difficulty in Leading a Healthy
Lifestyle between Hispanic and Non-Hispanic Teens .............................................. 1170

Critical Components of Evidence-Based Interventions to Prevent
Overweight/Obesity in Adolescents ............................................................................ 1170
L 11 - Engaging Interprofessional Teams: Promoting Community and Global Health
Initiatives for Education, Practice, Research and Policy.............................................. 1172
Implementation of an Innovative Interprofessional Curriculum for Community
Assessment, Practice, and Research for Masters' and Doctoral Education ........ 1172
Community Engagement: Implementation of an Innovative Interprofessional
Curriculum for Community Assessment and Practice for Master's Education ..... 1172
Implementation of an Innovative Interprofessional Global Health Curriculum for
Doctoral Education ......................................................................................................... 1173
M 09 - Evidence-Based Practice Mentors and Their Impact on Patient Outcomes and
Healthcare Quality.............................................................................................................. 1175
EBP Mentors Improving Healthcare Practice and Impacting Outcomes in Real
World Clinical Settings................................................................................................... 1175
EBP Mentors in Action in a Real World Clinical Setting to Improve Care and
Outcomes ........................................................................................................................ 1175
Creating an Environment Where EBP Is Reality: Engagement and Critical
Contributions of the Nurse Executive.......................................................................... 1176
M 11 - Meta-Analyses of Human Genome Studies: Epigenetic Risk Factors and
Population Health Issues in the World ............................................................................ 1178
Meta-Analyses of Human Genome Studies: Epigenetic Risk Factors and Population
Health Issues in the World ............................................................................................ 1178
Meta-Analyses of Epigenetics Risk Factors for Lung Cancer Prevention: MPO and
GSTM1 Human Gene Variations Across Different Race-Ethnicity Groups .......... 1178
Meta-Analyses of Epigenetics Risk Factors for Heart Disease Prevention: NOS3
Human Gene Variations Across Different Race-Ethnicity Groups ......................... 1179
Meta-Analyses of Epigenetics Risk Factors for Cardiovascular Health: APOA5
Human Gene Variations Across Different Race-Ethnicity Groups ......................... 1180
N 09 - The Impact of an Enculturated Evidence-Based Practice Environment on the
Roles and Responsibilities of Nursing Leaders ............................................................. 1182
The Changing Role of the Hospital-Based Clinical Nurse Scientist in an
Enculturated Evidence-Based Practice Environment ............................................... 1182
The Changing Role of the Administrator of Nursing Quality, Evidence-Based
Practice and Research in an Enculturated Evidence-Based Practice Environment
........................................................................................................................................... 1182
The Changing Role of the Chief Nursing Executive in an Enculturated Evidenced-
Based Practice Environment ........................................................................................ 1183

Part I: Plenary Sessions
OPENING PLENARY
Evidence-Based Nursing Practice: A Panel Discussion
Hester C. Klopper, PhD, MBA, RN, RM, FANSA , South Africa
Irmajean Bajnok, RN, MScN, PhD, Canada
Laura Cullen, DNP, RN, FAAN, USA
Craig Lockwood, RN, MNSc, PhD, Australia
Brendan McCormack, DPhil (Oxon), BScN (Hons), PGCEA, RGN, RMN, United Kingdom
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, USA
Kathleen M. White, PhD, RN, NEA-BC, FAAN, USA
Purpose
Discussion various programs of evidence-based practice in the nursing profession.
Target Audience
All nurses.
Abstract
Panel presentation from six evidence-based experts regarding perspective programs. Moderatored by
STTI President, Hester Klopper.
Contact
[email protected]

PLENARY SESSION 2
Engaging Colleagues: Improving Global Health Outcomes
Hester C. Klopper, PhD, MBA, RN, RM, FANSA , South Africa
Purpose
Discuss nursing’s potential effect on global health.
Target Audience
The target audience for this presentation is academics, practitioners, researchers and educators with an
interest in the global health agenda.
Abstract
Health is central in development and has been identified as a critical indicator for sustainable
development. Three of the Millennium Development Goals (MDGs) focused specifically on health. The
question and debate for the future is how the Sustainable Development Goals (SDGs) post-2015 should
reflect health, as these goals shape agendas and determine resource allocation. In this session the status
of the achievement of the MDGs will evaluated, the changing global health agenda will be explored and
some insights shared into how health could be linked to the SDGs post-2015. Specific attention will be
given to health outcomes that are important indicators of achieving sustainability. Nurses are the the
largest group of health professionals, and often the only available human resource for health in
communities, and will play a critical role towards sustainable development by reducing the burden of
disease. How nurses can strengthen health systems through being engaging will also be given attention
during this plenary session.
References
WHO. 2012. Positioning Health in the Post-2015 Development Agenda. WHO discussion paper. October 2012
Contact
[email protected]

CLOSING PLENARY
The Quest for Excellence in International Nursing Research
Stephanie L. Ferguson, PhD, RN, FAAN, USA
Purpose
To discuss international nursing research challenges and provide potential strategies to overcome them.
Target Audience
All nurses.
Abstract
There are multiple issues facing the 21st century. Challenges in developing countries may lead to
obstacles to providing health care. Challenges including poverty, chronic disease, an aging population
and an inability to provide or utilize technological innovations provide the ability for nurses to expand their
roles as healthcare providers. By assuming leadership roles, expanding nursing education and staying at
the forefront of research nurses can advocate for good health, equality and justice.
References
Kaplan, J, Bond, T., Merson, M. et al (2009) Lancet: 373: 1993-95 2. Minisman, G. Bhanushali, M. et al. (2012)
Journal of the Neurological Science 313, 1-6 3. Hampton, T. (2012) JAMA, May 16-Vol 307, No. 19
Contact
[email protected]

Part II: Special Sessions
A 02 - SPECIAL SESSION: Fostering Global Citizenship in Nursing
Education: The Role of the United Nations
Hester C. Klopper, PhD, MBA, RN, RM, FANSA
K. Joanne McGlown, PhD, MHHA, BS, RN, FACHE
Purpose
The presentation will discuss global citizenship in nursing education. It begins by defining global
citizenship – why it is important in nursing education and how it is taught.
Target Audience
The target audience includes: educators, clinical nurses, students and administrators.
Abstract
The session will begin with a power point presentation for background information, then progress to
examples of successful programs on teaching global citizenship and a discussion of United Nations
programs in developing global citizens. The implications of ECOSOC status will be discussed, including
the opportunities for STTI and our members that exist with this status. The future vision of STTI’s
relationship with the UN will also be explored, with discussion of how attendees may best use the
information from this presentation.
Contact
[email protected]

B 01 - SPECIAL SESSION: Educational Scholarships
Eric Chan, DMgt, MBA, RN, FACN
Purpose
The purpose of this presentation is to explore the current status of educational scholarships and discuss
whether it can be used as an effective HRH tool.
Target Audience
The target audience of this presentation is for practicing clinicians, academic leaders, adminstrators who
are interested in maximizing the contributions educational scholarships HRH and global health.
Abstract
As we move towards the final years for the Millennium Development Gosls (MDGs)" the issue of shortage
of human resources for health (HRH) remains high on the global agenda. HRH shortage still existed in
many countries or different corners of a country which are impacting on the delivert of health care. There
are many types and models of educational scholarships being offered by educational institutions, service
organizations, local or national health authorities across the globe. Can we see the use of educational
scholarships as one of the tools for the HRH retention, capacity building and enhancing access to care for
global health? What are the experiences so far on the use of educational scholarships? Have they been
beneficial? Does it help to manage the migration of HRH? Are there any opportunities for international
collaborations? These issues will be explored. This session will provide a forum for discussion on what
models and types educational scholarship are being offered across the globe. Participants will be invited
to contribute through experience sharing and discussion.
Contact
[email protected]

B 02 - SPECIAL SESSION: Celebrating the Asia Region's Excellence
and Advancements in Research and Scholarship Development
Claudia K. Y. Lai, PhD, RN
Misae Ito, RN, RMW, MSN, PhD
Alice Yuen Loke, PhD, RN
Mi Soon Song, RN, PhD
Pei-Shan Tsai, PhD
Alice K. Y. Wong, PhD
Shela Akbar Ali Hirani, MScN, BScN, IBCLC, AdvDipECD
Sally Wai-Chi Chan, PhD, MSc, BSc, DipEd, RN, RMN, FHKCERN
Purpose
After joining this session, the participants will be able to 1. describe the state of scholarship development
in the presenting countries/cities; 2. identify the areas of success in the Asia Region with regard to
research development and scholarly work 3. discuss the opportunities and barriers relating to regional
and international research and collaboration.
Target Audience
The target audience of this presentation is any participants who are interested in learning about research
and scholarship development in the Asia Region.
Abstract
The goal of this special session is to showcase the excellence in nursing scholarship in Asia and also
recognize the Asian nurse leaders in their contribution to the profession and society. Five chapters in the
Asia Region will present the work undertaken by their own chapter and leaders over the years. These five
chapters (in alphabetical order) are the Lambda Alpha-at-Large (Korea), the Lambda Beta-at-Large
(Taiwan), the Pi Iota (Hong Kong), the Rho Delta (Pakistan), and the Upsilon Eta Chapter. They will
portrait the development of their own country’s nursing research and scholarship. Not only will they
discuss research utilization and collaboration in their own country, but also they will introduce their own
nurse scholars. The lists of prominent nurse leaders and their publications from the four presenting
chapters will be distributed during the Session. We hope to introduce our nurse leaders to each other and
create a platform for the sharing of expertise through our presentation. The intended outcome is to create
a formal platform for Asian nurse leaders for scholarly exchanges. The ultimate goal is to form a STTI
Asian Alliance of Nurse Researchers - a network of Asian nurse scholars and researchers to realize the
mission and vision of the STTI in the regional context. Our goal is a positive response to the President’s
Call to Action – to serve locally, transform regionally and lead globally.
Contact
[email protected]

B 06 - SPECIAL SESSION: Exposing Quality of Life and Deadly Health
Disparities: Using Research to Change Health Care Policy
Carol Estwing Ferrans, PhD, RN, FAAN
Purpose
to trace Dr. Carol Ferrans’ research trajectory from its earliest beginnings in quality of life and health
disparities, over 30 years, including how she used research findings as a tool to strategically to shape and
create changes in healthcare policy and legislation.
Target Audience
novice and experienced researchers and clinicians,interested in quality of life and health disparities,
including how to use research findings as a tool to strategically to shape and create changes in
healthcare policy and legislation.
Abstract
At this meeting in Hong Kong, Dr. Carol Ferrans will be inducted into the International Nurse Researcher
Hall of Fame of Sigma Theta Tau International. The purpose of this presentation is to trace her research
trajectory from its earliest beginnings in quality of life and health disparities, over 30 years, including how
she used research findings as a tool to strategically to shape and create changes in healthcare policy and
legislation. Since the early 1980s when quality of life was a new concept, she has been an advocate for
the voice of the patient in QOL assessment, developing a conceptual framework for QOL and instrument
to capture the patient’s viewpoint. The Ferrans and Powers Quality of Life Index (QLI) was introduced in
1985 and since then has been translated into 21 languages and used in 30+ countries, in every continent
except Antarctica. To date, 48 published studies provide support for the instrument’s reliability and
validity, and 27 intervention studies have demonstrated its sensitivity in detecting change in QOL. More
than 250 studies using the QLI have been published to date by nurses, physicians, psychologists,
physical therapists, and other health care professionals. It is one of the most popular instruments for
cardiac rehabilitation and pulmonary rehabilitation programs across the USA. Dr. Ferrans’ program of
research also has focused on understanding and reducing disparities in cancer. In 1987 Dr. Ferrans
conducted one of the earliest comparisons of QOL of African American and white breast cancer survivors,
and reported various psychological sequelae of surgery, including significant depression persisting years
after treatment. Building on this work, Dr. Ferrans conducted a study with 16 participating institutions
across the country, examining the barriers to participation in cancer screening, long-term effects of
cancer, and QOL of African American survivors of breast, colon, and prostate cancer. In her next study,
Dr. Ferrans examined the factors contributing to late-stage diagnosis of breast cancer in economically
disadvantaged African American and Hispanic women. She found that delay in seeking diagnosis of a
suspicious breast symptom was twice that previously reported in the literature, and that cultural beliefs
and fear were major contributing factors. Next, she developed an instrument that correctly identified
cultural beliefs contributing to later stage of breast cancer at diagnosis for African American and Hispanic
women. Her team’s published findings were cited by the American Cancer Society in their 2011
guidelines for breast cancer screening. Dr. Ferrans then developed a short film on DVD to address these
beliefs, which was endorsed by the American Cancer Society. Evaluation of the DVD demonstrated that
cultural beliefs could be changed in a single viewing. Dr. Ferrans currently has reached more than 8,500
women with the DVD. Her research and advocacy work culminated in the creation of the Illinois Reducing
Breast Cancer Disparities Act, designed to improve access to screening and the quality of mammography
throughout Illinois. This work provides a model for the effective dissemination of research findings to
create wide-ranging changes in health care and policy.
References
1. Ferrans, CE. (2010). Advances in measuring quality of life outcomes in cancer care. Seminars in Oncology
Nursing, 26(1), 2-11. 2. Ferrans, C. (2007). Differences in what quality of life instruments measure. Journal of the
National Cancer Institute Monographs, 37, 22-26. 3. Ferrans, C. Zerwic, J., Wilbur, J., Larson, J. (2005). Conceptual
model of health-related quality of life. Journal of Nursing Scholarship, 37(4), 336-342. 4. Yarbro, C., & Ferrans, C.
(1998). Quality of life of prostate cancer patients treated with surgery or radiation therapy. Oncology Nursing Forum,
24(4), 685-693. 5. Ferrans, C. (1996). Development of a conceptual model of quality of life. Scholarly Inquiry for

Nursing Practice: An International Journal, 10(3), 293-304. 6. Ferrans, C. (1994). Quality of life through the eyes of
survivors of breast cancer. Oncology Nursing Forum, 21(10), 1645 1651. 7. Ferrans, C., & Powers, M. (1992).
Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15, 29 38 8. Ferrans, C. E.
(1990). Quality of life: Conceptual issues. Seminars in Oncology Nursing, 6(4), 248 254. 9. Ferrans, C. (1990).
Development of a quality of life index for patients with cancer. Oncology Nursing Forum, 17(3) suppl, 15 19. 10.
Ferrans, C., & Powers, M. (1985). Quality of Life Index: Development and psychometric properties. Advances in
Nursing Science, 8, 15 24.
Contact
[email protected]

B 07 - SPECIAL SESSION: Global Research Collaborations to Prevent
and Respond to Intimate Partner Violence
Nancy Glass, PhD, MPH, MSN, BSN, BS
Purpose
The purpose of the presentation is to provide detailed information on a productive global research
collaboration to prevent and respond to intimate partner violence.
Target Audience
The target audience of this presentation are researchers and clinicians who work in the area of women's
health and violence prevention.
Abstract
Gender based violence (GBV), including intimate partner violence (IPV) is a significant and widespread
public health issue. Among women globally, 1 in 3 women report physical or sexual violence in their
lifetime, most typically at the hands of their male partner. IPV is associated with numerous negative
physical and mental health consequences, yet few IPV interventions have been proven effective in
reducing the negative health and social consequences of IPV for women and their families. Safety
planning is the most widely advocated intervention to reduce IPV, yet the vast majority of abused women
never access safety planning services. Our challenge is to increase women’s access to safety planning,
with the opportunity to consider their unique priorities (e.g. privacy, feelings for partner, severity of
violence, social support/status) and level of danger in the relationship during and when ending an abusive
relationship. Therefore, a global collaboration of researchers from the U.S., Canada, Australia, New
Zealand and Hong Kong have come together in a collaborative research effort to conduct rigorous clinical
trials in each country to evaluate the effectiveness an interactive, personalized safety decision aid
delivered via internet and/or smartphone application (“App”) to improve safety and health for women in
abusive intimate relationships. The safety decision aid is adapted to the context of each country by the
lead investigators and their teams with support of collaborators in the other countries. The investigators
have shared resources and expertise to support each other in obtaining research funding to implement
the clinical trial with common outcomes for comparisons across the diverse countries. Findings from the
US based trial (completed in May 2014), preliminary findings from ongoing trials in New Zealand and
Canada, and details on the start-up of the research studies in Australia and Hong Kong will be provided
during the presentation.
Contact
[email protected]

C 01 - SPECIAL SESSION: Women's Health and Sleep Research: A
Health Ecology Exemplar for Dialogue on the Keys to Building a
Research Career
Joan L. Shaver, PhD, RN, FAAN, FWAN
Purpose
to describe the building of a research program in women's health and sleep science according to a health
ecology framework, emphasizing knowledge outcomes, meaning for clinical practice, and science growth
potential and to emphasize through dialogue lessons learned and tips for success as a clinical scientist.
Target Audience
novice and mid-career nursing scholars in academia or practice, students contemplating an academic
faculty career or practice inquiry and senior researchers -all invited to enrich audience dialogue.
Abstract
This session will involve interactive dialogue between the audience and presenter related to the strategies
and skills needed for the building of an interdisciplinary research program as an academic clinician
scientist. An exemplar of midlife women's health and sleep science according to a health ecology
framework will be outlined. Revealed will be the research program outcomes, meaning for clinical practice
and science growth potentials. Going beyond the typical Q & A, integrated will be opportunity for
presenter and audience ideas, lessons learned and tips. Content to include how to: optimize success in
attaining research funding through persuasive proposal writing; power pack a proposal to support the next
proposal; gain skill in self-critique and ‘how to play the game’; and prepare for outcomes that support or
refute hypotheses; all important to developing and sustaining a research program.
Contact
[email protected]

C 02 - SPECIAL SESSION: Using the Internet to Reach Teens with
Type 1 Diabetes
Margaret Grey, DrPH, RN, FAAN
Purpose
to share the results of a program of research on improving outcomes for youth with diabetes
Target Audience
nurse scientists, pediatric nurses and people interested in translational research.
Abstract
In this presentation, the results of a series of studies about a psycho-educational intervention developed
to improve outcomes in adolescents with type 1 diabetes will be described. Based on descriptive research
findings, the author developed the intervention and translated it into an internet delivery format which has
been tested in a large randomized clinical trial. Translational research is now being conducted.
References
Grey, M., Whittemore, R., Liberti, L., Delamater, A., Murphy, K., & Faulkner, M. S. (2012). A comparison of two
internet programs for adolescents with type 1 diabetes: Design and methods. Contemporary Clinical Trials, 33, 769-
776. PMCID: PMC22484337 Grey, M., Whittemore, R., Jeon, S., Murphy, K., Faulkner, M., & Delamater, A. (2013).
Internet psycho-education programs improve outcomes in youth with type 1 diabetes. Diabetes Care, 36, 2475-2482.
PMCID: PMC23579179
Contact
[email protected]

C 06 - SPECIAL SESSION: A Life Long Quest in Women's Health
through Internet Research Methodology
Eun-Ok Im, RN, MPH, PhD, CNS, FAAN
Purpose
The purpose of this presentation is to introduce Dr. Im’s program of research in women’s health and
Internet research and to discuss her most recently completed multi-ethnic Web-based study on midlife
women's menopausal symptom experience.
Target Audience
The target audience of this presentation is nurese who are working with midlife women, are interested in
midlife women's health issues, are interested in Web-based research methods, and are interested in
developing a research program in women's health.
Abstract
This session presents Dr. Im’s program of research in women’s health and Internet research. Her
beginning research question is presented with her former experience in oncology units and women’s
health. Her history of developing her research program is presented with evolving research questions.
Then, her most recently completed study on a Web-based multi-ethnic study on menopausal symptoms
among four major ethnic groups of midlife women is presented with implications for future research. The
study aimed to explore ethnic differences in menopausal symptom experience among four major ethnic
groups in the U.S. (Whites, Hispanics, African Americans, and Asians). The study was theoretically based
on a feminist perspective. This cross-sectional study included two phases: (a) a quantitative national
Internet survey and (b) four qualitative ethnic-specific online forums. The Internet survey was conducted
among 512 midlife women using multiple instruments including questions on background characteristics
and health and menopausal status and the Midlife Women’s Symptom Index. Four ethnic-specific online
forums were conducted among 90 midlife women using 7 online forum topics. The Internet survey data
were analyzed using multiple regression analyses and cluster analyses. The online forum data were
analyzed using thematic analysis. The findings indicated that there were significant ethnic differences in
the total number.
References
Im, E. O., Lee, B. I., Chee, W., Brown, A., & Dormire, S. (2010). Menopausal symptoms among four major ethnic
groups in the United States. Western Journal of Nursing Research, 32(4), 540-565. PMCID: PMC3033753 Im, E. O.,
Lee, B. I., Chee, W., Dormire, S., & Brown, A. (2010). A National Multi-ethnic Online Forum Study on Menopausal
Symptom Experience. Nursing Research, 59(1), 26-33. PMCID: PMC2882158 Im, E. O., Lee, S. H., & Chee, W.
(2010). "Our Own Experience": African American Women in Menopausal Transition. Journal of Obstetric,
Gynecological, and Neonatal Nursing, 39(4), 435-443. Im, E. O., Lee, S. H., & Chee, W. (2011). “Be conditioned, but
empowered”: Asian American midlife women in menopausal transition. Journal of Transcultural Nursing, 22(3) 290–
299. Im, E. O., Lim, H. J., Lee, S. H., Dormire, S., Chee, W., & Kresta, K. (2009). Menopausal Symptom Experience
of Hispanic Midlife Women in the U.S. Health Care for Women International, 30(10), 919-34.
Contact
[email protected]

C 07 - SPECIAL SESSION: A Research Journey: To Boldly Go Forward
Usha Menon, PhD
Purpose
The purpose of this presentations is to inform participants about developing and implementing a research
trajectory in an academic setting.
Target Audience
The target audience for this presentation is academic and clinical researchers and faculty engaged in
tenured or tenure-track positions.
Abstract
The development of a successful career requires passion, persistence, teamwork, and mentorship. In my
research career, I have focused on reducing disparities in the early detection of cancer among the poor,
elderly, underserved and/or minorities. Cancer is a deadly disease that kills many people worldwide, yet
the irony is that for certain cancers, early detection can lead to a complete cure and lives saved. Through
the testing of targeted and tailored interventions, my team has moved from efficacy testing to testing
dissemination and implementation designs. The use of rigorous models of cultural targeting and individual
tailoring of education can enhance relevance, effect, and sustained impact. Nurses are ideally placed to
lead translational efforts through dissemination and implementation. In addition to describing my research
journey, in this session, I will address designs, models, and readiness for translational research and
strategies for career development and mentoring.
Contact
[email protected]

C 13 - SPECIAL SESSION: International Leadership Opportunities
Suzanne Prevost, PhD, RN, COI
Purpose
Describe volunteer positions within STTI as well as qualifications and time commitments required.
Target Audience
All attendees.
Abstract
Suzanne Prevost, Chair of the Leadership Succession Committee will discuss opportunities for serving as
a volunteer leader in the Honor Society. Open positions and position descriptions will be identified during
this session as well as qualifications and time commitment required.
Contact
[email protected]

D 01 and J 07 - SPECIAL SESSION: Research Abstracts, Proposals
and Grant Writing: Basics from Start to Finish
Lois Sarah Marshall, PhD, RN
Purpose
to provide the novice researcher the basics to write a research abstract, proposal, and/or grant for
submission.
Target Audience
New nurse researchers and nurses seeking grants
Abstract
This presentation will provide the novice researcher the basics to write a research abstract, proposal,
and/or grant for submission. This session will enable participants to gain a basic understanding of the
steps of the abstract/proposal/grant writing process in order to enable them to put forth a submission in
the future. Participants will be able to interact with some past recipients of STTI small research grants
who will provide practical information on the writing, submission, and follow-up process.
Contact
[email protected]

D 02 - SPECIAL SESSION: Reducing HIV Health Disparities Among
Hispanics Through Culturally Tailored Intervention Science
Nilda (Nena) Peragallo Montano, DrPH, RN, FAAN
Purpose
The purpose of this presentation is to discuss a program of research, SEPA, on HIV Prevention and
Health Disparities among minority populations. SEPA intervention (Salud/Health, Educación/Education,
Promoción/Promotion, y/and Autocuidado/self-care) is an evidence based HIV prevention intervention for
Hispanic women.
Target Audience
The target audience of this presentation is nurses and other health care professional working in HIV
prevention at different settings, interested in the development of culturally specific interventions, and /or
working with minority populations.
Abstract
Introduction: Globally, HIV continues to be one of the leading causes of death. At the end of 2012, there
were more than 35 million people living with HIV worldwide. In the U.S., the incidence of HIV is increasing
more rapidly among racial and ethnic minorities, representing over 72% of new HIV cases and 65% of
those currently living with HIV. Interventions to prevent HIV are needed for Hispanic women at all ages.
SEPA (Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/self-care), an HIV
prevention intervention for Hispanic women has been demonstrated to be efficacious for decreasing HIV
risk behaviors. The purpose of this presentation is to discuss a program of research to develop, test,
adapt and disseminate SEPA. The aims of this presentation are to: (1) describe the development and
impact of the SEPA intervention and its successful implementation in different settings and diverse
Hispanic groups, and (2) discuss future opportunities and challenges in research with diverse
communities. Methods: SEPA is an evidenced-based HIV risk reduction intervention initially designed for
Mexican and Puerto Rican women living in Chicago. In the first SEPA randomized controlled trial (SEPA
I), 657 Hispanic women between 18 and 44 years old were assigned to SEPA or to a delayed-intervention
control group. Women completed structured interviews at baseline and 3 and 6 months post-baseline.
SEPA was culturally tailored and consisted of six weekly sessions, two hours each. The groups were
conducted in Spanish or English according to participants’ preference. After this trial, SEPA was
successfully adapted and implemented in different settings and among diverse Hispanic communities,
including: “Mano a Mano”, an initiative for women, men, and health care workers in Chile (R01TW-03-
007769-5; RO1007674-5; R01TW006977); I-STIPI, a web-based intervention for Chilean young women;
SEPA-O, for Hispanic women age 50 and above; and SEPA II, for Hispanic women in South Florida.
SEPA III, an effectiveness trial, is being implemented in a real world setting by community agency
personnel to reduce the gap between research and practice. Much of the recent work on SEPA is
conducted within the Center of Excellence for Health Disparities Research: El Centro (NIH/MCHMD
P60MD002266). Results: In SEPA I, SEPA was found to increase condom use and improve HIV
knowledge, partner communication and risk reduction behavioral intentions, and to decrease perceived
barriers to condom use. Similar results were reported in the second randomized clinical trial, SEPA II, and
women who received the SEPA intervention also reported a reduction in intimate partner violence. The
adaptations of SEPA have also had an impact in HIV prevention among diverse Hispanic groups. These
adaptations have maintained the core elements of the original SEPA intervention. Conclusion: SEPA has
been shown to be efficacious for reducing HIV risk among Hispanic women and provides evidence that
HIV/AIDS prevention interventions must be developed and disseminated in the community and culturally
tailored to the targeted population of the intended program. SEPA has contributed to research on health
disparities and HIV prevention by providing a culturally specific and evidence based intervention that can
be implemented in different settings.
References
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychology Review 84, 191-215.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37(2), 122-147 Cianelli, R.,
Ferrer, L., Norr, K. F., Miner, S., Irarrazabal, L., Bernales, M., Peragallo, N., McElmurry, B. (2012). Mano a mano-

mujer: An effective HIV prevention intervention for Chilean women. Health Care for Women International, 33(4), 321-
341. PMCID: PMC3348920 Cianelli, R., Lara, L., Villegas, N., Bernales, M., Ferrer, L., Kaelber, L., Peragallo, N.
(2012). Impact of mano a mano-mujer, an HIV prevention intervention, on depressive symptoms among Chilean
women. Journal of Psychiatric and Mental Health Nursing, 20(3), 263-272. doi: 10.1111/j.1365- 2850.2012.01907.x.
PMCID: PMC3401514 Cianelli, R., Villegas, N., Gonzalez-Guarda, R. M., Kaelber, L., & Peragallo, N. (2010). HIV
susceptibility among Hispanic women in south Florida. Journal of Community Health Nursing, 27(4) 207-215. PMCID:
PMC3092435 Florida Department of Health. Florida annual report 2007. Acquired immunodeficiency syndrome/
human immunodeficiency virus. 2007; Available at:
http://www.doh.state.fl.us/disease_ctrl/aids/trends/epiprof/mini_aids07c.pdf. Accessed August 27, 2009. Freire, P.
(1972) Pedagogy of the Oppressed, Harmondsworth: Penguin Freire, P. (1995) Pedagogy of Hope. Reliving
Pedagogy of the Oppressed, New York Gonzalez-Guarda, R. M., McCabe, B. E., Florom-Smith, A., Cianelli, R.,
Peragallo, N. (2011). Substance abuse, violence, HIV, and depression: An underlying syndemic factor among
Latinas. Nursing Research, 60(3), 182-189. PMCID: PMC3171180 González-Guarda, R.M., McCabe, B.E.,
Vermeesch, A.L., Cianelli, R., Peragallo-Montano, N., Florom-Smith, A.L. (2013). Cultural phenomena and the
syndemic factor: Substance abuse, violence, HIV and depression among Hispanic women. Annals of Anthropological
Practice, 36(2), 212-231. PMCID: PMC3932986 Gonzalez-Guarda, R. M., Vasquez, E. P., Urrutia, M., Villarruel, A.
M., & Peragallo, N. (2011). Hispanic women’s experiences with substance abuse, intimate partner violence, and risk
for HIV. Journal of Transcultural Nursing, 22(1), 46-54. PMCID: PMC3070462 Gonzalez-Guarda, R.M., Vermeesch,
A., Florom-Smith, A., McCabe, B. & Peragallo,N. (2013). Birthplace, culture, self-esteem and intimate partner
violence among community dwelling Hispanic women. Violence Against Women, 19(1), 6-23. doi:
10.1177/1077801212475336. PMCID: PMC3584196 Kaiser Family Foundation. The HIV/AIDS Epidemic in the United
States. 2009; Available at: http://www.kff.org/hivaids/upload/3029-10.pdf. Kim, Y.J., Peragallo, N., De Forge, B.
(2006). Predictors of participation in an HIV risk reduction intervention for socially deprived Latino women: a cross
sectional cohort study. International Journal of Nursing Studies, 43(5), 527-534. McCabe,B. E., Vermeesch, A., Hall,
R. F., Peragallo, N., & Mitrani, V. B. (2011). Acculturation and the center for epidemiological studies-depression scale
for Hispanic women. Nursing Research, 60(4), 270-275. PMCID: PMC3137136 Mitrani, V.B., McCabe, B.E.,
Gonzalez-Guarda, R., Florom-Smith, A., Peragallo, N. (2013).Participation in SEPA, a sexual and relational health
intervention for Hispanic women. Western Journal of Nursing, 35(7), 849-866. doi: 10.1177/0193945913480276.
PMCID: PMC3870584 Peragallo, N., Deforge, B., O’Campo, P., Lee, S.M., Kim, Y.J., Cianelli, R., Ferrer, L. (2005). A
randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women. Nursing Research,
54(2), 108-118.Peragallo, N., Gonzalez-Guarda, R.M., McCabe, B. & Cianelli, R. (2012). The efficacy of an HIV risk
reduction intervention for Hispanic women. AIDS and Behavior, 16(5), 1316-13126. PMCID: PMC3528343 UNAIDS
(2013). Global report. Retrieved from http://www.unaids.org/en/resources/campaigns /globalreport2013/globalreport/
Villegas, N., Cianelli, R., Ferrer, L., Kaelber L., Peragallo, N., Yaya, A. (2012). Risk factors for HIV acquisition among
Hispanic women 50 years and older living in south Florida. Horizonte de Enfermería, 23(1), 51-61. NIHMSID:
NIHMS412896 Villegas, N., Cianelli, R., Gonzalez-Guarda, R., Kaelber, L., Ferrer, L., & Peragallo, N. (2013).
Predictors of self-efficacy for HIV prevention among Hispanic women in South Florida. Journal of the Association of
Nurses in AIDS Care, 24(1), 27-37. PMCID: PMC3474856 Villegas, N., Ferrer, L., Cianelli, R., Miner, S., Lara, L.,
Peragallo, N. (2011). Knowledge and self-efficacy associated to HIV and AIDS among Chilean women. Investigación
y Educación En Enfermería, 2(29), 212-229. NIHMSID: NIHMS412908 Villegas, N., Santisteban, D.A., Cianelli, R.,
Ferrer, L., Ambrosia, T., Peragallo, N., Lara, L. (2014). The development, feasibility and acceptability of an internet
based STI-HIV prevention intervention for young Chilean women. International Nursing Review, 61(1), 55-63.
NIHMSID: NIHMS568104
Contact
[email protected]

D 06 - SPECIAL SESSION: Nurses and Tobacco Control: An
Intersection of Research and Health Care Policy
Linda Sarna, PhD, RN
Purpose
The purpose of the presentation is to present an intersection of research and health care policy focused
on nurses and tobacco control.
Target Audience
The target audience of the presentation is practicing nurses, faculty and researchers.
Abstract
This presentation will highlight the evolution and intersection of an international program of research in
lung cancer and tobacco control as model for changing nursing practice and health care policy. Dr.
Sarna’s initial program of research focused on the quality of life and symptoms experienced by patients
with lung cancer, the leading cause of cancer death worldwide. Dr. Sarna was one of the first to publish
about the quality of life concerns experienced by women with lung cancer, the leading cause of cancer
death among women in the U.S. since the mid 1980’s, and about issues faced by lung cancer survivors.
Tobacco use, rarely routinely collected in nursing research at the time, emerged as a variable impacting
symptoms and quality of life. Tobacco use is the leading cause of preventable death and the one risk
factor that cuts across all four noncommunicable diseases (NCDs) targeted by the United Nations for
global action. Although evidence-based interventions for tobacco dependence treatment are available,
they are underutilized by health care providers. After surveying barriers that nurses reported in supporting
tobacco control, four major areas were identified: 1) limited knowledge and skills about the problem; 2)
limited nursing leadership, 3) limited nursing scholarship, and 4) smoking among nurses. Dr. Sarna
addressed these barriers through her research and advocacy, especially through the Tobacco Free
Nurses initiative. She helped to shape policy about the role of nurses in tobacco control with nursing
organizations, including the American Nurses Association, the Oncology Nursing Society, the
International Society of Nurses in Cancer Care, the International Council of Nurses; and multidisciplinary
groups, including the American Society of Clinical Oncology, the Institute of Medicine, the National
Cancer Institutes, and the World Health Organization (WHO). She has surveyed tobacco-related content
in schools of nursing in the U.S. and Asia and tested educational interventions to grow capacity among
nurses in the U.S., China, the Czech Republic and Eastern Europe. She has promoted nursing research
in the field and published a synthesis in an Annual Review of Nursing Research. In collaboration with the
WHO she co-authored a monograph about strategies to enhance the nurses’ role in addressing NCDs
which helped to influence nursing policy. Nurses contributed to the knowledge and understanding of the
dangers of smoking among women through participation in the Nurses’ Health Study (NHS), the largest
and longest running study of women’s health in the world. Dr. Sarna’s analysis of data from the NHS
described the impact of smoking on female nurses’ survival and quality of life. She monitored smoking
among health care professionals using the Current Population Supplement-Tobacco Use Supplement,
published in a special issue of JAMA focused on the 50th anniversary of the Surgeon General Report on
smoking and health. Dr. Sarna also has provided leadership in policies surrounding exposure to
secondhand smoke. She lead the efforts to create a tobacco-free campus at UCLA; and co-authored a
resolution from the American Academy of Nursing for all schools of nursing to be tobacco-free.
References
Sarna L, Bialous SA, Nandy K, Antonio AL, & Yang Q. (2014). Changes in smoking prevalences among health care
professionals from 2003 to 2010-2011. JAMA. 311:197-199 Sarna L, Bialous SA, Chan SS, Hollen P, O’Connell KA.
(2012) Making a difference: Nursing scholarship and leadership in tobacco control. Nursing Outlook. 61:31-42.
www.tobaccofreenurses.org World Health Organization. (2012). Enhancing nursing and midwifery capacity to
contribute to the prevention, treatment and management of noncommunicable diseases. Human Resources for
Health Observer. Issue 2012.
Contact
[email protected]

D 07 - SPECIAL SESSION: Creating Academic Service Partnerships
for Education, Practice and Research
Joyce J. Fitzpatrick, PhD, RN, FAAN
Mary T. Quinn Griffin, PhD, RN
Carol Porter, DNP, MPA, RN
Maria Vezina, EdD, RN
Sylvia Fung, RN, FAAN
Agnes Tiwari, PhD, RN, FAAN
Sophia Chan, PhD, RN, FAAN
Purpose
The purpose of this presentation is to showcase exemplars of education, practice and research
partnerships.
Target Audience
The target audience includes leaders in nursing education, practice and research.
Abstract
This presentation describes a four-prong partnership model to enhance nurse involvement and quality of
care. The partnership consists or two academic institutions (one in the USA and one in Hong Kong) and
two acute care services, one a Magnet-designated hospital in the USA and one the major provider of
services for the population of Hong Kong. Several components of the partnership will be described,
including student exchanges, particularly among doctoral students, faculty collaborative research
projects, expert clinician exchange programs, site visits from one acute care facility to another, study
tours among key personnel. Particular emphasis will be on the experiences of visiting scholars ab the
partner institutions, including the following topics: enhancing the organizational culture, approaches to
quality improvement; patient safety and quality of care and value of patient and staff education. Another
exemplar that will be addressed is the 4-week study tour for Hong Kong nurse leaders who visited the US
hospital. Components of the study tour included leadership and management roles, change strategies,
creating excellence within an organization, positive practice environments for nursing personnel, and
patient quality and safety outcomes. A research example that will be described is focused on health
professional students’ understandings of end-of-life issues. Other collaborative projects include initiatives
comparing health care educational, administrative, and leadership structures and styles including
examination of quality and access of health care, in the partnership countries. Plans for collaborative
research include identifying existing projects at the partner institutions that connect faculty, students, and
practicing nurses. Metrics to measure success will include the number of participants who take advantage
of the collaborative opportunity and the number of joint presentations and publications in scholarly
journals with coauthors from partner countries. Key aspects of the successful ongoing partnership will be
described, and lessons learned will be identified so as to provide a foundation for future initiatives.
Contact
[email protected]

E 01 - SPECIAL SESSION: Transitional Care Using Telehealth: Fewer
Emergency Unplanned Admissions and Improved Quality of Life and
Functional Ability
Mary Courtney, PhD, MHP, BAdmin (Acc), RN
Chiung-Jung (Jo) Wu, RN, BN, MN, (ICU), DrHlthSc
Purpose
The purpose of this presentation is to overview an Australian program of research to: (a) develop,
implement and evaluate effectiveness of multidisciplinary transitional care interventions on preventing
emergency hospital readmissions in older people ‘at risk’ of poor outcomes; (b) compare cost-
effectiveness of innovative strategies including exercise and/in-home and telephone follow-up.
Target Audience
The target audience of this presentation is: - health service administrators - nurse managers - nurse
educators - health policy decision-makers - health service researchers
Abstract
Prof Courtney’s research program involves the development, trial and evaluation of innovative discharge
planning and transitional care models that span across hospital and community health sectors and
include hospital and in-home assessment, exercise strategies and telephone follow-up interventions with
‘at-risk’ community-living older adults (1,2,3,4) This presentation focuses on results of her previous clinical
trials in ‘general hospitalised medical patients’ and presents findings published in Journal of American
Geriatric Society (JAGS) and PlusOne which demonstrate significantly few emergency hospital
readmissions (22% intervention, 47% control, P = .007) and emergency GP visits (25% intervention, 67%
control, P
References
(1) Courtney M, Edwards H, Chang A, Parker T, Finlayson K, Hamilton, K. (2009) ‘Fewer emergency readmissions
and better quality of life for older adults at risk of hospital readmission: A randomised controlled trial to determine the
effectiveness of a 24 week exercise and telephone follow-up program’, Journal of American Geriatric Society (JAGS),
Vol. 57, pp. 395-402. (IF = 3.5) (2) Graves, N., Courtney M, Edwards H, Chang A, Parker T, Finlayson K. (2009)
‘Cost-effectiveness of an intervention to reduce emergency readmissions to hospital among older patients’, PLoS
ONE, Vol. 4, art. No. e7455. (IF = 2.3) (3) Courtney, M., Edwards, H., Chang, AM., Parker, A., Finlayson, K.,
Hamilton, K., (2011) ‘A randomised controlled trial to prevent hospital readmissions and loss of functional ability in
high risk older adults: a study protocol’, BMC Health Services Research, Vol. 11, pp. 1-7. (IF = 1.66) (4) Courtney M,
Edwards H, Chang A, Parker T, Finlayson K, Hamilton K. (2012) ‘Improved functional ability and independence in
activities of daily living for older adults at high risk of hospital readmission: A randomised controlled trial’, Journal of
Evaluation of Clinical Practice, Vol. 67, pp. 1-7. (IF = 1.57) (5) Wu, C-J & Chang, A.M (2008) Audit of patients with
type 2 diabetes following a critical cardiac event, International Nursing Review, Vol. 55, pp. 327-332. (6) Wu C-J (Jo),
Chang AM, Courtney M, & Kostner K. (2012) ‘Peer supporters for cardiac patients with diabetes: a randomised
controlled trial’, International Nursing Review, Vol. 59, No. 3, pp. 345-352. (7) Wu, C-J (Jo), Chang, AM., Courtney,
M, Ramis, M. (2012) ‘Using user-friendly telecommunications to improve a cardiac and diabetes self-management
program: A pilot study, Journal of Evaluation in Clinical Practice, Vol. 18, No. 3, pp. 695-697. (IF = 1.57) (8) Wu, C-J
(Jo), Sung, H., Chang, A., Atherton, J., Kostner, K., Courtney, M., & McPhail, S. (2013) ‘Protocol for a randomised
blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural
international collaborative project’, BMC Health Services Research, Vol. 13:402, pp. 1-7. (IF = 1.66)
Contact
[email protected]

E 02 - SPECIAL SESSION: The Resilience in Ilness Model: Dialogue on
Applicability in Other Illness Conditions and Difficult/Traumatic Life
Circumstances
Joan E. Haase, RN, PhD, FAAN
Purpose
The purposes of this presentation are to: (1) describe research on the Resilience in Illness Model (RIM) in
adolescents/young adults with cancer; (2) discuss and encourage dialogue around potential adaptations
of RIM to guide resilience research related other illness conditions, difficult life circumstances and/or
traumatic events (e.g., war, natural disasters).
Target Audience
The target audience for this presentation are individuals interested in resilience adolescents/young adults
facing chronic illness, researchers interested in exploring adaptation of the Resilience in Illness Model
and measures to other populations and difficult life circumstances, and students interested in models for
developing a program of research using mixed methods.
Abstract
Background. Individuals who develop a positive approach to deal with difficult life circumstance and/or
traumatic events are often called “resilient”. In the United States, the Institute of Medicine and National
Institutes of Health identified research on positive health concepts, such as resilience, as a priority. Over
her 35 year career as a nurse researcher, Dr. Joan Haase developed the Resilience in Illness Model
(RIM) in adolescents/young adults (AYA) with chronic illnesses, especially cancer. The resulting RIM
explains large amounts of variance in outcomes of self-transcendence (62%) and resilience resolution
(67%) for AYA with cancer. In 2011, the Nursing Discipline Committee of the Children’s Oncology Group
(a cooperative pediatric oncology research group in North America, Australia, New Zealand and parts of
Europe) adapted the RIM as the organizing framework for their research. Dr. Haase and her colleagues
are currently conducting multi-site randomized controlled clinical trials through the Children’s Oncology
Group to evaluate interventions to enhance resilience in AYA and their parents. Outcomes from the
therapeutic music video intervention study for AYA undergoing hematopoietic stem cell transplant for
cancer showed significant improvement in several RIM factors, compared to the control group. These
studies support RIM as a useful framework to guide the research and RIM measures were sensitive to
group differences. Purpose. American and international nurse researchers have asked about applicability
of the RIM in other chronic illness conditions, other age groups, and other difficult and/or traumatic life
circumstances, such as war or natural disaster. Because further research is needed to evaluate the RIM’s
applicability in other illnesses and circumstances, the purposes of this session are to: 1) describe the
current RIM and ongoing interventions; and, 2) foster dialogue among session attendees regarding how
the RIM may be useful and/or adapted for research on other illness conditions and/or traumatic life
situations. Methods. In this session Dr. Haase will: 1.Describe the current RIM as developed through
model development and intervention studies in AYA with chronic conditions. 2.Describe protective factors
in the RIM and lead audience dialogue about the ways these factors may be useful to improve resilience
in other cultures and individuals facing other illnesses and/or traumatic events (e.g. illness, war, natural
disaster). Protective factors include: spiritual perspective, including spiritual beliefs and practices; social
integration, including communication and perceived support from health care providers, friends, and the
community; family environment, including family adaptability, cohesion and communication; courageous
coping, including confrontive, optimistic, and supportant coping; and hope-derived meaning. 3. Discuss
risk factors that may negatively influence positive health outcomes and lead audience dialogue regarding
how these are similar and different in other cultures, illness conditions or circumstances. Risk factors in
the RIM include: illness related distress (uncertainty and symptom distress) and defensive coping
(emotive, evasive, and fatalistic coping). 4.Describe the mixed methods approach used to develop the
RIM measure model and lead audience dialogue about resilience-related measurement issues.
Outcomes. Participants will gain knowledge regarding factors that influence resilience outcomes and
explore potential adaptations and applications of the RIM internationally.

References
1.Kelly, K. P., Hooke, M. C., Ruccione, K., Landier, W., & Haase, J. (In Press) Developing an organizing framework to
guide nursing research in the Children’s Oncology Group (COG). SEMINARS IN ONCOLOGY NURSING. 2. Robb,
S., Burns, D., Stegenga, K., Haut, P., Monahan, P., Meza, J., Stump, T., Cherven, B., Docherty, S., Hendricks-
Ferguson, V., Kintner, E., Haight, A., Wall, D., Haase, J.E. (2014). Randomized Clinical Trial of Therapeutic Music
Video Intervention for Resilience Outcomes in Adolescents/Young Adults Undergoing Hematopoietic Stem Cell
Transplant: A Report from the Children’s Oncology Group. Cancer, 120(6), 909-17. doi:10.1002/cncr.28355. PMCID:
PMC3947727. 3. Roll, L., Stegenga, K., Hendricks-Ferguson, V., Barnes, Y., Cherven, B., Docherty, S., Robb, S.L.,
Haase, J.E. (2013). Engaging Nurses in Research for a Randomized Clinical Trial of a Behavioral Health Intervention.
Nursing Research and Practice. vol. 2013, Article ID 183984, 6 pages, 2013. doi:10.1155/2013/183984. PMCID:
PMC3786524. 4. Haase, J. E., Kintner, E. K., Monahan, P.O., Robb, S.L. (2013). The Resilience in Illness Model,
Part 1: Exploratory Evaluation in Adolescents and Young Adults with Cancer. Cancer Nursing. doi:
10.1097/NCC.0b013e31828941bb. PMCID: PMC3758400 [Available on 2014/9/20]. 5. Phillips-Salimi, C.R., Robb,
S.L., Monahan, P., Dossey, A., Haase, J.E. (2013). Perceptions of Communication, Family Adaptability, and
Cohesion: A Comparison of Adolescents Newly Diagnosed with Cancer and their Parents. International Journal of
Adolescent Medicine and Health, 26(1), 19-26. PMID: 24501152. 6. Docherty, S., Robb, S.L., Phillips-Salimi, C.,
Cherven, B., Stegenga, K., Hendricks-Ferguson, V., Roll, L., Donovan Stickler, M., Haase, J.E. (2012). Parental
Perspectives on a Behavioral Health Music Intervention for Adolescent/Young Adult Resilience during Cancer
Treatment: Report from the Children’s Oncology Group. Journal of Adolescent Health, 52(2), 170-8. doi:
10.1016/j.jadohealth.2012.05.010. PMCID: PMC3552240. 7. Hendricks-Ferguson, V., Phillips-Salimi, C., Oakley, B.,
Burns, D.S., Roll, L., Stegenga, K., Docherty, S., Cherven, B., Donovan-Stickler, M., & Haase, J.E. (2012).
Recruitment Strategies and Rates of a Multi-site Behavioral Intervention for Adolescents and Young Adults with
Cancer. Journal of Pediatric Healthcare, 27(6), 434-42. doi: 10.1016/J.PEDHC.2012.04.010. PMCID: PMC344870
[Available on 2014/11/1]. 8. Phillips-Salimi, C. R., Haase, J. E., & Kooken, W. C. (2012). Connectedness in the
Context of Patient-Provider Relationships: A Concept Analysis. Journal Advanced Nursing, 68(1), 230-45.
doi:10.1111/J.1365-2648.2011.05763.X. PMCID: PMC3601779. 9. Robb, S.L., Burns, D.S., Docherty, S., Haase, J.E.
(2010). Ensuring treatment fidelity in a multi-site behavioral intervention study: Implementing NIH Behavior Change
Consortium Recommendations in the SMART Trial. Psycho-Oncology, 20(11), 1193-201. .doi: 10.1002/PON.1845.
PMID: PMC3198011. 10. Burns, D., Robb, S.L., Haase, J.E., & Phillips-Salimi, C.R. (2010). Parental Perspectives of
an Adolescent/Young Adult Stem Cell Transplant and a Music Video Intervention. Cancer Nursing, 33(4), E20-27.
doi: 10.1097/NCC.0b013e3181d4b671. PMID: 20467305. 11. Burns, D.S., Robb, S.L., & Haase, J.E. (2009).
Exploring the feasibility of a therapeutic music video intervention in adolescents and young adults during stem cell
transplant. Cancer Nursing, 32(5), E8-16. doi: 10.1097/NCC.0b013e3181a4802c. PMID: 19661790. 12. Hinds, P.S.,
Burghen, E. A., Haase, J.E., & Phillips, C. R. (2006). Advances in defining, conceptualizing, and measuring quality of
life in pediatric patients with cancer. Oncology Nursing Forum, 33(1, Suppl), 23-. doi: 10.1188/06.ONF.S1. PMID:
17202086. 13. Haase, J.E. (2004). The adolescent resilience model as a guide to interventions. Special Section:
Proceedings from the 5th Annual State of the Science Workshop on Resilience and Quality of Life in Adolescents.
Journal Of Pediatric Oncology Nursing. 21(5) 289-299. 14. Haase, J.E. & Phillips, C. (2004). The adolescent/young
adult experience. Special Issue: Moving the research agenda forward for children and adolescents with cancer.
Journal Pediatric Oncology Nursing, 21(3), 145-149. doi: 10.1177/1043454204264385. 15. Haase, J.E., Heiney, S.,
Ruccione, K., & Stutzer, C. (1999). Research triangulation to derive meaning-based quality-of-life theory: Adolescent
resilience model and instrument development. International Journal Of Cancer, Supp. 12, 125-131. DOI:
10.1002/(SICI)1097-0215(1999)83:12+<125::AID-IJC22>3.0.CO;2-7. 16. Haase, J.E., Britt, T., Coward, D., Leidy, N.
& Penn, P., (1992). Simultaneous concept clarification: Spiritual perspective, hope, acceptance and self-
transcendence. Image, 24, 141-147. DOI: 10.1111/j.1547-5069.1992.tb00239.x. 17. Myers, S. & Haase, J.E. (1989).
Guidelines for combining qualitative and quantitative research approaches. Nursing Research, 38, 299-301. 18.
Haase, J.E. & Myers, S. (1988). Reconciling paradigm assumptions of qualitative and quantitative research. Western
Journal Of Nursing Research, 10(2), 128 137. 19. Haase, J.E. (1987). The components of courage in chronically ill
adolescents. Advances in Nursing Science, 9(2), 64-80.
Contact
[email protected]

E 06 - SPECIAL SESSION: Nurses, Healthcare Processes,
Partnerships and Patient Outcomes
Robin Newhouse, PhD
Yutao Xiang, MD, PhD
Purpose
The purpose of this presentation is to describe nurses’ work and work environment and the linkages to
patient outcomes.
Target Audience
The target audiences of this presentation are clinical and administrative nurses and researchers
interested in understanding how nurses work and work environment effect patient outcomes.
Abstract
This session will focus on a program of research linking nurses’ work and work environment to patient
outcomes through studies conducted in the United States and China. Two acute care health system multi-
site intervention studies to improve care for people with heart failure will be described. Multi-site survey
data collected from nurses in China will be discussed. The implications of study results to clinical practice,
research and administration will be identified.
References
Johantgen, M., Newhouse, R. P. (2013). Participating in a Multi-Hospital Study to Promote Adoption of Heart Failure
Guidelines: Lessons Learned for Nurse Leaders. Journal of Nursing Administration, 43(12), 660-666.
Doi:10.1097/NNA.0000000000000008. Lee, M.C., Johnson, K.L., Newhouse, R.P., Warren, J.I. (2013). Evidence-
based Practice Process Quality Assessment: EPQA Guidelines. Worldviews on Evidence-Based Nursing, 10(3), 140-
149. doi: 10.1111/j.1741-6787.2012.00264.x Newhouse, R.P., Dennison-Himmelfarb, C., Morlock, L., Frick, K.,
Pronovost, P., Liang, Y. (2013). A Cluster Randomized Trial of Rural Hospitals Testing a Quality Collaborative to
Improve Heart Failure Care: Organizational Context Matters. Medical Care, 51(5):396-403, May 2013.doi:
10.1097/MLR.0b013e318286e32e Newhouse, R.P., Bobay, K, Dykes, P.C., Stevens, K.R., Titler, M. (2013).
Methodology Issues in Implementation Science. Medical Care, 51,S32-S40. doi: 101097/MLR.0b013e31827feeca
Newhouse, R., Dennison, C., Liang, Y. (2011). Psychometric Testing of the Smoking Cessation Counseling (SCC)
Scale. Journal of Nursing Scholarship, 43(4), 405-11 doi 10.1111/j.1547-5069.2011.01420.x. Qi, Y., Xiang, Y., An,E.,
Wang,J., Zeng, J, Ungvari, G.S., Newhouse, R., Yu, D., Lai, K., Ding, Y., Yu, L., Zhang, X., Chiu, H. (2013). Nurses’
work-related stress in China: a comparison between psychiatric and general hospitals. Perspectives in Psychiatric
Care, epub ahead of print available at http://onlinelibrary.wiley.com/doi/10.1111/ppc.12020/full DOI:
10.1111/ppc.12020. Uys, L.R., Newhouse, R.P., Oweis, A., Liang, X.L. (2013). Descriptive survey of the contextual
support for nursing research in 15 countries. Curationis, 36 (1), available at
http://curationis.org.za/index.php/curationis/article/view/126. doi: 10.4102/curationis.v36i1.126 Zeng, J.Y., An, F.R.,
Xiang, Y.T., Qi, Y.K., Ungvari, G.S., Newhouse, R., Yu, D.S., Lai, K.Y., Yu, L.Y., Ding, Y.M., Tang, W.K., Wu, P.P.,
Hou, Z.J., Chiu, H.F. (2013). Frequency and risk factors of workplace violence on psychiatric nurses and its impact on
their quality of life in China. Psychiatry Research. doi:pii: S0165-1781(13)00329-6. 10.1016/j.psychres.2013.06.013.
Epub ahead of print
Contact
[email protected]

F 01 - SPECIAL SESSION: Global Advisory Panel on the Future of
Nursing
Hester C. Klopper, PhD, MBA, RN, RM, FANSA
Cathy Catrambone, PhD, RN, FAAN
Purpose
explain the need for GAPFON, and how it is positioning itself through global regional meetings to address
critical issues for nursing within the context of global health
Target Audience
All nurses interested in the future of nursing globally.
Abstract
This session will explain the purpose and goals of the recently formed Global Advisory Panel on the
Future of Nursing (GAPFON), which was envisioned and facilitated by Sigma Theta Tau International
(STTI). STTI President Hester Klopper and President-elect Cathy Catrambone will explain the need for
GAPFON, and how it is positioning itself through global regional meetings to address critical issues for
nursing within the context of global health.
Contact
[email protected]

F 02 - SPECIAL SESSION: WHO Collaborating Centers Advancing
Global Nursing Leadership and Fostering Collaboration
Phyllis Sharps, PhD, RN, FAAN
Debra Jackson, RN, PhD
Rachel Blankstein Breman, MSN, MPH, RN
Purpose
The purpose of this special session is to convene current WHO CCs and potential future CCs to discuss
the international collaboration opportunities through the WHO CC network. Discussions will showcase
how these centers's relationships and resources can be leveraged to advance global nursing leadership,
research, and practice.
Target Audience
The target audience for this special session would be universities, schools of nursing, leaders in nursing
and others who are interested in learning more about global nursing and possible opportunities to
collaborate globally.
Abstract
The Johns Hopkins University Center for Global Nursing World Health Organization Collaborating Center
(WHO CC) in collaboration with University of Technology Sydney's, WHO CC will present current and
past accomplishments of their WHO CCs. There are a variety of forms for WHO CCs such as research
institutes, parts of universities or academies, which are designated by the WHO to carry out activities that
support WHO activities. Currently there are over 800 WHO collaborating centres in over 80 Member
States working with WHO on areas such as nursing,midwifery, occupational health, communicable
diseases, nutrition, mental health, chronic diseases , information and health technologies. This session
will focus on WHO CC's that are nursing and midwifery specific. There will be a brief overview of the
WHO CCs network’s global presence, the application/designation process and how a WHO CC is a key
strategy for international nursing leadership development and collaboration. Examples from several
Nursing and Midwifery WHO CCs representing each area of the world will be discussed. How these
centers collaborate to advance global nursing leadership, research, and practice will demonstrate how
WHO CCs can leverage relationships and scarce resources. The system of CC's is at the forefront of
Global Nursing Leadership and Collaboration. The combined impact for nursing research, practice and
education is monumental. Nursing and Midwifery WHO CCs collaborate with universities, ministries of
health, governments, non-governmental organizations, and others to provide leadership, support and
advocacy. This session will provide participants with strategies to improve their institutions global nursing
activities, how to network with WHO CC to expand collaborative networks to advance nursing leadership
globally.
Contact
[email protected]

F 06 - SPECIAL SESSION: Sustaining Evidence-Based Nursing
Practices for Fall Prevention in Hospitalized Oncology Patients
Laura Cullen, DNP, RN, FAAN
Purpose
The purpose of this presentation is to promote discussion and sustained use of evidence-based fall
prevention.
Target Audience
The target audience is nurses from a variety of settings with responsibility for leading and evaluating EBP
for fall prevention, nurse leaders establishing and expanding an EBP program, or nursing faculty teaching
EBP and systems leadership.
Abstract
Aim: This study aimed to identify factors that sustain evidence-based fall prevention for hospitalized
oncology patients by examining patient factors (characteristics reported in incident reports 2009-2012 and
patient interviews regarding their perspectives of fall risks and prevention); nursing interventions
(documented for patients who fell 2009-2012); and nursing staff surveys regarding fall prevention
knowledge and self-efficacy. Background: Fall prevention is an important quality indicator and nursing
concern for hospitalized oncology patients. In fact, 3-20% of hospitalized patients fall with 60% related to
toileting, adding $4000 in cost. Up to 50% of patients are at risk and almost half who fall suffer injuries.
Fractures account for 35% of nonfatal injuries but 61% of costs. Cancer patients who fall often experience
severe injuries due to underlying medical conditions. Falls add to length of stay, costs and fear of falling
leading to less ambulation, which contributes to weakness, imbalance and further risks. Hospital fall
prevention must address both patient risk factors and context. Limited evidence exists to specifically
guide fall prevention for oncology patients. Moreover, capturing patients’ perceptions is important but
largely missing. Sample/Methods: Human subjects’ protection approval was obtained from the IRB. A
convenience sample of 39 adult oncology patients hospitalized less than 3 days, receiving inpatient
cancer treatment, and communicated in English were interviewed regarding fall risk, fall prevention,
getting assistance, communication with the team, routine nursing assessment, and use of equipment to
prevent falls. Oncology nursing staff (n=52 registered nurses [RNs], 18 nursing assistants [NAs])
completed a survey on self-efficacy and knowledge of fall prevention and an AHRQ context assessment.
Descriptive statistics were used to summarize findings. Results: Patients averaged 58.9 years of age,
36% report falling in the past five years, 18% with injury; however, 56% reported not being at fall risk
while hospitalized. Yet, 77% reported an injury risk if they fell during hospitalization; and 36% reported
assistance to the bathroom was not at all important. Patients’ identified being careful (30%) and getting
help (30%) as important. Only 27% of RNs and no NAs report involvement in interdisciplinary planning for
fall prevention; 65-83% of RNs and NAs reported consistently using safe-handling equipment; 56-62% of
RNs and NAs report ambulating patients to reduce fall risk; and 72-87% indicate hospital leaders are
engaged in fall prevention. 25% of RNs and 39% of NAs reported they leave patients alone in the
bathroom to provide privacy. Conclusions: Oncology patients have unique perceptions about fall
prevention that may not match the evidence. Consistent use of evidence-based fall prevention can be
challenging. Interdisciplinary planning for fall prevention, and the NA role were under-utilized. Fall
prevention has been largely relegated to nursing. Clinicians must merge patient perspectives and EBP
recommendations within daily interdisciplinary planning. Implications for practice: Effective fall prevention
is needed for hospitalized oncology patients. Practices that engage patients in understanding their risks
along with collaborative individualized fall prevention strategies are needed and effects of these practices
need further study. More effective training is also needed for fall prevention that engages all
interdisciplinary team members.
References
AHRQ (2013). Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. Agency for Healthcare Research
and Quality, Rockville, MD. Retrieved from: http://www.ahrq.gov/professionals/systems/long-term-
care/resources/injuries/fallpxtoolkit/fallpxtkack.html Retrieved April 16, 2014 Cameron, I. D., Murray, G. R., Gillespie,
L. D., Robertson, M. C., Hill, K. D., Cumming, R. G., & Kerse, N. (2010). Interventions for preventing falls in older

people in nursing care facilities and hospitals. Cochrane Database of Systematic Reviews (1), CD005465. Choi, M., &
Hector, M. (2012). Effectiveness of intervention programs in preventing falls: A systematic review of recent 10 years
and meta-analysis. Journal of the American Medical Directors Association, 13(2), 188.e13-21. Clyburn, T. A., &
Heydemann, J. A. (2011). Fall prevention in the elderly: Analysis and comprehensive review of methods used in the
hospital and in the home. [Review]. Journal of the American Academy of Orthopaedic Surgeons, 19(7), 402-409.
Cullen, L., & Adams, S. (2012). Planning for implementation of evidence-based practice. Journal of Nursing
Administration, 42(4), 222-230. Damschroder, L. J., & Hagedorn, H. J. (2011). A guiding framework and approach for
implementation research in substance use disorders treatment. Psychology of Addictive Behaviors, 25(2), 194-205.
Davies, B., Tremblay, D., & Edwards, N. (2010). Sustaining evidence based practice systems and measuring the
impacts. In D. Bick & I. Graham (Eds.), Evaluating the Impact of Implementing Evidence-Based Practice. United
Kingdom: Wiley-Blackwell. Evron, L., Schultz-Larsen, K., & Fristrup, T. (2009). Barriers to participation in a hospital-
based falls assessment clinic programme: An interview study with older people. Scandinavian Journal of Public
Health, 37(7), 728-735. Kline, N. E., Thom, B., Quashie, W., Brosnan, P., & Dowling, M. (2008). A model of care
delivery to reduce falls in a major cancer center. In K. Henriksen, J. B. Battles, M. A. Keyes & M. L. Grady (Eds.),
Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Rockville (MD):
Agency for Healthcare Research and Quality. Krauss, M. J., Nguyen, S. L., Dunagan, W. C., Birge, S., Costantinou,
E., Johnson, S., ... Fraser, V. (2007). Circumstances of patient falls and injuries in 9 hospitals in a midwestern
healthcare system. Infection Control and Hospital Epidemiology, 28(5), 544-550. Milisen, K., Coussement, J.,
Flamaing, J., Vlaeyen, E., Schwendimann, R., Dejaeger, E., . . . Boonen, S. (2012). Fall prediction according to
nurses’ clinical judgment: Differences between medical, surgical, and geriatric wards. Journal of the American
Geriatrics Society, 60(6), 1115-1121. Nyman, S. R., & Victor, C. R. (2012). Older people's participation in and
engagement with falls prevention interventions in community settings: An augment to the Cochrane systematic
review. Age and Ageing, 41(1), 16-23. Potter, P., Olsen, S., Kuhrik, M., Kuhrik, N., & Huntley, L. R. (2012). A DVD
program on fall prevention skills training for cancer family caregivers. Journal of Cancer Education, 27(1), 83-90.
Spyridonidis, D., & Calnan, M. (2011). Opening the black box: A study of the process of NICE guidelines
implementation. Health Policy, 102(2-3), 117-125. Stenberg, M., & Wann-Hansson, C. (2011). Health care
professionals' attitudes and compliance to clinical practice guidelines to prevent falls and fall injuries. Worldviews on
Evidence-Based Nursing, 8(2), 87-95. Stern, C., & Jayasekara, R. (2009). Interventions to reduce the incidence of
falls in older adult patients in acute-care hospitals: A systematic review. International Journal of Evidence-Based
Healthcare, 7(4), 243-249. The Joint Commission. (2010). Advancing effective communication, cultural competence,
and patient- and family-centered care. Oakbrook Terrace, IL: The Joint Commission. Tucker, S. J., Bieber, P. L.,
Attlesey-Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012). Outcomes and challenges in implementing hourly
rounds to reduce falls in orthopedic units. Worldviews on Evidence-Based Nursing, 9(1), 18-29. Tzeng, H. M., & Yin,
C. Y. (2012). Toileting-related inpatient falls in adult acute care settings. Medsurg Nursing, 21(6), 372-377. Volz, T.
M., & Swaim, T. J. (2013). Partnering to prevent falls: Using a multimodal multidisciplinary team. Journal of Nursing
Administration, 43(6), 336-341. Wiens, C. A., Koleba, T., Jones, C. A., & Feeny, D. F. (2006). The Falls Risk
Awareness Questionnaire: Development and validation for use with older adults. Journal of Gerontological Nursing,
32(8), 43-50.
Contact
[email protected]

G 01 - SPECIAL SESSION: Helping Patients and Families Enrich the
Quality of their Lives during Cancer
Ruth McCorkle, PhD, FAAN
Purpose
The purpose of this presentation is to present an overview of the impact a nursing intervention by
advanced practice nurses had on patient and caregiver outcomes in cancer.
Target Audience
The target audience of this presentation is clinicians, educators, and researchers.
Abstract
In this session an overview of a program of research in cancer care will be presented. The research
program will demonstrate the impact the intervention has had on patient and caregiver outcomes. Critical
nursing behaviors that were essential in effecting the outcomes will be described. Clinical and policy
changes related to the program of research will be discussed and future areas of research will be
recommended.
References
McCorkle, R., Strumpf, N., Nuamah, I., Adler, D., Cooley, M., Jepson, C., Lusk, E., Torosian, M. (2000). A specialized
home care intervention improves survival among older post surgical cancer patients. J Am Geriatric Soc 48(12):1707-
13. McCorkle, R., Robinson, L., Nuamah, I., Lev, E., Benoliel, J. (1998). The effects of home nursing care for patients
during terminal illness on the bereaved’s psychological distress. Nurs Res 47(1):2-10. McCorkle, R., Jepson, C. Yost,
L., Lusk, E., Malone, D., Braitman, L., Buhler-Wilkerson, K., Daly, J. (1994). The impact of post-hospital home care
on patients with cancer. Res Nurs Health 17(4):243-51. McCorkle, R., Benoliel, J.Q., Donaldson, G., Georgiadou, F.,
Moinpour, C., Goodell, B. (1989). A randomized clinical trial of home nursing care of lung cancer patients. Cancer
6(4):199-206.
Contact
[email protected]

G 02 - SPECIAL SESSION: Leadership and Person-Centredness: Time
for Change!
Brendan G. McCormack, DPhil(Oxon), BSc (Hons) Nursing, PGCEA, RGN, RMN
Purpose
challenge dominant leadership paradigms and propose new ways of understanding leadership in a prson-
cebntred culture.
Target Audience
anyone concerned with creating effective workplace cultures.
Abstract
In the past 10-15 years, healthcare services (particularly in the UK) have been rocked by various
‘scandals’ that have largely focused on a lack of dignified, compassionate, respectful and indeed unsafe
practices from practitioners (of many disciplines). The outcome in most of these has been the loss of
many lives, particularly vulnerable children, older people and people with disabilities (such as intellectual
disability). Whilst nothing about the exposed practices can be condoned in any way, the reports clearly
demonstrate the importance of a person-centred culture, i.e. a culture that treats all stakeholders as
persons and one in which the values of personhood are lived out in all parts and at all levels of an
organisation. However the reality is that despite the rhetoric of person-centredness, such cultures are not
dominant in healthcare settings and for most people (staff and patients) they experience ‘person-centred
moments’ at most . Research by McCance et al shows through narrative analysis that patients and staff
recognise these moments of person-centredness but also recognise that in between these moments
there are long periods/gaps where person-centredness is not the dominant way of being. Indeed, many
care environments are ‘psychologically unsafe’ and that this issue needs to be addressed if a person-
centred approach to practice is to be realised. One characteristic of a person-centred workplace culture is
situational leadership. However, for leaders to enable such a culture, they need to be able to flourish in
their role. The expectations on leaders to be the holders of the space in which effectiveness of services
happens is enormous. But within these expectations, how do we help nurse leaders to flourish as
persons? In this presentation I will address this issue and propose that we need to rethink the role of
leaders and ensure that they have the necessary conditions for their own flourishing.
Contact
[email protected]

G 06 - SPECIAL SESSION: Towards Improved Safety by Examining
the Complexities of Health Care
Elizabeth Manias, RN, MPharm, PhD
Purpose
The purpose of this presentation is to consider the complexities of health care practice by examining
communication practices in health care, interventions for medication adherence and measurement of
patient safety through risk screening tools.
Target Audience
The target audience of this presentation is researchers and clinicians with an interest in communication in
health care, medication adherence and development of risk screening tools.
Abstract
The overarching theme of this special session is the need to consider the complexities of health care
practice in order to make a difference and improve care. The focus of this special session is to examine
three main areas of my research. These three areas comprise: communication in health care, medication
adherence and patient safety. My work on communication in health care has involved the use of audio-
recording and video-recording observations of how patients, family members, and health professionals
interact with each other about managing medications in hospital settings. Critical ethnography has been
effectively used in examining communication processes in ward rounds, handovers and informal
interactions has contributed to repositioning and shifting researchers’ and health professionals’ thinking
about the importance of observing actual clinical practice. Knowledge gained on these real experiences
has been fed back to nurses and other health professionals in hospitals at the local level and contributed
to changes in health professionals’ thinking and in medication activities. My communication research into
medications has culminated in the development and publication of a conceptual framework on medication
communication. This framework delineates the link between medication management and
communication. It provides a structured approach in examining the defining attributes, environmental and
sociocultural influences, and consequences of communication. In the area of medication adherence, I
have collaborated to develop novel, consumer-centred interventions aimed at improving blood pressure
and medication adherence for consumers with diabetic-kidney disease of English speaking and non-
English speaking backgrounds, and consumers with osteoarthritis and other chronic conditions. These
interventions have included video-recorded information of the barriers to medication-taking experienced
by consumers and steps they have taken to resolve these barriers. Implementation of these interventions
have led to improved medication-taking behaviours, better blood pressure control and improved patient
engagement with health professionals about how to manage medications more effectively at home.
Research in patient safety has involved development and evaluation of three risk screening tools: self-
administration of medication by patients in hospital; the risk of representation to the emergency
department by homeless people; and the risk of medication mismanagement by people of non-English
speaking backgrounds. Prior to developing these tools, interviews and focus groups have been
undertaken with patients and health professionals to determine their perspectives of the particular issue.
Audits have been conducted to determine the effects of explanatory variables on outcomes variables. The
resulting tools have been tested in the actual environments in which they are to be used, thereby enabling
utility to be measured. These tools are used by nurses who work in rehabilitation units, outpatient units
and emergency departments.
References
Anderson, J., Manias, E., Kusljic, S., & Finch, S. (2014) Testing the validity, reliability and utility of the Self-
Administration of Medication (SAM) Tool in patients undergoing rehabilitation. Research in Social & Administrative
Pharmacy, 10, 204-216. Claydon-Platt, K., Manias, E., & Dunning, T. (2012) Medication-related problems occurring in
people with diabetes during an admission to an adult teaching hospital: A retrospective cohort study. Diabetes
Research and Clinical Practice, 97, 223-230. Manias, E. (2010) Medication communication: A concept analysis.
Journal of Advanced Nursing, 66, 933-943. Williams A, Manias E, Walker R, & Gorelik A. (2012) A multi-factorial
intervention (MESMI) to improve blood pressure control in co-existing diabetes and kidney disease: A feasibility
randomised controlled trial. Journal of Advanced Nursing, 68, 2515-2525.

Contact
[email protected]

G 07 - SPECIAL SESSION: Preventing Complications Associated with
Tube Feedings
Norma Metheny, RN, PhD, FAAN
Purpose
The purpose of this presentation is to describe the research-basis for guidelines to test feeding tube
placement and to prevent complications associated with tube feedings. The significance of signs of
gastrointestinal intolerance as predictors of aspiration will also be discussed.
Target Audience
The target audience of this presentation is nurses who provide care to tube-fed patients of all ages.
Abstract
The session will include a discussion of evidence to support or refute a variety of commonly used
methods to determine feeding tube placement. Among the methods to be evaluated are: pH testing of
feeding aspirates, observing the appearance of feeding tube aspirates, auscultation for a bubbling sound
over the epigastric region as air is injected through the tube, electromagnetic monitoring, and carbon
dioxide detection devices. Because the pH method is the most widely recommended bedside placement
method, factors that may affect its accuracy will be reviewed; among these are the use of gastric acid
inhibitors and recent feedings. Variations in methods used to detect feeding tube placement will be
discussed in relation to a patient’s age and severity of illness. The pros and cons of the various methods
will be reviewed and recommendations will be offered, based on the most current research findings. A
comparison of the efficacy of a variety of methods to assess for aspiration will be presented. Methods to
reduce risk for aspiration will be explored; among these are positioning of the head of the bed, positioning
of the feeding tube within the gastrointestinal tract, and monitoring for signs of gastrointestinal intolerance
to feedings. Controversy regarding the usefulness of gastric residual volumes as a predictor for aspiration
risk will be discussed. Other possible indicators of gastrointestinal intolerance to feedings (such as
hypoactive bowel sounds and vomiting) will be reviewed. Current guidelines issued by major practice
organizations (including the American Society for Parenteral and Enteral Nutrition, the American
Association of Critical Care Nurses Practice Alerts, and the National Patient Safety Agency) will be
compared and discussed.
References
Metheny NA & Frantz RA: Head-of-bed elevation in critically ill patients: A review. Critical Care Nurse. 33(3):53-67,
2013 Metheny NA, Stewart BJ, Mills AC: Blind insertion of feeding tubes in intensive care units: a national survey.
American Journal of Critical Care. 21(6):352-60, 2012 Metheny NA, Mills AC, Stewart BJ: Monitoring for intolerance
to gastric tube feedings: a national survey. American Journal of Critical Care. 21(2):e33-40, 2012 Metheny NA,
Jackson J, Stewart B.J.: Effectiveness of an aspiration risk-reduction protocol. Nursing Research. 59(1)18-25, 2010
Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Muller C, Robbins S,
Wessel J & A.S.P.E.N. Board of Directors. ASPEN Enteral Nutrition Practice Recommendations. Journal of
Parenteral & Enteral Nutrition. Vol 33, No. 2, 122-166, 2009 Metheny NA, Schallom L, Oliver DA, Clouse RE: Gastric
residual volume and aspiration in critically ill patients receiving gastric feedings. American Journal of Critical Care.
17:512-519, 2008 Metheny NA, Meert KL, Clouse RE: Complications related to feeding tube placement. Current
Opinion in Gastroenterology. 23(2)178-182, 2007 Metheny NA: Preventing respiratory complications of tube feedings:
evidence based practice. American Journal of Critical Care. 15(3):252:360-369, 2006 Metheny NA, Clouse RE,
Chang YH, Stewart BJ, Oliver DA & Kollef M: Tracheobronchial aspiration of gastric contents in critically ill tube-fed
patients: Frequency, outcomes and risk factors. Critical Care Medicine. 34(4)1007-1015, 2006 Metheny NA, Clouse
RE, Clark J, Reed L, Wehrle M, Wiersema L: Use of the pH method to predict feeding tube placement. Nutrition in
Clinical Practice 19(5)185-190, 1994 Metheny NA, Reed L, Berglund B, Wehrle M: Visual characteristics of aspirates
from feeding tubes as a method for predicting tube location. Nursing Research 43(5)282-287, 1994 Metheny NA,
McSweeney M, Wiersema L, Wehrle M: Effectivness of the auscultatory method in predicting feeding tube placement.
Nursing Research 39(5):252-267, 1990
Contact
[email protected]

H 01 - SPECIAL SESSION: From Evidence to Practice and Policy
Making: Promoting the Health Care Quality of Children with Asthma in
Taiwan
Li-Chi Chiang, RN, PhD
Purpose
1. To understand the research methodology by asking the clinical PICOs. 2. To realize the nursing
knowledge construction by clinical research questions for evidence-based practice. 3. To demonstrate the
health care policy making strategies based on the studies' results.
Target Audience
The target audience of this presentation is for young scholars, clinicians, PhD candidate, and nursing
scientist to share the experience for closing the gap from evidence to practice by the example of
promoting quality care of children with asthma in Taiwan.
Abstract
Background: Asthma is the most common chronic illness of children in Taiwan. As a pediatric nurse,
developed a series studies to explore the problems of their quality of life and tailor series nursing
intervention to improve their quality of life is our responsibilities. Advocating the needs of children and
family and designing the appropriate nursing intervention for them are the challenge and accountability of
nurses. Dissemination the quality care by clinical application and health care policy making for continuous
education of health care providers is the most important strategies for knowledge translation. Series
Research: From evidence-based perspective, we asked the clinical questions (PICO) by answer the
meaning, diagnosis, therapy of PICOs to assess the impact of asthma on children and families, and
examine the various nursing intervention to promote the quality care of children with asthma. Results: The
self-management behaviors scale of parents was developed by triangulation method. The predictors of
self-management behaviors of parents were explored by a clinical survey. We developed the Asthma-
related Quality of Life (ARQOL) to measure the impacts of chronic asthma by a qualitative study and a
psychometric evaluation. SEAT (Self-Efficacy for Asthma Teaching) was developed to evaluate the
teaching efficacy of health care providers, and it could be used for the preparation for the asthma
education among health care providers. A hospital-based health education was tailored to improve their
self-management for children with asthma. Relaxation techniques for reducing the anxiety of children with
asthma was examined by a RCT. Developing an asthma home control inventory for patient-centered care
was proved to reduce asthma sign/symptoms and increase the peak flow. Family-centered empowerment
was developed to increase the quality care. Application: Practice: Three instruments could be used as the
diagnosis tools for assessing the asthma disease impacts on life, the competency of parents’ self-
management, and the teaching efficacy of health care providers. Knowledge translation was
disseminated by the national-wide asthma education for primary nurses, school nurses, and community
nurses in Taiwan. TAC (Taiwan Asthma Council) was established to revise the GINA guidelines for up-
dated knowledge translation. Establishing the evidence for childhood asthma care is continuous
References
1. Chiang, L. C., Huang, J. L., & Chao, S. Y. (2001). Developing a scale of self-management behaviors of parents
with asthmatic children in Taiwan Through triangulation method. The Journal of Nursing Research, 9(1), 87-89. 2.
Chiang, L. C.*, Huang, J. L., & Lu, C. M. (2003). Educational diagnosis of self-management behaviors of parents with
asthmatic children by triangulation based on PRECEDE-PROCEED model in Taiwan. Patient Education and
Counseling, 49(1), 19~25. 3. Chiang, L. C., Huang, J. L., Yeh, G. W., & Lu, C. M. (2004). Effects of a self-
management asthma educational program in Taiwan based on PRECEDE-PROCEED MODEL for parents with
asthmatic children. Journal of Asthma, 41(2), 205-215. 4. Chiang, L. C. * (2005). Exploring the health-related quality
of life among children with moderate asthma. The Journal of Nursing Research, 13(1), 31-40. 5. Chiang, L. C.*,
Huang, J. L., & Fu, L. H. (2006). Physical activity and physical self-concept: Comparison between children with and
without asthma. Journal of Advanced Nursing, 54(6), 653-662. 6. Chiang, L. C., Tseng, L. F., Huang, J. L., & Fu, L.S.
(2006). Testing a Questionnaire to measure Asthma-related quality of life among children. Journal of Nursing
Scholarship, 38(4), 383-386. 7. Yeh, K. W., Chiang, L. C., & Huang, J. L. (2008). Epidemiology and Current Status of
Asthma and Associated Allergic Diseases in Taiwan- ARIA Asia-Pacific Workshop Report. Asian Pacific Journal of

Allergy and Immunology, 26, 257-264. 8. Chiang, L. C., Hsu, J. Y., Yeh, K. W., Liang, W. M., & Huang, J. L.* (2009).
Developing a scale to measure self-efficacy of asthma teaching for health care providers. Journal of Asthma, 46(2),
113-117. 9. Chiang, L. C.*, Ma, W. F., Huang, J. L., Tseng, L. F., & Hsueh, K. C. (2009). Effect of relaxation-breathing
training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled
trial. International Journal of Nursing Studies, 46(2009), 1061-1071. 10. Tzeng, L. F., Chiang, L. C.*, Hsueh, K. C.,
Ma, W. F., & Fu, L. S., (2010). A Preliminary Study to Evaluate a Patient-Centered Asthma Education Programme on
Parental Control of Home Environment and Asthma Signs and Symptoms in Children with Moderate-to-Severe
Asthma. Journal of Clinical Nursing, 19, 1424–1433.
Contact
[email protected]

H 02 - SPECIAL SESSION: Global Epidemics of Type 2 Diabetes and
Cardiovascular Disease: Nursing Opportunities for Prevention and
Management
Deborah Chyun, PhD, RN, FAHA, FAAN
Purpose
To present the state of the knowledge on the prevention and management of cardiovascular disease in
adults with type 2 diabetes.
Target Audience
Educators, clinicians and researchers who have an interest in reducing the global burden of
cardiovascular disease and type 2 diabetes.
Abstract
Cardiovascular disease (CVD) is the leading cause of death throughout the world. Type 2 diabetes
(T2DM) is not only an important risk factor for the development of CVD, but a prognostic marker for CVD-
related morbidity and mortality. An additional challenge is that individuals with T2DM frequently do not
display symptoms of coronary artery disease (CAD) and therefore CAD is often discovered late in the
disease process. This session will explore the challenges in the prevention, detection and management of
CVD in adults with T2DM through the current literature, as well as through the presenter’s program of
research. Specific areas of focus include: identifying individuals with T2DM who have an increased risk of
CVD events; screening for asymptomatic myocardial ischemia and factors associated with asymptomatic
CAD and subsequent CAD-related events; and cognitive-behavioral interventions to reduce CVD risk in
adults with T2DM. The research evidence will be synthesized and provide a basis for nursing
interventions aimed at reducing the risk of CVD and its complications in adults with T2DM. The session
will also provide an opportunity for discussion by audience members on clinical and research strategies to
address the global burden of both CVD and T2DM.
References
Hage, F.G., Iskandrian, A.E., Inzucchi, S.E., Wackers, F.J.Th., Bansal, S., Chyun, D.A., Davey, J.A., Young, L.H., for
the DIAD Investigators. The heart rate response to adenosine: A simple predictor of adverse cardiac outcomes in
asymptomatic patients with type 2 diabetes. International Journal of Cardiology, 2012, published on-line September
14, 2012. Tandon, S., Inzucchi, S.E., Wackers, F.J.Th., Bansal, S., Stain, L.H., Chyun, D.A., Davey, J.A., Young,
L.H., for the DIAD Investigators. Gender-based divergence in cardiac outcomes in a symptomatic patients with type 2
diabetes. Results from the Detection of Ischemia in Asymptomatic Diabetics (DIAD). Diabetes and Vascular Disease
Research. first published on January 6, 2012 as doi:10.1177/1479164111431470. Hayman, L., Helden, L., Chyun,
D.A., & Braun, L. A life course approach to cardiovascular disease prevention. Journal of Cardiovascular Nursing,
2011, 26(4):S22-S34. Bansal, S., Wackers, F.J.Th., Inzucchi, S.E., Chyun, D.A., Davey, J.A., Staib, L.H., Young,
L.H., for the DIAD Investigators. Five-year outcomes in “high-risk” patients in the Detection of Ischemia in
Asymptomatic Diabetics (DIAD) Study. A post-hoc Analysis. Diabetes Care, 2011, 34:204-9. Melkus, G. D., Amend,
A. M., Newlin, K., Langerman, S. Chyun, D. The effect of a diabetes education, coping skills training and care
intervention on physiological and psychosocial outcomes in black women with type 2 diabetes. Biological Research
for Nursing, 2010, 12(1):7-19. Young, L., Wackers, F., Chyun, D., Davey, J., Barrett, E., Taillefer, R., Heller, G.,
Iskandrian, A., Wittlin, S., Filipchuk, N., Ratner, R., Inzucchi, S. Cardiac outcomes after screening for coronary artery
disease in asymptomatic patients with type 2 diabetes in the DIAD Study. JAMA, 2009, 301:1-9. Wackers, F.J.Th.,
Chyun, D.A., Young, L.H., Heller, G.V., Iskandrian, A.E., Davey, J.A., Barrett, E.J., Taillefer, R., Wittlin, S.D.,
Filipchuk, N., Ratner, R.E., Inzucchi, S.E. for the Detection of Ischemia in Asymptomatic Diabetics (DIAD)
Investigators. Resolution of myocardial ischemia in patients with type 2 diabetes mellitus. Three-year follow-up by
adenosine SPECT imaging in the DIAD study. Diabetes Care, 2007, 30(11):2892-8. Chyun, D. A., Lacey, K.O.,
Katten, D. M., Talley, S., Price, W.J., Davey, J. A., & Melkus, G. D. Glucose and cardiac risk factor control in
individuals with type 2 diabetes: Implications for patients and providers. The Diabetes Educator, 2006, 32(6),925-36.
Chyun, D.A., Katten, D.M., Melkus, G.D., Talley, S., Davey, J.A., & Wackers, F.J.Th. The impact of screening for
asymptomatic myocardial ischemia in individuals with type 2 diabetes. Journal of Cardiovascular Nursing. 2006,
21(2):E1-7. Chyun, D. A., Melkus, G. D., Katten, D. M., Price, W.J., Davey, J. A., Grey, N., Heller, G., Wackers, F. J.
Th., & Young, L. H. The association of psychological factors, physical activity, neuropathy, and quality of life in type 2
diabetes. Biological Research for Nursing. 2006, 7(4): 279-88. Melkus, G.D., Spollett, G., Jefferson, V., Chyun, D.,
Tuohy, B., Robinson, & Kaisen, A. A culturally competent intervention of education and care for black women with

type 2 diabetes. Applied Nursing Research, 2004, 17(1):10-20. Wackers, F.J.Th., Young, L.H., Inzucchi, S.E., Chyun,
D.A., Davey, J.A., Barrett, E.J., Taillefer, R., Wittlin, S.D., Heller, G.V., Filipchuk, N., Engel, S., Ratner, R.E., &
Isakndrian, A.E.. For the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Investigators. Detection of silent
myocardial ischemia in asymptomatic diabetic subjects: the DIAD Study. Diabetes Care, 2004, 27(8):1954-61. Chyun,
D.A., Vaccarino, V., Murillo, J., Young, L.H., & Krumholz, H.M. Acute myocardial infarction mortality in the elderly with
diabetes. Heart and Lung, 2002, 31:327-339. Chyun, D., Vaccarino, V., Murillo, J., Young, L., & Krumholz, H.
Mortality, heart failure and recurrent myocardial infarction in the elderly with diabetes. American Journal of Critical
Care, 2002, 11:504-519.
Contact
[email protected]

H 06 - SPECIAL SESSION: Science Supporting the Practice of
Acute/Critical Care Nursing
Martha A.Q. Curley, RN, PhD, FAAN
Purpose
1. Discuss several converging phenomena that will stimulate new programs of nursing research. 2.
Describe data supporting the positive impact of nurse-led interventions on patient outcomes. 3. Envision a
future where data supports nurses practicing to the fullest extent of their clinical expertise.
Target Audience
Nurses interested in acute/critical care nursing practice.
Abstract
This is truly an exciting time for nurse scientists who support the practice of nursing. Numerous
investigations now link nurse-led interventions to improved patient outcomes. These data support a new
reconfigured autonomous role for nurses practicing within acute care environments. This session will
invite the audience to share a vision for acute care nursing practice; one that is patient and family
centered, one where nurses create a healing environment for patients and their families, one where
nursing practice is differentiated based on nursing expertise, and one where the practice of nursing is
supported by systems that enhance nursing’s capacity to optimize patient and family outcomes. This
vision of nursing practice is supported by Nursing Science.
Contact
[email protected]

H 07 - SPECIAL SESSION: Interventions to Improve Physical
Functioning and Psychological Adjustment in Advanced Heart
Disease
Cynthia M. Dougherty, RN, BSN, MN, ARNP, PhD
Purpose
The purpose of this presentation is to highlight nursing and interdisciplinary interventions that have been
developed and tested to improve outcomes in populations with advanced cardiovascular disease:
coronary artery disease, heart failure and cardiac arrhythmias.
Target Audience
nurses, nurse practitioners, nurse researchers, nursing educators, physicians,
Abstract
In developing a program of research in advanced heart disease, this session overviews the development
of a body of knowledge related to human responses to sudden cardiac arrest both for survivors and their
family members and the development and testing of nursing interventions to improve health outcomes
after sudden cardiac arrest and advanced heart disease. The results of this research program are
enhanced physical and psychosocial health and to reduced health care costs in persons with advanced
heart disease and their family members. Within the program of cardiovascular nursing research, four foci
will be addressed: Nursing intervention models to enhance adjustment, exercise interventions to improve
function, cardiovascular disease management interventions, and end of life care in severe heart disease.
References
Dougherty CM, Thompson EA, Kudenchuk PJ. Development and Testing of an Intervention to Improve Outcomes for
Partners following Receipt of an Implantable Cardioverter Defibrillator (ICD) in the Patient. Advances in Nursing
Science, 2012, 35(4):359-377. Flo GF, Glenny R, Kudenchuk PJ, Dougherty CM. Development and safety of an
exercise testing protocol for patients with primary or secondary ICD indication. Cardiopulmonary Physical Therapy
Journal, 2012;23(3): 16-22. Dougherty CM, Steele BR, Hunziker J. Testing an intervention to improve function in
advanced cardiopulmonary illness. J of Cardiopulmonary Rehabilitation and Prevention, 2011, 31:35-41. Dougherty
CM, Glenny R, Kudenchuk PJ, Malinick TM, Flo GR. Testing an Exercise Intervention to Improve Aerobic
Conditioning and Autonomic Function After an Implantable Cardioverter Defibrillator (ICD). Pacing and Clinical
Electrophysiology, 2010, 33: 1-8.
Contact
[email protected]

I 01 - SPECIAL SESSION: The Nurse Faculty Leadership Academy:
Outcomes from Leadership Development Mentoring in Three Domains
Deborah F. Cleeter, BSN, MSN, MEd, EdD
Pamela H. Mitchell, PhD, RN
Jackie L. Michael, PhD, APRN, WHNP-BC
Purpose
To describe outcomes of the Nurse Faculty Leadership Academy within three domains: individual
leadership development; advancing nursing education through a team leadership project; expanding
scope of influence: organization, community, and profession.
Target Audience
Nurse educators and those interested in pursuing intentional leadership development.
Abstract
The Nurse Faculty Leadership Academy (NFLA) is an intense international leadership development
experience designed to facilitate personal leadership development, promote nurse faculty retention and
satisfaction, foster academic career success, and cultivate high performing, supportive work
environments in academe. Scholars in the NFLA are selected through a competitive process and work
throughout the twenty two month experience within a triad that includes a leadership mentor and faculty
advisor. The academy curriculum is built upon the foundation of three domains: individual leadership
development, advancing nursing education through leadership of team projects, and the Scholars’
expanded scope of influence within their sponsoring academic institutions, the community, and the
profession. Outcomes within each of the academy’s three domains achieved by the Scholars of the first
cohort will be presented. The impact of the NFLA and its relationship to the future of leadership in nursing
education will be described.
Contact
[email protected]

I 02 - SPECIAL SESSION: Structuring Caring Science Data for
Operations and Outcomes.
John Nelson, PhD, MS, BSN
Jacqueline Brown, RGN
Purpose
to provide examples of how data has been structured for context to maximize interpretation of data for
application of findings within operations and outcomes management.
Target Audience
The target audience is staff nurses, leaders in health care, data/quality managers, or caring science
research who want to understand how to build context specific models of caring science to maximize
application of data in outcomes and operations.
Abstract
This session includes two sub-sessions regarding how caring science is structured for culture and
context. The first portion of the presentation will focus on how caring is structured using frameworks like
Relationship Based Care, Planetree, and Caring Behaviors Assurance Strategy (CBAS). The second
portion of the presentation will review how the structure of caring was established in 75% of the hospitals
in Scotland using CBAS. Structuring data based on a model of care deliver like Relationship Based Care,
Caring Behaviors Assurance System, Planetree, or other care delivery systems can assist with data
management. Using a model of care delivery system to structure data can assist with measuring the
predictors and outcomes proposed to be impacted by the model of care. Structuring data in this manner
can organize complex data for the purpose of interpretation and application of data. This session will
provide examples from organizations that use structural phenomenology to structure the study of caring
within specific models of care delivery, specifically Relationship Based Care (RBC), and Caring Behaviors
Assurance System (CBAS). A deeper examination of one of the models of care delivery, CBAS, will give
an overview of person centred healthcare across Scotland, specifically focusing on the seven aspects of
quality identified as most important by patients through surveys and feedback. Referred to as the 7 C's;
caring, compassion, collaboration, clear communication, clean environment, continuity of care and clinical
excellence. The Chief Nursing Officer for Scotland requested designing of a system that would assess
caring and compassion at the patient interface; provide one to one feedback and development to staff on
findings; deliver a cultural change program measured against a set of owned and agreed caring and
compassion standards; create a system of reporting from ward to board and introduce a program to
address caring for staff and building a resilient workforce. This work was commissioned by the Chief
Health Professions Office for NHS Scotland, and overseen and coordinated at the Executive Nurse
Director level. The presentation will demonstrate how this program has been developed and where at
local ward and hospital level, measures of caring are monitored alongside interventions of care and
patient and staff outcomes.
Contact
[email protected]

I 07 - SPECIAL SESSION: Getting Published in Nursing Journals:
Strategies for Success
Susan Gennaro, DSN, RN, FAAN
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN
Purpose
enable those attending to ask specific questions of the editors of Worldviews on Evidence-Based Nursing
and the Journal of Nursing Scholarship about writing and getting published.
Target Audience
Any nurse interested in submitting their work for publication.
Abstract
This session will be participatory and enable those attending to ask specific questions of the editors of
Worldviews on Evidence-Based Nursing and the Journal of Nursing Scholarship about writing and getting
published. The broad issues that will be covered include: - getting started in the writing process - the
publication process - how to respond to peer reviews - ethics of publication.
Contact
[email protected]

I 11 - SPECIAL SESSION: Basic Principles and Applications of
Community-Based Participatory Research to Advance Nursing
Science in HIV Prevention
Deborah Koniak-Griffin, RNC, EdD, FAAN
Adeline Nyamathi, ANP, PhD., FAAN
Purpose
The purpose of this session is to introduce participants to Community-Based Participatory Research
(CBPR) as an approach to research with vulnerable populations and to provide case illustrations of how
to effectively apply the method.
Target Audience
The target audience are nurse researchers and graduate students in countries across the globe who
share an interest in conducting community-based participatory research (also known as community-
partnered research).
Abstract
This session introduces participants to Community-Based Participatory Research (CBPR) and provides
case illustrations of research applying this approach. Participants learn how CBPR, also known as
community-partnered research, differs from traditional research; the rationale for using the approach and
historical grounding in nursing; fundamental principles of how CBPR is conducted; and strategies to
facilitate the planning of research in collaboration with the communities. The workshop also includes
information on establishing effective community advisory boards. Guidelines are provided for
implementation and evaluation of CBPR. The Anderson Community Partnership Model is presented with
its process phases (Pre-engagement; engagement; community assessment; intervention design;
implementation, evaluation, dissemination; and sustainment). Case illustrations of CBPR studies in the
U.S. and India involving high-risk young parents and adults are provided by two internationally acclaimed
nurse researchers. In these examples, participants learn how community partners were involved in the
planning, intervention design, implementation and evaluation phases of the studies. Application of CBPR
principles led to development of culturally-relevant, theory-based interventions for the prevention of HIV
and other infections as well as sustainable strategies to improve the physical and mental health of those
affected by HIV/AIDS. Furthermore, case scenarios of the impact that CBPR has on the lives of the
participants involved will be presented, which in many cases, can be life-changing. This includes a bright
future which promotes ongoing education, fulfillment of family aspirations, and an ongoing motivation and
passion to continue work in the community. For high-risk young mothers and fathers, concern about the
well-being of their child (parental protectiveness) served as a motivator of positive behavior change to
improve their life course. The session concludes with considerations for improving CBPR studies
involving community-academic partnership.
References
Koniak-Griffin D, Lesser J, Takayanagi S, Cumberland WG. (2011). Couple-focused human immunodeficiency virus
prevention for young Latino parents: randomized clinical trial of efficacy and sustainability. Arch Pediatr Adolesc Med.
165(4):306-12. Lesser J, Verdugo RL, Koniak-Griffin D, Tello J, Kappos B, Cumberland WG. (2005). Respecting and
protecting our relationships: a community research HIV prevention program for teen fathers and mothers. AIDS Educ
Prev. 17(4):347-60. Nyamathi A, Sinha S, Ganguly KK, Ramakrishna P, Suresh P, Carpenter CL. (2013). Impact of
protein supplementation and care and support on body composition and CD4 count among HIV-infected women living
in rural India: results from a randomized pilot clinical trial. AIDS Behav. 17(6):2011-21. Nyamathi A, William RR,
Ganguly KK, Sinha S, Heravian A, Albarrán CR, Thomas A, Greengold B, Ekstrand M, Ramakrishna P, Rao PR.
(2010). Perceptions of Women Living with AIDS in Rural India Related to the Engagement of HIV-Trained Accredited
Social Health Activists for Care and Support. HIV AIDS Soc Serv. 9(4):385-404.
Contact
[email protected]
[email protected]

J 01 - SPECIAL SESSION: The Geriatric Nursing Leadership Academy:
Outcomes across the Care Continuum
Deborah Cleeter, RN, MSN, EdD
Irene Fleshner, RN, MHA
Claudia Jean Beverly, RN, PhD, FAAN
Purpose
Describe outcomes from three cohorts of the GNLA within the practice settings of acute care, long term
care facilities, and community agencies.
Target Audience
Nurses interested in leadership development and the care of older adults.
Abstract
Across practice settings, significant needs exist for improvement in delivery models, advancements in
practice outcomes, and preparing the next generation of leaders in gerontological nursing. The Fellows of
the first three cohorts of the national Geriatric Nursing Leadership Academy (GNLA) have achieved
impressive outcomes within the three curricular domains: individual leadership and career development,
advancement of practice through leadership of interprofessional team projects, and expanded scope of
influence at the organizational, community, and professional levels. Fellows of the GNLA were positioned
to lead practice change within acute care settings, long term care facilities, and community arenas.
Through the rigorous intellectual and experiential learning platform of the GNLA, dedicated leadership
mentoring, faculty advisement and strategic partnerships with senior executives of the sponsoring
healthcare organizations, opportunities were created for the preparation and positioning of these Fellows
as leaders. Outcome data for each of the three domains and exemplars of specific achievements of
Fellows within acute care settings, community health agencies, and long term care facilities will be
presented.
Contact
[email protected]

J 02 - SPECIAL SESSION: Use of Caring Theory in Culture and
Context in Scotland and Cameroon
John Nelson, PhD, MS, BSN
Relindis Moffor, BS, RN
Purpose
to identify how theory must be used within consideration of context and how theory can be used in
various clinical populations and settings.
Target Audience
Administrator, nurses, healthcare providers, and/or researchers who are using or interested in using
caring science for operations and/or research. Also HIV/AIDS workers. Also any community health
workers interested in innovative methods of food sustainability.
Abstract
This session includes two sub-sessions regarding how caring science theory was selected and used in
two different cultures and context. The first sub-session will review how Swanson’s theory of caring was a
better fit for the culture of Scotland than was Watson’s theory. The second sub-session will review how
Watson’s theory of caring science was used to assess the farming needs of women living with AIDS a
village in Cameroon, Africa The first portion of this session will review how two different theories of caring
were tested for the purpose of developing a caring science model of research that was appropriate for the
context of Scotland. Theoretical models that fit the context are important to minimize error in data and
maximize the ability to implement findings operationally in clinical care. This presentation will review how
Watson’s and Swanson’s theory in caring science were both tested and how a decision was made to use
Swanson’s theory for examining caring science in an acute care hospital in Scotland. Central within the
discussion was the discussion of measuring spirituality within the construct of caring. Results will identify
how measures and interventions related to caring science must match the culture. The final model that
used Swanson’s theory and addressed spiritual needs of the patient population will be presented.
Presenters of this session were asked by an international agronomy research group to assist with
innovative ways to assess food sustainability in vulnerable populations. A village in Cameroon, comprised
of women living with AIDS, was selected to evaluate how caring science could be used to not only assess
the farming needs, but to assess if caring might enhance their CD4 counts. A pilot study was conducted,
using Watson’s 10 concepts of caring, to assess needs related to farming and food sustainability within
the village. This presentation will review the results from the pilot study, the process of implementing
findings from pilot study and plans for ongoing interventions and research to support these women who
are living with AIDS in Cameroon.
Contact
[email protected]

K 02 - SPECIAL SESSION: Caring Science in Asia
Grace K. I. Lok, MEd, MNS, RN
Michelle MingXia Zhu, PhD, MNS
Margaret May Alojipan Ga, MAN, RN
Purpose
to establish an understanding how nurses in select locations in Asia approach the concept of caring;
Filipino nurses in clinical care in the Hospice and ICU setting and Chinese nurses use of curriculum to
train student nurses in competence of caring.
Target Audience
Researchers, nurses, administrators, educators, or students of nursing or healthcare interested in caring
science and the application within context and culture. It is also intended for anthropologists, theorists, or
healthcare workers interested in learning about caring science within culture.
Abstract
This session includes two sub-sessions regarding caring science in Asia. The first portion of the
presentation will examine caring experiences of nurses employed in hospice care and the intensive care
unit (ICU) in the Philippines. The second sub-session will look at how Chinese nurses apply caring
science using the concept of gBenevolenceh.
-session The
in session III, first sub
Caring Science in
Asia, presents a study conducted in the Philippines that utilized Van Manen's method in analyzing the
essential meaning of the nurses hospice and ICU experience. Six activities are used to examine and
understand the experience: (1) turning to the nature of the lived experience; (2) exploring the experience
as we live it, (3) reflecting on essential themes; (4) describing the phenomenon through the art of writing
and rewriting;(5) maintaining a strong relation to the phenomenon; and (6) balancing the research context
by considering parts and whole. The thematization process, used to detail the bits and pieces of reality,
consists of four reflections: (1) profile of co-researchers, textual transcription of their experiences and
individual themes; (2) composite themes arising from co- researcher's experiences; (3) interlaced theme
on common ground and; (4) elicit eidetic insight or the vivid gist of the theme. The eidetic insight captured
in the lived experiences of Hospice Nurses included Holistic Care and Touching the Soul. It represented
the shared experiences of the co-researchers. Eidetic insight from the lived experiences of ICU Nurses
can be presented by a Carative Transfiguration: Nurses moving harmoniously with Medical Technologies.
ICU Nurses cannot work alone, they need the help of the life sustaining devices, and have adapted to the
technology but they believe that machines cannot replace Nurses. The second sub-session of session III,
presents a curriculum of nursing in Macau (a Special Administrative Region of China), which
encompasses with the educational ideology of hFrom Perso
is designed from the high virtues inherited from Traditional Chinese culture. The philosophy of hmh
in Chinese and the practical concept of nursing Caring are merged into the curriculum and intended to
nurture the nursing students to become a professional nurse with both excellent character and
competence of caring. Results from the client fs perception of caring and stude
-evaluated
caring competence shown that success of the curriculum.
Contact
[email protected]

K 07 - SPECIAL SESSION: Publishing: A Career Road for You?
Susan Gennaro, DSN, RN, FAAN
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN
Purpose
The purpose of this presentation is to provide career pathways for nurse scientists interested in
publication.
Target Audience
The target of this presentation is nurse scientists whether in the clinical or academic arena.
Abstract
The editors of Journal of Nursing Scholarship and Worldviews on Evidence Based Practice will discuss
how being involved in publications help an academic career trajectory. How to become a reviewer,
editorial board member, associate editor and editor will all be discussed.
Contact
[email protected]

L 02 - SPECIAL SESSION: Partnership-Based Health Care: Applying
Principles of Caring to Entire System
Teddie Potter, PhD, MS, RN
Purpose
The purpose of this presentation is to demonstrate the connection between caring science and cultural
transformation theory in order to further strengthen the application of principles of caring at the systems
level.
Target Audience
Nurses and other health care professionals working in direct patient care, education, and/or research.
This session will also interest professionals from social science and humanities fields as well as
interprofessional and cultural change theorists.
Abstract
We know that Caring Science is very effective in relations with patients and families. We also know it is a
key pillar of the nursing profession. However we sometimes lack the resources or tools to effectively apply
caring science at the systems level. This presentation has several objectives. The first is to introduce the
audience to two new theories for nursing practice, education, and research: The BASE of Nursing
Practice, and Cultural Transformation Theory. Attendees will learn how these theories can support the
application of Caring Science at a systems level. The second objective is to give attendees the tools and
knowledge to evaluate their own organizations on the domination-partnership continuum. Finally, the
presentation will prepare attendees to apply principles of partnership-based health care throughout the
health care system including: faculty-student relationships in health care education, patient-and family-
centered care, intra-professional relationships, interprofessional relationships, relationships with
communities, and relationships with the environment. Nursing has a long history that includes both
domination and partnership. It is time to develop skills, resources, and a shared language so we can
apply partnership-based health care to promote improved outcomes for our patients, increased career
satisfaction for our professionals, and sustainable health care systems globally.
Contact
[email protected]

Part III: Evidence-Based Practice Oral Presentations
A 12 - Reflective Writing Influencing Evidence-Based Practice
Using Reflective Writing as a Nursing Intervention: Review of the Literature
Monica Kennison, EdD, RN, USA
Purpose
To review the literature on studies that examined the effects of expressive writing interventions on
physical and mental health outcomes and describe implications for evidence based practice.
Target Audience
Practicing nurses and nurse educators
Abstract
Over twenty years ago in a groundbreaking study, participants who engaged in an expressive writing
intervention about emotionally-laden experiences showed positive changes in health outcomes when
compared with those in a neutral writing control group. The effects lasted several weeks after the writing
intervention concluded. Since then, a number of studies have indicated that written disclosure about
stressful experiences improves measures of physical and mental health in clinical and non-clinical
populations. For instance, expressive writing has been linked to: fewer physician visits, increases in T-
helper cell growth, drops in blood pressure and heart rate, and improvements in mood. Additionally,
writing about stressful events appears to increase meaning making and lead to fewer intrusive thoughts.
While these studies have been primarily in the fields of psychology and medicine, nursing has begun to
investigate expressive writing as a low-cost effective intervention. The purpose of this presentation is to
review the literature on the effects of an expressive writing intervention on measures of physical and
mental health outcomes. The presentation describes implications for evidence based practice including
guidelines for practitioners who want to study the effects of a minimally-structured writing intervention in
select populations.
References
Baikie, K.A.(2012). Expressive writing and positive writing for participants with mood disorders: An online randomized
controlled trial. Journal of Affective Disorders, 136, 310-319. Boals, A. (2012). The use of meaning making in
expressive writing: When meaning is beneficial. Journal of Social and Clinical Psychology, 31, 393-409. Boals, A.,
Banks, J.B., & Hayslip, B. (2012). A self-administered, mild form of exposure therapy for older adults. Aging & Mental
Health, 16(2), 154-161. Craft, M.A., Davis, G.C., & Paulson, R.M. (2012). Expressive writing in early breast cancer
survivors. Journal of Advanced Nursing, 69, 305-315. Frattaroli, J. (2006). Experimental disclosure and its
moderators: A meta- analysis. Psychological Bulletin, 132, 823-865. Frisina, P.G., Borod, J.C., & Lepore, S.J. (2004).
A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. The
Journal of Nervous and Mental Disease, 192, 629-634. Harris, A.H.S. (2006). Does expressive writing reduce health
care utilization? A meta-analysis of randomized trials. Journal of Consulting and Clinical Psychology, 74, 243-252.
Low, C.A., Stanton, A.L., Bower, J.E., & Gyllenhammer, L. (2010). A randomized controlled trial of emotionally
expressive writing for women with metastastic breast cancer. Health Psychology, 29, 460-466. Pennebaker, J.W.
(1995). Emotion, disclosure, & health. Washington, D.C.: American Psychological Association. Pennebaker, J.W., &
Beall, S.K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of
Abnormal Psychology, 95, 274-281.
Contact
[email protected]

A 12 - Reflective Writing Influencing Evidence-Based Practice
Reflective Journaling: Using a Blog with Undergraduate Senior Practicum
Nursing Students
Indra Hershorin, PhD, RN, CNE, USA
Purpose
This purpose of this presentation is to share information on innovative technologies that can be used in
clinical. The development and benefits of using a blog as a collaborative activity for reflective journaling in
the clinical setting will be discussed.
Target Audience
The target audience for this session is faculty, clinical educators, nurses and students.
Abstract
Blogs (web logs) are a phenomenon of the Internet. Web-based technology such as a blog supports
collaborative learning that enrich learning performance both for individual knowledge construction and
group knowledge sharing (Yang, 2009). Blogs afford students the opportunity to share their ideas and to
provide each other with feedback. The advancement of technologies has created new opportunities for
learning, teaching, and assessment in nursing and blogs can be a useful means for nurse educators to
communicate with students and facilitating effective group collaboration in clinical.
Thirteen (13) undergraduate nursing students in their senior practicum clinical rotation were invited to
participate in a blog created on the Blackboard course management system. Each week students were
required to write their personal learning objectives, to critique the objectives, and to reflect on their
learning. The instructor read the blogs each week and provided feedback to students. The blogging
activity was conducted over four weeks with students and an end-of-semester questionnaire was given.
Result of the questionnaire survey showed that the students unanimously preferred the weekly online
blog versus completing the written assignment at the end of the rotation. All students (100%) felt that the
blog served as a tool to communicate with the instructor and to keep connected with their peers. In
addition, the students commented that the blog was quick and easy, it help saved time, allowed them to
share their clinical experiences with their peers, and receive weekly feedback from the instructor.
The opportunity to instantly publish on the web encouraged student participation, provided them with a
chance to read the thoughts authored by their peers, and to interact with the instructor. Blogs can be a
useful tool for nurse educators to establish a nurturing communication space that enhances students’
reflection of their clinical learning.
References
Yang, S. (2009). Using blogs to enhance critical reflection and community practice. Educational Technology &
Society 12 (2), 11-21. Roland, J., Johnson, C., & Swain, D. (2011). “Blogging” as an educational enhancement tool
for improved student performance: A pilot study in undergraduate nursing education. New Review of Information
Networking 16(2), 151-166. Stoerm, A. (2010). Reflective journaling 2.0: using blogs to enhance experiential learning
The Journal of Nursing Education 49(10), 596.
Contact
[email protected]

A 13 - Evaluating Nursing Education
Objective Knowledge Assessment in Nursing Education: An Update on the
Evidence-Based Knowledge Assessment in Nursing (EKAN) Instrument
Amy Hagedorn Wonder, PhD, RN, USA
Darrell Spurlock, PhD, RN, NEA-BC, USA
Purpose
To provide an overview of the Evidence-based Knowledge Assessment in Nursing (EKAN) instrument
development process and findings from a multi-site instrument validation pilot study. To present how the
EKAN can facilitate global networking on objective educational measurement, student performance, and
development of programs and faculty to enhance student learning.
Target Audience
The target audience will be faculty, program coordinators, and academic leaders involved in
baccalaureate nursing education around the world.
Abstract
Providing effective, evidence-based nursing care requires an assortment of knowledge, skills, and
attitudes related to locating, evaluating, and integrating research evidence into nursing practice. Ideally,
the development of evidence-based practice (EBP) knowledge, skills, and attitudes begins early in one’s
professional preparation for nursing. Prelicensure nursing education programs have accepted the
challenge of preparing students with the knowledge, skills, and attitudes for EBP but have lacked an
effective, objective way to measure educational outcomes students achieve from these efforts. Though
several tools are available to measure students’ attitudes toward EBP, existing instruments to measure
EBP knowledge (one component of competence) are limited and rely predominantly on self-reports of
achievement. Other instruments are designed for specific populations such as medical students
(Anderson, & Stickley, 2002; Frohna, Gruppen, Fliegel, & Mangrulkar, 2006; Illic, 2009; Ramos, Schafer,
& Tracz, 2003), and have yet to be tested in nursing. The National Council Licensure Examination for
Registered Nurses (NCLEX-RN) is the current standard for prelicensure nursing competency assessment
for entry into practice in the United States. Yet this exam does not test students’ knowledge of EBP
principles per se (NCSBN, 2009), leaving nursing education programs with virtually no method to
evaluate the effectiveness of their curricular revision and instructional activities at their school or to
compare their students’ achievement with other programs nationally or internationally.
To bridge this measurement gap, the Evidence-based Knowledge Assessment in Nursing (EKAN)
instrument was developed to objectively measure nursing students’ knowledge of EBP principles. The
EKAN is based on the Quality and Safety Education for Nurses (QSEN) competencies and the American
Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional
Nursing Practice. These frameworks articulate the requisite knowledge, skills, and abilities for the entry-
level, generalist roles of caregiver and coordinator of care to enable the safe, high quality care associated
with EBP (AACN, 2008; Cronenwett et al., 2007). The QSEN competencies and AACN Essentials have
resulted in widespread curricular redesign and developmental progression models to promote
competency acquisition for different levels of nursing education (AACN, 2013; Barton, Armstrong,
Preheim, Gelman, & Andrus, 2009; Brady, 2011). The creation of an instrument based on these models
provides a reliable and valid way for faculty to measure EBP competency achievement in prelicensure
nursing education. Using the EKAN, educators can more effectively evaluate not only student-level
knowledge, but also curricular content and teaching strategies along with needs for faculty development
to support student learning.
This presentation will provide an overview of the EKAN instrument development process and findings
from a multi-site instrument validation pilot study. The use of item-response theory (IRT) modeling,
specifically Rasch modeling, enables the EKAN to accommodate testing for a variety of nursing program
types, settings, and student populations. Rasch modeling enables discrimination of student ability and

item difficulty with greater instrument stability across samples (Tavakol & Dennick, 2013), presenting an
opportunity for a global initiative to enhance education and promote best practice.
Through the use of a common instrument, educators around the world can explore ways to continue to
enhance student performance by collaborating on innovative ways to develop programs, teaching
strategies, and faculty. Interactive discussion among session participants will focus on identifying
innovative and unique strategies to foster student EBP knowledge development and how attendees might
become involved in further research with the EKAN.
References
American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional
nursing practice. Accessed December 9, 2013. http://www.aacn.nche.edu/education-resources/baccessentials08.pdf
American Association of Colleges of Nursing. (2013). Annual report. Accessed December 10, 2013.
https://www.aacn.nche.edu/aacn-publications/annual-reports/AnnualReport13.pdf. Anderson, M., & Stickley, T.
(2002). Finding reality: The use of objective structured clinical examination (OSCE) in the assessment of mental
health nursing students interpersonal skills. Nurse Education in Practice, 2(3), 160-168. Barton, A. J., Armstrong, G.,
Preheim, G., Gelmon, S. B., & Andrus, L. C. (2009). A national Delphi to determine developmental progression of
quality and safety competencies in nursing education. Nursing Outlook, 57(6), 313-322. Brady, D. (2011). Using
quality and safety education for nurses (QSEN) as a pedagogical structure for course redesign and content.
International Journal of Nursing Education Scholarship, 8(1), 1-18. doi:10.2202/1548-923x2147. Cronenwett, L.,
Sherwood, G., Barsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and
safety education for nurses. Nursing Outlook, 5(3), 122-131. Frohna, J. G., Gruppen, L. D., Fliegel, J. E., &
Mangrulkar, R. S. (2006). Development of an evaluation of medical student competence in evidence-based medicine
using computer-based OSCE station. Teaching and Learning in Medicine, 18(3), 267-272. Illic, D. (2009). Assessing
competency in evidence based practice: Strengths and limitations of current tools in practice. British Medical Council
Medical Education, 9(53), 1-5. National Council of State Boards of Nursing (NCSBN). (2009). 2010 NCLEX-RN test
plan. Accessed December 10, 2013. https://www.ncsbn.org/2010_NCLEX_RN_TestPlan.pdf Ramos, K. D., Schafer,
S., Tracz, S. M. (2003). Validation of the Fresno test of competence in evidence based medicine. British Medical
Journal, 326(7384), 319-321. Tavakol, M., & Dennick, R. (2013). Psychometric evaluation of a knowledge based
examination using Rasch analysis: An illustrative guide: AAME Guide No. 72. Medical Teacher, 35, e838-e848.
Contact
[email protected]

The Utilization of Adult Learning Models to Increase Course Evaluation Scores in
a Historically Poorly Evaluated, Graduate Level, APRN Pharmacology Course
Keith Bryan Haynie, DNP, RN, FNP-BC, USA
Purpose
To provide a systematic review of the implementation of diverse adult learning models employed in an
Advanced Practice Pharmacology course and its outcomes.
Target Audience
Educators at undergraduate, graduate and doctoral levels.
Abstract
The online Pharmacological Principles of Clinical Therapies- N543, a foundational course for Nurse
Practitioner students at the UNM College of Nursing, had been a historically poorly student evaluated
course. Student IDEA scores were consistently low in all areas, and the course was consistently
identified by UNM College of Nursing faculty as a course in need of significant improvement.
Co-Instructors Drs. Keith Haynie & Roy Addington strategically employed two models of adult
learning. The two models utilized were; the revised Bloom’s Taxonomy of Learning Objectives
(Krathwohl, 2002), and the Adult Learning Models (Pawlak & Bergquist, 2013). Students were asked to
read the text in preparation for the online learning activities-factual and conceptual knowledge. Each
student was then assigned a specific drug class/topic to create an informative paper or power-point
presentation to engage their peers and facilitate their learning- procedural knowledge and metacognitive
knowledge. Another student was then asked to respond to the presenters’ information by teasing out
alternative points of view, therapies, and any additional information they believed their peers would
benefit from- procedural and metacognitive knowledge. Test questions were derived exclusively from
these paired presentations, which encouraged all students to read and stay abreast of the shared
knowledge and even ask their peers for any needed clarification-metacognitive knowledge. The
instructors managed the course through supervision, additional information, knowledge or practice
caveats. This type of learning environment is respectful of Adult Learning Models 3 & 4 where an
environment is created for learning transformation to occur, it is created and allows the adult learner to
give “voice” to their existence knowledge base and wisdom with application to new topics.
References
Cox, B., Cullen, K., & Buskist, W. (2007). Making the transition from undergraduate to graduate student: insights from
successful graduate students graduate school. Eye on Psi, 12(2). 28. Krathwohl, D. (2002). A revision of Bloom’s
taxonomy: an overview. Theory in Practice, 41(4).Retrieved from:
http://www.unco.edu/cetl/sir/stating_outcome/documents/Krathwohl.pdf Pawlak, K. & Bergquist, W. (2013). Engaging
experience and wisdom in a postmodern age. Four Models of Adult Education. Retrieved from :
http://www.psychology.edu/about/four-models-of-adult-education/ Russell, S. (2006). An overview of adult learning
processes. Urologic Nursing, 26(5). 349-352.
Contact
[email protected]

Evaluation of the Master Instructor Concept in an Accelerated Baccalaureate
Program
Stephanie Black, MSN, RN, USA
Terry Throckmorton, PhD, RN, USA
Purpose
to report on the implementation and evaluation of the master instructor concept in an accelerated
baccalaureate program.
Target Audience
nursing facutly and educational administrators.
Abstract
Based on the concepts presented in Ken Bain’s book What the Best College Teachers Do; A Master
Level Instructor demonstrates and provides an authentic learning environment that will challenge and
support students as they strive to understand and apply complex concepts in simulated and live clinical
situations. The best instructors assist their students learn through mechanisms that affect a sustained,
substantial and positive impact on how students think.
The expectations of a Master Level Instructor at Chamberlain College of Nursing include:
1. 1. Creates a natural critical learning environment (Facilitation; Active Learning)

1. Assigns challenging tasks that help students to rethink their assumptions, develop
authentic ideas, and examine their mental models of reality.
2. Works collaboratively with faculty and peers to provide opportunities to try, fail, and
receive feedback in advance of and separate from any summative judgment of their
effort.
3. 2. Gets students’ attention and keeps it (Active Learning; Content Management)
1. Incorporates active learning strategies that are responsive to students’ needs
and learning style.
2. Provides relevant content for students through application to real life concepts.
3. 3. Starts with the student rather than the discipline (Facilitation)
1. Challenges faulty learning models and creates new ones that are
effective within a collaborative environment.
2. 4. Gets commitment from students (Content Management)
1. Ensures equal commitment of both faculty and students to class,
coursework, and learning. Explains how each specific rule,
regulation, or assignment is supported by the learning objectives
of the course.
2. 5. Helps students learn outside of class (Integration)
1. Develops course activities that promote learning outside
of class.
2. b. Promotes curiosity to expand application of
learning.
3. 6. Engages students in disciplinary thinking
(Relevance)
1. Guides students to professional education with
journals and texts from the profession.
2. 7. Creates diverse learning experiences
(Relevance)
1. Integrates instructional strategies that
promote lifelong learning.

2. Uses evaluation methods that support
strategic learning rather than promoting
deep learning.
In order to evaluate this program student satisfaction scores we reviewed before and after standard
lecture method and again before and after Master Instructor sessions where the same concepts were
taught.
In addition, student test grades for the course were compared between the standard lecture instruction
and the Master Instructor instruction. Finally faculty satisfaction scores were evaluated comparing
standard lecture instruction and Master Instruction modes of teaching.
Initially students were somewhat resistant to the active class participation that was required of them in the
Master Instruction approach. By the end of the course session student evaluation scores were positive.
Scores on course exams were higher in the Master Instructor sessions compared to the standard lecture
instruction sections.
A detailed analysis will be provided in the presentation.
References
Bain,K. (2011). What the best college teachers do.Boston, Massachusetts: Harvard University Press.
Contact
[email protected]

A 14 - Simulation Based Learning Technologies
Standardized Patient Simulation for Evidenced-Based Practice with First
Semester BSN Student
Pamela J. Hodges, PhD, RN, USA
Karen G. Mellott, PhD, RN, USA
Purpose
The purpose of this presentation is to share learning outcomes using evidenced based practice with
simulation and standardized patients among 83 undergraduate first semester BSN students.
Target Audience
The target audience of this presentation includes BSN faculty/educators, anyone interested in simulation
and standardized patients, or educators interested in EBP. This “Active learning" teaching strategy
provides a dynamic/safe environment for making mistakes & developing confidence; plus allows for
interaction with patients in a safe clinical setting.
Abstract
Purpose: The best strategy of incorporating evidenced based practice (EBP) concepts into first semester
undergraduate nursing curricula is not well established. Since new nurse graduates may have a 2 year
delay in translating research to practice, the purpose of this project is to illustrate how first semester BSN
students use initial EBP skills during an interaction with standardized patients (SPs) in a simulation lab.
Safe communication is key to reforming how evidence is formulated and used to enrich the value and
effectiveness of health care. Improvement in patient safety, patient satisfaction, and the value of health
care all depend on the improvement in communication. Effective communication skills are an essential
component in providing safe patient care. This experience allowed students to interact with patients in a
safe environment prior to going into an actual clinical setting.
Design: Descriptive, mixed methods design
Setting: School of nursing clinical performance lab in suburban university
Participants/Subjects: All nursing students (n=83) in the first fundamentals medical/surgical course of
the BSN program participated in a simulation experience with SPs as part of a clinical skills lab learning
experience.
Methods: Students were provided written instructions, objectives, and the rotation matrix 1week before
the lab. The SPs were cognitively and physically prepared with extremely realistic presentation of
conditions using moulage. Every 15 minutes, students rotated among four SP vignettes (shingles,
decubitus, colostomy, cellulitis). Students conducted physical assessments, developed nursing
diagnoses, and considered appropriate interventions. After rotating through vignettes, students met for 30
minutes to debrief with faculty. A Likert style tool evaluating student satisfaction, critical thinking, course
application and lab organization plus a comment section for open remarks about communication, critical
thinking and individualized care was completed at session end.
Outcomes: The Likert scale included a range of strongly disagree to strongly agree regarding several
criteria. Of those who chose agree to strongly agree, 84% were satisfied with the experience, 88% “used
critical thinking rather than memorization”, 89% said project “helped me apply coursework to real-life” and
91% stated “session coincided with other parts of the course”. Of those who chose disagree to strongly
disagree, only 16% stated “lab content was organized”. Student comments were reviewed using content
analysis; the following themes found: “Communicating like a nurse”, “Thinking like a nurse”, “Confidence
in getting to know the patient”, and “Decreased anxiety”.
Implications: First semester BSN students can apply initial EBP skills in simulated experiences with SPs.
Educators should provide learning experiences promoting these skills early in the curriculum. Future
research can determine 1) the relationship of student reflective journaling on the internalization of EBP

knowledge and practice and 2) the best distribution of EBP communication, critical thinking, and patient
centered care attributes throughout the curriculum.
References
Malloch, K. & Porter-O’Grady, T. (2010). Introduction to evidenced-based practice in nursing and health care. (2nd
ed.) Sudbury, MA.: Jones and Bartlett. Melnyk, B. M. & Fineout-Overholt, E. (2010). Evidenced-based practice in
nursing and healthcare: A guide to best practice. Philadelphia, PA.: Lippincott Williams and Wilkins, Moch, S. D.,
Cronje, R.J. & Branson, J. (2010). Part 1. Undergraduate nursing evidence-based practice education: Envisioning the
role of students. Journal of Professional Nursing, 26(1), 5-13. Makoul, G. (2006). Commentary: Communication skills:
How simulation training supplements experiential and humanist learning. Academic Medicine, 81(3), 271-274. Yoo,
M. S. & Yoo, I. Y. (2003). The effectiveness of standardized patients as a teaching method for nursing fundamentals.
Journal of Nursing Education, (42)10, 444-448
Contact
[email protected]
A 14 - Simulation Based Learning Technologies

Examining the Use of a Digital Clinical Patient in the Online Classroom
Environment
Linda M. Gibson-Young, PhD, CNE, USA
Purpose
The purposes are 1) to examine student perceptions when using digital standardized examinations with
history and assessment findings and documentation, 2) to explore relationships between student use of
digital patient with learning style and SOAP note scores, and 3) to evaluate faculty perception when using
digital patient .
Target Audience
The target audience of this presentation is any nurse, nurse leader, or nursing educator promoting
learning in an online or distance classroom.
Abstract
Background: While there are a number of instructional products designed to educate undergraduate
nursing students, the quality of these products vary, and there is a shortage of quality products that can
be used for advanced practice graduate nursing students. To address this need, Shadow Health™
introduced a new and innovative Digital Clinical Experience™ (DCE) in 2012. The DCE is a 28 year old
African-American female named Tina Jones. As faculty, I utilize Tina Jones in a fully-online advanced
health assessment course. In order to prepare students for the valuable time they spend face-to-face in
resource-intensive clinical laboratories, faculty must provide opportunities online for their students to learn
and reinforce the knowledge necessary to effectively apply advanced health assessment skills and
techniques and further develop diagnostic reasoning and skills.
The purpose of this presentation is to present student perceptions of digital standardized examinations
and to explore relationships between student use of a digital patient with learning styles.
Results: Student learning styles* were assessed prior to course with 70 % Visual, 30% Auditory, and 50%
Kinesthetic (*Percentages exceed 100% r/t multiple learning styles). Feedback from students prior to
DCE was positive, with some concerns related to lack of experience and new technology. Three themes
obtained post-DCE included a more comprehensive understanding of content, practice in questioning and
collecting history, and improved feedback with documentation.
Discussion: This presentation will relate the issue of technologies with online education to all disciplines
and will identify innovative teaching strategies to use with such challenges.
References

Anderson, K.M. & Avery, M.D. (2008). Faculty teaching time: A comparison of web-based and face-to-face graduate
nursing courses. International Journal of Nursing Education Scholarship, 5(1). Bembridge, E., Levett-Jones, T. &
Jeong, S.Y. (2010). The preparation of technologically literate graduates for professional practice. Contemporary
Nurse, 35(1), 18-25. Christiansen, A. (2010). Storytelling and professional learning: A phenomenographic study of
students’ experience of patient digital stories in nurse education. Elliott, L. (2012). Blending technology in teaching
advanced health assessment in a family nurse practitioner program: Using personal digital assistants in a simulation
laboratory. Kim, M. & Shin, M. (2013). Development and evaluation of simulation-based training for obstetrical
nursing using human patient simulators. Computers, Informatics, Nursing , 31(2), 76-84. Tilghman, J., Raley, D., &
Conway, J.J. (2006). Family nurse practitioner students utilization of person digital assistants (PDAs): Implications for
practice. Tilley, D.S., Boswell. C., & Cannon, S. (2006). Developing and establishing online student learning
communities. Computers, Informatics, Nursing,
Contact
[email protected]

B 12 - Preparing Students as Catalysts for Change
The Role of Preparatory Activities in Clinical Education for the Pre-Licensure
Nursing Student
Laureen E. Turner, MA, MSN, BSN, USA
Purpose
The purpose of this presentation is to disseminate information gained from a study exploring preclinical
preparation activities and their impact on clinical education.
Target Audience
The target audience for this presentation is clinical educators and nursing school administrators.
Abstract
Purpose: This study explores preclinical preparation activities (PPA) in nursing education. Significance:
The clinical environment represents the cornerstone of nursing education, where theory, psychomotor
skills, and critical thinking converge. Existing literature demonstrates limited data on PPA. This paper
investigates forms and student perceptions regarding PPA. Methods: A survey tool was created in
tandem with existing research and faculty consultation. This survey was distributed to students (N=541)
and clinical faculty (N=94). 298 students and 34 faculty returned the survey. Analysis: Quantitative data
was cleaned and analyzed using Stata 13. Qualitative student data was analyzed for underlying themes.
Authors assessed internal validity by correlating similar questions (r = 0.6111). Results: The most
common forms of PPA assignment included “student assigned patient - student gathers information” (37.3
percent) and “unit staff assigned patient - student gathers information” (33.6 percent). More than 50% of
students agreed or strongly agreed with statements indicating PPA importance; however, mean
comparison tests indicate no significant differences in perception of clinical activities between those who
perform PPA and those who do not with the exception of sleep and clinical informatics skills. The study
also analyzes the impact of PPA on stress and sleep, finding that students believe PPA increases stress
and decreases sleep quantity. Conclusions: Factors affecting student perception of PPA include: timing
of assignment, time spent on the assignment, stress, and anxiety. The findings suggest that students
receive diminishing returns on time spent on PPA; nevertheless,, PPA may indeed enhance learning and
safety. Implications: The findings provide insight into the usefulness of PPA from a student perspective
and explore how these activities might be conducted.
References
American Association of Colleges of Nursing (2008). The essentials of baccalaureate education for professional
nursing practice. Washington DC: Author. http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf .
Accessed February 15, 2013. American Association of Colleges of Nursing (1998). Essential Clinical Resources for
nursing’s academic mission. Washington DC: Author Bureau of Labor Statistics, U.S. Department of Labor,
Occupational Outlook Handbook, 2012-13 Edition, Registered Nurses, on the Internet at
http://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited July 28, 2013). Cohen, J. (1988). Statistical power
analysis for the behavioral sciences. Routledge. Ferguson, L., & Day, R. (2005). Evidence-based nursing education:
myth or reality? Journal Of Nursing Education, 44(3), 107-115. Freedman, D., R. Pisani, R. Purves (1997) Statistics,
Third Edition. City, State: W W Norton & Co Inc. Hickey, M. T. (2010). Baccalaureate nursing graduates' perceptions
of their clinical instructional experiences and preparation for practice. Journal of Professional Nursing, 26(1), 35-41.
doi: 10.1016/j.profnurs.2009.03.001 Kermode, S. (1987). Pre-clinical preparation of undergraduate nursing students.
Australian Journal of Advanced Nursing, 5(1), 5-10. MacIntyre, R. C., Murray, T. A., Teel, C. S., & Karshmer, J. F.
(2009). Five recommendations for prelicensure clinical nursing education. Journal of Nursing Education, 48(8), 447-
453. doi: http://dx.doi.org/10.1088/0957-4484/20/36/365707 McCoin, D. W., & Jenkins, P. C. (1988). Methods of
assignment for preplanning activities (advance student preparation) for the clinical experience. Journal of Nursing
Education, 27(2), 85-87. Phillips, A. (1988) Reducing nursing students' anxiety level and increasing retention of
materials… modified group testing. Journal Of Nursing Education. 27(1), 35-41/ Raisler, J., Michelle O'Grady, & Lori,
J. (2003) Feature: Clinical teaching and learning in midwifery and women's health. Journal of Midwifery and Women's
Health, 48, 398-406. doi: 10.1016/j.jmwh.2003.08.005 Wolf, Z., Beitz, J., Peters, M., & Wieland, D. (2009). Teaching
baccalaureate nursing students in clinical settings: development and testing of the Clinical Teaching Knowledge Test.
Journal Of Professional Nursing, 25(3), 130-144. doi:10.1016/j.profnurs.2008.10.007 Villafuerte, A. (1996). Structured

clinical preparation time for culturally diverse baccalaureate nursing students. International Journal of Nursing
Studies, 33(2), 161-170.
Contact
[email protected]

Educating Nursing Students as Change Agents: A Case Study
Tanya R. Friese, BS, BSN, MSN, USA
Purpose
The purpose of the presentation is to describe a case study using the Model of Situated Learning in
Leadership to educate generalist entry master's-level nursing students leading efforts to develop
programs that improve the quality of care and outcomes for individuals from at-risk populations.
Target Audience
The target audience of this presentation is nursing faculty members, nurse educators, community based
organizations, and medical center leadership
Abstract
In 1996, the Institute of Medicine Committee on Public Health proposed a model of engagement and
collaboration of public health, community, and hospital partnerships to improve population health. Nearly
seventeen years later, supported by aspects of the Affordable Care Act (ACA), this initiative requires a
nursing workforce with leadership capabilities to transcend boundaries between the two sectors. At our
college of nursing, faculty who teach public and community health nursing collaborate with the university
medical center and community based organizations to develop caring and responsible nurses with clinical
reasoning who are patient advocates and innovators capable of problem-solving and development and
implementation of changes that improve outcomes in complex health care systems. Using the Model of
Situated Learning in Leadership as a framework, students at Rush University College of Nursing (part of a
large academic medical center with Magnet® recognition for excellence in nursing practice) are educated
as change agents. Students to work with community partners, conduct a community assessment, identify
areas of need, and gather data to support and evaluate the changes. Faculty coached students lead the
needed changes, integrating coursework including organizational leadership, health care policy,
epidemiology, biostatistics, and finance with project experiences. A case-study of using this model for
education in leadership is nursing student involvement (with faculty guidance) in ongoing efforts at the
medical center to improve the care of patients with intellectual disabilities and developmental disabilities.
The experience provides real-life lessons in leadership to strengthen care coordination between
regulatory agencies, family, and community supports and to bridge the gap between inpatient care and
public health to improve the quality of care for an at-risk group of patients.
References
Ailey, S. H., & Hart, R. (2010). A hospital program for working with adult clients with intellectual and developmental
disabilities. Intellectual and Developmental Disabilities, 48, 145-147. Ailey, S. H., Johnson, T., Fogg, L., & Friese, T.
(In review). Hospital adverse events among adult patients with intellectual and developmental disabilities. Intellectual
and Developmental Disabilities. Ailey, S. H., & Friese, T. R. (2013). Improving hospital experiences for people with
intellectual and developmental disabilities: Perspectives from health care services and the community. Invited
presentation at the 11th Annual Qualified Intellectual Disability Professional (QIDP) Leadership Conference. The ARC
of Illinois. Alsip, IL. Ailey, S. H., & Friese, T. R. (2013). Improving hospital experiences for people with intellectual and
developmental disabilities: Perspectives from health care services and the community. Invited presentation at the
Illinois Guardian Conference. Office of the State Guardian. Chicago, IL. American Association of Colleges of Nursing
(2013). Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. Retrieved from:
http://www.aacn.nche.edu/cnl/CNL-Competencies-October-2013.pdf American Nurses Credentialing Center Backer,
C., Chapman, M., & Mitchell, D. (2009). Access to secondary health care for people with intellectual disabilities: a
review of the literature. Journal of Applied Research in Intellectual Disabilities, 22(6), 514-525. Hurtado, M. P., Swift,
E. K., & Corrigan J. M. (Eds). Envisioning the National Health care Quality Report. (2001). Washington DC: Institute
of Medicine. The National Academies Press. Iacono, T., & Davis, R. (2003). The experiences of people with
developmental disability in emergency departments and hospital wards. Research in Developmental Disabilities,
24(4), 247-264. Institute of Medicine Committee on Public Health. (1996). Healthy communities: New partnerships for
the future of public health. Washington, DC: National Academies Press Janicki, M. P., Davidson, P. W., Henderson,
C. M., McCallion, P., Taets, J. D., Force, L. T., & Ladrigan, P. M. (2002). Health characteristics and health services
utilization in older adults with intellectual disability living in community residences. Journal of Intellectual Disability

Research, 36, 287-298. McDaniel, C. & Wolf, G.A. (1992). Transformational leadership in nursing service: A test of
theory. Journal of Nursing Administration, 22(2):60-5. Owen, Harrison (2008). Open Space Technology: A User's
Guide (3rd ed.). Berrett-Koehler. ISBN 978-1-57675-476-4. Shaller D. (2007). Patient-centered care: What does it
take? NY: The Commonwealth Fund; 2007. Report for the Picker Institute and The Commonwealth Fund
.http://www.commonwealthfund.org/usr_doc/Shaller_patient-centeredcarewhatdoesittake_1067.pdf?section=4039
Sowney, M., & Barr, O. G. (2006). Caring for adults with intellectual disabilities: Perceived challenges for nurses in
accident and emergency units. Journal of Advanced Nursing, 55(1), 36-45. U.S. Public Health Service. (2001).
Closing the gap: A national blueprint for improving the health of individuals with mental retardation. Report of the
Surgeon General’s Conference on Health Disparities and Mental Retardation. Washington, DC: U.S. Department of
Health and Human Services, Office of the Surgeon General. World Health Organization. (2012).Social determinants
of health: key concepts. Retrieved from
http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.htm
Contact
[email protected]

Innovative Community Placements: Enhancing Students Experiences with
Diverse Population
Ivy Tuason, RN, MSN, FNP-BC, USA
Ruth Trudgeon, RN, MSN, PHN, USA
Stephanie Cornett, BS, USA
Purpose
The purpose of this presentation is to explore the role of innovative community placements (ICP) in
providing nursing students with comprehensive experiences with diverse population.
Target Audience
The target audience for this presentation are nursing students, faculty, and clinicians.
Abstract
Background: The recent focus on community and population based health care in nurse education
means that effective clinical experiences within the community are an essential component of the nursing
program. However, two factors have made this harder to do over the last decade as student nurse
enrollment has increased annually but at the same time budget cuts have led to reductions in many
traditional community health services. Therefore more students are competing for a limited number of
spots in traditional community sites such as clinics, public health agencies and schools. This has led to a
trend of implementing innovative community placements (ICP) in non-traditional sites within communities.
Use of ICP increases student engagement, initiative, and critical thinking. Students were able to put into
practice concepts such as community action, social justice and diversity.
Western University of Health Sciences is a non-for- profit private health professions university. The
university offers graduate education and has nine colleges. The College of Graduate Nursing offers a
variety of nursing tracks including the Master of Science of Nursing-Entry. The MSN-E offers a pathway
for students with baccalaureate degrees in other fields to obtain RN licensure and then continue with
graduate courses to obtain a Master of Science in Nursing degree. Community Health Nursing is required
in the pre-licensure program. The university is located in Pomona, California. Pomona is a diverse
community with over 72% Hispanic/Latino population. The median household income is $28, 407.
Purpose: To explore the role of ICP in providing nursing students with comprehensive experiences with
diverse population.
Methods: Eight out of the 58 MSN-E students were assigned to transitional housing complex for their 2-
unit Community Health Nursing clinical. Students participating in this clinical site worked with the Laurel
apartment dwellers in the Pomona area. This population consisted of low income families living in low
cost housing. Most apartments included more than one family with children of all ages. Large portions of
the population are Hispanic, with few Caucasian and African American families. Students predominantly
conducted tutoring for children in the apartments (ages range from 4 to 15). During these tutoring
sessions, students took the opportunity to educate the children about healthy eating and safety. The
students also collaborated with dental medicine students to provide dental care to the children in the
apartments. A garden project was started in order to provide healthy food choices and to teach the
apartment dwellers about the therapeutic effects of gardening. Students also taught safety to the families
through disaster preparedness. While working with this population, students had the ability to work with
professionals in the community such as food banks, homeless outreach organizations, local substance
abuse and mental health facilities, and the area police department.
The traditional sites included school nursing, community based clinic, and public health agencies.
A 10-item Likert scale survey to evaluate clinical experiences was created and validated by two faculties.
The first 3 questions were about opportunities to interact with community organizations, diverse

population, and collaboration with other disciplines. The rest of the questions inquired about student
perceptions in patient centered care, safety, understanding and respecting culture and diversity.
Results: Total of 48 students responded, 42 from traditional sites and 6 from the ICP site. Overall, the
ICP group scored higher than the traditional clinical groups. ICP group scored slightly lower on the last
three questions pertaining to the perceptions of patient centered care.
Limitations: Small sample size of ICP group may have affected the mixed findings of the study. Survey
tool may need to be retested for reliability and validity.
Implications: ICP may provide similar experiences as traditional sites to fulfill Community Health Nursing
requirements. In addition, ICP experiences may provide better opportunities to provide
comprehensive experiences with diverse population.
This is the first implementation of ICP experience, on-going evaluations and additional ICP sites are
needed to provide more students with these types of diverse learning experience. Future research will
focus on qualitative data to explore students lived experience with ICP. In addition community outcomes
should be measured to evaluate the effectiveness of students’ interventions such as increase attendance
in tutoring and wellness activities classes.
References
Stanhope, M. & Lancaster, J.(2012). Public Health Nursing: Population-Centered Health Care in the Community.
Mosby:Philadelphia American Association of Colleges of Nursing. Retrieved December 11, 2013.
http://www.aacn.nche.edu/public-health-nursing
Contact
[email protected]

B 13 - Academic Program Development
Development and Implementation of a Team-Based Learning Module: An
Academic Perspective
Jenny Morris, RN, BSc, PhD, PGDipEd, United Kingdom
Purpose
To share the experience of developing and implementing a team-based learning module in a second year
undergraduate nursing programme. The time and effort associated with development and implementation
will be highlighted, as will be the views of the academic team, plus the students' results.
Target Audience
Nurse educators as well as educators in any other specialism.
Abstract
Team-based learning (TBL) was developed as a method of ensuring the benefits of small group teaching
with large groups of 200+ students (Michaelsen, 2002). To implement TBL a course/module is divided
into learning units each of which follows a specific sequence of activities: (i) out-of-class preparation; (ii)
‘readiness assurance process’ of individual and team testing, plus the opportunity for team appeals; and
(iii) application activities in which teams work on problems (Parmelee & Michaelsen, 2010). Students are
also required to provide feedback on each team member’s contribution to team working. Teams of
between 5-7 students are formed in advance in a way that ensures team diversity (e.g. by grade, nursing
specialty).
To implement TBL a significant amount of preparation is required by the academic team (Andersen,
Strumpel, Fensom, & Andrews, 2011); plus a clear understanding of, and commitment to dialectical
questioning to facilitate deep learning and foster student engagement (Lane, 2008).
The aim of this presentation is to report the process and outcome of implementing TBL in a second year
evidence-informed decision making (EIDM) module in a BSc Nursing programme in England. The focus
will be on the development work required to implement TBL; and the perceived value of TBL as observed
by the academic team. Student results will also be presented. The methods and results describing the
student perspective have been presented elsewhere.
Design: A post-intervention evaluation involving structured interviews with members of the teaching team
involved in both the development of the module and the implementation (n=8 excluding the author JM).
Data Collection: A planning log was kept by the module leader (JM) recording the timeframe and work
required. Interview questions focused on the process around development and implementation, and the
perceived value of TBL.
Data Analysis: A timeline reporting key deadlines and decisions was extracted from the planning log. The
interviews were digitally recorded to aid documentation and interpretation, and Atlas.ti 6 was used to aid
the information sorting process. Thematic analysis was used guided by the interview questions.
Results: (1) Planning for TBL Implementation - In order to prepare the team for TBL which was new to all
of us, the module leader engaged in several academic development activities: studied TBL literature
(pedagogical and evaluation), participated in a workshop led by Larry Michaelsen the originator of TBL,
joined the TBL Collaboration listserve, attended the TBL Collaboration annual conference.
The preparatory work required for TBL implementation was undertaken over a nine month period led by
the module leader. The key stages were as follows: (i) Preparation of the teaching team; (ii) division of
the 257 students into five main groups, subdivided into a total of 44 teams of between five and six
students.; (iii) structuring the module into four learning units and identifying/developing the learning
resources for each unit; (iv) timetabling and room organisation; (v) development and review of test and
application activity resources for each unit; (vi) preparation of team folders, student handbook, tutor
notes, induction material etc.

A sub-group from the academic team was formed to review the resources and materials developed which
were then subsequently reviewed by the whole teaching team (n=10 including the module leader). Team
meetings were organised to ensure all understood the TBL process, what was required, and to ensure
parity in how the student groups were facilitated. A checklist documenting all actions and dates of
approval was developed and maintained by the module leader.
(2) Results from the Academic Team Interviews - Perceptions of TBL Prior to Implementation
All referred to previous difficulties associated with students not engaging with the subject material, nor
undertaking required reading and therefore coming unprepared to taught sessions. There was
deliberation about whether TBL would result in more engagement and consequently deeper
learning. Whilst all made positive comments about using TBL despite none having had previous
experience of the strategy, there was also a degree of apprehension.
Facilitating the TBL Sessions: One of the key features of TBL is the emphasis on using dialectical
questioning to help develop learning and engage students. Whilst most of the academic team did not find
this a problem, they did recognise the challenges associated with eliciting information and probing
students to establish levels of knowledge and understanding, rather than ‘providing’ students with
‘answers’.
TBL and EIDM: Most of the academic team felt that TBL helped address some of the challenges
previously experienced when teaching EIDM such as students not preparing for sessions, and
consequently not engaging with the subject; nor applying the concepts learned to a wider context. The
multiple choice question tests were seen as beneficial because the students had to complete the
preparatory work for each module unit in order to succeed. The team working processes were seen to
help those struggling to understand the subject concepts; and also demonstrate the level of knowledge
and understanding to those students able to explain concepts to others.
The preparatory work and team-based discussions were considered to help students understand the
language of EIDM through the level of engagement more readily than with more didactic methods. It was
suggested that through the application activities TBL helped contextualise EIDM in clinical practice which
was essential if students were to understand the centrality of EIDM to the provision of efficient and
effective health care.
General Perceptions of TBL: The academic team thought that overall TBL worked well. The preparatory
work meant that students had to take responsibility for their learning which as well as being beneficial for
helping ensure the module learning outcomes were achieved, was also seen as aiding the development
of lifelong learning skills especially around learning how to learn, working independently; and also
effective team working which is integral to professional practice.
The majority of the academic team indicated that the appeal process worked well and contributed to the
students’ learning, although one member of the team thought it was too much work for little benefit for the
students. There was a mixed response to the application activities with some members of the team
indicating they worked well and that the students engaged with this element; but three members of the
team did not see the benefit of this part of the TBL process. A team review meeting scheduled halfway
through the module indicated that this might be due to the fact that the dialectical questioning technique
and facilitation processes were not being implemented as required to fully engage the students.
By the end of the module, all members of the academic team indicated significant learning had taken
place about the process and pedagogical value of TBL. Preparing for the sessions was seen as key to
successful implementation, as was the effective use of dialectical questioning. Having two members of
the team facilitating each large group was seen as advantageous and helped ensure smooth running of
the sessions. Having a strong and engaged teaching team was highlighted as being essential to
successful implementation by one member of the team.
(3) Student Results - The mean score for the individual tests was 52.64, and 82.67 for the team
tests. The overall pass rate for the module was 89% which was 10% higher than the results for the EIDM
module for the previous academic year; 20% scored over 70% and a further 39% between 60-
69%. Perhaps of most interest, however, was the change in scores between the lowest quartile for the

two modules. The lowest quartile was 56% for the TBL module (median 62%), compared with 40% for
the non-TBL module (median 50%) completed in the previous year.
Conclusions: There was significant effort required on the part of the module leader to prepare the team,
as well as the resources and materials required prior to this first implementation of TBL. It was felt that a
minimum of nine months should be allowed for this process for those new to TBL. However future
implementation with the same module will not be so time consuming as the materials have been prepared
and can be reused. The interviews with the academic team indicated that TBL was a successful strategy
to use with EIDM, requiring students to be prepared for sessions resulting in greater student engagement,
and deeper learning. Student results indicated higher attainment than in a previous year, with a
significant shift in results towards higher grades. A testament to this successful implementation is the fact
that TBL will continue to be used for the next academic year and is being considered for use with other
modules.
References
Andersen, E., Strumpel, C., Fensom, I., & Andrews, W. (2011). Implementing team-based learning in large classes:
Nurse educators' experiences. International Journal of Nursing Education Scholarship, 8(1), 1-16.
Lane, D. (2008). Teaching skills for facilitating team-based learning. New Directions for Teaching and Learning, 116,
55-68.
Michaelsen, L. (2002). Getting started with team-based learning. Team-Based Learning: A Transformative Use of
Small Groups (pp. 27-51). Westport, CT.: Praeger Publisher.
Parmelee, D., & Michaelsen, L. (2010). Twelve tips for doing effective Team-Based Learning (TBL). Medical Teacher,
32, 118-122.
Contact
[email protected]
B 13 - Academic Program Development

Designing a Faculty Development Program for the Effective Use of Analytic
Grading Rubrics
Candice Phillips, PhD, APRN, CNM, RN, CNE, USA
Rachel Choudhury, MSN, MS, RN, CNE, USA
Purpose
The purpose of this presentation is to share the development of a faculty educational program to promote
effective use of standardized analytic rubrics for student assessment in nursing courses.
Target Audience
Nurse Educators, Nurse Administrators, Faculty Development Specialists, Curriculum Specialists
Abstract
Higher education literature recognizes the vital role that assessment tools exert on improving student
academic performance (Howell, 2011). Benefits of using analytic grading rubrics have been noted to
include: increased student understanding of instructor expectations (Oakleaf, 2008) and more meaningful
grading experiences due to clearly stated evaluative criteria (Brescian, Zelna & Anderson, 2004). An
analytic rubric, which allows for separate evaluation of each component of the assignment, has been
shown to provide objective formative feedback to guide student performance (Oakleaf, 2009). In addition,
studies of administrative and pedagogical advantages to using grading rubrics have been documented
(Solan & Linardopoulos, 2011). Despite the growing body of research on rubrics as assessments of
student performance and how students perceive them, few published findings focus on the rigorous use
of standardized rubric tools in instructional and program assessments, or on the perceptions of faculty
who use these standardized assessment tools (Reddy & Andrade, 2010).

This evidence-based presentation will discuss the development of a faculty educational program to
promote effective use of standardized analytic rubrics for student assessment in nursing courses. The
program development is based on our findings from a previous research study regarding faculty
perceptions about the use of standardized assessment tools. This study involved faculty participants
across thirteen campuses of a prelicensure baccalaureate nursing program from various regions of the
United States. Systematic assessments were evaluated for pedagological advantages to improve
teaching-learning practices in the nursing program. The goals of the faculty educational program related
to the use of standardized analytical rubrics include: (a) enhancing teaching effectiveness, (b) promoting
an objective and reliable basis for student performance assessment, and (c) developing an efficient
grading process. Faculty enrichment regarding the effective use of assessment tools fosters internal
consistency within the nursing program’s curriculum to support overall program assessment.
References
Bresciani, M.J., Zelna, C.L., & Anderson, J.A. (2004). Assessing student learning and development: A handbook for
practitioners. National Association of Student Personnel Administrators. Howell, R. J. (2011). Exploring the impact of
grading rubrics on academic performance: Findings from a quasi-experi¬mental, pre-post evaluation. Journal on
Excellence in College Teaching, 22 (2), 31-49. Oakleaf, M. ( 2009). Using rubrics to assess information literacy: An
examination of methodology and interrater reliability. Journal of the American Society for Information Science and
Technology, 60(5), 969–983. Reddy, Y. M. & Andrade, H. (2010). A review of rubric use in higher education.
Assessment & Evaluation in Higher Education. 35 (4), 435-448. Solan, A. M. & Linardopoulos, N.(2011).
Development, implementation, and evaluation of grading rubric for online discussions. Journal of Online Learning and
Teaching, 7(4), 452-464.
Contact
[email protected]

B 14 - Nursing Workforce Collaboration
Activation Planning: Preparing a Workforce for Expansion into a New Healthcare
Facility
Katherine Pakieser-Reed, PhD, RN, USA
Sally Black, RN, MSN, MBA, USA
Emily Lowder, PhD, RN, USA
Purpose
The purpose of this presentation is to identify strategies and guidelines on transitioning to a new hospital
facility and describe how our organization adapted them to the expansion of our adult hospital. We will
focus on workforce training, move-in day, and the re-opening of units in the previous hospital facility.
Target Audience
The target audience of this presentation is organizational nursing leaders, managers, and administrators
in clinical practice and education.
Abstract
Background and Purpose: An organization faces many challenges when building a new healthcare
facility and preparing to move or expand into this facility. Strategies to plan and implement such a move
have been described in the literature. Guzman, Nering, and Salamandra (2008) outline the use of specific
project management tools and the application of the nursing process (assess, plan, implement, and
evaluate) in organizational transition planning. The scope of a successful transition plan must address the
roles and responsibilities of organizational members, licensing and regulatory requirements, a transition
budget, move planning, and management of change related to transition (Guzman et al., 2008). Since the
physical transition to the new facility is at the heart of a move or expansion project, other authors focus on
specific guidelines for occupancy or activation planning. According to Wilson, Hejna, and Hosking (2004),
“Activation planning involves anticipation of and control over two types of issues: logistical and
operational” (p. 359). Logistical issues address facility-related aspects such as new equipment, readiness for
occupancy, and a move-in sequence. Operational issues include implementing novel processes and
practices within the new environment, which in turn drive education, training, and orientation efforts for
staff. Recommendations for success include using multidisciplinary teams, developing a database for
activation issues, timely decision making, real-time communication, adequate staff training and orientation
time, and simulation of operational procedures (Wilson et al., 2004). Focusing on staff education, Stichler
and Ecoff (2009) outline five key areas to address: new clinical competencies, life safety training, training
on new equipment, workflow exercises, and general orientation.
Despite these guidelines, there are few reports describing successful transitions to new hospital facilities.
Those that exist outline moving into a replacement hospital, with full occupation of the new facility as the
end result (Duffy, Pearson, & Waters, 2002; Ecoff & Thomason, 2009). There is little published on
expanding into a new healthcare facility and re-purposing the previous facility for continued use. Using
the Iowa Model of Evidence Based Practice to Promote Quality Care (Titler et al., 2001), our purpose was
to adapt the new facility transition strategies found in the literature and apply them to our adult hospital
expansion project. In particular, we focused on activation planning surrounding workforce education,
patient move-in day, and the re-opening of units in the previous hospital facility.
Methods: The expansion of our medical center, with the opening of a new adult hospital facility in
February 2013, provided an opportunity to utilize activation planning as a transition strategy. First, we
employed this strategy to develop and implement a training program for staff who would interact with and
within the new facility. Beginning six months prior to the move-in date, lists of new equipment and
technology were compiled to address the logistical aspects of the transition. Examples included wireless
phones for nursing staff, the use of patient status boards, and expanded telemetry monitoring capacity.
New safety measures and expected changes in practice were catalogued to address the operational
aspects of the transition. These included more containment isolation rooms, easily accessible medication
and supply rooms, and centrally located interdisciplinary workrooms.

Following identification of new clinical competencies, learning paths were created for the 173 individual
roles within the organization. Training was built by vendors, educators, and internal clinical experts, and
five methods of delivering the education were identified: station, class, on-line, mock room, and tour.
Based on recommendations in the literature, employees were oriented and trained using a step-wise
approach followed by simulation. Phase one included training on basic new equipment and safety
measures, while department-specific training occurred in phase two; each phase took place over six
weeks. Subsequent “Day in the Life” simulation scenarios allowed staff to test the new systems and
workflows in real time. Issues that arose from these simulations were systematically logged, prioritized,
and addressed prior to the move.
Second, activation planning was applied to move-in day. Both the new and previous hospital facilities are
on the same medical campus within a two block radius, connected by underground tunnels. The patient
transport sequence, pathways between buildings, and timeline of the move were carefully designed. Two
weeks prior to the move, staff members began daily rehearsals of patient transfers. Revisions to move-in
day plans were made based on feedback generated by testing the system in advance.
As part of organizational expansion, multiple units in the previous facility were designated for re-
purposing. On move-in day, these inpatient units were decommissioned. Activation planning was again
applied to identify and address logistical and operational issues. These included refurbished single
occupancy patient rooms, relocation of the inpatient dialysis unit, and creation of a short-stay unit.
Following structural and equipment updates, the units were sequentially re-opened beginning three days
post-move and continuing throughout the following year.
Findings: Over 200 educators, vendors, and internal clinical experts assisted in designing the training
program, which resulted in the education of 2500 clinical and procedural staff. The training program was
completed under budget; reduction of training hours without loss of content occurred as the curriculum
continued and was refined. For example, training was originally budgeted at 20 hours per registered
nurse but was delivered in less than 16 hours total. Weekly lists of questions from each training station
were compiled and answered by clinical experts. These answers refined the curriculum and became the
source of a Frequently Asked Questions document for staff. The over 1500 issues that arose from “Day in
the Life” simulations were addressed based on priority, with critical problems resolved first and less
urgent matters deferred until after the move.
On move-in day, 157 patients were safely transferred to the new hospital facility in 6 hours and 58
minutes, and ten inpatient units were successfully opened. Over 2000 staff, faculty, and volunteers
participated. Feedback from patients and families regarding the move was uniformly positive. The
operating rooms, pre- and post-operative care units, pharmacy, and blood bank were also subsequently
moved and opened in the new facility.
In the previous adult hospital, fourteen inpatient units designated for re-purposing were decommissioned.
Based on assessment of patient care and space requirements, five units have been updated and
reopened since March 2013, with two additional unit openings planned. The demand for additional
geographic space due to increased clinical program volume continues to drive our hospital expansion
project.
Since move-in day in February 2013, the need for additional training was identified through staff requests
and assessments by clinical educators. Nursing staff completed in-services to improve knowledge and
skills in telemetry use for cardiac monitoring. Unit secretaries underwent refresher training on new
modalities for tracking patients and contacting staff members. As planned prior to the move, vendors
returned for in-situ training on new patient care tools and equipment to help staff troubleshoot. Training to
ensure accurate and current familiarity with technology, workflows, and clinical practices in both facilities
is ongoing.
Conclusions/Implications for Practice: As academic medical centers build new hospital facilities and
prepare to move their workforces into these facilities, a systematic approach to staff training and patient-
care transition is critical for success. Based on the Iowa Model, we utilized strategies from the literature
and adapted them to our organizational expansion project. Activation planning identified and addressed
logistical and operational hurdles for training staff members, ensuring a safe and efficient move-in day,
and re-opening units in the previous facility. Despite constraints of cost, construction, regulatory issues,

and trainee scheduling, the training program was delivered on-time and under-budget. This was
accomplished with support from organizational leadership and by continuous performance improvement
while delivering the educational curriculum. Simulations of new workflows and of move-in day were
instrumental to ensure safe practices and transitions in patient care. Activation planning continues to
inform the expansion of our medical center within the previous facility as our adult inpatient population
grows. As noted by others, transition planning is resource-intensive, lengthy, and complex. However, the
reward of a successful transition is a well-trained workforce confident to safely care for patients in an
environment that facilitates the quality of that care. Sharing and disseminating information about our
experience in activation planning and implementation for a new facility hospital expansion project may be
valuable to other organizations facing similar challenges.
References
Duffy, K., Pearson, A., & Waters, M. (2002). Moving a hospital- a once in a lifetime experience. Australian Health
Review, 25(2), 155-161. Ecoff, L. & Thomason, T. (2009). Moving into a new hospital: Strategies for success. Journal
of Nursing Administration, 39(12), 499-503. Guzman, K., Nering, H., & Salamandra, J. (2008). An operational guide
for transition planning. Journal of Nursing Administration, 38(10), 409-413. Stichler, J. F. & Ecoff, L. (2009). Joint
optimization: Merging a new culture with a new physical environment. Journal of Nursing Administration, 39(4), 156-
159. Titler, M.G., Kleiber, C., Steelman, V., Rakel, B., Budreau, G., Everett, L.Q., . . Goode, C. (2001). The Iowa
model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497-
509. Wilson, M. N., Hejna, W. J., & Hosking, J. E. (2004). Activation and operational planning: Ensuring a successful
transition. Journal of Healthcare Management, 49, 358-362.
Contact
[email protected]

Fostering Healthy Work Environments: Diversity and Health Equity Competencies
for Managers
Rani Hajela Srivastava, RN, MScN, PhD, Canada
Janet Mawhinney, MA, Canada
Kristin Cleverley, RN, MSc, PhD, CPMHN, Canada
Purpose
describe an initiative aimed at developing manager competencies for diversity and equity in a hospital
setting as part of best practice guideline implementation for embracing diversity and cultural competence
Target Audience
senior adminstrators, clinicians, managers and directors, organizational development consultants,
diversity and equity champions, academics
Abstract
Although it is well recognized that 21stcentury health system transformation requires a foundation of
equity and cultural competence, this goal continues to be challenging and elusive. Healthcare providers
and organizations need to navigate complex, intersectional layers of diversity and social determinants in
order to develop effective strategies to achieve equity and quality care for all. The purpose of this
interactive presentation is to describe an innovative approach to equity education being used to guide the
development of individual and organizational capacity for cultural competence and equity. The initiative
was undertaken as part of the Best Practice Spotlight Organization initiative to foster a healthy work
environment. The initiative consisted of a one day interactive workshop which was evaluated through a
pre and post -test design. The pre/post survey is a self administered tool that focuses on application of
awareness and knowledge on diversity and equity issues. The tool is based on existing literature and was
developed for this initiative to specifically focus on the best practice guideline recommendations.
Pedagogy is the art and science of how something is taught and how students learn it. Our innovative
approach to equity pedagogy is based on a broad understanding of diverse identities and marginalized
communities and reflects an understanding of culture as patterns and culture as power. Our model
combines three key paradigms: 1) a human rights foundation and analysis of privilege, power and
marginalization; 2) an anchoring to professional practice expectations and quality care; and 3) an
integration of adult education principles and a developmental approach to the acquisition of knowledge
and skills on issues of power and inequality. It recognizes that individuals always bring a range of
knowledge, life experience and skill on diversity issues and it engaging multiple levels of learners to
disrupt prejudice and bias, while maintaining a positive learning edge for all is both challenging and
necessary. Our approach is grounded in evidence of health disparities and concepts of privilege and
marginalization. It invites students /health care providers to explore strategies for navigating the layers
and intersections of both privilege and marginalization at the same time, while avoiding the too frequent
pitfalls of diversity education which can (inadvertently) reinforce simplistic identity silos, hierarchies of
oppression or a guilt response – none of which are useful for health practitioners or service
organizations. We have found that this approach resonates with health professionals and provides a
clear ‘bottom line’ of equity practice expectations while equipping staff to recognize the complexities of
the application of principles into practice. The deeper level understanding and ability to apply in practice
is fundamental to health system transformation.
Our model and approach has been developed over several years of diversity education in a large urban
hospital as well as academic settings. Our context is one of the most diverse cities in the world that is
home to the largest Aboriginal and LGBT populations in Canada; where almost 50% of the city residents
are racialized people and immigrants who speak over 160 languages. In this context diversity must be
understood as a complex multiplicity of identities and effectively educating staff (and students) in a
framework on diversity and health equity is requisite to ensuring quality care.

In a health care context managers have a dual responsibility for cultural competence in clinical care to
achieve health equity while effectively addressing issues of workforce diversity. This can be particularly
challenging in a unionized environment where fairness is often translated into “treating everyone the
same”. The core objectives for the workshop included: understanding the impact of health inequities on
diverse and marginalized groups; identifying the impact of power dynamics and diversity in managing
teams and fostering a healthy workplace; and developing strategies and approaches to addressing
diversity and health equity in leadership. Strategies were grouped under three key domains: self
awareness, cross cultural communication and translating awareness of health equity into actions to
promote inclusivity.
Results indicate that the approach is effective in increasing awareness, knowledge, as well s the ability to
apply it to practice, Diversity & Health Equity Tool illustrated increased knowledge, skills, and
competencies of managers and the gains were maintained over time
References
Srivastava, R. (2007). Health care providers guide to clinical cultural competence , Toronto: Mosby RNAO(2007).
Embracing Diversity: Developing Cultural Competence. Best Practice Guildeline
Contact
[email protected]

Becoming a Better Interprofessional Practitioner: How Does it Happen; What is
the Impact
Doris Grinspun, RN, MSN, PhD, LLD (hon), OONT, Canada
Irmajean Bajnok, RN, MSN, PhD, Canada
Althea Stewart-Pyne, RN, BScN, MScN, Canada
Purpose
The purpose of this presentation is to highlight evidence related to interprofessional practice, share an
evidence based model of professional practice,and discuss strategies for enhancing interprofessional
practice.
Target Audience
Nurses, patients, clients, interprofessional health-care providers, managers and faculty
Abstract
Interprofessional care is comprehensive care provided by multiple health-care professionals working
collaboratively within their scope of practice and it is important in all health-care settings to enhance
health outcomes and patients’ experiences, reduce costs and facilitate a healthy work environment for all
providers. Interprofessional models of care have been gaining attention as the healthcare system seeks a
model that is patient-focused and emphasizes health-care professionals working collaboratively within
their full scope of practice.
Interprofessional care in a healthy work environment is a product of synergy among health-care teams,
who demonstrate expertise in its six key domains, fundamental for transforming work environments to a
collaborative interprofessional environment. The six themes are: 1. Care expertise; 2. Shared power; 3.
Collaborative leadership; 4. Optimizing profession, role and scope; 5. Shared decision making and 6.
Effective group functioning. When interprofessional care has been successfully implemented and
sustained, continuous improvement quality and safety occur on three levels—for patient/clients, for
interprofessional providers and for the organization and system.
There are many evidence-based processes that can be used to enhance interprofessional care. To do
this individuals practitioners can contribute to interprofessional practice cultues by:
• Practising and collaborating with colleagues, patients/clients and families in a way that fosters
respect, trust and understanding;
• Understanding their roles and expertise, reflecting on their practice, being confident in their own
abilities, and expertise, knowing the standards and boundaries of their practice and recognizing
when it’s time to turn to other team members; and
• Developing communication and conflict-management skills.
Teams of interprofessional staff are often acutely aware of the power differentials that exist when they
work actoss disciplines. It is important for teams to:
• Building a collaborative environment through recognizing and understanding power and its influence
on everyone involved;
• Creating balanced power relationships through shared leadership, decision making, authority, and
responsibility;
• Including diverse voices for decision making;
• Sharing knowledge with each other, openly; and
• Working collaboratively with patients/clients and their families to plan and deliver care.

It is important for all heath care professionals to be aware of their contribution to the interprofessional
team and their "team intelligence quotient". This presentation will incorporate a discussion of power as it
relates to the interprofesional team, and an opportunity for self assessment of the six
interprofessional competencies.
Contact
[email protected]

C 12 - EBP Moving Global Practice
Measuring Endoscopic Performance for Colorectal Cancer Prevention Quality
Improvement in a Gastroenterology Practice
Karen A. Hande, DNP, MSN, BSN, RN, ANP-BC, USA
Purpose
to demonstrate a DNP project to assess and improve adherence to colon cancer prevention (CRC-P)
benchmarking measures in a gastroenterology practice. Performance gaps and causes of deficiencies will
be presented. Practice changes for improvement in the quality and effective delivery of CRC-P care will
be emphasized.
Target Audience
nurses with a role in quality improvement for the delivery of care within his or her own domain of practice.
Nurses seeking how to improve patient outcomes and sustain levels of excellence in the delivery of care
by translating, evaluating, and applying science to practice will benefit from this presentation.
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death in the United States, but the majority
of cases are thought to be preventable by the use of screening colonoscopy. A gastroenterology private
practice lacked quality measures to evaluate the practice’s efforts to prevent CRC. This project assessed
the practice’s adherence to CRC prevention (CRC-P) benchmarking measures regarding colonoscopy
performance. Colonoscopy performance data were gathered from a retrospective review of 90 charts
using a modified form of The Colorectal Cancer Prevention Data Collection Form. The practice
stakeholders and the project leader reviewed the data, identified practice deficiencies, conducted root
cause analysis, and developed practice changes to implement. System issues were discovered as the
root cause for practice deficiencies. Implementing the prioritized recommendations and routinely
benchmarking care were warranted to ensure effective practice to improve outcomes for CRC-
P. Achieving higher-value care has led to increased efforts to improve systems for measuring care, using
these measures for quality improvement and directly linking quality outcomes to reimbursement.
Contact
[email protected]

Munchausen By Internet: A Netnographical Case Study
Cynthia A. Witney, RN, MHA, DipTch (Nsg) GradDipAdmin (Hlth), Australia
Joyce Hendricks, PhD, RN, RM, Australia
Vicki Cope, PhD, RN, RM, MHS, Australia
Purpose
The purpose of this presentation is to highlight through a case study, how a member of an online support
community for breast cancer sufferers was identified as possibly suffering from a factitious disorder and
how the member was managed to leave the site without causing distress to other members.
Target Audience
The target audience of this presentation is health professionals, who are members of online support
communities or who are employed to provide online evidence-based education, advice and support for
those with a life threatening disease, their family and friends.
Abstract
The Internet is a global phenomenon that provides a conduit for people to meet and collaborate without
ever meeting face to face. As such, issues of truthfulness and trust are ongoing for all those who choose
to click the mouse and enter cyberspace. This paper presents a case study drawn from a wider research
project using netnography (Kozinets, 2010) where a purpose built www site called
www.breastcancerclick.com.au or ‘the Click’ was developed and managed.
Netnography has been used for more than a decade by researchers in the consumer and marketing field,
thus is not now a new term and is widely accepted by these researchers as the preferred term to describe
ethnographic research applied to the study of online communities and cultures (Kozinets, 2010). When
Crotty’s scaffolding for research is applied to netnography, a relatively new research methodology, it
appears that it can be positioned in one of two ways, either under the category of ethnography as a
variation of ethnography (Crotty, 1998, p. 5), or because of the way the study is pursued per online
observation and interaction between researcher and research participants, as a new type of methodology.
'the Click' is a member only online therapeutic community set up to support people with breast cancer and
their family and friends. This case study reveals that a member of this online community was identified
with behaviors consistent with a factitious disorder the more extreme type of which is referred to as
Munchausen Syndrome. When Munchausen Syndrome occurs online it is referred to as Munchausen by
Internet. If the person also fabricates illnesses for immediate family members online it is known as
Munchausen by proxy by Internet (Cunningham & Feldman, 2011, p. 185). The aim of this case study is
to highlight how nurses and others can identify members of health related online support communities
who are untruthful, using some of the aids to diagnosis of a factitious disorder and management
strategies developed by Feldman (2000).
References
Crotty, Michael. (1998). The foundations of social research: Meaning and perspective in the research process:
Sage.Cunningham, J., & Feldman, M. (2011). Munchausen by Internet: Current perspectives and three new cases.
Psychosomatics, 52(2). Feldman, M. (2000). Munchausen by proxy: detecting factitious illness and crisis on the
Internet. Southern Medical Journal, 93(7), 669 - 672. Kozinets, R. (2010). Doing Ethnographic Research Online. Los
Angeles: Sage.
Contact
[email protected]

The Impact of Computerized Clinical Decision Support on Diagnostic Accuracy in
Nurse Practitioners
MaryJo Vetter, MS, RN, ANP, GNP, DNP, USA
Purpose
The presentation describes computerized clinical decision support (CCDS) as intervention with the
potential to improve clinical processes and health outcomes. Integration of this innovation in practice
benefited from using an implementation science framework to inform the development, implementation
and evaluation of an improvement project to promote adoption of this technology.
Target Audience
The target audiences are all clinicians and administrators interested in computerized clinical decision
support and the use of an implementation science methodology to promote innovation in practice.
Abstract
Clinical decision support (CDS) at the point of care is an evidence based intervention that has
demonstrated incremental positive impact on quality of health care delivery over the past two
decades. CDS information technologies help close the gap between healthcare provider knowledge and
performance. CDS systems offer the potential to improve overall care safety, foster evidence based
practice, optimize cost effectiveness and reimbursement for care, enhance patient education, and meet
regulatory reporting requirements. CDS systems have been studied extensively and identified as an
evidence based intervention that can positively impact practitioner performance in the areas of medication
prescription, preventive care, disease management and diagnostic accuracy.
This practice improvement project tested the impact of a newly acquired electronic clinical decision
support system on diagnostic accuracy among nurse practitioners (NPs) functioning in a community
based setting. Nurse practitioners delivering primary care in a home visiting practice are especially
vulnerable to lack of knowledge support as they are mobile in the community and often feel isolated from
peers and experts who can support clinical decision making. A CDS accessed via wireless broadband
was viewed as a means to assist these clinicians to deliver care based on best practice recommendations
obtainable via laptop or smartphones at the time of the patient encounter. To ensure adoption of
electronic decision support systems, the approach to integration is best accomplished by involving end-
users throughout the process. In addition to a pilot group of NPs who were representatives of the
workforce, other organizational stakeholders were engaged to provide tangible support and necessary
resources for successful adoption of this innovation in practice. A structured conceptual model of
Evidence Based Practice Improvement (EBPI) enhanced with elements of the Promoting Action on
Research Implementation in Health Sciences (PARIHS) framework was used to guide the development,
implementation and evaluation of the improvement initiative and ultimately informed decision making
about CDS dissemination strategies for the entire practice. Using an implementation science approach
helped illuminate the internal and external evidence that informed parameters of the work and elicited
both patient and clinician input in the process. Attention to the culture of the practice setting including
leadership attributes and availability of project evaluation support defined the local context of the
improvement effort. The nature of the facilitation required to ensure adoption of the CDS system was
designed to be flexible based on the nature of the evidence, the expectations of stakeholders and the
purpose of this evidence based practice change.
Data collection was comprised of small tests of change (Plan, Do, Study, Act cycles) at the local practice
level. Results informed refinement of CDS implementation processes that facilitated improvement in the
correctness of medical diagnosis and appropriateness of substantiating clinical documentation over
time. Clinician volunteers participated in vendor demonstrations and selection of the CDS system for the
practice. A baseline chart audit was conducted using an audit tool that sought to identify that the primary
diagnosis accurately reflects the current, most significant reason for the clinical encounter and that the
secondary diagnoses are identified and substantiated in documentation found in the review of systems,

history of present illness, diagnostic tests and physical examination. Clinical documentation elements
must be linked to the chosen ICD-9 code which was expected to be of the highest diagnostic
specificity. After training on the CDS system, charts of each participant were audited for the next three
months to assess the impact of the CDS system availability on diagnostic accuracy. After several
improvement cycles produced acceptable diagnostic accuracy results on chart audit, a focus group with
the pilot NPs was conducted to determine the level of satisfaction with the CDS system and input on CDS
system dissemination strategies to promote integration of decision support systems across the
practice. In this practice setting, use of a CDS system by nurse practitioners was effective in impacting
the outcome of diagnostic accuracy. Qualitative and quantitative data informed multiple strategies to
guide ongoing improvement efforts aimed at sustaining long term results.
References
Bryan, C., & Boren, S.A. (2008). The use and effectiveness of electronic clinical decision support tools in the
ambulatory/primary care setting: a systematic review of the literature. Informatics in Primary Care, 16, 79-91. Garg,
A.X., Adhikari, N.K., McDonald, H., Rosas-Arellano, M.P., Devereaux, P.J., Beyene, J….Haynes, R.B. (2005). Effects
of computerized clinical decision support on practitioner performance and patient outcomes. Journal of the American
Medical Association 293(10), 1223-1238. Garrett, B., & Klein, G. (2008). Value of wireless personal digital assistants
for practice: perceptions of advanced practice nurses. Journal of Clinical Nursing, 17, 2146-2154. Kawamoto, K.,
Houlihan, C.A., Balas, A., & Lobach, D.F. (2005). Improving clinical practice using clinical decision support systems: a
systematic review of trials to identify features critical to success. BMJ, March 14. Kitson, A., Harvey, G., &
McCormack, B. (1998) Enabling the implementation of evidence based practice: a conceptual framework. Quality in
Health Care, 7, 149-158. Krauskopf, P., & Farrell, S. (2011). Accuracy and efficiency of novice nurse practitioners
using personal digital assistants. Journal of Nursing Scholarship, 43(2), 117-124. Levin, R.F. (2012). Involving
stakeholders in determining the clinical problem: A learning Activity. In R.F.Levin & H.R. Feldman (Eds.), Teaching
evidence-based practice in nursing: A guide for academic and clinical settings (2nd Ed.). NY: Springer. Levin, R. F.,
Keefer, J. M., Marren, J., Vetter, M., Lauder, B., & Sobolewski, S. (2010). Evidence-based practice improvement:
merging 2 paradigms. Journal of Nursing Care Quality, 25(2), 117-126. Maloney, C., & BNur, L.B. (2009). Perceived
facilitators and inhibitors for the use of personal digital assistants (PDAs) by nurses: a systematic review. JBI Library
of Systematic Reviews, 7(33), 1431-1488. Osheroff, J.A., Pifer, E.A., Sittig, D.F., Jenders, & Teich, J.M. (2004).
Clinical decision support Implementers workbook. Chicago, Il: Health Information Management and Systems Society.
Primary Care Development Corporation (2012). Translating evidence into practice: A how-to Manual for implementing
clinical decision support. Retrieved from http://www.pcdc.org/resources/quality-improvement/translating-evidence-
into-practice.html Randell, R., & Dowding, D. (2010). Organisational influences on nurses’ use of clinical decision
support systems. International Journal of Medical Informatics, 79, 412-421. Rycroft-Malone, J. (2010). Promoting
Action on Research Implementation in Health Services. In Jo Rycroft-Malone & Tracey Bucknall (Eds.), Models and
Frameworks for Implementing Evidence Based Practice: Linking Evidence to Action (109-135). Oxford, United
Kingdom: Wiley Blackwell. Rycroft-Malone, J., & Bucknall, T. (2010). Theory, frameworks, and models Laying down
the groundwork, In Jo Rycroft-Malone & Tracey Bucknall (Eds.), Models and Frameworks for Implementing Evidence
Based Practice: Linking Evidence to Action (109-135). Oxford, United Kingdom: Wiley Blackwell. Stetler, C.B.,
Damschroder, L.J., Helfrich, C.D., & Hagedorn, H.J. (2011). A guide for applying A revised version of the PARIHS
framework for implementation. Implementation Science, 6(99). Stoud, S., Erkel, E., & Smith, C. (2005). The use of
personal digital assistants by nurse practitioner students and faculty. Journal of the American Academy of Nurse
Practitioners, 17(2), 67-75. Stroud, S., Smith, C., & Erkel, E. (2009). Personal digital assistant use by nurse
practitioners:a descriptive study. Journal of the American Academy of Nurse Practitioners, 21, 31-38. Weber, S.
(2007). A qualitative analysis of how advanced practice nurses use clinical decision support systems. Journal of the
American Academy of Nurse Practitioners,19, 652-667.
Contact
[email protected]

C 14 - Incivility in Nursing Practice
Bullying and Its Prevention Among a National Sample of Israeli ICU Nurses
Freda DeKeyser Ganz, RN, PhD, Israel
Purpose
to describe the prevalence of bullying as well as what measures were taken to prevent it, as perceived by
a national sample of Israeli ICU nurses.
Target Audience
all nurses, but especially ICU nurses
Abstract
Purpose: The purpose of this study was to describe the prevalence of bullying as well as what measures
were taken to prevent it, as perceived by a national sample of Israeli ICU nurses
Background: Bullying refers to repeated, offensive, abusive, intimidating, or insulting behaviors; abuse of
power; or unfair sanctions that make recipients feel humiliated, vulnerable, or threatened, thus creating
stress and undermining their self-confidence (Embree, & White, 2010; Hutchinson, Wilkes, Jackson &
Vickers, 2010; Murray, 2009; Rowell, 2005; Yildrim & Yildrim, 2007). This phenomenon has been shown
to be widespread within nursing in many different countries around the world (For example, Johnson &
Rhea, 2009; RCN, 2002; Vessey, DeMarco, Gaffney & Budin, 2009; Yildrim & Yildrim, 2007).
Bullying has been shown to have both physical and psychological consequences for the victim (Murray,
2009; Rowell, 2005; Katrini) and to affect patient care (Woelfle & McCaffrey, 2007), leading to decreased
job satisfaction and increased burnout (Laschinger, Grau, Finegan & Wilk, 2010).
There has been some literature that has described how to prevent bullying (Katrini, Atabay, Gunay &
Cangarli, 2010). These measures include increased awareness about the potential presence of bullying
and the development of institutional protocols that call for the documentation of bulling with disciplinary
action against it (Katrini, et al., 2010; Lewis, 2006; MacIntosh, 2006)
At present there are no reports that describe the prevalence of bullying among nurses in Israel nor are
there reports of what actions are taken to prevent its occurrence. Furthermore, no study was found that
investigated bullying only among critical care nurses, despite the fact that these units have been shown to
have a high prevalence of bullying.
Methods: This was a cross sectional, correlational, descriptive survey.
Sample: The sample was a convenience sample of 155 ICU nurses. Members of the Evidence Based
Practice Subgroup of the Israeli Society of Cardiology and Critical Care Nursing recruited ICU nurses
from five medical centers. As the primary purpose of the study was to describe the prevalence of bullying
and its perceived prevention, it was determined that data collectors would try and recruit a maximum
amount of respondents without concern for statistical power.
Data collection: Data were collected after institutional and ethical approval at each institution. Head
nurses were contacted and asked to approve participation of members of their units. A pilot test of the
initial 25 respondents was conducted. Questionnaires were found to be clear and so the results of the
pilot were included in the final results. Questionnaires were administered according to the preference of
the local administration, either in staff meetings or participants were approached individually on their
respective units. All responses were placed in an envelope at a central location and were anonymous.
Instruments: Three questionnaires were used:
a. Demographic and work characteristics questionnaire, including personal demographic
and work-related data.
b. Negative Acts Questionnaire-Revised: a 22 item, Likert-style questionnaire developed by
Einarsen, and colleagues in 1994 and revised in 2009 (Einarsen, Hoel & Notelaers, 2009)

to measure the level of exposure to bullying in the workplace. It was found to have
acceptable levels of reliability and validity.
c. Bullying Prevention Questionnaire: developed by the investigators to determine
measures currently available to prevent bullying. This questionnaire contains 42 items on
a 4 point Likert scale and lists measures conducted by institutions, units and
individuals. The questionnaire is based on a review of the bullying literature and
underwent content review.
Data Analysis: Descriptive statistics were conducted on all of the questionnaires. Bivariate analyses
were conducted to determine if there are any demographic or work characteristic variables associated
with bullying or perceived prevention. Those characteristics found to be significantly associated were
used as predictor variables in a logistic regression model with bullying as the criterion variable.
Results: The sample consisted of 155 ICU nurses. The majority of the sample was female (n=102,
69%), married (n=112, 77%) and Jewish (n = 96, 67%). Most worked as staff nurses (n=111, 76%), had
a baccalaureate nursing education (n=87, 60%) with post-basic ICU certification (n=122, 83%) with a
mean age of 41.3 (SD= 9.9) and 11.5 years experience as an ICU nurse (SD=9.0).
Almost one third of the respondents (n= 43, 29%) reported being the victim of some bullying, although no
one reported being bullied on a daily basis. The mean total score on the NAQ-R was 33.3 (SD=11.6)
with a mean item score of 1.6 (SD= 1.4) out of 5. The mean Bullying Prevention total score was 96.8
(SD=14.4, range: 48-140, out of a possible 168) with an item mean score of 2.4 (out of 4) (SD= 0.3);
Results for the subscale scores were: institutional prevention: item mean= 2.7 (SD= 0.5); unit prevention:
item mean = 2.2 (SD=0.4) and individual prevention: item mean 2.4 (SD=0.3).
A significant difference in the level of bullying was found between hospitals (F (4,155) = 2.7, p=.039). The
mean scores on the Prevention Scale was found to differ between type of unit (F (5,143) = 3.4, p=.006)
and hospital (F (4,155) = 2.9, p.026). However post-hoc Bonferroni analyses did not find significant
differences between specific hospitals or units. The Prevention Scale was found to significantly correlate
with that of the NAQ-R (r= .58, p < .001). No other variables were found to be associated with either the
bullying or prevention scores, therefore regression models were not created.
Conclusion: An alarming percentage of nurses were found to have been victims of bullying in their
workplace. The prevalence of bullying fell between levels presented in the literature (RCN, 2002;
Johnson and Rhea, 2009; Yildrim & Yildrim, 2007). This result is despite current policies of zero
tolerance for bullying. On the other hand, those who reported being bullied, were not bullied on a daily
basis and levels were low to moderate for specific bullying actions.
The level of prevention was weak to moderate with little difference between measures taken by the
individual, unit or institution. Prevention and perceived level of bullying significantly differed between
hospitals and types of units while no other demographic or work characteristic was found to be
associated. These results imply that bullying and its prevention happen for the most part at a unit and
hospital level. Others have found some individual characteristics related to bullying but this finding was
not seen in this study.
Implications: The results of this study suggest that on a policy and administrative basis, more measures
must be taken and adhered to, related to prevention of bullying. Nurses must be educated to accept only
a zero tolerance to bullying and to report bullying when confronted with it. More research should be
conducted to determine what other factors are associated with bullying, and based on these results, to
design interventional studies to prevent it.
References
Einarsen, Staale, Hoel, H., & Notelaers, G. (2009). Measuring exposure to bullying and harassement at work:
valdidity factor strucure and psychometric properties of the Negative Acts Questionniare-revised. Work & Stress,
23(1), 24-44. Embree, J.L., and White, A.H. (2010). Concept Analysis: Nurse-to-Nurse Lateral Violence. Nursing
Forum, 45 (3), 166-173. Hutchinson, M., Wilkes, L., Jackson, D., & Vickers, M.H. (2010). Integrating individual, work
group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. Journal of
Nursing Management, 18, 173–181 Johnson, S.L. & Rhea, R.E. (2009). Workplace bullying, Journal of Nursing
Administration, 39(2), 84-90. Laschinger, H.K.S., Grau, A.L., Finegan, J. & Wilk, P. (2010). New graduate nurses'

experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing, 12, 2732-2742. Lewis, M.A.
(2006). Nurse bullying: organizational considerations in the maintenance and perpetration of healthcare bullying.
Journal of Nursing Management, 14, 52-58. MacIntosh, J. (2006). Tackling work place bullying. Issues in Mental
Health Nursing, 27, 665-679. Royal College of Nursing (2002). Working Well Initiative, p. 39, retrieved from
http://www.RCN.org.il Rowell, P.A. (2005). Being a "target" at work. Journal of Nursing Administration, 35(9), 377-
379. Vessey, J.A., DeMarco, R.F., Gaffney, D.A., & Budin, W.C. (2009). Bullying of staff registered nursesin the
workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile
to healthy work environments. Journal of Professional Nursing, 25(5), 299-306. Yildrim, A. & Yildrim, D. (2007).
Mobbing in the workplace by peers and mangagers: mobbing experienced by nurses working in healthcare faciltities
in Turkey and its effect on nurses. Journal of Clinical Nursing, 16, 1444-1453.
Contact
[email protected]

Come In…The Water's Warm: A New Nurse's Induction to a Hostile Environment
Josiane Hickson, BSN, MA, EdD, RN, NE-BC, USA
Purpose
The purpose of this presentation is to: discuss characteristics of nursing hostility and the implications
towards nursing practice; differentiate the role/responsibilities of nurses involved with nursing hostility;
and discuss the strategies for discouraging nursing hostility and promoting a healthy work environment.
Target Audience
The target audience of this presentation is: nursing students, nursing educators, registered nurses,
nursing leaders, and nursing administrators.
Abstract
The success for the future of the nursing profession has relied upon the cultivation, assimilation,
professionalism, and satisfaction of newly licensed Registered Nurses (RNs). This presentation was
prompted by the descriptive study which investigated the perceptions of nursing hostility and job
satisfaction of new graduate nurses with less than three years of experience (N = 1,165), comparing the
working settings of Magnet and non-Magnet hospitals. An online survey was conducted using the
Negative Acts Questionnaire-Revised (Einarsen, Hoel, & Notelaers, 2009), the McCloskey/Mueller
Satisfaction Survey (Mueller & McCloskey, 1990), the Casey-Fink Graduate Nurse Experience Survey
(Casey, Fink, Krugman, & Propst, 2004), and a demographic questionnaire, through an advertisement on
Facebook which targeted individuals based on the specifications of this study‘s focus.
Findings indicated that RNs of Magnet and non-Magnet facilities had similar hostility and job satisfaction
results. Magnet nurses (n = 226) perceived nursing hostility significantly different than non-Magnet nurses
(n = 939); however, both groups reported a global perception of nursing hostility as new graduate nurses.
Additionally, there was a statistically significant difference (p < .001) indicating higher job satisfaction
among Magnet RNs. Furthermore, perceptions of comfort, confidence, and support revealed marginal
differences between both groups (p < .05), though these attributes of satisfaction were higher among
Magnet nurses.
Results indicated that RNs of Magnet facilities (48%) and non-Magnet facilities (49%) were classified as
victims of bullying. More than 70% of Magnet and non-Magnet RNs identified their level of job satisfaction
as moderately dissatisfied to very dissatisfied. More than 80% of RNs from both groups perceived a lack
of comfort, confidence, and support in their current job.
The theory of oppression provided a model for understanding the dynamics and the effects of nursing
hostility and job satisfaction of newly RNs. Based on this study’s findings, greater consideration should be
placed on: orientation/residency programs, collaborative partnerships between academia and service,
zero-tolerance for behaviors that undermine a culture of safety, and addressing nursing hostility.
References
American Nurses Association. (2011). Code of Ethics for Nurses. Retrieved from
http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf Center for
American Nurses. (2008). Lateral violence and bullying in the workplace. Retrieved from
http://www.upaya.org/uploads/pdfs/PositionStatementLateralViolenceandBullying.pdf Felblinger, D. M. (2008).
Incivility and bullying in the workplace and nurses’ shame responses. Journal of Obstetric, Gynecologic, and
Neonatal Nursing, 37(2), 234-242. doi:10.1111/j.1552-6909.2008.00227.x Griffin, M. (2004). Teaching cognitive
rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing
Education in Nursing, 35(6), 257-263. Hickson, J. (2013). New nurses’ perceptions of hostility and job satisfaction:
Magnet versus non-Magnet. Journal of Nursing Administration, 43(5), 293-301. Joint Commission. (2008). Behaviors
that undermine a culture of safety. Retrieved from
http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm Thomas, C. (2010). Teaching nursing
students and newly registered nurses strategies to deal with violent behaviors in the professional practice
environment. The Journal of Continuing Education in Nursing, 41(7), 299-308.

Contact
[email protected]

The Pebble Effect: Stopping Incivility in Clinical Environments
Cathleen Opperman, RN, MS, CPN, USA
Purpose
The purpose of this presentation is to demonstrate an effective method to move the common culture of
many clinical practice settings from incivility, poor communication and low staff satisfaction to respectful,
assertive and fulfilling professional practice.
Target Audience
The target audience for this presentation is interdisciplinary team members working in clinical
environments. Managers, Administrators, Clinical Educators and Multidisciplinary Leadership will find this
Workshop helpful.
Abstract
Purpose: The Pebble Effect: Stopping Incivility in Clinical Environments is a reporting of an effective
educational strategy used to improve the communication patterns and staff engagement of a 400 bed
hospital. Requests in our annual learning needs assessments, as well as feedback from continuing
education programs identified a strong desire by interdisciplinary clinical staff to eliminate coworker
incivility, horizontal hostility, bullying, lateral violence and intimidation.
Background: The literature review identified incivility as a widespread problem in healthcare. Whether
labeled as coworker incivility, horizontal hostility, bullying, lateral violence or intimidation, it is known to
contribute to missed communication, moral distress, preventable errors, low patient satisfaction and staff
turnover. The challenge was that simply inservicing staff to “be nice and patient with each other” is not
effective in changing deep rooted behavior. The literature described numerous educational activities
which focused individually on the knowledge, skills and attitudes needed to reshape the culture and
therefore change the behaviors. However, no educational intervention described a combination of all
three of these components. Through the efforts of a small group of clinical Educators, we developed a
day-long interactive Workshop based on Kathleen Bartholomew’s “Ending Nurse to Nurse Hostility,” and
Martha Griffin’s “Teaching Cognitive Rehearsal as a Shield for Lateral Violence.”
To encourage nursing staff initially to participate, we provided continuing education credits for the
day. Soon, we realized that providing incentives were not necessary because the demand for the
solution to this problem was so high, that we actually had waiting lists of 20 or more and other disciplines
were finding the topic and content appropriate and desired as well. In fact, after participating, some
managers were trying to scheduling all their staff to participate.
Design approach: The teaching strategy was a workshop design because changing behavior not only
needed knowledge (through reading before the workshop and lecture during) but practice with the skills
and a change in attitude regarding the tolerance of poor behaviors. The skills needed to respond in
various situations include use of cognitive rehearsal and DESC formulated statements for initiating
difficult conversations. These skills are practiced with role playing exercises and case scenarios in the
workshop. The focus on attitudes is the most challenging, yet most essential, in order to make a change
in the culture. With attitude, the educational activities need to help each individual recognize how they
contribute to the environment that enables these poor behaviors. When asked, many staff said that
“there are no problems with THAT on our unit,” yet in the next breath they describe how they “work
around this person” or “avoid that person.” With stakes as high as the death of a patient, the first step to
changing our culture is raising awareness that poor behaviors are present in our work area and choosing
to avoid only condones them. The educational activities designed to change attitudes regarding incivility
include self-reflection, telling stories of targets of incivility, and the “I can/We can” exercises.
A survey was completed before the workshop began and 6 months later to compare the change in
perception of incivility. The survey asked participants to score “respect”, “support” and comfort with
“sharing my opinions” with coworkers, charge nurses, supervisors, educators and managers. They scored

each individually. After the first two groups commented on how the workshop day changed their
understanding of how much poor behavior was on their unit, many commented that they wanted go give
different scores on the survey as a baseline. From these repeated comments, we started asking the
groups to complete the survey at the beginning and at the end of the workshop day. The scores on
respect and support of various members of the clinical team, as well as comfort communicating with each
dropped over the course of the day. The comments explaining this were that at the beginning of the
workshop they were not aware of how tolerant of poor behavior they had become and how the culture of
the work group was unacceptable in this regard. One person even stated that when her Clinical Leader
was “mean and unapproachable,” she now understands that this is “not a good management style of
strength,” but instead is it disrespectful and causes moral distress. Therefore from the changes in scores
from beginning to end of the workshop, we can conclude that awareness was heightened and attitudes
open to change.
Results: The first offering of this workshop had over 50 participants with tremendous evaluations and
word of mouth spread causing 4 subsequent workshops to be moved into the auditorium to accommodate
120 or more participants in each workshop. Over 650 interdisciplinary staff participated in the first 5
offerings. Anecdotal comments from unit managers described situations where they witnessed staff
removing themselves from situations when others were gossiping or an increase in overheard
compliments and “thank-yous” to coworkers. This caused one nurse practitioner to comment that “they
sure drank the kool-aid.” Within a week of one workshop, this author received an email from a participant
that used the DESC formula to assertively talk with someone about a misunderstanding and now feel a
mutual respect for each other.
Conclusions/ value of this presentation: The 6 month survey results will be available during the
presentation along with the agenda for the workshop and description of many of the educational
activities. Clearly, in order to change a culture of incivility to one of inquiry, mutual respect and genuine
concern for coworkers and patients, the knowledge, skills and attitudes must be included in educational
endeavors.
References
Bartholomew, K., (2010). Ending Nurse to Nurse Hostility. Juice Healthcare Series: Raising Awareness.Videotape
www.juicehealthcare.com. Griffin, M. (2004). Teaching Cognitive Rehearsal as a Shield for Lateral Violence: An
Intervention for Newly Licensed Nurses. The Journal of Continuing Education in Nursing • 35,(6) 257-263. Hutchinson
M. Bullying as workgroup manipulation: a model for understanding patterns of victimization and contagion within the
workgroup [published online ahead of print May 23, 2012]. J Nurs Manag. 2012. doi:10.1111/j.1365-
2834.2012.01390.x Hutchinson M.(2009). Restorative approaches to workplace bullying: educating nurses towards
shared responsibility. Contemporary Nurse: A Journal for the Australian Nursing Profession (CONTEMP NURSE),
2009 Apr-Jun; 32 (1-2): 147-55. Hutchinson M, Wilkes L, Vickers M, Jackson D . (2008) The development and
validation of a bullying inventory for the nursing workplace. Nurse Researcher, 13515578, January 1, 2008, 15(2), 19-
29. Manion, J.and Bartholomew, K.(2004). Community in the Workplace: A Proven Retention Strategy JONA, 34 (1)
46-53.
Contact
[email protected]

D 12 - Leadership in the Clinical Setting
The Ankle Blood Pressure Study: An Exemplar Project of Mentoring, Leadership,
and Collaboration to Promote Nursing Research
Rhonda E. Maneval, DEd, RN, USA
Kimberly A. Fowler, RN, MSN, USA
Purpose
to describe the evolution of a clinical practice question from inception through completed research study,
delineate the roles of the nurses involved,in particular the advanced practice nurse, and present the
outcomes of the project, both from a practice and professional development perspective.
Target Audience
professional and advanced practice nurses engaged in evidence-based practice and nurse leaders
responsible for advancing nursing evidence-based practice and research within their organizations.
Abstract
The purpose of this presentation is to describe the evolution of a clinical practice question from evidence-
based practice project to research study and delineate the roles of all nurses involved, with particular
attention to the role of the advanced practice nurse. Additionally, the presentation will focus on the
outcomes of the project, both from a practice perspective as well as a professional development
perspective. Strong leadership by the APN and the commitment to the mentoring process by the team
contributed to project success. This project serves as an exemplar for those wanting to increase nurse
engagement in research and nursing's influence within organizations.
In the Magnet® organization where this project took place, advanced practice nurses (APNs) are charged
with providing guidance for staff nurses regarding EBP and research. The APNs at this institution are
Master’s prepared nurses who hold the title of Clinical Nurse Specialist (CNS). Involvement in research
activities, including interpretation, translation, evaluation, and conduct of EBP and research, is an
essential component of the CNS role as identified by the 2004 National Association of Clinical Nurse
Specialists (NACNS) Statement on Clinical Nurse Specialist Practice and Education (NACNS, 2004). In
addition, the American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in
Nursing requires that graduates be prepared to lead the healthcare team in the implementation of EBP
and serve as role models and mentors for evidence-based decision making in practice (AACN, 2011).
The project began when a BSN nurse approached the cardiovascular specialty CNS and cardiovascular
nurse educator about the use of the ankle as an alternative site for blood pressure (BP) measurement.
The BSN nurse relayed that she had observed this practice being done by her colleagues when the arm
was not available for use. She wanted to know if an ankle BP was an acceptable option. The BSN nurse
was encouraged by the CNS to investigate this clinical question by participating in Research Roundtable
(Harne-Britner & Schafer, 2009). Research Roundtable is a collaborative effort, led by a team of CNSs,
in which staff nurses and senior baccalaureate nursing students, with the support of academic nurse
faculty, investigate clinical questions. Research Roundtable enables nurses to bring clinical questions
forward and to work with a group to explore the available evidence and determine if a practice change is
warranted or if additional research is needed. Under the guidance of the CNS, evidence related to this
EBP project was examined, and it was determined that there was a lack of evidence to either support or
discontinue the use of ankle BPs. The CNS met with the BSN nurse and the cardiovascular nurse
educator, who together decided that the next step would be the development of a formal research
proposal. To facilitate this work, the CNS recommended that the nurse apply for a Nursing Research
Fellowship. With the support from the team, the nurse was granted the Research Fellowship, which
provided release time for scholarly work and development of the proposal. The CNS contacted the
academic nurse researcher and elicited her support and expertise for the project. In addition, the CNS
served as a mentor to the BSN nurse in the writing of the proposal and championed the proposal through
the approval processes, which included the Nursing Research Council and the institutional review board.
The study was granted approval. Upon initiation of the study, the team was assembled, which included

the BSN nurse, CNS, cardiovascular nurse educator, and the academic nurse researcher. Roles were
delineated, and the timeline established.
During initiation of the study the nurse researcher served as a mentor and guide to the team regarding
study design, methods, and data analysis. The CNS ensured the integrity of the research process by
obtaining institutional review board approval, managing consent procedures, piloting data collection tools,
and monitoring the integrity of the data collection process. The BSN nurse served as the lead data
collector and recruited other nurses to the data collection team. She mentored here peers in the data
collection process and shared information about the study with other nurses on the unit and throughout
the organization.
In order to assess BP reading agreement between the arm and the ankle, the team performed a series of
3 readings for each subject and 2 sets of readings were recorded, 1 for the arm and the second for the
ankle. The results for all 3 tests and 6 pairings indicate that the readings taken at the arm are significantly
different (P < .001) from those taken at the ankle. Four composite mean readings (arm systolic, arm
diastolic, ankle systolic, and ankle diastolic) were computed for each subject across his/her 3
measurements. The mean (SD) arm systolic reading was 129.59 (16.13) mm Hg, whereas the mean
ankle systolic reading was significantly higher at 153.05 (15.55) mm Hg (P < .001). This was also true for
the diastolic readings, with a mean (SD) arm diastolic BP of 72.27 (8.93) mm Hg and mean (SD) ankle
diastolic BP of 82.62 (10.66) mm Hg (P < .001). The difference in scores for each subject was also
calculated. The mean difference in ankle systolic readings was determined to be 23.49 mm Hg (95%
confidence interval [CI], 21.44-25.54) higher than arm reading. For diastolic BP, the mean difference in
ankle readings was 9.35 mm Hg (95% CI, 8.23-10.46) higher than arm readings. Bland-Altman analysis
(Bland & Altman, 1995) revealed that there was considerable variation in the difference scores by
individual subjects. The SD of the difference in systolic BP was 13.65 mmHg, and for diastolic, it was 7.41
mm Hg; therefore, it is estimated that 95% of patients could have ankle measurements of systolic BP
readings that are 50.84 mm Hg above or -3.78mmHg below their arm measurements. For diastolic
pressure, the ankle readings could be 24.14 mm Hg above or -5.52 mm Hg below the arm
measurements. (For a full description of the study, detailed results, and limitations see Maneval, et, al.,
2014). The data suggest that arm and ankle BP measurements are not comparable, and there was not a
predictable relationship between the two measurements.
As a result of the study findings the quality of patient care was impacted through the development of a
new practice guideline by the CNS for ankle BP measurements and the education of staff nurses. The
findings of the study suggest that ankle BP measurements lack agreement, and often overestimate both
systolic and diastolic BP, when compared with arm BP measurements; thus, individual differences in
variation calls into question the practice of relying on ankle BP measurements in routine clinical practice.
The CNS, aware that nurses are faced with a difficult dilemma when attempting to obtain BP
measurements when the upper arm is not a viable option, crafted a new practice guideline to address this
issue. The guidelines call for obtaining baseline arm and ankle BP measurements upon admission. Then,
if ankle measurements become necessary, a comparison is to be made based upon the individual
patient’s arm and ankle systolic and diastolic differences. By doing this, the ankle BP measurement is
understood in the context of the individual patient’s BP measurements.
The CNS educated the nurses on the complexity of interpreting BP readings taken at the ankle and the
importance of careful consideration of the meaning of the results for the individual patient. The
importance of consistency in choice of extremity used and the need for careful charting of the location of
each BP measurement was communicated as a crucial component of ankle BP measurement. The CNS
worked to modify the electronic medical record so that alternative sites could be documented. The CNS
has continued to facilitate the development of organizational policies that require baseline assessment of
arm and ankle BP for select patients and the proper documentation of those results.
The project also enhanced opportunities for mentoring relationships which increased knowledge and
confidence of the team in both the EBP process and research process. Mentoring occurred between the
nurse researcher and the CNS, the CNS and the BSN nurse, and the BSN nurse and peers. The CNS
also mentored the BSN nurse in the creation of a poster and podium presentation on the study for
dissemination at both local and national conferences.

Additionally, leading the research project elevated the CNS’s visibility and influence within the
organization by clearly demonstrating the value of the CNS in the research process and the impact that
nursing research has on nursing practice and patient outcomes. Participation by the BSN nurse
demonstrated to peers, managers, and administrators the key role bedside nurses have in identifying
clinical issues and supporting the research process through active engagement. As demonstrated by
this project, nurses engaged in the EBP process and the conduct of original research influence nursing
practice at the bedside, organizational level, and beyond.
References
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pressures and peripheral occlusive arterial disease in diabetic and non diabetic subjects. J Vasc Surg.
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increased cardiovascular disease morbidity and lower quality of life. J Am Coll Cardiol [Serial Online]. 2008;
51(13):1292-1298. Available fromCINAHL, Ipswich,MA. Accessed February 27, 2011. Albert N, Fulton J. Four rights
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Association of Colleges of Nursing. The essentials of master’s education for advanced practice nursing. 2011.
http://www.aacn .nche.edu/Education/pdf/Master%27sEssentials11.pdf. Accessed December 30, 2011. American
Association of Critical Care Nursing. Practice alert: noninvasive blood pressure monitoring. 2010. http://www.aacn
.org/WD/Practice/Docs/PracticeAlerts/NIBP%20Monitoring%2004- 2010%20final.pdf2. Accessed January 6, 2011.
Anwar Y, Tendler B, McCabe E, et al. Evaluation of the Datascope Accutorr Plus according to the Association for the
Advancement of Medical Instrumentation. Blood Press Monit. 1997;3:339-346. Association for the Advancement of
Medical Instrumentation. American National Standard. Electronic or Automated Sphygmomanometer. Arlington, VA:
AAMI. ANSI/AAMI SP 10-2003. AQ8 Bates B. A Guide to the Physical Examination and History Taking. 8th ed.
Philadelphia, PA: Lippincott Williams &Wilkins; 2002. Bland J, Altman D. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet. 1986;1:307-310. Bland J, Altman D. Comparing methods of
measurement: why plotting difference against standard method is misleading. Lancet. 1995;346:1085-1087. Block F,
Schulte G. Ankle blood pressure measurement, an acceptable alternative to arm measurements. J Clin Monit
Comput. 1996;13(3):167-171. Coleman A, Steel S, Freeman P, et al. Validation of the Omron M7 (HEM-780-E)
oscillometric blood pressure monitoring device according to the British Hypertension Society protocol. Blood Press
Monit. 2008;13(1):49-54. de Greeff A, Shennan A. The Rossmax (ME 701 series) upper arm device: accuracy
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2007;12(1):51-55. de Lusignan S, Thiru K, Meredith K, et al. Measuring BP at the wrist: more comfortable for patients
and more convenient for doctors. Public Health. 2000;114:165-168. Domiano K, Hinck S, Savinske D, et al.
Comparison of upper arm and forearm blood pressure [corrected] [published erratum appears in Clin NursRes.
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through research roundtables. Clin Nurse Spec. 2009; 23(6):305-308. Kaplan NM, Rose BD. Technique of blood
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SingerH,DeLucca J, Rothenberger C. The role of the advanced practice nurse in facilitating a clinical research study:
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Clinical Nurse Specialists Leading Research to Improve Practice in the use of Ankle Blood Pressure Readings.
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Katz R, Shlipak MG, Cushman M, Newman AB. Mortality and cardiovascular risk across the ankle-arm index
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G, et al. Wrist blood pressure overestimates blood pressure measured at the upper arm. Blood Press Monit.
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R, Howard B, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease
mortality: the Strong Heart Study. Circulation [Serial Online]. 2004;109(6):733-739. Rooke TW, et al. 2011
ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (updating
the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task
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Clinical comparison of automatic, Noninvasive measurements of blood pressure in the forearm and upper arm. Am J
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pressure recorder. Br Heart J. 1980; 43:202-205. Smith L. Practice guidelines new AHA recommendations for BP
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two sites in the arm. Res Nurs Health. 1985;8:125-129. Wilkes J, DiPalma J. Brachial blood pressure monitoring
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Physical Status: The Use and Interpretation of Anthropometry. 1995:854.WHO Technical Report Series AQ10. Zahn
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Comparison of wrist BP measurement with conventional sphygmomanometry at a cardiology outpatient clinic. J
Hypertens. 2000;18(8):1013-1018.
Contact
[email protected]

D 12 - Leadership in the Clinical Setting
Acknowledging and Enabling Point-of-Care Leadership: A Key to Clinical Nursing
Excellence
Debra A. Bournes, BScN, MSc, PhD, Canada
Purpose
The purpose of this presentation is to define and clarify the concept of leadership at the point-of-care and
outline factors that support such leadership for positive outcomes for nurses and the health-care system.
It will highlight the key pillars of point-of-care leadership supported by the related emerging evidence.
Target Audience
The target audience of this presentation is nurses in all roles, with particular focus on point-of-care
nurses.
Abstract
Point-of-care nurses who have opportunities to engage in and be acknowledged for their leadership
behaviours find it a source of inspiration, motivation, and confidence building. Leadership at the point of
care is related to leadership behaviours that are informal rather than related to a formal leadership
role. Point-of-care nurses regularly engage in leadership behaviours related to their direct clinical work
where they make clinical decisions, consult with other team members and plan and carry out nursing
treatment plans. In addition, many point-of-care nurses, because of their expert clinical knowledge, are
involved in leading clinical change, quality improvement, evaluation or research initiatives as part of their
clinical care roles.
A regional collaborative of nursing leaders has taken on the challenge of raising awareness of the impact
of point- of- care leadership on clinical excellence, evidence based nursing practice, and nursing
retention. The collaborative has established an initiative to widely disseminate the emerging evidence
of the impact on organizations, nurses and practice when point of care leadership is enabled, expected
and acknowledged. A common understanding of the concept has been developed, along with key
strategies to support and foster this way of being in point- of- care practitioners. Key leadership
behavious form part of the framework of point-of care-leadership and include: build relationships and
trust, contribute to an empowering work environment, contribute to an environment that supports
knowledge integration, lead, support and sustain change, balance complexities and lead self.
Key target groups to influence related to point-of-care leadership include: front line/point of care nurses,
nurse managers, executive leaders, other health care professionals, faculty, and students, researchers
and health care organizations. The next steps for the collaborative involve sharing key messages with
target groups and assisting them to acknowledge and enable point of care leadership. The presentation
will reinforce the critical importance of spotlighting and fostering point-of-care leadership as a key driver of
evidence based nursing practice, and the primacy of the practice domain of nursing.
References
Abraham, P. (2011). Developing Nurse Leaders: A program enhancing staff nurse leadership skills and
professionalism. Nursing Administration Quarterly, 35(4), 306 – 312. Canadian College of Healthcare Leaders
[CCHL]. (2010). The LEADS in a Caring Environment Capabilities Framework. Retrieved from
Http://www.leadersforlife.ca/. Cook, M. (2001). The renaissance of clinical leadership. International nursing review,
48, 38-46. Doran, D., Koh, M., Dick, A.,Heys, L.,VanWirchen,C., Yim,O. (2012). Leading practices and programs for
developing leadership among health care professionals at the point of care. Final Report for MOHLTC. Retrieved
from Nursing Health Services Research Unit: http://www.nhsru.com/wp-content/uploads/FINAL-for-Website_No-
Appendix_Developing-Leadership-at-the-Point-of-Care-Report_March2012.pdf Dickson. G. (2008). Genesis of the
leaders for life framework. Victoria, BC. Leaders for Life (HCLABC). Patrick, A., Laschinger, H., Wong, C., &Finegan,
J. (2011). Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey.
Journal of Nursing Management, 19 (4), 449-460. Registered Nurses’ Association of Ontario. (2013). Developing and
Sustaining Nursing Leadership Best Practice Guideline. (Second Edition). Registered Nurses’ Association of Ontario:

Toronto, Canada. Reid, K.,Dennison, P. (2011). The Clinical Nurse Leader: Point-of-Care Safety Clinician. Journal of
Issues in Nursing, 16 (3),
Contact
[email protected]

D 13 - Practices Within Nursing Education
Debunking the Myths about Private Sector Nursing Education
Susan L. Groenwald, PhD, RN, USA
Connie R. Curran, EdD, RN, FAAN, USA
Purpose
The purpose of this presentation is to identify common perceptions about private sector nursing
education, and to engage participants in a discussion that helps debunk myths.
Target Audience
All those engaged in nursing education or clinical practice where students are trained or hired.
Abstract
A significant gap in knowledge about private sector ("for-profit") education currently exists, both in general
and specific to nursing education. While myths and misperceptions abound, growth of private sector
nursing education programs in the U.S. has sky-rocketed. The authors will facilitate a discussion in which
common perceptions about private sector education are identified and discussed. Using available data,
the authors will separate truth from fiction, and will compare and contrast strengths and weaknesses
among all sectors of education at both the undergraduate and graduate level. The authors will suggest
measures that could be used to assess the quality of nursing education programs, regardless of sector,
and discuss how those measures could serve as the basis for evidence-based research in nursing
education that could help standardize the way nursing programs are assessed for quality.
Contact
[email protected]

D 13 - Practices Within Nursing Education
Teaching/Learning Strategies to Integrate Genetics and Genomics into
Undergraduate Nursing Education
Leighsa Sharoff, EdD, RN, NPP, AHN-BC, USA
Purpose
To explore the implication of integrating genetics and genomics into nursing curriculum; identify essential
competencies for nurses and explore innovative teaching/learning strategies to provide for active
learning. Nurse educators will learn how to enhance their students learning process to become active
participants as they learn to apply their knowledge.
Target Audience
the nurse educator. Providing our future nurses with the basic genetic literacy level is fundamental if
nursing education is to remain at the forefront of health care. The implications of genetics and genomics
for nurses are becoming more evident and nurse educators must prepare our future professionals.
Abstract
Genetic and genomic science is redefining the understanding of the continuum of human health and
illness. As a new required competency for 21st century baccalaureate nursing students, providing crucial
information as outlined by the AACN Essential Competencies for Genetics and Genomics is paramount
for the nursing practice. How a nursing curriculum prepares these millennial nurses to function at their
highest capacity depends on how genetics and genomics are integrated into the curriculum. Integrating
genetics and genomics as a stand-alone course needs to be innovative and creative while teaching the
scientific content. The implications of genetics and genomics for nurses are becoming more evident, not
only in the care provided but also in the numerous medications administered. Genetic causes are being
discovered for an increasing number of chronic illnesses and diseases. By exploring innovative and
creative formats, nurse educators will learn how to enhance their students learning process to become
active participants, engaged and focused as they learn to apply their knowledge of genetics and
genomics. In addition, exploring group activities such as developing a Wiki on a specific genetic condition
that will then be incorporated into a group presentation, provides for collaborative learning. This
presentation will explore the application of a genetics and genomics course into an undergraduate
curriculum to provide the most up-to-date information, utilizing innovative teaching strategies for the 21st
century nursing student. Providing our future nurses with the basic genetic literacy level is fundamental if
nursing education is to remain at the forefront of health care. This presentation will explore the implication
of integrating genetics and genomics into nursing curriculum; identify essential competencies for nurses
and explore innovative teaching/learning strategies to provide for active learning.
References
Calzone, K., et al. (2011). Establishment of the Genetic/Genomic Competency Center for Education:
http://onlinelibrary.wiley.com/doi/10.1111/j.1547-5069.2011.01412.x/abstract Daack-Hirsch, S., et al.
(2011).Integrating Genomics Into Undergraduate Nursing Education: http://onlinelibrary.wiley.com/doi/10.1111/j.1547-
5069.2011.01400.x/full Lea D., Skirton H., Read C., & Williams J.(2011). Implications for Educating the Next
Generation of Nurses on Genetics and Genomics in the 21st Century. J Nurs Scholarsh, 43. pp.3–12.
Contact
[email protected]

D 14 - Evidence-Based Practices Affecting Global Women's Health
Implementing the Promotion of Ambulation and Upright Positioning During the
First Stage of Labor
Shelley F. Conroy, EdD, MS, RN, CNE, USA
Laura H. Curtis, DNP, BSN, RN, CNM, USA
Purpose
to describe how an evidence-based practice change was implemented regarding the promotion of
ambulation and upright positioning during labor on a unit where 90-95% of the patients remained in bed.
Nursing knowledge, satisfaction and patient outcomes were assessed after the practice change and their
impact will be shared.
Target Audience
Nurses, nursing managers and leaders, nursing and childbirth educators and faculty who lead practice
change, manage the delivery of care, and/or educate nurses and patients.
Abstract
Although mobility in labor for low-risk women is supported by professional organizations such as the
American Academy of Pediatrics, American Congress of Obstetricians and Gynecologists, the
Association of Women's Health, Obstetric and Neonatal Nursing, and the Royal College of Obstetricians
and Gynaecologists, its use in some hospitals does not match this recommendation. This practice-change
project introduced evidence-based guidelines regarding ambulation and upright positioning in a small
labor and delivery unit in a large urban area in which approximately 90-95% of laboring patients remain in
bed.
The aims of this project included: 1) establishing baseline knowledge and attitudes of unit staff regarding
ambulation and upright positioning; 2) developing and implementing a guideline promoting the use of
ambulation and upright positioning during the first stage of labor; 3) increasing patient satisfaction with the
labor experience.
In order to translate the evidence into practice, evidence-based guidelines were developed and
implemented to promote ambulation and upright positioning during the first stage of labor at a suburban
hospital’s labor and delivery unit using the Knowledge to Action (KTA) translational framework by Graham
et al. (2006). KTA is appealing because it has the ability to be fluid in its steps if needed; however, it lays
out a logical and sequential path for moving from knowledge to action and implementation.
Buy-in was sought from key stakeholders including: the Chief Nursing Officer (CNO), Chief of Obstetrics,
Chief of Obstetrical Anesthesia, Director of the labor and delivery unit, Unit Nursing Supervisors, and key
unit staff such as charge nurses and tenured OBTs. Letters of project endorsement from the Director of
the unit and the CNO were received. Preparation of the unit staff began with educational in-services
regarding the proposed change. During these in-services, knowledge and attitudinal assessments were
collected before and after the in-service. These assessments were developed specifically for use during
the project, and helped serve as points of specific data collection. During this time, the unit staff was
introduced to the proposed practice change in a document titled, “Guidelines: Ambulation and upright
positioning during the first stage of labor.” This document served as a guide for the proposed practice
change. The nurses and unit staff were also oriented to the data collection procedure for the purposes of
the project during these meetings.
Pre-implementation baseline data was collected via chart review by the Project Manager to ascertain the
frequency of patients’ upright positioning and mobility as was currently practiced on the unit. During
implementation, nurses used paper documentation regarding use of upright positioning and mobility
during labor, patient demographics, length of labor, adverse maternal/fetal outcomes, type of labor
(spontaneous, induction, or augmentation), type of anesthesia at delivery, cervical dilation at time of
epidural anesthesia, and mode of delivery.

Thirty-three patients were included in the study project, 18 nurses were included in a pre-test and first
post-test, and 15 nurses were included in a second post-test. Results indicated that during
implementation, 89.2% of eligible patients participated in data collection and used ambulation and upright
positioning during their labors. Nursing data suggested that nurses felt comfortable caring for mobile
laboring women and believed they should have the option to do so. After implementation, an increased
percentage of nurses responded they currently offer mobility in labor.
This study is the first in recent literature to assess nursing knowledge and attitudes towards the mobile
labor patient. The results also agree with current literature in regards to the safety of ambulation and
upright positioning, as well as patient desire to do so.
The findings of this project are similar to those of other studies. As in other studies, women find the use
of ambulation and upright positioning during labor satisfying (Bloom et al., 1998; Frenea et al., 2004;
Miquelutti et al., 2007; Stremler et al., 2005). This study went a step further, asking the participant to rate
her satisfaction with different positions using a Likert scale. These findings also agreed with existing
literature and showed that the majority of participants liked the individual positions used over the course
of their labor (Bloom et al., 1998; Frenea et al., 2004; Miquelutti et al., 2007; Stremler et al., 2005). The
data collected during the participants’ labor revealed no NICU admissions for infants of any of the study
participants, which also supports previous literature’s findings of no adverse neonatal outcomes (Albers et
al., 1997; Ben Regaya et al., 2010; Bloom et al., 1998; Karraz, 2003; Miquelutti et al., 2007; Stremler et
al., 2005; Vallejo et al., 2001).
This project also examined the nursing knowledge, attitudes, and beliefs surrounding ambulation and
upright positioning during labor in order to facilitate the practice change. Overall, the nurses indicated
good knowledge of the benefits of such positioning, and felt they were comfortable caring for these
patients. However, it is noted that some knowledge deficits about the benefits of mobility in labor existed
as evidenced by pre-test data, but these knowledge deficits decreased on the subsequent post-tests, in
that 100% of nurses were answering correctly. After implementation, nurses agreed patients should have
the option to be mobile. This finding suggests that, in this institution, nurses feel comfortable caring for
and supporting patients who desire mobility during labor. Likert scale scores improved after the first post-
test, suggesting the in-service given with the project manager was helpful in empowering the nurses’
feelings and beliefs about ambulation and upright positioning. When the second post-test was given after
cessation of patient data collection, the nursing Likert-scale scores changed. It appears that nurses, in
general, had a tendency to answer on either extreme of the Likert scale. In future studies, it may be
helpful to have a free-text section for comments from nursing staff about why they scored sections as
they did.
As a result of this project, more patients ambulated and assumed upright positioning on this unit than had
previously, and more nurses reported offering mobility in labor to their patients than prior to
implementation. During implementation, 33 out of 37 eligible patients (89.2%) had data collected and
used upright positioning and ambulation during their labor. This is noticeable improvement, as only 10-
15% of patients were mobile during labor before implementation. Promoting upright positioning and
mobility is an important step in empowering women and their care providers during labor, and is widely
accepted among professional organizations.
References
Adachi, K., Shimada, M., & Usui, A. (2003). The relationship between the parturient’s positions and perceptions of
labor pain intensity. Nursing Research. 52(1). 47-51. Albers, L. (2001). Monitoring the fetus in labor: Evidence to
support the methods. Journal of Midwifery & Women’s Health. 46(6). 366-373. doi: 10.1016/S1526-9523(01)00191-X
Albers, L., Anderson, D., Cragin, L., Daniels, S., Hunter, C., Sedler, K., & Teaf, D. (1997). The relationship of
ambulation in labor to operative delivery. Journal of Nurse-Midwifery, 42(1), 4-8. American Academy of Pediatrics
(AAP) & American College of Obstetricians & Gynecologists (ACOG). (2007). Guidelines for Perinatal Care, 6th ed.
Elk Grove Village (IL): AAP; Washington DC: ACOG Association of Women’s Health, Obstetric, & Neonatal Nursing
(AWHONN). (2011). AWHONN position statement: Nursing support of laboring women. Journal of Obstetric,
Gynecologic, and Neonatal Nurses. 40. 665-666. doi: 10.1111/j.1552-6909.2011.01288.x Ben Regaya, L., Fatnassi,
R., Khlifi, A., Fekih, M., Kebaili, S., Soltan, K., & Hidar, S. (2010). Role of deambulation during labour: A prospective
randomized study. Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 39(8), 656-662.
doi:10.1016/j.jgyn.2010.06.07 Bloom, S. L., McIntire, D. D., Kelly, M. A., Beimer, H. L., Burpo, R. H., Garcia, M. A., &
Leveno, K. J. (1998). Lack of effect of walking on labor and delivery. The New England Journal of Medicine, 339(2),

76-79. Declercq, E. R., Sakala, C., Corry, M. P., & Applebaum, S. (2007). Listening to mothers II: Report of the
second national U.S. survey of women's childbearing experiences executive summary. Journal of Perinatal
Education, 16(4), 9-14. Retrieved from: http://www.childbirthconnection.org/pdfs/LTMII_ExecutiveSum.pdf Enkin, M.,
Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., et al., (2000). A guide to effective pregnancy and
childbirth. NewYork: Oxford University Press. Styles, C. (2009). Maternal positions and mobility during first stage
labour. Cochrane Database of Systematic Reviews,(2), CD003934. doi:10.1002/14651858.CD003934.pub2 Frenea,
S., Chirossel, C., Rodriguez, R., Baguet, J., Racinet, C., & Payen, J. (2004). The effects of prolonged ambulation on
labor with epidural analgesia. Anesthesia and Analgesia, 98(1), 224-229. doi:
10.1213/.01.ANE.0000090317.01876.D9 Graham, I., Logan, J., Harrison, M., Straus, S., Tetroe, M., Caswell, W., et
al. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health
Professions, 26(1). 13-24. doi: 10.1002/chp.47 Karraz, M. (2003). Ambulatory epidural anesthesia and the duration of
labor. International Journal of Gynecology & Obstetrics, 80(2), 117-122. doi:10.1016/S0020-7292(02)00339-9
Maternal & Newborn Health/Safe Motherhood Unit. (1996). Care in normal birth: A practical guide. Geneva: World
Health Organization. Retrieved from: http://whqlibdoc.who.int/hq/1996/WHO_FRH_MSM_96.24.pdf Miquelutti, M. A.,
Cecatti, J. G., & Makuch, M. Y. (2007). Upright position during the first stage of labor: A randomised controlled trial.
Acta Obstetricia Et Gynecologica Scandinavica, 86(5), 553-558. doi:10.1080/00016340601185251 Phumdoung, S.,
Youngvanichsate, S., Jongpaiboonpatana, W., & Leetanaporn, R. (2007). The effects of the PSU cat position and
music on length of time in the active phase of labor and labor pain. The Journal of Nursing Research. 11(2). 96-104.
Porter, R., & Kaplan, J. (Eds.). (2011). Table 264-1: Pregnancy Risk Assessment. In Merck Manual for Health Care
Professionals. Retrieved from: http://www.merck.com/media/mmpe/pdf/Table_262-1.pdf Royal College of
Obstetricians & Gynaecologists (RCOG). (2009). RCOG statement on maternal position during the first stage of
labor. Retrieved from: http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-
maternal-position-during-first-stage-la Stark, M. A., & Jones, M. (2006). Advanced preparation and positive labor
support create an optimal experience for normal birth. Journal of Perinatal Education, 15(2), 4-7.
doi:10.1624/105812406X107753 Stremler, R., Hodnett, E., Petryshen, P., Stevens, B., Weston, J., & Willan, A.
(2005). Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Birth. 32(4).
243-251. Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, & measures. Southwest
Educational Development Laboratory, National Center for the Dissemination of Disability Research. Retrieved from:
http://www.ncddr.org/kt/products/ktintro/ktintro.pdf Vallejo, M., Firestone, L., Mandell, G., Jaime, F., Makishima, S., &
Ramanathan, S. (2001). Effect of epidural analgesia with ambulation on labor duration. Anesthesiology. 95(4). 857-
861. Walker, D., Shunkwiler, S., Supanich, J., Williamsen, J., & Yensch, A. (2001). Labor and delivery nurses'
attitudes toward intermittent fetal monitoring. Journal of Miwifery & Women’s Health. 46(6). 374-380.
Contact
[email protected]

Effects of Herbal Tea on Postpartum Sleep Quality
Chung-Hey Chen, PhD, Taiwan
Purpose
The purpose of the presentation is to examine the effects of German chamomile tea and Lavender tea on
Taiwanese women’s fatigue, depressive symptom, bonding with infant, and sleep quality during
postpartum.
Target Audience
The target audience of this presentation is to all the health professionals.
Abstract
Background: Postpartum sleep disorder is a significant problem for postnatal women. Although influence
factors that might predispose postnatal women to sleep disorder have been identified, few studies are
made to test its intervention protocols. Aim: This study aimed to test the effects of herbal tea on
postpartum sleep quality. Methods: A total of 120 normal postnatal women were randomly assigned to
the experimental group I (n = 40), experimental group II (n = 40), or the control group (n = 40). The
participants in experimental group I drank German chamomile tea and experimental group II drank
Lavender tea respectively for two weeks. Outcome measures include Postpartum Sleep Quality Scale
(PSQS), Edinburgh Postnatal Depression Scale (EPDS), Postpartum Fatigue Scale (PFS), and
Postpartum Bonding Questionnaire (PBQ). All the participants completed the Demographic Dada Form
and pre-tests, 38 participants in German chamomile tea group, 35 in Lavender tea group, and 38 in
control group completed the 2-week post-tests. 34 participants in German chamomile tea group, 35 in
Lavender tea group, and 37 in control group completed the 4-week post-tests. Results: Postnatal women
drinking 2-week Lavender tea showed significant effects on postpartum fatigue, depressive symptom, and
bonding with infant. Postnatal women drank 2-week German chamomile tea could significantly improve
physical symptoms-related sleep inefficiency and depressive symptom; the effects of German chamomile
tea on improving depressive symptom can be extended over two weeks.
References
Yang, C. L., Yu, C. H., & Chen, C. H. (2013). Development and validation of the Postpartum Sleep Quality Scale.
Journal of Nursing Research, 21(2), 148-154.
Contact
[email protected]

A Study on Teaching-Learning Methods to Promote Self-Directed Learning for
Women's Health Nursing
Jiin Kim, PhD, RN, RNM, South Korea
Purpose
It's gradually decreasing to get opportunities of clinical training for nursing students due to decreasing
birthrate and patient safety-first policy in hospital. The pursose of this study is to develop Self-directed
Teaching-learning methods of liaison between the school and clinical setting for women's health nursing.
Target Audience
The target audience of this presentation is nursing professors who are interested in teaching-learning
methods.
Abstract
Goal: It's gradually decreasing to get opportunities of clinical training for nursing students due to
decreasing birthrate and patient safety-first policy in hospital. The pursose of this study is to develop Self-
directed Teaching-learning methods of liaison between the school and clinical setting for women's health
nursing.
Method: The participants were 120 3rd grade nursing students of D college in Daegu city who had studied
women's health nursing in 2013. Data were collected from March to June using self-reported
questionaires. Instruments were the ability of Self-directed learning(Cho, 2011) and 20-question multiple-
choice test. These were used to evaluate for course outcome of the lecture. The data were analyzed by
frequency, percentage and paired t-test through SPSS 14.0 pc version.
Results: The results of analysis are as followed.
First, the analysis showed that pregnancy induced hypertension(4.01) and bleeding problem(3.98) is the
most interesting subjects.
Second, lecture(4.40), audiovisual education(4.24) and simulation(3.26) are preferred to the teaching
method.
Third, there was a statistically significant positive correlation after self-directed teaching-learning method
application(p=.000)..
Conclusion: In spite of these results, it is recommended that further research be conducted with the large-
scale samples from different areas and schools.
And it is recommended that teacher try to expose students to a variety of learning methods and to apply
actively simulation-based teaching methods for promoting learners' autonomy. Also, the curriculum
should be improved in order for students and teachers to have more choices about the outcome-based
learning.
References
Back, So. H. & Jung, I. C. (2010). A Study on Designing and Applying Geography Teaching and Learning Model
based on Problem-Based Learning. Journal of the Korean Association of Professional Geographic and Environmental
Education, 11(1), 27-41. Song, Y. A. (2008). Comparison of Learning Satisfaction, Critical Thinking Disposition,
Learning Attitude and Motivation between PBL and SBL Groups. Journal of Korean Academic Social Nursing
Education. 14(1). 55-62. Choi, E. Y. & Lee, W. S. (2010). A Case study on the Design and Operation of PBL by
Employing Blended Learning on Instruction in a Nursing College. Journal of East-West Nursing Research, 16(2). 96-
104. Cho, H. S. (2007). A Study on the Critical Thinking Disposition and Self-directed Learning, Academic
Achievement of Nursing Students. Journal of Korean Society of Health Information and Health Statistics. 32(2). 57-
72. Brookfield, S. (1985). Self-directed learning: A critical review of research. In S. Brookfield(Ed.). Self-directed
learning: From theory to practice (pp. 5-16). New Directions for Continuing Education, No. 25. San Francisco, CA:
Jossey-Bass. Brookfield, S. (1993). Self-directed learning, political clarity, and the critical practice of adult education.
Adult Education Quarterly, 43(4), 227-242. Brookfield, S. (2005). The power of critical theory: Liberating adult learning

and teaching. San Francisco, CA: Jossey-Bass. Caffarella, R. S., & O'Donnell, J. M. (1989). Self-directed adult
learning. Nottingham, England: Department of Adult Education, University of Nottingham. Knowles, M. S. (1975).
Self-directed learning: A guide to learners and teachers. Chicago, IL: Follett Publishing Co. Knowles, M. S., Holton III,
E. F., & Swanson, R. A. (2005). The adult learner(6th ed.), San Diego, CA: Elsvier Inc. Rogers, C. R. (1969).
Freedom to learn. Columbus, OG: Charles E. Merrill.
Contact
[email protected]

E 12 - Educational Simulation Strategies
Enhancing Nursing Students' Medication Safety Competencies with a Pediatric
Medication Simulation Experience
Donna M. Mesler, PhD, RN, CPNP, USA
Marcia Gardner, PhD, RN, CPNP, CPN, USA
Diane Stewart, MSN, RN, APNc, USA
Purpose
The purpose of this presentation is to describe outcomes of a pediatric medication simulation experience
in baccalaureate nursing students. Strategies for the development of outcome measures for a pediatric
medication simulation experience and student responses will be discussed. Post-simulation
competencies were retained in the clinical context.
Target Audience
The target audience of this presentation is nurse educators, graduate and undergraduate nursing
students and anyone who works with simulation. Anyone who teaches or reviews medication
administration with student nurses or novice nurses could benefit from this presentation.
Abstract
Background and Problem: Medication administration can absorb a significant amount of nursing time in
the acute care setting, and medication errors have been reported to occur in as many as 47.5% of
administrations (Holland, et. Al., 2012). Errors have been identified at all points in the medication
administration process, from calculation of dosage to delivery of the dose to the patient, and in all patient
populations, including the physiologically vulnerable pediatric population. Medication errors can be
particularly devastating to pediatric patients as a function of physiologic differences from adults
(Gonzales, 2010; Kaushal, Bates, Landrigan, McKenna, Clapp, Federico et al., 2001). Decreasing
medication errors is a national safety goal, and error prevention must be, and is addressed in pre-
licensure nursing curricula (IOM, 2011). However, evidence in support of the best education practices to
address this important issue is scant. Traditional methods for ensuring medication administration and
safety competencies often include dosage calculations tests coupled with medication administration
experiences in the clinical setting. This model has become increasingly inadequate, as clinical sites that
are able to provide the needed skills are increasingly in short supply (Butler & Veltre, 2009). To address
this concern and facilitate the development of appropriate knowledge, skills and attitudes (KSAs), we
developed and evaluated a medication administration safety competency simulation experience for a
baccalaureate-level pediatric nursing course (Harder, 2010; Leigh, 2008).
Methods: The quality and Safety Education (QSEN) competencies were utilized to develop four
simulations involving the process of medication administration to infants and children, incorporating
pertinent knowledge, skills and attitudes (KSAs) for safe and effective nursing practice. Simulations were
piloted in a group of eight students from a semester-long nursing of children course and were further
utilized with 107 students in a subsequent semester. Analysis of student outcomes from the pilot project
resulted in refinement and expansion of the scenarios. After completion of the simulation exercises,
students completed a 10-question evaluation of the experience.
Findings: A majority of students demonstrated competencies related to planning for and administration of
pediatric medications, accuracy of dosage calculation, knowledge of medication therapeutics,
modification of interventions by developmental levels of children. Student feedback was uniformly
positive. Students expressed increased understanding of components of medication administration to
infants and children and confidence in their abilities to administer medications. They recommended
additional focused simulation experiences. Post-simulation competencies were retained in the clinical
context.
Implications: Further exploration of outcomes of such simulation experiences, related to quality and
safety, will expand the evidence base for best educational strategies to promote medication

competencies. We plan to expand the use of this educational intervention, and collect skill, competency,
safety, and nursing efficacy-related data in a multi-site study.
References
References Butler, K.W., & Veltre, D.E. (2009). Implementation of active learning pedagogy comparing low-fidelity
simulation versus high-fidelity simulation in pediatric nursing education. Clinical Simulation in Nursing, 5, e129- e136.
Gonzales, K. (2010). Medication errors and the pediatric patient: A systematic search of the literature. Journal of
Pediatric Nursing 25 (6), 555-565. Harder, B.N. (2010). Use of simulation in teaching and learning in health sciences:
A systematic review. Journal of Nursing Education, 49(1), 23- 28. Holland, A., Smith, F., McCrossan, G., Adamson,
E., Watt, S., & Penny, K. (2012). Online video in clinical skills education of oral medication administration for
undergraduate student nurses: A mixed methods, prospective cohort study. Nurse Education
Today,oi:10.1016/j.nedt.2012.01.006. Institute of Medicine. (2011, January 26). The Future of Nursing: Focus on
Education,Retrieved from http://www.iom.edu/Reports;2010/The-Future-of- Nursing-Leading-Change-Advancing-
Health/Report-Brief-Education.aspx Institute, QSEN. (2011). Competencies. Retrieved from
http://qsen.org/competencies/ Jansen, D.A., Johnson, N., Larson, G., Berry, C., & Brenner, G.H. (2009). Nursing
faculty perceptions of obstacles to utilizing manikin-based simulations and proposed solutions. Clinical Simulation in
Nursing, 5, e9-e16. Jeffries, P.R. (2012). Simulation in Nursing Education: From Conceptualization to Evaluation
Second Edition (sec. Appendix B). New York, NY: National League for Nursing. Retrieved from
http://www.iom.edu/Reports/2010/The-Future-of-Nursing- Leading-Change-Advancing-Health/Report-Brief-
Education.aspx Kaushal, R., Bates, D.W., Landrigan, C., McKenna, K.J., Clapp, M.D., Federico, R., & Goldman, D.A.
(2001). Medication errors and adverse drug events in pediatric patients. JAMA, 285 (16), 2114-2120. Leigh, G.T.
(2008). High-fidelity patient simulation and nursing students’ self- efficacy: A review of the literature. International
Journal of Nursing Education Scholarship,5(1). National League of Nursing. (2002). A Vision for Nursing Education.
New York: Author. Thomas, C., Hodson-Carlton, K., & Ryan, M. (2011). Preparing nursing students in a
leadership/management course for the workplace through simulations. Clinical Simulation in Nursing, 7, e99-e104.
Zahara-Such, R.M. (2012). Improving medication calculations of nursing students through simulation: An integrative
review. Clinical Simulation in Nursing, e1-e5.
Contact
[email protected]

E 12 - Educational Simulation Strategies
A Comparison of Students' Perception on Effectiveness of Integrating Electronic
Health Records into Simulation in Undergraduate Nursing Program
Weihua Zhang, PhD, APRN, USA
Darla Ura, MA, RN, ANP, BC, USA
Barbara Kaplan, MSN, RN, USA
Purpose
The purpose of this presentation is to report the difference on simulation effectiveness perceived by the
students in the group with and without utilizing electronic health records in simulation exercise. The
findings of the study also provided an evidence based practice in teaching that could help other nursing
educators.
Target Audience
The target audience of this presentation will be nursing educators either in academic settings or clinical
settings.
Abstract
Background: Electronic Health Records (EHR) make real time point of care efficient. Interdisciplinary
teams can view the most updated patients’ progress thus ensuring safe and quality care. We
implemented EHR into our existing simulation exercise and attempted to see a change in students’
perception on effectiveness of the simulation in our undergraduate nursing program.
Purpose: The main purpose of this implementation is to assess the difference on simulation effectiveness
perceived by the students in the group with and without utilizing EHR in simulation exercise.
Method: Cross-sectional design and convenience sampling were used to compare the effectiveness
perception data collected from the students after the simulation in these two groups. The difference in
perception was compared by using the t-test.
Result: There is no statistically significant change in students’ perception (t = .79, p = .42) between the
simulation (SIM) and the simulation with EHR integration (SIMEHR) group. The total score of the first 13
survey questions (which were the same questions used for both years) was used for the analysis. The
total score of the first 13 questions was 34.07 in the SIMEHR group and 33.42 in the SIM group with 106
out of 110 participants in the survey in the SIMEHR group versus only 36 out of 99 students responded to
the survey in the SIM group from the previous year. The confidence in providing care and knowing the
patient by utilizing electronic health records has been reported as between somewhat agree to strongly
agree.
Discussion and implication: Integrating EHR into simulation did not significantly change students’
perception on simulation effectiveness. The implication from this study is that the integration of EHR into
the simulation can be accomplished with careful prior planning with emphasis on introducing the
strategies that enhance students’ ability to get familiarized with the EHR system. Positively comments on
students’ ability and confidence in using the EHR and providing patient care further support this
implication.
References
Blumenthal, D., & Tavenner, M. (2010). The "meaningful use" regulation for electronic health records. New England
Journal Med, 363(6), 501-504. doi: 10.1056/NEJMp1006114 Briggs, B. (2004). Patient safety driving point-of-care I.T.
plans. Health Data Managment, 12(10), 56, 58, 60 passim. Centers for Medicare & Medicaid Services. (2012). CMS
Medicare and Medicaid EHR Incentive Programs: Milestone Timeline. Di Bari, M., Deriu, A., Albanese, G., &
Cavatorta, F. (2005). QENS investigation of the dynamics of starch saccharides. Phys Chem Chem Phys, 7(6), 1241-
1244. Disch, J. (2012). QSEN? What's QSEN? Nurs Outlook, 60(2), 58-59. doi: 10.1016/j.outlook.2012.01.001
Ehrmeyer, S. S. (2011). Plan for quality to improve patient safety at the point of care. Ann Saudi Med, 31(4), 342-346.
doi: 10.4103/0256-4947.83203 Elfrink, Victoria L., , Leighton, Kim, Ryan-Wenger, Nancy, , Doyle, Thomas J., &
Ravert, Patricia (2012). History and Development of the Simulation Effectiveness Tool. Clinical Simulation in Nursing,

8(6), 199. The federal EHR incentive program: achieving 'meaningful use'. (2010). MGMA Connex, 10(8), 14-16.
Government takes first step in defining 'meaningful use' requirement for EHR incentives. (2009). MGMA Connex,
9(7), 12-14. Hagland, M. (2004). Point-of-care protection. Hospitals move to enhance patient safety in common but
high-vulnerability situations. Healthc Inform, 21(6), 80. HealthIT.gov. (2012). Accelerating Progress on EHR Adoption
Rates and Achieving Meaningful Use.
Contact
[email protected]

E 13 - Patient Safety Impacts on Evidence-Based Practice
Nursing Students' Perceptions of Knowledge and Training during the Medication
Administration Process
Kelly J. Betts, EdD, MNSc, RN-BC, USA
Purpose
The purpose of this presentation is to present student nurses' perceptions of knowledge and training
during the medication administration process
Target Audience
The target audience of this presentation is nursing education faculty in undergraduate nursing programs,
nursing educators of various levels and clinical nurses who work as preceptors of students in the clinical
hospital setting.
Abstract
Medication administration in nursing programs is a key skill that nursing students must master prior to
graduating and entering the nursing workforce. Lack of pharmacology knowledge, safety, and skill
proficiency is detrimental to the safety and welfare of patients. At the University of Arkansas for Medical
Sciences College of Nursing baccalaureate program nursing students have demonstrated a lack of
performance of the medication administration process as evidenced by anecdotal feedback from students
and faculty, and post course evaluations. The purpose of this study was to examine nursing students’
perceptions of their knowledge, skill proficiency, and safety during the medication administration process
during the first year of nursing school with the intent of creating an instructional program that intends to
improve nursing student performance. The conceptual framework utilized in this study was based upon
the work of Benner and her attempt to capture skill competence and knowledge using the seven domains
of nursing practice. The key research questions in this study focus on the students’ perceptions of
required knowledge, skill proficiency, and faculty instruction before, during, and after medication
administration instruction. Results from the study were very similar to other literature regarding student's
experiences with medication administration. Themes identified throughout the study indicated that
students lacked skill proficiency and knowledge related to stress factors that occur during the clinical shift,
fear of making medication errors, lack of knowledge regarding pharmacology, the complexity of the
patients and the medications that patients receive, and positive feedback regarding their clinical
instructors and buddy nurses on the clinical units. Since medication administration skill instruction affects
nursing students globally, implications from this study can be used to better understand how students
perceive their training for the medication administration process. This affects social change from a local
perspective as faculty can develop more effective ways to teach nursing students how to safely
administer medications hence promoting safe and positive outcomes for patients receiving medications
administered by nursing students.
References
References American Nurses Association. (2012). Safety and Nursing Quality. American Nursing Association.
Retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality
Annells, M. (1996). Hermeneutic phenomenology: philosophical perspectives and current use in nursing research.
Journal of Advanced Nursing, 23, 705-713. Baxter, P. E., & Boblin, S. (2008). Decision making by baccalaureate
nursing students in the clinical setting. Journal of Nursing Education, 47(8), 345-350. Beck, C. T. (1993). Nursing
students’ initial clinical experience: A phenomenological study. International Journal of Nursing Studies, 30(6), 489-
497. doi:10.1016/0020-7489(93)90020-U Beck, D., & Srivastava, R. (1991). Perceived level and sources of stress in
baccalaureate nursing students. Journal of Nursing Education, 30(3), 127-133. Benner, P. (1984). From novice to
expert: Excellence and power in clinical nursing practice. Menlo Park, California: Addison-Wesley Publishing
Company. Boswell, C., & Cannon, S. (2011). Introduction to nursing research: Incorporating evidence-based practice
(2nd ed.). Sudbury, MA: Jones and Bartlett. Burnard, P., Edwards, D., Bennett, K., Thaibah, H., Tothova, V.,
Baldacchino, D., … Mytevelli, J. (2008). A comparative, longitudinal study of stress in student nurses in five countries:
Albania, Brunei, the Czech Republic, Malta and Wales. Nurse Education Today, 28, 134-145.
doi:10.1016/j.nedt.2007.04.002 Burnard, P., Haji Abd Rahim, H. T., Hayes, D., & Edwards, D. (2007). A descriptive

study of Bruneian student nurses’ perceptions of stress. Nurse Education Today, 27(7), 808-818. Chan, C., So, W., &
Fong, D. (2009). Hong Kong baccalaureate nursing students’ stress and their coping strategies in clinical practice.
Journal of Professional Nursing, 25(5), 307-313. Chen, J. (2010). Morale and role strain of undergraduate nursing
students in a pediatric clinical setting. Journal of Nursing Research (Lippincott Williams & Wilkins), 18(2), 144-152.
Choo, J., Hutchinson, A., & Bucknall, T. (2010). Nurses’ role in medication safety. Journal of Nursing Management,
18, 853-861. doi:10.1111/j.1365-2834.2010.01164.x Cooper, C., Taft, L. B., & Thelen, M. (2005). Preparing for
Practice: Students’ Reflections on Their Final Clinical Experience. Journal of Professional Nursing, 21(5), 293-302.
doi:10.1016/j.profnurs.2005.07.002 Creswell, J. W. (2009). Research design: Qualitative, quantitative and mixed
methods approaches. (3rd ed.). Thousand Oaks, CA: Sage Publications Incorporated. Cronenwett, L., Sherwood, G.,
& Gelmon, S. B. (2009). Improving quality and safety education: The QSEN learning collaborative. Nursing Outlook,
57, 304-312. Deary, I., Watson, R., & Hogston, R. (2003). A longitudinal cohort study of burnout and attrition in
nursing students. Journal of Advanced Nursing, 43(1), 71-81. Edwards, D., Burnard, P., Bennett, K., & Hebden, U.
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for Safe Medication Practices. Retrieved from http://ismp.org/about/default.asp Jimenez, C., Navia-Osorio, P., & Diaz,
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disclosing nursing errors: A discussion paper. International Journal of Nursing Studies, 43, 367-376. doi:
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the importance of direct supervision for avoiding medication errors and near misses by undergraduate nursing
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Searl, K., Moxham, L., & Walker, S. (2008). Medication administration and nursing students. Australian Nursing
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doi:10.1111/j.1365-2648.2009.05214.x Reid-Searl, K., Moxham, L., Walker, S., & Happell, B. (2010). Supervising
medication administration by undergraduate nursing students: Influencing factors. Journal of Clinical Nursing, 19(5-6),
775-784. doi:10.1111/j.1365-2702.2009.03074.x Reid-Searl, K., Moxham, L., Walker, S., & Happell, B. (2010).
Whatever it takes: Nursing students’ experiences of administering medication in the clinical setting. Qualitative Health
Research, 20(7), 952 -965. Rentschler, D., Eaton, J., Cappiello, J., McNally, S., & McWillam, P. (2007). Evaluation of
undergraduate students using objective structured clinical evaluation. Journal of Nursing Education, 46(3), 135-139.
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of medication errors and barriers to reporting. Journal of Nursing Care Quality, 22(1), 28-33. Vaismoradi, M., Jordan,
S., Turunen, H., & Bondas, T. (2013). Nursing students’ perspectives of the cause of medication errors. Nurse
Education Today, Advance Online Publication. http://dx.doi.org/10.1016/j.nedt.2013.04.015 Walker, W. (2011).
Hermeneutic inquiry: Insights into the process of interviewing. Nurse Researcher, 18(2), 19-27. Watson, R., Deary, I.,
Thompson, D., & Li, G. (2010). The Stress in Nursing Students Scale (SINS): Principal components analysis of
longitudinal data from Hong Kong [corrected] [published erratum appears in J CLIN NURS 2010 Oct; 19(19/20):2955-
6]. Journal of Clinical Nursing, 19(7-8), 1170-1172. Watson, R., Gardiner, E., Hogston, R., Gibson, H., Stimpson, A.,
Wrate, R., & Deary, I. (2008). A longitudinal study of stress and psychological distress in nurses and nursing
students. Journal of Clinical Nursing, 18(2), 270-278. Weitzel, M. L., & McCahon, C. P. (2008). Stressors and
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Contact
[email protected]

E 13 - Patient Safety Impacts on Evidence-Based Practice
Nurses' Patient Safety Competencies in Korea
Haena Jang, MSN, RN, South Korea
Nam-Ju Lee, DNSc, RN, South Korea
Purpose
The purpose of this study is to investigate nurses’ patient safety competencies (PSC) in Korea.
Target Audience
The target audience is educator and clinical nurse in both of college and clinical field of nursing.
Abstract
PURPOSE: The wave of patient safety emerged in the early 2000s with IOM’s report ‘To Err is Human:
Building a Safer Health System’ in the form of a sustained renovation of healthcare field (Kohn &
Corrigan, 2000). Accordingly, intense criticism of the lack of healthcare profession’s competency to
assure patient safety has surfaced (Greiner & Knebel, 2003) and great attention has been shown to the
question of how nurses prepare for patient safety in terms of attitude, skill, and knowledge. Yet so far, no
definitive answer has been given to this question in Korea. The purpose of this study is to investigate
nurses’ patient safety competencies (PSC) in Korea.
METHODS: Data were collected from 346 nurses working in the three high-level general hospitals in the
Metropolitan area, South Korea. This study used Patient Safety Competency (PSC) measurement tool for
nursing students developed by Lee (2012) to assess nurses’ competencies of patient safety. The PSC is
a self-report questionnaires using Likert scale and includes attitude (18 items), skill (21 items), and
knowledge dimension (6 items). Its internal reliability (Cronbach’s alpha) in the original study was .90
(Lee, 2013) and it was .95 in the current study.
The PSC’s validity was verified using content validity with four experts (three team leaders in quality
improvement departments in high-level hospitals, one professor in college of nursing) in this study. The
construct validity of PSC measurement tool was confirmed through experimental factor analysis (EFA) in
this study. After the pilot survey with 11 nurses, main survey was conducted from January and February
2012.
The present paper was designed to test the hypothesis that nurses’ patient safety competencies would
differ by their length of clinical career and working units on the base of Benner’s model of skill acquisition
(Benner & Tanner, 1987).
The general characteristics were analyzed using descriptive statistics. The PSCs of participants were
analyzed with t-test, one way ANOVA, and Chi-squared test.
RESULTS: There were significant differences in the total scores of PSC according to the previous
experience of patient safety education and role, the length of clinical career, and current working units
and hospitals. The longer clinical experience nurses had, the higher PSC scores reported. The nurses
working in emergency rooms reported significantly higher scores in the total of PSCs than those who in
the other working units (ward, operating room, intensive care unit). The mean of the total PSC scores for
all participants was 3.93(±0.41); attitude, skill, and knowledge had mean values of 4.36(±0.37),
3.82(±0.52), and 3.30(±0.67), respectively.
CONCLUSION: The results of this study show that the length of clinical career and working units should
be considered in applying interventions to enhance nurses’ patient safety competencies. There was a gap
among working units in the levels of nurses’ PSCs, therefore, subsequent studies should investigate the
relevant influence factors of this gap and make up the specific strategies to narrow this space.
We need to endeavor to continuously assess nurses’ patient safety competencies in accordance with
clinical career progress. Also, we should try to fill out the lack of competency through developing of
systematic patient safety curriculum considering nurses’ clinical career and working units to enhance
nurses’ integrated patient safety competencies.

This study was supported by National Research Foundation of Korea (810-20120011)
References
A. C. Greiner & E. Knebel (Eds.) (2003). Health professions education: a bridge to quality. Washington, DC: National
Academy Press. Benner, P., Tanner, C. (1987). How expert nurses use intuition. AJN The American Journal of
Nursing, 87(1), 23-34. Kohn, L. T., Corrigan, J. M., Donaldson, M. S., McKay, T., & Pike, K. (2000). To err is human:
Building a safer health system. Washington, DC: National Academies Press. Lee, N. J. (2012). Development of
questionnaires to measure baccalaureate nursing students’ patient safety competencies. The 11th International
Congress on Nursing Informatics, Montreal, Quebec, Canada. Lee, N. J. (2013). Validity and Reliabilty Test of
Korean Patient Safety Competency Assessment for Nursing Student. The 16th East Asian Forum of Nursing Scholars
(EAFONS), Bangkok, Thailand.
Contact
[email protected]
E 14 - Using EBP Within the Elderly Population

Fall Prevention Algorithm for the Older Adult Population: A DNP Project Utilizing
Evidence-Based Practice and Translational Research
Jeffrey Williams, DNP, RN, CCRN, CCNS, USA
Purpose
The purpose of this presentation is to present a Doctor of Nursing Practice project that shows how
translational research can be utilized to translate an evidence-based community dwelling older adult fall
prevention algorithm into an algorithm for use in the acute care setting.
Target Audience
The target audience of this presentation is all clinical staff to include staff nurses, staff educators, nurse
managers, nurse administrators, advanced practice nurses, and both undergraduate and graduate
nursing students.
Abstract
Significance /Background: Prevention of falls in the older population is an important issue in patient
safety. Assessing patients for fall risk is a standard part of the hospital admission process. The American
Geriatrics Society (AGS), in collaboration with the British Geriatrics Society (BGS), revised and published
an updated version of its previously published guideline entitled “Falls Prevention in the Older Person.”
The updated version is titled “2010 AGS/BGS Clinical Practice Guideline: Prevention of falls in older
persons.”
Purpose: The purpose of this project was to decrease the risk of falling in the older adult population
during hospitalization with the utilization of an adapted evidence-based fall prevention algorithm. The
decreased risk of falling will lead to a decrease in the number of falls in the older adult acute care patient.
Intervention: The intervention utilized an adaptation of the algorithm, established within the guideline for
the prevention of falls in older persons living in the community within an acute care unit in those patients
over 65 years of age.
Evaluation: Evaluation of the adapted algorithm occurred in a twofold process. First, the adapted
algorithm was evaluated by comparing the number of falls and the fall rate before and after
implementation of the algorithm. Second, the algorithm itself was evaluated with a simple survey given to
the registered nurses on the pilot unit that evaluated multiple aspects including ease of use, the education
received on the TUG test, the simplicity of the TUG test, and whether or not the adapted algorithm is a
beneficial tool. The survey was given through Survey Monkey utilizing an online survey tool.
Discussion: Falls prevention in the older adult in the acute care setting must be a priority for all healthcare
organizations. The importance of falls prevention in the older adult in the acute care setting must be
reinforced at all levels of the healthcare organization. The older adult population is growing as will the

number of hospital admissions. Nurses provide most of the patient care and spend the most time with
patients, which places nurses in the perfect position to be the champions of fall prevention. The use of an
algorithms is simple and beneficial, allowing nurses to target specific safety related aspects of patient
care. Through the use of the algorithm, healthcare organizations will be able to reduce the risk of falls in
the older adult, thus reducing the number of falls in the older adult in the acute care setting.
References
Administration on Aging. (2010). Aging statistics. Retrieved from
http://www.aoa.gov/aoaroot/aging_statistics/index.aspx. Agency for Healthcare Research and Quality. (2010).
Healthcare Cost and Utilization Project (HCUP). HCUP Facts and figures. Retrieved from http://hcup-
us.ahrq.gov/reports/factsandfigures/2008/exhibit1_6.jsp. American Geriatrics Society and British Geriatrics Society,
(2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for
prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148-157. Cameron, I., Murray,
G., Gillespie, L., Robertson, M, Hill, K., Cumming, R., & Kerse, N. (2010). Interventions for preventing falls in older
people in nursing care facilities and hospitals (Review). Cochrane Database of Systematic Reviews, Issue 1,
CD005465. doi:10.1002/14651858.CD005465.pub2 Campbell, A. & Robertson, M. (2007). Rethinking individual and
community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age and
Ageing, 36(6), 656-662. doi:0.1093/ageing/afm122 Centers for Disease Control. (2011). Falls among older adults: An
overview. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html Chang, J., Morton, S.,
Rubenstein, L, Mojica, W., Maglione, M., Suttorp, M., …Shekelle, P. (2004). Interventions for the prevention of falls in
older adults: Systematic review and meta-analysis of randomized clinical trials. British Medical Journal, 328(7441),
680. Currie, L. (2006). Fall and injury prevention. Annual Review of Nursing Research, 24, 39-74. Evans, D.
Hodgkinson, B., Lambert, L. Wood, J., & Kowanko, I. (1998). Falls in acute hospitals: A systematic review. Joanna
Briggs Institute for Evidence Based Nursing and Midwifery. Ganz, D., Yeran, B., Shekelle, P., & Rubenstein, L.
(2007). Will my patient fall? Journal of the American Medical Association, 297(1), 77-86. Gates, S., Smith, L., Fisher,
J., & Lamb, S. (2008). Systematic review of accuracy of screening instruments for predicting fall risk among
independently living older adults. Journal of Rehabilitation Research and Development, 45(8), 1105-1116. doi:
10.1682/JRRD.2008.040057 Perell, K., Nelson, A., Goldman, R., Luther, S., Prieto-Lewis, N., & Rubenstein, L.
(2001). Fall risk assessment measures: An analytic review. Journal of Gerontology, 56A(12), M761-M766. Healey, F.,
Monro, A., Cockram, A., Adams, V., & Heseltine, D. (2004). Using targeted risk factor reduction to prevent falls in the
older in-patients: A randomized controlled trial. Age and Aging, 33(4), 390-395. Oliver, D., Healey, F., & Haines, T.
(2010). Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine, 26(4), 539-788. Stevens, K.
R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-based Practice. The
University of Texas Health Science Center at San Antonio. Retrieved from http://www.acestar.uthscsa.edu/acestar-
model.asp Todd, C. & Skelton, S. (2004). What are the main risk factors for falls among older people and what the
most effective interventions to prevent these falls? Copenhagen, WHO Regional Office for Europe, Health Evidence
Network report. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf.
Contact
[email protected]

Factors Affecting the BODE Index of Thai Older Adults with COPD
Rewwadee Petsirasan, PhD, RN, Thailand
Purpose
I would like to share the clinical outcome of COPD patient in rural area to any nurse researcher.
Target Audience
Nurse researcher and staff nurse
Abstract
Rationale: The aim of this cross-sectional study was to explore factors attribute to the severity of COPD
among older adults with COPD in southern part of Thailand.
Methods: This study was conducted with 105 older adults who are 60 years and above with diagnosed
COPD for a year and recruited by using systemic random sampling technique.The subjects were
assessed BODE index: the body-mass index (B), the degree of airflow obstruction (O) measured by FEV1
percentage of the predicted value, dyspnea (D) measured by the modified Medical Research Council
(MMRC) dyspnea scale, and exercise capacity (E) measured by the 6 minute walk distance (6MWD). The
higher scores indicate a higher risk of death. Socio-demographic information, Personal Health
Questionnaire Depression Scale (PHQ-9), smoking status, and other clinical data were collected.
Descriptiveand multiple regression analysis were applied for data analysis.
Results: Most patients (84%) were male; they had a mean (SD) age of 72(8) years and mild to severe
COPD (FEV1% 69(10) predicted) with BODE index score 3(2) points. The study showed that BODE index
scores related to age (r = .26, p < .01), length of stay (r = .20, p < .05), income (r = -.25, p < .05) and
depression (r = .26, p < .01). The regression analysis shows that BODE index score were affected by age
(p < .05) and depression (p < .05).
Conclusion: This study shows that the most affected older patients on the severity of COPD were age and
depression. Therefore, nurse should be concerned the influence of depression on older adults with
COPD.
Contact
[email protected]

What Impact Does Pharmacist Led Medication Reconciliation Strategies Have on
Reduction of Medication Errors in the Older Adult?
Lorraine A. Von Eeden, DNP, CPNP/ FNP, RN, USA
Purpose
The purpose of this presentation is to provide evidence-based information on pharmacist led medication
reconciliation strategies and its effect on medication errors in the community dwelling older adult.
Target Audience
The target audience of this presentation are nurse practitioners, physicians, pharmacists and other health
care personnel who work with the older adult community dwelling population.
Abstract
To study the role of the pharmacist in optimizing medication reconciliation strategies and the potential
impact on medication related problems in community dwelling older adults Purpose
Purpose: To determine what effect a pharmacist-led intervention can have on medication reconciliation
strategies /medication errors in the community dwelling older adult.
Methods: This review considered studies that evaluated the effects of medication reconciliation strategies
on medication errors in community dwelling older adults. The target population was older adults, 65 years
and older and living in the community. Excluded were any older adults with dementia or who were
dependent on family members or other individuals for the provision of care. The primary outcome
measure studied in this review was number of medication errors.
Results: This review yielded three studies for consideration; 2 level one randomized controlled trials
(RCT’s), and 1 level three prospective randomized comparative study. Each study presented evidence to
support the positive outcomes of a pharmacist led medication reconciliation process on medication errors
for community dwelling older adults. The way in which the pharmacist conducted the medication
reconciliation process, however, varied greatly in each of these studies. Reconciliation processes
included: medication reconciliation and review face-to-face with patients in the physician’s office; home
visits with patients; and a reconciliation process that stemmed from a team based approach to care.
Implications for practice: This review suggests that clinicians support pharmacist-led medication
reconciliation, specifically for older adults residing in community settings. This support is integral to the
health of the older adults in terms of identifying and preventing medication errors, and in the development
of appropriate recommendations to primary care providers for appropriate medication adjustments.
Implications for Research: This review underscores the need for continued research in order to
determine the effectiveness of pharmacist led medication reconciliation strategies on medication errors in
the community dwelling older adults. Additionally, there is a need to develop more research initiatives that
study medication reconciliation within a team-based approach; a need for more evidence-based
information relating to interdisciplinary team functioning. Research should focus on who the members of
the team are, roles and responsibilities of each team member, what facilitates the effectiveness of a team,
and most importantly, the impact on medication errors. Additionally the context within which medication
reconciliation is carried out, such as types of settings - in the patient’s home, in the pharmacy, in the
primary care provider’s office - warrants future research.
References
Elliott RA, Martinac G, Campbell S, Thorn J, Woodward MC. Pharmacist-Led medication review to identify
medication-related problems in older people referred to an Aged Care Assessment Team. Drugs Aging 2012; 29 (7):
593-605. Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus P et al. Pharmacist-led medication review in
patients over 65: A randomized, control trial in primary care. Age and Ageing 2001; 30: 205-211. Sellors J,
Kaczorowski J, Sellors C, Dolovich L, Woodward C, Willan A et al. A randomized controlled trial of a pharmacist
consultation program from family physicians and their elderly patients. CMAJ July 2003; 169(1): 17-22.

Contact
[email protected]

F 12 - Patient Education and Treatment Modalities
Enhancing Adherence to Treatment for Clients with Serious Mental Illness
Valerie N. Markley, BSN, MSN DNP, USA
Purpose
to report the results of an intervention study using technology for communication among providers and
clients between office visits to increase adherence to treatment for adults with serious mental illness in
support of evidence based practice emphasizing the impact of the therapeutic alliance as conceived by
Hildegard Peplau.
Target Audience
nurses and providers caring for clients with serious, chronic illnesses. The participants in this study were
psychiatric clients; however, the review of literature and the intervention used could be applicable to
working with clients with other chronic illnesses.
Abstract
Non-adherence to treatment is a common problem in many chronic disorders with higher rates among
clients with mental disorders. Non-adherence to treatment greatly compromises the effectiveness of
psychiatric treatment and is associated with higher rates of relapse, hospitalization, and increased health
care costs. Hildegard Peplau’s theory of the nurse-client relationship and Ludwig von Bertalanffy’s
general system theory provide a model for intervening to increase adherence. The study was conducted
over a 90 day period in the outpatient service of a for-profit psychiatric hospital. The intervention involved
communication between office visits by an advanced practice nurse who contacted clients via phone or
email. Thirteen adult clients between the ages of 21 and 59 agreed to participate (four males and seven
females). Patients’ diagnoses included bipolar disorder, major depressive disorder, anxiety disorder, and
post traumatic stress disorder. All of the participants were new to the clinic and had a history of
inconsistent compliance with medications. Clients were asked to keep a daily log of psychotropic
medications taken. They were considered as meeting the goal of adherence when taking the medication
75% of the time. Their attendance to psychiatric appointments was also recorded. Chi-Square tests
indicated that APRN communication was significantly associated with consistent adherence to
medications (χ2 (1, N = 13) = 13.00, p < .001) and to psychiatric appointments (χ2 (1, N = 13) = 13.00, p
< .001). These results support the use of an evidence based intervention to enhance adherence to
psychiatric treatment. Recommendations for further study include recruiting the psychiatric providers to
provide the intervention and conducting a cost effectiveness analysis.
References
Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., . . . Moher, D. (2009). The PRISMA
statement for reporting systematic reviews and meta- analyses of studies that evaluate health care interventions:
Explanation and elaboration. PLoS Medicine, 6(7), 1-63. American Psychiatric Association. (2000). Diagnostic and
statistical manual of mental disorders ( 4th ed., Text Revision). Washington, DC: APA. Anderson, K.H., Ford, S.,
Robson, D., Cassis, J., Rodrigues, C., Gray, R., (2010). An exploratory, randomized controlled trial of adherence
therapy for people with schizophrenia. International Journal of Mental Health Nursing, 19, 340-349. Bearden,
C.E.,Thompson, P., Dalwani, M., et al. (2007). Greater cortical grey matter density in lithium-treated patients with
bipolar disorder. Biological Psychiatry, 62, 7-16. Beebe, L.H., Smith, K., Crye, C., Addonizio, C., Strunk, D.J., Martin,
W., Poche, J. (2006). Telenursing intervention increases psychiatric medication adherence in schizophrenia
outpatients. Journal of the American Psychiatric Nurses Association. 14(i3), 217-227. Bennet, A., & Bennet, D. (n.d.).
The intelligent complex adaptive system model for organizations. Berk, L., Hallam, K.T., Colom, F. Vieta, E., Hasty,
M., Macneil, C., Berk, M. (2009). Enhancing Medication adherence in patients with bipolar disorder. Human
Psychopharmacology: Clinical and Experimental, 25, 1-16. Bertalanffy, L.V. (1968). General system theory. New
York: George Braziller, Inc. Breen, R., Thornhill, J.T. (1998). Noncompliance with medication for psychotic disorders:
Reasons and remedies. CNS Drugs, 9, 457-471. Byerly, M.J., Nakonezny, P.A., Rush, A.J. (2008). The Brief
Adherence Rating Scale (BARS)validated against electronic monitoring in assessing the antipsychotic medication
adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophrenia Research, 100, 60-69.
Compton, M.T., Rudisch, B.E., Weiss, P.S., et al. (2005). Predictors of psychiatrists-reported treatment-compliance
problems among patients in routine US psychiatric care. Psychiatric Research, 137, 29-36. Crowe, M., Wilson, L.,

Inder, M. (2011). Patients’ reports of the factors influencing medication adherence in bipolar disorder-An integrative
review of the literature. International Journal of Nursing, 48, 894-903. Fialko, L., Garety, P.A., Kuipers, E., Dunn, G.,
Bebbington, P.E., Fowler, D., Freeman, D. (2008). A large-scale validation study of the Medication Adherence Rating
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elapse and impairment in bipolar disorder. American Journal of Psychiatry, 152, 1635-1640. Greenberg, P.E.,
Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Bergland, P.A., Corey-Lisle, P.K. (2003. The economic
burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry,
64(12), 1465-1476. Haines, S. G. (1999). The manager’s guide to systems thinking and learning. Amherst, MA: HRD
Press. Horne, R., (2006). Compliance, adherence, and concordance: Implications for asthma treatment. Chest, 130,
56s-72s. Hospital Care Quality Information from the Consumer Perspective. (2013).
http://www.hcahpsonline.org/home.aspx Institute of Medicine. (2001). Crossing the quality chasm: A new health
system for the 21century. Washington DC: National Academies Press. Retrieved from:
http://www.nap.edu/catalog/10027.html Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K.R., Walters, E.E.
(2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey
Replication. Archives of General Psychiatry, 62(6), 617-627. Kleinpell, R. M. (2009). Outcome assessment in
advanced practice nursing (2nd ed.). New York: Springer. Kofke, W. A., & Rie, M. A. (2003). Research ethics and law
of healthcare system quality improvement: The conflict of cost containment and quality. Critical Care Medicine,
31(Suppl), S143-S152. Kresse, M. R., Kuklinski, M. A., & Caccione, J. G. (2007). An evidence-based template for
implementation of multidisciplinary evidence-based practices in a tertiary hospital setting. American Journal of
Medical Quality, 22, 148-63. Lacro, J.P., Dunn, L.B., Dolder, C.R., Leckband, S.G., Jeste, D.V. (2002). Prevalence of
risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature.
Journal of Clinical Psychiatry, 63(10), 892-909. Mitchell, A.J., Selmes, T. (2007). Why don’t patients attend their
appointments? Maintaining engagement with psychiatric services. Advances in Psychiatric Treatment, 13, 423-434.
Mutsatsa, S.H., Joyce, E.M., Hutton, S.B., Webb, E., Gibbins, H., Paul, S., Barnes, T.R.E.(2003). Clinical correlates
of early medication adherence: West London first episode schizophrenia study. Acta Psychiatrica Scandinavica,
108(6), 439-446. Nakanishi, M., Koyama, A., Ito, H., et al. (2006). Nurses’ collaboration with physicians in managing
medication improves patient outcome in acute psychiatric care. Psychiatry and Clinical Neurosciences, 60, 196-203.
Nose, M., Barbui, C., Gray, R. (2003). Clinical interventions for treatment non-adherence in psychosis: Meta-analysis.
British Journal of Psychiatry, 183, 197-206. Peplau, H.E. (1991). Interpersonal relations in nursing: A conceptual
frame of reference for psychodynamic nursing. New York: Springer Publishing Co. Polit, D. F. (2010). Statistics and
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Statistical Package for Social Sciences-version 21(SPSS; IBM, Inc.Chicago, IL). http://www-
01.ibm.com/software/analytics /spss/ Puschner, B., Angermeyer, M.C., Leese, M., Tornicraft, G., Schene, A., Kikkert,
M….Becker, T. (2007). Course of adherence to medication and quality of life in people with schizophrenia. Psychiatry
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intervention at four community mental health clinics in London. Psychiatric Services, 63(2), 161-168. Strauss, J.L.,
Johnson, S.L. (2006). Role of treatment alliance in the clinical management of bipolar disorder: Stronger alliances
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C.J.L. (2004). Global Burden of depressive disorders in the year 2000. British Journal of Psychiatry,184, 386-392.
Wilens, T. E. (1999). Medication Log. New York, NY: Guilford Press.
Contact
[email protected]

F 12 - Patient Education and Treatment Modalities
A Primary Health Care Campus Drive in Responding to a Research Study of
University Students' Knowledge, Perception Towards Human Papillomavirus
(HPV) Infection and Vaccination, and Acceptance of Vaccination for Themselves:
Comparison Between Males and Fem
Kar Yan Alice Wong, PhD RN, Hong Kong
Purpose
The purpose of this presentation is to showcase the involvement of first year nursing students in campus
health by giving primary healthcare promotion activities on HPV prevention.
Target Audience
The target audience of this presentation are Nurse academics and nurse educators.
Abstract
Background: Human Papillomavirus (HPV) infection becomes one of the commonest sexually
transmitted diseases (STDs) nowadays. The common types of HPV caused more than 70% of cervical
cancers and 90% of genital warts worldwide. Two HPV vaccines were available since 2006, which were
approved to be safe and effective in preventing HPV-related infections. The effectiveness is optimal in
people before sexual activity. As the mean age of first sex in Hong Kong found was 20 years old, it is vital
to understand the vaccination status, acceptance, knowledge and perception towards HPV infection and
vaccination among Hong Kong undergraduates who is the target group of vaccination.
Aim: To train first year nursing students to promote primary health care (PHC) on campus during
Summer 2013 by addressing the myth versus knowledge, perception and acceptance towards HPV
infection and vaccination between male and female university students in Hong Kong.
Method: Former research findings obtained from self-administered questionnaire including socio-
demographic characteristics, awareness, knowledge and perceptions of HPV infection and vaccination,
sexual history, medical history of personal and significant others as well as vaccination status, was used
in the study. The HPV prevention health pamphlets and mobile board games were used to achieve health
prevention for both male and female undergraduates.
Results: Over a thousand peer-students-encounter of primary healthcare activities were conducted in
following up the results based on former research study from 2243 of undergraduates participants.
14.6% (n=180) of female have received the vaccine when only 1.4% (n=1011) of male have initiated with
a significant difference (p=0.000). The acceptance varied between genders as 20.7% of female accepted
and 2.1% of male accepted (p=0.000). They had moderate knowledge level towards HPV when female
scored higher significantly (p=0.000). The relationship between knowledge level and acceptance was
shown in female group when the accepted one had higher knowledge. Perceptions which were assessed
by the Health Belief Model (HBM) showed significant differences among them. Male had lower
susceptibility, severity, benefits, cues to action and self-efficacy with higher barriers (all p=0.000). The
relationship between all items of perceptions and acceptance were shown in female group when the
relationship of perceived barriers and acceptance was shown in male group.
Conclusion: As PHC activity prepared students were using different purposive strategies for health
education and promotions for undergraduates as the differences between genders and age group were
identified.
References
1. Alexander AB, Stupiansky NW, Ott MA, Herbenick D, Reece M, Zimet GD. Parent-son decision-making about
human papillomavirus vaccination: a qualitative analysis. BMC Pediatr. 2012;12:192. 2. Oldach BR, Katz ML. Ohio
Appalachia public health department personnel: human papillomavirus (HPV) vaccine availability, and acceptance
and concerns among parents of male and female adolescents. J Community Health. 2012 Dec;37(6):1157-63. 3.
Reiter PL, McRee AL, Gottlieb SL, Brewer NT. HPV vaccine for adolescent males: acceptability to parents post-

vaccine licensure. Vaccine. 2010 Aug 31;28(38):6292-7. 4. Walhart T. Parents, adolescents, children and the human
papillomavirus vaccine: a review. Int Nurs Rev. 2012 Sep;59(3):305-11. 5. Gottvall M, Larsson M, Hoglund AT, Tyden
T. High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students. Eur J
Contracept Reprod Health Care. 2009 Dec;14(6):399-405. 6. Katz ML, Kam JA, Krieger JL, Roberto AJ. Predicting
human papillomavirus vaccine intentions of college-aged males: an examination of parents' and son's perceptions. J
Am Coll Health. 2012;60(6):449-59. 7. Reiter PL, McRee AL, Pepper JK, Gilkey MB, Galbraith KV, Brewer NT.
Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males. Am J
Public Health. 2013 Aug;103(8):1419-27. 8. Heckman CJ, Fang CY, Jayo I. Pilot study: health behaviors associated
with human papillomavirus vaccine acceptance among adolescents. J Prim Care Community Health. 2012 Jul
1;3(3):170-3. 9. Gilkey MB, Moss JL, McRee AL, Brewer NT. Do correlates of HPV vaccine initiation differ between
adolescent boys and girls? Vaccine. 2012 Sep 7;30(41):5928-34. 10. Jacobson RM, Roberts JR, Darden PM.
Parents' perceptions of the HPV vaccine: a key target for improving immunization rates. Expert Rev Clin Immunol.
2013 Sep;9(9):791-3. 11. Paul P, Tanner AE, Gravitt PE, Vijayaraghavan K, Shah KV, Zimet GD, et al. Acceptability
of HPV Vaccine Implementation Among Parents in India. Health Care Women Int. 2013 Jan 3. 12. Mortensen GL.
Parental attitudes towards vaccinating sons with human papillomavirus vaccine. Dan Med Bull. 2010
Dec;57(12):A4230. 13. Gargano LM, Herbert NL, Painter JE, Sales JM, Morfaw C, Rask K, et al. Impact of a
physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent
vaccines. Hum Vaccin Immunother. 2013 Jul 24;9(12). 14. Tisi G, Salinaro F, Apostoli P, Bassani R, Bellicini A,
Groppi L, et al. HPV vaccination acceptability in young boys. Ann Ist Super Sanita. 2013;49(3):286-91. 15. Hendry M,
Lewis R, Clements A, Damery S, Wilkinson C. "HPV? Never heard of it!": A systematic review of girls' and parents'
information needs, views and preferences about human papillomavirus vaccination. Vaccine. 2013 Sep 9. 16. Mullins
TL, Griffioen AM, Glynn S, Zimet GD, Rosenthal SL, Fortenberry JD, et al. Human papillomavirus vaccine
communication: Perspectives of 11-12 year-old girls, mothers, and clinicians. Vaccine. 2013 Oct 1;31(42):4894-901.
17. Zhang SK, Pan XF, Wang SM, Yang CX, Gao XH, Wang ZZ, et al. Perceptions and acceptability of HPV
vaccination among parents of young adolescents: a multicenter national survey in China. Vaccine. 2013 Jul
11;31(32):3244-9. 18. Wong MC, Lee A, Ngai KL, Chor JC, Chan PK. Knowledge, Attitude, Practice and Barriers on
Vaccination against Human Papillomavirus Infection: A Cross-Sectional Study among Primary Care Physicians in
Hong Kong. PLoS One. 2013;8(8):e71827. 19. Hofman R, van Empelen P, Richardus JH, de Kok IM, de Koning HJ,
van Ballegooijen M, et al. Predictors of HPV vaccination uptake: a longitudinal study among parents. Health Educ
Res. 2013 Sep 16. 20. Bryer J. Black Parents' Beliefs, Attitudes, and HPV Vaccine Intentions. Clin Nurs Res. 2013
Jun 6. 21. Taljaard M, Donner A, Villar J, Wojdyla D, Velazco A, Bataglia V, et al. Intracluster correlation coefficients
from the 2005 WHO Global Survey on Maternal and Perinatal Health: implications for implementation research.
Paediatr Perinat Epidemiol. 2008 Mar;22(2):117-25.
Contact
[email protected]

F 13 - Diverse Language Challenges Within Nursing Practice
Beyond the Language Barrier: "See," "Hear," "Speak," "Help Me"
Shirin Badruddin Verasia, MSN, BSN, Saudi Arabia
Shazia Arif, BSN,RN, Saudi Arabia
Purpose
The purpose of this study is to focus on the importance of implementing a communication toolkit to
enhance the communication between the nurse and the patient,to overcome the language barrier, provide
safe effective patient care and provide excellent quality care.
Target Audience
health care professionals
Abstract
Language is an important means of communication . King Faisal Specialist Hospital & Research Centre
employs staff from 87 different cultures; a significant number of these staff delivers front line care to
patients and families. Statistics showed that staff nurses from 38 different nationalities are hired to work in
King Faisal Specialist Hospital and Research Centre (KFSHRC) with 900 beds (Admission data, 2012). In
the intensive care unit, when these new nurses arrive, their grasp of Arabic is limited. The uniqueness of
this situation poses great challenges in day to day communication. Although the hospital supports the use
of the English language in the workplace, the reality is that many patients and relatives are Arabic
speaking only. The consequence of this is that a second party often carries out communication; usually
consisting of the family, care givers or hospital interpreters. This can lead to confusion occurring between
parties’ e.g. interpretation of medical terminology, clarity, sharing of culturally sensitive information and
the lack of confidentiality. This situation can be compounded by the patient’s inability to understand, or
that they may have hearing or language difficulties.
A systematic and comprehensive search was done in January, 2013, to access research studies on
overcoming language barriers among health care professionals and patients. Various words and phrases
were used to guide the search that included: communication, language barriers, language conflict,
overcoming language barriers and strategies to reduce language barriers. Data bases such as CINAHL,
Pubmed, Sage and Science Direct were used to guide the search. The search ranged from 2003 to 2012.
A total of 230 articles appeared relevant, but after reading the abstracts only fifteen were found relevant
to the study purpose.
Literature search highlighted that most of the studies were conducted in the western region but none of
the studies were found in the Middle East. In addition, most of the studies have explored the perceptions
and feelings of the health care professionals including expatriates nurses and doctors about caring for
patients with different language. Studies have emphasized the use of interpreters but none of the studies
focus on the interventions to overcome the language barriers.
The communication toolkit is an education tool for non- Arabic speakers by expediting learning of Arabic
language skills.
This communication project was created using collaborative decision making, different units worked
together to help create the toolkit.
Patients are at the focus point in this project raising the standards to ensure patient satisfaction is a vital
aspect for the hospital. Nursing staff care, understand the culture and are experienced in the art of
nursing Saudi patients; using these key aspects the nursing staff was able to develop the toolkit flipchart,
which is sensitive to the Arabic culture. Maslow’s Hierarchy of needs model was addressed as spirituality
is one of the main components in the communication flipchart. Benner’s Model has been addressed by
nursing staff utilizing their experience and skills to draft a creative communication toolkit that attempts to
address a gap in the language barrier within in the organization. The Communication toolkits aim is to
overcome the language barrier, provide safe effective patient care and provide excellent quality care.

References
References Diamond, L. C., & Jacobs, E. A. (2009).Lets not contribute to disparities: the best method for teaching
clinicians how to overcome language barriers to health care. J Gen Intern Medicine, 25, 189-193. Finke EH, Light J,
Kitko L 2008 A systematic review of the effectiveness of nurse communication with patients with complex
communication needs with a focus on the use of augmentative and alternative communication. Journal of Clinical
Nursing. 17 (16) pp. 2102-2115 Gregg, J., &Saha, S. (2007). Communicative competence: A framework for
understanding language barriers in health care. J General Intern Med, 22, 368-70. Grossbach, I., Stranberg, S.,
Chlan, L. 2011 Promoting Effective Communication for Patients Receiving Mechanical Ventilation. Critical Care
Nurse. 31 (3) pp. 46-60 Hudelson, P., &Vilpert, S. (2009). Overcoming language barriers with foreign-language
speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health services
research, 9, 187. Patak, L., Gawlinski, A., Fung, NI et al. 2006 Communication boards in critical care: patients' views.
Applied Nursing Research. 19 (4) pp. 182-90
Contact
[email protected]

Connections for Learning: An Innovative Program to Support Culturally and
Linguistically Diverse Students
Robyn E. Nash, PhD, MHSc, BA, RN, RCNA, Australia
Pamela M. Lemcke, RN, MLdsp, RCNA, Australia
Rena Frohman, MA, GradCertArts, BA, Australia
Purpose
Raise participants' awareness of a collaborative, co-curricular program that has been designed to support
undergraduate and postgraduate students from culturally and linguistically diverse backgrounds in the
Faculty of Health at a large university in Brisbane.
Target Audience
Academic staff who work with culturally and linguistically diverse student cohorts, and are interested in
stratgies to facilitate positive outcomes for students and teaching staff.
Abstract
Cultural, academic and social challenges can present significant obstacles to culturally and linguistically
diverse (CALD) students’ achievement of personal and professional goals. This paper reports on the
Connections for Learning Program (CLP), a collaborative, co-curricular initiative that supports
undergraduate and postgraduate CALD students in the Faculty of Health at QUT.
As expressed in the UNESCO Guidelines on Intercultural Education (2006), ‘intercultural education
cannot be just a simple ‘add on’ to the regular curriculum. It needs to concern the learning environment as
a whole, as well as other dimensions of educational processes’ (p. 19). Hence, the Connections for
Learning Program team has intentionally designed the CLP to offer students a suite of learning
opportunities that value-add to their course experience. The CLP’s learning focus is underpinned by the
value placed on the lived history that students bring to the learning experience. The program is oriented
to minimising the linguistic challenges which can make learning more complicated, sometimes referred to
as demystifying the ‘hidden rules of academia’, and enabling students to grow personally and
academically.
The CLP comprises a suite of student-focussed strategies and capacity-building initiatives for academic
staff and clinical supervisors. Based on a needs analysis undertaken in 2009, the Program addresses
three focal areas of student need - Academic, Professional and Socio-cultural – through four key
strategies: Language and Literacy, Workplace Preparation, Staff Development and Community Outreach.
The model underpinning the CLP draws upon the four pillars of intercultural education: Learning to know;
Learning to do; Learning to live together and Learning to be (UNESCO, 2006). Engagement in the

program has been substantial with more than 4,500 students participating in one or more CLP activities
over 2010-2012 period.
Quantitative and qualitative data, gained through an action research framework, indicate that the CLP is
having positive, sustained impact on academic and clinical outcomes. As an example, more than 70% of
students identified in 2011 and 2012 as ‘at-risk’ of failing particular courses went on to pass these
courses. These results are supported by feedback from clinical staff which highlights students’ improved
abilities to engage constructively with clinical practice.
Through its 4-pronged strategy and deliberative focus on creating safe, active learning environments, the
CLP provides students with a powerful means to experience the ‘joy of learning’ (Wang et al, 2008). This
is a strong catalyst for their engagement in the process and achievement of successful outcomes.
References
UNESCO. (2006). UNESCO Guidelines on Intercultural Education, Paris, France. Wang, C.-W., Singh, C., Bird, B., &
Ives, G. (2008). The learning experiences of Taiwanese nursing students studying in Australia, Journal of
Transcultural Nursing, 19(2), 140-150.
Contact
[email protected]

Validation of a Post-Entry English Language Assessment for Commencing
Undergraduate Nursing Students
Paul J. Glew, EdD, RN, BN, BEd, GradCertClinSc (ICN), MAAppLing (TESOL), MN, Australia
Sharon Patricia Hillege, RN, RM, BHS, PGCert, PhD, Australia
Yenna Salamonson, RN, BSc, CCUCert, GDNEd, MA, PhD, Australia
Kathleen Dixon, RN, BA, MHA, PhD, Australia
Anthony Good, BSc (Hon), PhD, Australia
Lien Lombardo, BN, Australia
Purpose
The purpose of this presentation is to discuss the validation of a post-entry English language assessment
(PELA) for undergraduate nursing students through examination of the relationship between assessment
of writing at course commencement using a PELA and responses to a validated survey instrument on
levels of English language usage.
Target Audience
The target audience of this presentation is nursing educators who teach and support undergraduate
nursing students in cohorts composed of diverse educational, linguistic and cultural backgrounds. These
educators may be responsible for assessing the language and academic literacy skills of students at
commencement and also during a nursing program.
Abstract
Background: The Australian society has become increasingly culturally and linguistically diverse as a
consequence of migration and globalisation, and this diversity is reflected in students choosing to take up
nursing studies in higher education (Salamonson et al. 2012). Similar trends are also reported in other
developed countries, for instance, the United States (American Association of Colleges of Nursing, 2012).
Although these students may meet a minimum entry requirement for university admission, some, in
particular, those with English as an additional language (EAL) experienced slower rates of progression
(Salamonson et al, 2011), which suggests that they may not be adequately prepared with the language
and literacy skills necessary to successfully meet the linguistic demands of their studies. In response to
this, a large Australian nursing school in Sydney used a post-entry English language assessment (PELA)
tool to assess the writing skills of commencing undergraduate nursing students, to identify those requiring
support, and to implement effective support interventions.
Aim: The primary aim of this study was to evaluate the utility of the PELA tool, for use with commencing
undergraduate nursing students. The study also examined the relationship between students’
performance in the PELA writing task and their levels of English language usage using the English
language acculturation scale (ELAS), a previously validated instrument (Salamonson et al, 2013).
Method: Using a prospective survey design, between 2010 and 2013, commencing students who
enrolled and completed a nursing communication unit (with a focus on academic literacy), and who
attended a course commencement session were invited to complete a brief survey. In addition to socio-
demographic information, students were also asked to complete the ELAS. A writing test using the PELA
tool was also administered to grade students’ writing skills, which took less than 20 minutes for students
to complete. The PELA grading levels were based on a literacy criterion with Level 1 (proficient), Level 2
(borderline), and Level 3 (poor and requiring additional support). Students who received a Level 2 or 3
were recommended to undertake support interventions involving literacy workbook tasks, accessing
essay planning podcasts, and attending consultations and workshops with literacy and English language
specialist support staff. We sought participant’s consent to link their completed survey and PELA to their
enrolment status and academic grades. The university Human Research Ethics Committee approved the
study. A p value of <0.05 was considered as statistically significant.

Results: Of the 3957 students who completed the nursing communication unit over the 4-year period,
2669 (67%) completed the ELAS, the PELA writing task, and provided consent for their enrolment status
and grades to be linked. The following participant groups were significantly more likely to achieve Level 2
or 3 on their PELA writing task: a) non-Australian-born (chi-square: 520.6, df: 2, p<0.001); b) spoke other
than English at home (chi-square: 490.2, df: 2, p<0.001); and c) international students (chi-square: 225.6,
df: 2, p<0.001). There was an inverse and statistically significant relationship between participants’ ELAS
scores and PELA Levels (r=-0.52, p<0.001), showing that participants with higher English language
usage were more likely to achieve Level 1 in their PELA writing task. At follow-up, upon completion of the
nursing communication unit, participants who achieved better levels in the PELA writing task were also
significantly more likely to achieve higher scores in an essay assessment (chi-square: 40.2, df: 2,
p<0.001), overall final mark (chi-square: 218.6, df: 2, p<0.001), and higher GPA (chi-square: 100.8, df: 2,
p<0.001).
Conclusion: The results of this study underscore the importance of using a post-entry English language
assessment as a screening tool for commencing students, particularly those at risk of academic
underachievement. The study also revealed that students’ performance on the PELA writing task have a
direct relationship with student English language usage, and predicted academic performance in the
nursing program.
References
American Association of Colleges of Nursing (2012) New AACN data show an enrollment surge in baccalaureate and
graduate programs amid calls for more highly educated nurses Available at: http://splashurl.com/q2r7ptw (accessed
December 12 2013). Salamonson, Y., Andrew, S., Clauson, J., Jacobs, S., Cleary, M. & Jackson, D. (2011) Linguistic
diversity as sociodemographic predictor of nursing program progression and completion. Contemporary Nurse, 38(1-
2), 84-93. Salamonson, Y., Attwood, N., Everett, B., Weaver, R. & Glew, P. (2013) Psychometric testing of the
English Language Acculturation Scale in first-year nursing students. Journal of Advanced Nursing, 69(10), 2309-
2316. Salamonson, Y., Ramjan, L., Lombardo, L., Lanser, L.H., Fernandez, R. & Griffiths, R. (2012) Diversity and
demographic heterogeneity of Australian nursing students: a closer look. International Nursing Review, 59(1), 59-65.
Contact
[email protected]

F 14 - EBP in the Global Clinical Setting
Collaboration in the Chain of Stroke Care: Stroke After-Care, a Gap to be Closed
Bianca Ivonne Buijck, PhD, MScN, RN, Netherlands
Purpose
to present the stroke after-care project of the Rotterdam Stroke Service in the Netherlands. For decades,
the RSS forms a collaboration with 20 health care organizations in the care for stroke patients in the
acute and chronically phase.
Target Audience
the group of nurses and researchers that are working in the field of care for stroke patients in the acute
and chronically phase.
Abstract
Background: In the Rotterdam Stroke Service (RSS), numerous hospitals, nursing homes/rehabilitation
centers and a home care organization collaborate to provide the best quality of care for stroke patients in
the acute and chronically phase. After a stroke, patients are confronted with physical disabilities and
changes in cognition and behavior. In spite, practice based research (RSS, 2010) shows that stroke
patients do not receive adequate care and support in the home environment after discharge from the
hospital, nursing home or rehabilitation centre. There is a lack of specialized care and support to learn to
cope with disabilities and changing roles after stroke. This may lead to an increase of complications on all
life domains, such as caregiver burden, alcohol and medication abuse, mobility problems and social
isolation. Caregivers, children and spouses are faced with multiple challenges related to this vulnerable
patient group. Patient target analysis shows that there is an increasing percentage of foreign residents in
the Rotterdam area. This population is hard to reach for care due to cultural and language barriers.
Furthermore, research shows that in the Rotterdam area residents have a more risk full life style than in
other parts of the Netherlands (GGD, 2010). Therefore, two of the participants of the RSS, “Rotterdam
Home Care” and “Laurens”, initiated an ambitious project to improve after-care for stroke patients in their
home environment.
Method: Eight hospitals, nine nursing homes, two rehabilitation centers and a home care organization
are collaborative partners within the RSS. A taskforce was formed from individuals working in these
organizations. In the project phase, three organizations participated in this project. From April 2012-
November 2013, the taskforce had the goal to create a shared policy, monitor infra-structure, and design
a research plan. The project was funded by ZonMW. During the project patients received out-reached
nursing support consisting of home visits. The nurses collected demographic data, assessed functional
abilities and used standardized checklists to record a wide range of problems that patients expressed.
Lastly, focus group interviews among managers and nurses were held to determine the feasibility and
applicability of the project. Informed consent of patients was obtained.
Results: One-hundred-forty-eight patients received out-reached nursing support. Patients were on
average 68 years old. Sixty-eight patients were female. Of these patients, 85% have had a Cerebro
Vascular Accident and 15% a Transient Ischemic Attack. The majority of the patients were discharged
home from the hospital (86%). Patients had on average three contact moments with the nurse in the first
three months after discharge. After stroke, patients reported changes concerning mobility of arm and leg
(51% and 44% respectively), balance (42%), cognition (49%), communication (45%), emotion (32%),
vision (10%) and behavior (9%). At baseline, 30% was unhappy with provided information. One year
later, only four patients were unhappy with provided information. At baseline, 75% of the patients was
happy with the support provided by health care professionals, one year later 80% of the patients was
happy with provided support. In the focus group interviews, managers and nurses reported that fine-
tuning of care and unity in the chain of stroke- care improves healthcare delivery. Nurses are able to
detect problems in an early stage and, therefore, they can respond earlier on patient en informal
caregiver needs. They feel that this ultimately can result in fewer readmissions to the hospital or
rehabilitation unit.

Discussion/conclusion: Nurses, patients and managers are convinced that the stroke after-care project
was successful in improving quality of care after stroke. Nevertheless, there is a major challenge for
organizations to find financial recourses to conduct this project in the future in the Rotterdam area,
because so far health care insurance does not cover the costs. Nevertheless, the participants of the RSS
are continuing the project, aiming at making it care as usual. And since the project results are promising,
the issue may be impactful in meetings with health care insurers.
References
www.rotterdamstrokeservice.nl GGD Rotterdam Rijnmond (2010). Mapping Health care Rotterdam (In Dutch:
Gezondheid in kaart Rotterdam).
Contact
[email protected]
F 14 - EBP in the Global Clinical Setting

Barriers Impacting Rapid Access to Tertiary Care for Time Sensitive Critically Ill
Patients
Scott M. Newton, RN, MHA, EMT-P, USA
Purpose
to identify barriers that impact rapid interhospital transfers, review the problem, discuss variables,
describe the impact, and summarize the evidence.
Target Audience
Nursing providers, leaders, administrators, educators, researchers, safety and quality officers.
Abstract
Introduction: Interhospital transfer of critically ill patients between community hospitals and tertiary care
centers are common within the United States. Medicare data from 2005, identifies an interfacility critical
care transfer volume of 47,820 (Iwashyna et al, 2009). Approximately 4.5% of all critical care patient
admissions to community hospitals experiences an interhospital critical care transfer. The process for
interhopsital transfers is not optimized for favorable patient outcomes and is a significant problem to be
addressed (Bosk, Vienot and Iwashyna, 2011).
Rapid access to tertiary care is paramount to the patient experiencing a time sensitive critical condition.
Time sensitive critical conditions include acute ST-segment elevation myocardial infarction (STEMI) of
which 30-50% are transferred to tertiary care (Iwashyna, 2012), acute stroke, major traumatic injury, non-
traumatic surgical emergencies (such as intracranial hemorrhage, aortic dissection, neurovascular
compromise, ruptured heart valve, etc.), and pediatric critical care (specialty expertise and skill at the
tertiary care center). Delays in tertiary care may contribute to increased morbidity and mortality, a
decrease in care system efficiency and effectiveness, an increase in costs of providing care, and a
decrease in revenues for the tertiary care center (Ligtenberg et al, 2005).
The Problem: Barriers to tertiary care exist at the community hospital and the tertiary care center.
Community hospital barriers include recognizing the need for tertiary care, regional knowledge of tertiary
care resources, and sending provider’s willingness or ability to present a case for transfer. Barriers
existing at the tertiary care center depend upon the efficiency of the patient transfer request process
(Warren et al, 2004). The patient transfer request process includes an initial telephone answering point,
the ability to quickly contact on-call specialty care providers, availability of an appropriate specialty care
bed, awareness of and access to bed availability information and a way to emergently transport patients
by critical care transport teams (ambulance, helicopter or airplane). Practice is variable at referring
community hospitals when making the decision to transfer a patient and tertiary care access is variable in
the ability to receive a patient resulting in delays (Bosk, Veinot and Iwashyna, 2011).

Variables and Factors: Several variables contribute to the problem. Recognizing the need to transfer a
patient with a critical diagnosis by the community hospital provider, may prevent efforts to initiate transfer
early in the patient encounter. Community hospitals care team knowledge of available tertiary care
resources and proximity to a tertiary care center. Existing bed capacity at the tertiary care center; without
an available bed to receive the patient, the transfer cannot occur. The availability of an accepting
specialty care provider at the tertiary care center; this is the provider who assumes care of the patient
once they arrive. Availability of appropriate medical transport; this is the clinical team that will safely and
quickly transport the patient between the sending community hospital and receiving tertiary care center.
The correct specialty care nurse staffing; this is the nursing team that will care for the patient once they
arrive to the tertiary care center. The efficiency of the patient referral process; the degree to which the
telephone answering point is adequately equipped to quickly contact on-call specialty providers, interface
with bed control for determining specialty bed availability, and to mobilize critical care transport teams
impact overall access to tertiary care (Missouri Department of Health, 2010; Bosk, Veinot and Iwashyna,
2011).
Clinical Context: The community hospital setting typically involves the emergency department or the
critical care unit. Staff involved includes emergency or critical care providers, nurses, ancillary
(respiratory, laboratory, radiology, pharmacy, etc.) and support staff (clerical, housekeeping, central
supply, etc.). The skill sets of these community hospital clinical providers may be exceeded by the needs
of the patient that requires tertiary care. A time sensitive critical condition patient draws resources away
from other patients and dilutes the overall capacity to deliver care for all the patients within the community
hospital (Bosk, Veinot and Iwashyna, 2011). At the tertiary care center the setting includes the telephone
answering point where the request for transfer is received, the specialty care unit where the patient will be
admitted and any interventional areas such as the cardiac catheterization laboratory or the operating
room. Staff at the tertiary care center involved includes the specialty care providers, critical care nurses,
ancillary staff, support staff and the critical care transport team (nurse, paramedic, emergency medical
technician). Administrative or clinical operations staff is responsible for facilitating communications
between the community hospital and tertiary care center care teams, confirming placement of the patient
in the correct patient care unit bed, and arranging the logistics of transport (Iwashyna, Christie, Moody,
Khan, and Asch, 2009).
Patients and Family Affected: Barriers impact patients and families who are experiencing a critical illness.
Time sensitive critical conditions such as acute STEMI, acute stroke and trauma have increased morbidity
and mortality when time to tertiary care intervention is delayed (Jacobs et al, 2006). For example, the
odds of receiving tertiary intervention for acute stroke is decreased by 2.5% for every minute of time of
onset until arriving to definitive care at a tertiary care center when thrombolytics are not available or the
community hospital care providers are unable or unwilling to administer the thrombolytics (Prabhakaran et
al, 2011). Patient transfer delays result in patients being cared for longer at the community hospital
without tertiary care, which may lead to a worsening of their clinical condition. This may result in
extended, reduced patient mobility and autonomy, increased dependence on family support for daily
living, increased costs of post-acute care (such as physical rehabilitation, chronic ventilator dependency,
etc.) and lack of employability due to a prolonged recovery, residual physical or cognitive impairment and
potential need for adaptive job skills retraining (Bosk, Veinot and Iwashyna, 2011).
Impact on Communities and Care Systems: Barriers to tertiary care result in reduced care system
efficiency by reducing patient throughput. At the community hospital increased length of stay leads to
decreased capacity to deliver care to the community because the patients are waiting to be transferred,
consuming limited community resources (DeLia, 2007). Community hospitals have increased burdens to
care for patients that exceed the resources available (such as nurses with specialty knowledge and
skills). Critical condition patients also draw resources away from other patients, because patient acuity
and instability requires community hospital staff to continuously care for the patient while waiting for
transfer to a tertiary care center (Iwashyna, 2012). At the tertiary care center, diagnostic procedures
performed at the community hospital are often repeated upon the patient’s arrival due to issues such as
variable image quality, conflicting diagnostic results or lack of clinical details from the community hospital
(Jacobs et al, 2006). Repeated diagnostic procedures add cost and are generally not reimbursed by
health insurance resulting in higher financial responsibility for the patient or tertiary care center. These
issues contribute to the tertiary care center’s reputation, and increase the risk of it becoming damaged

among community hospital providers, patients and families. A tertiary care center with a damaged
reputation receives less patient referrals in the future, captures less of the market share in a region and
has missed opportunities for revenue and growth (Iwashyna, 2012).
Impact on Society: Society’s access to the healthcare system is decreased when access barriers to
tertiary care exist. Patients, who would benefit from early intervention at a tertiary care center may
become more ill, suffer complications and require more health care spending when access is delayed
(Westfall et al, 2008). Tertiary care access barriers result in increased use of critical care resources at a
higher cost (mechanical ventilation, vasopressors, invasive pressure monitoring) and increase the
potential for complications such as hospital acquired infections, skin breakdown and prolonged
mechanical ventilator use. These complications lead to an increased cost to society and persisting
disabilities reduce the patients’ contribution to society through shorter and less healthy lives (Entenssoro
et al, 2005).
Summary: Patients who experience a time sensitive critical condition require rapid access to tertiary care.
A consistent, barrier free process is important to the community hospitals, as they often do not have the
capability to provide or sustain definitive care for time sensitive critical condition patients. Any barrier
variable may cause a referring community hospital provider to abandon the process and keep the patient
in the community hospital, or seek tertiary care services at an alternative or competing tertiary care
system, that is less preferred or further away (Iwashyna et al, 2009). With the advent of health care
reform in the United States, barriers impacting rapid access to tertiary care are a problem that is timely
and relevant to the clinical, operational and financial performance of tertiary care centers and regional
care systems.
References
Bosk, E.A., Vienot, T., and Iwashyna, T.J. (2011). Which patients and where. A qualitative study of patient transfers
from community hospitals. Medical Care, 49(6): 592-598. DeLia, D. (2007). Hospital capacity, patient flow, and
emergency department use in new jersey. A Report to the New Jersey Department of Health. Rutgers, Department of
Health and Senior Services, 1-63. Entenssoro, E., Gonzalez, F., Laffaire, E., Canales, H., Saenz, G., Reina, R., and
Dubin, A. (2005). Shock on admission day is the best predictor of prolonged mechanical ventilation in the ICU. Chest,
127(2): 598-603. Iwashyna, T.J (2012). The incomplete infrastructure for interhospital patient transfer. Critical Care
Medicine, 40(8): 2470-2478. Iwashyna, T.J., Christie, J.D., Moody, J., Kahn, J.M., Asch, D.A. (2009). The structure of
critical care transfer networks. NIH Med Care, 47(7): 787-793. Jacobs, A.K., Antman, E.M., Ellrodt, G., Faxon, D.P.,
Gregory, T., Mensah, G.A., Moyer, P., Ornato, J., Peterson, E.D., Sadwin, L., Smith, S.C. (2006). Recommendation
to develop strategies to increase the number of ST-segment elevation myocardial infaction patients with timely
access to primary percutaneous coronary intervention. Circulation, 113:2152-2163. Ligtenberg, J.M., Arnold, L.G.,
Stienstra, Y., van der Werf, T.S., Meertens, J.H.J.M., Tulleken, J.E., Zijlstra, J.G. (2005). Quality of interhospital
transport of critically ill patients: A prospective audit. Critical Care. 9(4): 446-451. Missouri Department of Health and
Senior Services. (2010). Time critical diagnosis system overview and fact sheet. Jefferson City, MO. Prabhakaran, S.,
Ward, E., John, S., Lopes, D.K., Chen, M., Temes, R.E., Mohammad, Y., Lee, V.H., Bleck, T.P. (2011). Transfer
delay is a major factor limiting the use of intra-arterial treatment in acute ischemic stroke. Stroke, 42:1626-1630.
Warren, J., Fromm, R.E., Orr, R.A., Rotella, L.C., Horst, H.M. (2004). Guidelines for the inter- and intrahospital
transport of critically ill patients. Critical Care Medicine. 32(1): 252-256. Westfall, J.M., Kiefe, C.I., Weissman, N.W.,
Goudie, A., Centor, R.M., Williams, O.D., Allison, J.J. (2008). Does interhospital transfer improve outcome of acute
myocardial infactions? A propensity score analysis from the cardiovascular cooperative project. BMC Cardiovascular
Disorders, 8(22): 1-9.
Contact
[email protected]
G 12 - Educational Strategies for Clinical Nursing Education

A Faculty and BSN Student Care Delivery Model for Patients with Diabetes
Patty M. Orr, EdD, MSN, BSN, USA
Kempa (Kim) French, MSN, FNP-BC, USA
Shondell Hickson, MSN, FNP, BSN, USA
Purpose

The purpose of this presentation is to describe a community-based healthcare delivery model provided by
nurse practitioner faculty and BSN students that uses the nurse practitioner as the provider and BSN
students as disease managers and care coordinators and drives improved health status outcomes for
patients with diabetes.
Target Audience
The target audience of this presentation is nursing faculty, including nurse practitioner faculty and
medical/surgical community health faculty, and baccalaureate nursing students. Community health center
administrators would also benefit from the presentation.
Abstract
The integrated, conceptual framework of faculty nurse practitioners (NPs) and BSN nursing students
caring for a chronic disease population in the community clinic serves as a model of applied health
service research. A teaching/learning clinical partnership environment serves as the pedagogy for
effective, active synthesis of critical thinking and skills building with a focus on prevention by the BSN
students. The care delivery model challenges faculty and nursing students to be part of the solution in
providing an example of health system reform by driving improved clinical outcomes for people with
chronic disease. In this study, NPs provide primary care and BSN students participate on a care delivery
team with the faculty NPs. Student team members provide disease management and care coordination
as a part of their BSN Community Health Curriculum. The care delivery team is evaluated based upon
achievement of improved standard outcome metrics, such as HbA1c and blood pressure, for their
assigned patient population. The care delivery team documents and provides evidence-based, disease-
specific standard interventions and documents patient outcomes in the electronic health record. Nursing
interventions administered by the BSN students promote patient adherence and include individual patient
follow-up care calls, review of outcome goals, assistance in patient self-care and patient selection of
healthy foods at the grocery store. The successful execution of the care delivery model has the potential
for saving health care dollars by driving improved health status and preventing complications of diabetes
and hypertension (Orr & Ciampini, 2014).
The primary research question is: Can a faculty/student nurse partnership care delivery model, by which
students and faculty provide primary care and disease management interventions for a diverse
population, significantly impact improvement in disease-specific, evidence-based outcomes? The second
research question is: Can the faculty/student nurse partnership system of care provide a
teaching/learning environment that supports the student nurse in: developing competencies in providing
patient-centered care; working as an effective member of an interdisciplinary nursing team employing
evidence-based practice; and using data in order to report outcomes and apply quality improvement
tactics? Outcomes measured over a recent 6 month period indicate that both research questions are
possible.
Literature to support this study centers on Institute of Medicine (IOM) recommendations, which serve as a
guide to developing innovative systems of care delivery that offer the opportunity for improvement in the
quality and safety for recipients of heath care. Two central strategies proposed by the IOM include the
use of systems for care delivery and the request to improve patients’ knowledge about their treatment
plans (Hurtado, Swift, & Corrigan, 2001; Kohn, Corrigan, & Donaldson, 2000). This model incorporates
both central strategies.
Using funding from two community grants obtained by the school of nursing, the school of nursing care
delivery model supports faculty NPs in delivering primary care for an underserved population with chronic
disease. Through a student/teacher learning partnership, the study tests a model of health care delivery
that offers innovation in clinical nursing education and subsequent student evaluation of clinical
performance. The care delivery model supports faculty NPs practicing with BSN students to provide
evidence-based standards of care for the identified population and to achieve improvement in the
corresponding key disease-specific outcome metrics. BSN students learn evidence-based practice for
managing and coordinating care for certain chronic disease, how to effectively influence change in patient
behavior and how to assist patients in taking responsibility for self-care interventions that promote
improvement in patient health status. Interventions are documented, measured and evaluated.
Performance of faculty and students is based upon the achievement of evidence-based outcome metrics

for the target patient population. Students have an opportunity to experience measureable success in
improving the health status for a diverse and underserved patient population. Faculty NPs and students
know in advance the key goals for patient outcomes and are held accountable for results.
Tactics to facilitate an effective systems approach for care delivery include the use of culturally competent
care, chronic disease management, a nurse-managed primary care medical home and use of evidence-
based care guidelines. In reference to culturally competent care, the IOM addresses unequal treatment
with specific recommendations to provide interventions which eliminate racial and ethnic disparities in
healthcare and also makes the request for research to “provide a better understanding of the contribution
of patient, provider, and institutional characteristics on the quality of care for minorities” (Smedley, Stith, &
Nelson, 2003, p. 22). This study population includes primarily minorities and demonstrates effective
strategies and tactics for culturally competent care that results in improved outcomes for an underserved
population. Prior diversity training helped assure that faculty and students accept patients’ beliefs and
values while providing care for the diverse and underserved study population.
Disease management interventions, in support of the primary care provider’s plan of care, assist the
patient in actively contributing to their success in adhering to the plan of care and have been proven to
drive improvement in achieving evidence-based care for large populations (Coberly et al., 2006; Coberly
et al., 2007; Orr et al., 2006a; Orr et al., 2006b; Orr et al., 2006c). Follow-up support with ongoing disease
management interventions integrated with culturally competent care assist the patient population in
actively participating and receiving evidence-based care. These interventions contribute to improvements
in the patient’s knowledge of their treatment plans.
An initial aggregate of participants cared for by the nursing/student partnership – care which includes
follow-up calls, review of outcome goals, assisting the patient to practice self-care, and patient selection
of healthy foods at the grocery store – shows an overall drop in HbA1c. During this 6-month study (which
is still ongoing), participants’ aggregate HbA1c dropped 1 point (9.5 to 8.5). The most significant changes
occurred with participants who saw a decrease in HbA1c of 11.8 to 7.3, 11 to 6.8, and 13.1 to 10. As of
December 2nd, 2013, twenty-two participants have seen a combined 22.1-point HbA1c decrease. A
subset of 11 participants was evaluated before and after interventions for biometric
changes. Participant's average weight dropped 3.6 pounds, the systolic BP remained stable but
essentially unchanged (129 to 128) and the diastolic BP dropped 7 points (84 to 77). These trends
suggest that the teaching/learning care delivery model delivered by the NP/student team increases
patient awareness and promotes positive and consistent changes in self-care for a diverse and
underserved population.
The Institute of Medicine (IOM) recommends that nursing education programs “prepare and enable
nurses to lead change to advance health” (Institute of Medicine, 2011, p. S-12). As guided by the IOM,
this study provides a model of care delivery that transforms practice and education by providing a
planned educational experience for BSN students who intervene as team members to provide affordable,
quality, patient-centered, evidence-based care to an underserved population. The NP faculty/student
team’s systems approach to care delivery results in improved health outcomes for the diverse population.
The model of care delivery provides the faculty NP an opportunity to practice as a NP with a chronic
disease patient population while providing the setting for BSN students to integrate leadership theory with
clinical practice, thereby contributing to improved patient outcomes. This care delivery team effort
supports faculty and BSN students in leading change and advancing the health of a diverse population.
References
Orr, P.M., & Ciampini, L.M. (2014). A BSN action guide for responding to the 2011 Institute of Medicine
recommendations. Building the Future of Nursing, p. 161-168.
Coberley, C.R., McGinnis, M., Orr, P., Coberley, S.S., Hobgood, A., Hamar, B., … Shurney, D. (2007). Association
between frequency of telephonic contact and clinical testing for a large, geographically diverse diabetes disease
management population. School of Population Health Faculty Papers. Paper 33.
http://jdc.jefferson.edu/healthpolicyfaculty/33.
Huratado M.P., Swift E.K. (2001). Envisioning the national health care quality report. Institute of Medicine, Committee
on the National Quality Report on Health Care Delivery. Corrigan J.M., editor. Washington, DC: The National
Academies Press.
IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The
National Academies Press;

Kohn L.T., Corrigan J.M., & Donaldson M.S. (2000). To err is human: Building a safer health system. Institute of
Medicine, Committee on Quality of Health Care in America. Washington, DC: The National Academies Press.
Orr, P., Hobgood, A., Coberley, S., Roberts, R., Stegall, G., Coberley, C., & Pope, J. (2006b). Improvement of LDL-C
laboratory values achieved by participation in a cardiac or diabetes disease management program. Disease
Management, 9(6), p. 360-370.
Orr, P. McGinnis, M.A., Hudson, L.R., Coberley, S.S., Crawford, A., Clarke, J., & Goldfarb, N.I. (2006c). A focused
telephonic nursing intervention delivers improved adherence to A1c testing. Disease Management, 9(5), p. 277-283.
Smedley, B.D., Stith, A.Y, & Nelson, A.R. (2003). Unequal treatment: Confronting racial and ethnic disparities in
health care. Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in
Health Care. Washington, DC: The National Academies Press.
Contact
[email protected]

It Takes a Village: Addressing Health Inequities Via Nurse Practitioner Education
Felesia Renee Bowen, PhD, RN, USA
Purpose
This presentation will demonstrate how the principles of community based participatory research(CBPR)
can be used by Nurse Practitioner (NP) programs with the local community to ameliorate the effects of
health inequities while providing rich service learning experience for NP students.
Target Audience
Faculty who supervise and evaluate NP education and administrative staff who are responsible for
obtaining clinical education sites. While the topic focuses on the NP student, faculty and administrators
who work with RN students will also benefit from this information.
Abstract
Introduction: This presentation describes how nurse practitioner (NP) education can be used to
ameliorate the effects of health inequities in an urban area. In the United States (U.S.) minorities who
reside in urban areas experience noticeable health inequities when compared with their white
counterparts. Primary care providers offer valuable preventive care and screening services that are
needed to prevent and manage chronic conditions. Early screening, detection and access to primary care
services can make a significant difference in the quality and longevity of an individual’s life. Nurse
practitioners can ease the burden of the primary care shortage however they must be provided with
meaningful learning experiences that will encourage them to remain in primary care. Providers are often
reluctant to precept NP students due to concerns of decreased productivity. In areas where there are
several nurse practitioner programs, students often compete for limited clinical practicum sites and
preceptors. All of these factors negatively affect the NP student’s experience making it challenging for
NP faculty to find appropriate clinical learning experiences for NP students.
Service learning (SL) in its traditional sense is a way of incorporating community service into an
educational experience. SL as an educational technique is often used with children in primary and
secondary schools. In nursing we typically see SL in the undergraduate curriculum. When combined
with the principles of community based participatory research (CBPR) the technique becomes much more
sophisticated and can be used to address areas of health inequities within a community. Using the
combined approach of SL and CBPR has allowed faculty at Rutgers University College of Nursing to
increase the number of high quality primary care agencies and practicum preceptors available to
students, especially in pediatrics.
Intervention: In Newark NJ there are approximately 22,000 infants and preschoolers who reside in the
community. Most of the children attend preschool however many do not receive preventive health
screenings. Utilizing the principles of CBPR the program director met with service agencies and schools
to identify needs for their preschool population. A memorandum of understanding was developed with
specific outcome goals for the term of involvement. In the spring of 2013 we piloted a learning experience
within an existing course for NP students to provide hands on primary care and screening for young
children in a community setting.
Students were randomly assigned to the community group. For half of the semester, seven weeks,
students worked in the community settings providing wellness care and for seven weeks they worked in
traditional primary care offices providing preventive but mostly acute care. The program director met with
the leadership of the various community agencies to coordinate logistics. Prior to visiting the sites
students received training in the skills lab for vision, developmental and obesity screening and referral
procedures for the preschool age child. Pre and post course assessments were done with the students to
determine their level of skills knowledge and their comfort level working in urban areas with minority
populations. Student provided care, collected data, made necessary referrals and prepared detailed
reports for the service agencies.

Results: Prior to the learning experience 100% of the NP students stated they had only
partial knowledge of child growth and development and health screening and only 83% had partial
knowledge of nutrition. After the experience 100% of the students indicated that they had full knowledge
and understanding of the subject matter. Prior to the experience 30% of the students indicated that they
were uncomfortable caring for children and 85% indicated that they were uncomfortable working with
minorities in urban settings. After the experience 85% of the students indicated that they were extremely
comfortable caring for children and 15% indicated that they were comfortable. Post experience 50% of
the students indicated that they were extremely comfortable working with minorities in urban settings and
50% indicated that they were comfortable. Student comments were overwhelming positive. Many
commented that the experience helped them with the didactic course and all recommended that the
experience be incorporated as a permanent part of the course.
NP students provided services for 368 children between the ages of 6 mo and ten years of age. 59
referrals were made for obesity, six referrals were made for failure to thrive/underweight, six referrals
were made for vision deficits, twelve referrals were made for speech delays, three referrals were made for
gross motor deficits and two referrals were made for detailed developmental/autism assessment. The
community agencies were appreciative of the services provided. Parents of the children who received
referrals for health or developmental services expressed appreciation. One preschool used the data that
was presented to make changes to their preschool program.
Next Steps: Based on the findings and feedback the community primary care rotation is now a
permanent part of the pediatric practicum course. After a successful implementation one year ago
community health agencies, health care foundations and social service agencies are now reaching out to
the College of Nursing to aid and partner in initiatives that benefit large segments of the urban population
and help the agencies meet their charge to the community. As a result, training and screening will be
expanded to include oral health assessment and fluoride varnish application and lead and hemoglobin
testing and referral.
References
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San
Francisco, CA: Jossey-Bass. Gaylord, N., Chyka, D., & Lawley, G. (2012). Developmental Evaluation of Preschool
Children: A Service-Learning Experience for Nursing Students. Journal Of Nursing Education, 51(12), 710-713.
Hacker, K. (2013). Community based participatory research. Los Angeles, CA: Sage. IOM (Institute of Medicine).
(2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academic Press.
Jacoby, B. & Associates (2003). Building partnerships for service learning. Sanfrancisco, CA: Jossey-Bass.
Narsavage, G. L., Lindell, D., Chen, Y., Savrin, C., & Duffy, E. (2002). A Community Engagement Initiative: Service-
Learning in Graduate Nursing Education. Journal Of Nursing Education, 41(10), 457-61.
Contact
[email protected]

A Substance Abuse Awareness Seminar for Nursing Students
Beverly J. Epeneter, EdD, MN, USA
Sue Butell, MSN, USA
Purpose
The purpose of the presentation is to inform educators about the effectiveness of a substance abuse
seminar for nursing students. Adopting this evidence-based program addresses the existing gap in
students’ education about the risks of addiction within the profession and how to handle a colleague who
may have an addiction.
Target Audience
The target audience for this presentation would be nurse educators; however, any nurse interested in the
prevention of substance abuse in the profession, would be encouraged to attend.
Abstract
Substance abuse is a public health problem worldwide. In fact, it is estimated that 2 billion people are
alcohol users, 1/3 billion are smokers, and 185 million are drug users (WHO, 2002). To respond to this
significant health issue, the National Student Nurses Association (NSNA, 2002) and American Nurses
Association (ANA, 2002) passed resolutions calling for nurse educators to address the risk of
addiction. Prevention of this health problem should begin within our own nursing profession. Although
the prevalence of substance abuse disorders among nurses is approximately the same rate as in the
general population (Kenna & Lewis, 2008), there are certain risk factors, like access to drugs and job
stress (Trinkoff, Storr, & Wall, 1999) that make nurses more susceptible to substance
abuse. Unfortunately, nurses often lack the awareness and skill to recognize and even help a colleague
who may have a substance abuse problem. This lack of preparedness can enable nurses to continue
unsafe practices by making excuses or covering up their nurse colleague’s mistakes (Quinlan, 2003). To
respond to the gap in nursing students’ education about the risks of addiction within the profession and
how best to handle a colleague suspected of abusing a substance, we developed a two-hour evidence
based prevention seminar for senior nursing students. The first hour addressed the ethical challenge of
unsafe practice including the statistical picture of substance abuse in nurses, the duty to report as
outlined by the ANA Code of Ethics for Nurses (ANA, 2001), and how substance abuse may impair a
nurse’s work performance and conduct. A communication model called NUDGE (Notice, Understand,
Decide, use Guidelines, and Encourage (Bennett, 2010) was taught and demonstrated in a role-play
scenario. In the second hour, students in triads practiced this skill by rotating the roles of nudger,
resister, and observer with a case scenario provided. The results of an intervention follow-up study
support the effectiveness of the prevention seminar in affecting knowledge about substance use disorders
and the nurses’ role in intervening when substance use behaviors are observed. The seminar also
increased students’ confidence in addressing future colleagues where substance abuse may jeopardize
safe nursing practice.
References
References American Nurses Association. (2002, June-July). Resolution: Reaffirming the profession’s response to
the problem of addictions and psychological dysfunctions in nursing. Resolution presented at the American Nurses
As- sociation House of Delegates, Philadelphia, PA. Bennett, J.B., Aden, C., Broome, K., Mitchell, K., & Rigdon, W.
(2010). Team resilience for young restaurant workers: Research-to-practice adaptation and assessment. Journal of
Occupational Health Psychology, 15, 223-236. Bennett, J.B., & Lehman, W.E.K. (2001). Workplace substance abuse
prevention and help-seeking: Comparing a team-oriented and informational training. Journal of Occupational
Health Psychology, 6, 243-254. Bennett, J.B., Lehman, W.E., & Reynolds, G.S. (2000). Team awareness for
workplace substance abuse prevention: The empirical and conceptual development of a training program. Prevention
Science, 1, 157-172. Cadiz, D., Truxillo, D., & O’Neill, C. (2012). Evaluation of a training program for nurse
supervisors who monitor nurses in an alternative- to-discipline program, Advances in Nursing Science, 35, 1-10.
Colquitt, J.A., LePine, J.A., & Noe, R.A. (2000). Toward an integrative theory of training motivation: A meta-analytic
path analysis of 20 years of research. Journal of Applied Psychology, 85, 678-707. Cook, T.D., Campbell, D.T., &

Paracchio, L. (1990). Quasi-experimentation. In M.D. Dunnette & L.M. Hough (Eds.), The handbook of industrial/
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O’Neill, C., Jarvis, K., Vander Ley, K., & Raya-Carlton, P. (2011). Substance abuse prevention in the electrical
industry: The NECA- IBEW team awareness and team vigilance programs. In J. Bray, D. Galvin, & L. Cluff (Eds.),
Young adults in the workplace: A multi-site initiative of substance use prevention programs (pp. 73-101). Research
Triangle Park, NC: RTI International. Hagemaster, J., Handley, S., Plumlee, A., Sullivan, E., & Stanley, S. (1993).
Developing educational programmes for nursing that meet today’s addiction challenges. Nurse Education Today,
13, 421-425. Kenna, G.A., & Lewis, D.C. (2008). Risk factors for alcohol and other drug use by healthcare
professionals. Substance Abuse Treatment, Preven- tion, & Policy, 3, 1-8. Kornegay, K., Bugle, L., Jackson, E., &
Rives, K. (2004). Facing a problem of great concern: Nursing faculty’s lived experience of encounters with chemically
dependent nursing students. Journal of Addictions Nursing, 15, 125-132. Luoma, J.B., Twohig, M.P., Waltz, T.,
Hayes, S.C., Roget, N., Padilla, M., & Fisher, G. (2007). An investigation of stigma in individuals receiving treatment
for substance abuse. Addictive Behaviors, 32, 1331-1346. National Council of State Boards of Nursing. (2011).
Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring
programs. Chicago, IL: Author. National Student Nurses Association. (2002, April). Resolution: In support of nursing
school policies to assist and advocate for nursing students experiencing impaired practice. Resolution presented at
the National Student Nurses Association House of Delegates, Philadelphia, PA. Quinlan, D. (2003). Impaired nursing
practice: A national perspective on peer assistance in the U.S. Journal of Addictions Nursing, 14, 149-155. Rassool,
G.H. (2004). Curriculum model, course development, and evaluation of substance misuse education for health care
professionals. Jour- nal of Addictions Nursing, 15, 85-90. 414 Copyright © SLACK Incorporated RESEARCH BRIEFS
Rassool, G.H., & Rawaf, S. (2008). Predictors of educational outcomes of undergraduate nursing students in alcohol
and drug education. Nurse Education Today, 28, 691-701. Snow, D., & Hughes, T. (2003). Prevalence of alcohol and
other drug use and abuse among nurses. Journal of Addictions Nursing, 14, 165-167. Trinkoff, A.M., Storr, C.L., &
Wall, M.P. (1999). Prescription-type drug misuse and workplace access among nurses. Journal of Addictive Dis-
eases, 18, 9-17.
Contact
[email protected]

G 13 - Nursing Educational Strategies
Emergent Care Competence and Its Related Factors Among Junior High and
Elementary School Nurses in Taiwan
Hsiao-Wei Tsai, MSN, Taiwan
Shu Yu, PhD, RN, Taiwan
Purpose
The purpose of this presentations is (1)understanding elementary and junior high school nurses’
emergent care competence in Taiwan;(2)exploring the relationships between personal, school factors and
emergent care competence in elementary and junior high school nurses;(3)identifying the predictors of
emergent care competence in elementary and junior high school nurses.
Target Audience
The target audience of this presentation is school nurse, policy maker including school administrators and
educator.
Abstract
Purpose: The main purposes of this study consisted of (1)understanding elementary and junior high
school nurses’ emergent care competence in Taiwan; (2)exploring the relationships between personal,
school factors and emergent care competence in elementary and junior high school nurses; (3)identifying
the predictors of emergent care competence in elementary and junior high school nurses.
Methods: This research was a nationwide study using a cross-sectional research design. A structured
questionnaire was used to collect data from 308 school nurses selected randomly and was delivered by
way of a mailing method.
Results: The main findings included: (1) A moderate to high level of emergent care competence was
revealed by this study (the mean score was 4.24 out of a possible score of 5; SD = 0.48). (2) Bivariate
analysis showed that age, years of employment, adequacy of emergent care training, knowledge of
emergent care, attitude toward emergent care, the level of understanding emergent care from school
administrators, the administrators’ perception of importance of emergent care, the level of support from
the administrators regarding emergent care, and the sufficiency of emergent care equipment and supplies
were related to school nurses’ emergent care competencies. (3) Multiple and stepwise regression
analyses on emergent care competencies indicating four variables (emergent care attitude, the
sufficiency of emergent care equipment and supplies, emergent care knowledge, and the level of
understanding emergent care from school administrators) could be singled out as significant factors and
accounted for 34.7% of the variance. Further examining the predictors of three stages of emergent care
(i.e. pre-stage prevention, occurring stage, and post-stage management), we found attitude towards
emergent care was the only factor of predicting three stages. Adequacy of emergent care training was
the predictor of pre-stage and post-stage; knowledge of emergent care and the sufficiency of emergent
care equipment and supplies were the occurring stage predictor factor; and the level of understanding
emergent care from school administrators was the post-stage predictor factor.
Conclusion: Based on our findings, we recommend that the Ministry of Education should offer more and
advanced emergent care in-service training to school nurses, especially in burn assessment, external
genital trauma management, pneumothorax management, drug abuse assessment and management,
and vomit disinfection management, and also provide better emergency equipment. At the same time,
school administrators should take the initiative to understand relevant policies and practice regarding
emergent care. School nurses should continuously increase knowledge of emergent care and develop a
positive attitude towards emergent care. By doing so, we look forward to better enhancing school nurses’
emergent care competencies to provide teachers and students the best care they can get.
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a pediatric problem? A national perspective. Pediatric Emergency Care, 28(4), 340-344. 16.Evans, W. K., & Ficca, M.
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Nursing, 28(6), 418-422.doi: 10.1177/1059840512451743 17.Gebbie, K, M., Qureshi, K. (2002). Emergency and
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injuries occurring within and outside of the school environment. Academic Emergency Medicine, 13(5), 567-570.
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33.Mclntyre, C. L., Sheetz, A. H., Carroll, C. R., & Young, M. C. (2005).Administration of epinephrine for life-
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(2000).Sport-related Injuries in Children. Academic Emergency Medicine, 7, 1376-1382 44.Tetuan, T., & Akagi, C.
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(2008).Cardiac nurses' views of continuing professional education.European Journal of Cardiovascular Nursing. 7(1),
59-66. Yang, J., Peek-Asa, C., Allareddy, V., Phillips, G., Zhang, Y., & Cheng, G. (2007). Patient and hospital
characteristics associated with length of stay and hospital charges for pediatric sports-related injury hospitalizations in
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& Rosh, J. (2007).School nurse knowledge and perceptions of recurrent abdominal pain: opportunity for therapeutic
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Contact
[email protected]

G 14 - Nursing Student Centered Learning Strategies
Evaluating Student Success after a Change in the Teaching/Learning
Environment
Laura Fillmore, DNP, MSN, RN, USA
Purpose
The purpose of this study is to evaluate the effectiveness of a student-centered learning environment in a
prelicensure nursing course. The evaluation followed a structured program to lead faculty in new teaching
strategies applied to an entry-level nursing course. The evaluation is in a subsequent nursing course.
Target Audience
The target audience of this presentation is for faculty and education administrators who are considering
flipping a classroom or curriculum to a student-centered learning environment, which is designed to
improve student engagement and student success.
Abstract
This study evaluates the effect of providing a structured development program for faculty to implement
student-centered learning strategies in an entry-level nursing course. A call to change our teaching and
learning practices in nursing comes from healthcare leaders who see the complicated healthcare
environment (National Academies, 2010). Also, our expected result of teaching and learning in nursing
has evolved to include clinical reasoning, situated learning, and civic professionalism (Benner, et al,
2010). Other academic leaders are referring to disruptive learning which questions how we know students
are learning and not just being taught (Bass, 2012).
Our challenge to meet the demands of the stakeholders continues to be impacted by the number of
faculty, the preparation of faculty, and institutions ability to drive and support change. Our other prevailing
challenge is to have test-ready students who can successfully pass the national licensing exam. This
study determined to prepare faculty with a course designed with alternative learning activities and a
student-centered focus. The goal is to evaluate student success in a proceeding course after students
become active participants in their own learning. The question is to determine if student-centered
designed courses promote student success in future courses by impacting learning behaviors.
References
Bass, Randy (2012). Disrupting ourselves: The problem of learning in higher education. Educause Review,
March/April, 2012.
Benner, P., Sutphen, M., Leonard, V., Day,L. (2010) Educating Nurses: A call for radical transformation. Jossey-
Bass, San Francisco, CA.
National Academies, Institute of Medicine (2010). The future of nursing, leading change, advancing health.
Washington D.C.
Contact
[email protected]

Innovative Approaches to Clinical Teaching and Learning: Caring for Clients
Undergoing Perioperative Surgical Experiences by Nursing Students
Dora Maria Carbonu, EdD, MN, RN, Canada
Purpose
To inspire and motivate the audience about how nursing students could overcome their
anxieties/apprehensions, embrace a new approach to teaching and learning while providing client care,
and found the outcome very enriching and rewarding for themselves, clients, and the multidisciplinary
healthcare and academic team.
Target Audience
A multidisciplinary team of nurse educators, students, care providers (NPs, RNs, LPNs), administrators,
managers/leaders - from all sectors of health care organizations, Day Surgery and Operating Room Staff,
including Perioperative Care Staff - Surgeons, Anesthesiologists, other health care providers and interest
groups
Abstract
Purpose: Clinical Instructors are constantly challenged to optimize clinical teaching and learning
opportunities for students, to master technical skills while providing patient care through critical thinking
and reflecting on their performance. Method: Students in the Nursing Program at Nunavut Arctic College
are oriented to client assignments a day before clinical placement, visit the Unit and, utilizing the nursing
process, develop a client-specific care plan for implementation and ensure optimal outcomes during client
care. In 2013 academic year, the third-year students’ clinical placement included Day Surgery and
Operating Room (OR) – to acquire skills in caring for clients undergoing peri-operative surgical
experience. Using Kurt Lewin’s force-field analysis model of change, a holistic approach to client care
and, in collaboration with the Day Surgery/OR multidisciplinary team, students initiated a care plan based
on their knowledge of the specialist surgery of the day only. They then met with clients on the morning of
surgery, gathered data and developed a plan of care, detailing their understanding of client needs through
pre-operative, intra-operative, and post-operative stages of care. They observed client responses on a
continuum, the effect of surgery on client ability to meet self-care needs, and conducted discharge
planning and teaching. Results: Students described this experiential learning as innovative, challenging,
holistic, comprehensive, patient-centered, and team-oriented. They learned to unfreeze and move,
overcoming their own individual anxieties and/or apprehensions about surgery and nursing care-plan
development without prior access to clients or their charts. They felt enlightened to see the clients smile
and in high spirits, as they recovered from anesthesia and actively participated in their discharge process.
This change brought feelings of achievement and pride as was demonstrated in the students' critical
thinking abilities, evaluation of care outcomes, reflections during clinical conferences, and in their written
reflective journals. Conclusion: The outcome of students taking their own initiatives in client-care
planning, and working closely with the multidisciplinary perioperative team, was evidently re-energizing
and empowering, while client care encompassed all aspects of primary health care, continuity of care,
cultural diversity, and preferences. The learning environment offered the students a medium for positive
growth and development as they went through the refreezing phase of change. It further generated
rewarding benefits to both academic and clinical sectors, promoted therapeutic communication among
the team members, including clients and their families, and accorded opportunities for subsequent
student placement in the Day Surgery and Operating Room settings.
References
Begin, Luanne (2007). The Nursing Student's Practical Guide to Writing Care Plans. Retrieved from
http://www.bristolcc.edu/students/writingcenter/forms/PROJECT.pdf Collaborative Care Guidelines for Perioperative
Nurses - RN and LPN (2013,January 10). Document Accountability: Nova Scotia Perspective Directors and
Managers, Version 18 - Final Draft. Retrieved from
http://novascotia.ca/dhw/mocins/docs/Collaborative_Care_Guidelines_for_Perioperative_Nurses_in_Nova_Scotia.pdf

Dosch, Michael. (2003). Nursing Management of the Perioperative Patient. Nursing Care of the Perioperative Client,
Retrieved on November 07, 2013, from http://www.udmercy.edu/crna/agm/periop03.htm
Contact
[email protected]

Student Remediation in Nursing Programs: The Evidence, the Gaps, and New
Directions
Barb Schreiner, PhD, MN, RN, USA
Cheryl L. Mee, MSN, MBA, RN, CMSRN, USA
Purpose
To review the existing evidence supporting effective remediation strategies for nursing students preparing
for licensure examinations and to identify gaps in nursing knowledge amenable to further study
Target Audience
To (1) review the existing evidence supporting effective remediation strategies for nursing students
preparing for licensure examinations and (2) identify gaps in nursing knowledge amenable to further study
Abstract
Nursing programs and faculty have increased pressure to produce safe nursing practitioners and have
turned to a variety of tools to facilitate success in NCLEX licensure exams in the United States. End-of-
course and end-of-program standardized testing are tools frequently used to prepare students. Nursing
educators use the results of these tests to remediate student knowledge and critical thinking
skills. Students also gain additional confidence by reviewing test results and planning further study and
preparation. But which strategies are most effective in producing positive outcomes on licensure
examinations? This session will explore evidence-based strategies most effective in preparing students
for professional licensure exams. A comprehensive review of the literature on remediation and student
self-confidence will be presented. The role of self-confidence will be highlighted with tactics educators
might employ to build self-assurance in graduating nursing students. Finally, the session will review gaps
in the literature and suggest future directions for nursing research. Participants in this session will leave
with an understanding of what is known about remediation of nursing students in preparation for nursing
licensure examinations and what is left to be addressed.
References
Breso, E., Schaufeli, W. B., & Salanova, M. (2010). Can a self-efficacy-based intervention decrease burnout, increase
engagement, and enhance performance? A quasi-experimental study. The International Journal of Higher Education
Research. Published online. Doi: 10.1007/s10734-010-9334-6 Daley, L. K., Kirkpatrick, B., Frazier, S., Chung, M. L. ,
& Moser, D. K. (2003). Predictors of NCLEX-RN success in a baccalaureate nursing program as a foundation for
remediation. Journal of Nursing Education, 42(9), 390-398. English, J. B., & Gordon, D. K. (2004). Successful student
remediation following repeated failures on the HESI Exam. Nurse Educator, 29(6), 266-268. Lauer, M. E. & Yoho, M.
J. (2013). HESI Exams: Consequences and remediation. Journal of Professional Nursing, 29(2), S22-S27. DOI:
10.1016/j.profnurs.2013.01.001. March, K. S., & Ambrose, J. M. (2010). Rx for NCLEX-RN success: Reflections on
development of an effective preparation process for senior baccalaureate students. Nursing Education Perspectives,
31(4), 230-232. Miedema, L. L. (2008). Impact of remediation on success of nursing students in a community college
associate degree program. Capella University, ProQuest, UMI Dissertations Publishing, 2008. 3311412. Mills, L. W.,
Wilson., C. B., & Bar, B. B. (2001). A holistic approach to promoting success on NCLEX-RN. Journal of Holistic
Nursing, 19(4), 360-374. doi: 10.1177/089801010101900405 Morrison, S., Free, K., & Newman, M. (2002). Do
progression and remediation policies improve NCLEX-RN pass rates? Nurse Educator, 27(2), 94-96. Nibert, A.,
Young, A., & Britt, R. (2003). The HESI Exit Exam: Progression benchmark and remediation guide. Nurse Educator,
28(3), 141-145. Sifford, S., & McDaniel, M. (2007). Results of a remediation program for students at risk for failure on
the NCLEX Exam. Nursing Education Perspectives, 28 (1), 34-35.
Contact
[email protected]

H 12 - Evidence-Based Practice Implications Within Emergency Care
Ultrasound-Guided Peripheral Intravenous Insertion
Alfie Jay C. Ignacio, DNP, MSN, RN, USA
Purpose
The purpose of this presentation is to incorporate the use of recommended best practice techniques
involving ultrasound-guidance performed by emergency nurses to improve peripheral IV access success
rates in patients with difficult sticks in the ED.
Target Audience
The target audiences of this presentation are nurses, technicians, and other healthcare practitioners who
establish intravenous access for medications, blood withdrawal, fluid therapy.
Abstract
Problem/Issue: Patients presenting to the Emergency Department (ED) often require peripheral
intravenous (IV) access to collect blood samples and administer IV medications and fluids. Inadequate IV
access can lead to delays in treatment, possible increased length of stay, and patient dissatisfaction.
Background: Although ED nurses are generally accustomed in obtaining peripheral IV access, there are
a number of patients who are difficult to cannulate. Difficult intravenous access may include patients with
chronic illness such as sickle cell, renal failure, cancer, history of intravenous drug abuse, obesity,
extremes of age, and hypovolemia. UGPIV access may be an alternative to blind insertion to establish
early IV access, start infusion therapy, perform blood withdrawal, and administer medications.
Purpose: The purpose of this project was to implement an evidence-based practice (EBP) guideline for
difficult IV access (DIVA) through the use of ultrasound guided IV (USGIV) access techniques.
Methods: An evidence-based USGIV access policy/procedure was developed and approved by the
Nursing Practice Council. Two unit champions and 6 ED staff nurses completed training which involved
didactic educational session, pretest/posttests and return demonstrations. The practice change was
implemented and monitored over a 6-month period. USGIV access procedures were documented on data
collection forms identifying reason for the difficult stick, number of attempts, time to successful
cannulation, site of insertion, and complications. Evaluation of the practice change was conducted during
a 3-week period to assess impact on DIVA patient outcomes (number of IV attempts and time to
successful cannulation).
Results: Findings showed significant differences in nurses’ knowledge regarding DIVA and USGIV
access techniques - pretest mean score of 9.6 vs. posttest mean score 16.2 (p value 0.0004). Significant
reduction in the number of IV attempts and time to successful cannulation were also observed for USGIV
access compared to traditional blind sticks. Average number of IV attempts using USGIV access was
1.11 compared to 4.75 for blind sticks (p value – 0.0001).Average time to successful cannulation for
USGIV access was 9.53 min. compared to 46.8 min. for blind sticks (p value – 0.0001). ED nurse
feedback was positive, average of 3.4 out of 5 on the level of cannulation difficulty.
Discussion: Implementation of an evidence-based policy and procedure for DIVA involving USGIV
access techniques can facilitate successful cannulation and impact quality of care by decreasing number
of attempts and time required. This can lead to greater patient and nurse satisfaction, reduced length of
stay, and lower hospital costs.
References
References: American College of Emergency Physicians (2012). Focus on dynamic ultrasound-guided peripheral
intravenous line placement. Retrieved from http://www.acep.org/Content.aspx?id=46060 Bagley, W. H., Lewiss, R.
E., Saul, T., & Travnicel, P. (2009, August). Focus on: dynamic ultrasound-guided peripheral intravenous line
insertion. South Dakota. Brannam, L., Blaivas, M., Lyon, M., & Flake, M. (2004). Emergency nurses’ utilization of
ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Academic Emergency
Medicine, 11, 1361-1363. Costantino, T., & Fojtik, J. (2003). Success rate of peripheral intravenous catheter insertion

by emergency physicians using ultrasound guidance. Academic Emergency Medicine, 10(5), 487. Costantino, T.,
Parikh, A., Satz, W., & Fojtik, J. (2005). Ultrasonography-guided peripheral intravenous access versus traditional
approaches in patients with difficult intravenous access. Annals of Emergency Medicine, 46(5), 456-461. Juckette, D.
(2011, April 4). Ultrasound-guided peripheral IV catheter insertion-Nursing practice protocol. New Mexico. White, A.,
Lopez, F., & Stone, P. (2010). Developing and sustaining an ultrasound-guided peripheral intravenous access
program for emergency nurses. Advanced Emergency Nursing Journal, 32(2), 173-188.
Contact
[email protected]

An Evidence-Based Approach for Death Notification
Elizabeth Roe, RN, PhD, USA
Purpose
The purpose of this presentation is to describe an evidence-based protocol for death notification.
Emphasis will be placed on he role of the nurse as an advocate for survivors during and following the
death notification.
Target Audience
The target audience of this presentation is nurses who work in the emergency department, critical care, or
areas where death notifications are done.
Abstract
The very nature of suddent death is emotionally heavy and requires evidence-based caring and
supportive interventions, involving an interprofessional team approach. This presentation will describe the
development of an evidence-based protocol for care of survivors of individuals who have died suddenly.
The responses of survivors are diverse, often unpredictable, and vary depending on how the care they
receive after the death. Nurses are often the ones that care for family members following a sudden death.
In this presentation, suggestions will be given regarding the care for the survivors and providers after a
sudden death. The focus will be on the immediate care provided in the emergency department, but
suggestions will be given for the provision of ongoing support. Research has found that how an individual
reacts to a sudden death is influenced by a number of factors including the notification itself,
circumstances of the death, the care they receive during and after the notification, and characteristics of
the survivor and those caring for them. It is important that the care be provided in a way that is sensitive
to the survivor’s individual needs. This presentation will make recommendations for care of individuals
after a death notification based on a review of the literature from nursing, medicine, law enforcement,
social work, clergy, and psychology. In this presentation, an evidence-based protocol for care of the
survivor after the notification of a death will be discussed with emphasis on the role of the nurse caring for
the survivors with a particular emphasis on advocacy. A case scenario will be presented for the
discussion of the protocol.
References
Byers B. Death notification: The theory and practice of delivering bad news. In Hendricks JE, Byers BB, editors. Crisis
Intervention in Criminal Justice/Social Service. Springfield Il: Charles C. Thomas; 2002.p.179-211. Eberwein KE. A
mental health clinician’s guide to death notification. International Journal of Emergency Mental Health, 2006;8:117-
126. Fraser S ,Atkins J. Survivors’ recollections of helpful and unhelpful emergency nurse activities surrounding
sudden death of a loved one. Journal of Emergency Nursing, 1990; 16:13-16. Hobgood C, Harwood D, Newton
K,Davis W. The educational intervention “GRIEV_ING” improves the death notification skills of residents. Academic
Emergency Medicine, 2005;12:296-301. Janzen L, Cadell S, Westhues A. From death notification through the
funeral: bereaved parents’ experiences and their advice to professionals. OMEGA, 2004;48:149-164. Leash
RM.Death notification: practical guidelines for health care professionals. Critical Care Nursing Quarterly, 1996;19:21-
34. Li SP, Chan CH, Lee, DT. Helpfulness of nursing actions to suddenly bereaved family members in an accident
and emergency setting in Hong Kong. Journal of Advanced Nursing, 2002;40:170-180. Merlevede E, Spooren D,
Hendrick H, Portzky G, Buylaert W, Jannes C, Calle P, et al. Perceptions, needs and mourning reactions of bereaved
relatives confronted with a sudden unexpected death. Resuscitation, 2004;61:341-348. Olson JC, Buenefe ML, Falco
WD. Death in the emergency room. Annals of Emergency Medicine, 1998;31:758-765. Smith-Cumberland, T. The
evaluation of two death education programs for EMTS using the theory of planned behavior. Death Studies, 2006;
30:637-647. Smith-Cumberland TJ, Feldman RH. EMTs attitudes’ toward death before and after a death education
program. Prehospital Emergency Care, 2006;10:89-95. Stewart AE. Complicated bereavement and posttraumatic
stress disorder following fatal car crashes: recommendations for death notification practice. Death Studies,
1999;23:289-321. Stewart AE, Lord JH, Mercer DL. A survey of professionals’ training and experiences in delivering
death notifications. Death Studies, 2000;24:611-631. Von Bloch L. Breaking bad news when sudden death occurs.
Social Work in Health Care, 1996;23:91-97.
Contact

[email protected]

ED Community Placement Project (EDCPP): Right Service-Right Venue Approach
in Managing ED Frequent Users
Karen Elizabeth Mitchell, RN, MSN, CMCN, USA
Purpose
The purpose of this presentation is an innovative , evidenced based project, multidisciplinary approach in
reducing ED recidivism by bridging homeless patients with co-occurring disorders and substance abuse
into hospital leased beds in intensive community based homeless prevention intensive case management
services.
Target Audience
Target audience, is hospital administrative leaders, multidiscipline teams in behavioral health and ED
medicine, nurse leaders, ED staff nurses, social workers, case managers , evidence based project
researchers, public health leaders, homeless prevention leaders, and community healthcare providers.
Abstract
Background Statement:San Diego has the 3rd largest homeless population in the United States,
following New York and Los Angeles. Homeless patients without medical homes account for nearly 1/3 of
the ED visits, resulting in longer ED wait times and avoidable inpatient admissions. Many of these
patients are non-funded or under-insured contributing to rising unreimbursed healthcare costs.
Emergency departments (ED) are ill equipped to meet the psychosocial, housing, substance abuse
treatment and mental health needs of homeless community.
Intervention Detail:The “Emergency Department Community Placement Project” (EDCPP) is designed
to bridge the highest ED users into community-based homeless prevention services, substance abuse
treatment, and intensive case management. The goal for this project is to reduce recidivism amongst the
neediest and costliest patients by 20% through provision of resources to address substance abuse,
homelessness and mental health issues.
A cohort of 215 patients was electronically pre-identified in EPIC electronic medical records. Inclusion
criteria included homeless with frequent ED visits (2 or more visits per month over the past 12 months)
and associated complaints of co-occurring disorders, substance abuse and alcohol related illness. Upon
patient presentation the Best Practice Advisory (BPA) flag is initiated and triggers targeted interventions.
The ED physician / psychiatrist places “Community Placement Order”. Patient consenting, screening and
placement (to community partners) are performed by ED Staff.
Setting and methods: Emergency Department is an urban, academic teaching healthcare facility.
Annually treating 42,300 patients.
Results: Six month analysis: Cost savings of $168,231. Based on program expenses, (contractual bed
cost) of $38,234 (6mos) = 4 .4 (ROI). 78 % reduction in ED visits among EDCPP placed patient
cohort. 3.8% increase in Press-Ganey patient satisfaction scores. Given results, program planned for
expansion to other healthcare system EDs and extended pt populations.
Contact
[email protected]

H 13 - Global Leadership
Graduate Students Meet Cinematic Leaders: A Creative Final Project for
Managerial/Leadership Course
Tova Hendel, PhD, RN, Israel
Purpose
The purpose of this presentation is to enhance students' awareness and understanding of managerial
leadership concepts and theories and assess their ability to integrate the learned body of knowledge
when analyzing a leader's role in a cinematic film
Target Audience
The target audiences of this presentation are nursing educators and managers, graduate nursing
students and clinical preceptors
Abstract
Background – Learning human behaviour and response in variety of situations is often difficult. Review
of the literature reveal that nursing education is based strongly on traditional teaching methods and points
to the need to incorporate new ways of teaching – learning and evaluation methods. The use of aesthetic
experiences, in nursing education, movies being one of them, provide students with vivid portrayals of
peoples' thoughts, emotions, feelings, human interactions, and everyday life situations and enable them
to analyse their behaviours and responses.
Purpose – Enhancing students' awareness and understanding of managerial leadership concepts and
theories by cinema viewing and reviewing, and assessing their ability to integrate body of knowledge
learned through analysing a cinematic leader characteristics.
Method – A list of 40 movies was prepared focusing on popular historic/social leaders. Some examples
are: Norma Rae (1979), Gandhi (1982), Truman (1995), Joan of Arc (1999), Erin Brocovich (2000), Devil
wears Prada (2006), Elizabeth: The Golden Age (2007); Che (2008); . Students were required to watch,
in pairs, a movie assigned to them and follow written guidelines for the final project for the course.
The guidelines included a brief overview of the movie, description of the leader and his leadership
characteristics and style, reference to selected aspects such as basic values reflected in the movie, the
use of power resources, interpersonal communication methods, collaboration with others, analysis of the
leader's characteristics in a relation to the literature and conclusions.
An evaluation tool was developed asking students' evaluation with regard to the process and the
outcomes of the project, about previous experience with watching movies as a basis for writing
assignments, their experience watching the film and the contribution to knowledge and understanding of
the contents learned in the course.
Result - Seventy graduate students (average age 38) answered the questionnaire at the end of the 2012-
2013 courses. Approximately 91% did not have previous experience with films as a tool for writing
assignments for a course. About 93% of the students pointed out that the assignment was a hekpful/very
helpful learning experience for writing the final paper. About 80% of the students recommended/highly
recommended the use of cinematic movies for future assignments. The participants were asked: "what do
you consider to be the main benefits of the movie to your learning process?" and "What were the main
disadvantages of using the movies for the end project?" Students' feedbacks included statements such as
"enjoyable assignment", "different and interesting", "challenging" and "innovative".
Conclusions - Educators have to develop creative and innovative teaching strategies to meet students'
learning needs. The use of popular movies was found as an effective, affective, and cognitive learning
and evaluation tool. It helped to facilitate leadership theories through the analysis process and create
tangible experiences for the graduate students. Using movies to teach and evaluate both undergraduate
and graduate students is another way to engage students in the teaching-learning process.

References
Hart, L., 2011. Using film to enhance students' interest in public health nursing. Journal of Nursing Education, 50(1),
pp.59-60. McConville, S.A. and Lane, A. M., 2006. Using on-line video clips to enhance self-efficacy toward dealing
with difficult situations among nursing students. Nurse Education Today, 26, pp.200-208. Nirthington, L. Wilkerson, R.
and Schenk, L., 2005. Enhancing nursing students' clinical experience using aesthetics. Journal of Professional
Nursing, 21(1), pp.66-71. Darbyshire, D. and Baker, P., 2012, A systematic review and thematic analysis of cinema in
medical education. Medical Humanities, 38, 28-33.
Contact
[email protected]
Global Nursing Leadership Collaboration: Chinese Evidence-Based Practice
Immersion Program
Linda Costa, PhD, RN, USA
Susan Kulik, RN, DNP, MBA, USA
Purpose
to provide information on approaches to facilitate the spread of evidence-based practice in China using
an immersion program for nurse leaders.
Target Audience
nurse leaders, educators, and clinical nurses.
Abstract
The mission of the Institute of Johns Hopkins Nursing is to share innovations in practice, education, and
research. Through a partnership with the Chinese Nursing Committee and a Chinese educational
consultant, two nurses from United States traveled to Beijing China to present a weeklong evidence-
based practice (EBP) immersion program for Chinese nurse leaders. Twenty-six participants
representing 18 Chinese hospitals completed the program. The EBP program was framed around the
EBP question: Will the assessment of fall injury risk factors and the implementation of appropriate
interventions decrease serious injury from falls in the adult acute care setting? Identifying a focused topic
for the program enabled participants to understand how to develop a practice question; search and
appraise the evidence; and translate findings. Knowledge translation, applying EBP knowledge within the
complex of healthcare settings in China, lead Chinese nurse leaders to identify the need to develop a
strategic plan to introduce EBP in their hospitals. The plan would include an assessment of organizational
readiness, alignment with the hospital mission, and identification of necessary resources to support the
infrastructure for EBP. Challenges identified by participants included staff educational levels, shortage of
nurses, and patient-nurse ratios in China. Lessons learned in working with interpreters will be shared. The
weeklong course was followed by monthly webinars for 6 months to provide further examples of EBP.
The experience enabled the conceptualization of a global perspective of healthcare and professional
nursing perspectives that facilitated the formation of partnerships to expand the offering of EBP training
programs. Implications for future collaborations will be shared.
Contact
[email protected]

Leadership is Key to High-Performance Amidst Inevitable Trends of Diversity
Rita K. Adeniran, DrNP, RN, CMAC, NEA, BC, USA
Purpose
The purpose of this presentation is to discuss how an academic medical center utilized the principles of
gracious space, confident and cultural humility to improve performance and satisfaction amidst a diverse
group of nurses.
Target Audience
The target audiences of this presentation are nurse leaders and any member of the healthcare
interdisciplinary team. Healthcare leaders and staff are equally challenged to not only provide care that is
evidence based and culturally relevant, but also to work effectively with an increasing culturally diverse
workforce
Abstract
Technology, generational divides, and differing personal values are some of the factors that contribute to
the inevitable diversity trends witnessed in today’s evolving healthcare system. Regardless of these
diversities, leaders have the responsibility of creating environments that optimize team performance while
enhancing patient outcomes, safety and quality of care. Gracious space, cultural and confident humility
are strategies that have been found to be effective for leaders to understand, support and manage
diversity in ways that foster high-performance. These strategies help teams to span boundaries, mitigate
tension, foster creativity, innovation, and high-performance by setting team’s direction, gaining
commitment from individual members and aligning team objectives and values to over-all organizational
goals. These tools have been effective in promoting inclusiveness, allowing leaders and teams to
leverage talents in ways that enable and sustain environments that respect and value diverse
perspectives, generate multiple alternatives, develop new possibilities and deepen team’s relationships
for high-performance.
Contact
[email protected]

H 14 - EBP Applied to Chronic Conditions
The Effectiveness of Nurse-Led Pre-Operative Assessment Clinics for Patients
Receiving Elective Orthopaedic Surgery: A Systematic Review
Sau Man Conny Chan, RN, BN, MN, Hong Kong
Wan Yim Ip, RN, RM, BN, MPhil, PhD, China
Janita Pak-Chun Chau, RN, BN, MPhil, PhD, Hong Kong
Purpose
The purpose of this poster presentation is to inform clinical practice of a systematic review on the
effectiveness of nurse-led POAC to elective orthopaedic patients. It identifies the best available research
evidence to promote better care, guide health-care decision making, and to identify the practice gap in the
existing practice.
Target Audience
The target audience of this poster presentation identified on all health care team members in particular to
the peri-operative nursing and surgical health members.
Abstract
Background: Patients are usually admitted to hospital on the day before a scheduled surgery. However,
patients are often found not fit for surgery due to changes in their medical or social conditions since the
last medical consultation. This results in high cancellation rates on the day of surgery. Evidence
suggesting that day of surgery cancellations waste hospital resources and cause anxiety in patients.
Nurse-led preoperative assessment clinic (POAC) has been introduced in many specialty areas to assess
and prepare patients prior to surgery. As the population ages, there is an increase in the number of
elective orthopedic surgeries. The POAC clinics can provide timely and effective care to older people
requiring orthopaedic surgery and those patients who are at high risk of perioperative morbidity and
mortality.
However, not all patients are referred to PAOC before surgery and the benefits of nurse-led POAC are
not well documented.Thus, a systematic review has been carried out to affirm nurse-led POAC as a
significant area of clinical practice.
Aim: The aim of this systematic review was drawn on the effectiveness of nurse-led POAC to summarize
and identify the best available research evidence in order to better inform of the current practice, promote
better care, guide health-care decision making, and to identify the practice gap in the existing evidence
and clinical practice.
Objectives:
• To examine the effectiveness of nurse-led POAC on orthopaedic patient outcomes such as levels of
satisfaction with the process of pre-operative assessment, incidence of post-operative complications,
post-operative recovery, as well as levels of fear and anxiety before surgery.
• To synthesize the evidence on the impact of nurse-led POAC for elective orthopaedic patients on
health service outcomes, including cancellation or delay of surgery, length of hospital stay and
waiting time for pre-operative assessment and surgery.
Method: This systematic review included all studies of adult patients who were 18 years old or above
required elective orthopaedic surgeries e.g. total knee replacement, total hip replacement, reduction of
fracture or procedure of arthroscopy etc in hospitals or day surgery centers, and had attended a nurse-led
POAC 2 to 4 weeks prior to the scheduled elective orthopaedic surgery. The nurse-led POAC could be
solely run by nurses, or nurses worked collaboratively with physicians.
While, the adult elective orthopaedic surgical patients within the American Society of Anesthesiologist
(ASA) Physical Status Classification of 1 or 2 are eligible for inclusion in the review. ASA classification 1 :
patients are considered to be healthy and normal, and ASA classification 2 : patients are patients with
mild systemic disease such as mild asthma, well-controlled hypertension, or well-controlled diabetes.

The review included randomized control trials, pseudo-randomized controlled trial, quasi-experimental
studies, cohort studies, and case-control studies among adult elective orthopaedic patients who attended
a nurse-led POAC. Electronic databases search encompassed all published and unpublished studies in
English and Chinese from inception to 2012. Given that the clinical and methodological diversity among
the studies, the review findings are presented in a narrative form.
Results: Systematic review of the pertinent literatures summarized and discussed the benefit of nurse-led
POAC for elective orthopedic patient. The existing systematic review on this specific field of knowledge
informed that nurse-led POAC can offer a very positive contribution to the optimization of care delivery for
patient before surgery experience.
Eleven studies were critically appraised in terms of the benefits of attending a nurse-led POAC. The
results showed nurse-led POAC could effectively reduce the rate of cancellations of impending surgery.
These studies suggested a reduction in the rate of post-operative mortality, blood transfusion requirement
after surgery, and length of hospital stay. In addition, the level of satisfaction towards services provided
was significantly high which affirmed the effectiveness of establishing POAC in current practice.
Implications and Conclusions: While POAC is being increasingly implemented worldwide, the
development of clinical guidelines, pathways and protocols was advocated. Adherence to these protocols
promotes efficiency by streamlining in clinical decision making and minimizing unnecessary consults and
costly diagnostic testing.
Moreover, this review suggests that collaborative multidisciplinary team approach in POAC can increase
patients’ understanding of the peri-operative processes and enhanced post-operative recovery. Likewise,
POAC can inform service improvement and policy development in the scheduling of theatre list and thus
enable better utilization of theatre and ward facilities.
In addition, the review further recognizes the educational role of nurses in POAC where they prepare
patients psychologically for the forthcoming surgery through education and information giving, to allay
fear and anxiety, as well as increase peri-operative knowledge for better compliance of post-operative
outcomes.
In conclusion, the best available evidence asserted that nurses in the POAC could serve as effective
coordinators, assessors and educators. The nurse-led practice optimized patients’ condition before
surgery and hence minimized elective surgery cancellations.
Contact
[email protected]

Intervention Study on Program Development of the Exercise Adherence for the
Elderly of Musculoskeletal Ambulation Disability Symptom Complex
Keiko Fukuroku, RN, PhD, Japan
Purpose
The purpose of this presentation is evaluate the effectiveness of this intervention program that home
exercise adherence for the fall prevention. The first is comparison of ADL,and physical measured value
between pre and post intervention in both groups. The second is evaluate of feedback effect of gait
analysis.
Target Audience
The target audience of this presentation is nurse and health-care provider that work in a community-
based clinic and out-patient clinic.
Abstract
OBJECTIVE: This study evaluate the effectiveness of this intervention program that home exercise
adherence for fall prevention. The first is comparison of activities of daily living (ADL) and physical
measured value between pre and post intervention in both groups. The second evaluate of feedback
effect of change in gait by motion analyzer.
DESIGN: 54 subjects recruited from female 65 years of age or older patients with Musculoskeletal
Ambulation Disability Symptom Complex (MADS) under treatment at the orthopedic clinic. We provided
the home exercise to improve the ability to trunk balance, range of motion in the ankle joint, toe grip force,
back muscle strength for them, and instructed them specific guidance on exercise to continue every day
for 6 months. We have analyzed 27 subjects who had continued exercise more than 5 days a week. The
number of subjects of intervention group is 17, and the control group is 10.In both groups, we conducted
the physical measured value and gait analysis between pre and post intervention. Only intervention
group, the subjects have interviewed about implementation status once a month by nurse.The
questionnaire response of 13 ADL item, 3 physical measured value (5m fast walking, Timed up and go
(TUG), balance on one-leg standing with vision),6 gait measurement item by motion analyzer were
compared between pre and post intervention. The physical measurements was analyzed that within-
group comparison with t-test, and comparison between group with paired t-test (p<0.05).
RESULTS:
1.Comparison of physical measured value
It showed significant differences improvement of the measurement value in 5m fast-walking and TUG in
the intervention group between pre and post intervention in the intervention group. The measured value
of range of motion in the ankle joint in the intervention group was significant improvement compared to
the control group.The high improvement rate of the measured value of each was gait cycle(65%),toe-
up(53%),heel-up(41%) in the intervention group, although there were no significant differences in the
measured value of gait analysis in both groups.
2.Comparison of ADL
The high improvement rate of the measured value of each was up stairs(35%),down
stairs(47%),uphill(41%) in the intervention group, and both were higher than the control group.In the
intervention group, the account for 40% or more subjects who were aware of improvement in “down
stairs” in the high improvement rate items(gait cycle, toe-up, heel-up).
CONCLUSIONS: There were no significant differences in amount of gait data change between pre and
post intervention. However, in the intervention group, it was high improvement rate in self-awareness of
ADL , and measured value of intervention group was high compared with control group. It suggests a
possible beneficial effect of feedback of change in gait by motion analyzer. As a consequence, it showed

significant differences in 5m fast-walking and TUG in the intervention group between pre and post
intervention. We will examine effective feedback by motion analyzer more closely in the future.
Contact
[email protected]

Evidence-Based Outcomes to Detect Obstructive Sleep Apnea, Identify Co-
Existing Factors, and Compare Characteristics of Patients Discharge Disposition
Joseph F. Burkard, DNSc, CRNA, USA
Purpose
The purpose of this EBP project is to highlight three completed projects in a series of clinical outcome
work to identify and treat OSA patients.
Target Audience
Advanced practice outcomes researchers
Abstract
Introduction:According to the American Heart Association, fifteen million adults are affected by
obstructive sleep apnea (OSA). Obstructive Sleep Apnea (OSA) is the most common disturbance during
sleep affecting 30% of the population. The occurrence of moderate/severe OSA is estimated at 11.4% in
men and 4.7% in women. This outcomes project included three completed bodies of work designed to
evaluate the effects of implementing the STOP BANG tool in preoperative clinics to identify undiagnosed
OSA surgery patients, examine the duration of recovery and the impact of co-factors and evaluate patient
characteristics of discharged patients to home versus admitted to a monitored bed.
Design and Methods:This outcomes project has three components which include the identification of
OSA patients and was completed in the first phase with a experimental time design series with 1010
subjects. The second component was an observational correlation design to compare co-factors that
impacted recovery stay times. The third component was a retrospective chart review of a total of 1300
patients to evaluate postoperative discharge characteristics. All three projects were IRB approved and
included statistical data plans.
Results:There was no difference in demographic data. Use of the STOP-BANG tool increased OSA
detection by 30.1%. Males and higher ASA classification were correlated with OSA. p<0.001. The
chance of identifying patients with OSA by using the STOP-BANG tool increased by 75% (p<0.001). The
second project indicated significant correlation with higher number of cofactors amongst patients
diagnosed with OSA (p< 0.012). Increased incidence of higher ASA classification in OSA diagnosed
patients; (p< .017) extended PACU stay time in OSA diagnosed patients; (p= 0.05) and unplanned
admissions in OSA patients; (p=. 007). In the third project four factors were found to be statistically
significant, namely, age, ASA classification, the anesthesia modality (monitored anesthesia care vs.
general anesthesia) and narcotics use.
Discussion: Chung et al. clearly states that the incidence of sleep apnea is 25% for men and 10% for
women. During this project, we were able to identify 37.6% of our surgical population who had sleep
apnea. This was a 26.6% improvement over our prior clinical assessment. The use of the STOP-BANG
tool is an easy addition to anesthesia pre-screening and increases patient safety. Complications
associated with OSA can be severe and life threatening. These complications include: hypoventilation,
hypoxia, airway obstruction, intubation difficulties, and a higher incidence of myocardial infarction. These
complications can occur intra-operatively, post operatively and during the PACU stay period. There
currently exists wide diversity in the postoperative management of the OSA patient. There is a
consensus that the OSA population requires more stringent anesthesia management during induction but
even more critical is the post operative period while the OSA patient is still under the effects of residual
anesthesia agents and narcotics. This study goes further identifying the incidence and significance of co-
existing factors (cofactors) that influence the PACU recovery time of OSA patients as compared with non-
OSA patients. The current study examined certain characteristics of OSA patients correlated with their
discharge disposition from the PACU and that certain patient risk factors contributed to adverse events
during a patient’s recovery period. The study evaluated the demographic characteristics, preoperative
comorbidities, ASA class, diagnostic conditions, types of anaesthetic and surgical interventions, pain

management, and postoperative complications that might influence a patient’s length of stay in the PACU
and their discharge disposition. The statistically significant risk factors were age, anaesthetic modalities
(general vs. MAC), ASA classification and narcotics used in the PACU. These results are consistent with
findings by other researchers studying perioperative risks of OSA patients. Time discharge, episodes of
desaturation and the lowest saturation were risk factors associated with postoperative adverse events.
Conclusions and Implications: Use of the STOP-BANG tool in anesthesia pre-screening will increase
patient safety. Findings will lead to optimum monitoring, management; recovery measures and
anesthesia techniques that will prevent extended postoperative periods and reduce or eliminate
postoperative complications of OSA. This descriptive retrospective chart review of surgical patients with
OSA in a defined six month period attempted to link an array of risk factors with a patient’s discharged
location and to learn about the characteristics of the patients at risk as measured by the lowest
oxygenation, episodes of desaturation and length of stay.
References
References: 1. Sommers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al: Meeting the challenge of
obstructive sleep apnea: Developing a protocol that guides perianesthesia patient care. J Perianesth Nurs. 2009;
24:103-113. 2. American Society of Anesthesiologists. Practice guidelines for the perioperative management of
patients with obstructive sleep apnea. Anesthesiology. 2006; 104:1081-1093. 3. Ead H. Meeting the challenge of
obstructive sleep apnea: Developing a protocol that guides perianesthesia patient care. J of Perianesth Nurs, 2009;
24: 103-113. 4. Isono S. Obstructive sleep apnea of obese adults: Pathophysiology and perioperative airway
management. Anesthesiology, 2009; 110: 908-921. 5. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan
S, Islam, S, et al: Validation of the Berlin Questionnaire and American Society of Anesthesiology Checklist as
screening tools for obstructive sleep apnea in surgical patients. Anesthesiology, 2008;108: 822-30. 6. Chung SA,
Hongbo Y, Chung F. Systemic review of obstructive sleep apnea and its implications for anesthesiologists. Anesth
Analg, 2008; 10: 1543-1563. 7. Chung FEH. Screening for obstructive sleep apnea before surgery: Why is it
important? Cur Opin in Anaesth, 2009; 22: 405-411. 8. Liao P, Yegneswaran B, Vairavanathan S, Zilberman P,
Chung F. Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study.
Can J Anaesth, 2009; 56: 819-28. 9. Chung FEH, Subramanyam R, Liao P, Sasaki E, Shapiro C, Sun Y. High Stop-
Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth, 2012; 108: 768-775.
Contact
[email protected]

I 12 - Using EBP Within Maternal-Child Health
The Effect of Breastfeeding Intervening Program in the Non-Authorized Baby-
Friendly Hospital
Ya-Ling Yang, RN, PhD, Taiwan
Purpose
The purpose of this presentation is to develop an interventing program for improving nurses'
breastfeeding care ability and evaluating its efficacy.
Target Audience
The target audiences can include nursing and inter-professional colleagues who are enthusiastic in
learning about how to develop an effect intervention program in breastfeeeding related care issues and to
understand the difference in breastfeeeding care between the non-authorized and authorized baby-
friendly hospital.
Abstract
Background: The program of “baby-friendly hospital” gave fresh impetus to enhance the rate of
effectively feeding of mother's milk in Taiwan area. Fifty-two percent babies were born in authorized
“baby-friendly hospital”. According to the authorized “baby-friendly hospital” qualifications, there is an
almost 100% attending rate in medical centers and regional hospitals, while community hospitals only
account for 41.5%. Even though the breastfeeding rate in private obstetrics clinics is only 3.5%, the birth
number rate is up to 32.5% of the yearly total birth. The breastfeeding rates at non-authorized “baby-
friendly hospitals”, which are classified as community hospital or private obstetrics clinics, can still have a
lot of room for improvements.
Purpose:The primary objective of this research is to find out the proper strategies for improving
breastfeeding care quality and breastfeeding rate of the postpartum women who were delivered in “non-
authorized baby-friendly hospital”, and evaluating its efficacy.
Methods:For reaching the goals, this research was split into 2 steps. In the first step, systematic data
collection and focus group research were used to establish standard intervention strategies, cross-
sectional study of nurses’ attitudes toward breastfeeding, knowledge and behavioral factors, as well as
the opinions and expectations of postpartum women and their family. Samples were divided into two
groups, experimental (non-authorized baby-friendly hospital) and control (baby-friendly hospital).
Developing the breastfeeding promoting and combined care program was evaluated by comparing the
difference between these two study groups. The goal of this clinical breastfeeding promoting and
combined care program is to provide a useful reference in increasing the breastfeeding rate for the
women who were delivered in “non-authorized baby-friendly hospital”. The second step- the prospective
longitudinal research design was adopted, and separated subjects by randomized control and treatment
group design to assess the outcomes in four “non-authorized baby-friendly hospital”. The intervening
strategies and combined care program is focus on the breastfeeding related job educational training for
the nurse who worked in study groups. This effect was measured by the postpartum women’s
breastfeeding rate, the breastfeeding related knowledge, attitude, self-efficacy and experience.
Results:First step- The effective sample is 350 into analysis. Breastfeeding rate is 63.4% in
hospitalization, 82.4% at first month after birth, 58.5% at fourth month after birth and 49.8% at sixth month
after birth. This breastfeeding rate of the women who had delivered baby in “non-authorized baby-friendly
hospital” is lower than the government announced rate. The nurses worked in non-authorized “baby-
friendly hospital” had lower scores in breastfeeding knowledge and attitude scales. The nurses also had
less breastfeeding education in “non-authorized baby-friendly hospital”. Based on this result, improving
the nurses’ breastfeeding knowledge and care ability related education program should be a key
intervention and consequently increasing the postpartum women’s breastfeeding rate and duration of
persistent breastfeeding. Second step- The efficacy of the breastfeeding intervening strategies and
combined care program was then evaluated. The results showed that the score of the breastfeeding

related knowledge, attitude, and self-efficacy of the study groups’ nurses were higher than the control
groups’, and the postpartum women’s problems in breastfeeding experience had lower of study group
than the control group. But the duration of persistent breastfeeding had no difference between the study
and control group.
Conclusion: The results of this study might helpful to establish the breastfeeding model in the “non-
authorized baby-friendly hospital” (community hospital and private obstetrics clinics). Providing specified
suggestions and standardizations, being the references of health policy in the future.
References
1.Howard, C. R., Schaffer, S. J.,& Lawrence, R. A.(1990). Attitudes, practices, and recommendations by obstetricians
about infant feeding. Birth, 24(4), 240-6. 2.Labbok, M.,& Krasovec, K.(1990). Toward consistency in breastfeeding
definitions. Studies in Family Planning, 21(4), 226-30,. Lutter, C. K., Perez-Escamilla, R., Segall, A., Sanghvi, T.,
Teruya, 3.Freed, G. L., Fraley, J. K.,& Schanler, R. J.(1992). Attitudes of expectant fathers regarding breast-feeding.
Pediatrics, 90(2 Pt 1), 224-7. 4.O'Campo, P., Faden, R. R., Gielen, A. C.,& Wang, M. C.(1992). Prenatal factors
associated with breastfeeding duration: recommendations for prenatal interventions. Birth, 19(4), 195-201. 5.Duckett
L.(1992).Maternal employment and breastfeeding. NAACOG’s Clinical ssues in Perinatatal & Woman’s Health
Nursing,3(4),701-711 6.Perez-Escamilla, R., Pollitt, E.,& Lonnerdal, B.(1994). Dewey KG. Infant feeding policies in
maternity wards and their effect on breast-feeding success: an analytical overview. American Journal of Public
Health, 84(1), 89-97. 7.Freed, G. L., Clark, S. J., Lohr, J. A., & Sorenson, J. R. (1995). Pediatrician involvement in
breast-feeding promotion: a national study of residents and practitioners. Pediatrics, 96(3 Pt 1), 490-4. 8.Saadeh,
R.,& Akre, J.(1996). Ten steps to successful breastfeeding: a summary of the rationale and scientific evidence. Birth,
23(3), 154-60. 9.Sikorski, J., Renfrew, M. J., Pindoria, S.,& Wade, A.(2003). Support for breastfeeding mothers: a
systematic review. Paediatric and Perinatal Epidemiology, 17(4), 407-17. 10.K.,& Wickham, C.(1997) The
effectiveness of a hospital-based program to promote exclusive breast-feeding among low-income women in Brazil.
American Journal of Public Health, 87(4), 659-63. 11.Arora, S., McJunkin, C., Wehrer, J.,& Kuhn, P.(2000). Major
factors influencing breastfeeding rates: Mother's perception of father's attitude and milk supply. Pediatrics, 106(5),
E67. 12.Ertem, I. O., Votto, N.,& Leventhal, J. M.(2001). The timing and predictors of the early termination of
breastfeeding. Pediatrics, 107(3),543-8. 13.Cattaneo, A.,& Buzzetti, R.(2001). Effect on rates of breast feeding of
training for the baby friendly hospital initiative. BMJ, 323(7325), 1358-62. 14.Fairbank, L., O'Meara, S., Sowden, A.
J.,& Renfrew, M. J.(2001). Woolridge MM. Promoting the initiation of breast feeding. Quality in Health Care, 10(2),
123-7. 15.Donath, S. M., Amir, L. H.,& ALSPAC Study Team. (2003). Relationship between prenatal infant feeding
intention and initiation and duration of breastfeeding: a cohort study. Acta Paediatrica, 92(3),352-6. 16.Guise, J. M.,
Palda, V., Westhoff, C., Chan, B. K., Helfand, M.,& Lieu, T. A.(2003). The effectiveness of primary care-based
interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive
Services Task Force. Annals of Family Medicine, 1(2), 70-8. 17.Noel-Weiss, J., Bassett, V.,& Cragg, B.(2006).
Developing a prenatal breastfeeding workshop to support maternal breastfeeding self-efficacy. JOGNN - Journal of
Obstetric, Gynecologic, & Neonatal Nursing, 35(3), 349-57. 18.Noel-Weiss, J., Rupp, A., Cragg, B., Bassett, V.,&
Woodend, A. K.(2006). Randomized controlled trial to determine effects of prenatal breastfeeding workshop on
maternal breastfeeding self-efficacy and breastfeeding duration. JOGNN - Journal of Obstetric, Gynecologic, &
Neonatal Nursing, 35(5), 616-24. 19.Philipp, B. L.,& Radford, A.(2006). Baby-Friendly: snappy slogan or standard of
care. Archives of Disease in Childhood Fetal & Neonatal Edition, 91(2), F145-9.
Contact
[email protected]

I 12 - Using EBP Within Maternal-Child Health
Reduction of Childhood Obesity via the Web-Based Programs in School-Aged
Children
Natalya Fazylova, DNP, FNP-BC, USA
Purpose
The purpose of this presentation is aimed to discuss the current available evidence on the effectiveness
of web-based programs on the reduction of childhood obesity.
Target Audience
The target audience of this presentation are nurses, nurse practitioners, physicians and other health care
providers involved in care of school aged children
Abstract
Purpose: This review aimed to to identify the current evidence on the effectiveness of web-based
programs on the reduction of childhood obesity.
Methods: A three-step search strategy and search terms were formulated based on the selection criteria.
This review considered studies that included school age children regardless of gender, ethnicity, or
national origin from 4-18 years of age. The outcomes measured in this review include overweight and
obesity among school aged children as measured by valid and reliable measurements including but not
limited to BMI, body weight, and/or waist circumference. Independent critical appraisals on selected
studies were performed using JBI CReMS and MASTARI for data extraction.
Results: A total of 12 randomized controlled studies were included in the review. A reduction in BMI,
BMI-z, and weight and/or waist circumference can occur when implementing web-based interventions in
school aged children. However, studies reviewed point to other variables playing a role in these
outcomes such as parental involvement, face-to-face interactions, culturally tailored programs, and
reinforcement of information to improve adherence.
Discussion: This review supports the development of web-based technology for the implementation of
weight reduction programs as a method to reach school-aged children. Evidence also suggests that these
web-based programs would produce better results in school-aged obese children with parental
involvement and when culturally sensitive. Furthermore, evidence suggests that these web-based
programs would produce better results in school-aged childhood obesity if done for a longer period of
time.
Conclusion: As identified by the reviewers, most of the RCT that included other variables such as
dietary, physical exercise, parental involvement and culturally tailored program had significant changes in
adherence to the program, decrease in BMI/waist circumferences/body fat, and increased in behavioral
changes was statistically significant. Therefore, future studies which will incorporate parental involvement,
cultural sensitive programs, larger sample size, and longer periods of studies beyond 16 weeks may be
needed to establish the full effect of web-based childhood obesity reduction.
References
Antwi, F., Fazylova, N., Garcon, M. C., Lopez, L, Rubiano, R., & Slyer, J. T. (2013). A systematic review of the
effectiveness of web-based programs on the reduction of childhood obesity in school aged-children. The JBI
Database of Systematic Reviews and Implementation reports
Contact
[email protected]

I 13 - Evidence-Based Practice Solutions
Patient Outcomes from Care Provided by Advanced Practice Nurses in the U.S.
Julie A. Stanik-Hutt, PhD, CRNP, CNS, FAAN, USA
Kathleen M. White, PhD, RN, NEA-BC, FAAN, USA
Purpose
The purpose of this presentation is to disseminate the results of systematic review of research literature
from 1990 - 2009 regarding the patient outcomes from care provided by advanced practice nurses in the
United States.
Target Audience
The target audience of this presentation includes advanced practice nurses (APN), those who educate
them, employ or work with them, investigators who examine practice models and outcomes and leaders
who develop policy related to APN practice.
Abstract
Background: Advanced practice nurses (APNs) are registered nurses who have completed post -
graduate education that prepares them for advanced and expanded practice as a nurse practitioner [NP],
nurse midwife [CNMs], nurse anesthetist [CRNAs], or a clinical nurse specialist [CNS].Issues related to
access, cost and quality are at the core of ongoing discussions regarding health care. With the growing
need for highly qualified health care providers, the best available evidence should be used to make
decisions regarding how best to utilize the skills of APNs. Data is needed by educators, governmental
officials and employers so they can create appropriate educational programs to prepare APNs, policies
which authorize optimal APN practice and delivery models that utilize each health care professional’s
skills to the fullest. A systematic review of all available research which uses systematic and explicit
methods to identify, select and critically appraise evidence and then aggregate that evidence, is needed
to support these decisions.
Purpose: To synthesize and critically apprise the body of knowledge produced by randomized controlled
trials (RCT) and observational comparative (OC) studies which examine patient outcomes derived from
care provided by APNs.
Data Sources: An exhaustive search of the published and unpublished research literature from 1990 –
2008 was completed. A variety of databases including the Cumulative Index to Nursing and Allied Health
Literature, Pub Med, Proquest, the Cochrane Database as well as others were searched. Governmental
reports and grants, and dissertations were included. Manuscript references and footnotes were also hand
searched.
Study Selection: A methodical process was used to select studies to include in this review. Two
reviewers independently reviewed first the title, then the abstract, and finally the article to determine
whether it met inclusion criteria. At the title level only one reviewer had to determine the article should be
included, there after both reviewers had to determine that the article met inclusion criteria. The TrialStat
System (SRS v4, Ottawa, ON) was used to store retrieved studies, conduct the title and abstract reviews,
and document decisions. Articles which reported on patient outcomes related to quality, effectiveness or
safety of care by an APN, whether from an RCT or OC study which compared patient outcomes from an
APN provider group to those from a provider group without an APN were included. All studies had to be
completed in the United States.
Data Extraction, Appraisal and Synthesis: 27,993 titles were reviewed and ultimately yielded 109
studies which met all criteria for inclusion (NP, 49; CNS, 24; CNM, 23; CRNA, 4; and CNS and NP
combined, 9). Data on patient outcomes were extracted from each study and used to create detailed
evidence tables stratified by APN type. Evidence tables also included information on study characteristics
(provider types, setting of care, patient characteristics, sample size, etc.). Studies were critically
appraised for quality using a modified Jadad Scale (> 5 = high quality, < 4 = low quality) and that score
was added to the data table. Outcomes from individual studies were then aggregated. For an outcome to

be reported, at least three studies had to report data for the outcome. Because not all outcomes met this
criteria, data from only 75 of the 109 studies could be aggregated (NP, 37; CNS, 13; CNM, 21; CRNA, 0;
and CNS and NP combined, 4). Aggregated data on each outcome was appraised for quality a second
time using the GRADE Working Group Criteria. The GRADE criteria assessed the quality, quantity and
consistency of the data. It had been hoped that outcomes could also be pooled from across studies in
order to complete a meta-analysis, however limitations in reporting the literature prevented same.
Conclusions: 30 abstracted outcomes from 75 of the 109 studies reviewed (22 randomized controlled
trials and 53 observational) were aggregated and contributed to the conclusions. 70 % of the patient
outcomes (21 of 30) were supported by a high level of overall evidence.
Nurse Practitioners: Patient outcomes from care by NPs or by physicians (MDs) supported 1) a high
level of evidence of similar patient outcomes regardless of provider for: patient satisfaction with
provider/care, self-report of perceived health status, functional status, blood glucose, blood pressure,
emergency department visits, hospitalization, and mortality; 2) a high level of evidence that NP
management of serum lipids produced better patient outcomes than those from management by a
physician; and 3) a moderate level of evidence that LOS and a low level of evidence that patient duration
of ventilation is similar among patients cared for by either provider type.
Clinical Nurse Specialist: Patient outcomes from care involving a CNS or without a CNS supported, 1)
a high level of evidence that CNS involvement decreases hospital LOS and costs; 2) a high level of
evidence that patient satisfaction is not affected by a CNS; 3) a moderate level of evidence that a CNS
reduces complications; and 4) a low level of evidence that patient’s perception of quality of life are
affected by a CNS.
Certified Nurse Midwives: When patient outcomes from CNMs are compared to those from MDs, a high
level of evidence shows that 1) numbers of low birth weight infants and Apgar scores are similar; and 2)
CNM care reduces the rate of episiotomy and perineal laceration, use of labor analgesia or labor
augmentation, vaginal operative delivery and Cesarean section. A moderate level of evidence indicates
that 3) mothers managed by a CNMs are more likely to breastfeed their baby; 4) admission to neonatal
intensive care unit after CNM delivery is no more likely than after MD delivery; and 5) lower use of
epidural analgesia and labor induction, as well as vaginal birth after Cesarean. Differences between
CNM and MD outcomes are particularly evident for so called ‘overused’ interventions (Cesarean section,
labor induction/augmentation, epidural anesthesia, forceps and vacuum use, episiotomy, and labor
analgesia).
References
*Stanik-Hutt, J., Newhouse, R., White, K., Johantgen, M., Bass, E., Zangaro, G.,… Weiner, J. (2013). The quality and
effectiveness of care provided by nurse practitioners: A systematic review of US research studies, 1990-2009. The
Journal for Nurse Practitioners, 9(8), 492-500. *Newhouse, R., Weiner, J. P., Stanik-Hutt, J., White, K. M., Johantgen,
M., Steinwachs, D., Zangaro, G., Aldebron, J. & Bass, E.(2012). Policy Implications for Optimizing Advanced Practice
Registered Nurse Use Nationally. Policy, Politics and Nursing Practice. 13 (2), 81 - 90. *Johantgen, M., Fountain, L.,
Zangaro, G., Newhouse, R., Stanik-Hutt, J., & White, K. (2012). Comparison of labor and delivery care provided by
certified nurse midwives and physicians: A Systematic review 1990 – 2008. Women’s Health Issues. 22(1):e73-81.
*Newhouse, R., Stanik-Hutt, J., White, K., Johantgen, M., Bass, E., Zangaro, G.,.. L. Weiner, J. (2011). Advanced
practice registered nurse outcomes 1990-2008: A Systematic review. Nursing Economics. 29(5), 230-50.
Contact
[email protected]

I 13 - Evidence-Based Practice Solutions
Translating the DASH Diet into Practice
Jozelle Laforteza, RN, BSN, PHN, USA
Mary Jo Clark, PhD, RN, PHN, USA
Kathy James, DNSc, APRN, FAAN, USA
Iyabo Daramola, MD, USA
Purpose
The purpose of this presentation is to describe the translation of evidence based high intensity diet
counseling emphasizing the DASH diet into primary care practice to improve health outcomes of
hypertensive adults.
Target Audience
The target audience of this presentation include nurse practitioners, advance practice registered nurses,
doctor of nurses scholars, and other healthcare professionals.
Abstract
Project Aim: The purpose of the project was to apply high-intensity counseling to improve compliance
with dietary and physical activity recommendations and decrease in blood pressure (BP) levels among
hypertensive adults.
Background: Hypertension is a major risk factor for the two leading causes of death in the United States,
heart attack and stroke. Although guidelines to prevent and treat hypertension recommend adoption of
the Dietary Approaches to Stop Hypertension (DASH) diet, there is lack of compliance with these
recommendations in practice. National Health and Nutrition Examination Survey (NHANES) data from
1999 to 2004 indicated only 19% of hypertensive adults were DASH accordant. Seven out of seven
hypertensive patients seen in a local primary care setting were found to be non-compliant with the DASH
diet. The medical director of the practice reported the majority of the hypertensive adults seen were non-
DASH diet accordant. Poor compliance leads to progression of pre-hypertension to hypertension and
poorly controlled blood pressure (BP) among hypertensive patients. Evidence consistently shows time-
intensive counseling generally produces larger changes in dietary behavior than less time-intensive
interventions. Despite the evidence in support of time-intensive counseling, current lifestyle modification
counseling in the local primary care setting was only limited to office visits.
Project Approach: Hypertensive adults seen in a primary care setting participated in three 1-hour group
classes and two 20-minute individual telephone follow-ups. Participants completed a 24-hour dietary
intake recall pre- and post-intervention. Pre-intervention systolic BP (SBP) was obtained through chart
review, and post-intervention SBP was obtained through BP measurements during the final class session.
The percentages of participants engaged in DASH-related behavioral changes and who had decreased
BP were used to evaluate data.
Outcomes: Data collection currently in progress, however it is expected there will be an increase in
percentages of participants engaged in DASH-related behavioral changes and those with lower BP.
Conclusions: To be determined following review and analysis of results. It is expected high-intensity diet
counseling in primary care will show early success in decreasing cardiovascular risk in hypertensive
patients seen in primary care. If successful, investment in high-intensity diet and lifestyle counseling
should be considered among high-risk patients in the primary care setting.
References
Kwan, M. W. M., Wong, M. C. S., Wang, H. H. X., Liu, K. Q. L., Lee, C. L. S., Yan, B. P., & Yu, C. M. (2013).
Compliance to the DASH diet: A systematic review. International Journal of Cardiology, 164, S24-S25.
doi:10.1016/S0167-5273(13)70592-8 Lin, J. S., O’Connor, E., Whitlock, E. P., & Beil, T. L. (2010). Behavioral
counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: A systematic
review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153, 736-750. doi: 10.7326/0003-
4819-153-11-201012070-00007. Mellen, P. B., Gao, S. K., Vitolins, M. Z., & Goff, D. C. (2008). Deteriorating dietary

habits among adults with hypertension. DASH dietary accordance, NHANES 1988-1994, and 1999-2004. Archives of
Internal Medicine, 168, 308-314. doi:10.1001/archinternmed.2007.119 Roger, V. L., Go, A. S., Lloyd-Jones, D. M.,
Benjamin, E. J., Berry, J. D., Borden, W. B., …Turner, M. B. (2012). Heart disease and stroke statistics – 2012
update: A report from the American Heart Association. Circulation,125, e2-e220. doi:
10.1161/CIR.0b013e31823ac046
Contact
[email protected]

I 14 - Implementing EBP with Staff
Staff Nurses' Use of Research to Facilitate Evidence-Based Practice
Linda H. Yoder, PhD, MBA, RN, AOCN, FAAN, USA
David Curk McFall, MSN, RN, USA
Purpose
to disseminate research about staff nurses use of research to implement evidence-based practice in an
acute care setting.
Target Audience
any nurse or healthcare professional working in an acute care setting.
Abstract
Purpose: The literature indicates that bedside nurses in the United States continue to lack the desire and
ability to integrate evidence into their practice for a variety of reasons. The purpose of this study was to:
(1) determine registered nurses (RNs) use of research findings in their practice within an acute care
hospital system, (2) determine what types of knowledge RNs used in their practice, and (3) determine
what personal, professional, and organizational factors enhanced or hindered research utilization (RU) by
RNs in the multi-hospital system.
Methods: A cross-sectional, descriptive, on-line survey design was used. Approval for the study was
obtained from the health system’s institutional review board. This study took place in a 10 hospital health
system located in a metropolitan city. Of the 10 hospitals, eight are acute care facilities, one is a regional
children’s hospital, and one is an acute care psychiatric hospital. Four of the hospitals are Magnet
hospitals and the others are Pathway to Excellence hospitals. All RNs across the hospital system
received an email invitation to participate in the survey, which was available on the organizational intranet
for eight weeks. The electronic survey was accessible to RNs at work and from home. The survey
consisted of 54-items grouped into five sections. Section one consisted of 12 questions asking about the
four types of RU: (1) overall, (2) direct, (3) indirect, and (4) persuasive. Section two of the survey
consisted of 23 questions regarding demographic and professional characteristics of the participants.
Section three consisted of six questions about nurses’ use of knowledge in practice, including attitudes
toward research and sources of knowledge about practice. Section four consisted of one question aimed
at identifying factors that influenced nurses’ decisions to apply research findings in practice. Section five
contained nine questions about organizational resources available to support research. The survey also
contained two open-ended questions asking the participants to list: (1) research findings they used in their
practice in the last 12-months, and (2) professional and organizational factors that enhanced or hindered
RU by registered nurses in the hospital system. 2900 registered nurses were invited to participate; 1112
nurses provided usable surveys, for a response rate of 38%. The focus of this presentation is the 794
staff nurses who responded to the survey and provide beside patient care at least 50% of the time.
Results: Most of the nurses (88%; n = 695) were females whose highest level of education was a
baccalaureate degree (49%; n = 380) or an associate degree (37%; n = 295). Most of the nurses had
been RNs for at least 10 years (50%; n = 387). The knowledge the nurses reported they relied on the
most for their practice came from their personal experience with patients, policies and procedures,
physician colleagues, and nursing peers. Despite the fact that a variety of resources were available for
nurses to locate research findings and conduct evidence-based practice (EBP), they reported the same
problems that were reported in other studies over the last two decades. They cited barriers such as: lack
of paid time to conduct reviews of the literature, an inability to understand the research literature because
it seems too complex, and the inability to synthesize research findings to formulate a practice change.
However, the nurses attitudes about RU/EBP were positive overall, but they expected unit based
educators, clinical nurses specialists, and nurses in nonbeside care roles to collect and synthesize the
research for them.
Conclusion: There continue to be many opportunities to inform, educate, and assist staff nurses with
RU/EBP implementation. Despite nursing leaders’ desire to have nurses at the bedside participate in

development of EBP practices, RNs continued to cite the same barriers that have repeatedly been
reported in other studies: lack of time, lack of resources, and lack of knowledge. The bedside nurse is
functioning in a complex healthcare environment with an ever increasing amount of research directed at
improving quality and safety practices. However, due to unit or hospital-based cultures and barriers, they
often continue to want others, such as masters prepared nurses, to read and synthesize the evidence and
convince them of the benefit to patients before they will adopt new evidence-based practices.
References
Estabrooks, C. A., Floyd, J. A., Scott-Findlay, S., O’Leary, K. A., & Gushta, M. (2003). Individual determinants of
research utilization: A systematic review. Journal of Advanced Nursing, 43(5), 506-520. Kenny, D. J. (2005). Nurses’
use of research in practice at three US Army hospitals. Nursing Leadership, 18(3), 45-67. LaSala, C. A., Connors, P.
M., Pedro, J. T., & Phipps, M. (2007). The role of the clinical nurse specialist in promoting evidence-based practice
and effecting positive patient outcomes. The Journal of Continuing Education, 38(6), 262-270. Melnyk, B. M., Fineout-
Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical
implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410-417.
doi:0/1097/NNA.0b013e3182664e0a Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2005). Readiness of U.S. nurses
for evidence-based practice. American Journal of Nursing, 105(9), 40-51.
Contact
[email protected]

The Nethersole Nursing Practice Research Unit: Reflecting on its Successes and
Challenges in Promoting Evidence-Based Practice in Nursing in Hong Kong
Helen Y. L. Chan, RN, PhD, Hong Kong
Diana T. F. Lee, PhD, MSc, PRD (HCE), RM, RN, RTN, Hong Kong
Purpose
The purpose of this presentation is to stimulate discussion among local and international clinicians and
researchers to share experiences of promoting evidence-based practice in clinical setting and discuss its
impact on care outcomes and staff competence.
Target Audience
The target audience of this presentation includes local and international nurses and researchers.
Abstract
Evidence-based practice is a global development trend in the healthcare field with an ultimate goal to
promote positive impacts on patient outcomes and care quality. Clinicians are empowered to make care
decisions for individual patients on the basis of current best available research evidence together with
their clinical expertise and patient preferences. This development trend calls for an urgent need to build
capacity among nurses on the integration of research and clinical practice, and hence promote a culture
of evidence-based care in nursing. In response to this, the Nethersole Nursing Practice Research Unit
(NNPRU) was established at the Nethersole School of Nursing with the generous support of the
Nethersole Endowment Fund of The Chinese University of Hong Kong (CUHK). The Unit is committed to
fostering nursing excellence through research and education, and thus promote evidence-based practice
to bridge the gap between knowledge and practice. Its specific objectives are: i) To develop, implement
and evaluate evidence-based nursing care protocols for clients and their families; ii) To strengthen the
interface between academic and clinical settings; and iii) To equip nursing colleagues and students with
knowledge and skills of conducting rigorous and quality research in clinical contexts.
The primary focus of the Unit is on promoting evidence-based practice in basic care in gerontological
nursing. This has been a neglected area in both research and clinical care, and so initially there was
hesitation among clinicians working at frontline on putting efforts into this area. Over the past few years,
the nurses of the Unit have teamed up with the ward colleagues to provide patient care and such
opportunity of working as a team had facilitated mutual understanding. The Unit and the ward nurses then
identified aspects of care that need improvement together. The frontline nurses appreciated that such
collaboration helped to heighten their awareness of the current development of nursing practices and
provided guidance to advance their practices. Thus far, the Unit has developed evidence-based care
protocols on oral care, foot and toenail care, skin care and bowel care, with the support of nurse
specialists of different specialties, and implemented and evaluated these protocols among older adults in
the local care setting. Study findings showed that these protocols are effective in improving care
outcomes and health-related quality of life of older adults.
Knowledge transfer is also another strategy used by the Unit for promoting evidence-based care in
nursing. The Unit has introduced the care protocols to frontline staff in different hospitals and long-term
care settings through in-service training, seminar and workshops. These knowledge transfer activities
aimed to enhance the gerontological care competence of nurses and co-workers in the field. They were
well received from clinical partners revealing that the importance of evidence-based care has been well
recognized. The Unit has also disseminated the works through publication and conference presentations
to facilitate sharing and exchange of opinions at both local and international levels. In addition, the Unit
also prepared educational booklets and video clips related to the various aspects of care for clients and
their families to enhance public awareness towards gerontological care and improve their knowledge and
skills in this area.

Through its work and achievements, the Unit has successfully demonstrated itself as an exemplar in
bridging up research and practice and in promoting evidence-based nursing practice.
Contact
[email protected]

Identifying Entry-Level Nursing Practice Characteristics and Emerging Trends in
the United States through Evidence-Based Research
Philip Dickison, PhD, RN, USA
Kathy Apple, MS, RN, FAAN, USA
Ada Woo, PhD, USA
Purpose
The authors aim to identify entry-level nursing practice characteristics through a series of large-scale
practice analysis studies. In addition to practice characteristics, emerging trends in nursing practice are
also identified.
Target Audience
The target audience of this presentation are nursing educators, regulators and practitioners.
Abstract
Background: The National Council of State Boards of Nursing (NCSBN) is responsible to its membership
for the preparation of psychometrically sound and legally defensible licensure examinations. The periodic
performance of practice analysis studies assists NCBSN in understanding practice characteristics of
entry-level nurses and evaluating the validity of its test blueprints. Due to the ever-changing nature of the
U.S. healthcare industry, entry-level nursing practice analyses are conducted on a triennial basis. In
2006, NCSBN began development of a series of continuous practice analysis studies to be conducted in
the three-year gaps among the regular practice analysis cycles. The purpose of conducting these
continuous practice analyses was to discover emerging trends in entry-level nursing and to provide
consistent validity evidence for the NCSBN test blueprints. In the present study, audience will learn the
results of these continuous practice analyses and identify any emerging practice trends in the U.S.
A large number of entry-level nurses are randomly sampled every three months to receive an electronic
survey on nursing practice. The sample is defined as candidates who successfully passed the NCLEX, a
nursing licensure examination used in the U.S., within the previous six months. In essence, no individual
sampled would have been working as a licensed nurse for more than six months. The electronic survey
contains an extensive list of nursing activities as determined by a subject matter expert (SME) panel,
questions about the respondent’s nursing experience and work environment, and respondent’s
demographic information.
Study Methodology: To illustrate the continuous practice analysis process, the following sections
provide a description of the methodology used to conduct the most recent Registered Nursing (RN)
Continuous Practice Analysis study in 2012. Descriptions of subject matter expert panel processes,
survey development, sample selection and data collection procedures are provided. The methodology
with which continuous practice analyses have been conducted since 2006 mirrors the process described.
Panel of Subject Matter Experts
Nursing activity statements from the 2011 RN Practice Analysis were used in the 2012 Continuous
Practice Analysis study. A panel of RNs was assembled to assist with the 2011 RN Practice Analysis.
Panel members worked with and/or supervised the practice of RNs within their first six months of practice
or were themselves newly licensed RNs and represented all geographic areas of the U.S., all major
nursing specialties and various practice settings.
The panel of experts performed several tasks crucial to the success of the practice analysis study. The
SMEs asked three newly licensed RNs whom they supervised to submit detailed daily logs describing the
activities they performed on the job. Additionally, SMEs were asked to submit job descriptions, orientation
and professional evaluations from their work settings. Using activity logs, past activity statements, job
descriptions, performance evaluation documents, as well as their own knowledge of newly licensed RN
practices, the panel created a category structure describing the types of activities performed by newly
licensed RNs. They were careful to create a structure that was clear, understandable and logical.

Once the list of categories was created, the panel members worked to create a list of activities performed
within each category. Each activity was reviewed for applicability to newly licensed practice and the
relationship to the delivery of safe nursing care to members of the public. Care was taken to create the
activity statements at approximately the same level of specificity and to avoid redundancy.
Survey Development: A number of processes were used to create, evaluate and refine the survey
instrument used for the 2012 RN Continuous Practice Analysis study. First, the activity statements
created by the SMEs for the 2011 RN Practice Analysis were reviewed and edited by the NCLEX
Examination Committee, and oversight group consists of U.S. nursing regulators. The resulting activity
statements were incorporated into a survey format. The survey included questions about the RN’s
practice settings, past experiences and demographics. Two forms of the survey were created to decrease
the number of activity statements contained on each.
The survey contained five sections. Section one focused on RN activity performance needed to safely
practice newly licensed nursing. In the second section, questions related to the respondent’s work
experience, including months of experience as an RN and type and length of work orientation. Section
three contained questions about the respondent’s work environment including questions about work
settings, client characteristics and work schedules. Section four requested information on the
respondent’s last day of work including numbers of hours worked, number of clients for whom care was
provided, and the amount of time spent in various RN activities. Section five asked for basic demographic
information. Survey Mailing Procedure A sample of newly licensed RNs was selected from the NCSBN
database of successful NCLEX-RN candidates over a six-month period. During each quarterly survey
administration period, a new group of candidates was selected. Invitations for each of the online surveys
were sent via e-mail. One week later, a reminder e-mail was sent to all participants reiterating the
importance of the study and urging participation. In the second week of the administration, a second
reminder e-mail was sent. The final reminder was e-mailed in the fourth week of the administration.
Confidentiality: All potential participants were assured confidentiality with regard to their participation
and their responses. Files containing mailing information were kept separate from the data files. The
study protocol was reviewed and approved by NCSBN’s chief executive officer for compliance with
organizational guidelines for research studies involving human subjects. Survey Rating Scales The
2012 RN Continuous Practice Analysis survey asked responders to answer two questions about each
nursing activity. The first question addressed the frequency of activity performance. The scale of
frequency ranged from “Never performed in work setting” to “5 or more times.” Responders were
instructed to mark “Never performed in work setting” then move to the next activity if an activity did not
apply to their work setting. If the activity did apply to their work setting, they were asked to mark a six-
point scale (0 to 5 or more times) reflecting the frequency with which they had performed the activity on
their last day of work. They were then asked to rate the overall importance of the activity considering
client safety and/or threat of complications or distress on a five-point Likert scale with 1 being “Not
Important” and 5 being “Critically Important.” Additionally, applicability to practice setting was assessed by
analyzing the number of responders not marking the “Never performed in work setting”
response. Responders were asked to rate performance frequency of all activities that were applicable to
their work settings. They reported how frequently they performed the activity on the last day they worked
on a six-point scale: “0 times” to “5 times or more.” The setting-specific frequency was calculated by
averaging the frequency ratings of those responders providing ratings (i.e., responders indicating that the
activity applied to their work setting). Anticipated Results and Practical Implications In the present
research, the authors will compile results of all continuous practice analysis conducted since 2006 to
provide a longitudinal picture of nursing practice characteristics in the U.S. Data depicting nursing
demographics will be reported. Changes in categories of nursing activities performed at the entry-level
will be noted, as will changes in time spent in or importance entry-level nursing assigned to these activity
categories. To ensure that the results of this study is beneficial to a larger audience in the nursing
community, additional background research will be conducted comparing nursing policies such as the
Institute of Medicine Future of Nursing report to results of the current study.
Contact
[email protected]

J 13 - Evidence-Based Practice Within the Pediatric Population
Child Sex Trafficking in the Health Care Setting: Recommendations for Practice
Cathy Miller, MSN, USA
Purpose
The purpose of this presentation is to educate nurses on the recognition, intervention, and referral of child
sex trafficking survivors.
Target Audience
The target audience of this presentation is nurses and advance practice nurses.
Abstract
The child sex trafficking (CST) industry can be conceptualized as a broad phenomenon encompassing
such human rights violations as survival sex, forced prostitution, debt bondage, child sex tourism and is
incorporated under the umbrella of human trafficking. The estimates of CST vary greatly from 600,000 to
2.5 million. This variance can in part be attributed to health care provider lack of education and best
practices on the recognition, intervention, and referral of CST survivors.
The purpose of this presentation is to provide a foundation for health care providers on the recognition,
medical and nursing management, and referral of CST survivors. The goals are 1) to increase health
care provider competency and confidence when caring for survivors of CST which will contribute to
improve mental and physical health outcomes for survivors, 2) contribute to reliable data for research
collection, law enforcement, and governmental agencies, and 3) increase prosecution of offenders.
Covered topics include:
• Recognition in the health care environment
• Appropriate interview techniques
• Nursing interview and management
• Safety-provider and survivor
• Documentation
• Importance of forensics
• Referral sources
Contact
[email protected]

Partnerships in Global Health: Nursing Assessments with School-Age Children in
Belize to Promote Healthy Living
Mary Lou De Natale, EdD, RN, CNL, USA
Enna E. Trevathan, DNP, MSN, MBA, RN, CNL, USA
Purpose
Provide information about a partnerships between nurses and nursing students who actively involved
children and adolescents in their own health assessments which provides a way to address global health.
Target Audience
Nursing clinicians, community nurses, and educators who support the health and wellness of children.
Abstract
School age children across the world represent the future, thus their growth and development are a prime
concern of all societies (World Health Organization, 2013). One way to address this need is to educate
children regarding their own health and wellness, which proved to be beneficial for a community in Belize,
Central America. This program provided a partnership for nurses and nursing students with children/
adolescents as they learned about how to perform their own health assessments.
Physical assessments and nutrition education for over 700 school-age children/ adolescents were
provided. Children and adolescents, as active participants in their learning and health screenings, gained
an understanding and skills for individualized health awareness. The participation of teachers/ class
members during the health assessments promoted dialogue on culture, traditions, and everyday life. In
addition, baseline measurements for each of the children/ adolescents on height, weight, blood pressure/
pulse, vision, and personal health concerns were learned by the children/ adolescents. Reflective nursing
practice helped build on the learning through: (1) understanding the individual health needs; (2)
developing an awareness of the resources available in the school, family, and community; and (3)
supporting leadership amongst the nurses and other health providers.
The rewards for teaching about health care practices also included being present with each child/
adolescent and listening to their personal thoughts and ideas. Outreach opportunities for nurses to
partner with a community to decrease potential health risks are a professional responsibility. Having a
child listen to his/ her own heart and learn to take his/her pulse is forever a teachable moment giving
support for learning, sharing, and practicing health promotion globally.
Based on the assessment results, some of the children were identified as undernourished with the
potential of micronutrient deficiencies such as: iron, vitamin A, iodine, and zinc. The health data provided
to the Ministry of Health supported the strengthening of a nutritional dietary program for seventy-five
additional children in the school. Early identification of at-risk students can provide needed school
feeding programs for this vulnerable population. In addition, educational awareness was provided for the
school principal, teachers, and staff with the tools to promote and sustain the implementation of healthy
lifestyle programs in primary schools.
References
http://www.who.int/topic/child/health/en/
Contact
[email protected]

Engaging At-Risk Youth Utilizing the Community Emergency Response Team
(CERT) Training as a Harm Reduction Tool
Shamika Tishema Ossey, RN, BSN, PHN, USA
Sharon E. Sylvers-Sidney, RN, BSN, PHN, MPA, USA
Purpose
The purpose of this presentation is to model how CERT training engaging youth, can increase
preparedness and resilience in vulnerable communities in the County and nationally as well as highlight
the importance of collaboration across governmental, community and private agencies in order to achieve
successful community development.
Target Audience
The target audience of this presentation includes health care proffessionals, educators, community
ambassadors, community organizers, public and private sector employees, governmental agencies,
community based organizations, and faith based organizations.
Abstract
If a disaster were to strike right now in Los Angeles County, 27 teens in Watts would be among those
prepared to respond. This project is part of Los Angeles County’s preparedness and sustainability efforts
focused on community engagement and getting to know one’s neighbors in order to plan together and be
ready for emergencies. Based on recent disasters, it has been shown that communities that know each
other and prepare together are better able to survive the event and recover more quickly afterward.
The Community Emergency Response Team (CERT) concept was developed and implemented by the
Los Angeles City Fire Department (LAFD) in 1985. The Whittier Narrows earthquake in 1987 underscored
the area-wide threat of a major disaster in California and confirmed the need for training civilians to meet
their immediate needs. As a result, the LAFD created the Disaster Preparedness Division with the
purpose of training citizens and private and government employees. However, in its 25 years of
existence, the program never got the opportunity to deliver its vital content with teens in one of the most
incident-prone areas of the City.
South Los Angeles (Watts), a community known for its determination to bounce back from the onslaught
of drugs, guns and civil unrest. A community with 67.8 violent crimes reported per 10,000 residents (278
violent crimes in a 6-month period). A community well-known for the number of young black men going to
jail than going to Yale. A community where young people are cautious to walk two blocks in a direction
that might land them in another “territory”--and into the line of unfriendly fire. A community where police
chases through residential areas is experienced far too often. A community where in 2006, public housing
residents had to wait over a week for help when local flash flooding occurred, bringing water 2-3 feet high
into the homes of public housing residents.
Times are changing and a new breed of community activists and partners, The Watts Gang Task Force,
has arisen to give young people hope and a vision of what can be –beyond their two blocks. This Task
Force opened their eyes and ears to a National Preparedness Month presentation at their local city
councilman’s office in September 2012, which focused on preparing the next generation. Within 4 short
months, members from the Task Force and other interested partners (representing community residents,
fire, police, public health, nongovernmental, faith and business) came together to design, promote,
launch and implement the first-ever Teen CERT program for youth in the “high-risk” area of Watts, South
Los Angeles.
In February 2013, the West and South Area Health Office spearheaded and implemented the first Teen
Community Emergency Response Team (CERT) Training Program in South Los Angeles. The objective
of the Teen CERT Training Program is to build community resiliency in the Watts community of South Los
Angeles targeting youth who are residents of four Los Angeles City Housing Authority Developments
(Jordan Downs, Imperial Courts, Nickerson Gardens, and Gonzaque Village).

The Teen CERT program was envisioned, planned and implemented by Service Planning Area (SPA) 5 &
6 Area Health staff (Shamika Ossey, PHN and Sharon Sylvers, PHN) in collaboration with the US
Department of Homeland Security Center for Faith-based & Neighborhood Partnerships, the Federal
Emergency Management Agency (FEMA), City of Los Angeles Fire Department, City of Los Angeles
Housing Authority, Women of Imperial Court, Watts Gang Task Force, Council of Pakistan American
Affairs, 7-eleven Corporation, Los Angeles City Council District 15 (Office of Councilman Joe Buscaino)
and the American Red Cross.
The CERT Program is a viable mechanism to ensure that communities are able to prepare for, respond
to, recover from, and mitigate future impacts from natural and manmade hazards. Anecdotal information
from both City and County CERT programs indicate that there are fewer CERT-trained individuals in
South Los Angeles despite a significant community interest.
The South LA Teen CERT Program was an opportunity to model how CERT training can increase
preparedness and resilience in vulnerable communities in the County and nationally. It also serves to
highlight the importance of collaboration across governmental, community and private agencies in order
to achieve successful community development. Training modules included Earthquake Awareness,
Disaster Fire Suppression Techniques, Disaster Medical Operations, Multi-Casualty Incidents, Light
Search and Rescue Operations, Team Organization & Disaster Psychology, and Terrorism & Homeland
Defense. Additional skill building activities included an American Red Cross Community CPR & First Aid
Certification Course facilitated on May 11, 2013.
Twenty seven students completed the training and received certificates and commendations at the Teen
CERT graduation ceremony held on April 20, 2013. Over 100 people were in attendance. Dignitaries who
spoke during the ceremony included Jackie Lacey (Los Angeles County District Attorney), Joe Buscaino
(Los Angeles City Councilman, District), Ron Fisher (2nd Supervisorial District Field Office Staff), Dr.
Jannah Scott (US Department of Homeland Security, A Center of the White House Office of Faith-based
& Neighborhood Partnerships), Dr. Jan King (Area Health Officer for West and South Los Angeles) and
Dr. Alonzo Plough (Director of the Los Angeles County Department of Public Health Emergency
Preparedness and Response Program).
The teens now have the skills and ability to organize a CERT team, join an existing one in their
community and increase the resilience of their community against the impacts of natural and manmade
disasters. Area Health Office staff, Ms. Ossey and Ms. Sylvers, are now CERT trained and certified
CERT Trainers. Next steps for the Area Health Office include continuing Teen CERT programming in
South Los Angeles and creating a novel Mobile CERT program which will include bicycle and equestrian
teams.
As a result of its successful program model, innovation, and comprehensive collaborative component our
planning team was the Third Annual Recipient of the John D. Solomon Whole Community Preparedness
Award (highest national preparedness award) on September 23, 2013 at the White House during its
annual FEMA 2013 Individual and Community Preparedness Award Ceremony. In addition, our efforts
have been recognized by President Obama and The White House Office of Faith-based and
Neighborhood Partnerships, Federal Emergency Management Agency (FEMA), U.S. House of
Representatives, Los Angeles County Board of Supervisors, Los Angeles City Council, and the Los
Angeles County Department of Public Health.
References
http://www.ready.gov/citizen-corps-awards
http://www.fema.gov/news-release/2013/09/19/fema-honors-achievements-community-preparedness
Contact
[email protected]

J 14 - Clinical Changes Resulting from Evidence-Based Research
Blood Aspiration during Intramuscular Injection
Megan A. Infanti Mraz, RN, PhD, USA
Christine Thomas, RN, DNSc, USA
Lois Rajcan, MSN, RN, USA
Purpose
The purpose of this presentation is to explore the incidence and prevalence of blood aspiration that
occurs during intramuscular injection.
Target Audience
The target audience of this presentation is practicing nurses who administer intramuscular injections to
their patients.
Abstract
Intramuscular (IM) injection is a common practice in nursing. The technique whereby one learns how to
administer an intramuscular injection is a practice that is taught very early in a student nurses career. For
many years student nurses were taught to aspirate prior to the administration of a medication into the
muscle. In recent years, this practice of aspiration had been called into question and subsequently been
removed as a recommendation. This has left the academic and professional communities with questions
such as: Why is aspiration no longer recommended and are there certain exceptions when aspiration
would be necessary? The authors of this presentation share these questions. Therefore, a study was
conducted to look into the expectations of a nurse in practice, a review of the events in history that may
have impacted the practice of aspiration, a review of what is required of a nurse in order to be successful
in IM injection, and the conflicts that the profession is faced with today in relation to applying practice that
is safe, effective, and rooted in the evidence.
Purpose: The purpose of this presentation is to disseminate findings identified through data gathering and
research analysis that occurred in the summer of 2012.
Research questions: Questions guiding the study included: What is the incidence of aspiration during IM
injection? What is the prevalence of blood aspiration during the aspiration phase of IM injection? And,
what techniques/ methodologies are practicing nurses using during IM injection?
Subject and Sample: 164 staff nurses participated from a community based hospital in Pennsylvania,
United States. Majority of the sample consisted of bedside nurses. Specialties in practice, years in
practice, and educational levels were varied.
Design and Methods: The research design for this study was a quantitative approach, in the form of a
non-experimental one group survey design.
Results: This study has generated new information on the incidence and prevalence of blood aspiration
during IM injection. The data identified that despite CDC recommendation (CDC, 2011), 82% of the
subject sample maintains aspiration technique during IM injection. Furthermore, over 38% reported to
have aspirated blood during their careers when administering an IM injection. Anecdotal data from this
study also identified other patient injury such as: infiltration, nerve injury, tissue necrosis, and abscess
during IM injection.
Implications: This study has identified that blood aspiration does occur during IM injection. Furthermore,
anecdotal information in relation to other patient injury was identified through administration of injection.
However, the data also identified concerns related to IM injection and when aspiration can be unsafe.
Future Recommendations for Research and Practice: Based on the prevalence of blood aspiration, and
identified patient injury, it is clear that aspiration should be recommended in certain instances. It is
possible that aspiration should not be recommended 100% of the time secondary to the concerns
regarding aspiration during unsafe conditions.

The infusion nurses’ society recommends that infusions intended to be infused through the vascular
system be assessed for a pH of less than 5 or greater than 9 and osmolality of greater than 600mOsm/L.
Medications that meet the above pH and osmolality parameters are known to be vesicants or irritants to
the vascular system and should be infused through the central circulation (Infusion nurses society,
Standard 32, 2011). Human blood has a pH of 7.35-7.45. Many varieties of medications are considered
vesicants or irritants based on the definition of pH less than 5 or greater than 9.
Common Medications administered IM such as:
Penicillin G reconstituted has a pH of 6-8.5 (US National Library of Medicine, 2011)
Haldol has a pH of 3-3.6 (FDA, 2009)
Morphine has a pH of 2.5-6.5 (U.S. National Library of Medicine, February)
Accidental administration of these medications into the peripheral vascular system during an IM injection
would cause significant discomfort related to phlebitis or thrombus formation in the vein or artery.
Historically, the aspiration technique was taught as a precaution against accidental intravenous or intra-
arterial administration of medications that can potentially lead to systemic allergic reactions (Li, 2003),
chemical phlebitis of the vascular system (Infusion nurses society, Standard 47, 2011) or arterial
embolism (Gammel, 1927).
Reference to an irritation index of a medication being administered, whether alkaline or acidic, is not a
routine consideration during an IM injection. Yet, the infusion nurses society recognizes a pH index for
irritation of the vascular system for medications being administered. Recommendations from this study
would include investigation to aspiration prior to IM injections to avoid accidental administration of a
potential irritant medication into the vein/artery.
References
Centers for Disease Control and Prevention. (2011). "General Recommendations on immunization:
Recommendations of the Advisory Committee on Immunization Practices (ACIP)" [Online]. MMWRRecommendations
and Reports, 60(RR-02), 1–60. Accessed June 2012 via the Web at http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf FDA.
(2009, June). accessdata.fda. Retrieved from fda.gov:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/015923s084lbl.pdf Gammel, J. A. (1927). Arterial
embolism: An unusual complication following the intramuscular admninstration of bismuth. The journal of the
american medical association: JAMA, 998-1000. Infusion nurses society. (2011). Standard 32: Practice criteria: Short
peripheral catheters. Journal of Infusion Nursing: Infusion nursing standards of practice, Pg S37. Infusion nurses
society. (2011). Standard 47: Practice criteria: Phlebitis. Journal of infusion nursing: Infusion nursing standards of
practice, pp S65-S66. Li, T., Lockey, R. F., Bernstein, I., Portnoy, J. M., & Nicklas, R. A. (January, 2003 ). Allergen
immunotherappy: A practice parameter. Annals of Allergy, Asthma, & Immunology, 1-39. U.S. National Library of
Medicine. (February, 2010). Morphine Sulfate for injection. Retrieved from DailyMed:
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=22055b20-bc20-4e45-8574-4b218e0901e4 US National
Library of Medicine. (2011, April). PFIZERPEN (penicillin g potassium) powder, for solution. Retrieved from DailyMed:
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d8aaefb6-3f7d-4bc5-b40a-1c58c3054320 Bindler, R., & Ball,
J. (1999). Quick reference in pediatric clinical skills. Stamford, CT Connecticut: Appleton & Lange. Centers for
Disease Control and Prevention. (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations of
the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene
Task Force. MMWR Recommendations and Reports, 51(RR-16), 1–45 Centers for Disease Control and Prevention.
(2011). "General Recommendations on Immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP)" [Online]. MMWRRecommendations and Reports, 60(RR-02), 1–60. Accessed June
2012 via the Web at http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf Chinn, P.L., & Kramer, M.K. (2004). Integrated
knowledge development in nursing. (6th ed.). Philadelphia: Mosby. Chiodini, J. (2001). Best Practice in Vaccine
Administration. Nursing Standard. 16, 7 pp. 35-38 DeLaune, S.C., & Ladner, P.K. (1998). Fundamentals of nursing:
Standards and practice. NY: Delmar. Gammel, J. (1927?) Aterial Embolism. JAMA pp. 998-1000 Kozier, B., Erb, G.,
Berman, A.J., & Burke, K. (2000). Fundamentals of nursing: Concepts, process, and practice. (6th ed.). Upper Saddle
River, NJ: Prentice Hall. Lynn, P. (2008). Lippincott’s photo atlas of medication administration. (3rd ed.). Philadelphia:
Wolters Kluwer, Lippincott Williams & Wilkins. Lynn, P. (2011). Lippincott’s photo atlas of medication administration.
(4th ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins. Lachman, E. (1963). Applied anatomy of
intragluteal injections. American Surgeon 29, 235-241. Netttina, S.M. (2006). Lippincott manual of nursing practice.
(8th ed.). Philadelphia: Lippincott Williams & Wilkins. Nicoll, L. & Hesby, A. (2002). Intramuscular injection. An
integrative research review and guideline for evidenced based practice. Applied Nursing Research. 16, 2 pp. 149-161

Ozel, A., Yavuz, H., &Erkul, I. (1995). Gangrene after penicillin injection: A case report. The Turkish Journal of
Pediatrics, 37, 67-71. Smith, S.F., Duell, D.J., & Martin, B.C. (2000). Clinical nursing skills: Basic to advanced skills.
(5th ed.). Upper Saddle River, NJ: Prentice Hall. Taddio A, Ilersich AL, Ipp M, et al (2009). Physical interventions and
injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of
randomized controlled trials and quasi-randomized controlled trials. Clinical Therapeutics, 31(Suppl 2), S48-76.
Talbert, J.L., Haslam, R.A., & Halter, J.A. (1967). Gangrene of the foot following intramuscular injectin in the lateral
thigh. A case report with recommendations for prevention. Journal of Pediatrics, 70(1), 110-121. Taylor, C., Lillis, C.,
LeMone, P., & Lynn, P. (2008). Fundamentals of nursing: The art and science of nursing care. (6th ed.). Philadelphia:
Lippincott Williams & Wilkins. Wilson, D., & Hockenberry, M.J. (2008). Wong’s clinical manual of pediatric nursing.
(7th ed.). St. Louis, MO: Mosby. Wilkinson, J.M., & Van Leuven, K. (2007). Procedure checklists for fundamentals of
nursing. Philadelphia: F.A. Davis. Workman, B. (1999). Safe injection techniques. Nursing Standard. 13, 39 pp. 47-54
Contact
[email protected]

Building an Integrated System of Care Across the Extended Care Continuum with
the LINCT Program (Liaison In Nursing Care Transitions)
Dina Lipowich, RN, MSN, NEA-BC, USA
Purpose
to demonstrate how a nurse-driven organizational partnership with local area skilled nursing facilities will
ensure continuity of quality outcomes for older adult patients as they transition between the hospital and
extended care continuum.
Target Audience
Hospital/Extended Care Facitly Nursing Administration, Clinical Nurses,Directors of Nursing, Case
Managers, Physicians with specialty in Palliative Care/Gerontology.
Abstract
Problem: Lack of adequate continuity of care at discharge has been identified as a factor for frequent
readmissions from Extended Care Facilities (ECFs). Older adults with chronic conditions hospitalized and
subsequently discharged to ECFs represent a particularly vulnerable population. (Jacobs 2011).
Review of hospital cases in 2011 revealed that over 20% of patient discharged to ECFs, were readmitted
within 30 days. Readmissions from ECFs are a hardship for patients, are costly for institutions, and
reflect fragmentation of care across the continuum.
Approach: The LINCT (Liaison In Nursing Care Transitions) Program Initiative is a nurse-driven
organizational partnership with ECFs to ensure continuity of quality outcomes during transition between
the hospital and extended care continuum.
Objectives:
• Reduce 30-day readmissions and hospital length of stay for patients discharged to partner LINCT
facility.
• Increase satisfaction of patient/family with discharge process and transition of care across the
continuum.
• Increase satisfaction of staff, physicians, and ECFs with discharge and transition process.
Methods and Intervention:

• Formal affiliation agreement established with high-volume ECFs to participate in the LINCT
Program.
• Dedicated acute nurse to serve as liaison between hospital and LINCT facility.
• Pre-discharge hospital rounding, collaboration with inter-professional team, and readmission risk
assessment on patients transitioning to LINCT facility.
• Education/support for patients/family members preparing for transition.
• Post-discharge rounding on high-risk patients admitted to LINCT factility within the first 24-72
hours.
• Education for ECF staff on topics relevant to care of patients with chronic conditions.
• Monthly inter-professional LINCT quality review meetings at ECF site.
Outcomes and Implications:

1. Data reflect dramatic reduction of readmissions from partnering facilities.
2. Satisfaction reported by partnering ECFs, patients, and physicians.
3. Program expanding to include additional ECF partners and rapidly evolving as an essential
component in the organization’s Integrated System of Care development plan.
Contact
[email protected]

Improving Alarm Profile Notifications and Responses
Helen S. Kane, RN, MSN, MBA, CCRN, USA
Linda Wilson, RN, PhD, CPAN, CAPA, BC, CNE, CHSE, USA
Purpose
The purpose of this project was to increase the adherence to the alarm profile notifications and responses
as described in the standard operating procedures for the telemetry monitoring on a medical surgical
telemetry floor.
Target Audience
The target audience of this presentation is all professional nurses, nurse managers, education specialiats,
and staff development specialists.
Abstract
Background: The Joint Commission published a sentinel event alert in April 2013 related to alarm safety
in hospitals. The Joint Commission report included 98 reported events and 80 patient deaths. The
majority of these events and deaths occurred in telemetry units, intensive care units and emergency
departments. The American Association of Critical Care Nurses (AACN) published a practice alert related
to nurse expected practices with cardiac monitored patients. The AACN expected practices for nurses
working with cardiac monitored patients include the following: 1) provide proper skin preparation for ECG
electrodes; 2) change ECG electrodes daily; 3) customize alarm parameters and levels on ECG monitors;
and 4) establish interprofessional teams to address issues related to alarms.
Problem statement: There are multiple undesired effects for the nurses and technicians in the new
process. There are many nuisance alarms (leads off; leads off & can see ECG complex; battery needs
change). Alarm Profile Notifications and responses are not consistently followed.
Project objective: The project objective is to increase the adherence to the Alarm Profile Notifications
and responses as described in the Standard Operating Procedures for telemetry monitoring.
Countermeasures implemented: The clinical nurse specialist coordinated a meeting with the nurses
and technicians who work on the telemetry units. The telemetry monitor company representative also met
with the nurses and technicians from the telemetry units. Focus groups were conducted to identify the
perceived issues of the nurses and technicians. New practices were implemented on the telemetry units
including the following: 1) all telemetry pack electrodes changed on the night shift every 24 hours; and 2)
all telemetry pack batteries changed on the day shift. Education was provided to the nurses and
technicians on the updated Alarm Profile Notifications in the Standard Operating Procedures. Data
collection processes and content were revised to improve the ongoing data collection monitoring
process.
Results: Improved processes and responses to the alarm profile notifications. Data collection is ongoing
to ensure adherence to the Alarm Profile Notifications and responses as described in the Standard
Operating Procedures for telemetry monitoring.
Contact
[email protected]

K 13 - Using Technology to Educate Nurses
Computer-Based Training at a Military Medical Center: Understanding Decreased
Participation in Training among Staff and Ways to Improve Completion Rates
Julie A. Lavender, EdD, MS, RNC-MNN, USA
Purpose
The purpose of this presentation is to describe a mixed method case study that examined factors that
may influence healthcare staff participation in mandatory computer-based training. Study results may
provide practical information for hospital educators to design training to improve participation rates.
Target Audience
The target audience of this presentation is clinical nurse educators who may struggle with staff
participation in mandatory training. Hospital educators need to understand why employees may not
complete required computer-based training and determine the best method to distribute training to
improve completion rates.
Abstract
Military health care facilities make extensive use of computer-based training (CBT) for both clinical and
non-clinical staff. Despite evidence identifying various factors that may impact CBT, the problem is
unclear as to what factors specifically influence employee participation in computer-based training. The
purpose of this mixed method case study was to examine factors that may influence healthcare staff
participation in mandatory CBT to provide practical information for hospital educators to design training to
improve participation rates. Participants were surveyed to collect quantitative data to measure the
relationship of factors that influenced employees’ participation in training, and interviews were conducted
to further explore those factors. Participants were self-selected from the population of 434 clinical and
non-clinical personnel at a large military healthcare facility. The actual sample size was 193 for a
participation rate of less than half (44%). Based on interpretation of findings from the Mann-Whitney U
test, there were no differences in participation in CBT between clinical or non-clinical staff, U = 626.5, p =
.11. Interpretation of findings using Kendall’s Tau indicated there was no relationship between degree of
comfort when using the Internet and computer technology and participation in computer-based training, rt
(141) = -.081, p = .32. However, a significant association was found between having a history of some
training with the Internet and technology and completion of computer-based training, χ2 (df = 1) = 19.63 =
p < .01. Pearson correlation analysis was performed between the number of hours spent weekly on e-
learning courses and the completion rate for e-learning courses and no relationship was evident, r (df =
101) = -.11, p = .34. However, five of the nine interviewees stated there is too much training and the
amount does affect training participation. The study was confined to one military healthcare facility so
results are not generalizable. To improve generalizability, larger studies with higher response rates are
needed. Further refinement of instruments to more accurately address research questions, along with
reliability and validity testing, is also recommended. Future studies with objective data, such as training
records from all participants, may provide insight into discrepancies between actual and perceived
participation in training.
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Contact
[email protected]

K 13 - Using Technology to Educate Nurses
Designing Service Learning Projects for an Online Course in Healthcare Delivery
Linda E. Jensen, PhD, RN, MN, USA
Purpose
The purpose of this presentation will be to discuss evidence from an online course with a service learning
assignment to: choose a volunteer organization in their community, complete a SWOT evaluation of a
volunteer organization, participate in a volunteer activity, and evaluate the experience.
Target Audience
The target audience of this presentation is nursing educators and/or researchers
Abstract
Service learning has become an important part of many academic healthcare programs as it has been
shown that service learning helps students become more aware of the needs of populations frequently
involved in healthcare disparities. Volunteer organizations are an important part of healthcare delivery
however, most students and many health care professional are unaware of many of the important
resources for their patients which can be found in these community service organizations.
However, a service-learning strategy is more difficult to design for an online course, as the instructor
cannot know the organizations involved in each of the student’s communities. This strategy has been
implemented for over 3 years in a health care delivery course in a master’s in nursing program that is
almost entirely online. This academic program has been recognized as one of the top five online MSN
programs in US News and World Reports for the past two years. Service to the community is one of the
Values of this healthcare professions college, and a Maltese Cross award is given yearly at graduation to
a person who has given exemplary service to the community, the state, and/or the nation. The author
received the Maltese Cross Award for Community Service in 2012.
The objectives for this service-learning experience included:
• Develop a firm foundation of the history and need for service in the community,
• Gain knowledge of agencies in the community and various ways in which an individual can become
involved with an agency,
• Participate in various activities with a community agency to gain a better understanding of the work
and services provided to the community,
• Analyze and evaluate the work and value of the service agency for healthcare clients.
The service-learning project included the following steps: choose a volunteer organization in their
community, complete a SWOT (Strengths, Weaknesses, Opportunities, and Threats) evaluation of a
volunteer organization, participate in a volunteer activity, and evaluate the experience. Students wrote
reflection papers briefly describing their experiences, new learnings, and their feelings during each
step. Students also shared these reflections in asynchronous discussions so that each student was able
to learn about a wide variety of volunteer service organizations within their communities and others parts
of the country.
Qualitative results of this service learning strategy will be compared and contrasted. Qualitative results of
this strategy will be compared and contrasted. Categories of service organizations chosen included
many national organizations including the National Alliance on Mental Illness, American Red Cross,
American Cancer Society, Multiple Sclerosis Society, Alzheimer’s Association, Cystic Fibrosis Society;
local social services including homeless shelters, domestic abuse shelters, adoption services, child
advocacy or mentoring services, food pantries; and free medical clinics and immunization services.
Themes of service were extracted including distribution of food, clothing, bikes, household, and personal
items; education of groups about health promotion and/or safety; assistance in free medical clinics;
helping with fundraisers; and attending meetings of support groups or board of directors.

Several students involved their families in volunteering with them and saw the volunteer activity as an
important value they wished to pass forward to their children. Many students remarked how their
experiences gave them more awareness of the difficulties that some people who were homeless or
disabled suffer, along with a sense of thankfulness for their own well being and advantages in life.
Numerous students expressed their commitment to continue to volunteer with the organization after the
class assignment was completed. Several students stated they had wanted to volunteer with the
organization before the class, and were grateful that the course required this experience.
Barriers and facilitators of the methodologies used will be discussed. Recommendations for further
development of service learning with volunteer organizations in online courses will be described.
References
References for Service Learning Experience in Online Education Health Care Delivery Course Cohen, S. & Milone-
Nuzzo, P. (2001). Advancing health policy in nursing education through service learning. Advances in Nursing
Science, 23(30), 28-40. Eastmond, J. & Legler, N. ( 2010)Service learning in online education: Opportunities to
promote meaning and harness student energy. Distance Learning, 7 (3), 1-8. Jansen, B. (2011). Civic Education and
the learning behaviors of youth in the online environment: A call for reform. Journal of Social Studies Education
Research, 2(2), 22-42. Lodgson, C. & Ford, D.(1998). Service-learning for graduate students. Nurse Educator, 23(2),
34-37. Moody Fairchild, R. (2012). Hold that tiger! A collaborative service-learning academic-practice partnership with
rural healthcare facilities. Nurse Educator, 37 (3), 108-114. Most, L. (2011). Hands on from a distance: The
community embedded learning model contextualizes online student coursework. Journal of Education for Library and
Information Science, 52 (4), 295-304. Narsavage, G., Batchelor, H., Lindell, D., & Yea-Jyh, C. (2003). Developing
personal and community learning in graduate nursing education through community engagement. Nursing Education
Perspectives, 24(6), 300-304. Narsavage, G. Lindell, D., Yea-Jyh, C., Savrin, C., & Duffy, E. (2002). A community
engagement initiative: Service-learning in graduate nursing education. Journal of Nursing Education, 41 (10), 457-
461. Stone, C. (2012).Engaging students across distance and place. Journal of the Australia and New Zealand
Student Services Association, 39, 49-55.
Contact
[email protected]

K 14 - Global Perspectives on EBP
Translating Practice into Policy: Disaster Nursing and Research in the American
Red Cross
Janice D. Springer, DNP, MAOL, BSN, RN, PHN, USA
Mary Casey-Lockyer, MHS, BSN, RN, CCRN, USA
Purpose
To introduce the use of disaster nursing research conducted by the American Red Cross in the
development of national policy, evidence-based process models, and training for disaster health care
professional responders.
Target Audience
Public Health Nurses, advocates for vulnerable populations, members of the disability community,
educators who teach disaster nursing, students interested in evidence-based practice methodology.
Abstract
Background: Multiple disaster events since 2005 have highlighted gaps and inconsistencies in collection
and use of data on behalf of disaster shelter populations in the entire disaster cycle of prepare, respond
and recover. There is a paucity of evidence-based research in publication that describe systems for
identifying needs of those at-risk within the population-based, non-medical setting of a disaster
shelter. Morbidity surveillance in congregate living shelters has not been well understood or incorporated
into nursing policy and practice. There is a need for qualitative data surrounding disaster related fatalities
to inform preparedness messaging. The multiple people, organizations, policies, and community
expectations involved in planning for and responding to a disaster reflects the complexities described as a
wicked problem. That is, it requires non-linear thinking and multiple stakeholders’ contributions to solve
for the best strategy. American Red Cross disaster health services leadership have engaged multiple
partners to assist with design, collection and analysis of critical data available during the response to a
disaster to inform training, response, and messaging to support prevention of morbidity and mortality in
disaster impacted communities.
Methodologies: American Red Cross nursing disaster responders use quantitative and qualitative
strategies to gather data. Data from the 2011 massive tornados in Alabama, a smaller tornado in North
Carolina and Hurricanes Irene, Isaac and Sandy contributed to these studies. In each of these disaster
operations’ instruments and processes were trialed, interviews were conducted, and new ideas were
tested.
Field-based pilot studies were done to identify needs of actual or potential at-risk clients in shelters
through a mixed-method approach. Populations in four congregate care shelters from two different
disasters of 2011 were included. Clients were interviewed using screening instruments in an attempt to
determine the “best” questions; nurses were interviewed to determine gaps between intake
questions/answers, and clients’ support needs identified later; and themes between disasters were
identified to inform design of the intake, health and mental health needs screening system.
Daily (24-hour) tally of shelter population health categories were instituted. Categories include Injury,
Illness, Symptoms, Exacerbation of Chronic illness, Health care maintenance, Behavioral and Mental
Health, and Functional needs support services. As health staff in the shelter identifies a client with a
need, that contact is counted, and each contact is collected on a worksheet. At the end of the 24-hour
period, this aggregate morbidity is then faxed, e-mailed, or sent by courier to nursing leadership at the
local disaster operations headquarters. From there, acute illness concerns are reported to local public
health, patterns of illness or injury are considered, and all reports are forwarded to leadership at National
Headquarters of the American Red Cross and the epidemiology section of the Centers for Disease
Control.
Nurses collect fatality data from medical examiners and coroners to verify number and identity of
individuals suffering a disaster-related death. Once the identity of a victim of the disaster is verified, the

integrated care team, led by nursing, reaches out to the family of the victim to conduct an interview and to
offer support. Once the interviews are completed, they are de-identified and sent to CDC for a
comprehensive analysis of the deaths pertaining to that specific disaster.
Results: The intent of intake screening was to identify activity of daily living (ADL) support needs, health
and mental health needs. The studies found that screening as people arrived at the shelter was
insufficient to understand the scope of clients’ needs. Shelter residents were newly displaced, unfamiliar
with what sheltering might mean, preoccupied with concerns related to the disaster such as losing their
home, family members, and their future. The setting of intake at the shelter registration desk provided
little or no privacy. Registration workers were reluctant to ask questions that might either feel too
intimate, or have an answer that the registration clerk could not address. Interviews of clients done on the
3rd shelter day showed that many needs were identified that had not been noticed prior to that day. Nurse
interviews showed that by the 3rdday clients were more comfortable with the setting, less anxious about
the evacuation, more familiar with and trusting of the shelter staff, and thus more able to share their
health, mental health and ADL support needs. In three of four shelters, the population with functional,
health and mental health support needs was double what predictions using county census data were.
Content and process training for daily surveillance improved nursing awareness of the value of this daily
review. The system is designed to observe for acute illness and injury as well as create a platform for
longer-term analysis of patterns for predictive illness and injury of populations in disaster. Development
of a more robust and comprehensive process for morbidity surveillance demonstrated in 2013 that
chronic disease management, minor acute illness and behavioral health issues were the most common
concerns seen in disaster shelters.
Qualitative data, which surround the circumstances of fatalities, are not captured in coroner, medical
examiner reports or electronic death records. In the massive tornados in Alabama in 2011, 21.9% of
deaths were directly or indirectly related to head trauma. In Hurricane Sandy, 34.2% of the deaths were
related to drowning. The 2013 study of mortality data from Hurricane Sandy showed significant
improvements in accuracy of matching Red Cross identified families to local coroner/jurisdiction
knowledge and demonstrated that the Red Cross data is comprehensive and includes details not typically
available to a medical examiner. This information contributes to better knowledge of
precipitating/contributing factors to disaster related deaths.
Application: The Red Cross shelter registration intake screening process has been altered to offer
multiple opportunities for clients’ needs to be identified and addressed. An initial intake at the registration
desk makes two observations and asks two questions of new shelter residents to help them immediately
if needed, and create an awareness that help is available. The intake is supplemented by a Cot-to-Cot
methodology of disaster health services nurses making at least daily rounds of the shelter to interview
individuals and families, and assess the community for ADL support, health and/or mental health needs.
Daily aggregate morbidity surveillance was strengthened during Hurricane Sandy when the CDC Epi-Aid
program was triggered to assist the Red Cross gather and analyze shelter morbidity data in New Jersey.
Previous education for Red Cross health Services leadership on the process and importance of
aggregate morbidity reporting increased the diligence of collection and transport of data to CDC and Red
Cross headquarters. The American Red Cross Preparedness unit and federal response partners are
utilizing data collected by family interview with Red Cross disaster nursing surrounding disaster deaths to
develop future content of preparedness messaging. Due to the nature of voluntary deployment, Just-in-
Time training modules for Registration and Cot-to-Cot, Managing Aggregate Morbidity and Mortality and
the Integrated Care Team process have been created. One of these modules uses Voicethread
technology for audio and visual training; two of the modules are PowerPoint presentations. Two of them
use algorithms to help with decision-making, and all are 30 minutes or less and can be done as part of
orientation at the Disaster Operations site. Intake screening, Cot-to-Cot, and Surveillance content have
been added to a national program to train student nurses in sheltering.
CDC and Red Cross have produced and presented national trainings based on the data from these
collaborations to educate others in disaster planning and response. The authors have done multiple
trainings to the volunteer workforce, to disaster response partners, to the disability advocacy community
and others.

Limitations: There are several chronic limitations to doing research in time of disaster. Disasters are
quite fluid in the response phase with populations often moving from address to address. Disasters are
capricious in their destruction, creating geographic barriers to recovery and demographic disparities in
impact.Entire communities are often dependent on donations for response and recovery support,
often limiting available resources. For the Red Cross the entire disaster-nursing workforce is
voluntary. Maintaining a workforce that has training in the latest procedures, such as Cot-to-Cot, or
surveillance tools is very difficult. There is a very tiny cadre of volunteers that come to “most” disasters,
leaving a significant part of the workforce as essentially ‘new’ each time.
Future: Additional tools are being added to the Cot-to-Cot process model to better assure success in
identifying ADL support, health and mental health needs. A new job aid called CMIST, was pilot-tested in
Hurricane Sandy and has been added to the Cot-to-Cot assessment process. CMIST organizes
assessment of client needs into functional categories of Communication, Maintaining Health,
Independence, Services/Support/Self-determination, and Transportation. Recommendations from these
research projects inform policy content for federal response partners in the United States. They have
been shared with the Canadian Red Cross. The process model of Cot-to-Cot, the CMIST strategy for
identifying at-risk individual and population needs and use of the surveillance instrument are being taught
to local public health departments, student nurses, and new volunteers planning to deploy. The future
promises strengthened messaging in preparedness, and improved support during response and recovery
for at-risk populations and communities impacted by disaster.
References
Sharon Stanley, PhD, RN Chief Nurse (ret) American Red Cross Linda Olson Keller,DNP,RN, Faculty, University of
Minnesota Rebecca Noe MN, MPH, RN Division of Environmental Hazards and Health Effects Centers for Disease
Control (CDC): [email protected]. Donna Jensen PhD, RN, American Red Cross, [email protected]. Trevor
Riggen, Vice-president Disaster Operations and Logistics, American Red Cross, [email protected].
Contact
[email protected]

L 13 - Global Pain Management Strategies
Will Introduction of a Pain Assessment Template in an Electronic Medical Record
Result in Improvement of Pain Assessment Documentation in an Outpatient
Setting
Theresa Ann Pechaty, DNP, USA
Purpose
The purpose of this presntation is to discuss the results of a pilot project that evaluated whether the pain
assessment instrument Brief Pain Inventory (BPI) embedded in the Electronic Medical Record (EMR)
used by providers in a primary care setting would improve documentation of pain assessments.
Target Audience
The target audience of this presntation is primary care providers and nurses that care for chronic pain
patients in an out patient setting
Abstract
Purpose: This pilot project evaluated whether the pain assessment instrument Brief Pain Inventory (BPI)
embedded in the Electronic Medical Record (EMR) used by providers in a primary care setting of Fort
Belvoir Community Hospital would improve documentation of pain assessments.
Background/significance: The Office of the Surgeon General’s Pain Management Task Force (PMTF)
determined that pain management in the military treatment system should have a biopsychosocial focus
and pain assessments reflect a multidisciplinary approach. Health-information technology, such as
electronic health records, has the potential to facilitate the assessment of pain through the incorporation
of valid pain assessment tools that would provide a comprehensive and timely assessment of pain
patients.
Methods: This project used a quasi-experimental design using non equivalent groups to determine the
difference, if any, in pain assessment documentation after the introduction of a pain assessment
documentation tool, the Brief Pain Inventory (BPI), as a template embedded into the existing EMR.
Results: The data was aggregated and summarized and a paired t-test was used to compare results
between patient encounters pre- and post-implementation of the BPI. Strong evidence demonstrated a
high effectiveness of the BPI to improve pain assessment documentation, particularly in the area of
patient functioning: general activity, walking, work, mood, enjoyment of life, relations with others, and
sleep.
Conclusion: Embedding a validated tool for comprehensive pain assessment in an EMR enables
providers to perform a comprehensive assessment of pain patients that reflects a multidisciplinary
approach to pain management.
References
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Journal of Rehabilitation Research & Development. 44(2), 179–194, retrieved from
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De Boo, T., Oostendorp, R., Oliver, R., Wilder-Smith, H., Crul, B. (2006). Outcome of transcutaneous electrical nerve
stimulation in chronic pain: short-term results of a double-blind, randomised, placebo-controlled trial. Journal of
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Kleinman, L., Dodd, S., & Schein, J. (2004). New tool to assess and document pain outcomes in chronic pain patients
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L. & Watkins, M .(2009). Foundations of Clinical Research: Applications to Practice. Upper Saddle River, New Jersey:
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opioids for patients with chronic pain? A critical review abstract World Institute of Pain. Pain Practice, 9(6), 468–479.
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treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology, 47, 670- 678.
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social workers. ProQuest Dissertations and Theses, 64. Retrieved from http://www.ncbi.nlm.nih.
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workers. Health & Social Work, 21 (2). DOI: 5000356338 Smith, H. & Kirsh, K. (2007). Documentation and Potential
Tools in Long-Term Opioid Therapy for Pain. Anesthesiology Clinics. 25, 809–823. DOI:
org/10.1016/j.anclin.2007.07.005 Upshur, C., Luckmann, R., Savageau, J. (2006). Primary care provider concerns
about management of chronic pain in community clinic populations. Journal of General Internal Medicine, 21(6): 652-
5. DOI: 10.1111/j.1525-1497.2006.00412.x Weinstein, S., et al. (2000). Physicians’ attitudes toward pain and the use
of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative. Southern Medical Journal, 93(5), 479-
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DOI: 10.1111/j.1526- 4637.2006.00113
Contact
[email protected]
L 13 - Global Pain Management Strategies

Comparative Differences in the Perception of Postoperative Pain in Patients and
Nurses
Marija Kadoviæ, MSN, Croatia
Purpose
The purpose of this presentation is to found out is there a difference in postoperative pain assessment
perception between patients and medical professionals - nurses involved in the patient care.
Target Audience
The target audience of this presentation are Head nurses of surgical wards, Manager and quality nurses,
assistants directors for quality and supervision,professors of nursing, representatives of Nursing council
and associations.
Abstract
Aim. To found out is there a difference in postoperative pain assessment perception between patients
and medical professionals - nurses involved in the patient care.
Patients and methods. This study is conducted on surgical wards at “Sveti Duh” University hospital,
Zagreb. Subjects included were patients on day one after the surgery. They reported their pain perception
on numeric and verbal scale of assessment. Their perception was compared with assessment performed
by nurses using the same method.

Results. Median pain perception measured on numeric scale was 4 if assessed by patients, while the
same pain perception was assessed by nurses to be 3. Both, patients and nurses assessed the pain
perception more objectively if the pain was assessed using numeric (p=0,083), compared to verbal scale
(0,677). Using verbal scale (range 1-5), 24,3% of nurses reported pain perception assessment to be 1
while at the same time such pain intensity was reported by 17,5% of patients. Similarly, pain intensity
perception of 4 was reported by 10,7% nurses and 20,4% of patients if assessed at the same time. The
difference was also found in pain assessment perception regarding the level to education of nurses, using
both, numeric (p=0,067) and verbal scale (p=0,286). There was no difference in the pain assessment
perception regarding the sex of the subjects included (median 4). However, there was a difference
reported between expected pain prior to surgery and actual pain after the surgery if assessed by numeric
scale (p=0,002). On verbal scale, high pain intensity was reported by 47,6% patients expecting mid pain
intensity and 28,6% of patients reporting the fear from the pain preoperatively.
Conclusion. There was no statistically significant difference found in the pain perception assessment
comparing patients and medical professional – nurses.
References
1. Kadoviæ M., et al. Nursing diagnosis 2. Manual for nurses. Croatian nursing council, 2013. 2. Varga S, Matijeviæ
R, Kadoviæ M, Paviæ N. Key Performance Indicators (KPI) and quality indicators in healthcare system. In: Drakuliæ
V, Sokol V, Ðukanoviæ Lj, et al. Health care system and the Croatian health care system prepares for accession to
the European Union.Zagreb: TEB; 2012. p. 64-67. 3. Kadoviæ M. The theory of unpleasant symptoms and the
concept of empathy. In : Theoretical considerations on / in health care, Proceedings of students. Osijek: Faculty of
Medicine, University J.J.Strossmayer Osijek, Croatia; 2012. p. 16-27. 4. Kadoviæ M., Measuring, monitoring and
analysis in health care. In: Proceedings of the Congress.Thorax 2013., Zagreb, Croatia; 2013. 5. Kadoviæ M., Work –
life balance for nurses. In: Proceedings of the Congress Empathy - the essence of nursing; Marija Bistrica, Croatia;
2013. 6. Kadoviæ M., In-hospital falls admission. In: Neurol Croat summaries 4th Congress of neurorehabilitation and
restorative neurology; Osijek, Croatia; Vol.62, Suppl. 1, 2013. 7. Kadoviæ M., Matijašiæ-Bodalec D. Empathy for the
eldery. In: Proceedings of lectures 2. 2.Scientific conference in the field of health sciences; Slovenj Gradec, Slovenia;
2012. 8. Kadoviæ M, Brajniæ T, Ðureš M, Tomac M. Rapid response system. In: Proceeding of 5. international
Congress of HDMSARIST; Zagreb, Croatia; 2012. 9. Kadoviæ M, Hegeduš Matetiæ M. Moldable Technology:
Aspects of nursing care in improving quality of life of patients. In: Proceeding of 11th ECET (Europien Council
Enterostomal Therapists); Bologna, Italy; 2011. 10. Kadoviæ M. Hypertension in transplant patients. In: Proceedings
of the 3rd International Congress HDMSARIST's; Zagreb, Croatia; 2010th 11. Kadoviæ M. Education of patients with
permanent and temporary pacemaker. In: Proceedings of the Symposium 2.Croatian Society of Hypertension,
Zagreb, Croatia; 2009th
Contact
[email protected]

L 14 - Evidence-Based Practice in Nursing
High Quality and Low Cost: Evidence-Based Nursing Workshops in a Large
Health Care Organization
Rivka Hazoref, PhD, MA, BS, RN, Israel
Dorit Weiss, PhD, MA, BS, RN, Israel
Limor Yariv, PhD, MA, BS, RN, Israel
Anat Peles Bortz, PhD, MA, BS, RN, Israel
Purpose
The purpese of this presentation is: Sharing with the Conference participants insights on innovative
strategic process in a large health care organization , whose mission is to provide tools and skill to
integrate recent evidence in nursing practice.
Target Audience
The target audience of this presentation is: Nursing managers, Nursing educator, Nursing researchers.
Abstract
Background: The trend for identify evidence of clinical nursing activity will lead to the most significant
reform in the nursing profession in the years to come.
The traditional practices in nursing still based on experience and health organizations around the world
are currently required to minimize the gap between tradition practice and current evidence.
The main process that can assimilate a new professional language in evidence based nursing as a well
structured educational program.
Purpose: To implement an educational program of EBP in clinical fields based on self learning model .
Objectives of a workshop in evidence base nursing in a clinical field:
1. The nurse will obtain skills in identifying clinical question the clinical field by the EBP model.
2. The nurse will acquire skills in performing hierarchic search in evidence computing database
according to the EBP model.
3. The nurse will acquire skills in integrative assessment of proficiency in the evidence and choosing
an alternative according to the EBP model.
Methods: Wandering workshop in health services , including medical center and primary care. The
workshop guided academic by nurses.
The scope of the workshop: 16 hours of theoretical instruction. 50 hours of practical experience. Subjects
of theoretical meetings:
1. Introduction and asking the clinical question.
2. Practice clinical question and finding evidence in the literature.
3. Integrative evaluation of evidence in the literature and expert opinion.
4. Guidelines for the documentation and drafting recommendations.
Results: In 3 years, 80 clinical questions were raised by staff nurses and were examined by the evidence
based steps. The model of the workshop is a low cost model but more important we succeed to
assimilate the language of evidence based nursing in a large health medical organization.
References
Stillwell, S.B ;Fineout-Overholt, E; Mazurek Melnyk, B. (2010). Asking the Clinical Question: A Key Step in Evidence-
Based Practice. American Journal Of Nursing (AJN) 110(3): 58-61. Mazurek Melnyk, B ;Fineout-Overholt, E ; Stillwell,
S.B. (2010). The Sevan Steps of Evidence-Based Practice. American Journal Of Nursing (AJN) 110(1): 51-53.

Fineout-Overholt, E; Mazurek Melnyk, B; Stillwell, S.B . (2010). Critical Appraisal of the Evidence: Part 1. American
Journal Of Nursing (AJN) 110(7): 47-52. Fineout-Overholt, E; Mazurek Melnyk, B; Stillwell, S.B . (2010). Critical
Appraisal of the Evidence: Part 2. American Journal Of Nursing (AJN) 110(9): 41-48. Fineout-Overholt, E; Mazurek
Melnyk, B; Stillwell, S.B. (2010). Critical Appraisal of the Evidence: Part 3. American Journal Of Nursing (AJN)
110(11): 43-51. Stillwell, S.B; Fineout-Overholt, E; Mazurek Melnyk, B;. (2010). Searching for the Evidence. American
Journal Of Nursing (AJN) 110(5): 41-47. Levin, R.F. (2006). Teaching Evidence- Based Practice in Nursing. New
York: Springer Publishing Company.
Contact
[email protected]

An Evidence-Based Approach to Successful Practice Change, the Toolkit:
Implementation of Best Practice Guidelines
Heather McConnell, RN, BScN, MA (Ed), Canada
Althea Stewart-Pyne, RN, BScN, MScN, Canada
Purpose
This presentation will highlight an evidence-based implementation resource that has been used widely by
health care organizations to guide the uptake of best practices, evaluate their impact, and support
sustainable practice change.
Target Audience
This session will be of interest to nurses in all domains of practice who are leading the implementation of
practice changes with the goal of enhancing client, nurse, organizational and system outcomes.
Abstract
An evidence-based practice program, funded by a provincial government and led by a professional
nursing association in Canada, has a mandate to develop, disseminate, and support the uptake and
evaluation of clinical and healthy work environment best practice guidelines. This program has achieved
global reach, a success due to its rigorous guideline development process, and innovative multi-pronged
implementation strategies. These strategies are focused at the individual, organizational and system
level, and incorporate evidence-based approaches to support the implementation of best practices. A key
resource that is utilized within this program to guide the systematic implementation process of best
practices is the Toolkit: Implementation of Best Practice Guidelines. This framework, based on
implementation science, presents a planned change approach designed to assist nurses and other
health-care professionals support evidence-informed clinical decision-making.
This Toolkit is based on the Knowledge to Action Framework and emerging evidence that the likelihood of
achieving successful uptake of best practice in health care increases when:
• Guidelines are selected for implementation through systematic, participatory processes including
relevant stakeholder engagement and environmental readiness assessment
• Guidelines are tailored to the local context
• Barriers and facilitators to guideline use are assessed and addressed
• Guideline use is systematically monitored and sustained
• Evaluation of the impacts of guideline use is an integral part of the entire process
• There are adequate resources to support completion of all aspects of implementation
The Toolkit: Implementation of Best Practice Guidelines will help guideline users and implementers take
best evidence and integrate it into practice, education and policy using a systematic approach consistent

with the local context of practice. This presentation will share the key phases of guideline implementation
outlined in the Toolkit, and discuss how this resource is being utilized to successfully address the key
challenges of developing evidence-based practice cultures through guideline implementation.
Contact
[email protected]

Evidence-Based Practice and Ways of Knowing
Sally A. Decker, PhD, RN, USA
Purpose
Explore the relationship between the multiple forms of evidence referred to in Carper's Patterns of
Knowing, and Evidence-Based Practice (EBP) through a paper assignment in an RN-BSN course.
Target Audience
educators and clinicians interested in bringing multiple forms of evidence to the practice of nursing.
Abstract
Carper’s Ways of Knowing have been used to help nurses understand all of the ways they know and
bring evidence to their nursing practice. Empirical knowing is easy to associate with Evidence-based
Practice (EBP), but there is not as clear of a connection between others ways of knowing and EBP. For
example, where do esthetic, personal, or ethical knowing belong when considering evidence in practice?
Is there credible “evidence” that nurses use these types of knowing in their practice? Registered nurses
with an Associate degree working on their Baccalaureate degree bring to the academic setting some level
of personal experience and knowing about practice. Being able to help them use reflective practice to
clarify their personal knowing and add it to what they are learning about empirical evidence helps them
experience empowerment. Registered nurses also have experienced and observed “artful” practice and
can often apply this form of evidence to their nursing interventions. Furthermore, ethical knowing in this
group of nursing students means having seen the Codes of Conduct and Patient’s Bill of Rights enacted
in a clinical context. So, for this group of students, the evidence is in different forms with different criteria
for credibility – but all potentially helpful in evidence-based practice.
In their first course in the RN-BSN program, these students are asked to identify a practice concept of
concern to them. In the past they have selected practice focused topics such as PICC line infections,
PTSD post ICU admission, and “Chemo Brain.” After selecting a practice concept, over the weeks of the
course students begin to identify sources of evidence, including the research literature, Codes of Ethics,
reflections on their own clinical practice, and interviews with patients and other clinical experts. They rate
the research literature using a traditional pyramid scale, but also critique the evidence from other sources
including their own expertise, the insights from patients they have cared for, and other clinical experts. In
doing this they use the appropriate credibility index such as congruity, justness, consensual judgment,
and validity. The students also identify esthetic experiences that capture their concepts.
Feedback from the students indicates that doing the multiple separate sections of this assignment across
the course, and then always relating them to their concept of interest, helps them to better understand all
of the ways nurses bring evidence to their practice and the how the credibility of that evidence relates to
the pattern of knowing.
References
Carper,BA. (1978). Fundamental patterns of knowing in nursing. Advances In Nursing Science,1(1),13-23. Chinn,P. &
Kramer, M. (2008). Integrated theory and knowledge development in nursing. St Louis, Missouri: Mosby. Porter, S.
(2010). Fundamental patterns of knowing in nursing: the challenge of evidence-based practice. Advances in Nursing
Science,33(1),3-14. White, J. (1995). Patterns of knowing: Review, critique, and update. Advances in Nursing
Science, 17(4),73-86.
Contact
[email protected]

M 13 - Best Practices in Long-Term Care Facilities
Building a Bridge to Improve Self-Care Independence Among Long-Term Care
Facilities Residents: From the Staff Caregiver Perspective
Su-Hsien Chang, PhD, RN, MSN, Taiwan
Ching-Len Yu, PhD, Taiwan
Purpose
The purpose of this presentation is provide important information for academia, long-term care facility‘s
administrators and caregivers on how staff and family caregivers should work together to reach a mutual
goal, which is to improve residents’ self-care ability.
Target Audience
The target audience of this presentation is nursing scholars, nursing students, administrators of long-term
care facilities, staff and family caregivers of elders.
Abstract
Background: Staff caregivers in long-term care facilities constitute an important factor affecting residents’
behavioral dependency in self-care performance. Few studies have focused on what staff caregivers
should do or how they should go about improving the self-care independence among residents living in
long-term care facilities.
Purpose: The purpose of this study was to understand the perspectives of staff caregivers on how to
build a bridge aimed at improving self-care independence among residents living in long-term care
facilities.
Methods: This study used a qualitative approach to gain a deeper understanding of how staff caregivers
do to build a bridge aimed at improving self-care independence among residents living in long-term care
facilities. This study used a purposive sampling method. Date was collected via face to face interviews
with 31 staff caregivers who were working in long-term care facilities in Taiwan.
Results: Results showed that to build a bridge aimed at improving self-care independence among
residents living in long-term care facilities, staff caregivers indicated three major elements: (1) setting
goals with residents, families and staff caregivers, (2) building trust between families of residents and staff
caregivers, and (3) staff caregivers should report residents’ conditions to family members voluntarily.
Results also showed that three major factors which are crucial to building a bridge between families of
residents and staff caregivers: (1) prior discussion, (2) building trust, and (3) reporting conditions of
residents voluntarily.
Conclusion/Clinical Implication: Results of this study provide important information for academia, long-
term care facility‘s administrators and caregivers on how staff and family caregivers should work together
to reach a mutual goal, which is to improve residents’ self-care ability.
Contact
[email protected]

Translating Evidence into Practice in the Residential Aged Care Setting: Long
Term Sustainability of the Champions for Skin Integrity Model
Helen Ethel Edwards, OAM, PhD, BA (Hons), BA, DipApSc, RN, Australia
Kathleen Finlayson, PhD, MN, BN, Australia
Anne M. Chang, PhD, RN, Australia
Michelle Gibb, MNS (NP), BN, Australia
Purpose
The purpose of this presentation is to disseminate results of an evaluation of long term sustainability and
effectiveness of strategies to facilitate implementation of evidence based wound care.
Target Audience
The target audience is all health care professionals and carers involved in the provision of evidence
based care and/or maintaining skin integrity in older adults
Abstract
Background and Aim: The incidence of both chronic and acute wounds increases with age and wound
care is thus a significant issue for carers and consumers in aged care facilities. The aim of this study was
to evaluate the long term sustainability of strategies introduced as part of the Champions for Skin Integrity
(CSI) model of evidence based wound management, in order to guide development of strategies and
resources for national dissemination of the project.
Methods: A telephone interview and postal survey was undertaken in late 2012 with 13 Champions for
Skin Integrity from seven aged care facilities, who had participated in a project to introduce the CSI Model
during 2008 – 2010. The Champions for Skin Integrity model was based on multi-faceted evidence based
strategies to promote transfer of evidence into practice and was implemented over a six month period
sequentially in each facility.
Results: In the initial implementation phase of the Champions for Skin Integrity model, significant changes
were found in increased implementation of evidence based wound management and prevention,
associated with significant decreases in the prevalence and severity of pressure injuries, leg ulcers and
skin tears (p<0.05). Two years after completion of the initial phase, although some participants reported
that factors such as logistical problems and costs hindered implementation of some evidence based
recommendations; 92% of the CSIs stated they had been able to sustain changes to their wound care
practice, had improved knowledge and confidence, improved resident outcomes had been maintained,
and the project resources remained in use.
Conclusion: Findings from this study informed the development of a plan for national dissemination of the
CSI Model, including refinement and updating of resources and a national series of ‘train the trainer’
workshops.
This Project was funded by the Australian Government Department of Social Services under the
Encouraging Better Practice in Aged Care program.
Contact
[email protected]

Promoting Resident-Centered Care through the Implementation of Best Practices:
A System-Level Implementation Program
Irmajean Bajnok, RN, MScN, PhD, Canada
Heather McConnell, RN, BScN, MA (Ed), Canada
Carol Holmes, RN, BScN, MN, GNC (C), Canada
Purpose
The purpose of this presentation is to will highlight a successful evidence-based system-level
implementation strategy that supports the long-term care sector to enhance quality resident care.
Target Audience
The target audience of this presentation is nurses in all domains of practice that have an interest in
enhancing evidence-based practice cultures, and specifically those working with older adults in the long-
term care sector.
Abstract
A system-level implementation strategy that supports the uptake, evaluation and sustainability of
evidence-based practices within the long-term care sector is being led by a professional nursing
association. This work has been made possible through government supported dedicated funding with
the goal of supporting long-term care homes in implementing best practices and enhancing resident-
centered, quality care. The strategies utilized by the program assist the long-term care homes to not only
leverage their efforts to meet provincially mandated programs in key practice areas such as falls
prevention, wound care, continence and pain, but to enhance resident and family-centered care within the
context of an evidence-based practice culture. The benefits of this initiative include enhanced quality care
for residents and families; capacity building for staff, both regulated and unregulated, working in long-term
care homes; promotion of interdisciplinary knowledge transfer; utilization of evidence-based decision
making in professional practice; and, improvement in work environments.
The framework that informs this unique program includes six distinct strategies directed towards: raising
awareness; engagement; capacity development; guideline implementation; integration and evaluation. A
team of registered nurses with expertise in long-term care and the care of older persons engage with long
term care homes as Long-term Care Best Practice Coordinators. They support the uptake of best
practices within the long-term care homes at the individual, organizational and system levels through
various evidence-based implementation strategies. Capacity building strategies to support providers and
organizations include site visits, practice consultation and facilitation, provision of educational programs to
staff members and assistance with implementation of multiple best practice guidelines as part of a
network of Spotlight Organizations. Regionally, the LTC Best Practice Coordinators facilitate networks of
key stakeholders and leaders within long-term care homes to share their successes and learn from each
other through knowledge exchange opportunities. Linkages to the program mandate and other quality
improvement initiatives are coordinated to ensure consistent messaging to the long-term care sector.
Numerous evidence-based implementation resources have been developed and are disseminated widely
to support the integration of evidence-based practice in the care of residents, and these resources have
been accessed provincially, nationally and internationally.
This presentation will share challenges, and key success stories of how the LTC Best Practices Program
is impacting on the long-term care sector as it fosters the development of evidence informed practice and
quality resident and family-centered care.
Contact
[email protected]

M 14 - Evidence-Based Practices Changing Global Practice
Changing the Face of Health Care in a Global Society, Sustaining EBP in Wound
Care: An International Collaboration in the Philippines
Rebekah Grigsby, MSN, BSN, RN, USA
Purpose
The purpose of this presentation is to describe strategies to overcome barriers to education on EBP in
underserved areas.
Target Audience
The target audience of this presentation is any health care professional who is interested in furthering
their own education on EBP in wound care or someone who is responsible for developing or
implementing educational curriculum in an international setting.
Abstract
The prevalence and incidence of wounds has reached epidemic proportions and there is a global priority
to provide wound care that is evidenced-based. However, areas around the world experience significant
gaps in evidence-based practice (EBP), and populations experience disparity in wound care. Studies
have identified specific barriers that impede knowledge acquisition and the translation of evidence into
practice for health care professionals. This quality improvement study explored strategies to diminish
barriers using Leffers and Mitchell’s Conceptual Framework for Partnership and Sustainability in Global
Health Nursing. The overarching purpose was to develop a sustainable program of wound care education
therefore closing the gap in EBP. The research question for this study examined the effectiveness and
sustainability of an online wound care course for a Filipino medical team working in rural and urban
barangays (communities) in the Philippines. The Precede-Proceed model was utilized as a framework for
planning and designing the quality improvement study. Following the path of this logic model,
stakeholders were recognized and needs identified. This led to sequential steps in designing and
implementing an online course. Additionally, this framework provided a structure for formative and
summative evaluation throughout the study. The outcomes of this study indicated that development of an
accessible program of education could contribute to translation of evidence in wound care practice and
quality outcomes for the patient. The social impact was evident by a successful international partnership
of nurses leading to a sustainable program of wound care education that will contribute to nursing
knowledge and support nurse professionals in a challenging health care environment.
Contact
[email protected]

Triplet Partnering: A Novel Approach to Introducing Evidence-Based Nursing
Practice in China
Elizabeth R. Barker, APRN, BC, PhD, USA
Purpose
To disseminate a model for instituting Evidence Based Nursing Practice as an international concept
Target Audience
Administrators, nursing leader and nursing academic personnel who are interested in developing a
successful implementation of a model for incorporating Evidence Based Practice into nursing protocols in
international settings
Abstract
Purpose: To disseminate a model for instituting EBP as an international nursing concept
Methods: Needs identification using international consultation. Review of the literature to determine the
most effective methodology for developing the innovation with special emphasis on cultural compe
Design of the strategies among academic and hospital based nursing service to model the development
of EBP nursing protoclols. Implementation of the plan with six month visiting scholar program for nursing
leaders from China. Evaluation of the effectiveness of the changes by visiting the target hospital in China
Results: There are five units is a new hospital in Shanghai where the visiting scholars have instituted
nursing councils that are reviewing and redesigning nursing protocols to reflect the use of EBP as a basis
for the protocols
Conclusion: For nursing to actively and productively respond to the Millennium Development Goals and
the Institute of Medicine’s recommendations, the use of EPB for nursing protocols is an obviously
choice. What works is a well planned collaborative effort among the nursing leaders at the target facility,
a large academic center and a College of Nursing where EBP is well integrated into the curriculum
References
[1] United Nations, Millennium development goals UNICEF summary of the convention on rights of the child Article
28. Retrieved from http://www.un.org/millenniumgoals/ [2] UNICEF, Summary of the convention on rights of the child
Article 28. Retrieved from
http://www.unicef.org/sowc2013/files/SOWC_SpecEd_CRC_Executivesummary_EN_091009 [3] E.K. George and O.
Meadows, Searching for collaboration in international nursing partnerships; a literature review, Nursing Outlook, vol.
58, pp.122-128, 2010. [4] H. Yun, A. Jian, Nursing shortage in China; State, causes and strategy, Nursing Outlook,
vol. 58, pp.122-128, 2010. [5] E. Barker and X.P Shen, Evidence based nursing, Shanghai, Fundan Press, p114,
2013. [6] J.A. Beal, A. Alt-White, J. Erikson, et al. Academic partnerships: A national dialogue, Journal of Professional
Nursing vol. 28 pp. 327-332, 2012. [7] American Association of Colleges of Nursing, Practice toolkit. Retrieved from
http://www.aacn.nche.edu//teachinginitiatives/academic_practice_partnerships/toolkit. [8] S.E. Barger, Partnership for
practice; A necessity in the new millennium, Journal of Professional Nursing, vol. 15, p. 208, 1999. [9] J.A. Beal, E.,
Breslin, et al., Hallmarks of best practice in academic service partnerships in nursing: Lessons learned from San
Antonio, Journal of Professional Nursing, vol.20, pp. e90-e95, 2011. [10] M. Libster, Lessons learned from a history of
perseverance in education practice partnerships, Journal of Professional Nursing vol. 27, e76-e81, 2011. [11] Institute
of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health. Retrieve from
http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-
Health/Recommendations.aspx. [12] H. Jiang, J. Erickson, Promoting a culture of international professional practice
for nursing through a twinning relationship, Journal of Nursing Administration vol. 42, pp. 117-122, 2012. [13]
American Nurses Credentialing Center, Application Manual; Magnet Recognition Program, Silver Springs, MD,
American Nurses Credentialing Center, 2008. [14] J. Clavell, Transformational leadership; Visibility, accessibility and
communication, Journal of Nursing Administration, vol. 42, pp. 345-346, 2012. [15] F. Girard, N.Linton,and J.Besner,
Professional practice in nursing: A framework. Retrieved from http://www.longwoods.com/content/19028 [16] A.
Pearson, K. Porrott, and D. Doran, A systematic review of evidence on the professional practice of the nurse and
developing and sustaining a healthy work environment in health care, International Journal of Evidence Based
Practice, vol. 4, pp. 221-261, 2006.

Contact
[email protected]

Global Collaboration to Build Nursing Competence in EBP
Chen Weiju, RN, BS, China
Marcia Rucker Shannon, MSN, RN, USA
Jinai He, RN, BS, MSN, China
Quinran Lin, RN, BS, China
Purpose
Purpose: Describe a 15 year collaboration between Jinan University, China and SVSU, USA. The
purpose was to build nursing competence in EBP. The building process will be shared including the
architectural, foundation, framing, and finishing work, and describing upkeep needed. This construction
has resulted in achieving better patient outcomes.
Target Audience
The target audience of this presentation is nursing faculty and nursing administrators interested in a
strategy to promote the translation of nursing evidence through an extended collaborative partnership.
Abstract
Purpose: This presentation will describe a 15 year collaboration between Jinan University, Guangzhou,
China and Saginaw Valley State University, USA. The purpose of the collaboration is to “build” nursing
competence in Evidence Based Practice. The building process will be shared including the architectural
work, digging the foundation, framing the final product, doing finishing work, and describing upkeep
needed. This has been a very successful construction project, with solid outcomes for nursing, in both
countries.
Methods and Results: Actual interventions taken will be shared along with ideas for improving upon our
experience. These are a few of the concrete examples of interventions that will be shared for each step of
the building process:
Consulting the Architect: Critical communications will be discussed between the two countries, and the
nursing personnel. Establishing links, personally and professionally, will be highlighted.
Digging the Foundation: Classes offered and workshops held will be outlined, over several years.
Classes in China centered on EBP, while in the USA they centered on cultural competence.
Framing: Examples of Evidence Based Practice Projects requested by different hospital units will be
shown. Implementation of EBP at the hospital /university will be outlined.
Finishing work: Having Chinese nursing scholars come to the USA to take EBP classes and study
research methods and share their experiences will be discussed. The importance of recognizing cultural
practices will be emphasized.
Upkeep of the Structure: Methods for continuing to engage nurses in translating nursing evidence to
achieve better patient outcomes and keep the “building” solid will be shared. Outcomes for both
organizations will be shared.
Conclusions: The many positive outcomes of this collaboration will be shared, both for SVSU students,
Jinan students and faculty and hospital nurses in both countries. Future ideas/possibilities for
collaboration will be shared. The audience will be involved in brainstorming other strategies that could be
implemented to further improve global health outcomes.
References
Beinfield, H.and Korngold, E. (1991) Between Heaven and Earth. A guide to Chinese medicine. New York: Random
House. Brown, C.E., Wickline, M.A., Eckoff, L., Glaser, G. (2009). Nursing practice, knowledge, attitudes, and
precieved barriers to evidenced-based practice at an acedemic medical center. Journal of Advanced Nursing, 65(2),
371-381. DOI: 10.1111/j.1365-2648.2008.04878.x Office for Human Rights Protection (2013). International
compilation of human research standards 2013 edition. Retrieved from

http://www.hhs.gov/ohrp/international/index.html Crigger, NJ, Brannigan, M & Baird, M. (2006)Compassionate
nursing professionals as good citizens of the word (a case study on nursing ethics). Advances in Nursing Science,
29(1): 1-15. Kit, W.(2002) Chinese Medicine. Kedah, Malaysia: Cosmos Internet. Melnyk, B.M., Fineout-Overholt, E.,
Stulwell, S.B. & Williamson, K.M. (2010). Evidence-based Practice: Step by Step. American Journal of Nursing,
110(1), 51-53. Office for Human Rights Protection (2013). International compilation of human research standards
2013 edition. Retrieved from http://www.hhs.gov/ohrp/international/index.html Purnell, L. & Paulanka, B. (1998)
Transcultural Healthcare. Philadelphia: FA Davis. Rosenberg, M. About: Geography. China’s One Child Policy.
Available at: http://geography.about.com/ad/population geography/a/onechild.htm. Accessed June 20, 2013.
Solomons,N.M. and Spross,J.A. (2011), Evidence-based practice barriers and facilitators from a continuous quality
improvement perspective: an integrative review. Journal of Nursing Management 19,109-120.
Contact
[email protected]

N 13 - Ensuring Patient Engagement and Adherence Through
Education
Effectiveness of Patient Engagement through Population-Focused Health
Education on Health Outcomes
Linda F. Samson, PhD, RN, BC, NEA, BC, USA
Sylvia Aruffo, PhD, USA
Purpose
Describe the use of ethnography to develop culturally and linguistically appropriate patient education
materials in order to actively engage patients in their own health care.
Target Audience
Nurses and other clinicians who want to improve patient outcomes in chronic diseases by actively
engaging previously difficult to reach patients in their own self care.
Abstract
The burden of chronic illness on patients and families continues to grow. This is particularly true for high-
risk populations where the incidence of diabetes, hypertension, and the complications of these conditions
disproportionately effects minority and underserved individuals. Despite the fact that the causes of these
disparities vary, a number of management strategies appear to be effective in improving overall health
status of individuals suffering from these diseases. This presentation reviews the development of an
evidence-based model for community based participatory research that leads to patient engagement and
improved health literacy.
Identifying obesity as one of the triggers for hypertension and diabetes in African American women, a
group of community and faith leaders working with the research team developed a faith-based initiative
called Women of Wonder. The intervention was conducted in a local church using the minister and other
volunteers. The project provided women with health education, blood pressure testing, weight
measurement, nutritional support, group support, and counseling. Over the 26 weeks of the project the
participants were able to reduce blood pressure and weight and sustain the losses for an additional 52
weeks through long-term life style changes.
This success led to other projects that attempted to delineate factors for success. Several projects
developed around chronic disease self- management used peer coaches to create patient engagement.
In each of these peer coaches were trained using a classroom model. They were then sent into homes to
assist others with the same health care issues to help them improve their health status. Although effective
in reducing hospital and emergency room utilization the level of patient engagement was not present in
the peer mentor models.
More recently the team and community has been addressing the issue of health literacy after recognizing
that an ongoing barrier to health care remains the issue of understanding and participating in care
decisions. Current interventions include use of materials that are developed after ethnographic research
is conducted to understand patient meaning and issues. Then from this framework materials are
developed to meet the needs of the patient and provide information that they find useful. Tools developed
using this format have had widespread success in a number of settings in reducing costs of health care,
readmission rates, emergency room utilization, and patient satisfaction. Recent literature suggests that
engaging patients in the care delivery process through health literacy may reduce or eliminate some of
the social barriers to health care.
References
Allen, K., Zoellner, J., Motley, M., & Estabrooks, P. A. (2011). Understanding the Internal and External Validity of
Health Literacy Interventions: A Systematic Literature Review Using the RE-AIM Framework. Journal Of Health
Communication, 1655-72. doi:10.1080/10810730.2011.604381 Bryant, A. (2011). Low health literacy affecting client's
ability to receive adequate health care education. JOCEPS: The Journal Of Chi Eta Phi Sorority, 55(1), 7-11. Dennis,

S., Williams, A., Taggart, J., Newall, A., Denney-Wilson, E., Zwar, N., & ... Harris, M. F. (2012). Which providers can
bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative
synthesis. BMC Family Practice, 13(1), 44-72. doi:10.1186/1471-2296-13-44 Gorman, B., & Porter, J. (2011). Social
Networks and Support, Gender, and Racial/Ethnic Disparities in Hypertension Among Older Adults. Population
Research & Policy Review, 30(6), 885-911. doi:10.1007/s11113-011-9215-4 Heinrich, C. (2012). Health literacy: The
sixth vital sign. Journal Of The American Academy Of Nurse Practitioners, 24(4), 218-223. doi:10.1111/j.1745-
7599.2012.00698.x Keenan, N.L., & Rosendorf, K. A. (2011). Prevalence of Hypertension and Controlled
Hypertension — United States, 2005-2008. MMWR. Supplements January 14, 2011; 60(01);94-97.
Contact
[email protected]

Education
Infused Telemental Health Home Monitoring: Right Care, Right Time, Right Place
Deborah A. Harris-Cobbinah, RN, MSN, ANP, MHCNS,BC, USA
Purpose
To provide current information to health clinicans regarding expanded provisions of patient care beyond
mental health institutional settings at New York Veterans Affairs Hospital, using health
informatics,infused(integrated mental health and medical disease management protocols and Telehealth
technologies.
Target Audience
All health professionals: Registered nurses and Licensed Practical nurses Licensed Mental Health and
Medical Primary Care Providers Psychologists Social Workers Case Managers Care Givers Interested in
Integrated Mental Health and Medical Telehealth Home Monitoring.
Abstract
Purpose: To provide current information to health clinicians regarding expanded provisions of patient care
beyond mental health institutional settings to Veterans with mental health and co-morbid medical
diagnosis using of health informatics, integrated mental health and medical disease management
protocols and Telehealth technologies. This presentation/ poster will also review New York Harbor’s
Veteran Affairs Infused (integrated) Telemental Health Home Monitoring Program.
Significance: In 2008 the Veterans Health Administration(VHA) added a subdivision, Telemental Health to
their Care Coordination/ Home Telehealth (CCHT) department. This subdivision was created to ensure
that eligible veterans with a mental health diagnosis have access to a comprehensive and integrated high
quality healthcare continuum that addresses both medical and mental health needs of veterans in urban
and rural communities utilizing home monitoring devices and case management. The Telemental staff
utilizes FDA approved in-home messaging devices and telephone automated programs for disease
management of mental health and co-morbid medical diagnosis. Registered nurses who specialize in
Mental Health nursing and who have medical skills provide case management services to augment care
provided by VHA and non-VHA medical and mental health providers.
Design (Background/Rationale): A chart review of patients enrolled in the program more than 12 months
was conducted. The review consisted of the most used mental health diagnosis, the percentage of
patients that have a medical diagnosis and mental health diagnosis, the percentage of psychiatric and
medical in-patient admissions, and the type of Telehealth devices used.
Description of Methods: Veterans are referred to the program by self-referral or medical/mental health
providers. Accepted veterans are expected to complete daily self-report protocols via telehealth monitors/
cell phone systems. If a high risk behavior or symptom is alerted, a Telemental health coordinator will
contact the patient for further interventions. These interventions include: patient education, provider
notification, crisis intervention, referrals to VHA/non-VHA community services.
Findings/ Outcomes :
1. The majority of patients in the telemental health CCHT program had at least one medical co-
morbidity.
2. There was a significant decrease in hospital admissions and length of stay. 3.
3. There has also been marked improvement in compliance with clinic appointments and medication
regimes.
Conclusions/Interpretations/Implications: Infused Telemental health services facilitate access to care and
improve the health of mental health patients with specific intent of providing the right care, in the right
place, at the right time. This expanded care improves chronic disease management, patient satisfaction,
increase access to services and reduce resource utilization, thus decreasing healthcare costs. VHA

health professionals emphasize that home telehealth does not replace traditional homecare but can help
veterans understand and manage their medical and mental health conditions at home. Proper
management of these chronic conditions can delay the need for institutional care and maintain
independence for an extended time.
The VHA has proven that an enterprise wide Infused (integrated)Telemental Health program is an
appropriate and cost effective way of managing mental health patients with co-morbid medical disorders
in both urban and rural settings. Infused home monitoring provides veterans with the Right Care, In the
Right Place, at the Right Time.
References
Webinars: Understanding Primary and Behavioral Health Care Integration,Hosted by the National Council, provides
an overview of integrated behavioral health and primary care. Working Together:FQ HCS and Community Behavioral
Organizations (October,29,2009) Funk,M.,Saraceno,B.,Drew,N., and Faydi,E.2008."Integrating mental health into
primary healthcare".Mental Health in Family Medicine.5(1):5-8
Contact
[email protected]

Education
Oral Chemotherapy Adherence
Judy Lynn Phillips, DNP, FNP-BC, AOCN, USA
Purpose
The purpose of this presentation is to show other nurses how an evidenced based oral chemotherapy
adherence project, at a large medical oncology practice, has led to improved patient outcomes.
Target Audience
The target audience of this presentation is clinical nurses dealing with oral medication adherence.
Abstract
In the past, chemotherapy has been given predominantly intravenously, which allowed for multiple
nursing therapeutic interactions. Currently oral chemotherapy is increasing in use at a rate of 40%, with
an escalating increase occurring rapidly. In order to ensure adherence to these oral medications, an in-
depth synthesis of the literature was performed, with the gained knowledge being used for the
development of a quality project. This evidenced based practice project has been implemented in a large
oncology-hematology practice, which includes one central urban facility and five rural sites.
The following people are at a higher risk for decreased compliance: newly diagnosed/overwhelmed, older
age, high co-morbidities, financial issues, decreased symptom management, poor education, and low
understanding of why the medications are necessary; therefore our quality project has adequately
covered these issues.
The follorwing is a descriptions of this project. Each patient who is beginning oral chemotherapy is given
an initial educational teaching session with a nurse practitioner. A clear understanding of the medications
is taught with a review of the side effects, safety factors, medication interactions, dosage, cost, why the
medication is necessary, and where/when the medication should arrive at their home. This session is
taped verbally, with written instructions and appropriate educational booklets given, so the patients and
their care givers can refer to this information as necessary. During this session, the patient and their care
givers are given a spread sheet of the medications, explaining exactly when and how the medications are
to be given. After this session, the nurses then schedule a telephone call to the patients two weeks after
the start of these medications. During these telephone interviews, the patient's understanding of why they
are taking their medications is assessed, along with a review of any problems, such as: side effects,
costs, compliance, knowledge, and safety issues. When problems are found, a reminder is sent through
our electronic medical records (EMR), to the providers. If there are issues, along with the reminder, the
patients are also made appointments in our nurse-run clinic or with their providers. If there are no
problems, they continue to receive calls every four weeks thereafter, with interventions as necessary.
An oral chemotherapy questionaire is completed after these calls and recorded in our EMR. The overall
information from these calls is tracked through the questionaires in the EMR. The tracking is monitored in
control charts; when issues are found, changes are made.
The project implementation process included multiple employee educational meetings. Due to the
involvment of varying departments these classes included: physicians, administration, nursing,
scheduling, financial, and information technology. The success was contingent upon the employees
understanding of why this project was so important. Through the employees new understanding, they
promptly agreed to participate in this endeavor.
We have found through careful use of the evidence, nurses are able to continue their therapeutic
interactions with patients, even if this is through a different form of action than with the intravenous
chemotherapy. The success of this project is being shared to help other practices have the opportunity to
adopt a similar project.
References

References Muro, K. (2013). Team medicine in chemotherapy for metastatic colorectal cancer. Gan to Kagaku
Ryoho.Cancer & Chemotherapy, 40(4), 435-439. Offord, S., Lin, J., Mirski, D., & Wong, B. (2013). Impact of early
nonadherence to oral antipsychotics on clinical and economic outcomes among patients with schizophrenia.
Advances in Therapy, 30(3), 286-297. doi:10.1007/s12325-013-0016-5; 10.1007/s12325-013-0016-5 Pagani, O.,
Gelber, S., Colleoni, M., Price, K. N., & Simoncini, E. (2013). Impact of SERM adherence on treatment effect:
International breast cancer study group trials 13-93 and 14-93. Breast Cancer Research and Treatment, 142(2), 455-
459. doi:10.1007/s10549-013-2757-x; 10.1007/s10549-013-2757-x Patel, K., Foster, N. R., Farrell, A., Le-
Lindqwister, N. A., Mathew, J., Costello, B., . . . Jatoi, A. (2013). Oral cancer chemotherapy adherence and
adherence assessment tools: A report from north central cancer group trial N0747 and a systematic review of the
literature. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education,
28(4), 770-776. doi:10.1007/s13187-013-0511-z; 10.1007/s13187-013-0511-z Rudek, M. A., Connolly, R. M.,
Hoskins, J. M., Garrett-Mayer, E., Jeter, S. C., Armstrong, D. K., . . . Wolff, A. C. (2013). Fixed-dose capecitabine is
feasible: Results from a pharmacokinetic and pharmacogenetic study in metastatic breast cancer. Breast Cancer
Research and Treatment, 139(1), 135-143. doi:10.1007/s10549-013-2516-z; 10.1007/s10549-013-2516-z Timmers,
L., Boons, C. C., Kropff, F., van de Ven, P. M., Swart, E. L., Smit, E. F., . . . Hugtenburg, J. G. (2013). Adherence and
patients' experiences with the use of oral anticancer agents. Acta Oncologica (Stockholm, Sweden),
doi:10.3109/0284186X.2013.844353 Verbrugghe, M., Verhaeghe, S., Lauwaert, K., Beeckman, D., & Van Hecke, A.
(2013). Determinants and associated factors influencing medication adherence and persistence to oral anticancer
drugs: A systematic review. Cancer Treatment Reviews, 39(6), 610-621. doi:10.1016/j.ctrv.2012.12.014;
10.1016/j.ctrv.2012.12.014 Vervloet, M., Spreeuwenberg, P., Bouvy, M. L., Heerdink, E. R., de Bakker, D. H., & van
Dijk, L. (2013). Lazy sunday afternoons: The negative impact of interruptions in patients' daily routine on adherence
to oral antidiabetic medication. A multilevel analysis of electronic monitoring data. European Journal of Clinical
Pharmacology, 69(8), 1599-1606. doi:10.1007/s00228-013-1511-y; 10.1007/s00228-013-1511-y Waimann, C. A.,
Marengo, M. F., de Achaval, S., Cox, V. L., Garcia-Gonzalez, A., Reveille, J. D., . . . Suarez-Almazor, M. E. (2013).
Electronic monitoring of oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid
arthritis: Consequences of low adherence. Arthritis and Rheumatism, 65(6), 1421-1429. doi:10.1002/art.37917;
10.1002/art.37917 Ward, M. (2013). Adherence to long-term warfarin therapy remains challenging. Journal of
Managed Care Pharmacy : JMCP, 19(4), 290. Wickersham, K. E., Sereika, S. M., & Bender, C. M. (2013).
Pretreatment predictors of short-term nonadherence to oral hormonal therapy for women with breast cancer. Nursing
Research, 62(4), 243-251. doi:10.1097/NNR.0b013e318298fd70; 10.1097/NNR.0b013e318298fd70
Contact
[email protected]

Part IV: Research Oral Presentations
A 01 - Ethical Issues in Nursing Practice
Expanding Our Understanding Complex Decision-Making in Emergent, Routine
and Urgent Ethically Challenging Clinical Situations
Monica McLemore, PhD, MPH, RN, USA
Purpose
The purpose of this presentation is to present a grounded theory of calculus formation which provides a
deeper understanding of processes that nurses use when making clinical decisions in ethically
challenging situations, particularly emergent, routine and urgent care provision using abortion as the
clinical context.
Target Audience
The target audience of this presentation is staff nurses, nurse managers, nursing administrators and
nurse researchers interested in clinical decision making, particularly in ethically challenging clinical
situations.
Abstract
Purpose: Nurses routinely provide care to patients in ethically challenging situations. The purpose of this
study was to discover and identify the continuum between conscientious objectors and designated staff in
the provision of nursing care to women seeking abortions. More specifically, we sought to gain a deeper
understanding of processes that nurses use when making clinical decisions in ethically challenging
situations in both urgent and routine care provision using abortion as the clinical context.
Methods: Constructivist grounded theory method was used. A purposive sample of 24 nurses who
currently or previously work in abortion clinics, emergency departments, labor and delivery, operating
rooms and post anesthesia care units were interviewed between November, 2012 and August, 2013.
Questions were designed to examine and explore the cognitive, emotional, and behavioral processes
associated with how nurses make decisions to care for women needing and seeking abortions.
Results: Nurses develop and use multifaceted, real-time calculi in several dimensions when making
decisions about their participation in emergent, routine, or urgent abortion care provision. Additionally,
nurses make a clear distinction between knowing how versus know that, meaning knowing how to take
care of women needing abortions doesn't always result in provision of care and knowing that (i.e., the
circumstances and back story of why women need this care) is a better predictor of its provision.
Parameters of the nurse-patient relationship are different than medicine in the abortion context as nurses
make clear distinctions between women and patients and these distinctions impacts the taxing between
the personal and professional factors that influence calculus formation. Finally, the role of others, broadly
defined in the abortion context creates a complex yet integrated variable to be considered in the decisions
impacting care provision.
Conclusion: This study provides a grounded theory of calculus formation that further develops the
science of real-time ethical decision-making in ethically challenging situations. These data expand our
understanding of the multitude of factors that impact and influence nurse decision-making. Effective
strategies exist that facilitate tuning of individual nurses’ calculus formation particularly infrastructural,
institutional and other external factors that are essential components of the environment of care.
Contact
[email protected]

Experience of Ethical Conflict in Advanced Practice Nurses and Nurse Managers
Shiuyu Katie C. Lee, DNSc, Taiwan
Purpose
The purpose of this presentation is to share the experience of ethical conflicts and ethical dilemma in
advanced practice nurses and nurses managers.
Target Audience
The target audience of this presentation may include nursing researchers, nursing educators, doctoral
students, advanced practice nurses and nurse managers.
Abstract
Purpose: There is an increasing of new, advanced clinical or management nursing roles globally. The
position in promoting ethical practice, such as preserving human rights and professional integrity may be
challenged among these nursing professionals in advanced practice. Thus, this study aimed to describe
the experience of ethical conflicts and distress in Advanced Practice Nurses (APN) and Nurse Managers
(NM).
Methods: A qualitative inquiry with constant comparative method was used. A purposive sample of 10
post-graduate nurses in advanced practice, including nurse practitioners, case managers, nurse
managers or clinical nurse educators, were recruited in Taipei, Taiwan. Voice-recorded interviews via
open-ended questions were conducted and transcribed. Constant comparative method was used across
interviews and subsequent data analysis.
Results: The post-graduate APNs or NMs had the age ranging from 32 to 45 and were trained in various
specialties, such as ICU, oncology, mental health or management, and practiced in either acute care,
community or nursing education setting for 5 to 7 years. The ethical conflict experience characterized as
emotional difficulty, distressed or perception of “professional fatigue,” which evoked by situational factors,
institutional culture or policy, and role function in the era of advanced practice nursing within the
traditional western medicine system. There were 26 ethical dilemma were identified, included care and
nurse-patient relationship, collaboration with nurse and non-nurse colleagues, and conflict between
profession and work. The experience challenged their professional accountability, professional value, and
was a personal experience.
Conclusion: The APNs and NMs’ ethical conflict were associated with the code of ethic in nursing and
the advanced practice, managerial or education role function. The healthcare system and situation factors
played an important role. Training in moral justice and resourcing with ethical support may need to
support the APNs’ ethical practice.
References
1.International Council of Nurses. (2012). The ICN Code of Ethics for nurses (pp. 12). Retrieved from
http://www.icn.ch/images/stories/documents/about/icncode_english.pdf 2. Begley, A. M. (2006). Facilitating the
development of moral insight in practice: teaching ethics and teaching virtue. Nursing Philosophy, 7(4), 257-265. 3.
Kegans, L. (2009). Occupational work ethic differences: Implications for organizational diversity initiatives in health
care organizations. Performance Improvement Quarterly, 22(3), 83-94.
Contact
[email protected]

Ethical Issues in Community Health Nursing in Botswana
Sheila Shaibu, PhD, MNS, BEd, RN, Botswana
Purpose
The purpose of this presentation is to share results of a study on ethical issues faced by Home based
care nurses and community health nurses in Botswana who look after patients in primary health care
settings.
Target Audience
The target audience of this presentation is nurses who work in primary health care settings as well as
Home Based Care nurses, particularly those based in rural settings and low resourced countries. Nurse
educators are also targeted as they have an input into nursing curricula.
Abstract
Purpose: The purpose of this study was to explore ethical issues that Community Health Nurses are
faced with in clinics in primary health care settings and home based care settings.
Methods: An exploratory descriptive qualitative design was used to interview 12 Home Based Care
Nurses in five urban and rural districts in Botswana. Content analysis was used to analyze the data.
Results: Registered Nurses employed as Community Home Based Care nurses were interviewed and
their ages ranged from 23 to 56 years. The themes that emerged included: Respecting client’s wishes
(autonomy and confidentiality), Negotiating political interference in care (changing operational rules for
patients’ care and non-procedural conflict resolution for community members for political gain), Caring in
the context of risk, and System issues. The findings indicate that the nurses’ goal was to optimize good.
However, there was evidence that there was tension regarding whose good should be upheld. The HIV
and AIDS scenario created many ethical problems that require health promotion strategies. They
expressed concern over shortage of staff and scope of practice issues.
Conclusion: There is need for support and continuing education in ethics for community based nurses in
practice. Ethics committees should also be established in PHC settings. Health promotion on HIV and
AIDS must be continued.
Contact
[email protected]

A 03 - Promotion and Lived Experiences of Breastfeeding Mothers
Promoting and Supporting Breastfeeding: A Local Support Group Perspective
Yu-Chen Huang, RN, MSN, Taiwan
Hsien-Hsien Chiang, MSN, RN, Taiwan
Purpose
The purpose of this presentation is promoting and supporting breastfeeding.
Target Audience
The target audience of this presentation is health care nurses.
Abstract
Purpose: Encouraging breastfeeding is a primary health promotion strategy. Breast-feeding policy helps
mothers to extend breastfeeding up to 6 months by local breastfeeding support groups. Through
breastfeeding support groups, mothers can continue get information from other experienced mothers and
professional health nurses after discharging.The purpose of this qualitative study was to explore mother
experiences of breastfeeding from women who have breastfed a child in Taiwan’s rural area.
Methods: Women were recruited during as peer-support volunteers in Minsyong Township Healthy
station, Chiayi County, Taiwan between April 2012 and September 2012. A hermeneutic approach was
used in this qualitative study. Sixteen women participated in the five sessions of support group for
breastfeeding women. In the semi-structured interviews, participants discussed their experiences of
breastfeeding. Data was gathered through group discussions with interviewees' permission. After
verbatim transcription, field notes, and individual and discussion group interviews with health nurses. The
text was analyzed to identify themes of meaning and interpretation of the explored phenomenon.
Results: A promising intervention is the complementation of professional services with peer support from
a mother experienced in breastfeeding. In the support group, we find three themes were identified: (1)
breastfeeding to promote infant health, (2) acceptance to endure suffer and fatigue, (3) producing energy:
gaining strength through sharing, nursing professional teaching, comfort stage with her own body.
Conclusion: Health nursing professionals considered maternal experience of breastfeeding and how
they face their roles, provided practical and emotional supports, avoided giving conflicting advice, and
acknowledged the importance of the support group. In Local support group, health care nurses not only
listened and cared, but also provided the relevant information to the mother, and considered how well it
meets women's needs. Each mother enriched our discussion and understood by sharing her experience
as well. Maternal wants to be listened to and encouraged without feeling pressurized. The findings
showed that group participants could get the breastfeeding support not only from health professionals
nurse, but also other mothers. They are becoming the mother support networks in the community.
References
Burns, E., Schmied, V., Sheehan, A., Fenwick, J., 2010. A meta-ethnographic synthesis of women’s experience of
breastfeeding. Maternal and Child Nutri- tion 6, 201–219. Hannula, L., Kaunonen, M., Tarkka, M., 2008. A systematic
review of professional support interventions for breastfeeding. Journal of Clinical Nursing 17, 1132–1143. Hoddinott
P, Pill R. A qualitative study of women’s views about how health professionals communicate about infant feeding.
Health Expect 2000;3(4):224–233 Hauck, Y.L., Langton, D., Coyle, K., 2002. The path of determination: exploring the
lived experience of breastfeeding difficulties. Breastfeeding Review 10, 5–12. Lin, S.-S., Chien, L.-Y., Tai, C.-J., Lee,
C.-F., 2007. Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Journal of
Clinical Nursing 17, 296– 303. Manhire, K.M., Hagan, A.E., Floyd, S.A., 2007. A descriptive account of New Zealand
mothers’ responses to open-ended questions on their breast feeding experiences.Midwifery 23, 372–381. Murphy,
E., 1999. ’Breast is best’: infant feeding decisions and maternal deviance. Sociology of Health and Illness 21 (2),
187–208. Schmied V., Beake S., Sheehan A., McCourt C. & Dykes F. (2011) Women's perceptions and experiences
of breastfeeding support: a metasynthesis. Birth 38, 49–60. Sheehan, A., Schmied, V., Barclay, L., 2010. Complex
decision: theorizing women’s infant feeding decision in the first 6 weeks after birth. Journal of Advanced Nursing 66,
371–380. World Health Organization and UNICEF, 2009. Baby-friendly hospital initiative: revised, updated, and
expanded for integrated care, Section 1–4. WHO, UNICEF and Wellstart International, Geneva. World Health

Organization (2003) Global Strategy for Infant and Young Child Feeding.Geneva:Available at:
http://whqlibdoc.who.int/publications/2003/ (Accessed 30 /12/ 2013).
Contact
[email protected]

A 03 - Promotion and Lived Experiences of Breastfeeding Mothers
Impact of a Nurse-Driven Breastfeeding Educational Intervention on Maternal-
Child Nurse Knowledge Gain and Patient Satisfaction in a Community Hospital
Shakira Henderson, MS, MPH, RNC-NIC, IBCLC, USA
Purpose
The purpose of this project is to describe the implementation and evaluation of a maternal-child nurse
breastfeeding educational training at South Miami Hospital.
Target Audience
nurses, lactation staff, IBCLCs, maternal-child nurse administrators, physicians, dieticians
Abstract
Purpose: The purpose of this project is to describe the implementation and evaluation of a maternal-child
nurse breastfeeding educational training at South Miami Hospital.
Methods: A hospital-based inter-professional team was developed to conduct an educational needs
assessment, identify a breastfeeding curriculum, execute the mandatory breastfeeding training, and track
nurse and patient outcomes pre- and post- the educational intervention. From that team, 10 lactation
specialists were trained to be breastfeeding instructors and taught twenty 4-hour sessions between
January 2013 and August 2013.
Nurse Knowledge gain was evaluated by conducting a paired t-test of a random sample of pre- and post-
test scores. Patient Satisfaction with nurse support of breastfeeding was tracked for the first quarter of the
year in 2013 and compared to five years prior.
Results: Approximately 287 maternal-child nurses attended the training. There was a statistically
significant increase in knowledge scores from pre to post testing (t (20) = 8.04, p < 0.0001). Patient
satisfaction for the first quarter of 2013 was the highest (92%) that it had been in the previous five years.
Conclusion: A nurse-driven breastfeeding educational intervention has the potential to impact nurse
knowledge gain, patient satisfaction, and the overall reputation of a hospital.
References
Smith, J., Dunstone, M., & Elliott-Rudder, M. (2009). Health professional knowledge of breastfeeding: are the health
risks of infant formula feeding accurately conveyed by the titles and abstracts of journal articles. Journal of Human
Lactation, 25 (3), 350-358. doi:10.1177/0890334409331506 Spiby, H., McCormick, F., Wallace, L., Renfrew, M. J.,
D'Souza, L., & Dyson, L. (2009). A systematic review of education and evidence-based practice interventions with
health professionals and breast feeding counsellors on duration of breast feeding. Midwifery, 25 (1), 50-61. U.S.
Department of Health & Human Services, Office of the Surgeon General. (2011). The Surgeon General’s Call to
Action to Support Breastfeeding. Washington, DC: Department of Health and Human Services.
Contact
[email protected]

A 04 - Cultural DIfferences in Reproductive Health
Understanding Cultural Impacts and the Truth of Taiwanese Women's Request for
Repeat Cesarean Delivery
Shu-Wen Chen, RN, MS, BS, Australia
Purpose
The purpose of this presentation is to present understanding cultural impacts and the Truth of Taiwanese
Women’s request for repeat cesarean delivery.
Target Audience
The target audience of this presentation is midwives and obstetricians, or educators who are specialized
in women health and maternal care
Abstract
Purpose: High cesarean birth rates continue to challenge maternal care in many countries. Literature
indicates that women prefer auspicious times for giving birth, contributing to a high cesarean birth rate in
Chinese society. The aim of this study was to explore cultural impacts on and reasoning behind
Taiwanese women’s request for repeat cesarean delivery (RCD).
Methods: A qualitative approach was applied to conduct this research. The research comprised three
stages. Stage I consisted of non-participant naturalistic observation at 33-34 weeks gestation to
understand the dynamic processes of decision-making about birth choice among obstetricians and
pregnant women within the antenatal clinic setting. Stage II involved interviews with pregnant women at
35-37 weeks gestation to explore the influences on their birth choice, including information accessibility,
their family and friends’ attitudes, and cultural considerations. Stage III consisted of interviews with
postnatal mothers, one month after birth, to reflect on their choices. Using a theoretical sampling
approach, seventeen pregnant women were recruited from a private medical centre, in northern Taiwan.
Data collection included in-depth interviews, observation and field notes in the Year of the Dragon, 2012.
Constant comparative analytic technique and thematic analysis were employed for data analysis, and
Software NVivo10 was used to organize the data.
Results: Findings indicate that the majority of women did not intend to give birth in the Year of the
Dragon, with the exception of one woman. Reasons for not wanting to give birth in the auspicious year
included increasing children’s competitiveness in academic performance, running out of education
resources, and encountering crowds of people (such as visiting obstetricians). Women were pregnant in
the auspicious year because of an unplanned pregnancy, planned pregnancy with a 2-3 year interval, and
wishing to have another baby as company for the first child.
Women’s decisions for RCD were subject to internal and external factors. Internal factors included a
previous cesarean (concern about wound healing or the scar), a negative experience of natural birth
(failure of trial of labour, emergency cesarean), fear of pain, evaluation of modes of birth and current
pregnancy. External factors included obstetricians’ recommendations, the experience of significant
others’, information retrieved from the internet and National Health Insurance (NHI) benefits.
Decision-making processes involved simply complying with the obstetrician’s recommendation or
consultation. Before visiting the obstetrician, the majority of women wished for as natural a birth as
possible. During the first trimester of pregnancy, some women accepted the obstetricians’
recommendations for RCD without being informed of alternatives; others made the decision at the second
or early third trimester of pregnancy. The consultation process included discussion with obstetricians,
respecting professional judgment, considering the condition of mother and foetus, making a decision for
RCD and then selecting auspicious time. Some women chose RCD after the risk of uterine rupture was
explained by obstetricians. Postnatal mothers who evaluated their birth choices after birth had emotional
reactions varying between satisfaction and acceptance.

Conclusion: The auspicious time/year to give birth did not impact on Taiwanese women’s birth choice
following a primary cesarean section. However, they selected an auspicious time/day to give birth
after the decision for RCD was made. Their decisions were influenced by internal and external factors.
Internal factors, in particular, education about empowerment associated with natural birth is helpful in
facilitating women’s confidence in natural birth. External factors such as the financial coverage for RCD
from NHI, and the explanation of risk from obstetricians are also potentially modifiable. All women have
the right to be informed of the alternative options for birth. Midwife-led models of care for information
provision may hold promise for promoting high quality maternal care in Taiwan.
References
Declercq, E., Young, R., Cabral, H., & Ecker, J. (2007). Is a Rising Cesarean Delivery Rate Inevitable? Trends in
Industrialized Countries, 1987 to 2007. Birth. Hsu, K. H., Liao, P. J., & Hwang, C. J. (2008). Factors affecting
Taiwanese women's choice of Cesarean section. Soc Sci Med, 66(1), 201-209. doi:
10.1016/j.socscimed.2007.07.030 Lin, H.C., Xirasagar, S., & Tung, Y.C. (2006). Impact of a cultural belief about
ghost month on delivery mode in Taiwan. Journal of epidemiology and community health, 60(6), 522-526. Liu, T. C.,
Chen, C. S., Tsai, Y. W., & Lin, H. C. (2007). Taiwan's high rate of cesarean births: impacts of national health
insurance and fetal gender preference. Birth, 34(2), 115-122. doi: 10.1111/j.1523-536X.2007.00157.x Mazzoni, A.,
Althabe, F., Liu, N. H., Bonotti, A. M., Gibbons, L., Sanchez, A. J., & Belizan, J. M. (2011). Women's preference for
caesarean section: a systematic review and meta-analysis of observational studies. BJOG, 118(4), 391-399. doi:
10.1111/j.1471-0528.2010.02793.x Moffat, M. A., Bell, J. S., Porter, M. A., Lawton, S., Hundley, V., Danielian, P., &
Bhattacharya, S. (2007). Decision making about mode of delivery among pregnant women who have previously had
a caesarean section: A qualitative study. BJOG, 114(1), 86-93. doi: 10.1111/j.1471-0528.2006.01154.x Tschudin, S.,
Alder, J., Hendriksen, S., Bitzer, J., Popp, K. A., Zanetti, R., . . . Geissbuhler, V. (2009). Previous birth experience
and birth anxiety: predictors of caesarean section on demand? J Psychosom Obstet Gynaecol, 30(3), 175-180. doi:
10.1080/01674820902789233 Vere, J. P. (2008). Dragon Children: Identifying the Causal Effect of the First Child on
Female Labour Supply with the Chinese Lunar Calendar*. Oxford Bulletin of Economics and statistics, 70(3), 303-
325. Wong, K.F., & Yung, L. (2005). Do dragons have better fate? Economic Inquiry, 43(3), 689-697. Yip, P. S., Lee,
J., & Cheung, Y. B. (2002). The influence of the Chinese zodiac on fertility in Hong Kong SAR. Soc Sci Med, 55(10),
1803-1812.
Contact
[email protected]

A 04 - Cultural DIfferences in Reproductive Health
Contraceptive Use Among Low-Income and Ethnic Minority Women Living in
Three Urban Underserved Neighborhoods
Adejoke B. Ayoola, PhD, RN, USA
Gail Landheer Zandee, MSN, RN, USA
Emily Johnson, BSN, RN, USA
Kendra Pennings, USA
Purpose
to present an overview of contraceptive use and the effectiveness of the methods used by low-income
women living in three urban medically underserved neighborhoods
Target Audience
Nurses and other health professionals who are interested in promoting women’s reproductive health and
better birth outcomes through understanding of current contraceptive use and the effectiveness of the
methods used by low-income women living in medically underserved neighborhoods
Abstract
Purpose: Ineffective and non–use of contraceptives have been associated with increased risk of
unplanned pregnancy in the United States. Unplanned pregnancy rates and their adverse outcomes such
as low birth weight and preterm birth are higher among minority and low-income women. Healthy People
2020 established a family planning goal to “increase the proportion of females at risk of unplanned
pregnancy or their partners who used contraception at most recent sexual intercourse” from the current
baseline of 83.3% to 91.6%. This study examined the rate of contraceptive use and types of
contraception used by low-income mostly minority women living in underserved neighborhoods.
Methods: One hundred and ten convenience sample of low-income women who called to be part of a
larger study were included in this analysis. The women were asked in a pre-intervention screening survey
about their contraceptive use and sexual behaviors 12 months prior to the time of interview. Simple
descriptive analyses namely univariate and bivariate analyses were conducted using STATA 10.
Results: Forty-eight (43.6 %) of the women were African American, 39.1% were Hispanic, and 15.5%
were White. The women were 18 to 55 years of age (mean =31 years). Forty percent of these women
who were not pregnant or planning to get pregnant had sex without using any contraceptives in the past
12 months. The percentage of women who used a contraceptive decreased from 77.3% users in the last
12 months to 63.6 % current users. The most common methods used within the last 12 months were:
condom use by male partner (28.2%), birth control pills (14.6%), depo provera (12.7%), intrauterine
device (10.9%) and the patch (1.8%).
Conclusion: Many of the low-income women from medically underserved neighborhoods in this study did
not use contraceptives and of those who used contraceptives, the majority used condoms, which is
described as a least effective method. These women are at risk of unplanned pregnancy if they continue
to use the least effective contraceptive methods. Contraceptive education and resources on effective
contraception should be provided, if the U.S. is to meet the Healthy People 2020 contraceptive use goal.
References
1. Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: incidence and disparities, 2006.
Contraception, 84(5), 478–485. doi:10.1016/j.contraception.2011.07.013 2. Frost, J. J., Singh, S., & Finer, L. B.
(2007). Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual and
Reproductive Health, 39(2), 90–99. doi:10.1363/3909007 3. Gold, R. B., Sonfield, A., Richards, C. L., & Frost, J. J.
(2009). Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an
Evolving Health Care System. Allan Guttmacher Institute. Retrieved from
http://www.guttmacher.org/pubs/NextSteps.pdf 4. U.S. Department of Health and Human Services. (2013a). Healthy
People 2020 Topics & Objectives. U.S. Department of Health and Human Services. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=13

Contact
[email protected]

A 05 - Nursing Burnout
Trait Negative Affectivity: A Predictor of Burnout and Secondary Traumatic Stress
in Nurses in WA
Desley G. Hegney, RN, BA (Hons), PhD, Australia
Mark Craigie, BSc (Psychology), PhD, Australia
David Hemsworth, PhD, MBA, BA, BAS, CET, Canada
Karen Francis, PhD, MEd, RN, Australia
Vicki Drury, RN, CertOpthNsg, BHlthSc, CertMensHlth, GradCertPsychNsgPrac, MSN, PhD, Australia
Samar Aoun, BSc (Hons), MSc, PhD, Australia
Purpose
describe the results of our work into compassion satisfaction and trait negative affectivity in nurses.
Target Audience
nurses, nurse researchers, policy makers and employers.
Abstract
Purpose: The aim was to ascertain the relationship between the constructs of trait negative affectivity
(TNA), depression, state anxiety, stress, compassion fatigue and compassion satisfaction.
Methods: In 2013 an on-line self-report study was conducted. The survey contained demographic
information and the Professional Quality of Life Scale (ProQOL), the DASS21 and the Spielberger Trait
Anxiety Scale. The study included all nurses employed part or full time in an acute tertiary hospital in
Perth.
Results: 299 of 1292 nurses provided useable data. Approximately 12% of nurses had stress levels in
the moderate, severe to extreme range and 15% of nurses had anxiety and depression levels (measured
by DASS 21) in the moderate, severe to extreme range. Approximately 11% of nurses had an ‘at risk’
profile and 8% had a ‘very distressed profile’ which indicated high secondary traumatic stress and/or
burnout on the ProQOL tool. Forty nurses (14.65%) had a TNA score in the elevated range. Higher TNA
was strongly associated with higher burnout and secondary traumatic stress and lower compassion
satisfaction. The association observed between TNA, burnout and secondary traumatic stress was
independent of current negative mood symptoms.
Conclusion: The personal variable of TNA is an important correlate of compassion fatigue in nurses, and
therefore a worthy target for interventions wishing to build resilience in nurses. Compassion satisfaction is
also a worthy of further investigation in alleviating burnout, but does not appear relevant to secondary
traumatic stress.
References
Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression
Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79-89. Gillespie, B. M.,
Chaboyer, W., Wallis, M., & Grimbeek, P. (2007). Resilience in the operating room: developing and testing of a
resilience model. Journal of Advanced Nursing, 59(4), 427-438. doi: 10.1111/j.1365-2648.2007.04340.x Hooper, C.,
Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion Satisfaction, Burnout, and Compassion
Fatigue among Emergency Nurses Compared with Nurses in Other Selected Inpatient Specialties. Journal of
Emergency Nursing, 36(5), 420-427. doi: 10.1016/j.jen.2009.11.027 Mealer, M., Jones, J., Newman, J., McFann, K.
K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile
in intensive care unit (ICU) nurses: results of a national study. International Journal of Nursing Studies, 49, 292-299.
Radey, M., & Figley, C. R. (2007). The social psychology of compassion. Clinical Social Work Journal, 35(3), 207-
214. Showalter, S. E. (2010). Compassion fatigue: what is it? Why does it matter? Recogniszing the symptoms,
acknowledging the impact, developing the toolsd to prevent compassion fatigue, and strengtehn the professional
alreday suffering from the effects. American Journal of Hospice & Palliative Care, 27(4), 239-242. doi:
10.1177/1049909109354096 Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983).
Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press. Stamm, B. (2010). The
Concise ProQOL Manual. In ProQoL.org (Ed.): Pocatello.

Contact
[email protected]

Nurse Burnout and Patient Outcomes
Apiradee Nantsupawat, PhD, RN, Thailand
Purpose
The purpose of this presentation is to examine the effect of nurse burnout and patient outcomes.
Target Audience
The target audience of this presentation is health care providers.
Abstract
Purpose: This study examined the effect of nurse burnout and patient outcomes.
Methods: This study was cross-sectional study. The sample consisted of 2,083 nurses across 92
community hospitals in Thailand. Nurse burnout was measured by the Maslach Burnout Inventory-Human
Service Scale. Patient outcomes were measured by five items assessing quality of care, medication
errors, confidence that patients can manage their own care after hospital discharge, infection, and falling.
Logistic regression was used for the analysis.
Results: The results of study showed that higher nurse burnout was associated with higher report of fair
to poor care quality, not confident that patients can manage their own care after hospital discharge,
medication errors, infection, and falling.
Conclusion: Results from this study provide confirmation for the association between burnout and patient
outcomes. Reducing nurse burnout is a promising strategy to help improve patient outcomes.
Contact
[email protected]

Application of Revised Nursing Work Index and the Maslach Burnout Inventory
for Registered Nurses from Public Health Institutions, Sao Paulo, Brazil
Lilia de Souza Nogueira, PhD, RN, Brazil
Erika de Souza Guedes, MSc, RN, Brazil
Regina Márcia Cardoso de Sousa, PhD, RN, Brazil
Ruth Natalia Teresa Turrini, PhD, RN, Brazil
Mariana Alvina Santos, RN, MNSc, Brazil
Diná de Almeida Lopes Monteiro da Cruz, PhD, Brazil
Purpose
to discuss about organizational characteristics of health institutions and association with burnout
syndrome
Target Audience
Researchers and nursing staff
Abstract
Purpose: The aim of this research was to verify the relationship between the results of the Revised
Nursing Work Index (NWI -R) and the Maslach Burnout Inventory (MBI).
Methods: The Revised Nursing Work Index (NWI-R) (1) is a tool that measures the practice environment.
It consists of 57 items, in which 15 of the 57 items were divided in 4 subscales: autonomy, control over
the practice setting, doctor nurse relationship and organizational support (1).
The autonomy subscale consists of five items and the control over the practice setting subscale
comprises of seven items. The doctor nurse relationship subscale is formed by three items. The
organizational support subscale consists of ten items derived from the subscales cited above (1).
The scale used in the NWI-R is the Likert and can vary from one to four. The lower the score, the greater
the favorable attributes of the nursing practice. The scores for the subscales are obtained by averaging
the scores of the subjects' responses. They can vary from one to four points (1).
The MBI aims to measure the physical and emotional exhaustion of workers by assessing their feelings
towards work. It has 22 items divided into three domains: emotional exhaustion reduced personal
accomplishment and depersonalization. The sum of the responses for each topic determines the variation
of each domain: nine to forty-five points for emotional exhaustion, eight to forty points for personal
fulfillment and five to twenty-five points for depersonalization and (5). The scores for the emotional
exhaustion and depersonalization items are considered as follow: the higher the score, the greater the
emotional exhaustion feeling and depersonalization perceived by nurses. Regarding the decrease in the
personal fulfillment item, higher scores depict high personal achievement Professional (2.5).
In this study five categories of response (never, rarely, sometimes, often, always) were used. They differ
slightly from the seven original categories. The choice of the five categories was due to the fact that
Brazilian professionals had difficulties to discriminate between the seven original categories of response
(8).
This study was conducted in hospitals and public clinics under direct supervision of the Coordinator of
Health Services of the State Secretariat of São Paulo, Brazil Health, and it is part of a larger study whose
objective was to know the nursing records and variables associated with them.
Among the 43 eligible health institutions invited, three institutions did not take part in the study. Thus, 40
health institutions, whose collection took place between January 2011 and January 2012, were included
in the study.
The questionnaires were completed by nurses who worked or were responsible for sectors where there
were patients. The project was submitted to the Ethics Committee of the School of Nursing for evaluation

of the ethical aspects. Participants who provided information by self-report were informed about the study
and its procedures and, if agreed, signed the Informed Consent Form.
The Pearson correlation coefficient was used to verify the correlation between variables. The correlation
strength used was that proposed by Levin, Fox (2004 ) in which perfect correlation was attributed for
those that reached 1.0 , strong correlation for those between 0.9 and 0.6 , moderate correlation for those
between 0.59 and 0.3, and weak correlation for those below 0.3.
Analysis of clusters was used to identify groups of similar institutions. The method of K-means was
employed and it was based on the Euclidean distance (6-7). The results of the MBI and these groups of
institutions were compared by Analysis of Variance (ANOVA). In the case of significant difference
between groups, the identification of these groups was done by multiple comparisons using the
Bonferroni test. In all analyzes, the significance level of 5 % was established.
Results: The NWI profile represented 40 institutions. The MBI was completed by 745 nurses with an
average age of 43 years (SD = 9.6), average training time of 14 years (SD = 8.5) and on average 9 years
of working in the participating institution (SD = 9.4). The study was comprised of 23 general institutions,
11 institutions and 6 psychiatric outpatient services.
The NWI-R showed reliability of 0,962 for the total items, 0,695 for autonomy items, 0.794 for control over
the practice setting, 0.773 for doctor nurse relationship and 0,815 for organizational support. Regarding
the MBI, the reliability was 0.602 for the total items, 0,877 for emotional exhaustion, 0.549 for the
depersonalization and 0.723 for personal fulfillment.
The mean NWI-R was 2.27 in the total sample, standard deviation (SD) 1.03, median two, minimum and
maximum values of 1 and 4, respectively. As for the MBI, the mean and SD of domains found in this
population were: emotional exhaustion 22.37 (± 6.47), depersonalization 8.98 (± 3.04) and decreased job
satisfaction 31.74 (± 3.98).
Table 1. NWI-R (total and subscales) and MBI (total and domains) correlation. São Paulo, Brazil - 2010-
2011
NWI-R
Total Control over the Doctor Nurse Organizational

Autonomy
MBI Score Practice Setting Relationship Support
0,26 0,25 0,24 0,19 0,21

Total Score
p=0,107 p=0,123 p=0,140 p=0,250 p=0,202
0,46 0,46 0,39 0,24 0,40

Emotional Exhaustion
p=0,003 p=0,003 p=0,013 p=0,134 p=0,010
0,28 0,33 0,19 0,13 0,27

Depersonalization
p=0,081 p=0,039 p=0,229 p=0,439 p=0,087
-0,41 -0,44 -0,26 -0,11 -0,40

Decreased Job
Satisfaction
p=0,008 p=0,004 p=0,104 p=0,516 p=0,011
Pearson correlation coefficient

Table 1 shows that the correlation between emotional exhaustion and NWI-R total score, autonomy,
control over the practice setting and organizational support were moderate and positive. The same results
were found between the depersonalization and autonomy variables. Moderate negative correlation was
present in the analysis between decreased job satisfaction and the total score of NWI-R, autonomy and

organizational support. The results of the analysis of the remaining correlations NWI-R and MBI were
weak, both among total scores, and between the domains of MBI subscales and the NWI-R.
Table 2. Health institution distribution according to NWI-R homogeneous groups. São Paulo, Brazil -
2010-2011
Groups N %
1 13 32,5
2 16 40,0
3 3 7,5
4 8 20,0
In cluster analysis, four groups of hospitals with similar profile were identified from the four subscales of
the NWI -R. In characterizing these groups, we found that group 4 had the lowest scores on all subscales
of the NWI -R. Group 3 received the highest scores on three subscales of the instrument (autonomy,
control over the practice setting and organizational support). The highest values of subscale doctor nurse
relationship were identified in group 1 (Table 2).
There was no difference between groups in relation to the total MBI and decrease the area of personal
fulfillment. Difference between groups was observed for emotional exhaustion ad depersonalization (p<
0.05) domains.
Considering multiple comparisons by the Bonferroni test, it was found that there were differences only
between groups 3 and 4 in relation to emotional exhaustion, and groups two and three, on the
depersonalization domain. Group 4, as the NWI -R, gathered the institutions with the most unfavorable for
the nursing practice, which might have contributed to the physical and emotional exhaustion of nurses in
these institutions.
Conclusion: The group of public hospitals in São Paulo, Brazil with the best nursing practice showed
significant statistical difference for the emotional exhaustion and depersonalization domains compared to
groups of hospitals with less favorable characteristics.
References
1. Aiken LH , Patrician PA . Measuring organizational traits of hospitals : the Revised Nursing Work Index . Nurs Res
2000 , 49 (3) :146 -53 2. Gasparino RC . Cultural adaptation and validation of the "Nursing Work Index - Revised" for
Brazilian culture [ dissertation ] . Campinas : University of Campinas , Faculty of Medical Sciences , 2008 3. Flynn M ,
McCarthy G. Magnet hospital characteristics in acute general hospitals in Ireland . Nurs J Manag. 2008 , 16 (8)
:1002-11 . 4. Hinno S , Partanen P , Vehviläinen - Julkunen K , Aaviksoo A. Nurses' perceptions of the organizational
attributes of Their practice environment in acute care hospitals . Nurs J Manag. 2009; 17 (8) :965-74 . 5. Maslach C ,
Jackson SE . Maslach Burnout Inventory . 2nd ed . Palo Alto , CA : Consulting Psychologists Press , 1986 . 6.
Bussab WO , Miazaki ES , Andrade DF . Introduction to cluster analysis . National Symposium on Probability
Statistics ( SINAPE ) . 1990. Sao Paulo . Brazilian Statistical Association , 1990. 105p 7. JFJr Hair , Anderson RE ,
Tatham RL , Black WC . Multivariate Data Analysis . Bookman , 2005. 8. Tamayo RM . Relationship between Burnout
Syndrome and organizational values in the nursing staff of two public hospitals . Dissertation unpublished . University
of Brasilia . 1997.
Contact
[email protected]

A 06 - Potential Development Within Nursing Programs
A National Survey of Faculty Knowledge and Experience with Lesbian, Gay,
Bisexual and Transgender (LGBT) Health and Readiness for Inclusion in
Teaching: Curricular Implications for Baccalaureate Nursing Programs
Fidelindo Lim, DNP, CCRN, USA
Purpose
The purpose of this presentation is to discuss findings of a U.S. national survey on faculty knowledge,
experience and readiness to integrate LGBT health in baccalaureate nursing programs. Curricular
implications and best practices in implementing LGBT health inclusion will be explored.
Target Audience
The traget audience of this presentation include nursing faculty, researchers, nurse preceptors, nursing
school administrators, LGBT policy advocates and nursing students,
Abstract
Purpose: The purpose of this faculty needs assessment survey is to appraise the LGBT health
knowledge, experience and readiness teaching LGBT health topics among the nursing faculty in
baccalaureate programs across the U.S.
Methods: An investigator-developed Likert-type survey questionnaire was used to collect data using
Qualtrics. Direct online solicitation of all chief administrative leader whose names and e-mail
addresses are publicly available on the website of the American Association of Colleges of Nursing
(AACN) (N=739) was conducted. The nursing school’s chief administrative leaders were requested to
forward the study link to all faculty teaching in the baccalaureate program.
Results: Of 1,119 participants, 43% reported limited or somewhat limited knowledge of LGBT health and
37% indicated limited awareness of LGBT health topics. Between 23 to 63% of respondents indicated
either never or seldom teaching LGBT health and 52% reported being fully or adequately ready
integrating LGBT health in their teaching. The median time devoted to teaching LGBT health is 2 hours.
Conclusion: Nursing faculty teaching in baccaluareate programs have limited knowledge of LGBT health
and a majority feels ready to integrate LGBT health into the courses they teach. Reviewing the curriculum
to identify gaps in LGBT health education is viewed by 75% of the respondents as the most essential
strategy in aligning the curriculum and designing faculty development activities with national LGBT health
priorities.
References
Dorsen, C. (2012). An integrative review of nurse attitudes towards lesbian, gay, bisexual, and transgender patients.
Canadian Journal of Nursing Research, 44, 18-43. Eliason, M., Dibble, S., & De Joseph, J. (2010). Nursing's silence
on lesbian, gay, bisexual, and transgender issues: The need for emancipatory efforts. Advances In Nursing Science,
33, 206-218. doi: 10.1097/ANS.0b013e3181e63e49 Institute of Medicine. (2011). The health of lesbian, gay,
bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National
Academy Press. Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., … Lunn, M. R.
(2011). Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA, 306,
971-977.doi: 10.1001/jama.2011.1255
Contact
[email protected]

How Politics Affect the Development and Evolvement of a Nursing Program:
Engaging Colleagues in the Community to Improve Global Health Outcomes
Patricia R. Messmer, PhD, RN-BC, FAAN, USA
Annette Gibson, DNP, MEd, RN, CNE, USA
Amy C. Pettigrew, PhD, RN, CNE, ANEF, USA
Purpose
To discuss how politics in US and Cuba affected the development and evolvement of a nursing program
in South Florida. To relate how the nursing program has engaged nursing colleagues to improve global
health outcomes.
Target Audience
All nurses who are interested in historical nursing research and motivated to understand the implications
of politics upon the development and evolvement of a nursing program
Abstract
On December 10, 2013 Barack Obama shook hands with Raul Castro at Mandela’s’ memorial in South
Africa. This gesture can be viewed as a move toward global cooperation and expanding Miami Dade
College (MDC) community across 90 miles addressing community health nursing, service learning and
medical missions for academics and global health outcomes.
Purpose: of this historical study was to shed light of the Cuban influence for the past 50+ years on the
nursing program at Miami Dade College (MDC).
Methods: Interviews from primary and secondary sources were collected along with a collection of
historical documents and newspaper articles. Validity of documents was established by external criticism;
reliability by internal criticism.
Results: The opening of the nursing program at Dade County Junior College began a new era of nursing
education for Miami’s diverse community. The program began soon after the federal government deeded
the old Marine airbase replete with buildings, barracks and an airfield on NW 27th Avenue to Miami-Dade
for $1.00. Operation Pedro Pan (1960-1962), a codename of the CIA project with 14,000+ Cuban
children being sent by their parents to Miami, Florida after rumors spread that Fidel Castro would begin
taking children against their parents’ wishes to military schools and Soviet labour camps. Pedro Pan
transported the children of parents who opposed the revolutionary government and placed them with
friends, relatives and group homes in 35 states. Until the last “freedom flights” ended in April 1973 there
was a constant stream of Cuban exiles filing through the Freedom Tower which is owned by the President
of MDC since he and other administrators, faculty and students are Cuban exiles. Chloe Trammel, a
former instructor at Jackson Memorial Hospital and on Florida League for Nursing Board was the first
director with 10 faculty at Miami-Dade Junior College (North Campus) program in 1962. Under Trammel’s
leadership, 26 students enrolled in Dade County’s first program to offer a two year associate degree in
nursing (ASN). In 1969, Mike Kinkead was the only man on the South Campus with Director Cora
Mazzagatti. Mike, married to Emilie of the US Air Force Medical Corps was inspired to pursue nursing at
Miami Dade Community College (MDCC) after 4 years as an Air Force medical specialist; Mike was
discriminated on gender bias while applying at different nursing schools. In 1969, Mike became President
of the Florida Student Nurses Association while he and Emilie worked as CNAs at Baptist Hospital. In
1971, the LPN program transferred from Mount Sinai Hospital to MDCC. Under Dean Jeanne Stark
(1978-1989), Chairperson of Florida Board of Nursing, the nursing programs included “Bridging Cuban
Nurses in Exile”, educating foreign educated physicians for nursing, providing programs for RNs returning
to work. Sylvia Edge (1990-1995) instituted flexible schedules and offered classes at hospitals facilitating
LPNs to ASN, based on King’s Goal Attainment Theory. Director Fran Aronvitz (1966-2004) offered
innovative programs with 100% scholarships; more than 50% of the graduates proceeded to 4 year
colleges with Nurses Charitable Trust Scholarships. Lessie Pryor (2006-2009) developed computerized

testing when only 4% of the schools used it and launched the RN-BSN program. Dean Amy Pettigrew has
integrated human patient simulation into the classroom, encouraged medical missions to Haiti and
Dominican Republic for faculty and students and hosts nursing students from Haiti for immersion.
Conclusion: Many of the area clinical nurses and nursing faculty began their career at MDC. There are
75+ faculty, 100 adjuncts teaching 650 students in RN-BSN (with an Honor Society) and 1200 in ASN (N-
OADN Honor Society) programs with 60% Hispanic, 30% Blacks and 10% White; 80% females 20%
males. More than 19,000 nurses have earned their degrees from MDC, making it the largest area
provider of nursing education especially for culturally diverse students. MDC nursing graduates, like their
predecessors, serve Miami’s ever-growing global community and perhaps Cuba in the future.
References
Ardalan, C. (2005). Warm Hearts and Caring Hands: South Florida Nursing from Frontier to Metropolis 1880-2000.
Centennial Press, Miami, Florida Ardalan, C & Messmer, P. (2007). Private Duty Nurse Undine Sams: Passion,
Power & Political Action. Centennial Press, Miami, Florida. LoBiondo-Wood, G & Haber, J. (2010). Nursing Research
7th ed Mosby Elsevier St. Louis,MO Polit, D.F. & Beck, C. T. (2012). Nursing Research: Generating and Assessing
Evidence for Nursing Practice 9th edition. Wolters Kluwer Health/Lippincott Williams & Wilkns Philadelphia, Pa
Contact
[email protected]

Development of Educational Program for Vietnamse Nurses Using ADDIE Model
Sunjoo Kang, PhD, South Korea
In-Sook Kim, PhD, South Korea
Purpose
The purpose of this presentation is to share the educational program development prosedd for nurses
working at the hospitals in the central region of Vietnam
Target Audience
The target audience of this presentation is either academic researcher or professors who are interested in
improving global nursing education especially least developed countries.
Abstract
Purpose: This study is to develop the educational program for nurses working at the hospitals in the
central region of Vietnam. The central region is a well-known place for former Vietnam war battlefield and
is the least developed area. There are many nurses who are in need of continuing education for their
competency maintaining and improvement in central regional hospitals in Vietnam. In this research, 6
hospitals and 488 nurses were selected in a provincial hospital. Less than 10 percentage of total nurses
has bachelor degree and remainders have associate bachelor degree. In addition, it shows a variety of
nurses’ educational gap between urban and rural hospitals.
Methods: To develop special educational program, ADDIE was applied. It is a widely used systematic
instructional design model composed of five phases such as analysis, design, develop, implement, and
evaluation. With the purpose for this study, we just focused on three phases of ADDIE from analysis to
develop. In analysis phase, An expert panel meeting was implemented in Vietnam for two times. The
result of analysis was reflected for designing of the program and finally it was converged to special
educational program.
Results: The result of the analysis was very meaningful. We included experts from two Vietnam
nursemanagers, two Vietnam doctors who has fellowship in Korea, and two professors from Korea. It
took for 3 months from analysis to develop phases. At first, we figured out that two major needs such as
trauma nursing and emergency maternal child nursing for learning after the expert meeting, making
consideration them as main topics. After another expert meeting, a lots of worries were drawn about
educational methods and materials because even though they wanted to learn main topics, their entry
level of knowledge and clinical experiences were not appropriate for problem-based learning.
Furthermore, it was so natural to be instructed by doctors in their culture. Second phase of design was
excelled by the first analysis process. We had to make easy teaching and learning method for them, and
we concluded that if we use audio-visual nursing skill video in learning session it would be a great help for
them. We used a videos system for nursing students and assessed the usefulness of it. Two Vietnam
doctors and professor working at Hue University responded that the suggested method is very good for
rural hospital nurses’ competency building. What we need is to translate Korean to Vietnamese without
mistaking cultural difference. We were lucky to find a woman who became a naturalized Korean with
majoring Korean language at the University in Korea. We planned translating work into two steps, a draft
version and expert revision. Third phase was developing a special educational program composed of
main topics so we could rearrange video lists having main topics and the level of skill. Average time of
each video is five to ten minutes and total number of 40 lists. Some nursing skills are performed both
doctors and nurses and we excluded doctors-owned skills even though they are allowed to nurses in
Korea.
Conclusion: We researched on the improvement of nursing education and practice in Vietnam. However,
we could not expect visible outcome so fast. For example, Vietnam does not have a license examination
or qualification proving system so whoever graduates from nursing college or program they can practice
at the hospital. In spite of these surrounding, we have a very optimistic view because Vietnam has
changed into global economy after doi moi while maintaining socialist regime. In addition, the changes of

disease structure and the reasons of death compared to other underdeveloped countries are not similar
to other underdeveloped countries, so we would take an another step to look inside to draw out their
needs and design for educational program for fulfill their requirements.
Since development of an educational program using ADDIE was very effective in systematically with
analyzing and then connecting to other phase, an each step having some outcome could convert into
next. Especially, there were some considerations to sort out the lists of subtopics because of difference in
work environment, job description among healthcare providers, and organizational culture. For example,
nasopharyngeal airway is only permitted to doctors. In needle decompression, doctors can do that
emergency skill while in Korea paramedic can do for saving patients from life threatening condition. It
means that we have very differentiated healthcare personnel according to their specialty area in Korea,
but there are non-existence of paramedic in Vietnam.
Through sequential three phases, we made a special educational program for hospital nurses working at
central region of Vietnam. We hope that this special program for improving hospital nurses competency
contribute to the situation for transitional patterns of health and medical disease. In addition, they could
have half-year in service education once or twice a week as scheduled with developed audio-visual
teaching method.
References
Chapman H, Lewis P, Osborne Y, Gray G. An action research approach for the professional development of
Vietnamese nurse educators. Nurse Educ Today. 2013 Feb;33(2):129-32. doi: 10.1016/j.nedt.2011.11.010. Epub
2011 Dec 3. Harvey T, Calleja P, Thi DP. Improving access to quality clinical nurse teaching--a partnership between
Australia and Vietnam. Nurse Educ Today. 2013 Jun;33(6):671-6. doi: 10.1016/j.nedt.2012.02.001. Epub 2012 Feb
29. Kulatunga GG, Marasinghe RB, Karunathilake IM, Dissanayake VH. Development and implementation of a web-
based continuing professional development (CPD) programme on medical genetics. J Telemed Telecare.
2013;19(7):388-92. doi: 10.1177/1357633X13506525. Reinbold S. Using the ADDIE model in designing library
instruction. Med Ref Serv Q. 2013;32(3):244-56. doi: 10.1080/02763869.2013.806859. Robinson B.K, Dearmon V.
Evidence-based nursing education: effective use of instructional design and simulated learning environment to
enhance knowledge transfer in undergraduate nursing student. J Prof Nurs. 2013 Jul-Aug;29(4):203-9. doi:
10.1016/j.profnurs.2012.04.022. Sunjoo K. Educational Requirements for Nurses Working at Central Region
Hospitals in Vietnam. 9th International Nursing Conference. 2013.10.20. Oral Presentation. Sunjoo K, Insook K. A
Prospect of Official Development Assistance in Nursing Management. 2013 Conference of Korea Nursing
Administration. 2013.12. 6. Poster Presentation.
Contact
[email protected]

A 07 - Pediatric Health Promotion
Validation and Sensitivity Pictorial Pediatric Symptom Checklist
Elif Ardic, MA, Turkey
Gul Unsal Barlas, PhD, Turkey
Serap Bulduk, PhD, Turkey
Purpose
to share the results of PPSC's validity and reliability in Turkish society - to introduce the Turkish version of
PPSC, which has translations only in English,Spanish and Filipino, to the field. - to highlight the
importance of this study by adjoining one more new study to the epidemiological ones.
Target Audience
The target audience of this presentation includes: -psychiatrists,psychologists,pediatry nurses, and the
other health staff, -academicians who take special interest in child-adolescence mental health, -nurses
working in schools, -other staff, especially school counsellors, who take care of children’s social problems
in schools where there are no nurses available, -social workers.
Abstract
Purpose: The purposes of this study are to share the results of PPSC's validity and reliability in Turkish
society, introduce the Turkish version of PPSC, which has translations in only 3 different languages
(English,Spanish and Filipino) and contribute to other studies carried out in the future, and draw people's
attention to the importance of this study by adjoining one more new study to the epidemiological ones
which are insufficient about the psycho-social problems of childhood in the world.
Methods: This study was carried out methodologically in order to report translation and adaptation of the
Pictorial Pediatric Symptom Checklist (PPSC) from English into Turkish and estimates of validity and
reliability of the Turkish version.
Results: The Content Validity Index was found to be 92.2%. According to the split half analysis, the
reliability levels were sufficient for one of the halves and for the whole scale (r=0.751 and r=0.858
respectively). Among the item-total correlations, the correlation of only one of the items (#20) was found
to be below 0.30. The Cronbach’s alpha internal consistency of the PPSC was found as 0.89. One of the
items was excluded from the scale, so the factor analysis was conducted with a total of 34 items. As a
result of the factor analysis, a four-factor construct was created. The factor load values of the items varied
between 0.33 and 0.72. The variance that the four-factor construct accounted for was 37.63%. The
results showed that the Turkish version of the PPSC was a valid and reliable screening instrument for
examining psychosocial and behavioral disorders in children.
Conclusion: In this study Cronbach Alfa of the PPSC was found 0.89. Borowsky, Mozayany and Ireland
(2003) found the total Cronbach Alfa of PSC 0.67. These results (Gardner et all 1999) are equal to the
results of Dutch version of PSC (Reijeneveld, Volges, Hoekstra and Crone 2006) and Filipino version of
PPSC (Canceko-Llego et all 2009). In addition, according to the split half analysis, it was found that the
reliability levels were sufficient for one of the halves (r=0.751) and for the whole scale (r=0.858) in terms
of suggested levels (Akdag 2011). In Erdogan and Ozturk(2011)'s study, retested test sensivity of Turkish
PSC was found 0.72. The results of this study showed that 11 of 100 children are at a critically psycho-
social problem level (28 points and over 28). Canceko-Llego and et all (2009) found this rate in a higher
level, which is %18. 9, in Filipino society. It was found in Leiner and et all (2010)'s study, in which they
used PPSC in Mexican society, at level %16. Jellinek and et all (1999) found it %12.5 in PSC study.
Contact
[email protected]

Factors Predicting Resourcefulness in Taiwanese Preadolescents
Ya-Fen Wang, PhD, MSN, RN, USA
Jaclene A. Zauszniewski, PhD, RN-BC, FAAN, USA
Purpose
The purpose of this presentation is to present study findings about the predictors of Taiwanese
preadolescents' resourcefulness.
Target Audience
The target audience of this presentations is nursing researchers and healthcare providers.
Abstract
Background/Significance: Resourcefulness is a set of cognitive and behavioral skills for coping with
stress in order to maintain quality of life. Resourcefulness begins to develop in early childhood and is
reinforced by further learning throughout life. However, research examining intrinsic (individual) and
extrinsic (family and caregiver) contextual factors in the development of resourcefulness in children is
limited. Purpose: This study examined the effects of the intrinsic and extrinsic contextual factors on
resourcefulness in Taiwanese preadolescents. Theoretical framework: Zauszniewski’s middle-range
theory of resourcefulness and quality of life provided the context for examining the relationships among
theory-driven variables. Subjects: A convenience sample of caregiver-preadolescent dyads from 368
families were recruited within communities in Taiwan. Methods: A cross-sectional approach was used to
examine hypothesized predictive effects of intrinsic contextual factors (children’s age, gender, school
performance, academic stress, and dispositional optimism/pessimism) and extrinsic contextual factors
(family income, caregivers’ age, gender, education, dispositional optimism/pessimism, and
resourcefulness) on preadolescent’s resourcefulness. Results: Academic stress and dispositional
optimism were found to be significant predictors of preadolescents’ resourcefulness (beta = -.22, p < .001
and beta = .39, p < .001). Preadolescents’ age and gender did not have influence on their
resourcefulness. Extrinsic contextual factors (family income, caregivers’ gender, education, dispositional
optimism, and resourcefulness) did not predict preadolescents’ resourcefulness. Conclusion: The
findings suggest that Taiwanese preadolescents’ resourcefulness was greatly influenced by their
academic stress and dispositional optimism. Further research may explore longitudinal effects of
academic stress and dispositional optimism on preadolescents’ resourcefulness in larger, more diverse
samples.
References
Lai, J.C.L. (2003, July). Psychological Impact of Economic Restructuring in Hong Kong. The 5th biennial Conference
of the Asian Association of Social Psychology, Manila, Philippines. Leung, G.S.M., Yeung, K.C. & Wong, D.F.K.
(2010). Academic stressors and anxiety in children: The role of paternal support. Journal of Child and Family Studies,
19, 90-100. Wu, H.-Y., Lin, Y.-N., Chen, H.-C., Chiu, F.-C., & Hsu, C.-C. (2008). The verification and measurement of
the bi-dimensional construct of optimism-pessimism. Psychological Testing, 55(3), 559-589. Zauszniewski, J.A.
(2006). Resourcefulness. In J. J. Fitzpatrick & M. Wallace (Eds.), Encyclopedia of nursing research (pp. 256–258).
New York, NY: Springer. Zauszniewski, J.A., Bekhet, A.K., & Bonham, E. (2010). Psychometric testing of the
children’s resourcefulness scale. Journal of Child and Adolescent Psychiatric Nursing, 23(3), 181-188. Zauszniewski,
J.A., Lai, C.-Y., & Tithiphontumrong, S. (2006). Development and testing of the resourcefulness scale for older adult.
Journal of Nursing Measurement, 14(1), 57-68.
Contact
[email protected]

Non-Urgent Emergency Department Use in an Urban Pediatric Primary Care
Population
Mei Lin Chen-Lim, MSN, RN, USA
Purpose
The purpose of this presentation is to describe the prevalence of non-urgent ED use in an urban pediatric
population, compare the urgent and non-urgent use based on race and insurance status, and to describe
the reasons why parents bring children to the ED when access to care are available.
Target Audience
The target audience of this presentation is nurses who have influence in urban low-income minority
population from health administration to direct patient care.
Abstract
Purpose: The purpose of this study is to evaluate the reasons that families use the Emergency
Department (ED) for their child’s non-urgent care when primary or after hours care is available.
Background and Significance: Garcia et al (2010) reported approximately 20% of patients nationwide,
with at least one Emergency Department (ED) visit, were children (ages 0-17 years). Past studies
reported that approximately half or more of these visits were for non-urgent conditions (Zandieh,
2009). Ambulatory Care Nurses provide primary well child and illness care to assist patient and families
to better manage health and illness in community settings through the use of a triage system and defined
protocols for decision making. Despite our best efforts, patients often seek care in the ED when access to
a primary care provider (PCP) or after hours program (AHP) is available. The increasing trend results in
an interruption of continuity in care which ultimately affects the quality of patient care as while impacting
negatively on health care costs.
Setting: The Children’s Hospital of Philadelphia (CHOP) South Philadelphia Primary care site is a large
urban pediatric primary care site serving low income minority families – primarily African American, Asian,
or Hispanic. There are approximately over 10,300 patients with an estimate of over 30,800 visits per
year. Languages spoken from this population include English, Spanish, Indonesian, Arabic, Cambodian,
Vietnamese, French, Urdu, Chinese, etc. Health insurance status includes state Medicaid (73.5%),
Private (25.7%), and Self Pay (0.85%). The CHOP level I trauma center ED serves approximately 85,700
visits per year. Each visit is triaged based on the Emergency Severity Index (ESI) which is a 5-Level
Triage System where the non-acute is rated as Level 4 and Level 5 (Gilboy, 2005).
Methods: A primary care based nursing research study was developed to evaluate the reasons for the
non-urgent ED use. IRB approval was obtained and study was completed early 2012. This descriptive
study consists of a retrospective chart review to determine incidence of non-urgent ED use and a
prospective parent telephone interview to identify factors that led to non-urgent ED use. The sample
consists of patients less than 17 years of age from an urban Philadelphia primary care center that used
the CHOP ED during 2011, and who were identified as non-acute based on a level system utilized by the
ED. A subsample of non-urgent, non-referred, patients was eligible for scripted telephone
interviews. Non-urgent was defined as care that can be administered by the primary care office (PCP)
during office hours or by telephone support that can be provided by After Hours Program (AHP) Call
Center during non-office hours.
Results: During 2011, the South Philadelphia primary care site had 4484 CHOP ED visits. An estimated
1450 visits (32%) were triaged as level 4 or 5 which represented non-acute visits. Medicaid was the
primary insurance (76.5%). In regards to race, utilization of the ED from the Asians group were
unchanged regardless of insurance status and were primarily triaged as level 5 (33% for Medicaid and
37% for private). Similarly, the White population ED utilization was also unchanged regardless of
insurance status but was primarily triaged as level 3 (36% for Medicaid and 47% for Private). For the

Blacks population, the majority utilization did change with insurance status from level 5 (33% for
Medicaid) to level 3 (41% for Private).
From the chart review data, a total of 869 non-acute ED visits were reviewed with 742 of those
determined to be non-urgent. The mean age was 4.11 years and the gender was even with 371 females
(50%). Blacks were the primary population (64%) followed by White (14%). Majority had insurance
(96%) with coverage through state Medicaid (86%). Majority of the patients were not referred by primary
care providers or after-hours program (89%). The duration of the ED visits last an average of 3.12
hours. The top 5 chief complaint were fever (247), vomiting (96), rash (78), cough (68), and ear pain
(60). The top 5 discharged diagnoses were fever (239), acute upper respiratory tract infection (156), viral
Syndrome, not otherwise specified (121), cough (89), and suppurative and unspecified otitis media,
acute, without eardrum rupture (78). Other descriptive statistics include the day and time of the ED visit
and frequency of non-urgent visits per patient. Reports from scripted interview include: treatments tried at
home prior to visit, reason for going to ED versus using the AHP or PCP, knowledge of AHP and
perception of waiting time and services provided from the ED vs. primary care. Frequently reported
symptoms reflected viral illness; Fever was most commonly mentioned symptom to bring child to
ED. Only 60% reported knowledge of AHP.
Conclusion: Majority of the patients are using the ED for non-urgent care especially during the times
when appointments are available. Subjects were primarily less than 5 years of age from the minority
population groups with state insurance. Majority have no prior contact with the PCP office or AHP
Program prior to the ED visit. Frequently reported symptoms reflected viral illness; Fever was the most
common mentioned symptom to bring child to ED. One-third reported coming to ED because of tests,
equipment, or better confidence at the hospital. Only 60% reported knowledge of AHP; however, majority
who used AHP reported as helpful.
Clinical Implications: Results of this study have led to practice care changes implemented in the primary
care setting that improve the clinic workflow such as identifying and educating families who use the ED
for non-urgent reasons. This has also strengthened the partnership with parents while empowering them
to seek care through appropriate channels. Programs such as ED use Education, Access to Care Guide,
Parent Education Toolkit on Fever, Office Video Education (English & Spanish) while waiting and Fever
teaching at newborn, 5 week and two month visit have been implemented as a result of the study
findings. Long term outcomes of study findings will be reduced use of the ED for non-urgent care and
improved clinic systems to support ill child services.
References
Garcia, T.C., Bernstein, A.B., & Bush, M.A. (2010, May). Emergency department visitors and visits: Who used the
emergency room in 2007? NCHS data brief, no 38. Hyattsville, MD: National Center for Health Statistics. Retrieved
from http://www.cdc.gov/nchs/data/databriefs/db38.pdf Rocovich, C. & Patel, T. (2012). Emergency department visits:
Why adults choose the emergency room over a primary care physician visit during regular office hours? World
Journal of Emergency Medicine, 3, 2, 91-97. DOI: 10.5847/ wjem.j.1920-8642.2012.02.002 Zandieh, S., Gershel, J.,
Briggs, W., Mancuso, C., & Kuder, J. (2009). Revisiting predictors of parental health care-seeking behaviors for
nonurgent conditions at one inner-city hospital. Pediatric Emergency Care, 25, 238-243.
Contact
[email protected]

A 09 - Global Prevention and Management of Cardiovascular Related
Disease
Factors and Outcomes Associated with Hypertension Management: A Structural
Model
Shiah-Lian Chen, PhD, RN, Taiwan
I-Chen Liao, MSN, RN, Taiwan
Wen-Lieng Lee, PhD, MD, Taiwan
Purpose
The purpose of the presentation is to present a hypothesized model of hypertension management based
on framework of the self regulation model using the technique of structural equation modeling approach.
Target Audience
The target audience of this presentation is those who are interested in management of chronic illness,
and in researches related to theoretical framework testing.
Abstract
Purpose: The purpose of the study is to examine a hypothesized and comprehensive model of factors
and outcomes associated with hypertension management based on the theoretical framework of the self-
regulation model (SRM).
Methods: The study was correlational with a questionnaire survey design. A purposive sample with a
total of 301 valid cases was drawn from 2 teaching hospitals in central Taiwan. Structured questionnaires
used for data collection included the Chinese Illness Perception Questionnaire-Revised (including
identity, cause and illness representations), the Medication Adherence Inventory (MAI), the Self-
Management Adherence Inventory (SMAI), the Treatment Satisfaction Questionnaire for Medication
(TSQM), the Hypertension Quality of Life Questionnaire (HQOLQ), and Profile of Mood States (POMS).
The IBM SPSS statistics (version 19.0 for PC) were used to explore descriptive statistics. The software of
LISREL version 8.54 was used to examine the hypothesized structure model.
Results: The results of structural equation models showed that the modified model was better fit to the
data than the theoretical model proposed by the SRM, because after adding illness identity into the
original self- regulation model as an antecedent, the model fit indices were improved significantly. Illness
identity was significantly and directly associated with negative illness representations, control, cause,
HQOLQ and POMS. Negative illness representations were negatively related to TSQM and positively
associated with SMAI. Control was negatively associated with SMAI and positively associated with MAI.
Cause was negatively associated with MAI. Both SMAI and MAI were negatively and significantly related
to both HQOLQ and POMS.
Conclusion: The findings suggested that illness identity may affect patients’ quality of life and mood
states directly and indirectly through illness perceptions, adherence to prescribed medication and self-
management. Yet, negative illness representations, control and cause may affect behavior outcomes
indirectly through different pathways. In sum, the study findings provide evidence explaining possible
mechanisms associated with adherence behaviors and behavior outcomes of patients with hypertension.
Further study may validate the causal relationships using an experimental study design.
References
Lorber, W., Mazzoni, G., & Kirsch, I. (2007). Illness by Suggestion: Expectancy, Modeling, and Gender in the
Production of Psychosomatic Symptoms. Annals of Behavioral Medicine, 33(1), 112-116. Moss-Morris, R., & Yardley,
L. (2008). Current issues and new directions in Psychology and Health: Contributions to translational research.
Psychology & Health, 23(1), 1-4.
Contact
[email protected]

Disease
Effects of Self-Management Education Programme in Improving Self-Efficacy of
Patients with Chronic Obstructive Pulmonary Disease: An Exploratory Trial
Wai I Ng, PhD, RN, Macau
Purpose
The purpose of this presentation is to share research findings derived from an exploratory RCT which
adopted mixed methods in examining a complex intervention. It also aims to draw attention to enhancing
the care delivery to Chinese COPD patients through research studies.
Target Audience
The target audience of this presentation is clinicians who work with chronically ill, researchers who are
specialized or interested in conducting nursing clinical trial or mixed methods, and administrative
personnels who are planning to initiate or evaluate chronic care delivery.
Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) cannot be cured, but can be prevented and
treated. Statistics show that it contributes more to the global burden of disease in terms of disability-
adjusted life years (DALYs) than other respiratory diseases. In Macau, respiratory disease is the top three
causes of all deaths in recent years (DSEC, 2008), however, the emphasis of healthcare service
provision in relation to COPD patients is mainly focused on acute management. Therefore, the purpose of
this study is to compare the self-efficacy of Macau COPD patients before and after implementation of self-
management education programme (SMEP).
Methods: An exploratory randomized controlled trial (RCT) was adopted (MRC 2008), and a mixed
methods approach was employed. 51 consented Macau COPD patients were randomly allocated to
experimental and control group. Experimental group received SMEP while the control group received
usual conventional care. All patients were assessed with COPD self-efficacy scale before and 6 months
after completion of self-management education. Focus group interviews were implemented to explore the
subjective view of patients towards their self-efficacy after the education.
Results: The patients demonstrated improvement in general self-efficacy and self-efficacy in intense
emotional arousal, physical exertion and weather/environmental effects. The subjective perception of the
patients towards the effects of SMEP in improving their self-efficacy was mostly consistent with the
quantitative findings, except that the programme was not the main cause for improving their self-efficacy
in negative emotional.
Conclusion: Macau COPD patients who are Chinese tend to tolerate intense emotional arousal and this
is a significant characteristic in Chinese. Due to the long lacking of chronic patient support, the Macau
COPD patients perceive self-management education programme as an essential element of self-efficacy
empowerment. Therefore, SMEP is necessary for COPD patients, but most importantly, the design of the
education should carefully put cultural factors into consideration.
Contact
[email protected]

Disease
How Risk Ideology Creates Patient Work in a Secondary Stroke Prevention Clinic:
Findings from an Institutional Ethnography in Canada
Sarah Flogen, RN, BScN, MEd, Canada
Purpose
share findings from an Institutional Ethnography that explored patient work in a secondary stroke
prevention clinic. Substantial patient health work went into providing information for the medical team to
discover a potential stroke, based on an ideology of risk. Patient experiential information was transformed
into objective, privileged data.
Target Audience
those who seek to understand how health care decisions have been made in Canada, those who have an
interest in a critical approach, those seeking to explore the workings of power and knowledge in health
care, those from an interdisciplinary practice and nurses interested in prevention and health promotion.
Abstract
Purpose: Patients at risk for stroke seem to have certain features of clinical importance which have been
associated with social determinants of health. Patients also seemed to be engaging with many activities
and life changes in order to reduce their risk of stroke. This project had two aims: to understand the role
of social determinates of health in health care, and to explore patient work in managing their stroke
risk. The purpose of this paper is to describe findings from a nursing doctoral dissertation which explored
the social organization of secondary stroke prevention from the standpoint of the patient.
Methods: The setting for this investigation was a Secondary Stroke Prevention Clinic (SSPC) which is
situated within a large academic hospital in downtown Toronto. This particular site was selected because
it is well known as a center of neuroscience expertise in Toronto, as well as a center known to serve a
diverse population. The staff in the clinic included two attending neurologists, a Fellow in neurology, an
Advance Practice Nurse (APN), a research nurse, and the on-call physiotherapist, an administrative
receptionist.
Institutional ethnography (IE) was used as the method of inquiry. IE requires two levels of data. In this
exploration, level one and level two data, as well as the connecting texts were collected. The first level of
data is about the local setting, the individuals that interact there and the accounts of their
experiences. These data were collected through observation, textual analysis, and interviews. In this
exploration, this included making visible the work of patients, understanding the work of the health
professionals in the clinic, attending to and capturing links to the extra-local and noticing and acquiring
texts that enter or exit the local setting. This included actively listening for ways the local setting was
organized externally by noting the texts, names of external clinics, companies or organizations. Activities
of both the patient and the health professional and the non-verbal behaviors of all parties were attended
to. Interviews were conducted with recruited people who came to see the neurologist and their family
members, spouses, or significant others. The setting and timing of these interviews flexed with the
rhythm of the clinic. These interviews were audiotaped with consent and transcribed. Interviews were
also conducted with the nurse and the doctors involved directly in the clinic appointments. Sometimes
these were formal interviews; sometimes these were quick clarifying questions between patients or after
clinic hours. Formal interviews were audiotaped and transcribed. Texts that entered, were part of, or
exited the clinic area were gathered for analysis. Research Ethics Board approval was received from the
hospital site.
Results: Regarding the role of social determinants of health: findings were drawn from the social
organization of knowledge that became apparent: the privileged knowledge is biomedical; social
knowledge was not included in the clinic, or in the system. Specifics: Using imperial and colonial
language embedded with risk, a speech delivered at an elite club pitched a new model of health care

called the Ontario Stroke Strategy. Formulated around the changing paradigm of stroke, an
interventionist one: the use of a medication administered to patients during the acute event of stroke and
stroke prevention mechanisms, the design of the model that was promoted, marketed and approved was
a model that spanned the ‘continuum of care’. One element of this continuum included Secondary Stroke
Prevention clinics, the setting of this study. These clinics represented a new medical
specialization. The definition of stroke prevention and the use of the modified Rankin Scale on the
stroke data sheet highlight the purpose of the clinic – the prevention of disability, defined as an economic
burden. The Empire Club speech argued that stroke is an expensive social burden and that reducing
damage from stroke would result in economic savings. Biomedical knowledge was privileged and
promoted by the Ontario Government, pharmaceutical companies and the Heart and Stroke Foundation
as they linked arms and successfully gained Ontario Provincial funding investment in reorganizing stroke
care around an interventionist, high risk pharmaceutical agent, continuing the investment in acute care
and industry interests.
2) Regarding patient work: The concept of ‘secondary’ prevention became visible as different than
primary prevention. The role of this secondary stroke prevention clinic is to provide precise targeted
investigations and interventions to very high risk patients after they have presented to a health care
referral source with symptoms of stroke or a completed prior stroke. All patients or their families in this
study identified a symptom that brought them to a health care provider. Three of eight patients related
their symptom to possible stroke, and specifically sought care for this. Their work of self-detection of
symptoms was promoted through social marketing strategies including a Heart and Stroke refrigerator
magnet and television commercials. Symptoms activated the medical team to search for disease, both
as a source of stroke and for risk factors. This search was conducted using imaging of the brain and
blood vessels, blood work, and heart rhythm tests. Pre-scripted assessments suppressed patient
experience, transforming it into stroke risk relevance. Subjective data entered into the clinic, was gleaned
as a vehicle to mining the patient for objective data. This objective data would then inform the possible
treatments, based on the statistical formulas such as “number needed to treat.” Patient work was
substantial and included providing a narrative medical history, attempting to answer technical questions,
attempting to have questions answered, listening to follow-up verbal instruction, attending to follow-up
investigations, taking medications, processing brain images, comprehending the numbers of blood
pressure and blood results, participating in assessments, examination and scales, going for blood work,
and participating in challenging discussion about the greatest risk.
Conclusion: The tools of institutional ethnography were used to explicate the social organization of
secondary stroke prevention. The standpoint used was that of the patient. Locally, patients work and
experience are organized by the texts that enter and exit the clinic; the extra-local connections to these
texts inform the work process and activities of connected sites. The referral form linked to referral
sources such as the family physician, the involved doctors’ act of information sharing and the clinic work
of managing urgency and risk. The triage form revealed the urgency and risk imperative. The letter of
appointment revealed the patients work of participating in the clinic appointment as personal knowledge
broker in bringing medications and scans, and revealed these two components as valuable. The stroke
data collection sheet linked to the Institute for Clinical and Evaluative Studies, a government evaluation
arm, and the expected performance of the clinic. The symptom magnet linked to the Heart and Stroke
Foundation, their work of social marketing, and patient work of symptom identification.
Textual analysis of these documents makes visible the biomedical ideology of risk that supported
prevention as a biomedical specialty. The major techniques and patient work arising from the stroke
prevention clinic involves the use of technology to determine disease and risk factors within the body, and
subsequent attempts to modify those risk factors through primarily pharmaceutical means. Factors known
as socially determined consequences of health sociologically are known only as biomedical risk factors in
the clinic, by the patients and in the greater extra local community. The ideology of risk seems to hold the
clinic hostage and in the drive to identify and document risk factors, the work of patients is not visible, not
able to be raised by patients, and in fact taken for granted. As a society we have had our consciousness
subjugated to the ideology of risk.
The ideology of risk which provides the machinations of health service delivery in the secondary stroke
prevention clinic obscures the complexity of patients individually, biomedically, socially and morally. On
an individual patient level, people came to the clinic with multiple coexistent conditions. The secondary

stroke prevention clinic provided a narrow slice of expertise into the vast personal complexity. Biomedical
complexity was obscured by the singular focus of vascular disease on one organ of the body. Risk
factors named as stroke risk factors – high blood pressure, diabetes, smoking, dyslipidemia - are also
contributors to heart disease and vascular dementia. A clinic so micro-specialized that it focuses on one
organ of the body that is impacted by vascular disease, without a larger picture of the impact of vascular
disease on the body as a whole contributes to the creation of multiple appointments for patients . Social
complexity brings into view the social determinants of health. The same risk factors in the field of stroke
are the same factors considered consequences of poverty, low education, environment, social
exclusion. These social risks were not considered. The schema of the Ontario Stroke System has been
directed towards the individual body and that individual’s behavior. Socioeconomic status is listed as a
risk factor, but a non-modifiable one. Moral complexity is obscured when population statistical data is
used to develop an individual treatment plan, especially when the rationale for the treatment plan is made
apparent to the patient as was the case in this study.
References
1. Smith, D. (1987). The everyday world as problematic: a feminist sociology. Northeastern University Press: Boston.
2. Smith, D. (1990). The conceptual practices of power. Northeastern University Press: Boston. 3. Lock, M., &
Nguyen, V. (2010). An anthropology of biomedicine. Wiley-Blackwell: London. Stiker, H. (1997). A History of
Disability. University of Michigan Press: Ann Arbor.
Contact
[email protected]

A 10 - Transforming Nursing Through Education and Collaboration
Transforming Healthcare through Educational Diversity: Academic Health Center
Pipeline Project
Greer L. Glazer, RN, CNP, PhD, FAAN, USA
Purpose
This presentation’s purpose, targeted at educators, is to share interviews with best practice universities
and 20 community town hall meetings with educational community groups (high schools), neighborhood
community groups, professional community groups, and student groups with a high proportion of
underrepresented including socioeconomically disadvantaged, students in U.S. Midwestern urban areas.
Target Audience
This presentation’s purpose, targeted at educators, is to share interviews with best practice universities
and 20 community town hall meetings with educational community groups (high schools), neighborhood
community groups, professional community groups, and student groups with a high proportion of
underrepresented including socioeconomically disadvantaged, students in U.S. Midwestern urban areas.
Abstract
Purpose: The purpose of this IRB approved research was to assess and develop a plan for an
educational pipeline in which underrepresented (economically disadvantaged, ethnically and racially
diverse, first generation college student) high school students will be recruited into a major urban, U.S.
research University’s Colleges of Allied Health Sciences, Medicine, Nursing, and Pharmacy. Minorities
are grossly underrepresented in the U.S. healthcare workforce, accounting for only 16.8% of nursing’s
workforce (5.4% African American, 3.6% Hispanic, 5.8% Asian/Native American, 0.3% American
Indian/Alaskan Native, 1.7% Multi-Racial) and empirical evidence supports a lack of diversity in the
healthcare workforce negatively affects patient outcomes (AAMC 2006, AACN 2013, HRSA 2006). It is
projected that minorities will account for over half the U.S. population by 2043. With an increase in
minority patients, there is an escalation in the need for a culturally diverse workforce that has the
propensity to provide high quality, culturally competent care (U.S. Census Bureau, n.d., AACN, 2013).
Solutions to achieving workforce diversity are multifaceted and depend on fundamental reforms in
precollege systems (Cohen, 2002). Hence, development of a databased pipeline program is critical to
increasing the number of underrepresented students and subsequent healthcare providers.
Thirty-five articles published from 2000-2012 were found using the search terms “educational pipeline
healthcare providers” and “evaluating educational pipelines”. Although all described pipeline programming
to increase diversity, there were few that evaluated their programs or had research based outcome
measures.
Methods: We reached out to and interviewed personnel at four universities identified as having best-
practice pipeline models by the Urban Serving Universities. Information was gathered about specific
components of their educational pipeline, demographics and criteria for selecting participants, initial
funding and sustainability, program objectives, strategies for implementation including barriers, evaluation
and outcome measures, and their successes and failures.
The second step to develop the educational pipeline program was to reach out to connect and involve the
local community to receive their input and feedback on developing the educational pipeline plan. Twenty
community town hall meetings were held with educational community groups, neighborhood groups,
professional community groups, and student community groups in our local urban area. Local high
schools and neighborhoods were selected based on having a high proportion of underrepresented
students. There were twenty-two participants in educational town hall meetings; forty-eight participants in
neighborhood town hall meetings; fourteen participants in professional community town hall meetings,
and thirty-three participants in student town hall meetings.
Audio recordings from all best practice interviews and town hall meetings were transcribed and verified to
ensure the quality of the data. All researchers independently reviewed all transcripts and identified

themes and categories. The process of theme and category identification continued until there was 100%
agreement.
Results: Three themes were identified that will unleash affinity for and achievement in healthcare
professions: augmenting student capability, enhancing parental competence and enlisting potential
collaborators. Within these themes are the following categories:
Augmenting Student Capability:
• Academic support (skill building, tutoring, and math and science enrichment and development)
• Building confidence (skill building, communicating academic expectations, helping support “can do
this” attitude)
• Opening up the possibilities (early exposure, exposure over time, removing biases and stereotypes,
exposure to various healthcare careers)
• Dealing with individuals (not blanketing issues, dealing with health issues, start with the basics)
Enhancing Parental Competence:

• Parental support (helping parents through the process, educating them about possibilities, making
value of education understood, understanding college expectations)
• Process (communication, intentional about the outcomes, written information about career paths)
• Trust (addressing issues of health equity, lack of trust in healthcare providers, community
perception, and awareness of options available)
• Finances (parents and students need to understand their financial situation, scholarship
opportunities, how to apply for financial aid, how to apply for bridge programs)
Enlisting Potential Collaborators:
• Community enrichment (partnering with our community stakeholder groups to support success of the
student)
• Mentoring (success by association, description of a concrete pathway to becoming a health provider)
• Opening up the possibilities (early exposure, exposure over time, removing biases and stereotypes,
exposure to various healthcare careers)
• Systems of support (bridge between high school and colleges; clubs; mentoring; tutoring; providing
school advisors, counselors, teachers and parents accurate information about career options; and
college requirements/expectations)
Conclusion: Based on the findings, we recommended immediate implementation of pipeline components
that do not require funding or require minimal funding, and to start small by partnering with one primary
school and one high school. Future work will be needed to assess and develop a plan for a pipeline that
focuses on retention and graduation.
References
Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The case for diversity in the health care workforce. Health Affairs
(Project Hope), 21(5), 90-102. doi:10.1377/hlthaff.21.5.90 American Association of Colleges of Nursing (2013). Fact
Sheet: Enhancing Diversity in the Nursing Workforce. Retrieved from: http://www.aacn.nche.edu/media-
relations/diversityFS.pdf Association of American Medical Colleges (2006). Diversity in the Physician Workforce:
Facts & Figures, 2006. Retrieved from: https://www.aamc.org/download/87306/data/ U.S. Department of Health and
Human Services Health Resources and Services Administration Bureau of Health Professions (2006). The Rationale
for Diversity in The Health Professions: A Review of the Evidence. Retrieved from:
http://bhpr.hrsa.gov/healthworkforce/reports/diversityreviewevidence.pdf
Contact
[email protected]

A Systematic Review of the Effectiveness of Knowledge Translation Interventions
to Promote Evidence-Informed Decision Making Among Nurses in Tertiary Care
Jennifer Yost, RN, PhD, Canada
Rebecca Ganann, RN, MSc, Canada
David Thompson, RN, MN, Canada
Fazila Aloweni, RN, MSc, Singapore
Kristine Newman, RN, CRN (C), PhD, Canada
Afeez Hazzan, MS, Canada
Ann McKibbon, MLS, PhD, FMLA, Canada
Maureen Dobbins, RN, PhD, Canada
Donna Ciliska, RN, PhD, Canada
Purpose
disseminate the findings of a systematic review which considered whether knowledge translation
interventions are effective improving the knowledge, skills, and behaviours needed research evidence
use in decision making among nurses in tertiary care and patient outcomes as result of research use; and
the contextual factors for why these interventions “work”.
Target Audience
researchers advancing the field of knowledge translation and nursing leaders who are charged with
implementing research evidence in practice to promote positive client outcomes. These leaders include
researchers, faculty, nurse executives, nurse managers, advanced practice nurses, and nurses providing
direct client care.
Abstract
Purpose: To improve the quality of client care, nurses are increasingly expected to engage in evidence-
informed decision making (EIDM); the use of research evidence along with information about patient
preferences, clinical context and resources, and clinical expertise in decision making (American Nurses
Association; Canadian Nurses Association, 2013; DiCenso, Ciliska, & Guyatt, 2005; Kitson, 2004;
Nursing & Midwifery Council, 2008; Sigma Theta Tau International Honor Society of Nursing, 2005). It is
believed, however, that the use of research evidence by nurses is not optimal (Squires et al., 2011).
Knowledge translation (KT) interventions, such as education, reminders, and champions, have been
identified as ways to increase EIDM among health care professionals, including nurses (Grimshaw,
Eccles, Lavis, Hill, & Squires, 2012). Previous systematic reviews, however, have largely focused on the
effectiveness of these interventions among physicians and allied health professionals. Only one
systematic review (Thompson, Estabrooks, Scott-Findlay, Moore, & Wallin, 2007) has considered the
effect of KT interventions upon nurses’ research use. As such, there is a lack of synthesized evidence in
regards to the effectiveness of KT interventions among nurses, especially in regards to promoting EIDM
knowledge and skills. To address this gap and inform the real-world questions of decision makers who
are in a position within their organizations to influence the uptake of the findings to promote EIDM, the
objectives of this project were to determine: 1) if KT interventions are effective for promoting EIDM
knowledge, skills, and behaviours among nurses, 2) if KT interventions for promoting EIDM knowledge,
skills, and behaviours among nurses effective for changing client outcomes; and 3) what contextual
factors which shape the effectiveness of the interventions.
Methods: To address these objectives, a systematic review was conducted. Using an integrated KT
approach, the research team engaged partners from two academic health centres in Ontario and an
advisory committee which included frontline practitioners (nurses, advanced practice nurses) and nurse
decision makers (nurse managers, nurse educators) from these health centres, as well as representatives
from provincial and national organizations (Canadian Nurses Association and the Registered Nurses
Association of Ontario) (Canadian Institutes of Health Research, 2013). The partners and advisory
committee members provided input into the methodology of the systematic review. A search strategy for

published and unpublished literature identified relevant articles. This strategy included a search of
electronic bibliographic databases, handsearching of the references lists of included studies and key
journals, and searches of key sources of grey literature (i.e. Open Grey
(http://www.opengrey.eu/); National Institutes of Health Science of Dissemination and Implementation
conferences (http://obssr.od.nih.gov/scientific_areas/translation/dissemination_and_implementation), and
Joanna Briggs Institute (http://joannabriggs.org/). Articles retrieved from the search were screened
independently by two reviewers. Articles were deemed relevant if they: 1) focused on nurses, defined as
registered nurses and advanced practice nurses (including clinical nurse specialists, nurse practitioners),
2) were conducted in tertiary care, 3) implemented any KT intervention; a list of KT interventions was
compiled from a review of previous systematic reviews in KT, 4) considered the outcomes of EIDM
knowledge, skills, and behaviour, and patient outcomes as a result of EIDM behaviours, and 5) was a
systematic review, randomized controlled trial (RCT), cluster RCT, non-randomized controlled trial, cluster
controlled trial, interrupted time series design, or prospective cohort study, qualitative study (i.e.
descriptive, phenomenology, grounded theory), or mixed methods study. A third reviewer was available
to resolve discrepancies not achieved through consensus, as agreement was necessary for inclusion
during full-text screening. Risk of bias assessments and data extraction were performed by two
independent reviewers, with a third reviewer to resolve discrepancies. Cochrane Risk of Bias was used to
assess quantitative studies (Higgins et al, 2011) and The Joanna Briggs Institute Qualitative Assessment
and Review Instrument (QARI) was used to assess qualitative studies (The Joanna Briggs Institute, n.d.).
For mixed methods studies, assessment of methodological quality was completed separately for
quantitative methods and the qualitative methods using the aforementioned criteria. Included studies
were synthesized using narrative and meta-analytic methods.
Results: Of the 44, 608 articles screened, 33 articles met the inclusion criteria (five RCTs, six cluster
RCTs, five non-randomized controlled trials, five cluster controlled trials, eight qualitative descriptive
studies, and two grounded theory studies, and two mixed methods studies. Although the original intent
was to include systematic reviews and prospective cohort studies, the research team and partners
determined that due to differences in the questions and objectives of the systematic reviews retrieved that
they would only be included to inform the search and that given the relatively large number of high-level
studies that met the inclusion criteria (i.e. RCTs, cluster RCTs, non-randomized controlled trials, and
cluster controlled trials) that the prospective cohort designs representing low-level evidence would not be
included in the synthesis. The included studies were conducted in various countries and within different
clinical areas within tertiary care. The majority of KT interventions implemented were multifaceted and,
with the exception of the two single component interventions that implemented either computerized
decision support or access to a library system, the interventions included an educational aspect.
Educational meetings were implemented most often, followed by educational materials, and educational
outreach visits. A range of innovative KT interventions unique to nursing, not captured well within
traditional categorizations of KT interventions, were also identified. While none of the included studies
examined the effect of the KT interventions on EIDM knowledge and skills, they did evaluate the
implementation of interventions to promote engaging in EIDM behaviours (i.e., searching for the best
available evidence, critically appraising research evidence) or the use of research evidence (i.e., an
evidence-informed guideline, protocol, pathway) for practice change, as well as patient outcomes as
result of nurses use of research evidence. While the majority of the studies were synthesized narratively,
a meta-analysis of two studies identified that EIDM behaviours did not significantly increase as a result of
a multifaceted intervention which involved educational meetings and mentorship [mean difference 2.7,
95% CI (-1.7 to 7.1)]. Findings from qualitative and mixed methods studies identified barriers and
facilitators to implementation consistent with the literature. Context and leadership were determined to be
important factors influencing the implementation of KT interventions for supporting the use of research
evidence in practice. Across all of the included studies there was variation in the clinical areas,
interventions (i.e. components, intensity), and measurement of the outcomes which prevented
conclusions about the relative effectiveness single or multifaceted KT interventions, as well as aspects of
multifaceted KT interventions.While further work is needed to determine the most effective intervention to
promote EIDM among nurses in tertiary care, some of the KT interventions identified in this systematic
review do show promise.
Conclusion: This systematic review addressed a gap in the literature and was also relevant, timely, and
useful for the partners involved. Interventions to enhance the EIDM behaviours and patient outcomes

among nurses in tertiary care are being implemented and evaluated. Although the recommendations for
the implementation of specific KT interventions cannot be drawn, decision makers can refer to the
synthesis of the included studies to assist in selecting KT interventions which may be able to be applied
to their local context in order to promote evidence-informed nursing practice for the delivery of quality
client care. Furthermore, recommendations for nursing research and nursing education became apparent
during the synthesis of the included studies. Nurses engaging in formal research projects and quality
improvement projects are encouraged to enhance the reporting the details of the KT intervention being
implemented. In addition, methodologies such as interrupted time series studies and mixed methods
designs would improve the rigour of the evaluations being undertaken and further an understanding of the
context in which KT interventions “work”.
References
American Nurses Association. (2010). Nursing scope and standards for practice (2nd ed.). Washington, DC: Author.
Canadian Nurses Association. (2013). Position statement: Evidence-informed decision-making and nursing practice.
Retrieved from: http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS113_Evidence_informed_2010_e.pdf
Canadian Nurses Association. (2013). Position statement: Evidence-informed decision-making and nursing practice.
Retrieved from: http://www2.cna-aiic.ca/CNA/documents/pdf/publications/PS113_Evidence_informed_2010_e.pdf
DiCenso, A., Ciliska, D., & Guyatt, G. (2005). Introduction to evidence-based nursing. In A. DiCenso, G. Guyatt, & D.
Ciliska (Eds.), In Evidence-based nursing: A guide to clinical practice (pp. 3-19). St. Louis, MO: Elsevier-Mosby.
Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research
findings. Implementation Science, 7, 50. doi: 10.1186/1748-5908-7-50 Higgins, J. P. T., & Altman, D. G. (2011).
Chapter 8: Assessing risk of bias in included studies. J. P. T. Higgins & S. Green, Cochrane Handbook for Systematic
Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. Retrieved from
www.cochrane-handbook.org Kitson, A., Silverston, H., Wiechula, R., Zeitz, K., Marcoionn,i D., & Page, T. (2011).
Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local
level. Journal of Nursing Management, 19(4), 542-555. doi: 10.1111/j.1365-2834.2011.01258.x Nursing & Midwifery
Council. (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. Retrieved from
http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf Sigma Theta Tau International Honor
Society of Nursing. (2005). Evidence-base nursing position statement. Retrieved from:
http://www.nursingsociety.org/aboutus/PositionPapers/Pages/EBN_positionpaper.aspx Squires. J. E., Hutchinson. A.
M., Bostrom. A. M., O'Rourke. H. M., Cobban. S. J., & Estabrooks. C. A. (2011). To what extent do nurses use
research in clinical practice? A systematic review. Implementation Science, 6, 21. doi: 10.1186/1748-5908-6-21 The
Joanna Briggs Institute (n.d.). SUMARI: User manual: Version 5.0 system for the unified management, assessment
and review of information. Retrieved from
http://www.joannabriggs.edu.au/Documents/sumari/SUMARI%20V5%20User%20guide.pdf Thompson, D. S.,
Estabrooks, C. A., Scott-Findlay, S., Moore, K., & Wallin, L. (2007). Interventions aimed at increasing research use in
nursing: A systematic review. Implementation Science, 2, 15. doi: 10.1186/1748-5908-2-15
Contact
[email protected]

Student and Faculty Collaboration: Revising a Mentorship Model
Marilyn D. Klakovich, DNSc, RN, NEA-BC, USA
Purpose
The purpose of this presentation is to describe the collaborative process used to revise a practicum
mentoring model for online students and outcomes from use of this model.
Target Audience
The target audience of this presentation is nursing students, educators, researchers, and clinicians.
Abstract
Purpose: Students completing a master’s in nursing degree in my online program are required to
complete a practicum project working with a master’s prepared mentor. During the practicum, students
implement a scholarly project to meet an educational need or administrate a project in a facility, such as
the workplace, or in the community. Given that students have no face-to-face contact with faculty who
supervise the capstone practicum course, effective mentors are critical to student success. The purpose
of this presentation is to describe the collaborative process used to revise a practicum mentoring model
and outcomes from use of this model.
Methods: The practicum course is divided into two parts. During part A, students develop a self-directed
learning agreement. In part B, students report on their projects and submit all evidence of fulfillment of
their learning agreement. The model was initially developed through a qualitative study that included
content analysis of student reports (n=263 representing 28 part A classes)of characteristics of effective
mentors and then Part B student confirmation of the identified categories. The major categories of
characteristics of effective mentors were organized into a pyramid-shaped mentorship model for online
program practicum experiences. The base or foundation of the pyramid is comprised of mentor
characteristics including background, experience, and education. The central core of the pyramid is
formed by mentor qualities and ways the mentor interacts with the mentee (resourceful, inspires and
challenges, caring relationship). I presented this model at an international conference and dialogue with
the audience suggested the need to refine the model.
Consistent with the collaborative approach used for initial development, to allow for student collaboration
in model refinement, I posted the model and supporting materials in 5 (n=65) practicum B classes for
student input. Based on their recommendations, the mentor qualities and characteristics are reorganized
within the pyramid. They believed that the bottom of the pyramid that includes the two cornerstones is the
foundation of the model. Thus, the two cornerstones are now nursing knowledge and nursing experience,
for without these two key elements, there is not a profession known as nursing. Interconnected between
the two cornerstones, in the middle and a very important part of the foundation is caring. The core of the
model is now Resourceful with the apex being Inspire and challenge. Professional ladder categories
(educator, clinician, researcher, manager) support the base and the core of the model. Once these
changes were made, I posted the model in 4 (n = 52) practicum B classes and students confirmed that
this model represented their positive experience with their mentor.
Results: Students in part A of the practicum have been using the model to help them select an
appropriate mentor for their project experience. Additionally, they have been sharing the model with their
mentors and use it to establish a relationship and determine the best ways that they can work together
throughout the project. Students and mentors report that this provides clarity on how to work together,
and gives them additional ideas for creative approaches to use. Since using this model, I have had fewer
students report negative mentoring experiences in part B.
Conclusion: Mentors play a critical role in guiding, supporting and challenging students to grow
personally and professionally throughout the practicum experience, culminating in attainment of a
master’s degree in nursing. This refined mentorship model that is specific to a practicum conducted in the

context of an online program facilitates appropriate selection of mentors and suggests ways that mentors
and mentees can work effectively together.
Contact
[email protected]

B 03 - Health Promotion Strategies in the Older Population
Robotic Pets as Companions for Socially Isolated Older Adults
Nancy E. Edwards, PhD, MS, ANP-BC, USA
Alan M. Beck, ScD, USA
Purpose
To describe the influence of robotic dogs on depressive symptoms, morale, and life satisfaction in socially
isolated older adults
Target Audience
Individuals who provide care to older adults and individuals who are interested in animal assisted therapy.
Abstract
Purpose: Robotic animals have been used in a variety of ways with older adults. Robotic animals have
been used in a service function as assistive or physical aides and as an entertainment or companion
role. Human interactive robots for entertainment and companionship are increasing in interest and
research applications. This projects examined the influence of a 6 week interaction with a robotic dog
(AIBO) on depressive symptoms, morale and life satisfaction in socially isolated older adults.
Methods: Fifteen older adults interacted with AIBO in their room in an assisted living facility for 6 weeks.
The individuals kept the dog in their home for the duration of the study. The individuals lived alone, were
over 65 years, had a MMSE over 23 and did not have a pet. Baseline data on morale, depressive
symptoms and life satisfaction was obtained. Two weeks later AIBO, a robotic dog, was introduced and
allowed to stay with the individual for 6 weeks (Week 8). Participants were invited to interact with AIBO
as often as they liked and could do whatever activities they chose. Data collection was completed at the
completion of the study. Video recordings of the adult/AIBO interactions were obtained at week 2, week
5 and at week 8 when AIBO was removed.
Results: The sample included 13 female and 2 males with a mean age of 84. The majority were
Caucasian. The participants reported increased physical activity and socialization while they had the dog
as noted in their daily journal. Paired sample T tests were conducted and found a significant increase in
life satisfaction (p<.05) and morale (p<.01) was noted while a significant decrease in depressive
symptoms (p<.05) was reported after a six week interaction with the robotic dog (AIBO). In addition, at
the completion of the study the participants identified that AIBO could serve as a companion.
Conclusion: Although human to human interaction is best and human to animal is next, robotic animals
can elicit some of the positive feelings that are commonly associated with live animals. Robotic dogs can
act as companions and are associated with increased life satisfaction, morale and decreased depressive
symptoms in socially isolated older adults. Individuals who live alone and cannot have pets may benefit
from the companionship of robotic pets.
Contact
[email protected]

B 03 - Health Promotion Strategies in the Older Population
The Significance of Walking Speed in Physical Function Among a Group of
Community Dwelling Older Adults
Jie Yu, PhD, RN, USA
Purpose
The purpose of this presentation is to explain and demonstrate the significance of the single variable of
walking speed in physical function among independent living older adults.
Target Audience
The target audience of this presentation is for any health care professionals who are interested in
promoting physical function in the gerontology population.
Abstract
Purpose: The purpose of this study was to describe the extent to which the variable walking speed
correlated with the modified physical function, which was measured by the combination of balance and
sit-to-stand tests.
Methods: The study sample included 70 community living older adults. Subjects were screened for
cognitive function with the Mini Mental State Exam (MMSE) and physical function data were collected
using the Short Physical Performance Battery (SPPB).
Results: Results of this study showed that there was significant correlation between walking speed and
physical function; therefore it was reliable to use walking speed as a sole surrogate of the assessment of
physical function.
Conclusion: This study further supports the significance of walking speed in the assessments of physical
function in the elderly. Findings from this study provide valuable information regarding the contributive
value of walking speed in physical function and disability status, especially for frail elderly who have
difficulties completing complex battery physical function tests. Researchers can be better prepared in
determining the direction and developing specific interventions to maintain physical function among the
elderly, such as implementing some smart home technologies to closely monitor the changes of
functional status on a daily basis.
Contact
[email protected]

B 04 - Psychiatric Education and the Nursing Student
Motivating Nursing Students to Intervene with their Psychiatric Clients who Use
Tobacco
Rhonda Garrett Schwindt, DNP, RN, PMHCNS-BC, USA
Purpose
The purpose of this presentation is to discuss the integration of comprehensive tobacco education into
undergraduate psychiatric/mental health nursing curricula and describe the effect of a theory-based,
hybrid tobacco education program on the competence and motivation of baccalaureate nursing students
to intervene with psychiatric clients who use tobacco.
Target Audience
The target audience for this presentation is nursing faculty who teach in undergraduate and graduate
nursing courses. Findings also have implications for nurse educators working in practice settings to
improve quality of care for psychiatric clients who use tobacco.
Abstract
Purpose: The purpose of this study was to assess the effect of a hybrid, online education program using
Self-Determination Theory as a guiding framework, on the autonomous motivation and perceived
competence of baccalaureate nursing students (BSN) to intervene with psychiatric clients who are
tobacco dependent.
Methods: A one-group, pre-test/post-test study design was employed with a purposive sample of 120
junior BSN students enrolled in a three-credit hour psychiatric/mental health nursing course at a large
university-affiliated school of nursing.
Results: The integration of the tobacco education program significantly improved the perceived
competence and autonomous motivation of BSN students to deliver cessation interventions to their
psychiatric clients who smoke.
Conclusion: Findings highlight the need for curricular change in undergraduate psychiatric/mental health
nursing in order to increase the number of entry-level nurses proficient in tobacco cessation interventions.
References
American Psychiatric Nurses Association (APNA), Tobacco Dependence Task Force. (2008). Psychiatric Nurses as
Champions for Smoking Cessation. Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageid=3827 Butler, K.
M., Rayens, M. K., Zhang, M., Greathouse, L., Riker, C., & Hahn, E. J. (2009). Tobacco dependence treatment
education for baccalaureate nursing students. Journal of Nursing Education, 48(5), 249-254.
http://dx.doi/10.9999/01484834-20090416-03 Centers for Disease Control and Prevention (CDC). 2013. Vital Signs:
Current cigarette smoking among adults aged ¡Ý18 years with mental illness ¡ª United States, 2009¨C2011. Morbidity
and Mortality Weekly Report (MMWR), 61, Retrieved from www.cdc.gov/media/dpk/2013/docs/dpk-vs-adult-smoking-
mental-illness-hyde_MMWR.pdf Fiore, M. C., Jaen, C. R., Baker, T. B., Bailey, W. C., Benowitz, W. C., Curry, S. J., &
Dorfman, S. F. (2008). Treating tobacco use and dependence: Clinical practice guidelines 2008 update. Rockville,
MD: U. S. Department of Health and Human Services. Kelley, F. J., Heath, J., & Crowell, N. A. (2006). Using the Rx
for change: Tobacco curriculum in advanced practice nursing education. Critical Care Nursing Clinics of North
America, 18, 131-138. http://dx.doi.org/10.1016/j.ccell.2005.11.003 Lenz, B. K. (2009). Nursing students¡¯ response
to tobacco cessation curricula in Minnesota baccalaureate nursing programs. Journal of Nursing Education, 48(10),
566-573. http://dx.doi.org/10.3928/014834-2009716-03 Levesque, C. S., Williams, G. C., Elliot, D. Pickering, M. A.,
Bodenhamer, B., & Finey, P. (2007). Validating the theoretical structure of the treatment self-regulation questionnaire
(TSRQ) across three different health behaviors. Health Education Research, 22(5), 691-702.
http://dx.doi.org/10.1093/her/cy1148 Niemiec, C. P., & Ryan, R. M. (2009). Autonomy, competence, and relatedness
in the classroom: Applying self-determination theory to educational practice. Theory and Research in Education, 7(2),
133-144. http://dx.doi.org/10.1177/1477878509104318 Ryan, R. M. & Deci, E. L. (2000). Intrinsic and extrinsic
motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25, 54-67. http://dx.
doi.org/10.1006/ceps.1999.1020 Sarna, L., Bialous, S., Rice, V., & Wewers, M. E., (2009). Promoting tobacco
dependence treatment in nursing education. Drug and Alcohol Review, 28, 507-516. http://dx.doi.org/
doi:10.1111/j.1465-3362.2009.00107x Schroeder, S., & Morris, C. (2010). Confronting a neglected epidemic:

Tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review Public Health,
31, 297-314. http://dx.doi.org/10.1146/annuarev.pubhealth.012809.103701 Sharp, D., Blaakman, S., Cole, R., &
Evinger, J. (2009). Report from a national tobacco dependence survey of psychiatric nurses. Journal of the American
Psychiatric Nurses Association 15(3), 172-181. http://dx.doi.org/10.1177/1078390309336746 Sheffer, C. E., Barone,
C., & Anders, M. E. (2010). Training nurses in the treatment of tobacco use and dependence: Pre- and post-training
results. Journal of Advanced Nursing, 67(1), 176-183. http://dx.doi.org /10.1111/j.1365-2648.2010.05483.x
Contact
[email protected]

Factors Affecting Assessment of Student Nurses` Clinical Practice: A
Phenomenographic Exploration of the Experiences and Understanding of
Mentors of a Mental Health Service in England
Peter Thomas Sandy, RMN, BSc (Hons), PGCertED, PGDipED, MSc, PhD, South Africa
Azwihangwisi Mavhandu-Mudzusi, PhD, RN, RM, South Africa
Purpose
The purpose of this presentation is to share mentors experiences and understanding of factors that efect
student nurses` clinical assessments in secure forensic mental health settings
Target Audience
The target audience of this presentation includes mental health nurses, nurse educators, mental health
service users, nurse managers and other mental health practitioners.
Abstract
Purpose: The purpose of this study was to explore mentors` experiences and understanding of factors
that may affect student nurses` clinical assessments.
Methods: This study utilised a phenomenographic methodology and was conducted in a mental health
Trust in England. 30 mentors, all registered mental health nurses, participated in the study. Data were
collected using five focus group interviews of six participants each. Data were analysed thematically
using Sjöström and Dahlgren approach to analysis.
Results: There are multiple factors that may affect clinical assessment of student nurses. Examples of
these include anxieties of assessment, student numbers, placement duration, transparency and the
nature of learning outcomes. The presence of multiple influential factors makes it practically impossible
for mentors to achieve absolute reliability of clinical assessments. Recommendations, such as
partnership working with link lecturers and use of protected time were offered to improve the quality of
assessments.
Conclusion: Assessment of students’ clinical performance is a significant and rewarding responsibility,
but challenging as well. Mentors need ongoing training and support to improve the quality of students`
assessments.
References
Price B 2007. Practice-based assessment: strategies for mentors. Nursing Standard, 21 (36), 49-56. Roberts D 2011.
Grading the performance of clinical skills: lessons to be learned from the performing arts. Nurse Education Today, 31
(6): 607-610. Rutkowski K 2007. Failure to fail: assessing students` competence during practice placements. Nursing
Standard, 12 (13):35-40.
Contact
[email protected]

Comparison with the State Level As Well As the Relationship of Stress,
Resilience and Psychological Health Between U.K. and China: A Newest Cross-
Sectional Global Study in Undergraduate Nursing Students
Fang Yang, PhD, RN, China
Graeme D. Smith, RN, BA, FEANS, PhD, United Kingdom
Purpose
The purpose of this presentation is to explore the state level and the relationship of stress, resilience, and
psychological health in nursing students between UK and China, as well as searching effective way to
ease stress and psychological distress in nursing education program and make more healthy for this
participates.
Target Audience
The target audience of this presentation is for global nursing educator as well as the nursing staff in
hospital and community.
Abstract
Purpose: To explore the state level as well as the relationship of stress, resilience, and psychological
health in nursing students between UK and China, with the purpose of searching for a strategy to forming
an effective way to ease stress and psychological distress in nursing education program and make more
healthy for this participates.
Background: Stress and psychological distress in student nurses has been widely demonstrated and
present globalization trend including UK and China. Resilience has been described as a personal
resource that can influence an individual’s ability to cope with the negative effects of stress for their better
life adaptation and health. To date, little research has been done to examine the relationship of both
stress and psychological health with resilience in these population, especially combined with UK and
China.
Design: A descriptive cross-sectional study.
Methods: To collect the data, Resilience Scale, Stress in nursing students Scale and General Health
Questionnaire-12 were used.1538 Chinese nursing students were investigated for making assessment for
multiple dimensions of Resilience, Stress and Psychological Health. Descriptive statistic analysis,
correlation analysis as well as stepwise multiple regression analysis were examined on matching pairs of
data. Convenient sampling method were used for this study. Then the result was been compared with the
UK study for the state level of the same undergraduate nursing students measured by the same Stress in
nursing students Scale and General Health Questionnaire-12. Data were analyzed by SPSS18.0.
Results: The mean score of resilience was 121.84 (SD=21.30). A comparison of the scores for the
dimensions of the SINS showed a relative difference in terms of mean scores and in descending order.
The sample ranked themselves as “clinical” (M=31.12, SD=8.18), “fininance” (M=17.35, SD=5.48),
“confidence” (M=17.14, SD=5.15), “education” (M=14.43, SD=4.06). The mean score of psychological
health was 6.20 (SD=1.83). Resilience was found to be related significantly with stress and psychological
health with the correlation coefficient is -0.195 and 0.064 respectively. Besides, four sub-scale of
resilience are also highly correlated to stress and psychological health except meaningfulness in these
participants. Compared with UK, the state level of Stress and Psychological Health of Chinese nursing
students was in the same high level.
Conclusion: This study illustrated that resilience was a stronger predictor of stress and psychological
health including in China and UK. Future research will be carried out to implement the strategies or
interventions including conducting nursing education programs and competencies in enhancing resilience
in global nursing research.
References

Baldwin P, Dodd M & Wrate M (1998) Nurses: Training, Work, Health and Welfare. A Longitudinal Study 1994-1998.
Working Minds Research, Edinburgh. Black C & Ford-Gilboe M (2004) Adolescent mothers: Resilience, family health
work and health-promoting practices. Journal of Advanced Nursing 48, 351-360. Campbell-Sills L, Cohan S & Stein M
(2006) Relationships of resilience to personality, coping and psychiatric symptoms in young adults. Behaviour
Research and Therapy 44, 585-599. Chang EM, Hancock KM, Johnston A, Daly J, Jackson D (2005) Role stress in
nurses: review of related factors and strategies for moving forward Nursing and Health Science 7, 57-65. Deary IJ,
Watson R & Hogson R (2003) A longitudinal cohort study of burnout and attrition in nursing students. Journal of
Advanced Nursing 43, 78-81. Friborg O, Hjemdal O, Rosenvinge J & Martinussen M (2003) A new scale for adult
resilience : what are the protective resources behind healthy adjustment? International Journal of Methods in
Psychiatric Research 12, 65-77. Gibbons C, Dempster M & Moutray M (2008) Stress and eustress in nursing
students Journal of Advanced Nursing 61(3), 282-290. Gibbons C, Dempster M & Moutray M (2011) Journal of
Advanced Nursing Mar;67(3):621-32 Glossop C (2001) Student nurse attrition rates from pre-registration course :
Investigating methodological issues. Nurse Education Today 21,3, 170-180 Goldberg D & Williams P (1988) A user’s
guide to the General Health Questionnaire . NFER-Nelson: Windsor.
Contact
[email protected]

B 05 - Health Promotion and Disease Prevention in the Diabetic
Patient
Factors Associated with Metabolic Syndrome Among Thai Women
Sununta Youngwanichsetha, PhD, Thailand
Purpose
The purpose of this presentation is to show factors associated with metabolic syndrome among Thai
women in order to share with scholars and researchers working on metabolic syndrome.
Target Audience
The target audience of this presentation is scholars and researchers working on metabolic syndrome
including medical, nursing and public healthcare providers, and graduated student.
Abstract
Purpose: This study aimed to describe factors associated with metabolic syndrome among Thai adult
women.
Methods: A cross-sectional analytic research was designed and carried out in a tertiary hospital located
in southern Thailand. Systematic random sampling was used to select the participants (n=120) from the
potential clients with metabolic syndrome (n=360). Data were collected through the metabolic syndrome
questionnaire on risk behavior concerning dietary intake, physical activity and exercise.
Results: Results showed that significant factors associated with the metabolic syndrome among Thai
adult women were: 1) current body weight, 2) current body mass index, 3) presence of abdominal obesity,
4) a history of overweight or obesity, 5) a history of consuming sweetened drink or disserts, 6) a history of
consuming processed food containing high fructose corn syrup, 7) a history of consuming animal fat, 8) a
history of gestational diabetes mellitus, 9) a history of gestational hypertension or preeclampsia, 10) a
history of postpartum impaired glucose tolerance, or impaired fasting glucose, 11) taking care of two
children or more, and 12) lack of regular exercise.
Conclusion: In conclusion, a history of overweight or obesity and lack of exercise are two main leading
causes of metabolic syndrome. These findings should be used to empower and promote self-
management to restrict unhealthy eating and motivate regular exercise, in particular for adult women with
a history of gestational diabetes, gestational hypertension or preeclampsia.
References
Blaha, M., J., Bansal S, Rouf R, Golden SH, Blumenthal RS, DeFilippis AP. (2008). A practical ABCD approach to the
metabolic syndrome. Mayo Clinic Proceeding, 83, 923-943. Haynes D, Pruitt R,Watt P, Parker V, & Price KM. (2010).
Controlling metabolic syndrome in the Latino population. Hispanic Health Care International, 8(2), 85-92. Alley, D. E.,
& Chang, V. W. (2010). Metabolic syndrome and weight gain in adulthood. Journal of Gerontology: Medical Sciences,
65, 111-117. Anderssen, S.A., Carroll, S., Urdal, P., Holme, I. (2007). Combined diet and exercise intervention
reverses the metabolic syndrome in middle-aged males: results from the Oslo diet and exercise study. Scandinavian
Journal of Medicine & Science in Sports, 17, 687-695. Beavers, K. M., Hsu, F., Houston, D. K., Beavers D. P., Harris,
T. B., Hue, T. F., et al. (2013). The role of metabolic syndrome, adiposity, and inflammation in physical performance
in the ABC study. Journal of Gerontology: Medical Science, 68, 617-623. Bjorge, T., Lukanova, A., Tretli, S., Ulmer,
H., Stocks, T., Selmer, R., et al. 2011). Metabolic risk factors and ovarian cancer in the metabolic syndrome and
cancer project. International Journalof Epidemiology, 40, 1667-1677. Bruce, K. D., & Byme, C. D. (2009). The
metabolic syndrome: Common origins of a multifactorial disorder. Postgraduate Medical Journal,85, 614-621. Chang,
A.K., Fritschi, C., & Kim, M.J. (2012). Nurse-led empowerment strategies for hypertensive patient with metabolic
syndrome. Contemporary Nurse, 42, 118-128. Chen YC, Wu HP,Hwang SJ, Li IC. (2010). Exploring the components
of metabolic syndrome with respect to gender difference and its relationship to health promoting lifestyle behavior: a
study in Taiwanese urban communities. Journal of Clinical Nursing, 19, 3031-3041. Cheng, H., Huang, J., Chiang, C.,
Yeh, C., Hung, K., & Wu, K. (2012). Metabolic syndrome and insulin resistance as risk factors for development of
chronic kidney disease and rapid decline in renal function in elderly. Journal of Endocrinology and Metabolism,97,
1268-1276. Despres, J. P., Poirier, P., Bergeron, J., Tremblay, A., Lemieux, I., Almeras, N. (2008). From individual
risk factors and the metabolic syndrome to global cardiometabolic risk. European Heart Journal Supplements,

(Supplement B), B24-33. Frisman, G. H., & Bertero, C. (2008). Having knowledge of metabolic syndrome: Does the
meaning and consequences of the risk factors influence the life situation of Swedish adults? Nursing and Health
Science, 10, 300-305. Gade, W., Schmit, J., Collins, M., Gade J. (2010). Beyond obesity: The diagnosis and
pathophysiology of metabolic syndrome. Clinical Laboratory Science, 23, 51-56. Gardiner PA, Healy GN, Eakin EG,
Clark BK, Dunstan DW, Shaw JE. (2011). Associations between television viewing time ad overall sitting time with the
metabolic syndrome in older men and women: The Australian diabetes obesity and lifestyle study. Journal of Geriatric
Society, 788-796. Goel, K., Misra, A. Vikram, N. K.,Poddar,P., & Gupta, (2010). Subcutaneous abdominal adipose
tissue is associated with the metabolic syndrome in Asian Indians independent of intra-abdominal and total body fat.
Heart, 96, 579-583. Jumean, M. F., Korenfeld, Y., Somers, V. K., Vickers, K. S., Thomas R. J., Lopez-Jimenez, F.
(2012). Impact of diagnosing metabolic syndrome on risk perception. American Journal of Health Behavior, 36,522-
532. Kelly, B. (2012). Managing metabolic syndrome in women. Nurse Practitioner, 37, 14-21. Potenza, M. V., &
Mechanick, J. I. (2009). The metabolic syndrome: Definition, global impact, and pathophysiology. Nutrition in Clinical
Practice, 24, 560-577. Salazar, M. R, Carbajal, H. A., Espeche, W. G., Sisnieguez, C. E. L.,March, C. E.,Balbin, E., et
al. (2013). Comparison of the abilities of the plasma triglyceride/high-density lipoprotein cholesterol ratio and the
metabolic syndrome to identify insulin resistance. Diabetes and Vascular Disease Research, 1, 1-7. Volek JS,
Fernandez ML, Feinman RD, Phinney SD. (2008). Dietary carbohydrate restriction induces a unique metabolic state
positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Progression in Lipid
Research, 47, 307-318. Vykoukal, D., & Davies, M. G. (2012). Biology of metabolic syndrome in vascular patient.
Vascular, 20, 156-165. Table 1. Characteristics of Thai women with the metabolic syndrome (n=245) Characteristics
Frequency Percent Age (years) 20-29 30 12.25 30-39 150 61.22 40-45 65 26.53 Education level Primary school 35
14.29 High school 48 19.59 Vocational school 99 40.41 Bachelor’s degree 63 25.71 Current employment Yes 135
55.10 No 110 44.90 Income (USD) 100-300 28 11.43 301-600 182 74.28 601-900 35 14.29 Number of pregnancies 1
58 23.67 2 122 49.80 3 or more 65 26.53 Table 2. Values of the characteristics and the metabolic risk profiles of the
participants (n=245) Demographics/Characteristics Min-Max Mean SD Age (years) 28-42 33.15 4.29 Current body
weight (kg) 56-96 71.35 10.84 Highest previous body weight (kg) 62-105 76.25 10.52 Current body mass index
(kg/m2 ) 26.50-37.0 29.68 3.33 Waist circumferences (cm) 79.2-88.0 83.75 2.50 Triglycerides (mg/dL) 120-345
197.57 60.22 HDL-cholesterol (mg/dL) 37.80-86.60 60.02 14.78 Fasting plasma glucose (mg/dL) 113-139 122.36
8.82 Systolic blood pressure (mm Hg) 138-160 145.64 5.69 Diastolic blood pressure (mm Hg) 85-106 89.71 5.22
Table 3.Factors associated with the metabolic syndrome among Thai women Associated factors Correlations p-
values Age 0.166 0.488 Current body weight 0.622** 0.003 Body mass index 0.746** 0.000 Body fat (skin fold> 2 cm)
0.454* 0.044 A history of consuming sweetened drink or disserts 0.454* 0.044 A history of consuming proceeded
foods 0.787** 0.000 A history of consuming foods containing high fructose corn syrup 0.471* 0.036 A history of
consuming animal fat 0.471* 0.036 A history of overweight or obesity 0.647** 0.002 A history of gestational diabetes
mellitus 0.489* 0.032 A history of gestational hypertension or preeclampsia 0.612** 0.004 A history of postpartum
impaired glucose tolerance 0.739** 0.000 A history of cardiovascular disease Regular exercise 0.651** -0.583**
0.003 0.007 *. Correlation is significant at the 0.05 level (2-tailed) **. Correlation is significant at the 0.01 level (2-
tailed)
Contact
[email protected]

Patient
Relationships Among Locus of Control, Psychology Status and Glycemic Control
in Type 2 Diabetes
Shu-Ming Chen, PhD, Taiwan
Purpose
The purpose of this presentation is to determine whether the factors of locus of control, self-efficacy,
depression, and self-care behavior relate to glycemic control in type 2 diabetes.
Target Audience
The target audience of this presentation is clinical nurse
Abstract
Purpose: The purpose of this study was to determine whether the factors of locus of control, self-efficacy,
depression, and self-care behavior relate to glycemic control in type 2 diabetes.
Methods: We used a descriptive correlational design. Convenience sampling was applied to enroll 285
subjects from diabetic outpatient clinics in Southern Taiwan. We applied the locus of control, self-efficacy,
depression, and self-care behavior questionnaires. Glycemic control was assessed by HbA1c measures.
Results: The internal locus of control was significantly positively correlated with self-efficacy and self-care
behavior, and significantly negatively correlated with depression. combined depression and self-efficacy
partly mediated the relationship between internal locus of control and self-care behavior (P<.01), and
completely mediated the relationship between external locus of control and self-care behavior (P<.01).
Depression and baseline HbA1c directly and significantly affected HbA1c post value. Higher depression
had the worst HbA1c levels. We integrated optimal self-care behavior requiring a high internal locus of
control, self-efficacy, and low depression to influence enhanced glycemic control.
Conclusion: This finding could form a basis for caring people with type 2diaberes and provide a
reference for further research.
References
1. UKPDS. Tight blood pressure control and risk of macro vascular and microvascular complications in type2
diabetes. BMJ 1998; 17: 703-13. 2. Chen, G., Wu, Y., Wang, T., Liang, J., Lin, W., Li, L., Wen, J., Lin, L., Huang, H.
Association between serum endogenous secretory receptor for advanced glycation end products and risk of type 2
diabetes mellitus with combined depression in the Chinese population Diabetes, Technology & Therapeatics 2012;
14: 936-42. 3. Zulman D.M., Rosland, A.M., Choi, H., Langa, K.M., Heisler, M. The influence of diabetes psychosocial
attributes and self-management practices on change in diabetes status. Patient Education and Counseling 2012; 87:
74-80. 4. Weng, H. C., Hung, C. M., & Chi, S. C. Psychosocial and biological factors associated with glycemic control
for patients with type 2 diabetes: an application of structural equation modeling analysis. Pan-Pacific Management
Review 2010; 13: 33-47. 5. Rotter, J. B. Generalized expectancies for internal versus external control of
reinforcement. Psychological Monographs 1966; 83: 1-28. 6. Wallston, K. A., Wallston, B. S., Smith, S., & Dobbins,
C. J. Perceived control and health. Current Psychological Research and Reviews 1987; 6: 5-25. 7. Nowicki, S. J. &
Strickland, B. R. A locus of control scale for children. Journal of Consulting and Clinical Psychology 1973; 40: 148-
154. 8. Chen, Y. M. Relationships among health locus of control, self-efficacy and self-care of the elderly with
hypertension. Journal of Nursing Research 1999; 7: 504-517. 9. O’Hea, E. L., Moon, S., Grothe, K. B., Boudreaux, E.,
Bodenlos, J. S., Wallston, K., Brantley, P. J. The interaction of locus of control, self-efficacy, and outcome expectancy
in reltion to HbA1c in medically underserved individuals with type 2 diabetes. Journal Behaviour Medicine 2009; 32:
106-117. 10. Hummer, K., Vannatta, J., & Thompson, D. Locus of control and metabolic control of diabetes. Diabetes
Educator 2011; 37: 104-110.
Contact
[email protected]

Patient
The Experiences of Siblings Living with a Child with Type 1 Diabetes
Donna Freeborn, PhD, FNP, CNM, USA
Tina Dyches, PhD, USA
Susanne Olsen Roper, PhD, USA
Barbara L. Mandleco, PhD, RN, USA
Purpose
The purpose of this presentation is to explore the experiences of siblings living with children with type 1
diabetes.
Target Audience
Nurses and nurse practitioners who provide care to children and families with type 1 diabetes.
Abstract
Purpose: Diabetes is one of the most common chronic diseases in childhood and adolescence in the
United States and currently affects roughly 215,000 people under the age of 20. Approximately one in
every 400 children has been diagnosed with type 1 diabetes, and every year more than 13,000 young
people are newly diagnosed with the disease.1 Indeed, this chronic illness affects all family members,
including mothers, fathers, siblings and the child, as it is a disease with physical and emotional
ramifications6 requiring lifestyle changes involving diet modification, blood glucose monitoring, and insulin
administration. In fact, it is not uncommon for families raising children/adolescents with diabetes (CWD)
to focus a fair amount of attention on making sure these children/adolescents do not experience major
health complications. Researchers who study chronic illness in families have long acknowledged the
importance of examining the entire family, instead of focusing only on the afflicted member. The
importance of the siblings has also been underscored by research indicating sibling relationships are
linked to many aspects of a child/adolescent with diabetes’ adaptation. The purpose of this study was to
explore the experiences of siblings living with a child with type 1 diabetes.
Methods: Fifteen families were recruited from Diabetes Management clinics and Diabetes camps. Most
families (40%) earned between $75.001-$100,000/year and were Caucasian (86.6%). All fathers worked
full-time with an average of 47 hours/week and about half of the mothers (46.6%) worked full or part-time
with an average of 4.67 hours/week. Seven males and 6 females participated in the focus groups; the
mean age of the siblings was 10.69 years.
Siblings were interviewed and asked 7 questions after receiving IRB approval and assent/consent. The
primary investigator and three research assistants transcribed the audio-taped interviews verbatim, and
then examined the transcripts for common patterns and themes. Direct quotes best illustrating the themes
were chosen to represent these themes. To ensure confidentiality, all identifying data was removed at the
time of transcription. To ensure accuracy, transcribed interviews were reviewed by an alternate research
assistant.
Results: Participants all knew that their sibling had type 1 diabetes. Major themes included: minimal
knowledge about diabetes; misunderstandings about the disease; not being personally affected; and,
awareness of increased parental stress due to diabetes. Most siblings did not have a lot of knowledge
about diabetes. Although many were familiar with diabetic terms such as ‘glucose’, ‘highs/lows’, ‘pumps’,
etc.; they were generally not aware of what these terms meant. Many siblings also seemed to
misunderstand diabetes management, illustrated by the following comment from (6 year old female) “…so
like he eats something get he’ll…he’ll die. Well he won’t die he’ll just have to battle for it. And he won’t
have anything to help it. I know there’s something to help it. And I know what it’s called...I know what it’s
called but I forgot.” Participants also did not feel affected by their sibling’s diabetes as described by a 16
year old female: “… you just kind of get used to it after a while. You just hardly notice it. I don’t even know
that she has diabetes…promise you, you will not notice it.” Although they did not feel that type 1 diabetes

affected them, participants were aware that their parents were very affected. They described financial
worries, diabetes management difficulties, and parental stress in general. Most participants wanted to
know more about diabetes and how they could help their sibling.
Conclusion: Previous research shows having a chronic illness like diabetes has a significant impact on
the individual, but little research has been conducted to determine the effects on siblings. This study
revealed some interesting information that may be beneficial to additional research and practice: most
siblings seemed unaware and have a lot of misunderstanding about diabetes and how it is managed.
However, these siblings would like to learn more and be able to help/support their brother/sister with
diabetes. Families of children with diabetes could benefit by receiving additional information about how
diabetes affects siblings of diagnosed individuals. Healthcare providers would also greatly benefit in
knowing how to better offer support to these siblings and how to educate and involve them in caring for
their brother or sister.
References
Adams, R, Peveler, R. C., Stein, A., & Dunger, D.B. (1991). Siblings of children with diabetes: Involvement,
understanding, and adaptation. Diabetes Medicine, 8, 855-859 Barlow, J., & Ellard, D. (2004). Psycho-educational
interventions for children with chronic disease, parents and siblings: An overview of the research evidence base.
Child, Care, Health & Development, 30(6), 637-645. Knafl, K., Breitmayer, B., Gallo, A., & Zoeller, L. (1996). Family
response to chronic illness: Description of management styles. Journal of Pediatric Nursing, 11, (5), 315-326.
Nielson, K., Mandleco, B., Roper, S., Cox, A., Dyches, T. & Marshall, E. (2009). Sibling relationships in families
raising a child with a disability. Submitted to The Journal of Pediatric Nursing.
Contact
[email protected]

B 09 - Global Research in the Acute Care Setting
A Case-Control Study on Predictors and Outcomes of Unplanned Extubation in
Mechanically Ventilated Critically Ill Patients
Eunok Kwon, PhD, RN, CCNS, South Korea
Kyung Sook Choi, PhD, RN, South Korea
Purpose
The purpose of this presentation is to find out predictors & outcomes of unplanned extubation in
mechanically ventilated critically ill patients. Delirium, agitation, ventilation mode and night shift are high
predictive factors of unplanned extubation.
Target Audience
The target audience of this presentation is critical care nurses in hospital & professors who teaching
crtical care nursing in nursing school.
Abstract
Purpose: To find out predictors & outcomes of unplanned extubation in mechanically ventilated critically
ill patients.
Methods: Researcg design is a case-control study over 3 years period from January 1,2010 through
December 31,2012. Settings is A 62-beds medical & surgical intensive care unit of 1800 beds tertiary
hospital. Data were retrospectively collected from electronic medical records. A total 230 episodes of
deliberate unplanned extubation in 242 patients from 41,207 mechanically ventilated patients for 3
years(frequency 0.53%). 460 episodes in 460 patients with planned extubation age, gender & diagnosis-
matched controls were analyzed in this case-control study.
Results: Predictors associated with unplanned extubation include better motor response (OR 1.3),
admission route via ER(OR 1.8),higher APACHE IIscore(1.061), mode of mechanical ventilation (CPAP,
PSV: OR4.1, SIMV:3.0), peripheral O2 saturation(OR:0.9), heart rate(OR: 1.0), respiration rate(OR:1.0),
pain (OR:0.3), agitation(OR:9.0), delirium(OR:11.6), night shift(OR:6.0)and morning care time(OR:0.5).
The patients’ & organizational outcomes of unplanned extubation were reintubation(OR;85.66), a poor
discharge result(OR:0.2), a longer length of stay in the ICU (adj R-square:7%)and a longer length of stay
in the hospital(adj R-square:4.3%).
Conclusion: Delirium, agitation, ventilation mode and night shift are high predictive factors of unplanned
extubation. The outcomes of unplanned extubation were increasing reintubation, a poor patient outcome
at the time of discharge and poor organizational outcome including longer length of stay in the ICU and
hospital.
References
A. Rhodes, R. P. Moreno, E. Azoulay, M. Capuzzo, J. D. Chiche, J. Eddleston. et al(2012). Prospectively defined
indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and
Quality of the European Society of Intensive Care Medicine (ESICM), Intensive Care Med 38, 598–605. Chang,
Wang, Yann-Fen & Chao(2008). Influence of physical restraint on unplanned extubation of adult intensive care
patients: A case control study. American Journal of Critical Care. 17(5),408-415. Curry, K., Cobb, S., Kutash, M., &
Diggs, C(2008). Characteristics associated with unplanned extubations in a surgical intensive care unit. American
Journal of Critical Care, 17(1), 45–51 Da Silva, Lucas, Fonseca & Machado(2012). Unplanned extubation in the
intensive Care unit: systematic review, Critical Appraisal, and Evidence-Based recommendations. Anesthesia &
Analgesia, 114(5), 1003-1014. Juliana Barr, et al(2013). Clinical Practice Guidelines for the Ma- nagement of pain,
Agitation, and Delirium in Adult Patients in the intensive care unit. Critical care medicine 41(1), 263-306.
Contact
[email protected]

Mixed Methods: Ideal for Research in the Emergency Department
Joanne Porter, PhD, MN, GradDipHSM, GradDipCC, GradCertHEd, BN, RN, Australia
Purpose
The purpose of this presentation is to present the findings of a mixed methods research study on family
presence during resuscitation in the emergency department explaining the importance of this approach.
Target Audience
The target audience of this presentation is clinicians and researchers alike. The presentation will outline
the data collection tools and findings of this mixed methods study with an emphasis on the complexities of
research in the emergency clinical setting.
Abstract
Purpose: The aim of this paper is to report the findings from a Mixed Methods PhD study which
incorporated a two phase approach to investigating the implementation and practice of family presence
during resuscitation (FPDR) in the emergency department. The practice of allowing family to be present
during resuscitation has been debated among clinicians working in emergency departments since the
early 1980’s. There remains cause for further investigation with evidence that the practice and
implementation of FPDR continues to remain inconsistent. FPDR in both adult and paediatric
resuscitations was formally endorsed in the year 2000 by leading Emergency Associations and
Resuscitation Councils1 who were responsible for releasing practice guidelines. This study aimed to
investigate the implementation and practice of FPDR with the objective of identifying the benefits, barriers
and enablers2, evaluating the role of the family support person, and assessing the level of education and
training in rural and metropolitan emergency departments, in Victoria, Australia.
Methods: A mixed methods sequential explanatory design was utilized to investigate the extent to which
FPDR is implemented and practiced. Phase One disseminated a quantitative questionnaire to ascertain
the extent to which emergency personnel endorsed and supported FPDR practice and to explore current
training and education. The survey was divided into 5 key interest areas including: demographic data,
qualifications, resuscitation team, family presence – personnel attitudes, and training and education.
Phase Two incorporated a total of four weeks, in two Victorian, emergency departments, observing adult
and paediatric resuscitations. Qualitative data collection tools included a combination of observation field
notes, semi-structured audiotaped interviews and resuscitation template notes.
Results: A total of 347 questionnaires were included in the final data set with a 27% response rate
representing emergency personnel from rural and metropolitan emergency departments in Victoria,
Australia. Descriptive and inferential statistics were used to describe the population followed by a factor
analysis of the 26 statements on FPDR. A total of 65 doctors and 282 nurses completed the
questionnaire, with a mean age of 37.2 years and a mean of 7.8 years working emergency care. The
doctors (77%, n=50) and nurses (79%, n=222) believed that family had a right to be present during
resuscitation events and that it helped with the grieving process (54% of doctors and 62% of nurses). The
staff greatly agreed that a designated support person was essential when allowing family to be present
(89% of doctors and 92% of nurses)3. Following a content analysis of the open ended responses the
acronym ER-DRIP was developed which helped to define the essential information that family required
during a resuscitation event4. The acronym stands for E-emergency personnel, R-reassurance, D-
diagnosis, R-regular updates, P-prognosis. During the observations in Phase Two of the study a total of
29 interviews were conducted together with observation of six rural and 18 metropolitan resuscitations.
The interviews were audiotaped and later transcribed for analysis. A content analysis was conducted and
six major themes emerged including; the importance of the care coordinator, balance of power, delivering
bad news, life experience generates confidence, allocating roles and family centre care in action.
Conclusion: In order to investigate complex emergency issues such as FPDR a Mixed Methods
approach was essential and yielded a rich data set that lead to the development of a number of future
recommendations in training and education, practice and implementation of FPDR in both adult and
paediatric resuscitations.

References
Reference 1. American Heart Association. (2000). Guidelines 2000 for cardiopulmonary resuscitation and emergency
cardiopulmonary care. Circulation, 102(8 supp.), 1-374. 2. Porter, J. Cooper, S, & Sellick, K. (2013) Family presence
during resuscitation (FPDR): Perceived benefits, barriers and enablers to implementation and practice. International
Emergency Nursing Journal. DOI 10.1016/j.enj.2013.07.001 (In Press) 3. Porter, J. Cooper, S. & Taylor, B. (2013).
Family presence during resuscitation (FPDR): A survey of emergency personnel in Victoria, Australia. Australasian
Emergency Nursing Journal – AENJ (Under review) 4. Porter, J. Cooper, S. & Taylor, B. (2013). Emergency
Resuscitation team roles: What constitutes a team and who’s looking after the family? Journal of Nursing Education
and Practice. (In Press)
Contact
[email protected]

Acute Confusion Among the Patients in Surgical Intensive Care Units
Li Yu Hsiao, RN, Taiwan
Purpose
This study incidence of acute confusion, the related factors and predictors of acute confusion.
Target Audience
ICU patients
Abstract
Purpose: An ICU patient’s probability of occurrence of acute confusion is higher than that of a general
inpatient. Acute confusion is likely to not only cause accidental injury and prolong ICU stay, but also
increase the mortality. Accordingly, this triggers the motivation to explore it. This study incidence of acute
confusion, the related factors and predictors of acute confusion.
Methods: A descriptive correlational design was adopted. This study recruited patients, transferred to
ICU after the surgery and had been in ICU for more than 24 hours as subjects, totaling 263 people.
Results: The results showed acute confusion was 79.41% and the incidence was the highest after one
day of ICU stay, accounting for up to 33.1% of the population. The predictor of acute confusion was
catheterization p-value, which was 0.004 (OR, 13.465; 95% CI, 2.266 ~ 79.99). The age p-value was
0.002 (OR, 2.339; 95% CI, 1.356 ~ 4.033). The pain index p-value was 0.002(OR, 2.339; 95% CI, 1.356 ~
4.033). PSQI score p-value was smaller than <0.001 (OR, 1.823; 95% CI, 1.342 ~ 2.475). APACHE II and
acute confusion there is a significant positive correlation (r =. 389, p <.000). Linear regression analysis
APACHE II (R2 = .092%, P <.000).
Conclusion: These four variables are statistically significant and therefore can be the predictor for SICU
patients with acute confusion (R2 = 0.538). APACHE II and predictable 9.2% of the variance in acute
confusion. It is hoped that this study can be used in clinical practice for early detection of high risk of
acute confusion to prevent further damage so that ICU nurses can establish a care model that prevent
risk factors of acute confusion and improve the quality of health care.
References
Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., et al. (2001). Delirium in mechanically
ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).
The Journal of the American Medical Association, 286 (21), 2703-2710.
Contact
[email protected]

B 10 - Leadership Within the Nursing Workforce
Engaging Interprofessional Colleagues in a Collaborative Community of Faculty
Scholars
Maria R. Shirey, PhD, MBA, MS, BSN, RN, USA
C. Elizabeth Bonham, PhD, MSN, BSN, RN, USA
Purpose
to discuss early findings of an interventional mixed methods study designed to test and evaluate the
implementation of a formalized Community of Faculty Scholars (CFS) in an academic institution.
Leadership strategies used to facilitate the CFS intervention and lessons learned from the experience will
also be shared.
Target Audience
nurses at any level interested in building scholarly writing capacity.
Abstract
Purpose: This study evaluated outcomes associated with implementation of an academic Community of
Faculty Scholars (CFS).
Methods: A correlational, repeated measures mixed methods design was used to answer the research
question: What effect does a faculty writing mentoring program have in cultivating a culture of scholarly
inquiry? The intervention consisted of three phases. Phase I, used a scholarly writing retreat to
inaugurate a CFS. Faculty writing groups paired scholar mentors with scholar fellows for a one year
partnership. Phase II, initiated customized strategies to support mentors and fellows. Phase III, entailed
celebration and closure. Twenty interprofessional fellows collaborated with five mentors.
In Phases I and III, fellows completed pre/post scales: Inner Strength Scale, Resourcefulness Scale,
Climate and Culture Assessment Survey. Program evaluations took place in Phases I, II, and III with
number of publications assessed. Paired t-tests analyzed pre/post scale scores. Narrative analysis
evaluated qualitative data across phases.
Results: Early findings from the one year CFS indicate five (25%) participants published manuscripts, six
(30%) had manuscripts in process, and nine (45%) made no progress on manuscript preparation. All
participants reported personal benefit from the CFS experience independent of whether or not they
experienced publication success. All fellows successfully publishing, however, demonstrated five scholar
readiness characteristics: early tenure track participation, individual follow through with commitments,
short mentorship requirements, go-getter temperaments, and predisposition to action as compared to
contemplation.
Conclusion: Although scholarly writing is a hallmark of academic life, faculty members do not report
receiving consistent mentoring in this area. Participants in this study reported benefit from the CFS
intervention. Faculty members also demonstrated having different scholarly needs at different times. For
most benefit, investment in a resource intensive CFS intervention may need to be targeted to faculty
members demonstrating scholarly readiness. Further study is needed to identify how best to support
faculty members lacking scholarly readiness.
Contact
[email protected]

B 10 - Leadership Within the Nursing Workforce
Understanding Workplace Reciprocity of Emergency Nurses: A Qualitative Study
Christine Marie Corcoran, PhD, RN, FNP-BC, USA
Purpose
The purpose of this presentation is to inform the research community of my dissertation research findings
of workplace relationships and reciprocal behaviors of emergency nurses. The findings of this research
offer insight into workplace relationships of emergency nurses as well as avenues for further study into
workplace relationships of nurses.
Target Audience
The target audience for this presentation is the nursing community at large. Yet, more specifically, nursing
leadership may be enlightened to the findings of the study to be able to incorporate a better
understanding of staff nurses performing direct patient care.
Abstract
Purpose: Emergency Departments (ED) are unpredictable environments and are well-known for
instantaneous change. At one moment, the ED may be relatively quiet and then suddenly ambulances
and helicopters arrive with multiple patients from a serious car accident. Typically, nurses are the first
healthcare provider encountered by the patient. Given the rapid changes, this is an environment with
high levels of stress and more so for the ED nurse (Browning, Ryan, Thomas, Greenberg, & Rolniak,
2007; Spence, Laschinger, & Havens, 1997).
EDs are open for patient care all day, every day. The flow of patients and their reasons for presenting to
the ED for care is not predictable. Multiple patients can present to an ED with a variety of healthcare
problems and concerns. Prioritization of patient care in EDs is based on the patient’s acuity level. Acuity
levels are designated by the patient’s presenting illness or injuries. This is termed triage. Triage sorts
patients according to the severity of illness or injury and how rapidly they require treatment (Sheehy,
2003).
ED RNs care for a multitude of patients at any stage of care. The number of patients in an ED is a
census. The census of an ED includes patients who are: awaiting triage, have been triaged and are
awaiting care, have had encountered the healthcare provider and care is in progress or pending results of
diagnostic tests, are admitted to the hospital and are awaiting bed assignments, and are pending
discharge. The census can change at any time as can the acuity level.
Any ED can rapidly transition from low acuity and census levels into high acuity and high census levels at
any point during a nurse’s shift. The unpredictability of the environment can impact the relationships of
the workplace. Unpredictable environments can create stressful situations within workplace
relationships. Continued exposure to high levels of stress may have negative effects on organizations
(Manzoni & Eisner, 2006; Piko, 1999). Reciprocity is a crucial component of relationships (Chow & Chan,
2008; Flap & Völker 2001). Reciprocity yields productivity. For emergency nurses to maintain effective
workplace performance, reciprocity is present within workplace relationships (Bowey & Easton,
2007). Reciprocal workplace relationships facilitate productivity, efficiency, and improved consumer
outcomes (Back & Flache, 2008; Carpenter, Bowles, Gintis, & Hwang, 2009; Meeker, 1983). One
question propelled this study: What is the emergency nurse’s experience of workplace reciprocity?
There is a paucity of research on nurses working in the ED. Most research is clinically based regarding
competency and patient outcomes (Dent, 2010; Johnson & Bakas, 2010; Kratz & Mason, 2010; Pines,
Shofer, Isserman, Abbuhl, & Mills, 2010). As patient care is the focus and there is a lack of research
among healthcare providers, exploring the lived experience of reciprocity among emergency nurses
contributed to the current literature on workplace reciprocity. Additionally, the study enhanced the
literature on emergency nursing and provides more information regarding the healthcare work
environment.

Methods: Nurses with three or more years of current emergency nursing experience were recruited using
a purposive technique to obtain a convenient sample. Purposive sampling is essential to naturalistic
inquiry. Random sampling is not appropriate for conducting a naturalistic inquiry (Erlandson, Harris,
Skipper, & Allen, 1993). My focus was to discover the experience of workplace reciprocity among
emergency nurses. Purposive sampling technique allowed me to deliberately search for participants
because of certain qualities. For this study, currently practicing emergency nurses with three or more
years of experience, who were willing to discuss their experiences of workplace reciprocity, were
recruited. A sampling method specific to purposive sampling is snowball sampling. Snowball sampling,
which is used when studying social groups, relies on referrals from initial participants to solicit another
who has experienced similar attributes of the phenomena of interest; thus providing rich data from in-
depth interviews (Babbie, 2001; Munhall, 2007; Streubert & Carpenter, 1995). Each participant was
interviewed. The data was analyzed and interpreted using Giorgi’s Phenomenological Methodology to
gain an understanding of the lived experience of workplace reciprocity of emergency nurses. In order to
psychologically understand an experience, the experience must be described (Giorgi & Giorgi,
2003). According to Giorgi, exploration of an individual’s experience allows for subjective meanings to
emerge (Giorgi, 1985). Giorgi’s method assisted in clarifying experiences from a psychological
perspective. The Giorgi method was not used to interpret or predict outcomes. This method was used to
illuminate and understand the lived experience of those interviewed. Specifically, how the participant
relived the experience through storytelling.
Results: The participants in this study shared their experiences of working with other emergency nurses
to better understand workplace reciprocity. The final step in Giorgi’s method is synthesis of the
essences. Caring is essential to the profession of nursing. For any nurse, the focus is caring for
patients. The ED RNs’ identified that although patient care is the focus, caring for the other ED RN is
also important in their workplace relationships. Caring to perform as a reciprocal experience, bridging
relationships to gain a sense of connection and to enhance the workplace relationship and how nurses
work together (workplace reciprocity). Three aspects impact on caring and workplace
reciprocity: technology, balancing, and the ED culture. The technology used in an ED setting affect
feelings of caring among ED nurses; thus affecting workplace reciprocity. To have a good team takes a
specific balance of nurses, who have personalities and experience that can enhance or hinder the ability
to create connections and to allow for bridging of relationships of ED RNs’ to foster workplace
reciprocity. The culture of the ED, each work shift and the impact that the institution sets forth can affect
workplace reciprocity.
The concept of study, workplace reciprocity, was woven throughout all of the essences and when
synthesized it identified itself to be an integral part of workplace relationships of ED RNs. Workplace
reciprocity between and among ED RNs is influenced by the ED environment, balancing, and technology
on caring for patients and each other as seen in the bridging and connection for the purpose of creating
and maintaining workplace relationships.
Conclusion: Understanding workplace relationships can provide insight into ED culture, balance, and
technology impact on the essential essence of caring that nurses possess, which affect the bridging and
connections that ED RNs require for workplace relationships. Allowing ED RNs to have control over their
environment may yield better outcomes, which are always patient related. To provide balance, assessing
ED RN personalities and performance at frequent intervals may aide in retention of staff and prevent
burnout of ED RNs. Technology is in place to support nursing practice, not to impede on workplace
relationships and care of patient. Recognizing and remembering that the patient, not the computer, is the
priority is essential to nursing practice regardless of specialty. Although patient care is primary focus, the
business of healthcare is employee focused as to improve consumer outcomes. Take care of the
employees and they will take care of the consumer, the patient. Workplace relationships need to be
established and nurtured for efficient, productive and effective outcomes. Those outcomes are always
patient related for the ED RN.
Two further studies are recommended to examine workplace relationships of ED RNs. An ethnographic
study to explore the culture of ED nursing could enlighten the essence of ED Culture identified in this
current study. As previously discussed, ED culture affects the caring essence in which the ED RN
workplace relationship exits. The second study recommended is a phenomenological study to gain
insight into the experience of being an ED RN. Gaining insight into the perspective of being an ED RN

may enlighten the essence of balance identified in this study. Individually and jointly, these two proposed
studies could not only add to the literature of nursing workplace relationships but also provide
understanding of providing quality patient care in a rapidly changing environment.
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of Social Psychology, 130, 267-268. Yip, W., Subramanian, S. V., Mitchell, A. D., Lee, D. T. S., Wang, J., & Kawachi,
I. (2007). Does social capital enhance health and well-being? Evidence from rural China. Social Science & Medicine,
64 (1), 35-49.
Contact
[email protected]

C 03 - Health Promotion and DIsease Prevention in the Patient with
Cancer
Predictors of Exercise Counseling Behaviors of Oncology Nurses to Women with
Breast Cancer Experiencing Treatment-Induced Cancer-Related Fatigue
Donna Ho-Shing, PhD, RN, USA
Purpose
To explore the predictors of the exercise counseling behaviors of nurses who care for women undergoing
treatment for breast cancer who are experiencing fatigue.
Target Audience
registered nurses who care for women undergoing treatment for breast cancer
Abstract
Purpose: Fatigue is the most common long-term side effect of breast cancer treatment. Exercise is
beneficial in managing the fatigue that women experience during and after treatment. Although exercise
counseling is included in the National Comprehensive Cancer Network’s (NCCN) guidelines for managing
cancer related fatigue, many women undergoing treatment for breast cancer have never been counseled
to exercise. This reveals inconsistencies between clinical care behaviors and the national treatment
guidelines.
There has been limited empirical research of factors that influence the exercise counseling behaviors of
nurses who care for women undergoing treatment for breast cancer who are experiencing fatigue. This
study explores the predictors of the exercise counseling behaviors of nurses who care for these women.
Methods: This study uses a theoretical approach to address the factors that predict the improvement of
patient outcomes. According to the Common Sense Model of Self-Regulation (1997) contextual factors
(such as one’s knowledge and experience) and treatment beliefs influence illness management
behaviors.
A descriptive correlational design was used. The sample included 126 registered nurses who are
members of the Oncology Nursing Society and working in oncology settings. Data were collected from
responses on the Exercise Benefits Beliefs scale (2011), the Exercise Barriers Beliefs scale (2011), and
the Exercise Counseling Behaviors scale (2011) developed for this study. The Godin Leisure Time
Exercise Scale (1985) was used to assess nurses' personal exercise behaviors. Demographic information
and knowledge level about the NCCN guidelines for cancer treatment related fatigue were also collected.
The data analysis included descriptive statistics, correlations and regression analyses.
Results: The sample mean score for exercise counseling behaviors was 21.46 (SD = 4.71). Interestingly
nurses’ personal experience with exercise, r = .11, p = .278 and exercise benefits beliefs, r = .008, p =
.936 did not predict their exercise counseling behaviors. A nurse’s current position (role), r = -.23, p < .05,
and knowledge about NCCN guidelines for cancer treatment related fatigue, r = -.25, p < 0.05, were
significantly related to exercise barriers beliefs. A nurse’s current position, beta = .209, p = .044,
knowledge of the NCCN guidelines, beta = .535, p = .000, and Exercise barriers beliefs, beta = -.311, p =
.000, predicted exercise counseling behavior.
Conclusion: Analyses supported the relationships among contextual factors, treatment beliefs, and HCP
illness management behaviors of the CSM. Nurses’ beliefs about exercise barriers of women with breast
cancer and CRF are more important for the extent to which they counsel these women to exercise than
their beliefs in the exercise benefits for these women. Future nursing research is needed to explore the
influence of nurses’ roles and to target negative exercise beliefs in interventions designed to improve
nurses’ exercise counseling behaviors for women with breast cancer and CRF, thus effecting positive
outcomes for these women.
References

Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., and Robitaille, C.
(1997). Illness representations: Theoretical foundations. In K. J. Petrie & J. A. Weinman (Eds.), Perceptions of health
and illness (pp. 19–45). The Netherlands, Amsterdam: Harwood Academic Publishers. Godin, G., & Shepard, R. J.
(1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Science,
10(3), 141-146.
Contact
[email protected]

C 03 - Health Promotion and DIsease Prevention in the Patient with
Cancer
Prevalence of Depression in Patients with Pituitary Tumors: Association of
Depression with Perceived Social Capital
Christine G. Yedinak, DNP, FNP, MN, BS, USA
Purpose
to demonstrate the clincial application of validated psychometric instruments in the evaluation of specific
patient populations. Additionally to apply current knowledge and validated
Target Audience
Practitioners who evaluate and treat patients with neuroendocrine disorders and brain tumors in hospital
or clinic setings. Practitioners in specialty settings interested in clinical and translational research.
Academicians interested in DNP capstone projects and clinical research applications.
Abstract
Purpose: The relationship between the pituitary gland to the limbic system has been implicated in the
development of psychological and psychiatric symptoms found in patients with pituitary tumors (PT) and
disorders. Brain-Derived Neurotrophic Factor (BDNF) produced in response to neuroendocrine effectors
has been linked to depression. In turn, a direct relationship has been demonstrated between
psychological health and social capital in numerous chronic illnesses.
The purpose of this study was to investigate the prevalence of depression in patients who were newly
diagnosed with pituitary adenomas and to evaluate the impact of perceived interpersonal and social
support on depression severity. Secondary analysis was performed to evaluate the prevalence of
depression by tumor hormonal expression, including non-functional adenomas (NF), prolactinomas (P),
growth hormone (GH) secreting adenomas and adrenocorticotrophin (ACTH) secreting adenomas.
Methods: Prospective review was conducted of 104 patients (32 male/71 Female) with MRI confirmed
pituitary tumors at one institution from 2011-2013 ( NF 44, P28, GH9, ACTH 6, other 17). All patients
completed the 21 question Beck Depression Inventory II (BDI-II) and 6 questions designed to solicit the
patient’s perception of social support from family member, spouse/partner and friends (Crohnbach’s alpha
.952). All patients were newly diagnosed and were asked to complete the questionnaire at initial
presentation. Comparison of means was performed using Pearson’s 2 tailed ANOVA and bivariate
analysis and descriptive analysis was performed. All analysis was performed using PASW 18.
Results: Mood disturbance was reported by all patients. 27.8% of patients reported mild mood
disturbance and 65.4% qualified as borderline to moderate clinical depression. Only 7 (6.7%) patients
reported severe depressive symptoms and 5/7 of these patients reported high levels of social
capital/support. However, overall there was no correlation between the severity of depression and social
support (r=-.15, p=0.13). 76% of patients perceived moderate to high levels of support. There was no
correlation between gender and depression or perceptions of social support. Perception of support was
similar with respect to both family and friends. Tumors were classified by diagnosis, analyzed for the
prevalence of depression for each diagnosis and correlated with social support. There was no significant
difference in prevalence of depression (p=0.3) or perception of social support (p=0.21) based on
diagnosis. Nor were higher levels of depression correlated with poor social capital/support. Depression
and social support were positively correlated (r=.409, p=0.000).
Conclusion: Although depression is common to patients with pituitary tumors, most reported high levels
of social support. While mild mood disturbance may be associated with a recent brain tumor diagnosis,
more severe levels of clinical depression warrant further evaluation. The use of tools for early
identification of at risk patients provides for timely intervention and improved outcomes. Treatment
protocols differ according to pituitary hormonal activity and tumor size symptoms such as visual field
disturbance. Further evaluation of the impact of specific interventions on both depression and any
changes in social capital over time is required.

References
Haines, V, A., Beggs,J.J., & Hurlbert.J.S. (2002). Exploring the Structural Contexts of the Support Process: Social
Networks, Social Statuses, Social Support, and Psychological Distress. Advances in Medical Sociology, 8:269–92.
Zea,M.C., Belgrave,F.C.,Townsend,T.G.,Jarama,S.L., Banks,S.L. (1996) The Influence of Social Support and Active
Coping on Depression Among African Americans and Latinos With Disabilities Rehabilitation Psychology,
41 (3) 225-242.
van der Klaauw,A.A., Kars,M., Biermasz,N.R., Roelfsema,R., Dekkers,O.M.,Corssmit,E.P., van Aken,
M.O.,Havekes,B., Pereira,A.M., Pijl,H., Smit ,J.W. & Romijn,J.A. (2008).Disease-specific impairments in quality of life
during long-term follow-up of patients with different pituitary adenomas. Clinical Endocrinology, 69, 775–784. doi:
10.1111/j.1365-2265.2008.03288.x Berry, A.,Bellisario,V., Capoccia, S.,Tirassa,P.,Calza,A.,Alleva, E.,Cirulli,F.,
(2012). Social deprivation stress is a triggering factor for the emergence of anxiety- and depression-like behaviours
and leads to reduced brain BDNF levels in C57BL/6J mice. Psychoneuroendocrinology ,37, 762—772 Wetterberg.L.
(1986). The Relationship Between The Pineal Gland And The Pituitary-Adrenal Axis In Health, Endocrine And
Psychiatric Conditions. Psychoneuroendocrinoogy, 8 (1) 75-80. Liu,L.,Ran Pang,R.,Sun,W.,Wu, M.,Qu,P., Lu,C.
&Wang,L. (2013).Functional social support, psychological capital, and depressive and anxiety symptoms among
people living with HIV/AIDS employed full-time BMC Psychiatry, 13:324 doi:10.1186/1471-244X-13-324
Jaremka,L.M., Fagundes,C.P., Glaser,R., Bennett e,J.M., Malarkey,W.B.& Kiecolt-Glaser,J.K.(2013). Loneliness
predicts pain, depression, and fatigue: Understanding the role of immune dysregulation Psychoneuroendocrinology,
38, 1310—1317. Bassett,E.& Moore,S. (2013). Gender Differences in the Social Pathways Linking Neighborhood
Disadvantage and Depressive Symptoms PLOS ONE,8:10 e76554. Grynderup,M,B.,, Kolstad,H.A.,
Mikkelsen,S.,Andersen, J.H.,Bonde, J.P.,Buttenschøn,H.N.,Kærgaard, A.,Kærlev,L.,Rugulies,R., Thomsen
,J.F.,Vammen,M.A.,Mors, O.&Hansen,M( 2013). A two-year follow-up study of salivary cortisol concentration and the
risk of depression. Psychoneuroendocrinology, 38, 2042—2050. Irwin,J.,LaGory,M.,Ritchey, F. & Fitzpatrick,K.
(2008) Social assets and mental distress among the homeless: Exploring the roles of social support and other forms
of social capital on depression. Social Science & Medicine. 67. 1935–1943 Sharp, L,K. & Lipsky, M.S (2002).
Screening for Depression Across the Lifespan: A Review of Measures for Use in Primary Care Settings. American
Family Physician., 66(6)1001-1008. Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An
inventory for measuring depression. Archives of General Psychiatry, 4, 561-571 Beck, A. T., Steer, R.A., & Garbin,
M.G. (1988) Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical
Psychology Review, 8(1), 77-100
Contact
[email protected]

C 04 - Impacting Student Behaviors Through Engagement
Measuring Student Satisfaction and Loyalty: A Waste or a Goldmine?
Susan L. Groenwald, PhD, MSN, RN, USA
Purpose
to present the results of research on the key drivers of nursing student satisfaction and loyalty, and
discuss the efficacy and implications of satisfaction/loyalty measures for schools of nursing.
Target Audience
those interested in or working in nursing education.
Abstract
Purpose: This non-experimental quantitative research study was conducted to identify the key factors
affecting a student’s likelihood to recommend the college as measured by Net Promoter Score. The
focus of the study was whether and to what extent student and institutional variables such as academic
status, student satisfaction, and demographic factors predict students’ loyalty behavior, and whether
those factors differ among student groups.
Methods: Archival data were collected from 2,732 records of pre-licensure baccalaureate degree nursing
students at a multi-campus, regionally-accredited nursing college. Data from Net Promoter Score
surveys, annual student satisfaction surveys, end-of-course surveys, and student records were analyzed
using correlation, cross tab, Pearson chi-square, and factor analysis to identify factors that had a
significant relationship with the dependent variable Net Promoter rating. Once relationships were
established, a hierarchical model was developed and multinomial logistics regression was employed to
determine the most important contributors to Net Promoter rating.
Results: Results of the study indicated that the most important drivers of a pre-licensure BSN nursing
student’s satisfaction/loyalty rating were satisfaction with faculty, satisfaction with the curriculum,
satisfaction with course quality, and satisfaction with college communication. Results of the study
also demonstrated that students who responded that they were likely to refer the school to others actually
exhibited referral behavior, suggesting that an increase in Net Promoter rating is likely to increase student
referral behavior.
Conclusion: The study provides information with which college administrators can make decisions about
allocation of resources to address issues that are most important to students. The results indicate that
implementing initiatives that improve key drivers of satisfaction/loyalty likely will have a positive impact on
ratings and actual referral behavior, and can have a positive impact on the institution's reputation,
financial resources, and student engagement.
Contact
[email protected]

Enhancing Leadership Characteristics in Baccalaureate Nursing Students
Nancy E. Edwards, PhD, MS, ANP-BC, USA
Karen S. Yehle, PhD, MS, RN, FAHA, USA
Enjung Lim, BS, MS, PhD, USA
Purpose
To examine the role of senior clinical leader on the development of leadership qualities in students
enrolled in an elective leadership development course
Target Audience
Individuals in academic or clinical settings who are responsible for leadership skill devevlopment
Abstract
Purpose: Recent baccalaureate graduates are expected to quickly assume clinical leadership roles. This
project reports the results of an innovative elective leadership course utilizing senior nursing students
known as a Senior Clinical Leader (SCL) to encourage the translation of leadership concepts into nursing
practice and to allow students to experience the nurse educator role.
Methods: One hundred senior baccalaueate nursing students (4 male; 96 female) participated in a
semester long elective course over a period of 5 years. The SCL completed ten self-directed leadership
modules and implemented the leadership concepts through a sixteen week leadership practicum in a
clinical setting. The practicum consisted of assisting a faculty member teaching a sophomore or junior
level undergraduate clinical group. A pretest posttest design was utilized to evaluate the change in
perceived leadership abilities. The SCL completed a leadership performance competence profile
questionnaire and an inventory of leadership characteristics at the beginning and completion of the
semester. In addition, the SCL’s performance was evaluated by both the faculty member and the junior
students at midterm and at the end of the semester.
Results: The leadership characteristics were categorized into 6 subscales: communication, association,
sanction, delegation, initiation, and legitimacy. Both pretest and posttest measures showed good
reliability (Cronbach’s alpha = 0.78 for pretest and 0.84 for posttest). A repeated measures analysis of
covariance controlling for gender and management experience revealed that the students’ perception of
their leadership skill significantly improved overall (F=27.71; p<.0001) and in all six subscales. A large
majority (98%) of the SCLs received positive performance evaluations from both their faculty mentor and
junior students. A significant number of SCLs expressed an interest in the faculty role (p<.05) after the
leadership practicum experience.
Conclusion: Perceived leadership skills improved after the completion of the senior clinical leader
experience. Faculty members role modeled both the educator role and leadership skills. Clinical leaders
reported increased self-confidence and served as role models for the junior students. With the senior
clinical leaders, faculty were able to assign more complex patients and the SCL functioned as an
additional set of “eyes” and “ears” for the faculty member. This educational program can be implemented
in a variety of academic and clinical settings.
Contact
[email protected]

Growing the Flowers: Preparing Undergraduate Nursing Students for a
Community Healthcare Placement in a Neoliberal Economy
Eleanor S. Horton, RN, ADN, BHlthSc (Nsg), MHlthSc (Nsg)PhD, Australia
Purpose
The purpose of this presentation is to share with our colleagues how we utilized government funding to
engage our community partners and develop resources for them and also blended learning tools to
enhance students learning opportunities to better prepare them for a community placement in a Primary
healthcare facility.
Target Audience
The target audience for this presentation is those involved in Primary healthcare and Nursing education.
Abstract
Purpose: Our objective was to engage and develop initiatives with our community partners to better
prepare our nursing students for a community clinical placement in their Undergraduate Nursing Degree
program thus increasing our clinical placements and stimulating students to consider community nursing
as a viable career option.Many nursing degree programs have made the decision that to maintain a
Primary healthcare community focus within the curriculum that addressees not just the theoretical
component but the practicalities of a community placement is a very expensive exercise and one that in
the current neoliberal economic climate is difficult to justify. Our government has a commitment to Primary
healthcare. In Australia at our regional university we have decided to work actively at maintaining and
developing our community placements and we were successful in accessing funding from a government
initiative aimed at increasing clinical placements. This project was also well aligned with our University
graduate attributes.
Methods: We engaged our partners at a breakfast to canvas their ideas. This stimulating discussion
resulted in a needs analysis of our clinical placement partners to find out if there was any support we
could provide for them to encourage them in supporting students on placement and /or to increase their
intake of student placements. From the analysis a Preceptorship workshop program was developed and
offered to nurses in the community. The workshop was very engaging and feedback was positive. Then a
multi media resource was developed that could be put on the electronic leaning management system for
students to access before placement. This resource included interviews with a General Practitioner, a
practice nurse, a community domiciliary nurse and previous students. All espousing the benefits of
community nursing experience. After viewing the vodcasts the students complete a brief on line quiz and
were issued with a certificate.
Results: Feedback from both the students and the nurses has been really positive and students have an
increased appreciation of community nursing, and we have increased our community placements.
Partnerships with our community placements have been strengthened and students have access to a
multi media resource that they can access prior to their placements at a time and place convenient to
them to enhance their learning.
Conclusion: This project model based on consultation, participation and partnership with the community
has enhanced community relationships with our primary healthcare partners and increased and enhanced
student learning opportunities during the undergraduate nursing degree program. It aligned with the
University Graduate Attributes and a the commitment to Blended Learning. Long term it may have a
positive impact on the Primary Healthcare workforce with more graduates considering Primary Healthcare
providers as a career option.
Contact
[email protected]

C 05 - Global Women's Health and Cancer
Transition of Women's Perceptions of Health Status When Diagnosed with Breast
Cancer
Maude Hebert, RN, BNSc, MSc, Canada
Purpose
The purpose of this presentation is to explain the perception of health status transition process of women
living with breast cancer. We schematized the process of becoming ill from a breast cancer starting at the
diagnosis up to the recovery.
Target Audience
The target audience of this presentation is all health professionals in contact with women living with
breast cancer.
Abstract
Purpose: To model the transition process of the perceptions of health and illness of women with breast
cancer.
Methods: Grounded Theory as been selected as the research design to study the process of becoming ill
from a breast cancer and to detail the phases that women pass through.
Results: The 32 semi-structured interviews conducted with women suffering from a breast cancer
revealed that they don't feel sick from the breast cancer and that there is a drastic illness perceptions shit
between before their diagnosis and after the treatments which is influenced by the transition process they
experience.
Conclusion: This research permits a better comprehension of women's breast cancer perceptions, the
different phases they pass through, the meaning they attribute to it, their help seeking behaviors and their
health care system appreciation. These findings add to the knowledge on women’s experience with
breast cancer and offer guidelines to incorporate patient-centered care along the chronic illness
trajectory.
References
Corbin, J. M., & Strauss, A. L. (2008). Basics of qualitative research (Version 3e). Thousand Oaks, CA: Sage.
Contact
[email protected]

C 05 - Global Women's Health and Cancer
Insights into the Experiences of Women with Physical Disability in Accessing
Cancer Screening
Kath Peters, RN, BN (Hons), PhD, Australia
Antoinette Cotton, RN, PhD, Australia
Purpose
The purpose of this presentation is to highlight facilitators and barriers to the uptake of cervical and breast
cancer screening for women with physical disability.
Target Audience
The target audience of this presentation is providers of primary health care.
Abstract
Purpose: Previous studies have identified that internationally women with physical disabilities have lower
uptake rates of cancer screening than women without disability (Ahmed, Smith, Haber & Belcon, 2009;
Peters, 2012). Decreased rates of breast and cervical cancer screening limits opportunity for early
detection and treatment of such cancers and potentially leads to greater morbidity and mortality (AIHW,
2011). This study aimed to explore the breast and cervical screening practices in a population of women
in Australia with physical disabilities and the barriers and facilitators to these women accessing cancer
screening.
Methods: A concurrent mixed-methods approach was used to collect both survey and interview data.
Survey data was analysed using descriptive statistics and audio recorded interviews were transcribed
verbatim and thematically analysed.
Results: Findings showed that issues related to cancer screening for women with disability are
multifarious. Approximately 15% of participants had never had a Pap smear and almost 30% of
participants had never had a mammogram. 35% of participants indicated that they had never received
information about cancer screening, 60% revealed they had difficulties receiving health care or services
from a health care professional. Among the most common reasons given for not having regular cancer
screening were physical access issues, health professionals’ knowledge deficit, discomfort, and staff not
being trained or available to assist women with a disability.
Conclusion: These findings provide valuable insights into the barriers and facilitators of cervical and
breast cancer screening in women with physical disability and highlight practice issues in need of change
to ensure increased screening uptake rates in this group. These insights have the potential to inform
interventions that can be implemented by primary health care providers to increase the uptake of cancer
screening by women with physical disabilities, and therefore decrease rates of morbidity and mortality in
this group from breast and cervical cancers.
References
Ahmed, N.U., Smith, G.L., Haber, G., & Belcon, M.C. (2009). Are women with functional limitations at high risk of
underutilization of mammography screening? Women’s Health Issues. 19, 79-87. Australian Institute of Health and
Welfare, Cervical screening in Australia 2008-2009. Cancer series no. 61. Cat. no. CAN 57, 2011, AIHW: Canberra.
Peters, K. (2012). Politics and patriarchy: Barriers to health screening for socially disadvantaged women. Advances in
Contemporary Nursing 42(2), 190-197
Contact
[email protected]

C 09 - Healthcare Education for the Older Adult
Cogito Ergo Sum: A Grounded Theory of the Filipino Elderly Transition
Experiences in Third Age Education Program
Rowena Escolar Chua, PhD, RN, Philippines
Purpose
This purpose of this presentation is to provide perspectives to the nursing community regarding third age
learning in the Asia-Pacific region considering that the older adults need to take a proactive part in
collaborating with program organizers about their preferences and concerns so that their programs can
be structured properly.
Target Audience
Target audience will be those interested in gerontological education and the nursing community engaged
in dealing with older adults
Abstract
Purpose: A considerable number of studies have been carried out to explore the experiences of the
elderly engaging in third age education, but most of these investigations have focused on elderly
motivation, the benefits accruing from their participation, and the barriers they have encountered during
their lifelong learning experience. However, there has been little attempt to probe into the experiences of
the elderly engaging in third age education and how they view themselves during that time. This
grounded theory study purported to describe the processes through which a select group of Filipino
elderly experienced community-based third age learning programs.
Methods: Cognizant of the purpose of this study, the grounded theory design was employed. A series of
in-depth interviews were conducted on 24 Filipino elderly who participated in a four-month third age
education program.
Results: This study revealed four distinct and yet inter-related stages of Holding Back, Opening Up,
Moving Forward and Empowering which were embedded in the model H.O.M.E: A Pulley Model of Elderly
Participation in Third Age Education Program. The emerged model is a valuable compass for
gerontologists as they provide meaningful and geriatric-friendly programs, projects and activities that
address the growing needs of the elderly but also facilitate their smooth entry to and completion of their
third age learning participation.
Conclusion: This model provides a greater understanding of how these elderly go through their learning
experience, from the time they hesitantly started the program until they were able to go beyond their
expectations. The H.O.M.E Pulley Model has important implications to geriatric education as it provides
educators a comprehensive model that they can use in understanding and facilitating the various facets of
participation of the elderly in third age learning
References
Aldridge, F. (2009). Enhancing Informal adult learning for older people in care settings . Leicester : National Institute
of Adult Continuing Education . Aldridge, F., & Lavender, P. (2000). The impact of learning on health. Retrieved from
National Institute of Adult Continuing Education : http://www.niace.org.uk/Publications/I/ImpactHealth.htm American
Council on Education . (2007 ). Framing New Terrain: Older Adults and Higher Education . Washington, D.C. :
American Council on Education . American Council on Education . (2008). Mapping New Directions; Higher
Education for Older Adults . Washington, D.C. : American Council on Education . Chua, R.E. & de Guzman, A.B.
(2013). Do you see what I see? Understanding Filipino Elderly’s needs, benefits and expectations from an Adult
Continuing Education Program. Educational Gerontology. Chua, R.E. & de Guzman, A.B. (2013). Effects of third age
learning programs on the life satisfaction, self-esteem and depression level among a select group of community
dwelling Filipino elderly. Educational Gerontology. Cohen, G. (2005). The Mature Mind: The Positive Power of the
Aging Brain . New York : Basic Books. Cohen, G. (2006). Creativity and Aging Study: Initial Results for Chorale.
Retrieved August 21 , 2010, from http://www.gwumc.edu/cahh/rsch/nea studt.htm Creswell, J. (1998). Qualitative
inquiry and research design: Choosing among five traditions . Thousand Oaks, CA : Sage . Crombie, I., Irvine, I.,
McMurdo, M., Williams, B., P., S., & Alder, E. (2002). Identifying Strategies to increase physical activity in sedentary

older people . Edinburgh: Deaprtment of Epidemiology and Public Health, University of Dundee . de Souza-Talarico,
J., Caramelli, P., Nitrini, R., & Chaves, E. (2009). Stress Symptoms and Coping Strategies in Healthy Elderly
Subjects. Rev Esc Enferm USP, 43(4), 801-807. Dench, S., & Regan, J. (2000). Learning in later life: motivation and
impact. Retrieved November 26, 2011, from Department for Education and Employment Research Brief No. 183:
http://www.employment-studies.co.uk
Contact
[email protected]

C 09 - Healthcare Education for the Older Adult
"Don't Leave Us Out" Civic Literacy: Older Mexican-American Women and
Cervical Cancer Screening
Bertha Eloisa Flores, MSN, RN, WHNP-BC, USA
Lyda Arevalo-Flechas, PhD, MSN, BSN, USA
Sara Gill, PhD, RN, USA
Sharon Brown, PhD, RN, FAAN, USA
Michael Mackert, PhD, RN, USA
Purpose
The purpose of this presentation is to describe and explain health literacy and civic literacy as it relates to
cervical cancer screening among older Mexican American women living in the United States.
Target Audience
The target audience of this presentation is nurses in public health and prevention education.
Abstract
Purpose: Describe the health literacy knowledge and experiences of English and/or Spanish speaking
older women of Mexican American ancestry as they relate to cervical cancer screening following
Zarcadoolas et al. (2005) model of health literacy which descries four domains; fundamental literacy,
science literacy, cultural literacy and civic literacy.
Methods: A qualitative study design was conducted using focus group and individual interviews in
English and Spanish. A moderator guide was developed following Zarcadoolas et al. (2005) health
literacy framework. Participants were presented with two brochures one from the Texas Department of
State and health Services and one from the Centers for disease Control (CDC). A purposeful
convenience and snowball sample of thirty women 50 and older were recruited to participate. Interviews
were audio taped and transcribed in its original language. Content analysis was used to analyze data and
matrices were developed. Codes and themes in Spanish were translated to the target language for
meaning. Bilingual researchers concurred with translations from Spanish to English.
Results: Participants reported receiving health information from different sources including, doctor’s
offices, TV, women’s magazines. Participants were not aware of government programs available such as
the Breast and Cervical Cancer Services (BCCS) or educational government websites through the
Centers for Disease Control (CDC) or the Texas Department of State Health Services. All participants
preferred simple and easy to read text and graphics from the Texas Department of State Health Services.
However participants did not like the brochure from the CDC, it was “too busy” and presented too much
information.
Participants said that the brochures did not apply to women of their age and lacked of age representation.
Participants recommended adding pictures of older women. The following statements best describe the
overall sentiments “We need another viejita” [little old lady] and “Don’t leave us out”.
Conclusion: Further efforts are needed to develop national health polices and educational campaigns
which are inclusive of all populations including older Mexican American women. Global communication
efforts through different mediums aimed at improving health promotion practices which are cultural,
linguistic and age appropriate will aide in decreasing this health disparity gap.
References
References Akers, A. Y., Newman, S. J., Smith, J. S. (2007). Factors underlying disparities in cervical cancer
incidence, screenng, and treatment in the United States. Current Problems in Cancer, 31(3), 157-181. Baker, D. W.,
Gazmararian, J. A., Sudano, J., & Patterson, M. (2000). The association between age and health literacy among
elderly persons. Journal of Gerontology, 55B(6), s368-s374. DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, N., &
Pignone, N. P. (2004). Literacy and health outcomes: a systematic review. Journal of General Internal Medicine,
19(12), 1228-1239. Flores, B. E. (2012). Las Doñas: Health literacy and cervical cancer screening among older
Mexican Americanwomen. (Doctoral dissertation). The University of Texas at Austin. Kirsh I., Braum, H., &

Yamamoto, K. (2007). America’s perfect storm: Three forces changing our nation’s future. Princeton, NJ. Educational
Testing Service. Scarinci, I. C., Garcia, F. A., Kobetz, E., Partridge, E. E., Brandt, H. M., Bell, M. C., … Castle, P. E.
(2010). Cervical cancer prevention: New tools and old barriers. Cancer, 2531-2542. Weiss, B., & Palmer, R. (2004).
Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid
population. Journal of the American Board of Family Medicine, 17(1), 44-47. Zarcadoolas, C., Pleasant, A., & Greer,
S. D. (2005). Understanding health literacy: An expanded model. Health Promotion International, 20(2), 195-203.
Contact
[email protected]

C 10 - At-Risk Behaviors in the Adolescent Population
Effectiveness of Structured Teaching Programme on Addiction Among
Adolescents
Umapathi Mariappan, PhD, Malaysia
Purpose
The purpose of this presentation is to highlight the adolescents addiction problem and importance of
school based health Health Education programmes” to enhance the adolescents’ knowledge on addiction
and inturn reduces the incidence of addiction among adolescents.
Target Audience
The target audience of this presentation is nurse educator, community health nurses ,paediatrics or child
health nurses,Nurse administrator, nurse researcher and school health nurse.
Abstract
Purpose: This study was aimed to assess the effectiveness of Structured Teaching Programme (STP) on
Addiction {related to alcohol abuse} among adolescents in selected schools of Salem District, Tamil Nadu
State
Methods: Quantitative approach with one group pre test, post test quasi experimental design was
adopted for this study. Cluster random sampling technique was used to select the study area and
purposive non - random sampling technique was used to select the sample (Rural n =200, Urban n=200).
Adolescents between the age group of 15-17 years and who were studying 10thclass in selected schools
in rural and urban area of Salem district were selected. Self administered structured questionnaire was
used as a tool. On the first day, pre test was administered and the second day STP was intervened to the
selected sample. After 10 working days, post test was conducted by using the same structured
questionnaire. A formal written permission was obtained from school authority and consent was obtained
from the sample. The data obtained was analyzed by using Descriptive & Inferential Statistics.
Results: Overall post test knowledge score on alcohol abuse showed that, majority of the sample had
good knowledge. The urban school adolescents gained more knowledge than rural school adolescents
(Urban 93% and Rural 84.5%). The STP implementation was effective on alcohol abuse (Paired ‘t’ value
= Rural 77.020 and Urban 92.328; P<0.000).
Conclusion: Significant differences were identified between adolescents of rural and urban school on
their knowledge level on alcohol abuse.The results indicated the STP intervention was very effective in
enhancing the knowledge of adolescents on alcohol abuse.
References
1) WHO Report. Management of substance abuse. Regional Office for South-East Asia ; 2011 2) Substance Abuse
and Mental Health Services Administration (SAMHSA). Results from the 2010 National Survey on Drug Use and
Health: Volume I. Summary of National Findings. Rockville, MD: Office of Applied Studies, SAMHSA. 2011 3)
Rotgers Frederick. Treating alcoholic problems. New Jersey: John Wiley & Sons Publications; 2006,p. 33. 4)
Humphreys, K., & Tucker, J.Towards more responsive and effective intervention systems for alcohol-related
problems. J Addiction. 2009; 97, 126-32. 5) Benegal V, Velayudhan A and Jain S. Social costs of alcoholism. A
Karnataka perspective. NIMHANS journal .2010;18 (1&2): 67. 6) P. Selvaraj. A study on alcoholism among students.
Nursing Times Journal.2007; 31 (5): Pp 9-19. 7) Indian alcohol policy alliance. Report on Alcohol tragedies in India ;
2009 8) Anil Malhotra & Ashwin Mohan.National policies to meet the challenge of substance abuse: programmes and
implementation. Indian journal of psychiatry, 2000, 42 (4), 370-377. 9) Johnson, D. E. The behavioral system model
for nursing. In J. P. Riehl & C. Roy, Conceptual models for nursing practice. Appleton-Century-Crofts. 2nd edition,
New York: 1980. 10) Geshi M, et al.Effects of alcohol-related health education on alcohol and drinking behavior
awareness among Japanese junior college students: a randomized controlled trial. Acta Med Okayama. Dec
2007;61(6):345-54. 11) P. Balakrishnan .A Comparative study to assess the knowledge and attitude of adolescents
(16-18 years) regarding alcoholism and its hazards between selected rural and urban Pre-University College at
Bangalore. AJNER,2011; Volume 01, Issue 01, January-March, A and V Publication, Raipur, India. 12) Licanin
I.(2009) Impact of parental attitude to adolescents who abuse drugs.Med Arh;63(5):278-9.

Contact
[email protected]

Teen Pregnancy: A Multi Method Community Evaluation
Ainat Koren, RN, PhD, USA
Jennifer Stanton, RN, BS, CCM, USA
Krissy Naugton, BSN, RNC, USA
Purpose
The purpose of this presentation is to inform about multi method of community teen pregnancy evaluation
Target Audience
The target audience for this presentation are researchers and clinicians that are interested in reproductive
health, teen pregnancy prevention and community assessment
Abstract
Purpose: Teen pregnancy is a complex issue, which attracted a great deal of attention from service
providers, educators, and policy makers in recent years. Science-based teen pregnancy prevention
programs are funded in select high-risk communities in Massachusetts to provide evidence-based teen
pregnancy prevention services. This presentation will share one-community multi method assessment
related to teen pregnancy and teen pregnancy prevention programs.
Methods: The process consisted of five components: a youth online survey; focus groups with parents;
teen mom survey; stakeholder interviews; and Geographic Information System (GIS) mapping.
Results: Evaluation outcome show that teen birthrate in the community declined by 46.1% in the past ten
years. The services in the city prioritize teen empowerment and prevention along with support for
pregnant teens. GIS mapping provides a tool to not only to assist with visualizing the location of high-risk
populations, but also for planning of location of services. Parents, teens and key informants all recognize
the existing problem of teen pregnancies in the community. Teens expressed the need for improved
communication with their parents along with sexual education from their schools. Parents admitted that
the topic might be difficult and challenging to communicate with their teens. They too support the need for
groups geared towards parents. The key stakeholders in the community were aware of the services
offered in the city. They supported teen empowerment as a method to prevent teen pregnancy. Career
planning and college preparation would focus teens on reaching positive goals. They too supported the
development of groups to support parents.
Conclusions: A multi method diverse approach helps with leaning about the complexity of teen
pregnancy and obtain more comprehensive information about the community.
Data from this assessment will assist the community and Massachusetts Department of Public Health
(MDPH) with developing targeted and effective Teen Pregnancy Prevention Programs, strengthen
existing efforts, or better coordinate activities and referral networks so that all teens and their parents
have access to a wide array of prevention services.
Contact
[email protected]

Improving Global Health Outcomes for Teenage Pregnancy Prevention:
Intervention Programs in the United States, Canada, China and the Philippines
Kathleen A. Sternas, PhD, RN, USA
Mary Ann Scharf, EdD, USA
RoseMarie Peterkin, MAT, USA
Janet Summerly, BSN, MSN, RN, USA
Purpose
To discuss intervention programs to prevent/reduce teenage pregnancy in the United
States,Canada,China and Philippines; To describe an evidence-based intervention in the USA which
promotes abstinence from premarital sex in teenagers and has demonstrated positive outcomes; To
identify differences in outcomes between teenagers who received the intervention and comparison
participants.
Target Audience
Nurses, nursing students, researchers, educators, clinicians, administrators, policy makers and other
health care professionals caring for teenagers, who have an interest in global health promotion and
disease prevention, teenage pregnancy prevention, and evidence-based interventions that promote teen
health and prevent or reduce teenage pregnancy.
Abstract
Purpose: The number of teen births remains high. Teenage birth rates are higher in the United States
than in Canada and China (Bielski, 2013; McKay, 2012). Teen pregnancy rates are increasing in China
and the Philippines (InterAksyon, 2012; Santos, 2012; Wang et al., 2002; Zhang, 2002). Sexual activity in
teenagers contributes to teenage pregnancy and health problems (Chen, et al., 2000; Li, et al., 2003; Ma
et al., 2006; National Campaign to Prevent Teen and Unplanned Pregnancy, 2011; Parish et al., 2003;
Zhang et al., 2002). Societal and economic changes, education, media, and teenagers’ attitudes are
related to teenage pregnancy (Chelala, 2008; National Summit on Teen Pregnancy, 2012; Santelli,
Melnikas, 2010; Wang, et al, 2007). Teenage pregnancy is associated with dropping out of school,
poverty, remaining unmarried, and children at risk for poverty and health problems. This presentation
describes: global perspectives on teenage pregnancy and intervention programs to prevent or reduce
teenage pregnancy in the United States, Canada, China and the Philippines; outcomes for an evidence-
based intervention program in the United States which promotes sexual abstinence; and outcomes
for intervention and comparison participants.
Methods: A pretest post-test design was used. Four intervention schools (n=230 girls; 221 boys) and five
comparison schools (n=134 girls; n=110 boys) participated. The sample included 6th, 7th and 8th graders,
primarily of African American ethnicity. Bandura's Social Learning theory guided the intervention program
which focused on sexuality discussions, mentoring, health and fitness classes, cultural events, community
service, and a recognition ceremony. Intervention participants were randomly selected. Comparison
participants were a convenience sample. Comparison and intervention schools were matched on grade,
ethnicity, and socioeconomic status. Instruments were the AFL Core Baseline/Follow-up and
Demographic Questionnaires. Trained staff administered the questionnaires to the participants in a
school setting. Pearson Chi Square and Mann Whitney U statistical tests and .05 level of significance
were used.
Results: Abstinence education, comprehensive sex education, and health promotion education are used
to prevent/reduce teen pregnancy in the United States, Canada, China and the Philippines (Bennett,
Assefi, 2005; Chelala, 2008; Franklin et al., 1997; Kirby, 2002; Lou, et al. 2004; National Campaign to
Prevent Teen and Unplanned Pregnancy, 2011; National Summit on Teen Pregnancy, 2012; Wang et al.,
2005). Early prevention education on teenage pregnancy, sexual norms, and managing peer pressure are
utilized to promote abstinence. Post-Test III Results for the evidenced-based intervention were:
Significantly more intervention than comparison participants: talked to parents about no sex

(p=.005) and life (p=.023); said no to wrong activities (p=.012); had an adult who was available to talk
about problems (p=.012) and who provided encouragement (p=.020); reported self-confidence (p=.001).
Significantly more intervention than comparison participants reported: it was important to get a good
education (p=.003), to have a good marriage/family life (p<.001), to remain abstinent (p<.001), and for
future spouse to remain abstinent (p<.001); abstinence prevents STDs/pregnancy/health
problems(p<.001). Significantly more intervention than comparison participants admire teens who are
abstinent (p<.001); had friends who admire teens who are abstinent (p<.001). Significantly more
comparisons than intervention participants reported: it was okay to date younger or older persons
(p=.006); sex is okay if dating a long time (p<.001); more control over life (p=.001). More intervention
than comparison girls reported: remaining abstinent (p<.001); abstinence prevents
STDs/pregnancy/health problems (p<.001); important for future spouse to remain abstinent (p<.001);
premarital sex makes it difficult for good marriage/family life (p=.004); sex is for married people (p<.001).
More intervention than comparison girls reported: talking about puberty (p=.018); saying no to wrong
activities (p=.013); staying away from trouble (p=.020); importance of a good education (p=.028) and
marriage and family life (p=.002); success at plans (p=.015); and self-confidence (p=.014). Post-Test IV
Results: Significantly more intervention than comparison participants reported: bright future (p=.019);
important to remain abstinent until marriage (p=.001), and future spouse should remain abstinent
(p=.003); only married people should have sex (p<.001); abstinence is the way to avoid STD’s, pregnancy
and health problems (p=.002). Significantly more intervention girls than comparison girls reported: feeling
accepted/supported by peers (p=.005); and reported a bright future (p=.010). Significantly more
intervention boys than comparison boys reported: having an adult who encourages them (p=.036);
important to remain abstinent until marriage (p=.031); abstinence is a way to avoid
STDs/pregnancy/health problems (p=.028).
Conclusion: Abstinence education, comprehensive sex education, and health promotion education are
used to prevent or reduce teen pregnancy in the United States, Canada, China and the Philippines.
Results from the evidenced-based intervention indicated intervention participants have more significant
outcomes related to abstinence behaviors/attitudes than comparison participants. Findings suggest the
intervention promotes abstinence and prevents teenage pregnancy. Findings have implications for
development of intervention programs which promote abstinence attitudes and behaviors in teenagers.
Contact
[email protected]

D 03 - Workplace Behaviors Affecting Nursing Engagement
Workplace Violence Towards Nurses at Private and Government Healthcare
Settings of Karachi Pakistan
Rozina Somani, BScN, MScN, Pakistan
Purpose
To disseminate the research findings of workplace violence towards nurses conducted at four major
hospitals of Karachi, Pakistan. Attending and presenting in the conference will also provide an opportunity
to discuss with other researchers who are working in the same area. It will guide the path for research
work.
Target Audience
This research study will provide some evidence based strategies for nursing staff working at clinical
setting Moreover, nursing management staff can be the audience as they need to deal with violence
scenarios at workplace setting. Lastly, policy makers and academician can be the target audience
Abstract
Purpose: Workplace violence towards nurses is a worldwide problem. Among all healthcare workers,
nurses are at a greater risk of being subjected to workplace violence. The present study identified the
magnitude of the issue of violence towards nurses at the healthcare settings in Pakistan.This study aims
to identify the prevalence and characteristics of physical and psychological violence which includes,
verbal abuse, bullying/ mobbing behavior, and sexual violence experienced by nurses working in all the
In-patient units and the Emergency Departments of two private and two government healthcare settings
in Karachi, Pakistan. This abstract will focus on the sexual harassment among nurses.
Methods: This Cross-sectional study included 458 nurses from selected healthcare settings in Karachi,
Pakistan. A simple random sampling method was used for the study. The instrument used for collecting
the data was jointly developed by International Labour Office (ILO), International Council of Nurses (ICN),
World Health Organization (WHO), and Public Services International (PSI).The primary investigator and
the research assistant interviewed the participants to complete the study tool.
Results: The present study found that workplace violence was prevalent among 82% of the nurses. The
reported prevalence of sexual violence was 10%. It is likely that the mentioned prevalence of sexual
abuse found in this study could be because of the negative image nurses have in the Pakistani society,
the lack of training facilities for them to deal with sexual harassment, the lack of security measures taken
to prevent sexual violence prevention, and a feeling of guilt associated with experience of sexual
harassment. Female Nurses who fell in age group ranging between 19 and 29 years were mostly the
victims of sexual violence. These nurses specifically belonged to the Medical Surgical units, and
Emergency departments. Most of them were working in the shift duties. The most common perpetrators of
sexual violence were found to be Patient’s relatives (47.8%), and the staff members (32.6%). With regard
to sexual abuse (69.6% n= 32/46) nurses had not taken any action or had pretended that the incident had
never taken place. 74% nurses experienced psychological symptoms at moderate to extreme levels after
being victims of sexual harassment.
Conclusion: This pioneer study is an attempt towards the implementation of one of the World Health
Organization’s (WHO) goals, that is, a violence free healthcare environment. The study also put forward
some evidence based recommendations; based on the findings, for the government, the nursing services,
nursing educators, and for future research.
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Kuwait. International Journal of Nursing Studies, 39, 469-478. Arnetz, J. E., & Arnetz, B. (2000). Implementation and
evaluation of a practical intervention programme for dealing with violence towards healthcare workers. Journal of
Advanced Nursing 31(3), 668-680. Arnetz, J. E. (1998). The violent incident form (VIF): A practical instrument for the
registration of violent incidents in the healthcare workplace. Work and Stress, 12, 17- 28. Beech, B., & Leather, P.
(2006). Workplace violence in the healthcare sector: A review of staff training and integration of training evaluation
models. Aggression and Violent Behavior, 11, 27-43. Bronner, G., Peretz, C., & Ehrenfeld, M. (2003). Sexual
harassment of nurses and nursing students. Journal of Advanced Nursing. 42(6), 637-644. Camerino, D., Estryn-
Behar, M., Conway, P. M., Heijden, B. I., & Hasselhorn, H. (2008). Work-related factors and violence among nursing
staff in the European next study: A longitudinal cohort study. International Journal of Nursing Studies, 45, 35-50.

Celik, Y., & Celik, S. S. (2007). Sexual harassment against nurses in Turkey. Journal of Nursing Scholarship, 39(2),
200-206. Chaudhuri, P. (2006). Sexual harassment in the workplace: Experiences of women in the health sector.
Health and Population Innovation Fellowship Programme Working Paper, 1, 1-30. Chen, W., Sun, Y., Lan, T., & Chiu,
H. (2009). Incidence and risk factors of workplace violence on nursing staffs caring for chronic psychiatric patients in
Taiwan. International Journal of Environmental Research and Public Health, 6, 2812-2821. Christmas, K. (2007).
Workplace abuse: Finding solution. Nursing Economics, 25(6), 365-367. Chuang, S. C., & Lin, H. M. (2006). Nurses
confronting sexual harassment in the medical environment. Student Health Technology Information, 122, 349-352.
Connell, B., Young, J., Brooks, J., Hutchings, J., & Lofthouse, J. (2000). Nurses’ perceptions of the nature and
frequency of aggression in general ward settings and high dependency areas. Journal of Clinical Nursing, 9, 602-610.
Cowie, H., Naylo, P., River, I., Smith, P. &, Pereira, B. (2002). Measuring workplace bullying. Aggression and Violent
Behavior 7, 33–51. Crilly, J., Chaboyer, W., & Creedy, D. (2004). Violence towards emergency department nurses by
patients. Accident and Emergency Nursing, 12, 67–73. Dellasega, C.A. (2009). Bullying among nurses. Advanced
Journal of Nursing, 109(1),52-58. Einarsen, S. (2000). Harassment and bullying at work: a review of the Scandinavian
approach. Aggression and Violent Behaviour,5(4), 379-401 Ergun, F.S., & Karadakovan, F. (2005). Violence towards
nursing staff in emergency departments in one Turkish city. International Nursing Review , 52 , 154–160. Farrell, G.
A., Bobrowski, C., & Bobrowski, P. (2006). Scoping workplace aggression in nursing: Findings from an Australian
study. Nursing and Healthcare Management and Policy, 55(6), 778–787. Ferns, T., & Meerabeau, L. (2007). Verbal
abuse experienced by nursing students. Journal of Advanced Nursing 61(4), 436–444. French, S. E., Watter, D., &
Matthews, D. R. (1994). Nursing as a career choice for women in Pakistan. Journal of Advance Nursing, 19, 140-
151. Gates, D. M. ,Gillespie, G. L., & Succop, P.(2011). Violence against nurses and its impact on stress and
productivity. Nursing Economics, 29(1), 59-66. Gerberich, S. G., Church, T. R., McGovern, P. M., Hansen, H. E.,
Nachreiner, N. M., Geisser, M. S., Ryan, A. D., Mongin, S. J., Watt, G. D. (2004). An epidemiological study of the
magnitude and consequences of work related violence: The Minnesota nurses’ study. Occupation Environment
Medicine, 61, 495–503. Goldberg, C. B. (2007). The impact of training and conflict avoidance on responses to sexual
harassment. Psychology of Women Quarterly, 31, 62-72. Hahn, S., Muller, M., Needham, I., Kok, G., Dassen, T., &
Halfen, R. J. (2010). Factors associated with patient and visitor violence experienced by nurses in general hospitals
in Switzerland: A cross- sectional survey. Journal of Clinical Nursing, 19, 23-24. Hahn, S., Zeller, A., Needham, I.,
Kok, G., Dassen, T., & Halfen, R. J. (2008). Patient and visitor violence in general hospitals: A systemic review of the
literature. Aggression and Violent Behavior, 13, 431-441. Hegney, D., Plank, A., & Parker, V. (2003). Workplace
violence in nursing in Queensland, Australia: A self- reported study. International Journal of Nursing Practice, 9, 261-
268. Hesketh, K. L., Duncan, S. M., Estabrooks, C. A., Reimer, M. A., Giovannetti, P., Hyndman, K., & Acorn, S.
(2003). Workplace violence in Alberta and British Columbia hospitals. Health Policy, 63, 311-321. Hutchinson, M.,
Vickers, M., Jackson, D., & Wilkes, L. (2006).Workplace bullying in nursing: Towards a more critical organizational







due to violence in a psychiatric ward. Journal of Occupational Health, 51, 349-354. Shaikh, M. A. (
Contact
[email protected]

Work Stressors and Perceived Organizational Support on Front Line Nurse
Manager Work Engagement
Anne Marie Simmons, PhD, RN, USA
Purpose
The purpose of this presentation is describe the relationship of work stressors and perceived
organizational support on the front line nurse manager work engagement.
Target Audience
The target audience of this presentation is graduate education in administration and front line and
executive levels of nursing management.
Abstract
Purpose: The purpose of this study was to examine the relationship of work stressors and perceived
organizational support on front line nurse manager work engagement. A non-experimental descriptive,
cross sectional design examined the relationship in a convenience sample of 97 front line nurse
managers from the New York tri-state area and members of the American Organization of Nurse
Executives.
Methods: All participants were asked to complete a survey that included the following instruments to
measure work engagement, work stressors and perceived organizational support. Instruments ultilized
were: (1) the Utrecht Work Engagement Scale (UWES); (2) Challenge-Hindrance Stressor Scale and (3)
Survey of Perceived Organizational Support (SPOS). An electronic survey was used to gather the data
from AONE members (nationally) and nurse managers within the tri-state region surrounding New York
State. The researcher also explored the influence of perceived organization support on the relationship of
the study variables. The conceptual framework of Kahn’s work engagement and the Job Demands–
Resources Model was utilized.
Results: There was a negative direct relationship between work engagement and work stressors ( -.325,
p < .001) and a positive significant relationship between perceived organizational support and work
engagement (.419, p < .001). The conceptual framework of Kahn’s work engagement and the Job
Demands–Resources Model revealed that organizational support is needed to promote front line nurse
manager work engagement. Pearson’s correlation and linear regression analyses indicated support for
the relationship between all variables.
Conclusion: Work engagement, perceived organizational support and work stressors are professional
environmental factors that impact the leadership and well-being of FLNM. These factors, properly
promoted and implemented, lead to FLNM’s success, retention and job performance.
References
Bakker, A. B., & Demerouti, E. (2008). Towards a model of work engagement. Career Development International, 13,
209–223. Cavanaugh, M.A., Boswell, W.R., Roehling, M.V., & Boudreau, J.W. (2000). An empirical examination of
self-reported work stress among U.S. managers. Journal of Applied Psychology, 85, 65-74. Duffield, C., Roche, M,
Blay, M & Stash, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical
Nursing, 20, 23–33. Eisenberger, R., Huntington, R. Hutchinson, S. & Sowa, D. (1986). Perceived organizational
support. Journal of Applied Psychology, 71, p.500-507. Institute of Medicine. (2004). Keeping patients safe:
transforming the work environment of nurses. Washington: National Academies Press. Institute of Medicine (2010).
Future of nursing: leading change, advancing health. National Academy of Sciences. Kahn, W. A. (1990).
Psychological conditions of personal engagement and disengagement at work. Academy of Management Journal, 33,
pp. 692-724. Kleinman, C. (2004).The relationship between managerial leadership behaviors and staff nurse
retention. Hospital Topics, 82, 2-9. Lanser, P. & Coshow, S. (2007). Culture of the truth about health care employee
engagement. HR Pulse. Fall. Laschinger, H., Purdy, N., Cho, J. & Almost, J. (2006). Antecedents and consequences
of nurse managers' perceptions of organizational support. Nursing Economics, 24, 20-29. LePine, M.A., LePine, J.A.,
& Jackson, C.L. (2004). Challenge and hindrance stress: Relationships with exhaustion, motivation to learn, and
learning performance. Journal of Applied Psychology, 89, 883-891. Mackoff, B & Triolo, P. (2008). Why do nurse

managers stay? Building a model of engagement:Part 1, dimensions of engagement. Journal of Nursing
Administration, 3,118-124. Mackoff, B. & Triolo P.K. (2008)Why do nurse managers stay? Building a model of
engagement: Part 2, cultures of engagement. Journal of Nursing Administration, 4, 166-171. Macy, W. & Schneider,
(2008). The meaning of employee engagements. Industrial and Organizational Psychology, 1, 3–30. Manion J.
(2009). The Engaged Workforce: Proven Strategies to Build a Positive Health Care Workplace. Chicago, IL: Health
Forum Inc. Parsons. M. & Stonestreet, J. (2003). Factors that contribute to nurse manager retention. Nursing
Economics, 21, 120-126. Podsakoff, N.P., LePine, J.A., & LePine, M.A. (2007). Differential challenge stressor-
hindrance stressor relationships with job attitudes, turnover intentions, turnover, and withdrawal behavior: A meta-
analysis. Journal of Applied Psychology, 92, 438-454. Rhoades, L. & Eisenberger, R. (2002). Perceived
organizational support: a review of the literature. Journal of Applied Psychology, 87, 698-714. Rhoades, L. &
Eisenberger, R. (2002). Affective commitment to the organization: the contribution of perceived organizational
support. Journal of Applied Psychology, 86, 825-836. Rich, B. L., Lepine, J. A., & Crawford, E. R. (2010). Job
engagement: Antecedents and effects on job performance. Academy of Management Journal, 53, 617–635.
Schaufeli, W. B., Salanova, M., Gonzalez-Roma, V. & Bakker, A. B. (2002). The measurement of engagement and
burnout: a two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3, 71-92. Simpson, M.
(2009). Predictors of work engagement among medical-surgical nurses. Western Journal of Nursing Research, 31,
44-65. Stichler, J. (2008). Succession planning: Why grooming their replacements is critical for nurse leaders.
Nursing for Women’s Health, 12, 525-528. Wendler, C., Olsen-Sitki, Kristi & Prater, M. (2009). Succession Planning
for RNs: Implementing a nurse management internship. Journal of Nursing Administration, 39,324-333.
Contact
[email protected]

When the Postive Attributes of Leadership Become Harmful: A Pre Post-Test
Analysis
Joyce M. Hendricks, PhD, MNS, BA (AppSc, Nsg) GradDipEd, BA (SocSc) RN, RM, Australia
Vicki Cope, PhD, RN, RM, Australia
Gilly Smith, DBA, RN, JP, Australia
Purpose
The purpose of this presentation is to develop a critical awareness of the concepts and examples of
leadership within theoretical constructs to produce an image of how the these attributes, creating
purpose, building community, follower focus, motivation and respect of leadership may be used in a
harmful way.
Target Audience
The target audience of this presentation is clinical, academic and managers how have or share
leadership role or aspire to be leaders.
Abstract
Purpose: Nursing leadership in the academic setting and how leadership attributes may align with and
differ from transformational, servant, and charismatic leadership theories are considered to form the basis
of “good” leadership. The purpose of this presentation is to examine and raise awareness of how the
concepts and examples of leadership within theoretical constructs have the potential to produce an image
of how the positive attribute of leadership may be used in a harmful way.
Methods: Mixed methods was used to examine the role of leaders in the academic setting in creating a
positive context and work experience for followers. Data was collected using pre post-test analysis; and,
followers were asked to provide qualitative reasons for their answers and to give their solutions to
problems. A focus group was convened to validate the finding at post-test.
Results: Data at post-test indicated a negative trend suggesting that the perceptions of follower of their
leaders had not improved from time of pre-test. Qualitative analysis revealed the themes of nepotism,
favouritism, information provision to favouritism and lack of consultation to be the main ways of leadership
control and follower focus.
Conclusion: Harmful leadership results when positive leadership strategies are combined with the
potential of leaders to pursue personal agendas, including pursuing and abusing power, developing a
sense of self-importance, using fear, and creating a sense of isolation through alienation.
References
Mohr,J.M. (2013). Wolf in seeps clothing: harmful leadership a moral façade, Journal of Leadership Studies, 7(1) 18-
32. Yukl, G. (2013). Leadership in organizations (8th ed.). Boston, MA: Pearson. Simola, S. K., Barling, J., & Turner,
N. (2010). Transformational leadership nd leader moral orientation: Contrasting an ethic of justice and an ethic of
care. The Leadership Quarterly, 21, 179–188.
Contact
[email protected]

D 04 - Care Issues With the Cardiac and Diabetic Patient
An International Comparison of Prevalence and Clinical Efficacy of Using
Telehealth to Support Diabetic Self-Management by Patients with Both Cardiac
Disease and Diabetes
Chiung-Jung (Jo) Wu, RN, BN, MN (Intensive Care), DrHlthSc, FACN, Australia
Huei Chuan Sung, PhD, MSN, RN, Taiwan
Anne M. Chang, PhD, RN, Australia
Mary Courtney, PhD, MHP, BAdmin (Acc), RN, Australia
John Atherton, PhD, MD, Australia
Karam Kostner, PhD, MD, Australia
Purpose
The purpose of this presentation is to highlight the importance and to share our experience for
international collaboration and for improving quality of care by addressing different needs of patients in
different cultural contexts.
Target Audience
The target audience of this presentation is to highlight the importance of collaboration team and to share
our experience for improving quality of care by addressing different needs of patients in different cultural
contexts.
Abstract
Purpose: To evaluate a cardiac-diabetes self-management program with telephone and text-message
follow-up (T-CDSMP) in patients admitted with cardiac disease and comorbid diabetes across Australia
and Taiwan.
Background: As cardiac disease and type 2 diabetes are global health problems of increasing incidence
it is expected that management of patients with both of these chronic conditions will have a significant
impact on global healthcare systems. There is evidence of comparable prevalence of cardiovascular
disease combined with diabetes between Australia and Taiwan with these at-risk patients having higher
readmission rates compared to those cardiac patients without diabetes. Many studies have aimed at
improving patient self management of their conditions, but have not been tested across different cultural
backgrounds. Our previous studies within one population have shown effectiveness in using telephone
and text-messaging to assist patients with better self-management of their dual conditions to improve
outcomes of self-management behaviour, self-efficacy, condition knowledge and health-related quality of
life. However, this strategy has not been tested and compared across different cultures.
Methods: An international collaborative project using a randomised block design was used to address
the heterogeneity of patients from two different cultural contexts. For 90% power to detect the main
effects of intervention, and with location (country) being the block variable, 90 patients (a total sample of
180 patients) were required from each country.
Results: Preliminary results showed patients with dual diagnoses of cardiac disease and type 2 diabetes
in Taiwan have approximately a 21% readmission rate, compared to 22.6% in Australia (within 28 days).
Initial analysis also suggests patients in the intervention group have significantly improved self-efficacy
level.
Conclusion: Whilst we demonstrated similar readmission rates in patients with dual diagnoses of cardiac
disease and diabetes in two high-income countries, further studies will determine whether T-CDSMP can
be culturally adapted to allow similar treatment effects.
References
Australian Institute of Health and Welfare (AIHW) (2011). Cardiovascular disease: Australian facts 2011,
http://www.aihw.gov.au/publication-detail/?id=10737418510&tab=2 • Caughey, G. E., Vitry, A. I., Gilbert, A. L.,
Roughead, E.E. 2008. Prevalence of comorbidity of chronic diseases in Australia, BMC Public Health 8 (221)

doi:10.1186/1471-2458-8-221 • Shaw, J.E., Sicree, R.A., Zimmet, P.Z. 2010. Global estimates of the prevalence of
diabetes for 2010 and 2030. Diabetes Research and Clinical Practice 87, 4-14. • Ueshima, H., Sekikawa, A., Miura,
K, et al. 2008. Cardiovascular disease and risk factors in Asia: a selected review, Circulation 118, 2702-2709. •
Department of Health (2011) Health and Vital Statistics, 2010. Department of Health, Taipei, Taiwan. Retrieved from:
http://www.doh.gov.tw • Access Economics. The economics costs of a heart attack and chest pain (Acute Coronary
Syndrome) June 2009. Available from: http://www.accesseconomics.com.au/publicationsreports • Vermeire. E., et al.
(2005). Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus
(Review). Cochrane Database of Systematic Reviews, (2), 37. • Beswick, A. D., Rees, K., West, R. R., Taylor, F. C.,
Burke, M., Griebash, I., et al. (2005). Improving uptake and adherence in cardiac rehabilitation: literature review.
Journal of Advanced Nursing, 49(5), 538-555. • Kim. H.S. & Jeong H.S. (2007). A nurse short message service by
cellular phone in type 2 diabetic patients for six months. Journal of Clinical Nursing, 16(6), 1082-7. • Mistiaen, P. &
Poot, E. (2006). Telephone follow-up, initiate by a hospital-based health professional, for postdischarge problems in
patients discharge from hospital to home. Cochrane Database of Systematic Reviews, Issue 4, Art. No.: CD004510.
DOI:10.1002/14651858.pub3. • Fjeldsoe B.S., Marshall A.L., Miller, Y.D. (2009). Behaviour change interventions
delivered by mobile telephone short-message service, American Journal of Preventive Medicine, 36(2), 165-173. •
Jackson, C.L., et al. (2006). A systematic review of interactive computer-assisted technology in diabetes care.
Journal of General Internal Medicine, 21, 105-110. • Wu C-J Jo, Sung H-C, Chang AM, Atherton J, Kostner K,
Courtney M, McPhail SM. Protocol for a randomised blocked design study using telephone and text-messaging to
support cardiac patients with diabetes: A cross cultural international collaborative project, BMC Health Services
Research, 13, 204,doi:10.1186/1472-6963-13-402 • Wu, C-J (Jo). Chang, AM., Courtney, M., Ramis, M. (2011).
Using user-friendly telecommunications to improve cardiac and diabetes self-management program: A pilot study.
Journal of Evaluation in Clinical Practice. 17 (6). DOI: 10.1111/j.1365-2753.2010.01621.x • Wu, C-J, Chang, A.M. &
McDowell, J. (2009). Innovative self-management program for diabetics following CCU admission, International
Nursing Review, 56(3), 396-399. • Wu, C-J & Chang, A.M. (2008). Audit of patients with type 2 diabetes following a
critical cardiac event, International Nursing Review, 55, 327-332.
Contact
[email protected]

D 04 - Care Issues With the Cardiac and Diabetic Patient
Does Diabetes Mellitus Make a Difference in Symptom Presentation of Patients
with Acute Myocardial Infarction?
Polly W. C. Li, MSc (Cardiology), BNurs, RN, Hong Kong
Doris S. F. Yu, PhD, BSc (Nursing Studies), RN, Hong Kong
Purpose
The purpose of this presentation is to alert healthcare professionals to remain high clinical suspicion in
recognizing atypical symptom presentation of acute myocardial infarction in diabetic patients.
Target Audience
The target audience of this presentation is the healthcare professionals working in clinical as well as
community settings, and the researchers who are expertizing in cardiac and diabetic care.
Abstract
Purpose: The study aimed to compare the differences in symptom presentation between diabetic and
non-diabetic patients with acute myocardial infarction (AMI), and to examine the impact of diabetes on
symptom presentation in AMI patients.
Methods: A consecutive sample of patients with a confirmed diagnosis of AMI was recruited from the
cardiac units of three regional hospitals in Hong Kong. Data collection was conducted through face-to-
face interview. The validated Chinese version of the Symptoms of Acute Coronary Syndromes Inventory
(SACSI-C) was used for symptom assessment.
Results: A total sample of 397 patients was recruited, with the mean age of 63.3 ± 12.7 years. Diabetes
(32%) was the second most prevalent comorbidity in the sample. Diabetic patients were less likely to
present with chest pain (p<0.0001) and sweating (p=0.001). Conversely, they were more likely to present
with shortness of breath (p=0.001) and difficulty in breathing (p=0.003) than the non-diabetic patients.
Overall, the diabetic patients were more likely to present with atypical AMI symptoms (p<0.0001). The
result of multivariable logistic regression analysis showed that diabetes was an independent predictor of
atypical symptom presentation in AMI patients, with an odds ratio of 2.37 (95% confidence interval: 1.36–
4.12; p=0.002).
Conclusion: In summary, diabetic patients have a 2.4-fold increased risk for atypical symptom
presentation than that of non-diabetic patients. Health professionals should remain vigilant at recognizing
atypical AMI presentation in diabetic patients. A tailor-made educative intervention should be directed to
them.
Contact
[email protected]

D 05 - Global Research of Tools to Effect Clinical Change
A Model Testing on Health Literacy, Knowledge about Vitamin D, and Actual
Behavior in Sunlight Exposure
Angela Yee Man Leung, PhD, MHA, BN, RN, FHKAN (Gerontology), Hong Kong
Purpose
The purpose of this presentation is to discuss the relationship between health literacy and actual sunlight
exposure behavior.
Target Audience
The target audience of this presentation is those who are interested in gerontological nursing care.
Abstract
Purpose: To test whether health literacy is associated with actual sunlight exposure behavior, we
interviewed 648 Chinese adults aged 65 years or older.
Methods: Using the information–motivation–behavioral skills model and structural equation modeling, we
tested how health literacy was associated with the complex relationship among knowledge about vitamin
D, attitudes towards sunlight exposure, doctor recommendations regarding sunlight exposure, and actual
sunlight exposure behavior. Health literacy was directly associated with sunlight exposure (beta = .20, p <
.01). Indirect relationships also existed between knowledge and sunlight exposure through health literacy
(beta = .46, p < .001) and between attitudes and sunlight exposure through health literacy (beta = -.12, p
< .05).
Results: The model had good fit (chi-square/df = 2.79; RMSEA = .053, p = .346; CFI = .95; TLI = .92).
Health literacy should be considered when educating older adults about vitamin D supplements and
sunlight exposure. Providing relevant knowledge or making doctor recommendations might not be
effective.
Conclusion: Training should be focused on individuals with low health literacy who would be less likely to
receive sunlight exposure.
Contact
[email protected]

Is the Braden Mobility Subscale Alone as Predictive as the Braden Scale?
Siti Zubaidah Mordiffi, RN, BN, MHlthSc(Edun), Australia
Bridie Kent, RN, PhD, United Kingdom
Nicole M. Phillips, PhD, MNS, GDipAdvNur(Ed), DipAppSc(Nurs), BN, RN, Australia
Choon Huat Koh, MBBS, MMed, MGer, PhD, Singapore
Purpose
The purpose of this presentation is to ascertain whether the Braden mobility subscale is comparable to
the Braden scale in predicting the likelihood of pressure injury in an acute care setting.
Target Audience
The target audience of this presentation are general ward nurses involved in managing patients at risk of
pressure injury or those who have interest in identifying patients at risk of developing pressure injury.
Abstract
Purpose: Pressure injury is known to cause not only debilitating physical effects, but also leads to
substantial psychological and financial burdens. Given the importance of this issue, it remains imperative
that nurses identify patients that are at risk of developing pressure injury, so that preventive interventions
can be initiated early. Risk assessment tools are used to assist nurses in identifying such
patients. However, research has suggested that using risk assessment tools may be no more effective in
preventing actual pressure injury than clinical judgement. Research has also suggested impaired mobility
is a significant risk factor for developing pressure injury, and that mobility assessment alone may be an
adequate alternative for assessing pressure injury risk for the purpose of instituting preventive
interventions. Thus, the purpose of the study is to ascertain whether the Braden mobility subscale is
comparable to the Braden scale in predicting the development of pressure injury.
Methods: This is a retrospective case-control study on review of medical records of adult patients
admitted to an acute care hospital. One hundred cases of patients with pressure injury were matched with
controls of patients who had no pressure injury at a 1:1 ratio for age, gender, length of stay, having had
surgery and have been admitted to the intensive care unit or high dependency unit. Bivariate analysis,
logistic regression analysis and backward logistic regression were undertaken using SPSS version 19.0.
Results: We found that patients who were assessed using the Braden mobility subscale as having "very
limited mobility" or worse (cut-off score ≤ 2) is 5.23 [95% confidence interval (95%CI): 2.66 – 10.20] times
more likely to develop pressure injury compared to those with "slightly limited" or "no limitation" to
mobility. In contrast those assessed using the Braden scale as having "low risk" or higher risks (cut-off
score ≤ 16) is 3.35 [95%CI: 1.77 – 6.33] times more likely to develop pressure injury compared to those
assessed as having “no risk”. Using full model logistic regression analysis and including other Braden
subscales, the mobility subscale was the only subscale that was a significant predictor of pressure injury.
When using backward logistic regression to determine the most parsimonious model, the Braden mobility
subscale remained a significant factor in predicting pressure injury.
Conclusion: The study found that the Braden mobility subscale alone was as good as the Braden scale
as a tool for predicting pressure injury. In addition, other Braden subscales (i.e., moisture, activity,
sensory, nutrition, and friction and shear) did not improve the prediction of pressure injury.
Contact
[email protected]

A Study on Reliability and Validity of a Tool for Measuring Foreign Patient
Satisfaction
Keum Soon Kim, PhD, RN, South Korea
Yun-Kyoung Choi, PhD, RN, APN, South Korea
Myogyeong Kim, RN, BS, BA, South Korea
Jung Won Ahn, RN, BS, South Korea
Purpose
The purpose of this presentation is to share for the results of the reliability and validity for the foreign
patient satisfaction measurement tool.
Target Audience
The target audience of this presentation is researcher who is interested in measuring outcomes such as
patient experiences (patient satisfaction) of the foreign patients.
Abstract
Purpose: This study sought to improve the already developed tool for measuring foreign patient
satisfaction to develop a highly reliable and valid tool.
Methods: In the first stage, the said existing tool was improved to develop preliminary questions. In the
second stage, the validity of preliminary items was examined targeting 15 working experts of international
teams in 10 hospitals where the rate of foreign patients is relatively high. In the third stage, preliminary
questions were translated into relevant foreign languages and back translated. In the fourth stage, by
surveying foreign patients, the reliability and validity of the tool were verified. Specifically, from June 10 to
July 7, 2013, 200 foreign patients (84 English copies, 70 Russian copies, and 46 Mongol copies) in 9
hospitals which operate an international team were surveyed.
Results: The tool for measuring foreign patient satisfaction, developed by Health Industry Development
Institute, was improved to validate its reliability and validity. Thus, a tool for measuring foreign patient
satisfaction, which is comprised of 7 items and 39 questions, was developed. The 7 items are doctor’s
care (5 questions), information and education (6 questions), hospital environment and financial aspect (8
questions), hospital convenience (5 questions), services of nurse, coordinator, reception and payment
system, communication and respect for patients (4 questions), and accessibility (4 questions). The total
number of questions was determined as 39 including overall satisfaction, intention to reuse, and intention
to recommend. The Cronbach’s alpha coefficient for this tool was found high at .95, and the Cronbach’s
alpha coefficient by item was .83 for doctor, .88 for information education, .89 for hospital environment
and financial aspect, .85 for hospital convenience, .77 for services of employees, .86 for communication
and respect for patients, and .65 for accessibility.
Conclusion: Putting together the above results, a highly reliable and valid tool for measuring foreign
patients who visit medical institutions in South Korea was developed. The tool is considered useful to
measure foreign patients’ experience to eventually improve the medical service for foreign patients.
References
Campbell, J. L., Richards, S. H., Dickens, A., Creco, M., Narayanan, A., & Brearley, S. (2008). Assessing the
professional performance of UK doctors: an evaluation of the utility of the General Medical Council patient and
colleague questionnaires. Qual Saf Health Care, 17, 187-193. Care Quality Commission. (2012). Inpatient survey
2012: Technical document. Retrieved May 1, 2013, from
http://www.cqc.org.uk/sites/default/files/media/documents/20120311_ip12_technical_document_final.pdf Center for
Medicare & Medicaid Services. (2012). HCAHPS survey. Retrieved May 1, 2013, from
http://www.hcahpsonline.org/Files/HCAHPS%20V7 %200%20Appendix%20A1%20-
%20HCAHPS%20Expanded%20Mail%20Survey%20Materials%20( English)%20July%202012.pdf Connell, J. A., &
Burgess, J. (2006). The influence of precarious employment on career development: the current situation in Australia.
Journal of education and training, 48(7), 493-507. Davies, A. R., & Ware, J. E. (1988). Involving consumers in quality

of care assessment. Health Affairs, 7, 33-48. Grewal, I., Das, J. K., & Kishore, J. (2012). Concerns, Expectations and
Satisfaction of Medical Tourists Attending Tertiary Care Hospitals in New Delhi, India. JIMSA, 25(3). 151-154.
Jenkinson, C., Coulter, A., & Bruster, S. (2002). The Picker Patient Experience Questionnaire: development and
validation using data from in-patient surveys in five countries. Int J Qual Health Care, 14(5), 353-358. Patient
Satisfaction Survey Report of Foreign Medical Korea. (2011). Patient Satisfaction Survey Report of Foreign patients
in Korea. Seoul: Author. Korsch, B. M., Gozzi, E. K., & Francis, V. (1968). Gaps in doctor-patient communication. I.
Doctor-Patient Interaction and Patient Satisfaction. Pediatrics, 42(5), 855-871. Lunt, N., Smith, R., Exworthy, M.,
Green, S. T., Horsfal, D., & Mannion, R. (2011). Medical Tourism: Treatments, markets and health system
implications: A scoping review. OECD, Directorate for Employment, Labour and Social Affairs. Retrieved May 1,
http://www.oecd.org/dataoecd/51/11/48723982.pdf Lynn, M. (1986). Determination and Quantification Of Content
Validity. Nursing Research, 35(6), 382-386. Marquis, M. S., Davies, A. R., & Ware, J. E. (1983). Patient satisfaction
and change in medical care provider: A longitudinal study. Medical Care, 21, 167-175. Mika, C.Katsapi, A., & Al-
Fade, H. (2013). Quality in International Patient Management. Asian Hospital & Healthcare management. Quality in
International Patient Management. Retrieved May 1, http://www.asianhhm.com/healthcare_management/quality-
international-patient-management.html Ministry of Health and Welfare, & Korea Health Industry Institute. (2011).
Analysis of 2011 foreign patients in Korea. Pocock, N. S., & Phua, K. H. (2011). Medical tourism and policy
implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and
Malaysia. Globalization and Health, 7, 1-12. Rad, N. F., Som, A. P. M., & Zainuddin, Y. (2010). Service quality and
patients' satisfaction in medical tourism. World Applied Sciences Journal, 10, 24-30. Sherbourne, C. D., Hays, R. D.,
Ordway, L., Dimatteo, M. R., & Kravitz, R. (1992). Antecedents of adherence to medical recommendations: Results
from the medical outcomes study. Journal of Behavioral Medicine, 15, 447-468. Ware, J. E., Snyder, M. K., & Wright,
W. R. (1976a). Development and Validation of Scales to Measure Patient Satisfaction with Medical Care Services.
Vol I, Part A: Review of Literature, Overview of Methods and Results Regarding Construction of Scales. (NTIS
Publication No. PB 288-329). Springfield, VA. National Technical Information Service. Ware, J. E., Snyder, M. K., &
Wright, W. R. (1976b). Development and Validation of Scales to Measure Patient Satisfaction with Medical Care
Services. Vol I, Vol I, Part B: Results Regarding Scales Constructed from the Patient Satisfaction Questionnaire and
Measures of Other Health Care Perceptions. (NTIS Publication No. PB 288-329). Springfield, VA. National Technical
Information Service. Ware, J. E., Snyder, M. K., Wright, W. R., & Davies, A. R. (1983). Defining and measuring
patient satisfaction with medical care. Evaluation and program planning, 6, 247-263.
Contact
[email protected]

D 09 - Improving Nursing Student Behavior through Research
Nursing is a Team Sport: Sideline Coaching to Achieve NCLEX-RN Success
Tricia O'Hara, PhD, RN, USA
Purpose
to present findings from a descriptive comparative and correlational research study on Academic
coaching and its effect on NCLEX-RN success
Target Audience
Nurse Educators who are involved in promoting nursing student academic success and preparing
students to take the NCLEX-RN Exam
Abstract
Purpose: To measure the effect of Academic Coaching on Nursing students academic success,
perceptions of the coaching relationship, perceived NCLEX-RN exam readiness and NCLEX-RN success
Methods: Descriptive, comparative correlational research study
Academic coaching is one educational intervention cited in the literature as a strategy to assist students
to achieve academic success, additionally it helps to formulate strong faculty-student relationships that
students perceive as paramount to facilitate their academic success. A descriptive comparative and
correlational research study was conducted to explore the relationships among the students' academic
success; perceptions of the academic coaching relationship; perceived NCLEX-RN exam readiness; and
NCLEX-RN exam success. The O'Hara Model of Academic Coaching, based on Peplau's Theory of
Interpersonal Relations in Nursing served as the theoretical basis for the study
The O'Hara Perception of the Coaching Relationship (PCR) was used in this study to measure students’
perceptions. The PCR instrument was a newly developed valid and reliable tool. Data were collected from
51 senior baccalaureate nursing students at one university in southeast Pennsylvania, who participated in
an 8-week academic coaching experience with their assigned faculty coach. There were four research
questions generated for this study. Data were analyzed using Pearson correlations, t-tests, discriminate
analysis, chi-square, and one-way analysis of variance. Two out of the four research questions did not
achieve statistical power due to the low sample size. These same two research questions were not
statistically significant. Students’ total scores on their perceptions of the coaching relationship were high.
There was a statistically significant difference between the pre and post coaching HESI exit exam scores.
Major categories were identified on students’ responses to three open-ended questions on coaching.
The discussion of the findings, implication for nursing, conclusions and recommendations for future
research were presented. The findings of this study contributed to advancing nursing knowledge in the
areas of nursing research, science and education. This study does support the newly developed O’Hara
Model of Academic Coaching. The high NCLEX-RN exam first time pass rate in this study is also
noteworthy. More research on the role of academic coaching is warranted.
Results: Statistical signficance on Academic success, NCLEX-RN success; High positive perceptions of
the Academic coaching relationship and NCLEX-RN readiness.
Conclusion: Many Implications for further resarch, nursing education.
References
References Ashley, J., & O’Neil, J. (1991). The effectiveness of an intervention to promote successful performance
on NCLEX-RN for baccalaureate students at risk for failure. Journal of Nursing Education, 30, 360-366. Bondmass,
M., Moonie, S. & Kowalski, S. (2008). Comparing NET & ERI standardized exam scores between BSN graduates
who pass or fail the NCLEX-RN. International Journal of Nursing Education Scholarship, 5, 1-15. Burns, N., & Grove,
S. (2009). The practice of nursing research. (6th ed.) St. Louis, MO: Elsevier. Carper, B. A. (1978). Fundamental
patterns of knowing in nursing. Advances in Nursing Science, 1, 13-24. Carrick, J. (2010). Student achievement and
NCLEX-RN success: Problems that persist. Nursing Education Perspectives, 32, 78-83. Carter, J. (2007). Coaching
for results. Critical Care Nurse, 2, 40-44. Carol, R. (2006). Degrees of success. Discrimination in nursing school:

Thing of past or alive and well? Minority Nurse, 2, 56-60 DeMonica, L., Malecha, A., Tart, K., & Young, A. (2010).
Stress and perceived faculty support among foreign-born baccalaureate nursing students. Journal of Nursing
Education, 49, 261-270. Donner, G., & Wheeler, M. (2009). Coaching in nursing: An introduction. International
Council of Nurses and the Honor Society of Nursing, Sigma Theta Tau International. Indianapolis, IN: Printing
Partners. Douglass, J., Sowell, R., & Phillips, K. (1997). Using Peplau’s theory to examine the psychosocial factors
associated with HIV-infected women’s difficulty in taking their medications. The Journal of Theory Construction &
Testing, 7, 10-17. Eich, M., & O’Neill, T. (2007). NCLEX delay pass rate study. NCSBN Psychometric Research Brief,
4, 1-5. Ekigil, A.,& Sari, H. (2008). Students’ opinions about and expectations of effective nursing clinical mentors.
Journal of Nursing Education, 47, 118-123. Feely, M. (1997). Using Peplau’s theory in nurse-patient relations.
International Nursing Review, 44, 115-120. Fitzpatrick, M. (2001). Coaching champions. Nursing Management, 6, 7-
8. Forchok, C. (1994). The orientation phase of the nurse-client relationship: Testing Peplau’s theory. Journal of
Advanced Nursing, 20, 532-53. Gall, M. Gall, J. & Borg, W. (2007). Educational research: An introduction (8th ed.).
Boston, MA: Pearson. Government iIrmation. (2012). Retrieved January 11, 2013 from http://www.govinfo.org
Graham, J. (2006). Nursing theory and clinical practice: How three nursing models can be incorporated into the care
of patients with end stage kidney disease. The CANNT Journal, 16, 28-31. Griffiths, M., Pepastrad, K., Gze Kanski,
K., & Hagan, K. (2004). The lived experience of NCLEX failure. Journal of Nursing Education, 43, 322-325. Haidar, E.
(2007). Coaching and mentoring nursing students. Nursing Management, 14, 32-35. Harding, M. (2010). Predictability
associated with exit examinations. A literature review. Journal of Nursing Education, 49, 493-497. Hayes, E., &
Kalimakis, K. (2007). From the sidelines: Coaching as a nurse practitioner strategy for improving health outcomes.
Journal of the American Academy of Nurse Practitioners, 19, 555-562. Hayes, E., McCahon, C., Panahi, M., Harme,
T., & Pohlman, K. (2008). Alliance not compliance: Coaching strategies to improve Type 2 diabetes outcomes.
Journal of the American Academy of Nurse Practitioners, 20, 155-162. Hertzog, M. (2008). Considerations in
determining sample size for pilot studies. Research in Nursing & Health, 31, 180-191 Johnson, A. (2008). NCLEX-RN
success with boot camp. Nursing Education Perspectives, 30, 11-16. Jones, A. (1995). Utilizing Peplau’s
psychodynamic theory for stroke patient care. Journal of Clinical Nursing, 4, 49-54. Keller, S. P., & Kelvin, E. A.
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Bergstrom, B. A. (1991). Comparability of decisions for computer adaptive and written examinations. Journal of Allied
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K. (2007). Assisting nursing graduates who have failed the NCLEX. ASBN Update, 14, 24-25. McGahee, T.,
Gramling, L., & Reid, T. (2010). NCLEX-RN success: Are there predictors? Southern Online Journal of Nursing
Research, 10, 208-21. McGann, E., & Thompson, J. (2008). Factors related to academic success in at-risk senior
nursing students. International Journal of Nursing Education Scholarship, 5, 1-15. McNaughton, D. (2005). A
naturalistic test of Peplau’s theory in home visiting. Public Health Nursing, 22, 429-438. Morrison, S., Adamson, C.,
Nibert, A., & Hsia, S. (2008). HESI exams. An overview of reliability and validity. Nurse Educator, 22, 39S-45S.
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R. (2003). The HESI exit exam: Progression benchmark and remediation guide. Nurse Educator, 28, 141-145.
O’Hara, P. (2012). Perception of the coaching relationship. Chester, PA: Widener University. Unpublished
manuscript. O’Hara, P. (2010). Coaching: A concept analysis. Chester, PA: Widener University. Unpublished
manuscript. Pennington, T. & Spurlock, D. (2010). A systematic review of the effectiveness of remediation
interventions to improve NCLEX-RN pass rates. Journal of Nursing Education, 49, 485-492. Peplau, H. (1952).
Interpersonal relations in nursing. New York, NY: Putnam. Peplau, H. (1991). Interpersonal relations in nursing. New
York, NY: Springer. Peterson, V. (2001). Predictors of academic success in first semester baccalaureate nursing
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Generating and assessing evidence for nursing practice ( 8th ed.). Philadelphia, PA: Wolters Kluwer. Poorman, S.,
Mastorouich, M., & Webb, C. (2008). How faculty help and hinder students at risk. Nursing Education Perspectives,
29, 272-277. Potolsky, A., Cohen, J., & Saylor, C. (2003). Academic performance of nursing student: Do prerequisite
grades and tutoring make a difference? Nursing Education Perspectives, 24, 246-250. Radmacher, S., & Martin, D.
(2001). Identifying significant predictors of student evaluations of faculty through hierarchical regression analysis. The
Journal of Psychology, 135, 259-268. Robinson, E., & Niemer, L. (2010). A peer mentor tutor program for academic
success in nursing. Nursing Education Perspectives, 31, 286-289. Schenk, S. (2002). Nurse coach: Healthcare
resource for this millennium. Nursing Forum, 37, 14-20. Shelton, E. (2003). Faculty support and student retention.
Journal of Nursing Education, 42, 68-75. Spurlock, D., & Hunt, L. (2008). A study of the usefulness of the HESI exit
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Nursing theorists and their work. St. Louis, MO: Mosby. Vale, M., Jelinek, M., & Best, J. (2005). Impact of coaching

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Contact
[email protected]

D 09 - Improving Nursing Student Behavior through Research
Improving the Skills of RN-BSN Students in Maximizing the Use of Data and
Information for Evidence-Based Nursing: Nursing Information Behavior
Edmund J. Y. Pajarillo, PhD, RN-BC, CPHQ, NEA-BC, USA
Alexei Oulanov, PhD, MBA, MLIS, USA
Purpose
The purpose of the presentation is to describe the information behavior of RN-BSN students to help
nursing educators and supervisors, information specialists, and application developers gain insights into
the RN students' information, education, and technology needs to help enhance their professional
functioning and maximize on their learning experiences.
Target Audience
The target audience of this presentation are nurse educators, supervisors, informaticists, and nursing
professionals.
Abstract
Purpose: This present research explored the nursing information behavior (NIB) of RN-BSN students to
understand how they access and use data and information, taking into consideration their status as
nurses and students in pursuit of their baccalaureate education. The relevance of evidence-based nursing
cannot be overemphasized with the heightened focus on healthcare quality and patient safety. This is
evident in current reports and initiatives (IOM, 2010; AACN, 2008; IOM, 1999) articulating the basic and
essential skills that nursing students and nurses must have to be able to perform nursing under the best
circumstances. Nursing students and nurses should be able to integrate research and evidence-based
practice, informatics concepts, and technology-mediated applications into nursing. A critical proficiency in
achieving this expertise is for nurses and nursing students to have a strong and solid information
behavior. Wilson (2010) defines information behavior as “distinct and broad … a collective and
encompassing concept covering information seeking, information searching and information use. It entails
behavior associated with active and passive information, including its conceptualization, formulation, use
and application.” It is oftentimes associated with two relevant components, namely information needs and
sources of information.
How nursing students and nurses identify, seek and use information is important to understand, more so
if the students are registered nurses (RNs) pursuing their baccalaureate degrees in nursing. Components
of the nursing information behavior (NIB) of RN students include their information needs, sources
frequently accessed, barriers encountered, and the manner by which information is processed (Pajarillo,
2008). Understanding the NIB of RN students is a requisite step in evidence-based practice so that
educators are more able to assist them on how to best access and use relevant information when faced
with critical, patient-related information needs. Healthcare modalities and approaches related to nursing
assessments and interventions have been significantly affected with advancements in medicine, health,
nursing, and information technology. Nurses and nursing students need to be able to obtain and apply the
most appropriate and current evidence and be able to integrate this into their professional practice.
Knowing information sources that are reliable, as well as the appropriate steps and processes to obtain
information will enhance nurses’ patient care skills, critical thinking proficiency, and evidence-based
patient care.
Information behavior is likewise contingent on the user’s social structure and setting, so that motivations,
processes, strategies and barriers consequently vary depending on the locale. A previous research was
conducted to describe the nursing information behavior of home care nurses (Pajarillo, 2008), describing
their information needs (drivers) and information leads and conduits (sources). This study described a
framework of nursing information behavior that includes the information processes used by home care
nurses in the contextual setting of their community work place. Findings of this research showed that the
information behavior of home care nurses is attributed to the very nature of their job being set in the
community. There was much reliance on the use of human sources of information, rather than the

traditional hard copy manuals and textbooks, or those obtained electronically through the Internet or
electronic databases.
An appreciation of the NIB of RN students should be able to provide educators, information specialists,
and application developers insights into their specific information, education, and computer program
needs to help enhance their professional functioning as nurses and maximize on their learning
experiences. In the long run, these RN students will gain better knowledge and skills in information
identification, access, processing and use for integration and application in their nursing practice and care
of patients.
Methods: A mixed-method approach was used in this research. RN students in two nursing programs,
one in New York and another in New Jersey were requested to complete a survey of their frequently-
identified information needs, sources used, and roadblocks experienced during the process. The
framework devised by Pajarillo (2008) was used to describe their information behavior. Additionally, a
small group of these RN students (4-5 in each nursing program) were recruited to participate in individual
interviews and focus groups to describe their specific information needs identification, searching,
processing, and use. The survey was conducted using Survey Monkey during the Fall 2013. Volunteers
were recruited from the same cohort of survey respondents.
Results: Data triangulation that resulted from the survey, individual interviews, and focus groups
revealed an interesting mix of information needs that were mostly patient care and nursing course-
related. Information leads used by the RN students were of electronic and manual formats and from
human sources. There were issues identified relating to difficulties accessing database sources, massive
quantities of available information, and concerns relating to the authenticity of available information
coming from web searches. Some themes identified from the individual interviews and focus groups
include “the necessity to pursue the information search process is contingent on the scope and severity of
the information need,” “need for information searching is a professional duty,” “human sources come
handy when there is no time to waste,” and “the information search process is a complex but relevant
task.”
Conclusion: A follow-up study will be conducted using the findings from this exploratory study with a
larger number of RN student-respondents, with the goal of identifying factors and elements that will likely
influence improved information behavior that will also be incorporated into nursing curriculum.
References
AACN (2008). Essentials of baccalaureate education for professional nursing education. American As- sociation of
Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/education-resources/ baccessentials08.pdf IOM
(2010). The future of nursing. Leading change, advancing health. Report Brief Robert Wood Johnson Foundation
initiative on the future of nursing, at the Institute of Medicine. Retrieved from http://
www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nurs-
ing%202010%20Report%20Brief.pdf IOM (1999). To err is human. Institute of Medicine. Retrieved from
http://www.iom.edu/~/media/Files/ Report%20Files/1999/To-Err-is-
Human/To%20Err%20is%20Human%201999%20%20report%20 brief.pdf Pajarillo, E. J. Y. (2008). A conceptual
model of nursing information behavior (NIB). Contextual perspectives of information for home care nurses.
Saarbrücken, Germany: VDM Verlag Dr. Müller Aktiengesellschaft & Co. Wilson, T. D. (2010). Fifty years of
information behavior research. Bulletin of the American Society for Information Science and Technology 36(3), 27-34.
doi: 10.1002/bult.2010.1720360308.
Contact
[email protected]

D 10 - Patient Safety and Nursing Autonomy
Registered Nurse Individual Innovative Behavior and Research Utilization
Jose J. Dy Bunpin, RN, BSN, MBA, USA
Purpose
The purpose of this presentation is to provide the participant with information about individual innovative
behavior among registered nurses who work in acute care hospitals.
Target Audience
The target audience for this presentation are registered nurses, administrators and researchers.
Abstract
Purpose: The purpose of this study was to describe individual innovative behavior among registered
nurses who work in acute care hospitals and to understand the antecedents to individual innovative
behavior as well as the relationship of individual innovative behavior and research utilization.
Methods: A descriptive, cross-sectional research design was used to answer the questions for this study.
A questionnaire (paper and on-line) was administered to registered nurses who worked in acute care
hospitals. Registered nurses were asked to identify the hospital they worked for in order to tie them to
organizational characteristics.
Results: It was found that nurses had on average moderate individual innovative behavior as well as
moderate commitment to research utilization. Individual innovative behavior was predicted by autonomy,
specialty certification, and belief suspension. Research utilization was predicted by individual innovative
behavior, attitude towards research, and in-services and continuing education.
Conclusion: Both individual innovative behavior and research utilization needs to be improved among
registered nurses. Organizations need to provide the support and environment necessary to help cultivate
both behaviors in order to help improve the quality and safety of patient care. Registered nurses should
engage in identifying problems and accessing, assessing, applying, persuading, implementing, and
integrating research findings into their nursing practice to help resolve quality and safety problems in
healthcare.
References
Basu, R., & Green, S. (1997). Leader-member exchange and transformational leadership: An empirical examination
of innovative behaviors in leader-member dyads. Journal of Applied Social Psychology, 27(6), 477-499. Berwick, D.
(2003). Disseminating innovations in health care. JAMA, 289(15), 1969-1975. doi: 10.1001/jama.289.15.1969
Champion, V. L., & Leach, A. (1989). Variables related to research utilization in nursing: an empirical investigation.
Journal of Advanced Nursing, 14(9), 705-710. Chang, L. C., & Liu, C. H. (2008). Employee empowerment, innovative
behavior and job productivity of public health nurses: A cross-sectional questionnaire survey. International Journal of
Nursing Studies, 45(10), 1442-1448. doi: 10.1016/j.ijnurstu.2007.12.006 Donaldson, N. E., Rutledge, D. N., & Ashley,
J. (2004). Outcomes of adoption: Measuring evidence uptake by individuals and organizations. Worldviews Evidence
Based Nursing, 1 Suppl 1, S41-51. doi: WVN4048 [pii]10.1111/j.1524-475X.2004.04048.x Estabrooks, C. A. (2009).
Mapping the research utilization field in nursing. Canadian Journal of Nursing Research, 41(1), 218-236. IOM.
(2010a). The future of nursing: Leading change, advancing health. Washington, D.C.: The National Academies Press.
Knol, J., & Van Linge, R. (2009). Innovative behaviour: The effect of structural and psychological empowerment on
nurses. Journal of Advanced Nursing, 65(2), 359-370. doi: 10.1111/j.1365-2648.2008.04876.x Scott, S. G., & Bruce,
R. A. (1994b). Determinants of innovative behavior: A path model of individual innovation in the workplace. Academy
of Management Journal, 37(3), 580-607. Weng, R.-H., Huang, C.-Y., & Lin, T.-E. (2013). Exploring the cross-level
impact of market orientation on nursing innovation in hospitals. Health Care Management Review, 38(2), 125-136.
doi: 10.1097/HMR.0b013e31824b1c84
Contact
[email protected]

Underlying Factors of Medication Errors at a Tertiary Care Hospital, Pakistan
Shirin Badruddin Verasia, MSN, BSN, Saudi Arabia
Purpose
To identify the underlying factors that contribute towards medication errors at tertiary care hospital in
Karachi, Pakistan
Target Audience
nurses, clinicians, administration and policy makers.
Abstract
Purpose: Medication error is considered to be an important indicator of a patient’s safety. Several error
producing factors contribute to its occurrence and may result in patients’ morbidity and mortality. Using a
mixed method design, this study aimed to identify the underlying factors of medication errors. The study
was conducted at a tertiary care hospital in Karachi, Pakistan.
Methods: Following the eligibility criteria, 64 medication errors, reported in this period from December
2011 to March, 2012 were included in this study. Data was collected by reviewing documents pertinent to
the errors, a self-administered survey questionnaire, and face to face interviews with doctors,
pharmacists, and nurses who had committed an error.
Results: Analysis of the quantitative data showed that of the 64 errors, 49 were actual errors, 15 were
near misses and 2 were classified as sentinel events. The highest percentage of errors was committed in
the administration phase, by nurses in the morning shift and they were working more than forty five (45)
hours per week. The content analysis of the qualitative data led to two themes – stress and workload and
the violation of policies.
Conclusion: These findings have implications for the hospital administration, and recommendations
provided in this study will help them to bring an improvement in the system.
References
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Prescribing errors in hospital inpatients: Their incidence and clinical significance. Quality and Safety in Health Care,
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(1995). Medication administration errors: A study into the factors underlying the occurrence and reporting of
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intravenous fluid administration errors in Australian surgical care wards. Quality and Safety in Health Care, 14, 179-
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United Kingdom: John Wiley & Sons. Institute of Medicine of the National Academic Report. (2006). Retrieved from
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Contact
[email protected]

Measurement of Moral Courage
Georgia A. Dinndorf-Hogenson, PhD, RN, CNOR, USA
Purpose
show the impact of moral courage in perioperative nurses on patient safety.
Target Audience
registered nurses in the clinical setting, leadership, and in academia.
Abstract
Purpose: Threats to patient safety exist. Nurse appraisals of these threats and the likelihood to act with
moral courage have not been documented. This descriptive correlational study examined moral courage
response to threats to patient safety. The moral courage model was based on Lazarus and Folkman’s
theory of stress and coping. The Dillman, Smythe, and Christenson (2009) tailored design method was
used to construct the Moral Courage Questionnaire for Nurses (MCQN) instrument. Moral courage
frequency and intensity were explored.
Methods: A randomized mail questionnaire distributed to Midwest perioperative registered nurses yielded
50% response rate (N = 154).
Results: Multiple regression analysis results indicate moral courage in perioperative nurses is
significantly influenced by Magnet® status, certification, peer support, institutional culture, fear, and
previous operating room experience. Perioperative nurses from Magnet® hospitals were significantly
more likely than nurses from non-Magnet® hospitals to stop a surgical procedure performed by a
physician with alcohol breath (F = 7.99, p = .005). Urban perioperative nurses were significantly more
likely to stop the procedure than nurses from smaller rural hospitals (F = 4.95, p = .028). Significant
positive correlations were shown between previous OR experience and the level of moral courage
addressing physician substandard practice (p = .004). Significant negative correlations occurred between
fear of reprisal and retaliation and (a) reporting ethical issues to administration (p = .001), (b) questioning
provider when not in best interest of patient (p = .001), (c) frequency of speaking up when risks to the
patient are known (p = .006), and (d) moral courage overcoming being silent about an ethical issue (p =
.005). Fear of reprisal and retaliation were positively correlated with moral distress (p = .000). Sufficient
performance of the MCQN Likert-type scale showed contrast of scale scores to reflect variance;
Cronbach’s alpha measured 0.81.
Conclusion: Findings indicate the moral courage model performance was robust with the exception of
the motivational value systems variable. Perioperative nurses reported high moral courage in situational
threats to patient safety. Significant findings clustered influencing factors of fear, previous experience,
peer support, and institutional culture. Furthermore, Magnet® status, peer support, previous operating
room experience, institution’s urban location, supportive nursing management and administration promote
perioperative nurses’ exhibition of moral courage. Future research is indicated for supportive nursing
management and policy creation promoting moral courage in situations that are threats to patient safety
within the perioperative area.
Contact
[email protected]

E 03 - Global Nursing Migration
Managing Migration of Human Resources for Health: The Philippine Perspective
Erlinda Castro Palaganas, PhD, Philippines
Ruel Dupan Caricativo, BA, Philippines
Marian Caterial Sanchez, BA, Philippines
Purpose
to present a critical social perspective on the ethics concerning migration of health professionals as they
pursue opportunities with significant ramifications on both source and receiving countries. Migration is a
global phenomenon, thus both the source and receiving countries need to establish equitable
partnerships in the management of migration.
Target Audience
are representatives from organizations/agencies involved with recruitment and employment of nurses and
other health professionals; professional associations and advocacy groups; private sector employees;
public health facilities/employers; teaching institutions; recruitment agencies.
Abstract
Purpose: While there are varied perspectives on the ethics concerning migration, health professionals
continue to pursue opportunities with significant ramifications on both source and receiving countries. As
migration continues to be a global phenomenon, both the source and receiving countries need to
establish equitable partnerships in the management of migration. This qualitative research aims to
present a critical social perspective as a form of discourse in the management of migration.
Methods: Interviewed individuals knowledgeable of human resources for health. Purposively chosen key
informants (KIs) included doctors, nurses, midwives, and physical/occupational therapists who
formed participants of the 32 KIIs; plus 3 Group Interviews; 2 FGDs. They represent a range of
stakeholder interests from national government agency officials; health regulatory bodies; health
professional associations and advocacy groups; private sector employees; public health
facilities/employers; teaching institutions; recruitment agencies. Interviews were transcribed and
translated following approved ethical procedures. The data collected was analyzed simultaneously via
systematic, documented procedures of thematic and constant comparative analysis using Nvivo
and manual procedures.
Results: Data revealed that the Philippines has made the following strides in addressing this necessary
intervention: bilateral agreements, tracking of health professionals, and improving the educational system.
Bilateral Agreements: The Philippines continues to produce world class doctors, nurses, midwives, and
other health professionals who are highly specialized and sought after in countries across the globe.
However, migration has not come without cost for both the country and the migrant workforce. On the
local front, despite the need for specialized health professionals in many of the poorest parts of the
country, the Philippines continues to lose health professionals to better opportunities abroad. At the same
time, while the host countries benefit from the excellent care provided by the migrating health
professionals, our health professionals are also subjected to discrimination and exploitation, either
undervalued and not receiving the same wages as the locals or either under-skilled and forced to work in
positions not commensurate to their skill level. The Philippines is now in official negotiations with several
receiving countries to establish mutual recognition agreements to protect both country and migrant
workforce. In addition to measures on ethical recruitment guidelines, it is being proposed that receiving
countries should also take strides to help the source countries. For a certain number of doctors or nurses
that a country will hire, the receiving country should also pay for the training of a proportionate number of
health professionals in the Philippines, or provide support through upgrading of a health facility in the
poorest regions. Receiving countries should also be willing to allow migrant health professionals to return
to the Philippines every so often at cost to the host country to share training and skills they have learned
while abroad as a means of transfer of technology, so that instead of a “brain drain” there will be “brain
circulation” instead.

Tracking of Health Professionals: Data and statistics on Filipino health professionals in the Philippines
and abroad are often only estimates and the exact number and location of Filipino health professionals
are still unclear. Different agencies have their own data and figures but there is still no centralized
database. Government agencies are proposing collaborations in order to establish a more efficient
tracking system. This tracking system will help not only for collection of data, but will also enable better
protection of rights of health professionals and also for better allocation and mobilization of resources.
Improving the Educational System: The demand for migrant health professionals saw a sudden increase
in the number of medical and nursing schools hoping to capitalize on the trends. However, a significant
number of these schools have not been at par with technical standards, resulting in an increased number
of doctors and nurses with inadequate skills and competencies who have thus been unable to find job
opportunities. In addition, receiving countries have assessed the local training system for some health
professionals as inadequate, such that health professionals who want to work abroad have to pursue
additional training to fulfill these requirements. As a response, educational institutions have reassessed
and revised their curriculum to reach set standards. Regulatory boards have cracked down on
substandard medical and nursing schools to improve or close down. By improving the local curriculum to
be at par with international standards, the Philippines will be in a better position to negotiate for equitable
partnerships with receiving countries. There is also a call for “transformative education” with focus on the
health needs for the country and sense of service, such that students will not enter into courses with the
intention to migrate but rather to stay and serve.
The study has revealed other key issues that may not be apparent but will have significant implication in
the future. While migrant health workers provide health care for others abroad, there have been reports
that their own personal health has been neglected. Migrant workers may return home with illnesses of
their own, and in some instances have died because of illness abroad. The illnesses they face and the
conditions behind this may be interest for further study.
Conclusion: Health professionals will continue to choose to migrate abroad if the conditions which force
them to seek opportunities elsewhere are not addressed. The glaring reality that the local socio-political-
economic atmosphere is rife with problems of unjust wages and inadequate career opportunities among
other issues must be given priority. Unless health professionals will have better opportunities for
economic and personal advancement, staying in the Philippines will not be considered a viable option and
migration will continue. Thus, the study brought forward key mesages: migration as a human right,
international human rights instruments, migration and development, social determinants of migration,
rights-based approach to migration, and the “ethical” in ethical recruitment. It is necessary to recognize
migration as a human right. But what underlies this argument is the inherent human right to freedom of
movement. One of the basic principles of human rights is that all rights are interrelated. The recognition of
migration as a basic human right entails the recognition of other rights an individual is entitled to.
International human rights instruments have already been established to secure the respect and
recognition of migrant workers’ rights. These instruments recognize the significant contributions of migrant
workers in development, both for the source and destination countries. Moreover, these instruments
provide us a viable approach – the rights-based approach – that could mitigate the negative impacts of
economic development to migrant workers. All these human rights instruments recognize that migrant
workers are significant contributors to development. They contribute to the development of their countries
of origin through remittances and increase in domestic consumption as well as the transfer of skills. They
contribute to the development of their destination countries through their skills and by augmenting its
existing labor force. But an approach to international migration that only focuses on their contributions on
development would inevitably dehumanize migrant workers. Migration should not be looked at from an
economic perspective but instead, a rights-based approach is necessary. In addition, this approach can
be used to analyze the policy of ethical recruitment. Again, this approach is based on the freedom of
movement, labor rights, and the right to health of source country, in case of HHR migration. Hence,
ethical recruitment is that which recognizes these three foundations.
References
Atanackovic, J., Bourgeault, I.L., Ogempo, B., Chan, J. (2011). Source Country Perspectives on the Migration of
Health Professionals: Philippines. University of Ottawa, Interdisciplinary School of Health Sciences & Institute of
Population Health; Unpublished Paper. Ronquillo, K., Elegado-Lorenzo, F., & Nodora, R. 2005.HUMAN
RESOURCES FOR HEALTH MIGRATION IN THE PHILIPPINES: A Case Study and Policy Directions. Paper for

ASEAN Learning Network for Human Resources for Health, August 2-5,2005 Bangkok, Thailand. Lorenzo, F. M.,
Dela Rosa, j. F., Villegas, S., Yabes, J., Trinidad, F., Fernando, G., & Atienza, J. (2006). Migration of health workers:
Country case study Philippines (International Labour Office Working Paper WP.236). Geneva, Switzerland:
International Labour Organization (ILO).
Contact
[email protected]

E 03 - Global Nursing Migration
Examining Filipinos as Foreign-Educated Nurses in the United States from the
Perspectives of Post-Colonialism
Leo-Felix M. Jurado, PhD, RN, NE-BC, APN, CNE, USA
Purpose
The purpose of this presentation is to have a better understanding on the long standing mass migration of
Filipino Foreign-educated nurses (FEN) to the United States.
Target Audience
The target audience are nurse administrators, nurse educators, nurse researchers, nurse regulators and
nurse clinicians who have worked or currently working with foreign-educated nurses particularly Filipino
nurses.
Abstract
Purpose: The study objectives were: (a) describe the historical events contributing to mass recruitment of
nursing graduates from the Philippines to the US, ( b) analyze the political and economic factors
underlying the unidirectional flow of foreign-educated nurses from the Philippines to the US, (c) examine
the impact of large scale nursing recruitment from the Philippines to the US, and (d) analyze the influence
of post-colonial forces on conditions of employment and perceived value of FENs in the US.
Methods: The qualitative study design used historical research and focus groups. The data sources
included primary and secondary sources, collected between 1900 to 2013 in the US and the Philippines.
Four separate focus groups were conducted with 21 FENs who entered the US under different visas for
training or employment between 1962- 2006. Findings from historical data and focus groups were
triangulated in analyzing linkages and significance of events in the phenomenon of interest.
Results: The findings revealed that mass emigration of nurses from the Philippines to the US is facilitated
by nursing shortages that brought changes in immigration laws easing entry of nurses to the US.
Conclusion: The fusion between the subjective and objective reality constructed nursing and migration to
the US as key to improving the economic well-being and social status of FENs and their families. Filipino
families, schools, and government take an active role in promoting this social reality. The American
benevolent assimilation agenda, US-based public education, and nursing education and practice have
perpetuated American superiority and dependence of Filipinos on Americans. Findings provide an
understanding of institutionalized structures perpetuating global inequalities in nurse migration and
distribution that impact differentially among sending and receiving countries. The study has implications in
policy development to promote retention of nurses in their home countries and foreign countries where
they immigrate.
Contact
[email protected]

E 04 - Nursing Research in Critical Care
A Qualitative Study of Family Members of ICU Patients Who Require Extensive
Monitoring
Claudia DiSabatino Smith, PhD, RN, NE-BC, USA
Kristi M. Custard, BSN, BS, RN, USA
Purpose
The purpose of this presentation is to report findings of a qualitative study that explored family members’
perceptions about the extensive monitoring technology used with their critically ill family member following
cardiac surgery, and the education provided to them.
Target Audience
The target audience of this presentation is researchers, educators, ICU leaders.
Abstract
Purpose: Monitoring technology has become more high tech and complex in healthcare over the last ten
to fifteen years. The computer age has facilitated the development of a host of more sensitive invasive
and non-invasive monitors with which healthcare professionals both monitor and deliver therapy to
critically ill patients. Accompanied by the emergence of this extensive monitoring technology is a growing
gap between the healthcare providers who use the technology when caring for critically ill patients and
the patients’ family members who strain to understand and cope with its use.
In order to provide education materials that address family concerns related to high tech monitoring
equipment, we need a better understanding of the family’s perception of the equipment. We need to
understand their perception as seen through the eyes of family members. Little is written about the family
members’ experience related to monitoring equipment. The greatest need of ICU family members is
information about the patient’s status and about the equipment in use. Therefore, it is important to explore
the experience of family members who observe their critically ill loved one receiving high tech monitoring
and therapy. The study utilized both survey data and a qualitative hermeneutic interpretive
phenomenological approach to explore family members’ perceptions about the extensive monitoring
technology used with their critically ill family member following cardiac surgery and the education
provided to them.
Methods: Following approval by the hospital institutional review board, investigators used purposive
sampling to select study participants during patient visitation in the Cardiovascular Surgery ICU for this
mixed methods study. Inclusion criteria consisted of English-speaking family members of patients who
had cardiac surgery and with whom extensive monitoring technology was utilized. Additionally, family
members must have visited the patient in the ICU during the time that the patient had extensive
monitoring in place. Digital recordings were transcribed and verified by the study team.
The data collection methodology consisted of a researcher-generated demographic data sheet and the
use of a semi-structured interview guide with which to conduct family research in a group interview
setting. Participants completed Spielberger’s State Trait Anxiety Inventory (STAI) at the outset of the
interview session. Each member of the family (maximum of four family members) was consented and
interviewed as a family. Diekelmann’s descriptive phenomenological method was used to analyze
interview data. To ensure trustworthiness of the data, the PI secured the services of a professional
colleague, familiar with qualitative research, to review the interview transcripts and interpretive findings for
accuracy and consistency.
Results: Despite efforts to recruit a representative sample, the study sample consisted of four Caucasian
families and one Hispanic family. Five general themes emerged from the analysis of five family interviews.
They were: 1. Overwhelmed by all of the equipment; 2. Feelings of uncertainty; 3. Methods of coping with
uncertainty; 4. Meaning of the numbers on the monitors; 5. Need for education.

Conclusion: Younger family members and those with information technology-associated jobs were more
likely to educate themselves using online resources. Older family members preferred to ask nurses
questions as a means of educating themselves. Early in each of the interviews families praised nurses for
providing “all the necessary education”, while later in the interviews all family members identified
educational needs and missed opportunities for education.
References
Auerbach, S. M., Kiesler, D. J., Wartella, J., Rausch, S., Wark,. K., & Ivatury, R. (2005). Optimism satisfaction with
needs met, interpersonal perceptions of the healthcare team and emotional distress in patients’ family members
during critical care hospitalization. American Journal of Critical Care, 14, 202-210. Davidson, J. E., Powers, K.,
Hedayat, K. M., et al. (2007). Clinical practice guidelines for support of the family in the patient-centered ICU: Merican
College of critical Care Task Force 2004-2005. Critical Care Medicine, 35, 2, 605-622. Polit, D. F., & Beck, C. T.
(2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice, (9th ed.). Philadelphia: Wolters
Kluwer/Lippincott Williams & Wilkins.
Contact
[email protected]

Impact of a Smart Phone Application on ICU Family and Provider Satisfaction
Florence Schaefer, MS, RN, ACNS-BC, USA
Purpose
to disseminate the findings of the impact that smart phone technology, specifically an application
developed entitled “The ICU Survival Guide”, had on improving ICU patient (and family as surrogate)
satisfaction by providing support in three domains: information, emotional and logistical and hence
reportable satisfaction with the hospital as an institution.
Target Audience
all nursing staff, managers, administrators and informatics nurses. This topic would also be of interest to
nursing educators.
Abstract
Purpose: The most important factor affecting the overall satisfaction of the family with the ICU is the
thoroughness of the information that they receive. Family members and their significant others are
frequently called upon to share information and to make decisions pertaining to care, particularly when
the loved one is a patient in an Intensive Care Unit (ICU) and are unable to make decisions for
themselves. An increase in anxiety and distress experienced by families has particularly been noted
when they receive poor communication. Communication barriers, fear, and uncertainty all add to the
distress levels of family members.
Literature supports the need to increase and improve communication between healthcare professionals
and the patients’ families. There is a need for the family of the critically ill patient to receive updated
information more than once to decrease anxiety. It is imperative that these surrogate decision makers are
provided with early and effective communication. The use of print material, as well as computer kiosks as
vehicles for better communication are documented in the literature; however there is a paucity of research
in which a smart phone application is used to improve and reinforce knowledge and communication with
patients’ family members as well as influence family members’ level of satisfaction with information.
The central hypothesis of the proposed study is that the smart phone technology, specifically an
application entitled “The ICU Survival Guide”, will improve family satisfaction of ICU patients as measured
by the ICU FS-24. For the study, the application was placed on iPads which were given to the family
member for a period of 72 hours or until patient discharge from the ICU.

Methods: A randomized control intervention study was conducted to test an application for a smart
phone or I Pad as an effective strategy for providing thorough, accurate information to family members of
critically ill ICU patients. Three data collection tools were used to evaluate family satisfaction with the care
in the Intensive Care Unit, family satisfaction with the application, and staff nurse perception of their
interactions with family members of ICU patients who used/ didn’t use the application.
Conducted in three medical-surgical ICUs in a large tertiary hospital in the Texas Medical Center, a
sample of 250 study participants was limited to one family member per critically ill patient who was
admitted to one of the study units. Participants were randomly assigned to either the intervention or
control group.
Study results were analyzed using descriptive and inferential statistics at a level of significance of p =
0.05. The sample size was calculated to reflect a power of 0.80 and a moderate effect.
Results: Data collection is complete and analysis is underway. Results will be reported at the time of the
conference.
Conclusions: Family members generally found the “ICU Survival Guide” very informative. Utilizing an
iPad, however, was a barrier to many participants. Participants who were randomly assigned to the
intervention group, who either owned iPads or were in the 20-30 age range, were likely to consent
participate. Older adults who were assigned to the intervention group, voiced concern and did not want to
be responsible for the iPad. They did not want the added stress of learning how to work the iPad and the
ICU Survival Guide application.
References
Alvarez, G.F. & Kirby, A. S. (12/01/2006). The perspective of families of the critically ill patient: their needs. Current
Opinion in Critical Care 12(6), 614-618. Azoulay, e., Chevert, S. Leleu, G., Pochard, F., Barboteu, M., Adrie, C.,
Canoui, P., LeGall, J.R.,& Schlemmer, B. (2000). Half the families of intensive care unit patients experience
inadequate communication with physicians. Critical Care Medicine, 28(8), 3044-3049 Heyland, D.K., CARENET. FS-
ICU 24 Retrieved on April 1, 2011 at: http://www.thecarenet.ca Hickman, R.L.,& Douglas, S.L., (2010).Impact of
Chronic Critical Illness on the Psychological Outcomes of Family Members. Advanced Critical Care, 21(1), 80-91.
Jacobowski, N.L., Girard, T.D., Mulder, J.A., & Ely, E.W. (2010). Communication in critical care: family rounds in the
intensive care unit. American Journal of Critical Care, 19(5), 421-430. Wall, R.J., Curtis, J. R., Cooke, C.R., &
Engelberg, R.A. (2007). Family satisfaction in the ICU: differences between families of survivors and nonsurvivors.
Chest, 132, p. 1425-1433. DOI 10.1378/chest.07-0419 Wall, R.J., Engelberg, R.A., Downey, L., Heyland, D.K., &
Curtis, J. R. (2007). Refinement, scoring, and validation of the family satisfaction in the intensive care unit (FS-ICU)
survey. Critical Care Medicine, 35(1), p. 271-279. DOI: 10.1097/01.CCM.0000251122.15053.50
Contact
[email protected]

Involving Relatives in ICU Patient Care: The Barriers and Enablers
Bridget Anne McConnell, RN, BN (Hons), Australia
Purpose
The purpose of this presentation is to educate registered nurses as to the findings of a current research
study which investigated relative involvement in ICU patient care. The author will discuss methodologies
utilised to discover barriers and enablers to relative inclusion.
Target Audience
The target audience of this presentation is critical care nurses. However, the information discussed in the
presentation may be applicable to many nursing specialities and so, all registered nurses would benefit
from this research.
Abstract
Purpose: Relative involvement in ICU patient care has received growing recognition in recent times.
However, relative involvement in the care of a critically ill patient remains a controversial issue. Past
research has investigated the relatives experience within the intensive care environment, highlighting the
benefits of their inclusion in care activities. However, whilst past research has identified the benefits of
relative involvement in ICU patient care for the relative, patient and critical care nurse, there has been no
investigation as to whether this practice is occurring within Intensive Care Units or if there are any barriers
and enablers to this practice. This research study aimed to investigate barriers and enablers that impact
on a critical care nurse’s ability to involve relatives in ICU patient care activities and identify possible
reasons for their existence. It is of great significance to recognise barriers and enablers to improve the
relative’s experience within the intensive care environment and gain the benefits of this practice as
outlined in nursing literature.
Methods: A mixed methods methodology consisting of two phases was utilised for this study. To address
the diversity of this nursing issue and provide comprehensive answers to the research questions, a mix of
both quantitative (Phase 1) and qualitative (Phase 2) data was needed to create a more complete picture
of the research problem. An explanatory mixed method design was utilised. An online questionnaire was
conducted in Phase 1, in which 70 participants responded to a series of questions related to relative
involvement in ICU patient care. The intensive care network was used for questionnaire participant
recruitment. As a subset of purposive sampling, a snowball sample approach was used, with third parties
emailing the questionnaire link and information sheet to potential participants within the intensive care
network. Thirteen interview questions were developed following Phase 1 data analysis and 6 participants
were interviewed in Phase 2. Participants were critical care nurses, employed in an Intensive Care Unit at
the time of data collection. Although small, the study sample reflected a range of ages and intensive care
experience.
Results: Descriptive statistics and thematic analysis was used to produce the study’s results. The results
of the study demonstrated a range of perspectives demonstrating that relative involvement in patient care
is ultimately the personal decision of the gatekeeper critical care nurse. This led to the identification of two
distinctive critical care nurses: ‘The Gatekeeper’ and ‘The Facilitator’. The characteristics of these two
types of critical care nurses assisted in the identification of barriers and enablers to this practice. This
study fulfilled its aim in determining specific barriers, such as the role of the critical care nurse, critical
care nurses expertise, knowing what is best for the patient, time constraints, short term ICU stay, the
‘right’ relative, insecurity, hospital policies and the fear of adverse events. Enablers identified included the
relative-patient relationship, the relative as a resource, veracity, care competency, experience, the
individual relative, knowledge of benefits and an extended stay in ICU. The researcher also suggests
possible reasons for the existence of barriers and enablers.
Conclusion: This study has concluded that policies and guidelines to relative involvement in ICU patient
care should be produced to assist critical care nurses in their decision making. This practice requires
discussion and promotion within the intensive care setting to limit barriers and uphold enablers.

Knowledge of barriers and enablers to relative involvement in patient care has the potential to improve
the relatives ICU experience. This research has contributed unique findings to the body of knowledge on
the topic of relative involvement in ICU patient care, however further investigation is required to identify
the ways in which barriers can be reduced and enablers enhanced.
Contact
[email protected]

E 05 - Utilizing Multiple Technologies to Influence Nursing
Radio Frequency Identification Device (RFID) and Real Time Location Systems
(RTLS) Enhance Nursing Care Delivery
Sandra Reeder, MSN, USA Particia Toor, MSN, USA
Purpose
The purpose of the presentation is to use RTLS & RFID technology to measure the direct patient care
work by shift and patient type in order to develop process improvements for safe, effective and efficient
care.
Target Audience
The target audience of this presentation is front line nurses, nursing educators, process improvement,
safety officers and administration.
Abstract
Purpose: The purpose of the project was to use the technology to measure the direct patient care work
by shift and patient type in order to develop process improvements for safe, effective and efficient care.
Technology has the potential to create a better work environment for inpatient nurses by improving
efficiency, safety, and quality of care. Technology solutions such as RFID and RTLS can have a dramatic
impact on patient safety, quality of care, patient and nurse satisfaction contributing to overall enhanced
hospital operations. (California HealthCare Foundation, 2008). RFID and RTLS have mainly been used to
help track equipment. A study conducted by Indiana University-Purdue University Indianapolis
documented nursing time spent locating equipment was 60 minutes per shift. Implementing the
technology resulted in process improvements to save $750,000 in-direct costs and give the nurses back
the hour to spend with their patients (Wicklund, 2009). Nurses are the hub in a complex web of care
delivery as well as an expensive resource in the acute care setting. Validating the work of nurses can
identify opportunities for improvement.
Methods: Staff members were assigned RFID tags to allow tracking of movement and time on the
Innovation Unit. Data was collected for three months and converted into spaghetti maps and graphs to
demonstrate traffic flow and time spent in patient care by shift, day of the week, and month. The data was
analyzed and validated by leaders and members of the team to identify opportunities for process
improvement in the specific areas of staffing by shift, by patient type, and time of day that impacts care
delivery and expense for the unit.
Results: RFID and RTLS technology data identified minutes by shift workload (direct care) day shift and
night shift as similar, supporting that the nurse to patient ratio for both shifts should be the same. Day shift
spent 129,452 minutes versus 90,207 minutes during night shift. The differences between the shifts were
39,245 minutes which converted to .5 FTE annually. The technology validated care delivery patterns by
total minutes spent per hour in patient’s room specifically related to hand off communication and
assessments. Data, sorted by patient type, documented the time spent by specialty service patient type.
This information supported adjusting assignments to allow for patients with complex care needs to be
balanced with those requiring less time. Individual nurse data was used to improve individual efficiencies.
Data was also used to support redesign of work spaces based on actual flow of nursing staff to minimize
steps and inefficiencies.
Conclusion: RFID and RTLS on the Innovation unit have validated process improvements related to
nursing ratios, patterns of care delivery, nursing assignments, and work flow efficiencies. These changes
created a better work environment for nurses through improved efficiency, safety and quality of care
delivered. Celebration Health embraces, supports, and experiments with technology to understand the
work of nursing and to fulfill one of our core purposes to be a living laboratory. Technology is rapidly
growing in healthcare but for it to be successful it is extremely important to understand the current
workflow and explain the “why” behind the implementation. Michael Fraai director of biomedical
engineering at Brigham and Women’s hospital quoted “There is a huge cultural component to the
implementation of technology. You can install a lot of technologies, but if a technology doesn’t fit into the
existing workflow, it won’t be adopted”.

References
Daniely, G. (2010). White Paper:Unified Asset Visibility Converging Location, Condition and Status Across the Entire
Enterprise.http://aeroscout.com/wi-fi-rfid Evans, D.N., Where is RFID's ROI in Health Care? The most strategic
benefits for radio frequency identification in health care aren't necessarily found in applications with the most
apparent return on investment.(2006). http://www.rfidjournal.com/articles/view?2124 Swedberg, C. (2013).Marshall
University Researchers Foresee a 'Perfect Storm' for RFID in Health Care RFID technology is competing for the
attention of hospital IT departments, a study says, but when deployed, it can reduce costs by hundreds of thousands
of dollars, and benefit hospitals experiencing growth due to the Affordable Care Act.
http://www.rfidjournal.com/articles/view?11253 Tyruscim F., Rhoads, J. (2008). Equipped for Efficiency: Improving
Nursing Care Through Technology. http://www.chcf.org/ Wicklund, E. (2009). Study: RTLS technology can save
hospitals time and money, boost care. www.healtcareitnews.com/news/study-rtls-technology
Contact
[email protected]
E 05 - Utilizing Multiple Technologies to Influence Nursing

Comparison of Telemedicine to Traditional Face-to-Face Care for Children with
Special Healthcare Needs: Analysis of Cost, Caring, and Family-Centered Care
Mary A. Hooshmand, PhD, MS, BS, RN, USA
Purpose
The purpose of this presentation is to examine issues of cost, caring and family-centered care specific to
telemedicine services. To promote acceptance by health care providers and recipients of health care, it is
critical to provide research-based evidence that health services provided via telemedicine are cost
effective, caring, and family-centered.
Target Audience
The target audience of this presentation includes nurses in research, practice, and academia particularly
those working with vulnerable and hard to reach populations facing challenges in access to health care
services. Specific interest groups may include those in maternal child health, community health and
informatics.
Abstract
Purpose: The purpose of this research project was to examine cost, caring and family-centered care in
relation to pediatric specialty services utilizing telemedicine technology compared to traditional face-to-
face visits for CSHCN in rural, remote and medically underserved areas of Southeast Florida. Family
costs, caring, and family-centered care were examined from the perspectives of the parents/ guardians of
CSHCN.
Methods: A quasi-experimental research design was used with a convenience sample of 222 parents/
guardians of CSHCN residing in rural, remote and medically underserved areas of Southeast Florida
enrolled in the Children’s Medical Services (CMS) program. The sample was comprised of two study
groups: traditional (n = 110) which included families receiving traditional face-to-face pediatric specialty
care; and the telemedicine group (n = 112) which included families who have received telemedicine visits
along with traditional face-to-face pediatric specialty care. Measures of cost, caring, and family-centered
care were obtained using three instruments including a Family Cost Survey, Caring Professional Scale
(CPS), and Measure of Processes of Care- 20 Item Scale (MPOC-20).
Results: Results indicated that there were no significant differences in family costs when telemedicine
was available locally compared to traditional face-to-face care in the local community. Family costs were
reported to be significantly higher if telemedicine was not available in their communities. Families within
the telemedicine group reported significantly greater anticipated costs for pediatric specialty care visits if
telemedicine had not been available locally. If telemedicine had not been available, parents anticipated
significant increases in both costs and burdens to the family including increased mileage/ travel, number

of family members missing work, loss of wages impacting family weekly incomes, child care needs,
lodging, and additional other costs associated with the specialty visit.
While there were no differences in the families’ perceptions of care as caring, parents in the telemedicine
group reported more positive perceptions of the system of care as being family-centered compared to
families receiving traditional face-to-face pediatric specialty care. The study results are significant
because they indicate that families do perceive systems of care inclusive of telemedicine as family-
centered. In fact, while parent/ guardians in both groups reported that they perceived the system of care
as family-centered, the scores were significantly higher among the parent/ guardians in the telemedicine
group compared to traditional face-to-face care across all domains of family-centered care.
These results with significantly higher scores for family-centered care under the telemedicine condition
render further investigation. The provider groups were consistent across traditional and telemedicine
clinics within the same overall system of care for CSHCN in the Southeast region of Florida. One primary
difference observed is that, within the telemedicine clinics, there is consistently a Registered Nurse (or
Advanced Registered Nurse Practitioner) with the family during the telemedicine sessions. While
traditional clinics may have a Registered Nurse present, they are not consistently with the family
throughout the clinical sessions. In contrast, there may be a Licensed Practical Nurse or Medical
Assistant with the family and pediatric specialty provider in traditional face-to-face clinics. This warrants
further study not only in respect to telemedicine but the possible impact of the Registered Nurse role in
terms of effect on family-centered care across the system of care including the pediatric specialty clinics
for CSHCN.
Conclusion: This study demonstrates the acceptance of telemedicine by parents of CSHCN. The use of
innovative systems of care such as telemedicine has promise to promote caring, family-centered systems
of care in communities. These results together underscore the importance of assuring and facilitating
access to pediatric specialty care for CSHCN and their families by further reducing their burdens and
costs. Systems of care for CSHCN should be accessible, reduce financial burden, and construed by the
recipients of care as caring and family-centered in order to build family- provider partnerships, and
optimize health outcomes for CSHCN and their families.
The findings of this study indicate that the use of technology, specifically telemedicine, did not diminish
the human connection, caring, and this has implications for all kinds of health care technologies. For
example, potential technologies could range from video teleconferencing ‘home visits’ through computer
technology connecting families to a community health nurse, medical home, pediatric specialist, or even
back to the Neonatal or Pediatric Intensive Care Unit for a follow-up; telemedicine based in pediatrician
offices connecting to schools and day cares perhaps conducting ‘sick’ visits; to the use of twitter or other
social networking tools to provide health information or health reminders to a child with Juvenile
Diabetes. The possibilities for the use of technology in health care are vast and have not been tapped to
their full potential.
The results suggest that telemedicine can reduce family cost burden, maintain caring behaviors on the
part of health care professionals, and promote caring, family-centered systems of care in local
communities. We make the assumption that technology lessens the interpersonal relationship in the
health care setting. This study debunks that mindset and provides evidence that the human connection is
not lost through the use of technology. In this era of health care reform, this study provides powerful
evidence to support expansion of technology in the health care arena.
References
Hooshmand, M. (2010). Comparison of telemedicine to traditional face-to-face care for children with special health
care needs: Analysis of cost, caring and family-centered care (Doctoral dissertation). Retrieved from University of
Miami and ProQuest at http://scholarlyrepository.miami.edu/oa_dissertations/408/ and
http://gradworks.umi.com/34/11/3411647.html.
Contact
[email protected]

E 09 - Using Simulation Through the Lifespan
The Use of a Death Notification Simulation and Readiness for Interprofessional
Learning in Nursing and Social Work Students
Adrienne A. Galbraith, RN, MSN, USA
Catherine Macomber, MSW, USA
Purpose
describe the results of a research study to explore readiness for interprofessional learning in Nursing and
Social Work students before and after an interprofessional death notification simulation
Target Audience
nurse educators
Abstract
Purpose: Traditionally the emphasis on interprofessional collaboration has been in the practice setting
and not during the education of health care professionals. In order for healthcare disciplines to effectively
collaborate at the patient’s bedside, it is important for healthcare education to allow students to participate
in interprofessional learning as part of their educational process. The purpose of this study was to
determine whether participation in an interprofessional simulation on death notification influences
undergraduate nursing and social work students’ perception of readiness for interprofessional learning.
For the past two years, senior Nursing and Social Work students have participated in a death notification
simulation. Through this interactive simulation, the students are able to enact and discuss their
professional roles and differentiate how they may overlap or vary, thereby potentially increasing
understanding, mutual trust, and respect for other professions. The students participated in the simulation
either in the role of the Nurse, Social Worker, or observer. All the students participated in the simulation
debriefing together.
Methods: In this research study, The Readiness for Interprofessional Learning Scale, a 19 item Likert
type scale, was used to assess readiness for interprofessional learning in Nursing and Social Work
students before and after a pre-established death notification simulation. A descriptive-comparative
design was used with senior Nursing and Social Work students to collect data over a one year period. All
students that participated in the simulation each semester (Approximately 100) were asked to participate
in this study. Data was collected using The Readiness for Interprofessional Learning Scale one week
before and immediately following the death notification simulation.
Results: A total of 232 students completed the surveys (110 before the simulation and 122 after). T-tests
showed a significance difference in scores on the total RIPLS (t= -3.32, p=.001), the teamwork and
collaboration subscale (t=-2.88, p=.004), and the professional identity subscale (t=-3.20, p=.002)
indicating an increase in the readiness for interprofessional learning after the simulation.
Conclusion: The participation of Nursing and Social Work students in an interprofessional simulation
resulted in an increased readiness for interprofessional learning. The use of interprofessional simulations
may be a strategy that can be used in a variety of settings to increase interprofessional teamwork and
collaboration.
References
Parsell, G., Bligh, J. (1999). The development of a questionnaire to assess the readiness of health care students for
interprofessional learning (RIPLS). Medical Education, 33, 95-100.
Contact
[email protected]

Baby Boy Jones: Using Technology to Engage Undergraduate Nursing Students
in a Case-Based Learning Activity
Lisa M. Cleveland, PhD, RN, PNP-BC, IBCLC, USA
Bonnie Taylor, MA, CAPM, USA
Linda Grace Solis, PhD, USA
Bruce Paper, BA, USA
Purpose
The purpose of this presentation is to describe the use of an innovative and effective learning strategy
that can assist educators in maximizing limited resources and enhance the achievement of learning
outcomes to meet the future demands for qualified nurses.
Target Audience
The target audience for this presentation is nurse educators at both the undergraduate and graduate
levels.
Abstract
Purpose: Case-based learning activities (CBLA’s) are an effective strategy for teaching clinical reasoning
and decision-making skills in the health sciences. Baby Boy Jones, our prototype CBLA focused on
newborn infection, is an interactive, unfolding case scenario within the context of interprofessional care,
deployed as a web-based independent learning activity. The purpose of this presentation is to describe
the develpment of this CBLA, discuss learning outcomes and student attitudes as well as our plans
for continued development of this project.
Methods: The CBLA, situated in the undergraduate maternal-newborn nursing course, was designed
using SoftChalk® e-learning, authoring software and delivered using the Blackboard learning
management system. Content addressing learning objectives was presented using branching decision
points, immediate feedback, opportunities for reflection, and formative assessment. Identical pre/post-
activity assessments were used to measure learning outcomes and a survey was used to measure
attitudes.
Results: Students (N=342) participated in the Baby Boy Jones CBLA; 315 completed all 10 items of the
pre and post-activity assessments. Findings revealed a statistically significant difference in their scores
(z=-11.03, p<.001) indicating that students performed better on the post assessment. In addition, 195
students responded to the attitude survey. Results showed that students agreed the CBLA was relevant
to their learning needs for the course (94%) and focused on the learning objectives (95%). They also felt
the activity incorporated decision-making and feedback (92%) and was visually compelling and thought
provoking (85%). Students agreed the activity reflected current theory and evidence-based practice (96%)
and they learned content more effectively for transfer to the clinical setting using this method of instruction
(82%). Lastly, following the activity, students felt more capable of identifying an infant at risk for
developing infection and more capable of providing nursing care for that infant (86%).
Conclusion: The Baby Boy Jones CBLA is an example of innovation in nursing education demonstrating
student achievement of learning objectives and a high degree of student satisfaction. Continued
exploration of this method of instruction in nursing and other health professions education is strongly
encouraged.
Contact
[email protected]

Aging Simulation Program: Improving Nursing Students' Attitudes Toward Caring
for Older People
Min-Feng Huang, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to explore the effects of an aging simulation program on improving
nursing students' attitudes toward caring for older people.
Target Audience
The target audience of this presentation is nursing educators and health professionals.
Abstract
Purpose: This study aimed to explore the effects of an aging simulation program on improving nursing
students' attitudes toward caring for older people.
Methods: The aging simulation program includes 3 stages: Stage 1 was an introduction section; Stage 2
was the aging simulation; and Stage 3 was a post-simulation discussion. All participants completed a
post-simulation report after the aging simulation program. The content analysis was conducted to analyze
the post-simulation report.
Results: A total of 67 undergraduate students studying in a gerontological nursing curriculum joined the
aging simulation program. The majority of participants was females (92.3%; n=62). Four categories
emerged from the data, including: requiring patience and empathy not sympathy, understanding the
limitation of aging, creating a friendly and supportive environment, and preparing to face aging of parents
and grandparents.
Conclusion: Results of this study show that nursing students have positive attitudes toward aging. The
findings suggest that the use of the aging simulation program in nursing education may prove helpful in
enhancing undergraduate nursing students' attitudes toward caring for the elderly.
Contact
[email protected]

E 10 - Medication Related Research in the Clinical Setting
Medication Communication during Handovers Involving Nurses in Speciality
Hospital Settings
Elizabeth Manias, RN, MPharm, PhD, Australia
Sandy C. Braaf, RN BN PhD, Australia
Sascha P. Rixon, BSc/BA (Hons) PhD, Australia
Allison Williams, BNurs, PhD, Australia
Danny Liew, MBBS PhD, Australia
Purpose
The purpose of this presentation is to inform the audience about how medication communication occurs
during handovers involving nurses.
Target Audience
The target audience of the presentation is clinical health practitioners and others involved in performing,
teaching, researching, managing or writing policy for handover processes.
Abstract
Purpose: Handover may be defined as “the exchange between health professionals of information about
a patient accompanying either a transfer of control over, or of responsibility for, the patient” (Cohen &
Hilligoss, 2010, p. 494). It is an important forum for communicating patient information. Communication
breakdowns during handover may have adverse effects on patient safety and quality of healthcare
(Department of Health, 2012). Existing research on handovers involving nurses has largely focussed on
information provision during shift-to-shift nursing handovers in specific hospital settings (e.g., medical
wards). Research to date does not adequately convey the detail and complexity of handover
communication. Handovers take place multiple times during a nurse’s working shift, and is an important
communication forum for conveying information pertaining to a patient’s medications (e.g., at-home
medications, medication treatment, goals and outcomes of medication treatment, and discharge
medications). Liu, Manias, and Gerdtz (2012) and Manias, Aitken, and Dunning (2005) have explored
medication communication during nurse-to-nurse handovers in individual settings. However, there is a
lack of research on communication about medications during handovers involving nurses (in which health
professionals other than nurses may give or receive handover) in a variety of specialty hospital settings.
We seek to address this gap in research by examining how medications information is communicated
during handovers involving nurses in a variety of speciality hospital settings.
Methods: This exploratory qualitative study draws on over 200 hours of audio-recorded participant
observation of health care professionals in hospital specialty settings. The study was conducted at a
metropolitan Australian public hospital in cardiothoracic care, intensive care, emergency care, and
oncology care settings. Communication interactions involving nurses performing handovers to, or
receiving handovers from, ambulance officers, doctors or other nurses, were observed. Handover types
included health care professionals’ communication for the purposes of shift changeover, moving patients
between or within a ward, receiving or sending patients via ambulance services, and leaving or returning
to the patient area for tea breaks or other purposes. All audio recorded handovers were de-identified and
transcribed verbatim. A comprehensive thematic analysis was performed by three researchers.
Results: Factors shaping medication communication during all types of handover included: whether an
intravenous infusion was being administered and the type of infusion, medication tasks to be attended to,
anticipated time away from the bedside, a receiving nurse’s knowledge of the patient, and potential risk to
the patient. Outgoing nurses who left the bedside temporarily, such as for a tea break, infrequently
received a handover of information upon return to the patient area. There was a lack of medication
communication involving patients and any present family members during handovers, despite these
handover interactions often taking place at the bedside. Little time was devoted to conveying medication
information. Information conveyed focused on medications prescribed during a patient’s hospital stay.
Patient medications taken prior to hospitalisation were seldom mentioned, except in ambulance officer-

nurse interactions. Medication names were not always mentioned during handover, with generic
medication referents used instead (e.g. antibiotics). Often the names of medications were abbreviated
and units of medication doses omitted. In regard to shift-to-shift handovers, the structure of
communication varied according to the setting in which it was conducted. In cardiothoracic care and
intensive care nurses were observed to use a body systems approach to order their communication,
which facilitated the sharing of medication information. In emergency care and oncology care, patient
documentation was used to structure communication. Medication communication did not arise
consistently with this approach. In all settings, medication administration records were often reviewed at
the end of handover interactions.
Conclusion: Effective communication between health care professionals during handover enhances
patient safety and quality of care. Currently little time is allocated to the communication and discussion of
medication information. Greater emphasis on medications during handover, and the involvement of
patients and family members, could improve the content, accuracy, timeliness and completeness of
medication communication. This may reduce the risk of medication incidents.
References
Cohen, M. D., & Hilligoss, P. B. (2010). The published literature on handoffs in hospitals: deficiencies identified in an
extensive review. Quality and Safety in Health Care, 19(6), 493-497. doi: 10.1136/qshc.2009.033480 Department of
Health. (2012). Supporting patient safety. Sentinel event program annual report 2010-11. Liu, W., Manias, E., &
Gerdtz, M. (2012). Medication communication between nurses and patients during nursing handovers on medical
wards: A critical ethnographic study. International Journal of Nursing Studies, 49(8), 941-952. doi:
http://dx.doi.org/10.1016/j.ijnurstu.2012.02.008 Manias, E., Aitken, R., & Dunning, T. (2005). Graduate nurses'
communication with health professionals when managing patients' medications. Journal of Clinical Nursing, 14(3),
354-362.
Contact
[email protected]

A Systematic Review of Non-Pharmacological Management of Heel-Stick Pain in
the Pre-Term Neonates
Ming-Huei Lu, MS, RN, Taiwan
I-chuan Li, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to help pediatric clinical staff and administrators appraise, select and
synthesize all high quality research evidence about the efficacy of non-pharmacological interventions in
the management of Heel Stick Pain in preterm neonates.
Target Audience
The target audience of this presentation is Pediatric clinical nursing staff, Nursing administrators, Nursing
educators, and Nursing researchers.
Abstract
Purpose: To identify effective non-pharmacological interventions in the literature regarding Heel Stick
Pain prevention and treatment in preterm neonates.
Methods: A literature search from 2007 to 2012 was conducted using MedLine, CINAHL, and the
Cochrane Library databases, and was complemented by a search of known articles. Two independent
reviewers extracted data and assessed methodological quality according to pre-defined criteria.
Results: We identified 14 randomized controlled studies that pertained to non-pharmacological pain
management methods. The selected interventions were "non-nutritive sucking"," sucrose "," glucose " ,"
sensorial saturation ", "facilitated tucking", "kangaroo care", " sensorial saturation", " breast milk " and
"incubator care(inclined, nested, and prone)". Some of the non-pharmacological interventions reduced
changes in pulse rate, respiration and oxygen saturation, motor activity, and clinical excitation states
during painful intervention.
Conclusion: Evidence supported "non-nutritive sucking"," sucrose "," glucose" ," sensorial saturation ",
"facilitated tucking" and "kangaroo care" for their pain-alleviating effects on neonates. However,
unambiguous evidence of their effects remains to be presented. Further research must use validated pain
assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological
interventions.
References
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morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet,
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Nolent, P., Ducrocq, S., . . . Breart, G. (2008). Epidemiology and treatment of painful procedures in neonates in
intensive care units. JAMA, 300(1), 60-70. doi: 10.1001/jama.300.1.60 Castral, T. C., Warnock, F., Leite, A. M., Haas,
V. J., & Scochi, C. G. (2008). The effects of skin-to-skin contact during acute pain in preterm newborns. Eur J Pain,
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K. J., & Engberg, S. (2012). Oral sucrose and "facilitated tucking" for repeated pain relief in preterms: a randomized
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A. (2008). Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial.
Pediatrics, 122(3), e716-721. doi: 10.1542/peds.2008-0221 Cong, X., Ludington-Hoe, S. M., McCain, G., & Fu, P.
(2009). Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early
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Thomas, J., Synnes, A. R., Cepeda, I. L., Keidar, A., . . . Johannesen, D. (2009). Neonatal pain, parenting stress and
interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain, 143(1-2), 138-
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Stankus, A., & Jarrell, J. R. (2008). Kangaroo Care (skin contact) reduces crying response to pain in preterm
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Neonatal Nurs, 25(8), 691-703. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: a new theory. Science,
150(3699), 971-979. Okan, F., Coban, A., Ince, Z., Yapici, Z., & Can, G. (2007). Analgesia in preterm newborns: The
comparative effects of sucrose and glucose. European Journal of Pediatrics, 166(10), 1017-1024. Porter, R. H., &
Winberg, J. (1999). Unique salience of maternal breast odors for newborn infants. Neurosci Biobehav Rev, 23(3),
439-449. Stevens, B., Johnston, C., Franck, L., Petryshen, P., Jack, A., & Foster, G. (1999). The efficacy of
developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates.
Nurs Res, 48(1), 35-43. Stevens, B., Johnston, C., Petryshen, P., & Taddio, A. (1996). Premature Infant Pain Profile:
development and initial validation. Clin J Pain, 12(1), 13-22. Xiaomei, Cong, Ludington-Hoe, S. M., & Walsh, S.
(2011). Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a
pilot study. Biol Res Nurs, 13(2), 204-216. doi: 10.1177/1099800410385839
Contact
[email protected]

Exploration of the Medication Disturbance, Quality of Life and Effectiveness of an
Educational Program on the up to Six Months Follow-Up in Atrial Fibrillation
Patients Under Warfarin Treatment
Yu-Hsia Tsai, RN, MS, Taiwan
Hsueh-Erh Liu, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to share our research results about: 1.the medication disturbances
and quality of life among atrial fibrillation patients under Warfarin treatment. 2.the most important
educational issues for AF patients under Warfarin treatment.
Target Audience
The target audiences of this presentation are clinicians, researchers, educators, and administrators in
medical associative disciplines.
Abstract
Purpose: Purposes of this study were to (A) assess the medication disturbance and QoL of AF patients
taking Warfarin, and to (B) evaluate patients’ cognition of medication, compliance to medical treatment,
INR (international normalized ratio) values , bleeding side effect, thrombosis or stroke after individual
education on Warfarin implemented by nurses.
Methods: A total of 122 AF patients with Warfarin treatment were recruited from the outpatients in a
medical center, Taiwan. They received the baseline assessment of INR, medication knowledge and
disturbance, medicine compliance and QoL by laboratory data and questionnaire when they signed up
the informed consent. Based on these results, they were divided into 3 groups. Group 1 (standard group,
n=15) was patients showed an understanding of how to take Warfarin safely and had good compliance of
the medicine. For them, no intervention was implemented. The other participants with limited
understanding and poor compliance were divided into group 2 (control group, n=48) and 3 (experimental
group, n=59) randomly. The control group received routine care whereas the experimental group received
the personal education program. All these 3 groups received 6 months’ follow-up assessments in order to
identify the effectiveness of the educational program. Finally, only 113 participants completed the 6
months’ follow up (group 1=15; group 2=45; group 3=53).Outcome indicators included: medication
knowledge, compliance to medical treatment, INR values, leading side effect, thrombosis or stroke was
carried out at the third and sixth month. The post-test at the sixth month were accomplished for
medication disturbances and SF-36-QoL among these 3 groups.
SPSSPC-Win18.0 was used for statistics analysis. Descriptive statistics included mean, standard
deviation, frequency and percentage. Inferential statistics including unpaired t test, two-way analysis of
variance (ANOVA), Chi-Square test, and Fisher’s exact test were used to compare the differences
between groups; paired t test and McNemar’s test were used to compare pre-test and post-test within 3
groups. Multiple regression was used for predicting the significant factors of participants’ QoL. The
significant level of this study was 0.05.
Results: The mean age of whole participants was 69.7 years old (SD=12, range: 38-95). Most of the
participants were male (51.6%), married (68%), diagnosed as AF more than one year (89.3%) and take
Warfarin more than 1 years (74%). In addition, no significant differences of demographic data and
medical conditions existed between experimental and control groups. In regard to the INR value, there is
no significant difference between the first assessment and the 6 month’s follow for both the experimental
and control groups. However, 2 participants experienced stroke and 4 cases experienced bleeding side
effects during study period.
For the experimental group, the levels of anticoagulant knowledge and medication compliance were
increased from 5.7±1.2 (first assessment) to 6.8±1.4 (3- month, t=-6.1; p=0.000) and 6.6±1.6 (6-momth,
t=-3.9; p<.001). Significant improvements were found in the single items as “observing the symptoms or

signs of abnormal bleeding”, “purpose of taking anticoagulant” and “medication precautions”. When
comparing 3 groups, we found that the highest knowledge score of anticoagulant was the standard group,
but there was no significant difference between experimental and control group both in the first
assessment and post-test. Overall, the lowest score items of anticoagulant knowledge were “diet
adjustment “and “medication precautions” both in pre-test and post-test.
When “disturbances of anticoagulant” as an issue in the experimental group, the levels significantly
increased from 0.9±1.1 (first assessment) to 1.7±1.9 (6-momth, t=-1.74; p=0.01) in experimental group. In
addition, most patients worry about ” incidence of stroke or thrombus” and “frequent blood test” in first
assessment. However, more participants worried about “medication side effects” in 6-month follow-up. As
for QoL, in first assessment, participants in experimental group reported their ranges of QoL were 58 to
83, where “role restriction due to physical problems”, “general health” and “vitality “ were the worst ones
reported. When compared with the first assessment, participants reported significantly decreased “social
function” (t=2.0, p=0.046) and “mental health” (t=3.9, p=0.00). Additionally, age, gender, married status,
education level, stroke, congestive heart failure, past surgery, comorbidity, bleeding experience and
medication disturbances affected participants’ subgroup QoL in the first assessmen among 122 AF
patients who were taking Warfarin.
Conclusion: The personalized education program could improve the levels of anticoagulant knowledge
and medication compliance. However, we still recommend enhancing the subjects of health education
over “diet adjustment” and “avoiding medication interaction “among AF patients who are taking Warfarin.
We require balancing the effectiveness of health education without causing patients to excessively worry
about medication. Otherwise, patients’ QoL is a complicated and important issue. The effectiveness of
educational intervention in patients’ QoL is a subjective outcome indicator. The relationships between
education intervention, medication disturbances, or other factors and patients’ QoL could be explored in
advance. Thus, finding out how to improve real QoL of AF patients’ under Warfarin treatment by
increasing their medication knowledge and decreasing medication disturbances are our ultimate goals.
Contact
[email protected]

F 03 - Geriatric Nursing Research
Determinants of Physical Function Recovery in Elderly during Three Months
Post-Hospitalization
ChiaoWen Chang, BS, Taiwan
Ching-Huey Chen, PhD, RN, Taiwan
Purpose
The purpose of this presentation is share the specific finding of Geriatric nursing.
Target Audience
The target audience of this presentation is who interested in Geriatric nursing.
Abstract
Purpose: For many older adults, hospitalization can lead to functional decline because of diseases or
activity restriction. Previous researches found that at least 30% hospitalized older adults experienced
functional decline and this even influenced about 70% elders in Taiwan. Three months post-
hospitalization elders, less than 75% of them could regain their previous physical function. Experience
functional decline may not only affect the quality of life but else increase the mortality rate of elders.The
aim of this study was to describe functional recovery and its determinants among elderly patient three
months post-hospitalization.
Methods: This was a cross-sectional and correlational study, used secondary data analysis. The data
originated from the research entitled “Risk Factors of Functional Decline in Hospitalized Elderly Patients”
which supported by The National Science Council. Subjects recruited through convenience sampling from
eight medical units at a university hospital in southern Taiwan. Subjects were patients aged ≥ 65 years
without conscious disturbance and being able to communicate in Mandarin or Taiwanese. A structured
questionnaire was used to collect data. Data of the subjects’ demographic information, diagnosis,
Charlson comorbidity index, Mini-mental state examination, Katz ADL, exercise habits and associated
information were retrieved. The Statistical Package for the Social Sciences (SPSS) version 17.0 software
was used to perform statistical analyses.
Results: More then half (54.22%) elderly persistent functional impairment at 3 months post-
hospitalization. Regular exercise habits (OR = 3.789, 95% confidence interval = 1.430-10.039, p = 0.007)
the only independent factor associated with functional recovery.
Conclusion: Regular exercise habits can be used as reference indicators predict functional recovery of
the elderly after discharge. For those hospitalized elderly patient who has occurred or is prone to
experience functional decline, interventions early are needed to enhanced their participation in regular
exercise after discharge from hospital.
References
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Hospitalized Adults. Journal of the American Geriatrics Society, 60(1), 187-189. doi: 10.1111/j.1532-
5415.2011.03716.x Boyd, C. M., Landefeld, C. S., Counsell, S. R., Palmer, R. M., Fortinsky, R. H., Kresevic, D.,
Covinsky, K. E. (2008). Recovery of activities of daily living in older adults after hospitalization for acute medical
illness. Journal of the American Geriatrics Society, 56(12), 2171-2179. doi: 10.1111/j.1532-5415.2008.02023.x Boyd,
C. M., Ricks, M., Fried, L. P., Guralnik, J. M., Xue, Q., Xia, J., & Bandeen-Roche, K. (2009). Functional decline and
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Journal of the American Geriatrics Society, 57(10), 1757-1766. doi: 10.1111/j.1532-5415.2009.02455.x Boyd, C. M.,
Xue, Q.-L., Guralnik, J. M., & Fried, L. P. (2005). Hospitalization and Development of Dependence in Activities of
Daily Living in a Cohort of Disabled Older Women: The Women's Health and Aging Study I. The Journals of
Gerontology Series A: Biological Sciences and Medical Sciences, 60(7), 888-893. doi: 10.1093/gerona/60.7.888
Brown, C. J., Friedkin, R. J., & Inouye, S. K. (2004). Prevalence and outcomes of low mobility in hospitalized older
patients. Journal of the American Geriatrics Society, 52(8), 1263-1270. Callen, B. L., Mahoney, J. E., Grieves, C. B.,
Wells, T. J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an

academic hospital. Geriatric Nursing, 25(4), 212-217. doi: 10.1016/j.gerinurse.2004.06.016 Charlson, M. E., Pompei,
P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies:
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G. H., & Wang, C. (2010). Shared risk factors for distinct geriatric syndromes in older Taiwanese inpatients. Nursing
Research, 59(5), 340-347. doi: 10.1097/NNR.0b013e3181eb31f6 Chen, C. C., Wang, C., & Huang, G. H. (2008).
Functional trajectory 6 months posthospitalization: a cohort study of older hospitalized patients in Taiwan. Nursing
Research, 57(2), 93-100. doi: 10.1097/01.NNR.0000313485.18670.e2 Chen, Y. M., Chuang, Y. W., Liao, S. C., Lin,
C. S., Yang, S. H., Tang, Y. J., Chen, D. Y. (2010). Predictors of functional recovery (FR) for elderly hospitalized
patients in a geriatric evaluation and management unit (GEMU) in Taiwan. Archives of Gerontology and Geriatrics,
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(1999). Risk factors for lack of recovery of ADL independence after hospital discharge. Journal of the American
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Dwelling Older Persons. JAMA: The Journal of the American Medical Association, 291(13), 1596-1602. doi:
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Contact
[email protected]

The Experience of Giving Informed Consent in a Mexican-American Older Adult
Herlinda Zamora, MSN, RN, USA
Purpose
To explore and describe the experience of giving informed consent in a Mexican American older adult
who had undergone outpatient cataract surgery to reveal and understand the meaning of informed
consent from the first person perspective.
Target Audience
Interprofessional clinicians, educators, researchers, and policy-makers with the specific aim to aid these
professionals in the development of age-specific interventions to ultimately improve the informed consent
process among the older adult population.
Abstract
Purpose: World population estimates for 2030 show that there will likely be 1 billion older adults, which
will account for 13 percent of the entire population. As people live longer, they may be confronted with
the need for surgical procedures that require giving informed consent. Informed consent is a complex
process that has ethical and legal implications for the health care professionals who are tasked with
obtaining it. Therefore, the purpose of this qualitative study was to explore and describe the experience
of giving informed consent in a Mexican American older adult who had undergone outpatient
surgery. This research study was conducted to understand the experience of giving informed consent
from the first person perspective, which is important to inform and guide clinical practice and research.
Methods: A hermeneutic phenomenological methodology was utilized to answer the following research
question: What is the experience of giving informed consent in Mexican American older adults who have
undergone outpatient surgery? An in-depth, one-on-one interview and field notes were used to explore
and describe the experience of giving informed in one Mexican American older adult, aged 74
years. Thematic analysis was utilized to identify meaningful themes that were characterized through the
data.
Results: Based on interpretation of this older adult’s narrative, multiple themes became apparent in the
experience of giving informed consent. The older adult’s informed consent historical and educational
experiences merged to influence his perceptions of how the experience of giving informed consent
changed with age and education. In a historical context, this older adult described how he experienced
informed consent in early adolescence and later in life. In an educational context, this older adult
described how his educational level helped him to understand the health-related information about
outpatient cataract surgery. For this older adult, the essence and meaning of informed consent included
being prepared by receiving health-related information from the interprofessional health care team, being
aware of what the proposed surgery entailed, and being given the freedom to make an autonomous,
informed choice.
Conclusion: In this qualitative study, this researcher provides foundational evidence that the experience
of giving informed consent can potentially change with age and education. This older adult’s ‘being in the
world’ was a personified experience in which he described how the historical and educational contexts of
the experience influenced his choice of giving informed consent. These findings about the informed
consent experience from the first person perspective can be used to aid interprofessional clinicians,
educators, researchers, and policy-makers to develop age-appropriate interventions in informed consent,
and, ultimately, to improve the surgical informed consent process for the vulnerable older adult
population. Future research with a larger sample of participants is needed to further understand the
meaning of giving informed consent in Mexican American older adults.
References

Heidegger, M. (1962). Being and time. (J. Macquarrie & E. Robinson, Trans.). New York: Harper & Row. (Original
work published 1926) U. S. Department of Health and Human Resources (2011). Health & Aging. Why population
matters: A global perspective. Retrieved from www.nia.nih.gov/health/publication/why.../trend-1-aging-population
Contact
[email protected]

A Mixed-Methods Study for Evaluating the Effect of a Cultural and Contextual-
Specific Exercise Program on Therapeutic Exercise Adherence of Older People
with Knee Osteoarthritis
Fung-kam Iris Lee, PhD, RN, Hong Kong
Winnie Kwok Wai So, PhD, RN, Hong Kong
Purpose
The purpose of this presentation is to share the research findings of a mixed-methods study which
evaluated the effect of a cultural and contextual-specific exercise program on promting therapeutic
exercise adherence among older Chinese people with knee osteoarthritis.
Target Audience
The target audience of this presentation is researchers, nurses and other healthcare professionals.
Abstract
Purpose: Knee osteoarthritis (KOA) is a common health problem in the older population (Gabriel &
Michaud, 2009). Exercise has been recommended as the first-line clinical management strategy (Zhang
et al., 2008) and its effectiveness has been well documented (Bosomworth, 2009; Scott & Kowalczyk,
2007; Zhang et al., 2008). However, exercise adherence is questionable and thus affecting the
effectiveness of the recommended therapeutic exercise (Ettinger et al., 1997; Pisters et al.,
2007). Previous literature indicates that a client-centered exercise intervention may improve exercise
adherence of older people with KOA (Campbell et al., 2001). To promote therapeutic exercise
adherence, a cultural and contextual-specific exercise program was developed for older people with KOA
in Hong Kong (Lee, 2011). This exercise program was developed with reference to the findings of a
qualitative study which explored the experience and perceptions of exercise in a group of older people
with knee osteoarthritis (KOA), a comprehensive review of previous scientific evidence on exercise
intervention in older people with KOA, and in consultation with a group of multidisciplinary healthcare
experts (i.e. medical officer, traditional Chinese practitioner, sports scientist, physiotherapists, geriatric
nurse, and social worker). The purposes of this study were to evaluate the effectiveness of a cultural and
contextual-specific exercise program in promoting therapeutic exercise adherence among older people
with KOA and to explore the participants’ perceptions and experiences of participating in the exercise
program.
Methods: The objectives of the study were:
1. To evaluate the participants’ exercise adherence.
2. To evaluate the participants’ level of mastering of the recommended exercise movements.
3. To assess the participants’ satisfaction with the exercise program.
4. To explore the participants’ perceptions towards the design and content of the exercise program.
5. To explore the participants’ experiences of practicing and integrating the exercise in daily living.
Design and subjects: This study used a mixed-methods design which was a single group quantitative
study followed by an exploratory qualitative study. The subjects of this study were recruited from a
community center for older people and the final sample consisted of 33 older Chinese people with KOA
dwelling in the community. Among the 33 older people who had completed the quantitative study, 6 of
them with different levels of satisfaction and exercise adherence were selected for individual face-to-face
semi-structured interviews.
Study instruments: An exercise diary was used to evaluate the participants’ exercise adherence. A skill
assessment checklist was used to evaluate the participants’ level of mastering of the recommended
exercise movements. In addition, participants’ satisfaction with the exercise program was also assessed
by a self-developed questionnaire. A semi-structured interview guide was employed in the qualitative

phase of the study. Example of questions asked are: “What is your view about the exercise program?”
and “What is your experience of integrating the recommended exercise into daily living?“.
Data collection procedures: The participants were asked to give individual written consent. The
exercise program provided to the participants consisted of four one-hour weekly sessions. It was
delivered by using a small group (N = 8-10) approach. On completion of the exercise program, the
participants were individually interviewed for filling out the satisfaction questionnaire. They were also
given a diary and a chop to mark down their practice of the recommended exercise movements for a
period of 12 weeks. At 12 weeks after the exercise program, the participants were invited to an individual
return-demonstration session to demonstrate their level of skills in mastering the recommended exercise
movements.
Six participants, who gave their written consent for an individual face-to-face semi-structured interview,
were interviewed after the return-demonstration session.
Results: The quantitative results showed that the participants were highly adhered to the recommended
exercise regimen (mean percentage = 91.04%; SD = 14.54) in a 12 weeks period. Their overall
performance in mastering of the exercise movements was good (mean score = 76.71/100; SD =
21.75). The participants also demonstrated a high satisfaction level with the exercise program (mean
score = 90.15/100; SD = 8.05). The qualitative findings revealed four major categories: satisfaction with
the exercise program, mastering of the exercise movements, experience of the exercise’s effects, and
integration of the exercises into the daily routine. These findings were consistent with the quantitative
results of the study.
Conclusion: The quantitative and qualitative findings of this study were consistent and complementary,
showing that the exercise program was well accepted by the older Chinese people with KOA in terms of
satisfaction with the exercise program, adherence to the exercise regimen, and mastering of the exercise
movements. The findings of this study provide evidence to support the need to take into consideration of
clients’ cultural and contextual environment in the development of exercise program in order to promote
clients’ adherence to the therapeutic exercise regimen. However, the 12 weeks follow up period in this
study has limitations to the understanding of the long-term effect of the exercise program. Future studies
should consider a longer follow up period such as 5 years (Pisters et al., 2010). Exercise adherence is
fundamental for effective exercise intervention, client-centered approach in development of exercise
intervention should be considered a way forward in order to promote exercise adherence among clients
with chronic diseases.
References
Bosomworth, N. J. (2009). Exercise and knee osteoarthritis: benefit or hazard? Canadian Family Physician, 55(9),
871-878. Campbell, R., Evans, M. Tucker, M., Quilty, B., Dieppe, P., & Donovan, J. L. (2001). Why don’t patients do
their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. Journal
of Epidemiology and Community Health, 55, 132-138. Ettinger, W. H., Burns, R., Messier, S. P., Applegate, W.,
Rejeski, W. J., Morgan, T., et al. (1997). A randomized trial comparing aerobic exercise and resistance exercise with
a health education program in older adults with knee osteoarthritis: the fitness arthritis and seniors trial (FAST).
Journal of the American Medical Association, 277(1), 25-31. Gabriel, S. E., & Michaud, K. (2009). Epidemiological
studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Research & Therapy,
11, 229-245. Lee, F. K. (2011). Developing and Piloting an Exercise Programme for Older Chinese People with Knee
Osteoarthritis in Hong Kong. Unpublished doctor’s thesis, The Chinese University of Hong Kong. Pisters, M. F.,
Veenhof, C., van Meeteren, N. L. U., Ostelo, R. W., de Bakker, D. H., Schellevis, F. G., et al. (2007). Long-term
effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review. Arthritis Care
and Research, 57(7), 1245-1253. Scott, D., & Kowalczyk, A. (2007). Osteoarthritis of the knee. BMJ Clinical
Evidence, 12, 1121-47. Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., et al. (2008).
OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert
consensus guidelines. Osteoarthritis and Cartilage, 16, 137-162.
Contact
[email protected]

F 04 - Affairs Surrounding End-of-Life
Spirituality as a Predictive Factor for Signing an Organ Donor Card
Semyon Melnikov, RN, PhD, Israel
Tamar Ashkenazi, RN, PhD, Israel
Anat Peles Bortz, RN, PhD, Israel
Purpose
To report survey results regarding the association between spirituality, attitudes toward organ donation
and signing an organ donor card.
Target Audience
Nurses in clinical, academic and managerial positions
Abstract
Purpose: Organ donation in the Western world is entirely dependent on the willingness of people to
donate organs after their death. In Israel, the wish to donate organs posthumously is expressed by
signing an organ donor card. Spirituality as the fundamental dimension of people's overall well-being
might affect the willingness to sign an organ donor card. The purpose of the current study was to examine
the differences in spirituality and attitudes toward organ donation between people who signed and those
who did not sign an organ donor card.
Methods: A descriptive cross-sectional survey. The sample included 312 respondents from the general
population. Respondents completed a web-based questionnaire consisting of three sections: spirituality,
attitudes towards organ donation, and social-demographic questions.
Results: The differences in mean scores between respondents who signed an organ donor card
and those who didn’t were indicated in transcendental spirituality (p<.01) and attitudes toward organ
donation (p<.01). No statistically significant difference was found between the groups in the overall
spirituality mean score. The spiritual transcendental dimension and attitudes toward organ donation
explained 24.9% of the variance of signing an organ donor card.
Conclusion: Signing an organ donor card can be explained by low levels of transcendental spirituality
and positive attitudes toward organ donation. Nurses should assess the patient’s spiritual needs in order
to construct appropriate programs for promoting signing an organ donor card.
References
Fisher, J. W. (1998). Spiritual health: its nature and place in the school curriculum. PhD thesis, Department of
Science and Mathematics Education,(University of Melbourne.). Fisher, J. W. (2009). Investigating Australian
education students f as
g, views about spiritual
compared well]bein
with teachers in schools. International Journal
of Children's Spirituality 14(2), 151-167. Gauher, S. T., Khehar, R., Rajput, G., Hayat, A., Bakshi, B., Chawla, H., . . .
Warrens, A. N. (2013). The factors that influence attitudes toward organ donation for transplantation among UK
university students of Indian and Pakistani descent. Clin Transplant, 27(3), 359-367. doi: 10.1111/ctr.12096 Gorsuch,
R. L. W., D. (2006). Measurement and Research Design in Studying Spiritual Development. In The Handbook of
Spiritual Development in Childhood and Adolescence; Roehlkepartain, E.C., King, P.E., Wagener, L.M., Benson,
P.L., Eds.; Sage Publications: Thousand Oaks, CA, USA . 92-103. Morgan, S. E., Harrison, T. R., Afifi, W. A., Long,
S. D., & Stephenson, M. T. (2008). In their own words: The reasons why people will (not) sign an organ donor card.
Health Communication, 23(1), 23-33. doi: 10.1080/10410230701805158
Contact
[email protected]

F 04 - Affairs Surrounding End-of-Life
Post Mortem Nursing Care Effectiveness as Perceived by U.S. Hospital Staff
Nurses
Mikel W. Hand, EdD, MSN, RN, OCN, NE-BC, USA
Purpose
The purpose of this presentation is to disseminate completed research examining how hospital staff
nurses perceive the effectiveness of the post mortem nursing care that they provide to deceased patients.
Within this study, effectiveness refers to how the care contributes to a desired cosmetic appearance with
further body preparation.
Target Audience
The target audience of this presentation is any nurse interested in end of life and death care from a
research, clinical practice, nursing education, or administrative policy perspective.
Abstract
Purpose: The purpose of this study was to explore postmortem nursing care from the perspective of the
hospital staff nurse. The objectives were to describe phenomenon of postmortem nursing care from the
perspective of the hospital staff nurse, explore perceptions concerning how the care provided either helps
or hinders the achievement of a desired cosmetic result of the deceased with further body preparation,
and to gain insight into common nursing care practices and recommendations concerning the
improvement of care.
Methods: Approval to conduct the study was obtained from the Institutional Review Board of the
University of Southern Indiana. A qualitative survey method using open ended questions was used for
the study. A convenience sample of 34 members of a state nursing association in the USA who self-
identified as hospital staff nurses participated in the study. Each participant completed an anonymous
web based questionnaire that included four demographic questions and twenty five open ended items
concerning post mortem care practices used by nurses, perceptions of whether that care practice aids or
hinders a desired cosmetic result with further body preparation, and alternative care recommendations to
aid in the preparation process. Questions were focused to address practices concerning body
positioning, use of ligatures to secure extremities, intravenous catheters and lines, surgical tubes and
drains, dentures and partial plates, cleansing of the body, identification, shrouding and exposure
prevention. In order to analyze the data, the researcher reviewed each questionnaire several times. The
responses were then initially coded to identify broad themes. The broad themes were then reviewed for
similarity of meaning and categorically clustered. The clusters were then reviewed again twice by the
researcher in order to determine final theme labeling. Questions were accepted and reviewed until there
were significant repetitions in responses and no new revelations of information.
Results: The results are reported based on the focus of the questions and the accompanying
exemplars. The majority of participants reported a flat position as the most frequent body placement
used for postmortem care and that this position aids in producing a desired cosmetic result. However the
exemplars concerning alternative recommendations for body placement contain substantial insights
including elevation of the head to prevent swelling drainage, and the presentation of a natural
appearance. Questions concerning the use of ligatures and ties to secure extremities produce a very
limited response inadequate to determine a perception for or against use. A single exemplar indicated
rare use of these in current practice. The majority of participants reported that they typically remove
intravenous catheters and lines and that doing so aids in producing a desired cosmetic result. Exemplars
support this perception addressing concerns such as normal appearance, creating a less disturbing
environment, and comfort for family. Recommendations from exemplars include consideration of the
setting and legal requirements that may require retention. Responses concerning tubes and surgical
drains mirror those regarding intravenous catheters and lines. Exemplars supporting removal include
family consolation by removal, and ease in viewing. A majority of participants reported leaving dentures
and partial plates in the mouth of the decedent. Rationale in the exemplars included leaving in place for

mouth positioning, loss prevention, and leaving in place for hospital viewing. Typical body cleansing
practices reported by participants varied greatly and included cleaning head to toe, use of warm water
and soap, inclusion of oil or perfume, and basic removal of soiling. Participants identified the toe and wrist
band as the most frequent locations to place identification tags and that these provide safe and adequate
identification of the deceased. Exemplars did not include alterative locations for placement, but rather
emphasis on confirmation of identification, verification that identification tags in all locations match, and to
never assume that one tag is correct. Typical wrapping and shrouding procedures reported by
participants varied and included use of a plastic shroud, wrapping in bed sheets, body bags with a zipper,
blankets for infants, and no longer wrapping bodies as a practice. Exemplars did not include alternative
recommendations for shrouding, but rather additional suggestions such as the use of a covered gurney,
closing the curtain and the door, and providing privacy for removal. This study had limitations included
limited geography, convenience sampling, lack of maximum variation in participants, and focused nature
of the questions. Data were collected in a single mid-western state with limited variation in population
demographics and burial practices. A convenience sample was used and no method to incorporate
diversity among participants was incorporated. It is unknown if this may have contributed to minimal
diversity in responses. The web based questionnaire allowed for anonymity of participants, but it also
prevented any follow up inquiry. The focused nature of the questions directed the responses in a relevant
manner. However, this may have hindered the participant from sharing additional sights pertaining to
postmortem nursing care that were not included in the preset questions.
Conclusion: The practices, observations, and recommendations reported by participants are based on
their nursing practice, observations, and experience with the provision of postmortem nursing care. The
perceptions and recommendations shared by participants demonstrate a commitment to comforting the
surviving family by attempting to make the appearance of the deceased as normal as possible. However,
it is important to note that the perceptions and alternative recommendations identified here are not
consistent with those reported by Licensed Funeral Directors in a study published in 2013 addressing the
same areas of inquiry. There are notable differences in perceptions between nurses and Funeral
Directors pertaining to commonly observed postmortem nursing care practices and their
effectiveness. These include body positioning, use of ligatures and ties, removal of IV catheters and
lines, surgical drains and tubes, and placement of dentures and partials. These are worthy of
consideration because Funeral Directors are the next care provider for the decedent and are the
professionals who complete the additional body preparation following post mortem nursing care. As a
result, they are in an ideal position to provide valuable insight into the effectiveness of these nursing care
practices. Additional research is needed to expand on the body of knowledge concerning postmortem
nursing care. Future research efforts should include secondary analysis of data from this study and the
prior involving Funeral Directors in an effort to develop a more in depth and coherent understanding of the
perceived effectiveness of these practices, examine and scrutinize alternative recommendations, and to
potentially generate further research questions.
References
Burns, N & Grove, SK (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th
ed.). St. Louis, MO: Saunders Hand, MW(2013). Postmortem/last offices nursing care effectiveness as perceived by
US licensed funeral directors. End of Life Journal,(3)4, 1-9. Mayer, RG (2012). Embalming: History, theory, and
practice (5th ed.). New York, NY: McGraw Hill. National Funeral directors association (2013. Funeral service facts.
Retrieved from http://nfda.org/about-funeral-service-/trends-and-statistics.html#fsfacts(last accessed November 4,
2013). Smith-Stoner, M & Hand, MW (2012). Expanding the concept of patient care: Analysis of postmortem policies
in California hospitals. Medsurg Nursing,21(6), 360-366. Stoner, M. Hand, MW, & Foley, R(2010). Patients with
cancer: Experiences of medication management. Journal of Hospice and Palliative Nursing. 12(2), 99-104.
Contact
[email protected]

F 05 - Global Issues Within the Nursing Workforce
Gender Differences in the Interrelationships Among Job Stress, Job Satisfaction,
and Intention to Leave Among Hospital Nurses in Taiwan
Wen-Yen Lo, MS, Taiwan
Li-Yin Chien, ScD, Taiwan
Fang-Ming Hwang, PhD, Taiwan
Shu-Ti Chiou, PhD, Taiwan
Nicole Huang, PhD, Taiwan
Purpose
The purpose of this presentation is to inform gender differences in interrelationships of job stress, job
satisfaction, and intention to leave among hospital nurses in Taiwan.
Target Audience
The target audience of this presentation are Staff Nurses and Nurse Managers.
Abstract
Purpose: Few studies have compared gender differences in job stress, job satisfaction, and intention to
leave among nurses. There is little understanding about the interrelationships among job stress, job
satisfaction, and intention to leave among nurses. The objective of this study was to examine gender
differences in interrelationships of job stress, job satisfaction, and intention to leave among hospital
nurses in Taiwan.
Methods: This cross-sectional survey included 33475 full-time nurses (584 males and 32891 females)
working in 100 hospitals across Taiwan. The participants filled up a self-administered structured
questionnaire during the period of May to July, 2011. Intention to leave and job satisfaction was each
measured by one item with a 5-point Likert scale. Job stress was measured by a 19-item scale, with
higher scores indicating more job stress.
Results: Female nurses had significantly higher mean job stress than male nurses (33.61 vs 28.09,
p£¼0.01). There were no significant differences in mean level of job satisfaction (2.51 vs 2.50, p©ƒ0.05)
and intention to leave (2.91 vs 2.91 , p©ƒ0.05) between males and females. The structural equation
modeling results suggested that job stress had a direct and negative effect on job satisfaction
(standardized factor loading = -0.41 , t = -68.26, p£¼0.01, r2 = 0.18). Job satisfaction had a direct and
negative effect on intention to leave (standardized factor loading = -0.42 , t = -84.19, p£¼0.01, r2 = 0.14).
Job stress had a direct and positive effect on intention to leave (standardized factor loading = 0.25 , t =
45.43, p£¼0.01, r2 = 0.22). The negative effect of job satisfaction on intention to leave appeared to be
stronger among females (standardized factor loading = -0.42) than males (standardized factor loading = -
0.33; p£¼0.05). The model had good fit to the data (RMSEA = 0.046, CFI = 0.99, NFI = 0.99, SRMR =
0.019).
Conclusion: Job satisfaction is a mediator between job stress and intention to leave among nurses.
Strategies should be developed to decrease job stress and increase job satisfaction in order to decrease
nurse turnover. Special emphasis could be placed on job satisfaction among female nurses.
Contact
[email protected]

Registered Nurses Extended Work Shifts and the Association with Quality of
Nursing Care and Patient Safety: A Cross Sectional Survey in Twelve European
Countries
Peter Griffiths, PhD, United Kingdom
Purpose
to present the findings of a major international collaborative research study exploring associations
between nursing work and care quality. This paper specifically focusses on the association between shift
length, overtime work and nurse reported quality and safety of care.
Target Audience
those researching and planning the organisation and deployment of nursing work and the nursing
workforce and those making workforce policy and setting guidleines.
Abstract
Purpose: In some countries, there is a move toward nurses working shifts of longer duration to reduce
time and cost of shift handovers and staff overlap, and to potentially improve work life balance; ‘12 hour’
shifts have become the norm in some countries and hospitals. However, concerns have been raised as
to whether nurses can perform reliably and effectively when working longer shifts. This presentation
gives the results of a study that aims to describe shift patterns of European nurses and to investigate
whether shift length is associated with nurse-reported quality and safety of care and with aspects of
needed nursing care left undone.
Methods: Cross-sectional survey of 31,627 registered nurses (RN) in 2170 general medical/surgical units
within 487 acute general hospitals across 12 European countries. Multi-level regression modelling to
explore associations between shift work and nurse reported measures of quality and safety of care.
Results: Most nurses (50.5%) reported working shifts <8 hours, whilst 15% of nurses worked shifts >12.
There was considerable variation in typical shift length between countries and within some countries. For
example in Spain 90% of day shifts were ≤8 hours compared to 45% in England and 9% in Ireland with
73% of nurses working 12 hour day shifts. Working a shift of >12 hours was associated with nurses being
more likely to report poor or failing patient safety (OR 1.46 95% CI 1.16 - 1.83), and poor or fair quality of
care (OR 1.39, 95% CI 1.00-1.85). Nurses reported a significantly increased number of care activities
needed, but left undone on their last shift when working any shift >8 hours (OR 1.04 to1.13). Working
beyond contracted hours was also associated with reports of poor or fair quality of care (OR = 1.35), poor
or failing patient safety (OR = 1.67) and missed care (OR = 1.29).
Conclusion: European nurses working 12 hours or longer and those working overtime were more likely
to report low quality and safety ratings. Policies to adopt a 12 hour nursing shift length should proceed
with caution. Use of overtime (i.e. working a longer shift than contracted) to mitigate staffing shortages or
increase flexibility may also incur additional risk to quality. Further research is required using objective
measures of quality and safety and patient experience.
References
1. Ferguson, S.A. and D. Dawson, 12-h or 8-h shifts? It depends. Sleep Med Rev, 2012. 16(6): p. 519-28. 2. Caruso,
C.C. and T.R. Waters, A Review of Work Schedule Issues and Musculoskeletal Disorders with an Emphasis on the
Healthcare Sector. Industrial Health, 2008. 46(6): p. 523-534. 3. Lorenz, S.G., 12-hour shifts: An ethical dilemma for
the nurse executive. Journal of Nursing Administration, 2008. 38(6): p. 297-301. 4. Stimpfel, A.W. and L.H. Aiken,
Hospital Staff Nurses’ Shift Length Associated With Safety and Quality of Care. Journal of Nursing Care Quality,
2012. 5. Hasselhorn, H.-M., B.H. Müller, and P. Tackenberg, NEXT Scientific Report July 2005. Wuppertal The
European NEXT-Study (Nurses’ Early Exit Study, University of Wuppertal, NEXT-Study Coordination), 2005: p. 1-56.
6. Ogińska H, C.D., Estryn-Behar M, Pokorski J, NEXT-Study Group, Work schedules of nurses in Europe, in
Working conditions and intent to leave the profession among nursing staff in Europe, T.B. Hasselnhorn HM, Müller H,
Editor. 2003, National Institute for Working Life and authors. p. 82-87. 7. NHS Evidence, Moving to 12-hour shift

patterns: to increase continuity and reduce costs. 2010, Basingstoke and North Hampshire NHS Foundation Trust. 8.
Sullivan, C. and S. Reading, Nursing shortages: let's be flexible. Collegian, 2002. 9(4): p. 24-8. 9. Stone, P.W., et al.,
Comparison of Nurse, System and Quality Patient Care Outcomes in 8-Hour and 12-Hour Shifts. Medical Care, 2006.
44(12): p. 1099-1106 10.1097/01.mlr.0000237180.72275.82. 10. Richardson, A., et al., A study examining the impact
of 12-hour shifts on critical care staff. J Nurs Manag, 2007. 15(8): p. 838-46. 11. Nelson, R., Long Work Hours for
Nurses. AJN The American Journal of Nursing, 2012. 112(5): p. 19,20 10.1097/01.NAJ.0000414310.10965.f4. 12.
Stimpfel, A.W., D.M. Sloane, and L.H. Aiken, The Longer The Shifts For Hospital Nurses, The Higher The Levels Of
Burnout And Patient Dissatisfaction. Health Affairs, 2012. 31(11): p. 2501-2509. 13. Trinkoff, A.M., et al., Nurses'
work schedule characteristics, nurse staffing, and patient mortality. Nurs Res, 2011. 60(1): p. 1-8. 14. Geiger-Brown,
J., et al., Sleep, Sleepiness, Fatigue, and Performance of 12-Hour-Shift Nurses. Chronobiology International, 2012.
29(2): p. 211-219. 15. Estabrooks, C.A., et al., Effects of shift length on quality of patient care and health provider
outcomes: systematic review. Quality and Safety in Health Care, 2009. 18(3): p. 181-188. 16. Stimpfel, A.W., et al.,
How Differing Shift Lengths Relate to Quality Outcomes in Pediatrics. Journal of Nursing Administration, 2013. 43(2):
p. 95-100 10.1097/NNA.0b013e31827f2244. 17. Bae, S.H., Presence of nurse mandatory overtime regulations and
nurse and patient outcomes. Nurs Econ, 2013. 31(2): p. 59-68, 89; quiz 69. 18. Olds, D.M. and S.P. Clarke, The
effect of work hours on adverse events and errors in health care. Journal of safety research, 2010. 41(2): p. 153. 19.
Sermeus, W., et al., Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs, 2011.
10: p. 6. 20. Aiken, L.H., et al., Nurses' reports on hospital care in five countries. Health Aff (Millwood), 2001. 20(3): p.
43-53. 21. Squires, A., et al., A systematic survey instrument translation process for multi-country, comparative health
workforce studies. Int J Nurs Stud, 2013. 50(2): p. 264-73. 22. Schubert, M., et al., Rationing of nursing care and its
relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health
Care, 2008. 20(4): p. 227-37. 23. Lake, E.T., Multilevel models in health outcomes research. Part II: statistical and
analytic issues. Appl Nurs Res, 2006. 19(2): p. 113-5. 24. Nakagawa, S. and H. Schielzeth, Repeatability for
Gaussian and non-Gaussian data: a practical guide for biologists. Biol Rev Camb Philos Soc, 2010. 85(4): p. 935-56.
25. Kock N, Variance Inflation Factors, in Interdisciplinary Applications of Electronic Collaboration Approaches and
Technologies, K. N, Editor. 2013, Information Science Refernce: United States of America. p. 74-75. 26. R
Development Core Team, RStudio: Integrated development environment for R 2013: Boston, MA. 27. Bates D, M.M.,
Bolke B, lme4: Linear mixed-effects models using S4 classes. 2013. 28. Aiken, L.H., et al., Patient safety,
satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and
the United States. BMJ, 2012. 344: p. e1717. 29. The National Institute for Occupational Safety and Health. Work
schedules: shift work and long work hours. 2013 [cited 2013 05/07]; Available from:
http://www.cdc.gov/niosh/topics/workschedules/. 30. Dean, G.E., L.D. Scott, and A.E. Rogers, Infants at risk: when
nurse fatigue jeopardizes quality care. Adv Neonatal Care, 2006. 6(3): p. 120-6. 31. Surani, S., J. Murphy, and A.
Shah, Sleepy nurses: are we willing to accept the challenge today? Nurs Adm Q, 2007. 31(2): p. 146-51. 32. Rogers,
A.E., et al., The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 2004. 23(4): p. 202-212.
33. Kane, R.L., et al., The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review
and Meta-Analysis. Medical Care, 2007. 45(12): p. 1195-1204 10.1097/MLR.0b013e3181468ca3. 34. Berney, B., J.
Needleman, and C. Kovner, Factors Influencing the Use of Registered Nurse Overtime in Hospitals, 1995–2000.
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Regulations and Nurse Overtime. Policy, Politics, & Nursing Practice, 2010. 11(2): p. 99-107. 36. Yu, S. and T.G.
Kim, Evaluation of nurse staffing levels and outcomes under the government – recommended staffing levels in Korea.
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care: a measure of hospital quality. Res Nurs Health, 2012. 35(6): p. 566-75
Contact
[email protected]

Does Moonlighting Influence South African Nurses' Intention to Leave Their
Primary Jobs?
Laetitia C. Rispel, PhD, RN, RM, South Africa
Purpose
examine whether moonlighting influences South African nurses intention to leave their primary jobs.
Target Audience
nurse researchers, practitioners and managers
Abstract
Purpose: Moonlighting is commonly understood as having a second job, usually part-time, in addition to
a primary full-time job. This paper examines whether moonlighting influences South African nurses
intention to leave their primary jobs.
Methods: During 2010, a stratified random sample of 80 hospitals was selected from the public and
private health sectors in four South African provinces. All nurses working in intensive care, theatre,
casualty, maternity and general medical and surgical wards on the survey day completed a self-
administered questionnaire after obtaining informed consent. In addition to demographic information, the
questionnaire focused on the prevalence of moonlighting and participants’ intention to leave their primary
jobs in the 12 months following the survey. Survey data were analysed using STATA version 10.
Results: Survey participants (n=3 784) were predominantly middle-aged (median 42 years). The
prevalence of moonlighting in the previous year was 34.1% [95%CI: 32.6–35.6]. Overall, 1 133
participants (31.5%) indicated that they planned to leave their primary jobs, ranging from a low of 23.4%
among nursing auxilliaries to 39% of all nurses working in Gauteng, the wealthiest and most urbanised
province in South Africa. 15.5 % of all survey participants indicated that they planned to go overseas in
the 12 months following the survey. Among this group, 18.1 % of moonlighters, compared to 14.3% of
non-moonlighters planned to go overseas, but this difference was not statistically significant. The odds
ratio of moonlighters planning to go overseas compared to non-moonlighters was 1.32 [95% CI: 0.81-
2.16], but this was not statistically significant (p=0.266).
Conclusion: This study provides empirical information on whether moonlighting influences nurses’
decisions to leave their primary jobs. There is the need for strategies to reduce turnover among South
African nurses.
Contact
[email protected]

F 07 - Psychological Care of rthe Patient with Cancer
The Journey of Fighting Cancer: Chinese Canadians' Experiences
Tsorng-Yeh Lee, PhD, Canada
F. Beryl Pilkington, PhD, Canada
Purpose
The purpose of this presentation is to understand the experience of Chinese immigrants in Canada who
are survivors of cancer through focus groups and individual interviews.
Target Audience
The target audience of this presentation is healthcare providers who work in oncology.
Abstract
Purpose: To understand the experience, informational and psychosocial needs of Chinese immigrants in
Canada who are survivors of cancer through focus groups and individual interviews.
Background: Cancer is the leading cause of death for both men and women in Canada. Most Chinese
Canadians are foreign-born, with limited social networks. The language obstacle, cultural adaptations and
the Eastern view of health beliefs and practices may act as barriers to both access to and utilization of,
services. Although the number of Chinese Canadians is growing in Canada, there are very few
appropriate culture-sensitive resources available for them to obtain in-depth information after being
diagnosed with cancer. This lack of information may jeopardize their adjustment by increasing their
cancer-related anxiety and degrading their quality of life.
Design: A qualitative approach and in-depth interviews were used.
Methods: Ten Mandarin-speaking Chinese women and men who had a diagnosis of cancer were
recruited from the Chinese community in Toronto, Canada. Two focus group interviews and 10 individual
interviews were conducted. The interviews were tape-recorded and transcribed verbatim. Data were
analysed using content analysis.
Results : Six themes were emerged from the interview data: a) the emotional upside down in receiving
the diagnosis of cancer, b) the relatively short waiting time in getting treatment, c) the non-empathetic
attitude of healthcare providers, d) the language barrier in searching for cancer information, e) the
dramatic change in lifestyle, and f) the tremendous support from spouse, family and friends.
Conclusion: The result of the study can facilitate the healthcare providers’ understanding of the
experience, informational and psychosocial needs of Chinese Canadian cancer survivors. Appropriate
interventions and strategies in caring for cancer patients should be developed in hospitals and
communities to help them to face physical and psychosocial challenges in the journey of fighting cancer.
Contact
[email protected]

F 07 - Psychological Care of rthe Patient with Cancer
CAM Use: Change across Cancer Treatment and Impact on Stress, Mood, and
Quality of Life
Duck-Hee Kang, PhD, RN, FAAN, USA
Traci McArdle, RN, BSN, USA
Purpose
To report the findings on complementary and alternative medicine (CAM) use change over cancer
treatment, specific reasons for and satisfaction with CAM use, and impact of CAM use on stress, mood,
and QOL in women newly diagnosed with breast cancer.
Target Audience
healthcare providers and the public who are interested in current status of CAM use in women with
cancer and potential influence of CAM on other health issues.
Abstract
Purpose: Complementary and alternative medicine (CAM) use has been substantial in healthy and sick
populations, but changes in CAM use, reasons for and impact of CAM use need further investigation. The
purposes of this study were to determine if CAM use changes over cancer treatment period, why a certain
type of CAM was selected, how satisfied users were, and if CAM use influenced the perception of stress,
mood, and quality of life (QOL) in women with breast cancer.
Methods: Seventy seven women newly diagnosed with breast cancer were recruited from a
comprehensive cancer center. Data were collected three times across cancer treatment: shortly after
diagnosis before adjuvant therapy (baseline), 2 months after, and 6 months after the start of adjuvant
therapy. The reliable and valid instruments were used: Impact of Event Scale (stress), Profile of Mood
State (mood), Functional Assessment of Cancer Therapy-Breast Cancer (QOL), and CAM Questionnaire
(frequency, duration, satisfaction, and reason for using CAM).
Results: Participants were relatively well-educated Caucasian women with the mean age of 52.4
receiving various types of cancer treatment. Seventy five out of 77 participants used some type of CAM at
baseline. The average number of CAM use was 6.0 with the range of 0-23 per person. Typically CAM use
started before cancer diagnosis and continued across cancer treatment in a stable manner. Types of
CAM used remained quite stable: Top 5 common CAMs remained same over time: prayer (88.3%),
multivitamin use (58.4%), massage (42.9%), vitamin E (41.6%), and vitamin C (40.3%). Next level
common CAMs included music, meditation, green tea, chiropractic care, and vitamin A at baseline with
slight changes across cancer treatment period. Prayer induced the highest level of satisfaction, followed
by meditation, music, and vitamin uses. Prayer, meditation, music, and massage were used mostly to
have a feeling of control over life, whereas vitamins were used to improve the immune system. Stress,
mood disturbance, and QOL all declined significantly over time, p <.001-.04, but the number of CAM use
was unrelated to these variables or to the type of cancer adjuvant therapy.
Conclusion: Nearly all women diagnosed with breast cancer used some type of CAM, although the
number of CAM use differed among participants. Prayer was most commonly used and seemed to
provide a high level of satisfaction. Although CAM use did not differ across cancer treatment and did not
impact perceived stress, mood, or QOL, long-term CAM use and potential benefits of CAM use on other
health outcomes need to be investigated using biobehavioral approaches.
Contact
[email protected]

F 10 - Learning Environments and Outcomes
Negative Depictions of Nursing and the Clinical Learning Environment in South
African Newspapers: Optimizing the Hidden Curriculum to Teach Values to
Student Nurses
Martha Oosthuizen, DLittetPhil, MA (Nsg), BA (Nsg) (Hons), BCur, South Africa
Purpose
The purpose of this presentation is to present findings on the negative depiction of nursing in South
African newspapers and to propose innovative strategies to teach values to students utilising the hidden
curriculum.
Target Audience
The target audience of this presentation is professional nurses and nurse educators
Abstract
Purpose: A qualitative content analysis of newspaper reports about nursing in South Africa paints
a dismal picture of the clinical learning environment for nursing students. This paper briefly presents the
findings and then propose strategies to teach students values, utilising the hidden curriculum, preceptors
and other teaching strategies.
Methods: A qualitative content analysis was done to determine how South African newspapers reported
issues related to nurses and nursing. A search of the database SA Media of Sabinet was performed for
the period 1 January 2005 to 31 December 2009, using the keywords, “nurse and nursing”. A purposive
sample of 161 newspaper articles from national and regional newspapers was analysed using a
qualitative, inductive approach. Four themes emerged from the data. Three of the themes painted a
negative picture of the profession and the professional values of its practitioners. Only one theme
reflected positively on the nursing profession in South Africa. Content analysis has been described as
suitable for qualitative studies and enabled the researcher to sift through large volumes of data, contained
in 161 newspaper articles.
Results: The analysis yielded four themes. This paper reflects on two of the themes namely "poor
working environments" and " death, suffering, humiliation, misconduct and incompetence" that suggest an
erosion of nursing values. It paints a dismal picture of the clinical learning environment where students
are socialised into the professional role in addition to what is taught in the formal curriculum. Negative
learning experiences in the clinical area often relate to attitudes and conduct which contradict moral and
ethical values taught in the classroom. Students will internalise poor practice if it is the norm. Positive
role models, mentors and preceptors are however able to counteract the effects of negative role models
and shape the attitudes and behaviour of students and newly qualified nurses.
Conclusion: This paper investigates the role of the hidden curriculum in cultivating values in nurses and
proposes teaching strategies to enhance socialisation of student nurses to become competent, caring
and moral practitioners.
References
Oosthuizen, MJ. 2012. The portrayal of nursing in South African newspapers: a qualitative content analysis. Africa
Journal of Nursing and Midwifery. 14(1):49-62.
Contact
[email protected]

Consensus on Outcomes for a Standardized Preceptor Training Programme in
South Africa
Yvonne Botma, PhD, South Africa
Purpose
The purpose of this presentation is to describe the outcomes on which nurse educators in South Africa
reached consensus. The presentation will include a brief discussion on the Nominal Group Technique
that was used to reach consensus among the spectrum of nurse educators.
Target Audience
The target audience of this presentation is everybody that is involved in facilitating learning in clinical
practice with the aim to support nursing students in becoming competent in making sound clinical
judgment.
Abstract
Purpose: The purpose of the study was to determine what the learning outcomes of a preceptor training
programme should be to enable them to support students in various clinical settings.
Methods: The Nominal Group Technique was used to reach consensus among nurse educators. Multiple
groups were used to gather data from. One group consisted of nursing deans of schools at universities
and the other group consisted of nurse educators from public and private nursing colleges. A brief
overview of the need for a standardized training programme was given to both groups by the facilitator.
Both groups agreed that public and private health service institutions expect nurses entering the
profession to be competent. The facilitator explained the components of competence. Thereafter the
participants were asked to silently write down their ideas on what a preceptor should be able to do to
enable students to make sound clinical judgment. All ideas were listed on a flip chart, clarified and
clustered by the participants. Through an anonymous voting process the most important outcomes were
identified. Data from both groups were combined to determine the final high ranking outcomes.
Results: Preceptors should be experts in making sound clinical judgment but need training in various
techniques that will stimulate critical thinking and clinical reasoning in students. Strategies that promote
valid and reliable assessment, as well as techniques to provide constructive feedback to students should
be part of the training programme. Furthermore, preceptors should be trained in the process of evidence
based practice and be able to assist students in finding the best evidence for a specific question
Conclusion: Many training programmes include sessions on adult learning theories, learning styles,
personality differences, clinical topics, transition to professional behavior, creating positive learning
environments etc. Apparently these topics are insufficient to enable preceptors to support students in
becoming competent professionals. Udlis, (2008) concluded in an integrative review that preceptors do
not promote the development of clinical reasoning or clinical judgment. Clearly the traditional training of
preceptors is not aligned with what is expected of them. Hopefully, the outcomes as determined by this
research are more aligned with what is expected of preceptors and will enable preceptors to assist
students in becoming competent professionals.
References
Botma, Y., Jeggels, J., & Uys, L. R. (2012). Preparation of clinical preceptors. In L. R. Uys & H. C. Klopper (Eds.),
Trends in Nursing 2012 (pp. 73–84). Pretoria: FUNDISA. Boyle, C. J., Morgan, J. A., Layson-wolf, C., & de Bittner, M.
R. (2009). Developing and Implementing an Academy of Preceptors. American Journal of Pharmaceutical Education,
73(2), Article 34. Brathwaite, A. C., & Lemonde, M. (2011). Team preceptorship model: a solution for students’ clinical
experience. ISRN nursing, 2011, 530357. doi:10.5402/2011/530357 Conway-Klaassen, J. M., Brennecke, P. J.,
Wiesner, S. M., & Spannaus-Martin, D. J. (2012). Development of online conferencing and web-based in-service
modules for preceptor training. Clinical laboratory science : Journal of the American Society for Medical Technology,
25(4), 26–33. Duffy, A. (2009). Guiding students through reflective practice - The preceptors experiences. A
qualitative descriptive study. Nurse education in practice, 9(3), 166–75. doi:10.1016/j.nepr.2008.07.002 Haggerty, C.,

Holloway, K., & Wilson, D. (2012). Entry to nursing practice preceptor education and support: coould we do it better?
Nursing Praxis in New Zealand, 28(1), 30–39. Magobe, N. B., Beukes, S., & Müller, A. (2010). Reasons for students’
poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme.
Health SA Gesondheid, 15(1), 1–6. doi:10.4102/hsag.v15i1.525 Mulder, M., & Uys, L. R. (2012). Baseline
measurement of the implementation process of the proposed model for clinical nursing education and training in
South African universities. In L. R. Uys & H. C. Klopper (Eds.), Trends in Nursing 2012 (pp. 59–84). Pretoria:
FUNDISA. Nursing Education Stakeholders (NES). (2012). A proposed model for clinical nursing education and
training in South Africa. In Trends in Nursing 2012 (pp. 49–58). Pretoria: FUNDISA. Nursing Summit Organising
Committee and the Ministerial Task Team. (2012). The nursing summit of 2011. In Trends in Nursing 2012 (pp. 33–
48). Pretoria: FUNDISA. Omansky, G. L. (2010). Staff nurses’ experiences as preceptors and mentors: an integrative
review. Journal of nursing management, 18(6), 697–703. doi:10.1111/j.1365-2834.2010.01145.x Smedley, A., &
Penny, D. (2009). A Partnership Approach to the Preparation of Preceptors. Nursing Education Perspectives, 30(1),
31–36. Troxel, D. (2009). Connections: Online preceptor education. Nursing Management, (October), 32–37. Vos, S.
S., & Trewet, C. B. (2012). EXPERIENTIAL EDUCATION A Comprehensive Approach to Preceptor Development.
American Journal of Pharmaceutical Education, 76(3), Article 47.
Contact
[email protected]

Assessment of Related Learning Experience: Basis for a Proposed Dedicated
Education Unit Model (DEU)
Vina Grace Belaya, MSN, MAN, BSN, USA
Joyce Chow, MAN, DMD, RN, Philippines
Purpose
The purpose of this presentation is to illustrate that DEU model can solve the theory-practice gap
problems among student nurses in the clinical setting. That combination of DEU and Moose Learning
Environment theory can be adapted and applicable to Philippine clinical setting.
Target Audience
The target audience of this presentation are student nurses, people from the academe (nursing
instructors and professors), and people from the hospital (both staff nurses and administration).
Abstract
Purpose: The purpose of the study is to determine the assessment rating of nursing students (NSs),
clinical instructors (CIs) and staff nurses (SNs) on the current status of their RLE program . Also, it
attempted to identify the problems encountered in their RLE program. The main intention of the study is to
develop a Dedicated Education Unit (DEU) model through convergence of quantitative and qualitative
data. Methods: Triangulation mixed method design was used in the study. A total of 105 Level IV NS
were recruited as respondents through stratified random sampling, while purposive sampling technique
was used for 21 CI’s and 54 SN’s of Ospital ng Sampalok (OSAM) as respondents. RLE Status
Questionnaire was employed to gather quantitative data. To find significant differences among the
assessment of three groups of respondents, ANOVA was used and Tukey Kramer post hoc analysis was
utilized to further explore the differences. Simultaneous gathering of qualitative data was done through
the used of Focus Group Discussion (FGD). A Modified Rabiee’s Framework was utilized to analyze the
qualitative data. Results: Among the significant findings were the following: The overall status of RLE is
Achieved with a weighted mean of 3.49. However, the utilization of appropriate feedback mechanism and
ratio of student to clientele based on the objectives and the capacity of the student, obtained an Almost
Achieved status , with weighted mean of 3.23 and 3.39 respectively. Except for the utilization of
appropriate feedback mechanism, the result of ANOVA test shows that there are significant differences
on the assessment of RLE status among the three groups of respondent. Tukey Kramer ‘s post hoc
analysis revealed that SNs assessment is significantly different compared to the other two respondents
(NS’s and CI’s). Through data analysis of the results of FGD, three main themes were formulated:
Institutional deficiencies, hospital deficiencies and how students are being treated. Under the institutional
deficiencies, problems emerged were the following: Inconsistent RLE schedule, young and inexperienced
CIs, theorypractice gap, inadequate RLE hours. While the problems emerged under hospital deficiencies
were the following: Inadequate and outdated equipment, simultaneous duty hours, inadequate space,
absence of practice guidelines on duties and responsibilities of SN and CI, healthcare team not following
the ideal set-up. On how students are being treated, the problems that surfaced were the following:
humiliated, intimidated and need for collaboration. After quantitative and qualitative data were analyzed,
results were converged and grouped into: Relationship dimension, personal dimension, system
maintenance and change dimension. DEU model was created through adaptation of Moos “Learning
Environment theory”. Conclusion: The study was able to provide empirical evidences on the short-
comings of the current RLE program, hopefully the recommended DEU Model (which emphasizes a
strong collaboration between the Learning Institution and Hospital, to deliver the curriculum, and one of its
innovation is a dedicated practice area for student nurses in hospital setting} can be an answer to the
identified RLE problems.
References
1.Hart, G. & Rotem A. (2004). The best and the worst: Students' experience of clinical education. The Australian
Journal of Advanced Nursing, 11(3), 26-33. 3. Moscato, S.R., Miller, J., Logsdon, K., Weinberg, S., & Chorpenning, L.

(2007) Dedicated education unit: An innovative clinical partner education model. Nursing Outlook. 55 (1), 31-37. 5.
Miller, T. W. (2005) The Dedicated Education Unit: a practice and education partnership. Nursing Leadership Forum.
9 (4), 169-173.
Contact
[email protected]

G 03 - Education Based Simulation
Outcomes of an Evidence-Based Research (EBR) Tool to Teach Online Research
and Critical Thinking Skills
JoAnn D. Long, RN, PhD, NEA-BC, USA
Paula Gannaway, BA, MLS, USA
Rita Doumit, PhD, MPH, RN, Lebanon
Cindy Ford, PhD, RN, CNE, USA
Purpose
The purpose of this presentation is for nursing educators and researchers to evaluate the outcomes of an
evidence-based research tool designed to teach research skills and critical thinking using a web-based
and smart phone application
Target Audience
The target audience of this presentation is for nursing educators and researchers interested in the
outcomes of an evidence-based research tool designed to teach research skills and critical thinking using
a web-based and smart phone application
Abstract
Purpose: Advances in global technologies have changed how students access evidence-based
information. Research suggests nursing students overestimate their ability to accurately acquire online
research and lack the critical thinking skills to evaluate the trustworthiness of the scientific literature. In
response to this need a research team created an online Evidence-based Research (EBR) tool to
enhance student research skills. The EBR tool is located on a secured university website and is
accessible online or by smart phone. The purpose of this project is to report the outcomes of the EBR tool
on student research skills and to discuss the use of the data for program and institutional effectiveness
metrics.
Methods: We used a quasi-experimental, pre-test post-test mix-method design. The research questions
are 1) Does the use of the online EBR tool increase student self-report of research skills? 2) Does self-
reported data triangulate with embedded questions assessing student acquisition of evidence-based
research skills? Data was collected from six cohorts over an 18 month period from 2012-2013 using first
semester RN/BSN (n=85) and MSN (n=70) students in a southwestern university. Pre/post-test data was
analyzed by t-test. Narrative data was analyzed by word count and clustering into recurring themes.
Results: A statistically significant difference between mean pre and post-test research skills was found in
both RN/BSN and MSN students (t = 6.10, p < 0.001; t = 8.23, p < 0.001) moving students from perceived
“good” research skills to “very good” after use of the EBR tool. Descriptive data from two case-based
questions embedded within the EBR tool supports 84% of students can correctly apply PICO search
terms to online search skills and 76% are able to differentiate the steps needed for critical appraisal of the
research literature.
Conclusion: It is imperative that nursing educators find effective ways to teach evidence-based research
skills to students using methods relevant to today’s learner. The data from this study suggests the
technology-based EBR tool effectively enhanced student online evidence-based research skills and
producing objective data suitable for programmatic evaluation of student research skills usable for
programmatic evaluation and institutional assessment. International testing of the tool is underway.
Contact
[email protected]

The Effectiveness of Simulation Using in Nursing Education
Rei-Mei Hong, RN, PhD, Taiwan
Jun-Yu Fan, RN, PhD, Taiwan
Purpose
The purpose of this study was to explore the experiences of simulation class in nursing education. Also,
we would like to find out the factors of causing performance differences in two campuses.
Target Audience
The target audience of this presentation is nursing teachers, nursing students and managers.
Abstract
Purpose: Nursing education systems and training courses vary in different countries. However, the caring
and training skills are similar. In Taiwan, the criteria of entering to one big university in two campuses are
similar. However, we find that nursing students in two different campuses (north and south of Taiwan)
have different academic performance after three years nursing education training program. The students
in north of Taiwan have better academic performance than the students in south of Taiwan at the same
university. Both the students in two campuses had simulation class. The purpose of this study was to
explore the experiences of simulation class in nursing education. Also, we would like to find out the
factors of causing performance differences in two campuses.
Methods: In-depth interviews with audio-recorded were collected by the researcher. During the face-to-
face interviews, the researcher asked the students in two campuses about their clinical practice
experiences. A descriptive qualitative was used. 30 students were participated.
Results: Four categories emerged from the analysis were found. Participants revealed thoughts of “the
essence of confidence”, “ the essence of nursing practice”, “feeling stressful”, and “feeling anxious.”
Conclusion: The findings provide potential insight into the nursing students. Nurse educators can
consider the perspectives into the school program in the future.
References
Filer, D. (2010). Everyone's answering: Using technology to increase classroom participation. Nursing Education
Perspectives, 31(4), 247-250. Grealish, L., & Smale, L. A. (2011). Theory before practice: Implicit assumptions about
clinical nursing education in Australia as revealed through a shared critical reflection. Contemporary Nurse, 39(1), 51-
64. Jeffries, P. R. (2001). Computer versus lecture: A comparison of two methods of teaching oral medication
administration in a nursing skills laboratory. Journal of Nursing Education, 10 40(7), 323-329. Lujan, J., & Vasquez,
R. (2010). A case study of the scaffolding clinical practicum model: Is it culturally competent for Hispanic nursing
students? Journal of Nursing Education, 49(7), 394-397. Kurtz, C. P., Lemley, C. S., & Alverson, E. M. (2010). The
master student presenter: Peer teaching in the simulation laboratory. Nursing Education Perspectives, 31(1), 38-40.
Parker, R. M., Keleher, H. M., Francis, K., & Abdulwadud, O. (2009). Practice nursing in Australia: A review of
education and career pathways. BM C Nursing, 8(5), 1-6.
Contact
[email protected]

Examining the Effects of a Standardized Patient Simulation Experience on
Decision Making, Self Efficacy and Critical Thinking
Linda Wilson, RN, PhD, CPAN, CAPA, BC, CNE, CHSE, USA
Purpose
The purpose of this presentation is to present the results of a study examining the effect of a standardized
patient simulation experience on decision making, self efficacy and critical thinking in nursing students
from a variety of types of programs.
Target Audience
The target audience of this presentation is academic nurse educators, clinical nurse educators, education
specialists, and staff development specialists.
Abstract
Purpose: The purpose of this study was to examine the effects of a standardized patient simulation
experience on decision making, self efficacy and critical thinking. Standardized patient simulation is a
simulation technique used in the curriculum of nursing and many healthcare professions (Wilson &
Rockstraw, 2012).
Methods: This was a quasi-experimental pre-test post-test design study. The sample included medical
assistant students, practical nurse students and undergraduate nursing students who were participating in
a standardized patient simulation experience. Prior to the simulation experience each participant
completed the following: 1) a demographic sheet; 2) the Decision Making Quality Scale (DMQS) with 7
questions; 3) the General Self-Efficacy Scale (GSE) with 10 questions; and 4) the Critical Thinking
Disposition Scale (CTDS) with 75 questions. Immediately after completing the standardized patient
simulation experience each participant completed the following: 1) the Decision Making Quality Scale
(DMQS) with 7 questions; 2) the General Self-Efficacy Scale (GSE) with 10 questions; and 3) the Critical
Thinking Disposition Scale (CTDS) with 75 questions. All data collected were anonymous but coded to
match the pre-test with the post-test. All data were entered into SPSS version 20 and analyzed.
Results: A total of 388 students participated in the study. Participants included 6 medical assistant
students (1.5%), 44 practical nurse students (11.3%) and 338 undergraduate nursing students
(87%). The undergraduate nursing students were from a variety of programs including an associate
degree nursing program (2 year program) 18%, a baccalaureate nursing traditional program (4 to 5 year
program) 11.1% and a baccalaureate nursing accelerated program (11 month program)
58%. Participants were aged 19 to 62 years with the majority between the ages of 20 to 33. As for
marital status of the participants, 75.5% were single, 20.9% were married, .3% were widowed, and 1.8%
were divorced. For gender there were 16.7% were male and 83.3% were female. As for race 66.5% were
White, .3% American Indian or Alaskan native, 7.7% were Asian, 21.1% were Black or African American,
and 4.4% identified as more than one race. Due to the small number of medical assistant student
participants they were excluded from the pre-test post-test analysis which left a total of 382
participants. The analysis will identify the main effect (F-test) of the independent variable (the four groups
[practical nurse students, associate degree nursing students, baccalaureate traditional program nursing
students and baccalaureate accelerated program nursing students]) on the post-test scores of each of the
dependent variables (decision making, self efficacy, and critical thinking). The pre-test post-test
comparisons were analyzed using an analysis of covariance (ANCOVA). A separate ANCOVA was used
for each of the dependent variables of decision making, self efficacy and critical thinking. Covariates
were pre-test scores from the dependent variable under consideration. Post-test scores served as the
dependent variable. The results for Decision Making were F(2, 305) = 1.475, p = .230 showing no
statistically significant difference in post-test scores after initial differences were controlled through
covariation. The results for Self Efficacy were F(2, 304) = 1.021, p = .362 showing no statistically
significant difference in post-test scores after initial differences were controlled through covariation. The
results for Critical Thinking were F(2,308) = .933, p = .395 showing no statistically significant difference in

post-test scores after initial differences were controlled through covariation. In summary there were no
statistically-significant differences in post-test scores between the groups on any of the three dependent
variables.
Conclusion: The analysis showed that here was no significant difference in any of the 4 groups (practical
nurse students, associate degree nursing students, baccalaureate traditional program nursing students
and baccalaureate accelerated program nursing students) when examining the dependent variables of
decision making, self efficacy and critical thinking following a standardized patient simulation
experience. Possible reasons for these results include 1) variation in the types of students; 2) variation in
the simulation cases; 3) participant exhaustion due to the length of the pre-test and post-test and 4) other
factors not yet identified. Future research plans include the following: 1) continued examination of the
dependent variables of decision making, self efficacy and critical thinking along with other concepts
important to healthcare education and patient safety; 2) Further examination of the subscales of decision
making and critical thinking following a standardized patient simulation experience; and 3) examination of
decision making, self efficacy and critical thinking following a human patient simulator simulation
experience. Continued research is needed to find the simulation technique or technology that will have
the biggest impact on nursing student education to foster student knowledge, student success and patient
safety.
References
Wilson, L. & Rockstraw, L. (2012) Human Simulation in Nursing and Health Professions, Springer Publishing, Inc:
New York.
Contact
[email protected]

G 04 - Dealing with HIV and Vulnerable Populations
Motivational Factors and Preferences Regarding Research Participation Among
HIV+ Adults in an Urban Setting
Victoria B. Mitrani, PhD, USA
Brian E. McCabe, PhD, USA
Lisa R. Metsch, PhD, USA
Purpose
The purpose of this presentation is to describe a study that explored factors (cost/benefits,
social/community endorsement) that influence research participation, and comfort with different data
collection formats (face-to-face, paper and pencil, computer assisted) of African Americans and Hispanics
with HIV/AIDS.
Target Audience
The target audience of this presentation is persons who do, or plan to do, research with vulnerable
populations, including minorities with HIV/AIDS.
Abstract
Purpose: The purpose of this study was to explore factors (cost/benefits, social/community endorsement)
that influence research participation and comfort with the format for data collection (face-to-face interview,
paper questionnaire and computer assessment) of potentially sensitive information of African Americans
and Hispanics with HIV/AIDS. We examined whether the importance of cost/benefits, the importance of
social/community endorsement, and comfort with three data collection formats were related to ethnicity,
age, education, or first-time study participation. This was an exploratory study aimed at building
hypotheses for future research and to inform researchers wishing to enroll people from ethnic minority
backgrounds with HIV into research studies. The study aims to add to the knowledge base on research
participation factors of members of minority groups with HIV.
Methods: This was an exploratory cross-sectional study. Participants were 453 English-speaking adults
attending two HIV primary care clinics in South Florida. All participants gave informed consent before
completing the survey. The University of Miami institutional review board approved the study prior to
recruitment. Participants received $10 for completing the survey.
Of the 453 participants, 30% were taking part in their first study. A small majority (57%) were male with
42% female, and 1% intersex. Almost two-thirds (61%) were African American, 35% were Hispanic, and
5% were white or of other ethnicity. The average age of participants was 45.97 years (SD = 9.17), 64%
had a high school education (or equivalent), and 75% were unemployed at the time of the interview. Most
(57%) participants had been diagnosed with HIV more than 10 years before the interview, with 21% 5-10
years before, 17% 1-5 years before, and 5% less than a year before. Nearly all (90%) participants were
taking HIV medications.
Participants completed a survey developed for the study. Ten items asked about the importance
of research participation cost/benefits and social/community endorsement of the research in the
participant’s decision regarding research participation. Cronbach’s alpha for these scales was high:
Cost/Benefits α = .88, Community/Social Endorsement α = .93. Three items asked about the participant’s
level of comfort with faces to face interview, paper questionnaire, and private computer screen when
being asked personal questions in a research study.
Results: All of the Cost/Benefits and Community/Social Endorsement items were rated as either
“important” or “absolutely important” by the majority of participants. However, the majority of participants
reported that confidentiality of information (66%), respect (63%), understanding the study (57%), and
benefit to society (53%) “were absolutely important” for their decision to participate in a research
study. Other items related to the cost/benefits of research participation, receiving a benefit (49%) and the
study not being a hassle (45%) were also deemed “absolutely important” by nearly half of the participants.
Items related to community/social endorsement were rated as “absolutely important” by about a third of

participants. . Most participants reported comfort with all of the data gathering techniques (face-to-face
interview, paper questionnaire and computer assessment), with face to face as the most popular (93%),
followed paper questionnaire (80%) and private computer assessment (70%).
Individuals with no past experience as research participants were less likely to report that cost/benefits, B
= -0.47, SE = 0.21, p = .025, OR = 0.63, or community/social endorsement, B = -0.60, SE = 0.23, p =
.008, OR = 0.5 were important, and less likely to endorse comfort with face to face interviews, B = -0.82,
SE = 0.40, p = .041, OR = 0.44. Advance age was associated with a preference for face to face
interviews, B = 0.78, SE = 0.21, p < .001, OR = 2.18. Educated individuals preferred paper and pencil
survey, B = 0.65, SE = 0.25, p = .008, OR = 9.91, and computer data collection, B = 0.44, SE = 0.22, p =
.044, OR = 1.55, to face to face interviews.
Conclusion: This study explored factors related to research participation among persons with HIV. We
learned that age, education and research experience differentiated the importance or preference for
specific study characteristics. The study suggests that more experienced research participants were more
likely to discriminate and carefully evaluate the costs/benefits and community endorsement aspects of a
study before agreeing to participate. It may be that participants with experience in previous studies were
more informed “consumers” of research participation, and thus had more well-developed opinions about
what was important to them.
A large majority of participants were comfortable with any of the three possible data collection formats,
but face to face interviews was the most preferred format. These findings are consistent with literature
that shows that many individuals with HIV prefer more personal methods of data collection. In particular,
findings suggest that researchers should carefully consider face-to-face interviews with study samples
that are likely to include a substantial number of elders or people without a high school education.
References
Adeyemi, O.F., Evans, A.T., & Bahk, M. (2009). HIV-infected adults from minority ethnic groups are willing to
participate in research if asked. AIDS Patient Care and STDs, 23, 859 – 865. DOI: 10.1089=apc.2009.0008 Alvarez,
R.A., Vasquez, E., Mayorga, C.C., Feaster, D.J., & Mitrani, V.B. (2006). Increasing minority research participation
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Kelly, P.J., & Cordell, J.R., (1996). Recruitment of women into research studies: a nursing perspective. Clinical Nurse

Specialist, 10, 25 - 28. Menzes, P., Eron Jr., J.J., Leone, P.A., Adimora, A.A., Wohl, D.A., & Miller, W.C. (2011).
Recruitment of HIV/AIDS treatment-naıve patients to clinical trials in the highly active antiretroviral therapy era:
influence of gender, sexual orientation and race. HIV Medicine, 12, 183 – 191. DOI: 10.1111/j.1468-
1293.2010.00867.x Moreno-John, G., Gachie, A., Fleming, C.M., Napoles-Springer, A., Mutran, E., Manson, S.M., &
Perez-Stabel, E.J. (2004). Ethnic minority older adults participating in clinical research: developing trust. Journal of
Aging and Health, 16, 93S-123S. DOI: 10.1177/0898264304268151 Newman, P.A., Duan, N., Roberts, K.J., Seiden,
D., Rudy, E.T., Swendeman, D., & Popova, S. (2006). HIV vaccine trial participation among ethnic minority
communities. Journal of Acquired Immune Deficiency Syndrome, 41, 210 – 217. NIMH Collaborative HIV/STD
Prevention Trial Group. (2007). The feasibility of audio computer-assisted self-interviewing in international settings.
AIDS, 21, S49 – S58. Paskett, E.D., Reeves, K.W., McLaughlin, J.M., Latz, M.L., McAlerney, A.S. Ruffin,
M.T.,…Gehler, S. (2008). Recruitment of minority and underserved populations in the United States: the centers for
population health and health disparities experience. Contemporary Clinical Trials, 29, 847 – 861.
doi:10.1016/j.cct.2008.07.006 Sengupta, S., Strauss, R.P., DeVellis, R., Quinn, S.C., DeVellis, B., & Ware, W.B.
(2000). Factors affecting African-American participation in AIDS research. Journal of Acquired Immune Deficiency
Syndromes, 24, 275 – 284. Siegel. K., & Raveis, V. (1997). Perceptions of access to HIV-related information, care,
and services among infected minority men. Qualitative Health Research, 7, 9 – 31. DOI:
10.1177/104973239700700102 Stone, V.E., Mauch, M.Y., Steger, K., Janas, S.F., & Craven, D.E. (1997). Race,
gender, drug use, and participation in AIDS clinical trials. Journal of General Internal Medicine, 12, 150 – 157.
Sullivan, P.S., McNaghten, A.D., Begley, E., Hutchinson, A., & Cargill, V.A. (2007). Enrollment of racial/ethnic
minorities and women with HIV in clinical research studies of HIV medicines. Journal of the National Medical
Association, 99, 242 – 250. Van der Elst, , E.M., Okuki, H.S., Nakamya, P., Muhaari, A., Davies, A., McClelland, R.S.,
… Sanders, E.J. (2009). Is Audio Computer-Assisted Self-Interview (ACASI) useful in risk behaviour assessment of
female and male sex workers, Mombasa, Kenya? PLoSOne, 4, e5340. Willis, G.B., Al-Tayyib, A., & Rogers, S.
(2001). The use of touch-screen ACASI in a high-risk population: implications for surveys involving sensitive
questions. Proceedings of the Annual Meeting of the American Statistical Association, August 5-9.
Contact
[email protected]

Zero New HIV and TB Infection: Vision Impossible with the Current Management
of LGBTI Students in a Rural-Based University
Purpose
The purpose of this presentation is to highlight the impact of Homophobia towards LGBTI on HIV
prevention in a South African rural based university and to introduce the stratergy for implementing LGBTI
friendly HIV and AIDS programme on campus. and
Target Audience
The target audience of this presentation is helth care practitioners working in the institutions of higher
education, nurse educators, policy makers, nurse administrators, students and the entire university
community.
Abstract
Purpose: The purpose of this study was to investigate the impact Homophobia has on HIV/AIDS
management for LGBTI students in a South African Rural-Based University with the view of developing
a LGBTI-friendly HIV/AIDS management model.
Methods: Interpretative Phenomenological Analysis (IPA) methodology was used to conduct this study.
Individual interviews (n=12) and focus group interviews, (n=2 X 8)were used as data collection
methods. An open interview format was adopted with the use of two open-ended questions focusing on
the experience of stigma, descrimination and utilisation of the available HIV programmes on campus.
Results: Data were analysed using Interpretative Phenomenological Analysis framework as outlined by
Smith (2005). The results indicate that:
• Homophobia could increases the risk of HIV infection amongst LGBTI students.
• University HIV/AIDS programmes do not embrace the LGBTI community.
Conclusion: For the country to reach the ‘Zero new HIV and TB infection, a level of Zero stigma and
discrimination’ towards LGBTI students should be reached. Higher Education HIV/AIDS programmes
(HEAIDS) should ensure that the institutions of higher education address homophobia toward LGBTIs
and ensure that HIV/AIDS programmes on campus also caters for LGBTI students.
References
1. Associated Press, Johannesburg. (2012, February 1). Men who stabbed and stoned a lesbian to death are
sentenced to 18 years’ jail. The Guardian. 2. Bernstein, M (2008) Afterward: The analytic Dimensions of Identity: A
political Identity Framework. Social movements protest and contention, 30, 277-301. 3. Billies, M., Johnson, J.,
Murungi, K. & Pugh, R. (2009). Naming our reality: low-income LGBT people documenting violence, discrimination
and assertions of justice. Feminism & Psychology, 19 (3) 375-380. 4. Ellis, S.J. (2008). Diversity and inclusivity at
university: a survey of the experiences of lesbian, gay, bisexual and transgender (LGBT) students in the UK. Higher
Education, 57:723-739. 5. Human Rights Watch. (2009). Together, apart: organizing around sexual orientation and
gender identity worldwide. New York: Human Rights Watch and International Gay and Lesbian Human Rights
Commission. 6. South African National Aids Council. (2011).The South African National Strategic Plan on HIV,
Sexually Transmitted Infections (STIs) and Tuberculosis (TB) 2012 – 2016. Government printers : Pretoria 7.
Republic of South Africa (1996): Constitution of the Republic of South Africa. Act no. 108 of 1996. Pretoria: State
Press.
Contact
[email protected]

SEPA II: Links from Childhood Abuse to Adult Intimate Partner Violence,
Depression, and Drinking in Hispanic Women
Nilda (Nena) Peragallo, DrPH, RN, FAAN, USA
Rosa Maria Gonzalez-Guarda, PhD, MPH, RN, CPH, USA
Natalia Villegas, PhD, MSN, RN, USA
Rosina Cianelli, PhD, MPH, RN, FAAN, USA
Purpose
The purpose of this study was to examine relationships between childhood abuse (physical, sexual, and
emotional) and adult intimate partner violence, depression, and high-risk drinking in a sample of Hispanic
women in South Florida.
Target Audience
This presentation is aimed at nurses and other professionals working in Intimate Partner Violence (IPV),
depression, substance abuse and HIV prevention at different settings and/or interested in the
development of culturally-specific interventions. The importance of including IPV in HIV risk reduction
interventions is discussed.
Abstract
Purpose: There is evidence that experiencing abuse during childhood increases the risk of a number of
physical and mental health problems during adulthood. Women or girls experience childhood abuse at
higher rates than men. Research that has examined these topics have sampled Hispanic women less
than non-Hispanic Whites. The purpose of this study was to examine relationships between childhood
abuse (physical, sexual, and emotional) and adult intimate partner violence, depression, and high-risk
drinking in a sample of Hispanic women in South Florida. The study aims to add to the knowledge base
on relationships between childhood experiences and adulthood health problems.
Methods: Data were from the baseline assessment of a randomized clinical trial of SEPA (Salud/Health,
Educacion/Education, Promocion/Promotion, y/and Autocuidado/Self-care; Peragallo et al., 2012), a
HIV/STI risk-reduction intervention compared to a wait-list control. Participants were 548 adult Hispanic
women from South Florida. Participants were assessed by female bilingual interviewers using a
structured questionnaire. All participants gave informed consent before completing the interview. The
interviews were conducted in offices at or near a community service agency. Assessments were collected
with the assistance of a web-based research management software system (e-Velos). Most women
(n=504, 92%) chose to complete the interview in Spanish. The average age of participants was 38.48
years (SD = 8.53), 74% had a high school education (or equivalent), and 67% were unemployed at the
time of the interview. Women completed an interview in English or Spanish with bilingual research
assistants. Childhood abuse was assessed using a Violence Assessment developed for a previous
randomized trial with Hispanic women (Peragallo et al., 2005); child abuse was divided into three
categories: physical abuse, sexual abuse, and emotional abuse. Three adulthood health problems were
examined as outcomes. Intimate partner violence was measured with the Revised Conflict Tactics Scale
(2004), and coded as 1 (any reported violence) and 0 (no reported violence). Depression was measured
with the CES-D (Radloff, 1977), and coded as 1 (depression) and 0 (no depression) using 16 as the cut-
off score for depression. High-risk drinking was assessed using the CAGE (Ewing, 1984), and coded as 1
(high-risk) and 0 (low-risk) using a cut-off score of 1. Mplus 7.11 (Muthen & Muthen, 2013) was used for
analyses.
Results: Most women scored over the clinical cutoff point for depressive symptoms (M = 16.41, SD =
12.91) and reported at least one incident of physical, sexual, or psychological abuse in their lifetime (M =
1.07, SD = 1.49). Over a quarter of women reported experiencing intimate partner violence (64%) and
13% reported being high or drunk in the past 3 months. Childhood physical abuse was significantly
related to high-risk drinking in adulthood, B = 0.78, SE = 0.35, p = .026, OR = 2.19. Childhood sexual

abuse was significantly related to adulthood depression, B = 0.99, SE = 0.32, p = .002, OR = 2.69; and
high-risk drinking, B = 0.77, SE = 0.32, p = .016, OR = 2.17. Childhood emotional abuse was significantly
related to adulthood depression, B = 0.82, SE = 0.32, p = .012, OR= 2.26.
Conclusion: This study identified four significant relationships between childhood abuse and adulthood
health problems. Adulthood depression was related to childhood sexual and emotional abuse. Adulthood
high-risk drinking was related to childhood physical sexual abuse. Adulthood intimate partner violence
was not significantly related to childhood abuse in this sample. These results are largely consistent with
previous research with non-Hispanic samples that links childhood traumatic experience with adulthood
problems. Intervention programs that reduce childhood abuse, and improve protective factors that can
buffer against childhood abuse, are likely to help women well into adulthood.
References
Ewing, J.A. (1984). Detecting alcoholism: the CAGE Questionnaire. Journal of the American Medical Association,
252, 1905 – 1907. Muthen, L. K., & Muthen, B.O. (2013). Mplus user’s guide (5th ed.). Los Angeles: Author.
Peragallo, N., Deforge, B., O’Campo, P., Lee, S. M., Kim,Y. J., Cianelli, R., et al. (2005). A randomized clinical trial of
an HIV-risk reduction intervention among low-income Latina women. Nursing Research, 54, 108 - 118. Peragallo, N.,
Gonzalez-Guarda, R.M., McCabe, B.E., & Cianelli, R. (2012). The efficacy of an HIV Risk Reduction Intervention for
Hispanic Women. AIDS and Behavior, 16, 1316 – 1326. Radloff, L.S. (1977). The CES-D scale: a self-report
depression scale for research in the general population. Applied Psychological Measures, 1, 385 – 401. Straus, M.A.,
& Douglas, E.M. (2004). A short form of the Revised Conflict Tactics Scale, and typologies for severity and mutuality.
Violence and Victims, 19, 507 – 520.
Contact
[email protected]

G 05 - Health Promotion in the Postpartum Arena
The Early Postpartum Experience of Previously Infertile Mothers
Sigrid Lynn Ladores, PhD, ARNP, MSN, USA
Karen Aroian, RN, PhD, USA
Purpose
The purpose of this presentation is to describe the early postpartum experience of previously infertile
mothers in order to sensitize healthcare providers to the difficulties faced by these women during their
transition to new motherhood.
Target Audience
The target audience of this presentation is any healthcare practitioner who provides care to women,
infants, and families.
Abstract
Purpose: The clinical literature suggests that the physical, emotional, and financial investment
associated with fertility treatment makes it difficult for previously infertile women to transition into new
motherhood. Yet no studies have been conducted that explore the lived experience of becoming a new
mother from the unique perspectives of previously infertile women. This descriptive phenomenological
study fills this gap.
Methods: Twelve first-time, previously infertile mothers aged 27 to 43 years, were interviewed twice. The
first interview focused on eliciting descriptions of motherhood in the early postpartum period after
overcoming infertility. The second interview validated the interpretations from the first interview and
provided additional information and reflection. The data were analyzed using Colaizzi’s approach.
Results: Two main themes emerged that described the early postpartum experience of first-time,
previously infertile mothers: 1) Lingering Identity as Infertile; and 2) Gratitude for the Gift of
Motherhood. Participants reported that their lingering identity as infertile and immense gratitude for the
gift of motherhood propelled them to establish unrealistic expectations to be the perfect mother. When
they were unable to live up to being the perfect mother, they censored their feelings of inadequacy, guilt
and shame.
Conclusion: Findings from this study sensitize healthcare providers to the difficulties faced by previously
infertile women during their transition to motherhood.
References
Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R.S. Valle & M. King (Eds.),
Existential-phenomenological alternatives for psychology (pp. 48-71). NY: Oxford University Press.
Contact
[email protected]

Effect of Self-Efficacy Regarding a Smooth Labor on Cesarean Deliveries Among
Primiparas in Taiwan
Kuei-Hui Chu, RN, MS, Taiwan
Ai-Chieh Chen, RN, MS, Taiwan
Mei-Hwa Hsu, RN, MS, Taiwan
Purpose
The objective of this study was to examine the association between self-efficacy regarding a smooth labor
during pregnancy and cesarean deliveries among primiparas in Taiwan.
Target Audience
The learner will be able to understand the reasons why women want to adopt cesarean deliveries. The
learner will be able to understand the effect of self-efficacy during pregnancy on cesarean section.
Abstract
Purpose: The objective of this study was to examine the association between self-efficacy regarding a
smooth labor during pregnancy and cesarean deliveries among primiparas in Taiwan.
Methods: This prospective study included 770 women, who were interviewed during the second and third
trimester of pregnancy for their self-efficacy regarding a smooth labor, and at one month postpartum for
their actual mode of delivery. Self-efficacy regarding a smooth labor was defined as the level of
confidence in going through a smooth normal spontaneous labor process and successfully giving birth to
a baby. The scale included 20 items, with a higher score indicating a higher level of self efficacy.
Results: The rate of cesarean section was 36.5%. Women undergoing cesarean deliveries have lower
mean self-efficacy regarding a smooth labor during second and third trimesters of pregnancy. The logistic
regression results showed that spousal age >40 years, being unmarred, and had received assisted
reproductive technology were associated with an increased risk for cesarean delivery. After adjusting for
those variables, self-efficacy during second trimester (OR = 0.99, 95% CI: 0.98-0.99) and increases in
self-efficacy from the second to third trimesters (OR=0.98, 95% CI: 0.97-0.99) were associated with lower
risks for cesarean delivery.
Conclusion: Health professionals could screen pregnant women with low self-efficacy about labor,
identify their concerns and obstacles about normal spontaneous delivery, and intervene to increase their
self-efficacy, which could help decrease rate of cesarean section.
Contact
[email protected]

Depression and Social Support Trajectories during One Year Postpartum Among
Marriage-Based Immigrant Mothers in Taiwan
Hung-Hui Chen, RN, MS, Taiwan
Purpose
The purpose of this presentation is that the audience will be able to realize postpartum mental health
among marriage-based immigrant womenthe in Taiwan, Asia, including trajectories of depression and
social support during the first year postpartum, and predictors for depression.
Target Audience
The target audience of this presentation is the person who is interested in women health and immigrant
issue.
Abstract
Purpose: Increasing number of women from south-east Asian countries married to Taiwanese men.
Immigrant mothers in Taiwan often face birth soon after moving to Taiwan. More studies have identified
social support as a crucial protective factor for postpartum depression. However, little is known about the
relationships between different domains of social support and postpartum depression trajectory among
marriage-based immigrant women in Asia. The aim of this study was to examine the trajectories of
depression and social support during the first year postpartum, and predictors for depression, among
marriage-based immigrant mothers in Taiwan.
Methods: This panel study recruited immigrant mothers to complete structured questionnaire at 1 month,
6 month, and 1 year postpartum during the period from September 2008 to June 2010. There were 203
and 163 immigrant mothers who completed the questionnaire at 1 and 6 month, and 1 year postpartum,
respectively. Postpartum depression was measured using the Edinburgh Postpartum Depression Scale.
Social support was composed of 3 subscales, emotional, instrumental, and informational support.
Hierarchical linear modeling (HLM) was used to examine the relationships between trajectories and
factors associated with depression.
Results: Depression and instrumental support followed downward curvelinear trajectory during the first
year postpartum; while emotional and informational support followed upward curvelinear trajectory.
Emotional and instrumental support negatively covaried with postpartum depression over time. When 3-
dimensional support was considered together, only emotional support retained its significance when
background variables were adjusted in the model.
Conclusion: Our results demonstrated that depression was highest at 1 month and lowest at 10 month
postpartum, though further study may be needed to confirm the trajectory. To decrease postpartum
depression among immigrant mothers, strategies should be developed to increase emotional and
instrumental support during postpartum period.
References
[1]Ehlert, U., Patalla, U., Kirschbaum, C., Piedmont, E., & Hellhammer, D. H. (1990). Postpartum blues: salivary
cortisol and psychological factors. Journal of Psychosomatic Research, 34, 319-25. doi:10.1016/0022-3999 [2]Chien,
L. Y., Tai, C. J., Hwang, F. M., & Huang, C. M. (2009). Postpartum Physical Symptoms and Depressive
Symptomatology at One Month and One Year after Delivery: A Longitudinal Questionnaire Survey. International
Journal of Nursing Studies, 26 (9), 1201-1208. doi: 10.1016/j.ijnurstu.2009.02.007 [3]Sutter-Dallay, A.-L., Murray, L.,
Dequae-Merchadou, L., Glatigny-Dallay, E., Bourgeois, M.-L., & Verdoux, H. (2011). A prospective longitudinal study
of the impact of early postnatal vs. chronic maternal depressive symptoms on child development. European
Psychiatry, 26(8), 484-489. [4]Collins, C. H., Zimmerman, C., & Howard, L. M. (2011). Refugee, asylum seeker,
immigrant women and postnatal depression: rates and risk factors. Archives of Women's Mental Health, 14(1), 3-11.
doi:10.1007/s00737-010-0198-7 [5]Sword, W., Watt, S., & Krueger, P. (2006). Postpartum health, service needs, and

access to care experiences of immigrant and Canadian-born women. Journal of Obstetric, Gynecologic & Neonatal
Nursing, 35(6), 717-727. doi:10.1111/j.1552-6909.2006.00092.x [6]Stewart, D., Gagnon, A. J., Dougherty, G.,
Saucier, J. F. & Wahoush, O. (2008). Postpartum Depression Symptoms in Newcomers. Canadian Journal of
Psychiatry, 53(2), 121-124. [7]Chien, L. Y., Tai, C. J., & Yeh, M. C. (2012). Domestic decision-making power, social
support, and postpartum depression symptoms among immigrant and native women in Taiwan. Nursing Research,
61(2), 103-110. doi: 10.1097/NNR.0b013e31824482b6 [8]National Immigration Agency, Ministry of the Interior, ROC.
The number of marriage immigrants, 2012. Available at:
http://www.immigration.gov.tw/public/Attachment/210251813126.xls [9]Chen, T. L., Tai, C. J., Chu, Y. R., Han, K. C.,
Lin, K. C., & Chien, L. Y. (2011). Cultural factors and social support related to breastfeeding among immigrant
mothers in Taipei city, Taiwan. Journal of Human Lactation, 27(1), 41-48. doi:10.1177/0890334410376519 [10]
Edwards, R. C., Thullen, M. J., Isarowong, N., Shiu, C. S., Henson, L., & Hans, S. L. (2012). Supportive relationships
and the trajectory of depressive symptoms among young, African American mothers. Journal of Family Psychology,
26(4), 585-594. doi:10.1037/a0029053 [11] Haga, S. M., Ulleberg, P., Slinning, K., Kraft, P., Steen, T. B., & Staff, A.
(2012). A longitudinal study of postpartum depressive symptoms: multilevel growth curve analyses of emotion
regulation strategies, breastfeeding self-efficacy, and social support. Archives of Women's Mental Health, 15(3), 175-
184. doi: 10.1007/s00737-012-0274-2 [12] Poehlmann, J., Schwichtenberg, A. J., Bolt, D., & Dilworth-Bart, J. (2009).
Predictors of depressive symptom trajectories in mothers of preterm or low birth weight infants. Journal of Family
Psychology, 23(5), 690-704. doi:10.1037/a0016117 [13] Kingston, D., Heaman, M., Chalmers, B., Kaczorowski, J.,
O'Brien, B., Lee, L., Dzakpasu, S., O'Campo, P.; Maternity Experiences Study Group of the Canadian Perinatal
Surveillance System, Public Health Agency of Canada. (2011). Comparison of maternity experiences of Canadian-
born and recent and non-recent immigrant women: findings from the Canadian Maternity Experiences Survey.
Journal of Obstetrics and Gynaecology Canada, 33(11), 1105-1115 [14] Chen, H. H., Hwang, F. M., Tai, C. J., &
Chien, L.Y. (2013). The interrelationships among acculturation, social support, and postpartum depression symptoms
among marriage-based immigrant women in Taiwan: A cohort study. Journal of Immigrant and Minority Health, 15(1),
17-23. doi:10.1007/s10903-012-9697-0 [15] Ozbaþaran, F., Coban, A., & Kucuk, M. (2011). Prevalence and risk
factors concerning postpartum depression among women within early postnatal periods in Turkey. Archives of
Gynecology and Obstetrics, 283(3), 483-490. doi: 10.1007/s00404-010-1402-8 [16] Diaz, M. A., Le, H. N., Cooper, B.
A., & Muñoz, R. F. (2007). Interpersonal factors and perinatal depressive symptomatology in a low-income Latina
sample. Cultural Diversity & Ethnic Minority Psychology, 13(4), 328-336. doi: 10.1037/1099-9809.13.4.328 [17]
Schaefer, C., Coyne, J. C., & Lazarus, R. S. (1981). The health-related functions of social support. Journal of
Behavioral Medicine, 4(4), 381-406. [18]Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner,
T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school
entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202 [19] O'Mahony, J., &
Donnelly, T. (2010). Immigrant and refugee women's post-partum depression help-seeking experiences and access
to care: a review and analysis of the literature. Journal of Psychiatric and Mental Health Nursing, 17(10), 917-928.
doi: 10.1111/j.1365-2850.2010.01625.x [20] Callister, L. C., Beckstrand, R. L., & Corbett, C. (2011). Postpartum
depression and help-seeking behaviors in immigrant Hispanic women. Journal of Obstetric, Gynecologic, & Neonatal
Nursing, 40(4), 440-449. doi: 10.1111/j.1552-6909.2011.01254.x [21] Bandyopadhyay, M., Small, R., Watson, L. F., &
Brown, S. (2010). Life with a new baby: how do immigrant and Australian-born women's experiences compare?
Australian and New Zealand Journal of Public Health, 34(4), 412-421. doi:10.1111/j.1753-6405.2010.00575.x
Contact
[email protected]

G 09 - Healthcare Delivery Among Vulnerable Populations
Nursing Health Promotion Interventions Needed to Reduce Oral Health
Disparities: The Situation in Israel
Cheryl Zlotnick, RN, MS, MPH, DrPH, Israel
Orna Baron Epel, PhD, Israel
Shlomo Zusman, DDS, Israel
Lital Keinan-Boker, MD PHD, Israel
Purpose
To identify health disparities and subgroups at risk for oral health problems so nurses can appropriately
target oral health education in their health promotion interventions.
Target Audience
researchers in health disparities, and community and public health nurses.
Abstract
Purpose: The World Health Organization (WHO) reminds us that Nursing is a holistic discipline that
"encompasses autonomous and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings. It includes the promotion of health, the prevention of
illness, and the care of ill, disabled and dying people." Yet, despite the well-established link between oral
health and cardiovascular disease, nurses rarely consider this important aspect of health care in their
disease prevention and health promotion activities. This omission needs to be corrected. In the quest to
reduce health disparities among different subgroups, public and community health nurses will want to
identify subgroups who are at risk for oral health disparities and include oral health education in their
health promotion interventions.
The Andersen and Aday's Behavioral Model of Health Care Utilization, a commonly used model for
identifying characteristics and attributes of adults who use (or do not use) services, has been employed to
examine oral health services in the UK, Sweden and Canada. The Model proposes that three major
components promote or block service use: predisposing factors (e.g., demographic characteristics and
attitudes), enabling factors (e.g., internal resources comprised of personal habits/behaviors and external
resources such as socioeconomic status that facilitate service use), and reinforcing/need factors (e.g.,
reasons to use services such as increased risk of oral health disease).
Accordingly, this study uses the Andersen and Aday Behavioral Model of Health Care Utilization in a
nationwide sample of Israeli adults to: (1) compare the use of primary dental care services between the
years 2000 and 2010, (2) examine the factors associated with using primary dental care services for
Israel's two largest ethnic groups, Jews and Arabs, (3) consider approaches for nursing health promotion
interventions to reduce oral health disparities.
Methods: This study used two national, cross-sectional, datasets (years 2000 and 2010) of surveys
administered by the Israel Center for Disease control that explored knowledge of eating, smoking and
other habits or behaviors; attitudes towards health behaviors; and activities indicating use and practice
of health behaviors (KAP). Institutional Ethics Committee approval was obtained for this secondary data
analysis (#13/056). In 2000, the sample consisted mostly of Israeli-Jews (n=2920); and in 2010, targeted
sampling resulted in a nationally representative sample of Israeli-Jews (n=2739) and Israeli-Arabs
(n=2,196).
Results: Primary dental care use increased between 2000 and 2010 in Israel, but many differences were
found by ethnic minority status, education, income, immigration and other factors. Results indicated that
primary dental care was sought by Israeli-Jews who: were born in Israel (OR-1.43, CI-1.17, 1.75); had at
least a high school diploma (OR-1.62, CI-1.23-2.13); were employed (OR-1.36, CI-1.09,1.70); reported at
least average income (OR-1.78, CI-1.45,2.19); flossed their teeth (OR-1.84, 1.49-2.28); had a normal BMI
(OR-1.23, CI-1.02-1.48); and were not smokers (OR-0.78, CI-0.65-0.94). Primary dental care was
sought by Israeli-Arabs who: were less likely to be age 45-54 (OR-0.62, CI-0.39-0.99) or 65+ (OR-0.46,

CI-0.22-0.99), compared to age <24 years; had at least high school education (OR-1.62, CI-1.20-2.20);
reported at least average income (OR-1.67, CI-1.29, 2.16); and flossed their teeth (OR-2.22, 1.57-3.15).
Conclusions: Like many western countries, increasing numbers of Israelis used primary dental services
between 2000 and 2010; and the proportion of Israeli adults using primary dental care use was similar to
other western countries with 67.7% of adults in the United Kingdom and 70% in Canada. However, there
were clear ethnic disparities between the Israeli-Jewish majority (72.0%) and the Israeli-Arabs minority
(61.7%). Among Israeli-Jews, being an immigrant versus native-born was significantly associated with
lower use of primary dental care in 2000 and 2010. This same relationship was found in non-native born
immigrant citizens of Canada. Both studies found that being native-born had independent effects from
other socioeconomic variables; thus, rather than service cost, potential explanations for lower use of
primary dental care could be knowledge or language barriers. Attitudes towards preventive care also
may be a possible explanation. Almost 20% of Israeli citizens are non-native born and more than 15,000
new immigrants arrive each year.
Disparities in health habits by income level were found worldwide. Higher income level may increase
exposure to education on preventive oral health habits such as brushing teeth and flossing. Consistent
with our findings, other studies have noted that when dental care services are not a regularly covered
service, lower service use results. Moreover, while possession of health insurance is not always
correlated to engaging in better health habits, possession of health insurance is almost always related to
use of primary dental care. Still, cost of services is not the only barrier to primary dental care. Attitudes
also pose barriers to use of services and good health habits. Current evidence suggests that Israeli
adults do not rank dental
All three factors of the Andersen and Aday's Behavioral Model (i.e., predisposing, enabling and
reinforcing/need factors) demonstrated a relationship with the use of primary dental services in 2010;
however, only enabling factors such as higher level socio-economic status, high school education factors,
and positive dental health behaviors factors were associated with use of primary dental care services for
both Israeli-Arabs and Israeli-Jews.
This study's findings show that in Israel, a country with a mixed western and middle-eastern culture, the
use of primary dental care is an indicator of health care inequity for vulnerable population subgroups
including minorities, immigrants, and those of lower socioeconomic status. Therefore, the onus is on
policymakers, researchers and health professionals to identify methods of raising public awareness in
minority and disadvantaged communities, using culturally-appropriate strategies, to reduce the existing
disparities in primary dental care services. Nurses can make a difference to reducing ethnic and
socioeconomic disparities by adding oral health education to their health promotion activities, particularly
when their interventions target at-risk populations.
It is important to acknowledge this study's limitations including self-reported responses on cross-sectional
surveys, where verification of responses was not possible. Moreover, due to the uniqueness of the State
of Israel, generalizability of these national results may be limited. Additionally, response bias has been
found in reporting personal habits – in particular reports of flossing were found to be biased in Israeli-
Arabs. Still, the samples used by this study are drawn from two nationwide surveys on a topic not
commonly studied in the peer-reviewed literature. In conclusion, although Israelis overall have
demonstrated continued improvement in dental outcomes and use of primary dental care services;
disparities in use of preventive services that could promote better dental outcomes are apparent in
vulnerable subgroups such as ethnic minorities and those with less education and low income.
References
Andersen, R. M (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health
and Social Behavior 36, 1-10. Baron-Epel, Orna, Giora Kaplan, Ruth Weinstein and Manfred S Green (2010).
Extreme and acquiescence bias in bi-ethnic population. European Journal of Public Health 20, 543-548. Central
Bureau of Statistics in Israel (2010). Jews, by Country of Origin and Age (2.24). In Jews, by Country of Origin and
Age (2.24), CBS, Statistical Abstract of Israel 2010. Central Bureau of Statistics in Israel (2012). Table E/4.-
Immigrants, by last country of residence. In Table E/4.-Immigrants, by last country of residence, ed. Monthly Bulletin
of Statistics N. 12/2012. Feingold, G and J Setcos (2004). Oral health in Israel. A review of surveys over several
decades. Refuat Hapeh Vehashinayim 21, 15-21. Israel Center for Disease Control (ICDC) (2002). Knowledge,
Attitudes and Health Behaviors 2000-2002 [in Hebrew]. In Knowledge, Attitudes and Health Behaviors 2000-2002 [in

Hebrew]. Jerusalem: Department of Education and Health Promotion. Levin, Liran and Alon Shenkman (2004). The
relationship between dental caries status and oral health attitudes and behavior in young Israeli adults. Journal of
Dental Education 68, 1185-1191. Lundegren, N, B Axtelius, P-E Isberg and S Akerman (2013). Analysis of the
perceived oral treatment need using Andersen's behavioral model. Community Dental Health 30, 102-107. Machnes,
Yaffa and Abraham Carmeli (2009). The provision of oral care by local government authorities in Israel: policy issues
and empirical evidence. Health Policy 89, 107-114. Marshman, Zoe, Jenny Porritt, Tom Dyer, Ceri Wyborn, Jenny
Godson and Sarah Baker (2012). What influences the use of dental services by adults in the UK. Community
Dentistry and Oral Epidemiology 40, 306-314. Muirhead, V E, C Quinonez, R Figueiredo and D Locker (2009).
Predictors of dental care utilization among working poor Canadians. Community Dentistry and Oral Epidemiology 37,
199-208. Watt, Richard G (2012). Social determinants of oral health inequalities: implications for action. Community
Dentistry and Oral Epidemiology 40, 44-48.
Contact
[email protected]

G 09 - Healthcare Delivery Among Vulnerable Populations
Health Services or Debt Servicing?: SAPs in the Philippines and the Healthcare
Delivery System
Erlinda Castro Palaganas, PhD, Philippines
Ruel Dupan Caricativo, BA, Philippines
Purpose
to present a discourse on a social determinant of health as it affects the promotion of health. This social
determinant focuses on the imposition of Structural Adjustment Programs (SAPs) in the Philippines
through the International Monetary Fund and World Bank had severe consequences on the country’s
health care delivery system.
Target Audience
Any/every nurse or development workers at any level and field of practice.
Abstract
Purpose: To discuss using a critical social perspective severe consequences on the country's health
care delivery system of the imposition of Structural Adjustment Programs (SAPs) in the Philippines
through the International Monetary Fund and World Bank (IMF-WB). This will present SAPs as a socio-
cultural determinant of health in the efforts of a comprehensive health promotion framework.
Methods: This qualitative study is a review of existing evidences on the impacts of SAPs in the Philippine
social sector during the 1980s to early 2000s.
Results: There are several channels through which the negative impacts of SAPs in the social sector are
manifested. These channels include poverty; human resource development; population dislocation,
migration, and brain drain; disproportional effects on women; and, civil unrest and conflict. The purpose of
this article is to establish a relationship between SAPs and its conditionalities and government policies
which had gross negative impacts to health care services and health human resource development.
The establishment of IMF and WB in 1944 during the Bretton Woods Conference rests on the belief that
an unregulated market would result to depression, poverty and another major war. However, what was
decisive in the said conference was the “reality of American power” in the face of European destruction
after World War II. The IMF and WB, driven by the neoliberal ideology, have been forcing developing
countries with debt-related conditionalities embodied in the Washington consensus under the guise of
promoting the values of democracy and free trade.
During the 1980s, developing countries were unable to pay their loans from Western commercial banks
which went on a lending spree during the mid to late 1970s after rising oil prices filled their coffers with
petro-dollars. This debt crisis gave Washington the opportunity to “blast open” the developing countries.
The SAPs and its conditionalities served as a disciplining mechanism used by developed countries to
exercise indirect control over developing countries. These conditionalities include enforced privatization of
industries (including necessities such as health care), cuts in government spending, liberalizing of capital
markets, market-based pricing (which tends to raise the cost of basic goods), higher interest rates (which
reduces access to credit), and trade liberalization (which reduces barriers to trade and foreign investment
such as tariffs and import duties). But the SAPs evolved to cover more areas of domestic policy including
labor laws, health care, and environmental regulations, among others.
The Philippines suffered significant macroeconomic setbacks in the 1980s. The crisis from oil price hikes
in 1973-1974 and 1980-1981 overlapped with a major political crisis triggered by the assassination of
Senator Benigno Aquino Jr. in 1983 producing the worst post-war economic crisis in the country. This
was the backdrop of the imposition of SAPs in the Philippines. However, the intervention of the IMF-WB’s
SAPs and its conditionalities like trade liberalization, privatization, and cuts in government spending
resulted to the decline of the country’s GNP levels. The lowest annual average in GDP growth also took
place during the period of 1980 to 1989. The effect of this stunted economic growth was severely felt by

poor Filipinos. Since the 1980s, chronic poverty, especially in the rural areas, has plagued the
Philippines. From 1985 to 2003, the share in the national income of the poorest 60% of the population
has decreased by 1.8% (25.8% of the total income) while the share of the richest 20% increased by 1.2%
(53.3% of the total income).
The review of existing evidences showed that the budget for social services like health care has struggled
due to continued debt payments. From 1986-2007, the government’s interest payments on public foreign
and domestic debt averaged roughly three times the spending on health care services. The problem
associated with foreign debt has historical antecedents. During the administration of the former President
Ferdinand Marcos, he issued Presidential Decree 1177 (Budget Reform Decree of 1977) which stipulated
automatic appropriations for debt servicing from the national budget. His successor, the former President
Corazon Aquino continued this policy through Executive order 2092 (Administrative Code of 1987).
In addition, the dismal budget for health care services became a crucial factor for Filipino health workers
to look for better opportunities overseas. It was in 1974 under the Marcos administration that export of
labor was encouraged through the Labor Export Policy supposedly as one of the drivers for economic
growth. But the literature revealed that the primary objectives of the LEP were: (1) to address the
increasing surplus of reserved labor force both in the urban centers and in the countryside which was
being slowly transformed as the social base of the rising discontent against the Marcos administration;
and, (2) to generate resources in the form of dollar remittances for the country’s ballooning foreign debt.
Labor export remains to be the major dollar earner for the Philippine economy. According to the
International Labor Organization (ILO), the Philippines is the primary source of migrant workers worldwide
bringing in almost US$ 21 billion in annual remittances.
The migration of Filipino health professionals reveals the gross negative impact of SAPs and its
conditionalities on human resource development. External migration is a manifestation of the Philippines’
backward, export-oriented and import-dependent economy lacking in capacity to build industries and
create adequate jobs for its citizens. The country is losing human resources vital to domestic production,
especially with the exodus of highly skilled workers and professionals. From 1972 to 1987, the Bureau of
Labor and Employment Statistics showed an increasing outflow of unskilled production workers.
However, during the period of 1992-2004, there was a continued rise in deployment of highly skilled
professional and service sector workers. Still, the government encourages labor export as a means of
finding a solution to the rising unemployment problem, to reduce social tensions, and to earn dollars that
would finance imports and debt servicing.
Labor export has also led to the following patterns: (1) commodification of Filipino migrant labor since the
“overseas Filipino worker (OFW) phenomenon” has become an industry linking source to receiving
countries; (2) trafficking of women in domestic service and in entertainment and sex industries in the
receiving countries; (3) creation of an exploitable and expendable labor force in the receiving countries;
and, (4) feminization of migrant labor since Filipino women comprises majority of labor export.
Conclusion: In conclusion, this review showed that SAPs-related conditionalities imposed by the IMF
and WB had severe consequences for the Philippines. These “adjustment programs” resulted to gross
negative impacts in the country’s social sector manifested in the declining quality of health care services
and the dismal health human resource development. In addition, these programs play a determinant role
in the persistent overseas migration of Filipino human resources, especially its health personnel. And this
has work, most of the time, at the expense of themselves, their family, and their fellow Filipinos.
References
ADB, Poverty in the Philippines: Income, Assets and Access (2005) Chronically Ill: An Overview of the Philippine
Health Sector. Quezon City: IBON Foundation Inc., 2008, p. 50. From Monterrey to Doha: Financing
(Under)Development, IBON Facts & Figures Special Release, Vol. 31, No. 18, 30 September 2008, 13. “The
Philippine Overseas Employment: Understanding Its Trend and Structural Change (Part 4)”, in LabStat Updates,
Bureau of Labor and Employment Statistics, DOLE, Vol. 10, No. 8, May 2006, 4. “The High Costs of Illegitimate and
Odious Debt”, in IBON Facts & Figures, Vol. 30, No. 17, 15 September 2007, 3; Illegitimate Debt &
Underdevelopment in the Philippines: A Case Study. Zimbabwe: African Forum and Network on Debt and
Development, March 2007, 17.
Contact

[email protected]

G 10 - Global Nursing Research: Medication Related Randomized
Controlled Trials
Randomized Controlled Trial of Motivational Interviewing to Improve Medication
Adherence of Heart Failure Patients in Mainland China: A Pilot Study
Jing Meng, China
Purpose
The purpose of this presentation is to introduce my research project of a randomized control study to
evaluate the efficacy of motivational interviewing to improve medication adherence of heart failure
patients in mainland China.
Target Audience
The target audience of this presentation is all the clinical nurses and nursing researchers.
Abstract
Purpose: To evaluate the effects of motivational interview for improving heart failure patients' (1) beliefs
about medication, (2) adherence confidence and motivation, (3) medication adherence.
Methods: Purposive sampling was used to recruit 120 inpatients who were in Fuwai cardiovascular
diseases hospital in Beijing and randomly assigned to an intervention group (IG) or control group (CG).
Patients from the IG received 60~80min one to one motivational interview on the basis of routine care and
a handbook of heart failure and medication usage. Data on beliefs about medication, adherence
confidence and motivation, and medication adherence behavior were collected at baseline, before
discharge by interview, one and three months after discharge by phone. The effects of motivational
interview were assessed by testing changes in the medication adherence beliefs about medication,
adherence confidence and motivation ratings over time using repeated measures ANOVAs and by
comparing the ratings of IG to that of CG using t test or X2 test.
Results: 97 patients (49 from IG, 48 from CG) completed data collection three months after discharge.
The results were (1) Compared to baseline, medication adherence of IG had significant improvement one
and three months after discharge (P<0.017); Compared to that of control group, the medication
adherence of IG had significantly higher score at discharge, one and three months after discharge
(P<0.05). (2) Compared to baseline, beliefs about medication of IG had significant improvement one and
three months after discharge (P<0.008); Compared to that of control group, the beliefs about medication
of IG had significantly higher score at discharge, one and three months after discharge (P<0.05). (3)
Compared to baseline, motivation and confidence of adherence of IG had significant improvement one
and three months after discharge (P<0.008); Compared to that of control group, motivation and
confidence of medication adherence of IG had significantly higher score at discharge, one and three
months after discharge (P<0.05).
Conclusion: It is necessary to have one to one motivational interview among heart failure patients, which
can improve beliefs about medication, adherence confidence and motivation, and medication adherence
three month after discharge.
Conclusion: Motivational interview is useful to improve patients' medication adherence and could be used
in clinical practice.
References
[1]Wu JR, Moser DK, Lennie TA, et al. Medication adherence in patients who have heart failure: a review of the
literature[J]. Nurs Clin North Am. 2008,43:133–153. [2]Osterberg L, Blaschke L. Adherence to Medication[J]. N Engl J
Med.2005,353:487-97. [3]Possidente CJ, Bucci KK, Mcclain WJ. Motivational interviewing: a tool to improve
medication adherence?[J]. Am J Health Syst Pharm,2005,62(12):1311-1314. [4]Schmaling KB, Blume AW, Afari N. A
randomized controlled pilot study of motivational interviewing to change attitudes about adherence to medications for
asthma.[J] J Clin Psychol Med Settings. 2001,8:167-72.
Contact

[email protected]

Controlled Trials
A RCT of the Effects of Medication Adherence Therapy for People with
Schizophrenia Specturm Disorders
Wai Tong Chien, PhD, MPhil, BN, RMN, Hong Kong
Jolene Mui, MSc, BSc, RMN (UK, HK), CPN (HK), Hong Kong
Eric Cheung, MB, BS (HK), FRCPsych (UK), FHKCPsych, FHKAM (Psychiatry), Hong Kong
Purpose
The purpose of this presentation is to describe and discuss a randomized controlled trial, using a
repeated measures control group design, tested the effectiveness of a 6-session medication adherence
program for Chinese outpatients with schizophrenia specturm disorders over a 12-month follow-up.
Target Audience
The target audience of thsi presentation is all nurses and health professionals who are working in
psychiatric and mental healthcare settings, as well as those researchers in mental healthcare.
Abstract
Purpose: This randomized controlled trial, using a repeated measures control group design, tested the
effectiveness of a 6-session medication adherence program for Chinese outpatients with schizophrenia
and its subtypes over a 12-month follow-up.
Methods: A two-site controlled trial was conducted with 134 Chinese patients with psychotic disorders in
Hong Kong. The program is a motivational and insight-inducing educational program that addresses
patients’ awareness and knowledge of schizophrenia and skills of medication management (Gray et al.,
2006) . They were randomly assigned to either the medication adherence program or usual psychiatric
outpatient care. The patients’ levels of medication adherence (using Drug Attitude Inventory, DAI), mental
(Positive and Negative Syndrome Scale, PANSS) and psychosocial (Specific Level of Functioning scale,
SLOF) functioning, insights into illness (Insight and Treatment Attitude Questionnaire, ITAQ), and re-
hospitalization rates (number and length in six months) were measured at recruitment and at one week
(Post-test 1) and 12 months (Post-test 2) after the intervention.
Results: Preliminary results of MANOVA test indicated that the participants in the NPP reported
significantly overall improvements on the patient outcomes [F (1, 132) = 6.12, p=0.005; Wilks’ Lambda=
0.95; a large effect with partial (eta)2 = 0.39]. Post hoc Tukey’s HSD test indicated that their mental state
(PANSS score), attitude towards medication use (DAI score), and insight into the illness (ITAQ scores)
were significantly improved and hospitalization rates (both number and length of re-admissions) were
significantly reduced at both one week and 12 months after the intervention, compared with standard
care.
Conclusion: The results of this controlled trial can provide evidence of the effectiveness of a community-
based adherence therapy for schizophrenia in improving medication adherence, mental condition and
insight into the illness and its treatment. This can then result in reducing the risk of relapse and re-
admission over 12 months, and hence minimize those tragic events in relation to relapse such as violence
and self-harm, as well as the medical and social costs.
References
1. Coldman, E.L., Addington, J., Addington, D. (2002) “Medication adherence of individuals with a first episode of
psychosis”. Acta Psychiatrica Scandinavia, vol 106, pp 286-290. 2. Gray, R., Leese, M., Bindman, J., Becker, T.,
Burti, L., David, A. et al. (2006) “Adherence therapy for people with schizophrenia: European multicentre randomized
controlled trial”. British Journal of Psychiatry, vol 189, pp 508-514. 3. McIntosh, A., Conlon, L., Lawrie, S., Stanfield,
A.C. (2008) “Compliance therapy for schizophrenia”. Cochrane Database of Systematic Reviews, Issue 3.
CD003442.
Contact

[email protected]

Controlled Trials
Examining Usual Care Relating to Medicine Adherence Across Kidney
Transplantation Sites: Implications and Managing Differences in Preparation for a
RCT
Allison Fiona Williams, PhD, RN, Australia
Elizabeth Manias, RN, MPharm, PhD, Australia
Jac Kee Low, BSc (Hons), Australia
Kimberley Crawford, PhD, BSc (Hons), Australia
Purpose
to describe what usual care entails for patients who received a kidney transplant at all five tertiary
hospitals offering adult transplantation in Victoria, Australia and how the differences in usual care will
have implications for the testing of an intervention designed to improve medicine adherence in a
randomised controlled trial
Target Audience
any health professional who is involved in the care of kidney transplant patients or other solid organ
transplants and other health professionals that have an interest in medicine adherence
Abstract
Purpose: The increasing prevalence of end-stage kidney disease, the shortage of kidney donors, and the
economic and health-related benefits of kidney transplantation make the prevention of adverse outcomes
following transplantation a healthcare imperative (Khan & Amedia 2008). Medicine adherence in kidney
transplantation is critical to the success of the graft (Pinksy et al. 2009). Interventions are needed to help
kidney transplant patients take all their medications as prescribed. The purpose of this study was to
establish what usual care entails for adult patients who received either a live or deceased kidney
transplant at all five tertiary hospitals offering adult kidney transplantation in Victoria, Australia in
preparation for testing an intervention designed to improve medicine adherence in this cohort.
Approximately 230 kidney transplants are performed in Victoria annually.
Methods: Renal nurse transplant coordinators were interviewed face-to-face by two investigators who
took hand written notes. The structured interview schedule consisted of 12 questions, such as, ‘If a
patient is receiving a kidney transplant from a live donor, what occurs prior to the operation?, ‘How does
this differ from a deceased donor?’ and ‘If a patient was found to be non-adherent to their medications,
what actions would you take?’. Renal pharmacists were interviewed by telephone regarding their role in
preparing patients to take their medications as prescribed. The structured interview schedule consisted of
12 questions focussing on patient education and methods to enhance medicine adherence. Examples of
questions included, ‘Are you aware of patients using a Dosette box? If so, when is the Dosette box
introduced post-transplantation?’, and ‘How do you ensure that the patient has adequate prescriptions for
their medications?’. Notes were sent back to each renal transplant coordinator and pharmacist as a
method of verification. All data underwent Sandelowski’s (2000) method of descriptive analysis.
Results: Nine renal nurse coordinators participated in face-to-face interviews lasting approximately one
hour and five renal pharmacists were interviewed for approximately 15 minutes by telephone. Although
usual care differed between sites, there were similarities in approaches to facilitate medicine adherence.
These included pre-transplant education sessions which included medications used to treat rejection, the
use of medication aids such as Dosette boxes and Webster packs, and ensuring adequate medication
supplies. It was more difficult to ensure recipients of deceased kidney transplants had received adequate
preparation for their kidney transplant due to the urgency of the surgery. However, each site had
developed their own way of educating the patient about their medications delivered by certain health
professionals. Generally, pharmacists took the main responsibility for educating patients about their
medications post-transplantation prior to discharge and registered nurses reiterated this information every

time the patient took their medications in hospital. Post-discharge, renal nurse transplant coordinators
followed up long term medicine adherence that was monitored by medical staff through laboratory
investigations. Overall, there was no standard approach to education regarding medications or the
printed material given to the patient or the use of dose medication aids to facilitate medicine adherence.
Conclusion: Differences in usual care at the sites and a lack of standardised approaches to promoting
medicine adherence have implications for evidence-based health care that maximises kidney transplant
outcomes. Differences in usual care also have implications for the testing of an intervention designed to
improve medicine adherence in a randomised controlled trial. Details of usual care is necessary with
regard to minimise the risk of study-induced behavioural change (Smelt et al. 2010), and to ensure quality
reporting of randomised controlled trials, the gold standard for evaluating interventions because of their
ability to reduce bias (Moher et al. 2010).
References
Khan, S., & Amedia, C. A. (2008). Economic burden of chronic kidney disease. Journal of Evaluation in Clinical
Practice, 14, 422-434. Moher, D., Hopewell, S., Schulz, K., Montori, V., Gotzsche, P., Devereaux, P., et al. (2010.
CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.
British Medical Journal, 340:c869. Pinsky, B. W., Takemoto, S. K., Lentine, K. L., et al. (2009). Transplant outcomes
and economic costs associated with patient noncompliance to immunosuppression. American Journal of
Transplantation, 9, 2597-2606. Sandelowski, M. (2000). Whatever happened to qualitative description? Research in
Nursing & Health, 23, 334- 340. Smelt, A., van der Weele, G., Blom, J., Gussekloo, J., & Assendelft, W. (2010). How
usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials. Britsish Journal of
General Practice, 60(576), 305-318.
Contact
[email protected]

H 03 - Clinical Based Simulations
The National Simulation Study: A Longitudinal, Multi-Site, Randomized,
Controlled Study Examining the Use of Simulation as a Substitute for Clinical
Hours
Jennifer K. Hayden, MSN, RN, USA
Maryann Alexander, PhD, RN, FAAN, USA
Purpose
The purpose of this presentation is to present the educational outcomes from a multi-site, randomized,
controlled study when simulation is used to replace traditional clinical hours throughout the undergraduate
nursing curriculum.
Target Audience
Nurse educators, regulators and policy-makers will benefit from this presentation of a large-scale, national
study of simulation use as a clinical replacement throughout the prelicensure curriculum.
Abstract
Purpose: The purpose of this presentation is to discuss the findings from a multi-year, multi-site,
randomized, controlled study of the educational outcomes when simulation is used to replace traditional
clinical hours throughout the undergraduate nursing curriculum. Providing high quality clinical education
experiences for nursing students is a challenge for nurse educators worldwide. An international nurse
faculty shortage, along with competition for clinical sites, high patient acuity, and short hospital stays
make it difficult for students to obtain consistently good educational experiences. Educators have turned
to high fidelity patient simulation as one solution to the perennial challenges of traditional clinical
education. Program administrators and faculty have witnessed the benefits of this teaching pedagogy and
are interested in using simulation to replace a portion of their clinical hours with simulation, but the
research literature has not addressed the end of program outcomes achieved when simulation is used as
a clinical replacement throughout the curriculum. This was the largest, most comprehensive study to date
examining the use of high fidelity simulation in the undergraduate nursing curriculum. Educational
outcomes of clinical competency, nursing knowledge and new graduate nurse readiness for practice will
be discussed.
Methods: The Fall 2011 student cohort from 10 nursing programs across the US were randomized to one
of three study groups: traditional clinical (control group), 25% simulation in place of traditional clinical
hours, or 50% simulation in place of traditional clinical hours. This randomization was maintained
throughout the two years of clinical courses. In each clinical course, and at the end of the nursing
program, students were assessed on clinical competency and tested on their nursing knowledge. The ATI
Comprehensive Assessment Review Program was used to assess nursing knowledge throughout the
study. The Creighton Competency Evaluation Instrument (CCEI) was used by clinical instructors to
assess competency throughout each clinical course. End of Program determinations of clinical
competency were made by the final clinical preceptor/instructor using the Critical Thinking Diagnostic and
New Graduate Nurse Performance Survey.
The study cohort graduated in May 2013. A follow-up study of these new graduate nurses was conducted
to evaluate their clinical abilities in the workplace. Nurse Managers completed surveys of the new
graduates’ critical thinking, clinical competence and readiness for practice at 6 weeks, 3 months and 6
months after being hired for a clinical position.
Results: A total of 667 nursing students completed the study requirements at graduation. There were no
differences between the study groups in nursing knowledge assessed by the ATI Comprehensive
Predictor (p=0.48), New Graduate Nurse Performance Survey scales (p-values ranged from 0.43 to 0.85),
the Critical Thinking Diagnostic scales (p-values ranged from 0.32 to 0.49), or the overall rating for clinical
competence and readiness for practice (p=0.69). Course specific data showed some variability in the

competency assessments, while the standardized nursing knowledge assessments revealed a trend of
higher scores in the 50% group. National licensure examination results will also be presented.
At graduation, 587 new graduates consented to participate in the follow-up study. Once these new
graduate nurses starting working in clinical positions, their managers provided ratings of clinical
competency, critical thinking and readiness for practice using the New Graduate Nurse Performance
Survey and Critical Thinking Diagnostic. These results will be reported for the 6 week, 3 month and 6
month follow-up periods.
Conclusion: We found no differences in end of program nursing knowledge, clinical competency or
readiness for practice between the three study groups when up to half of the required clinical hours were
replaced with simulated clinical experiences. These results indicate that using well trained simulation
faculty to provide nursing students with simulated clinical experiences produce educational outcomes
equivalent to traditional clinical education at the end of the nursing program. These results have
significant policy implications for regulation and education in the US and other countries.
Leading nurse educators have been calling for a transformation to clinical education. Human patient
simulation provides students the opportunity to learn while in the role of the nurse, rather than the nursing
student. Educational opportunities can be standardized for all students; high morbidity and low frequency
patient conditions can be practiced in a safe learning environment; interprofessional communication and
safety standards can be incorporated in scenarios, and all students can debrief and reflect on the
experience afterwards as a group. When best practices are utilized, nursing students can be exposed to
many patient conditions, practice critical behaviors and synthesize key concepts in the simulated
environment, then work to solidify those concepts and behaviors in the traditional clinical environment.
References
International Nursing Association for Clinical Simulation and Learning. (2013). Standards of Best Practice: Simulation.
Clinical Simulation in Nursing, 9(6S).
Contact
[email protected]

H 03 - Clinical Based Simulations
Training Nurses for Charge Nurse Duties through Simulation
Igal Zlatkin, RN, MA, Israel
Haia Peker, RN, MA, Israel
Purpose
The purpose of this presentation is a discussion about novice nurses' preparation for the charge nurse
duties trough simulation.
Target Audience
The target audience of this presentation is nursing managers, nursing educators, clinical preceptors and
hospital nurses.
Abstract
Purpose: A charge nurse is responsible for patient safety, quality of care and team functioning during
the shift. Also, the charge nurse must care for some patients in addition to performing management
duties. Every Israeli registered nurse is expected to function as a charge nurse after about two years of
nursing experience. Commencing performing charge nurse duties is a stressful situation for a novice
nurse. The anxiety and uncertainty that novice charge nurses feel stem from lack of experience in
managing other staff members, the multitask nature of the job and the required on-going, sometimes
critical, decision making. This stress is aggravated by more complex in-patients and shortage in
manpower which may avert rapid yet quality response to emerging needs. Traditionally, novice nurses
learned to perform effective shift management through trial and error. In order to diminish this stress and
increase effectiveness, the novice nurse should be specifically prepared for charge nurse duties.
It is suggested that a specific workshop, based on simulations that portrayed real world situations in a
controllable format, may provide an effective nurse's preparation for successful performance of the
charge nurse duties.
Methods: The present study is a prospective and comparative with a convenience sample of 40
registered nurses during their first year of charge nurse duties' performance. 24 of them were trained for
the charge nurse position by simulation-based workshop , while the others were prepared by lectures
only. Both the groups were comparable in regard to age, gender and ethnicity. The study was based upon
observations by the shift supervisors on the novice charge nurse's accomplishment of shift management's
tasks . Each observation was scored by checklists that were developed and validated by the researchers.
In addition, the Script Concordance Test , evaluating decision-making and self-confidence was performed
by the novice charge nurses 6 month after commencing shift management. The questions were
developed by researcher and validated by the expert judgment.
Results: The results indicate significantly higher performance levels of simulation group. Levels of
decision-making and self-confidence are significantly higher amongst simulation group.
Conclusion: Simulation techniques provide a realistic yet safe learning environment that more closely
represents clinical care, efficiently prepare novice nurses for shift management tasks and improve their
self-confidence.
References
Brannan, J., White, A. & Bezanson, J. (2008). Simulator effects on cognitive skills and confidence levels. Journal of
Nursing Education, 47(11), 495-500. Cant, R. P. & Cooper, S. J. (2010). Simulation-based learning in nurse
education: systematic review. Journal of Advanced Nursing, 66(1), 3-15. Cooper, S., McConnell-Henry, T., Cant , R.,
Porter, J, Missen, K, Kinsman, L, Endacott, R. & Scholes, J. (2011). Managing deteriorating patients: registered
nurses' performance in a simulated setting. Open Nursing Journal, 5, 120-126. Charlin, B. & Vleuten, C. (2004).
Standardized assessment of reasoning in context of uncertainty. The Script Concordance Test approach. Evaluation
and the Health Professions 27, 304-319. Decker, S., Sportsman, S., Puetz, L. & Billings, L. ( 2008). The evolution of
simulation and its contribution to competency. Journal of Continuing Education in Nursing, 39(2), 74-80. Ebright, P.,
Urden, L., Patterson, E. & Chalko, B. (2004). Themes surrounding novice nurse near-miss and adverse-event

situations. Journal of Nursing Administration, 34(11), 531-538. Hayes, J.M. & Scott, A. S. (2007). Mentoring
partnerships as the wave of the future for new graduates. Nursing Education Perspectives,28( 1),27-29. Kerridge, J.
(2013). Why management skills are a priority for nurses. Nursing Times, 109 (9), 16-17. Kneebone, R.L. (2005).
Evaluating clinical simulation for learning procedural skills: a theory based approach. Academic Medicine, 80(6), 549-
553. Larew, C., Lessans, S., Spunt, D., Foster, D. & Covington, B.(2006). Innovations in clinical simulation:
application of Benner's theory in an interactive patient care simulation. Nursing Education Perspectives, 27 (1).16–21.
Miller, A. & Buerhaus, P.I. (2013). The changing nature of ICU charge nurses' decision making: from supervision of
care delivery to unit resource management.Joint Commission journal on quality and patient safety, 39(1), 38-47.
Shepherd, I. A., Kelly, C. M., Skene, F. M. & White, K. T. (2007). Enhancing graduate nurses’ health assessment
knowledge and skills using low-fidelity adult human simulation. Simulation in Healthcare, 2(1),16-24. Stirling, K.,
Smith, G. & Hogg, G. (2012). The benefits of a ward simulation exercise as a learning experience. British Journal of
Nursing, 21(2), 116-122. van der Vleuten, C. P. M, Scherpbier, A. J. J. A., Dolmans, D. H. J. M., Schuwirth, L. W. T.,
Verwijnen, G. M. & Wolfhagen, H. A. P. (2000). Clerkship assessment assessed. Medical Teacher, 22(6), 592-600.
Contact
[email protected]
H 04 - Health Promotion and Prevention of HIV/AIDS

SEPA II: Predictors of Self-Efficacy for HIV Prevention Among Hispanic Women
Natalia Villegas, PhD, MSN, RN, USA
Rosa Maria Gonzalez-Guarda, PhD, MPH, RN, CPH, USA
Lilian Ferrer, PhD, MSN, RN, Chile
Lorena Kaelber, PhD, CNM, RN, USA
Purpose
Self-efficacy is a critical element for HIV prevention, however little is known about the predictors of self-
efficacy for HIV prevention among Hispanic women. The purpose of this presentation is to identify
predictors of self efficacy for HIV prevention among Hispanic women in South Florida.
Target Audience
This presentation is aimed at nurses and other professionals working in HIV prevention at different
settings.
Abstract
Purpose: One of the strongest predictors for HIV prevention that has emerged is self-efficacy. Strong
levels of self-efficacy for HIV prevention influence personal change toward HIV prevention
behaviors. Self-efficacy is a critical element for HIV prevention, however little is known about the
predictors of self-efficacy for HIV prevention among Hispanic women. Few studies have identified
predictors of self-efficacy for HIV prevention among Hispanic women. Exploring predictors of self-efficacy
for HIV prevention can contribute to Hispanic women’s abilities to develop and carry out HIV prevention
behaviors. The purpose of this presentation is to identify predictors of self efficacy for HIV prevention
among Hispanic women in South Florida. We assessed if the following predictors: age, living with a
partner, employment status, HIV knowledge, self-esteem, and intimate partner violence (IPV) predicted
self-efficacy for HIV prevention in Hispanic women in South Florida who participated in a randomized
controlled trial (SEPA).
Methods: This is a cross-sectional study that used baseline data from a randomized controlled trial of
Salud, Educacion, Prevencion y Autocuidado (SEPA; translated as Health, Education, Prevention, and
Self-Care). A sample of 548 Hispanic women from South Florida was selected. Bilingual female
interviewers administered standardized health and behavior measures through face-to-face interviews.
For these measures, participants selected their language of preference, English or Spanish. Prior to
beginning recruitment, the University of Miami and the Miami-Dade County Health Department’s
institutional review boards approved the study. PASW version 18.0 was used to analyze the data and

simultaneous multiple regression. The simultaneous multiple regression analysis described the
relationship between self-efficacy for HIV prevention and a set of independent variables or predictors. The
independent continuous variables were age, HIV-related knowledge, and self-esteem. The independent
dichotomous variables were living with a partner, employment status, and IPV.
Results: Most of the women were between ages 32 and 45 (mean 5 38.5 6 8.5; range 5 18–49). Most
(68%) had a moderately low family income of less than $2,000 a month. One third of the women reported
being employed. Almost half indicated that they were married. More than two thirds of the participants
lived with a spouse or partner. More than half of the women identified their religion as Catholic. The mean
score for self-efficacy for HIV prevention was 22.6 6 4.1 points (range =7–28). More than half of the
participants scored 23 points or higher on this scale; the majority of the women reported high levels of
self-efficacy for HIV prevention. The multiple regression analysis revealed that the omnibus test was
statistically significant, R2 5 .127, F(6, 514) 5 12.41, p , .001. The six explanatory variables together
accounted for 12.7% of the variance in self-efficacy for HIV prevention. Women who were older, living
with a partner, had less HIV knowledge, and had a history of IPV reported significantly lower levels of
self-efficacy for HIV prevention. HIV knowledge was the most important predictor of self-efficacy for HIV
prevention. Employment was not a significant predictor of self-efficacy for HIV prevention.
Conclusion: The predictor variables proposed by our study (age, living with a partner, HIV-related
knowledge, IPV, and self-esteem), were significant predictors of self-efficacy for HIV prevention. The
model successfully identified predictor variables. These variables have the potential to inform
interventions aimed at increasing self-efficacy for HIV prevention. The predictors identified in the study
can be used to identify high-risk Hispanic women who are in need of HIV prevention interventions.
References
Bandura, A. (1990). Perceived self-efficacy in the exercise of control over AIDS infection. Evaluation and Program
Planning, 13(9), 17. http://dx.doi.org/10.1016/0149-7189(90)90004-G Bandura, A. (1995). Self-efficacy in changing
societies. New York, NY: Cambridge University Press. Centers for Disease Control and Prevention. (2008a). MMWR
analysis provides new details on HIV incidence in U.S. populations. Retrieved from
http://www.cdc.gov/nchhstp/newsroom/ docs/CDC_Incidence_MMWR.pdf Centers for Disease Control and
Prevention. (2008b). HIV/AIDS among women. Retrieved from http://www.cdc.gov/hiv/
topics/women/resources/factsheets/women.htm Cianelli, R., Ferrer, L., & McElmurry, B. J. (2008). HIV prevention and
low-income Chilean women: Machismo, marianismo and HIV misconceptions. Culture, Health & Sexuality, 10(3),
297-306. http://dx.doi.org/10.1080/13691050701861439 Cianelli, R., Ferrer, L., Norr, K., Miner, S., Irarrazabal, L.,
Bernales, M., & McElmurry, B. (2012). Mano a mano mujer an effective HIV prevention intervention for Chilean
women. Health Care for Women International, 33(4), 321-341. http:// dx.doi.org/10.1080/07399332.2012.655388
Florida Department of Health. (2007). Florida annual report 2007. Acquired immunodeficiency syndrome/human
immunodeficiency virus. Retrieved from http://www.hivsarasota.org/ Documents/archive/FL-
Annual_Report_AIDS_2007.pdf 36 JANAC Vol. 24, No. 1, January/February 2013 Gullette, D. L., & Lyons, M. A.
(2006). Sensation seeking, selfesteem, and unprotected sex in college students. Journal of the Association of Nurses
in AIDS Care, 17(5), 23-31. http://dx.doi.org/10.1016/j.jana.2006.07.001 Heckman, T., Kelly, J., Sikkema, K., Cargill,
V., Solomon, L., Roffman, R., . Hoffman, R. (1995). HIV risk characteristics of young adult, adult, and older adult
women who live in inner-city housing developments: Implications for prevention. Journal of Women’s Health &
Gender Based Medicine, 4(4), 397-406. Kaiser Family Foundation. (2009). The HIV/AIDS epidemic in the United
States. Retrieved from http://www.kff.org/ hivaids/upload/3029-10.pdf Lara, L., Cianelli, R., Ferrer, L., Bernales, M., &
Villegas, N. (2008). Comunicacion de pareja y VIH en mujeres en desventaja [Partner communication and HIV in low
income women]. Revista Horizonte De Enfermerıa, 19(2), 35-43. Lauby, J., Semaan, S., O’Connell, A., Person, B., &
Vogel, A. (2001). Factors related to self-efficacy for use of condoms and birth control among women at risk for HIV
infection. Women & Health, 34(3), 71-91. http://dx.doi.org/10. 1300/J013v34n03_05 Lerner, C., & Kennedy, L. (2000).
Stay–leave decision making in battered women: Trauma, coping and self-efficacy. Cognitive Therapy and Research,
24(2), 215-232. http://dx.doi.org/ 10.1023/A:1005450226110
Contact
[email protected]

A Comparative Study of HIV Positive African Migrants' Efforts to Gain Health
Services in the U.K. and U.S
James Whyte, ND, PhD, USA
Purpose
The purpose of this presentation is to detail the social processes and associated barriers to gaining HIV
specific care in the case of African migrants living with HIV disease in the UK and the US.
Target Audience
The target audience for this presentation is nurses, other healthcare professionals and students in
nursing and the health related disciplines. The presentation, in particular, is targeted at nurses working
with vulnerable populations, including persons from Africa who are living with HIV/AIDS.
Abstract
Purpose: There is a dearth of studies that detail the processes underlying African migrants’ efforts to
gain health services in the UK and US. The purpose of the presentation is to present the results of
parrelell studies designed to detail the efforts of HIV positive African migrants' in the UK and US to gain
access to vitally needed health services.
Methods: The Grounded Theory Method was used throughout the conduct of this study, due to the
method’s ability to integrate data and offer a structured method through which data may be analyzed and
interpreted. Since this study involved contact with individuals vested in the issue at hand, in their
naturalistic environment, this was an ideal method through which to conduct a study of this nature. One
of the primary challenges of the study was to gain adequate data that reflected the broad range of
experiences within the HIV positive African community. Due to their experience with multiple cases
involving HIV positive migrants, social care workers at agencies that provide services to undocumented
African migrants were selected. Data was collected from workers at 16 Non-Governmental Organizations
(NGOs) that offer assistance to undocumented migrants in the UK and US. Each of these agencies was
visited in person by study personnel.
Results: The pattern of access to care within general practice clinics was highly inconsistent when
considering African migrant’s ability to reliably access services. The data revealed the existence of
several vitally important processes: 1) All African migrants to the UK are granted access to care at the
GM clinics upon arrival to the UK. COnversely, African migrants' to the US face significant challenges in
gaining access to care in general practice settings. 2) There is wide agreement on the part of participants
that their clients are losing eligibility to receive care at the GM clinics once they have failed on appeal of
negative asylum decisions. Under the US system, migrants', due to current regulations, face significant
challenges in gaining government aupported access to health services 3) Pulically supported HIV care
clinics in the UK and US, regardless of size, have been seen to inconsistently enforce the prohibition on
providing care to the undocumented. Factors such as healthcare worker unwillingness to deny care to
their previously legal clients were cited repeatedly. 4) There are cases wherein African migrants who
previously had access to publicly funded clinics in the UK and US, have lost their access due to losing
their asylum claims on appeal. A prime factor in such cases tended to be associated with hospitalization
during acute illness, which resulted in administrators performing eligibility checks. 5) Undocumented
migrants were able to maintain access to health services through their GP, however, GPs are not able to
provide HIV specific therapy. Thus, undocumented African migrants maintain limited access to healthcare
via the GP, and at times when they experience life-threatening illness. Otherwise, they eventually lose the
ability to gain treatment with common anti-retroviral therapies. A comparative analysis of the data yields a
highly complex interaction between individual migrants efforts to survive in the countries that they have
immigrated to superimposed over their efforts to gain care for their HIV disease. The result is a pattern
wherein migrants frequently prioritize daily subsistence and housing needs abover their health related
needs. This results in progressive health related challenges.

Conclusion: The findings obtained in this study reflect upon a complex representation of the interaction
between the basic social processes underlying African migrants’ efforts to gain healthcare services and
their efforts to maintain their lives in their new countries. The findings identified a pattern wherein
migrants are often forced to prioritize daily life needs above their medical needs. This results, eventually
in degradation of their health and their need to seek healthcare in an acute care setting. Thus, limits to
health access result in significant health related expenditures and concurrent human suffering and loss of
productivity. The presentation, in concluding, calls for reforms that will address the needs of this hghly
volnerable population in a humane manner.
Contact
[email protected]

HIV Pilot Program for Chinese College Students: Differences by Gender
Teresa D. Serratt, PhD, USA
Purpose
The purpose of this presentation is to present results of a pilot study exploring gender differences in the
effectiveness of the translated VOICES intervention on condom use intention, perceived benefits and
barriers to condom use, condom use self-efficacy, and HIV/AIDS knowledge among Chinese college
students in a U.S. university.
Target Audience
The target audience of this presentation is nurses who provide sexual education to college age students
and those involved in public health interventions related to health promotion and disease prevention.
Abstract
Purpose: Nearly 10 million young people between the ages of 15 and 24 are diagnosed with a sexually
transmitted disease annually. [1]. Young people are disproportionately affected by HIV/AIDS and account
for 40% of all new adult HIV infections in the world (UNAIDS, 2012b). Condom use has been identified as
an effective means of preventing sexually transmitted diseases, however male and female Chinese
college students may respond differently to educational interventions aimed at increasing condom use. [2]
Chinese students account for 30% of all international students attending U.S. colleges and universities,
but there are is a lack of linguistically- and culturally-appropriate programs for this student population. [3]
The study intervention was based on the VOICES (Video Opportunities for Innovative Condom Education
and Safer Sex). The purpose of this study was to explore gender differences in the effectiveness of the
translated VOICES intervention on the condom use intention, perceived benefits and barriers to condom
use, condom use self-efficacy, and HIV/AIDS knowledge among Chinese college students in a U.S.
university.
Methods: A one group pre-test/post-test quasi-experimental design was used. Sixty-Seven Chinese
students at the local university were recruited to view a 20-minute video with Chinese subtitles followed
by one 25-minute small group discussion and condom feature education. Questionnaires collected data
on demographic information, condom use intention, perceived benefits and barriers to using condoms,
confidence in using condoms in different situations, and HIV/AIDS knowledge.
Results: Multiple linear regression analysis showed that female participants showed significantly greater
mean scores of perceived benefits (M = 4.653, SD = 0.472 vs. M = 4.405, SD = 0.761, p = 0.027) and
condom use self-efficacy (M = 4.506, SD = 0.583 vs. M = 4.121, SD = 0.881, p = 0.031), in comparison
with male participants. Additionally, the multiple linear regression analysis showed that female
participants reported significantly higher scores than male participants in five perceived benefits items
and one self-efficacy item.
Conclusion: The findings from this study provides important information for developing more
differentiated intervention strategies specific to gender, particularly in the Chinese international student
population.
References
1. Weinstock, H., Berman, S., & Cates, W. (2004). Sexually transmitted diseases among American youth: Incidence
and prevalence estimates, 2000. 2. Perspectives on Sexual and Reproductive Health, 36(1), 6–10. 3. Holmes, K.K.,
Levine, R., & Weaver, M. (2004). Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of
the World Health Organization; 82:454-461. 4. Institute of International Education. (2012). Fast Facts Open Doors
2012. http://www.iie.org/opendoors. Accessed 1 November, 2013.
Contact
[email protected]

H 05 - Complementary Global Initiatives for Patient Health
The Effect of Warm-Water Footbath on Fatigue, Sleep and Quality of Life of Stroke
Patients
Wan-Jing Li, RN, BS, MSN, Taiwan
Purpose
The purpose of this presentation is to validate and demonstrate the effectiveness and safety using warm-
water footbath to improve stroke patients’ fatigue, sleep and quality of life, in a prospective case-control
study.
Target Audience
The target audience of this presentation is healthcare professional who is taking care of stroke patients
and especially interested in how to enhance the quality of care and the easiness of self-care.
Abstract
Purpose: Fatigue and sleep disturbance are two common problems in stroke patient. They are
multifactorial, and can develop in different phase of stroke. Stroke itself and its treatment often stress the
patients significantly; fatigue and sleep disturbance may further impair patients’ quality of life. Since
increased distal (foot)-proximal (abdominal) skin temperature gradient (DPG) is a known predictor for
one’s “readiness” for sleep, and it is also associated with shorter sleep latency and better sleep
quality, we aimed to validate the safety of and explore the effect of warm-water footbath on fatigue, sleep
and quality of life in hospitalized post-stroke patients.
Methods: In our study, a quasi- experimental design was applied. The stroke subjects were recruited
from two rehabilitation wards in a regional hospital in northern Taiwan. A total of fifty-one subjects were in
the control group (under routine care) whereas fourty- one subjects were in the experimental group
(added warm water footbath). The warm water footbath with 41°Cwas lasted 15 minutes before bedtime
for 7 nights. The feet and legs of samples were immersed in a standardized footbath tank, with a depth of
10 cm above ankles. All subjects received structured questionnaires, such as: demographic data, Fatigue
Severity Scale, Verran and Snyder-Halpern Sleep Scale, and Stroke Impact Scale. Data were processed
by SPSS 18.0 for Windows.The major statistical procedures applied were frequencies and percentages,
independent t test, paired t-test, chi-square test,and repeated-measures ANOVA. A value of P < 0.05 was
considered statistically significant.
Results: In total, 92 subjects (experiment group=41, control group=51) were included in the study, all of
them completed the study. There was no adverse effect noted during the study period, and no significant
demographic differences noted between the experiment group and control group.
The results showed that:
1). Fatigue was common in both the experimental and control groups. However, the severity of fatigue
increased significantly in the control group whereas the severity of fatigue was decreased in the
experimental group.
2). Similar quality of sleep was found between control and experimental groups in the pretest. After the
implementation of footbath, samples in the experimental group reported better daily quality of sleep than
samples in the control group.
3). During research period, no significant changes in quality of life was reported by the control group. But
the experimental group showed a significant improvement in the “emotion” (p<.05), “ADL” (p<.05), and
“mobility” (p<.05) domains of quality of life.
Conclusion: In post-stroke patients receiving hospitalized rehabilitation, fatigue is not only common, but
could significantly worsen during the hospital stay. Significant improvement over fatigue, sleep and quality
of life were noted in the patients. Moreover, none of the subjects experienced burn injury, erythematous
change of the skin, pain or other adverse effect, either before, during or after the footbath treatment.

Warm water footbath is a relatively safe and effective modality for post-stroke hospitalized patients
receiving rehabilitation program, especially in improving the patient’s fatigue, sleep and certain domains
in quality of life; and its easiness to be applied by non-professional care giver and even the patients
themselves may further enhance the accessibility of post-stroke rehabilitation. Further study in a larger
cohort with longer study period is needed.
References
1. Bassetti, C. L. (2005). Sleep and stroke. Semin Neurol, 25(1), 19-32. 2. Baumann, C. R., Kilic, E., Petit, B., Werth,
E., Hermann, D. M., Tafti, M., et al. (2006). Sleep EEG changes after middle cerebral artery infarcts in mice: Different
effects of striatal and cortical lesions. Sleep, 29(10), 1339-1344. 3. Hermann, D. M., & Bassetti, C. L. (2003). Sleep
apnea and other sleep-wake disorders in stroke. Curr Treat Options Neurol, 5(3), 241-249. 4. Hsueh, I. P., Lee, M.
M., & Hsieh, C. L. (2001). Psychometric characteristics of the Barthel activities of daily living index in stroke patients.
J Formos Med Assoc, 100(8), 526-532. 5. Liao, W. C., Chiu, M. J., & Landis, C. A. (2008). A warm footbath before
bedtime and sleep in older Taiwanese with sleep disturbance. Res Nurs Health, 31(5), 514-528. 6. Liao, W. C.,
Landis, C. A., Lentz, M. J., & Chiu, M. J. (2005). Effect of foot bathing on distal-proximal skin temperature gradient in
elders. Int J Nurs Stud, 42(7), 717-722. 7. Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The Barthel
index. Md State Med J, 14, 61-65. 8. Mohsenin, V., & Valor, R. (1995). Sleep apnea in patients with hemispheric
stroke. Arch Phys Med Rehabil, 76(1), 71-76. 9. Sandberg, O., Franklin, K. A., Bucht, G., & Gustafson, Y. (2001).
Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke. J Am Geriatr Soc, 49(4), 391-397.
10. Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel index for stroke rehabilitation.
J Clin Epidemiol, 42(8), 703-709. 11. Snyder-Halpern, R., & Verran, J. A. (1987). Instrumentation to describe
subjective sleep characteristics in healthy subjects. Res Nurs Health, 10(3), 155-163. 12. Sung, E. J., & Tochihara, Y.
(2000). Effects of bathing and hot footbath on sleep in winter. J Physiol Anthropol Appl Human Sci, 19(1), 21-27.
Contact
[email protected]

Effects of Aromatherapy on Sleep Quality and Emotional Status of Hong Kong
Nursing Students Facing Final Examination: A Randomized Controlled Trail
Ricky W. K. Yuen, EdD, MN, MSocSc, BN, RN, Hong Kong
Margaret Mei Lin Pau, DN, MSc, MN, BN, RN, Hong Kong
Wing Yan Yeung, MPH, BNur, RN, Hong Kong
Purpose
The purpose of this presentation is to examine the effects of aromatherapy on the emotional status and
sleep quality of the nursing students in Hong Kong.
Target Audience
The target audience of this presentation is nurse educators, researchers and nursing students.
Abstract
Purpose: The purpose of the study is to examine the effects of aromatherapy on the emotional status
and sleep quality of the nursing students in Hong Kong facing final examination.
Methods: It was a single blind; two groups pretest-post-test randomized controlled trial study. Fifty five
students were being blinded and randomly allocated into 2 groups, the intervention group (Group A) and
the control group (Group B). All participants in Group A were given 42 drops of pure lavandula
augustifolia essential oil inside a 5 ml glass bottle with dropper. Group B would be filled up with 42 drops
of pure almond carrier oil in the same type of glass bottle.
Three weeks before the final examination, they were instructed to prepare two gauzes, in which one drop
of the oil added to each gauze, and one of them was placed on right side of the pillow and the other on
the left side before sleep. The gauze should be placed in a position that they could inhale the aroma. A
new piece of gauze with the given oil must be used every night.
Two instruments, Pittsburgh Sleep Quality Index (PSQI) and Depression, Anxiety, Stress Scale (DASS),
were adopted in this study to examine the emotional status and sleep quality of nursing students. PSQI is
used to examine the sleep quality and it is a 24-item questionnaire assessing the sleep quality and
disturbances over a one month time period. The psychometric property of PSQI was examined in other
studies and favorable results were documented with reliability coefficient (Cronbach’s alpha) 0.83;
sensitivity 89.6% and specificity of 86.5% in distinguishing good and poor sleepers (Buysee et al, 1988).
DASS is a 42-item self-report questionnaire grouped into three scales with four-point Likert scale. Scores
are calculated by summing up the scores for the relevant items. It yields acceptable reliability with alpha
values for the 14-item scales of depression is 0.91; anxiety 0.84 and stress 0.90 (Lovibond & Lovibond,
2004).
Participants were asked to complete two sets of questionnaires, PSQI and DASS, before the
commencement of the study as baseline and on the 21stday, ie. the day of final examination. The
collected data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22.
Descriptive statistics were used for mean and standard deviation., between baseline and the completion
of the programme; repeated measures ANCOVA were used to compare differences between two groups.
Results: Paired-t test was used to compare within outcome of groups and significant improvement in the
reduction of stress level (p=.001) and the reduction of anxiety level (p=.044) was found when compared
within the intervention group before and after aromatherapy. Apart from paired t-test, ANCOVA was also
used to compare the scores and similar results were obtained. Age and gender were identified as
covariates and there is a significant difference between the stress (F=(1,56)=12.167. p=.001) and anxiety
(F=(1,56)=4.326. p=.042) when compared within the intervention group before and after aromatherapy.
For the between group comparison, the subjective sleep quality, sleep disturbance and overall PSQI total
score were found significant improvement (p= <.001, .025 and .001 respectively). The anxiety and stress
level of intervention group were also improved significantly (p=<.001 and .001 respectively) when

compared with the control group. By using ANCOVA, gender and age as covariates, the significant
difference of the subjective sleep quality (F=(1,56)=7.652, p=.001), sleep disturbance (F=(1,56)=3.791,
p=.031), overall PSQI total score (F=(1,56)=5.283. p=.001), anxiety (F=(1,56)=9.718, p=.001)and stress
level (F=(1,56)=8.645, p=.001) between the intervention and control group still exists.
Conclusion: In conclusion, the findings of the current study suggested that lavender when exposed at
night for 21 nights before final examination was beneficial to nursing students and were able to lessen
their anxiety level, stress level and overall sleep quality.
References
Appleton, J. (2013). Lavender Oil for Anxiety and Depression. Natural Medicine Journal. Retrieved November 6, 2013
from http://www.naturalmedicinejournal.com/article_content.asp?article=289 Brewer, T. (2002). Test-taking anxiety
among nursing & general college students. Journal of Psychosocial Nursing and Mental Health Service, 40(11), 22–
29. Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. (1988). The Pittsburg Sleep Quality
Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213. Lewith G.T.,
Godfrey A.D., Prescott P. (2005). A single-blinded, randomized pilot study evaluating the aroma of lavendula
augustifolia as a treatment for mild insomnia. The Journal of Alternative and Complementary Medicine, 11(4): 631-
637. Lovibond, S.H.; Lovibond, P.F. (2004). Manual for the Depression Anxiety Stress Scales. Australia: University of
New South Wales. McCaffrey R., Thomas D.J., Kinzelman A.O. (2009). The effects of lavender and rosemary
essential oils on test-taking anxiety among graduate nursing students. Holistic Nursing Practice, 23(2):88-93.
Contact
[email protected]

Using Healing Touch to Help Junior Nursing Students with Their Anxiety
G. Jean Klein, PhD, PMHCNS, BC, USA
Melissa Krouse, USA
Katharine Lowe, BSN, RN, HTP, USA
Purpose
The purpose of this presentation to present the findings of a quasi-experimental investigation using
Healing Touch to lower junior nursing students anxiety.
Target Audience
The targets audience of this presentation are nurse educators and Healing Touch Practitioners.
Abstract
Purpose: The purpose of this study was to investigate if a Healing Touch session could lower junior
nursing students anxiety.
Students frequently discuss their anxieties with their professors. They worry about being successful in the
academic environment. Test anxiety is a major concern for many students, and more so for students who
are continually evaluated for progression in a program, such as nursing. Students are aware of their
anxiety, and the consequences of that anxiety. They look for strategies to help them deal with their
anxiety so that they may gain control over situations.
Additionally, junior nursing students often have difficulty making the transition from theory laden courses
to courses where they are required to apply previously learned information, such as the clinical nursing
courses. They report feeling anxious applying this information when they are tested and/or are when they
are in the clinical experience. The anxiety experienced by the junior nursing students may be preventing
them from being successful in objective testing, which may prevent them from progressing in the nursing
program.
Healing Touch is a non-invasive bio-field relaxation therapy that is an energy based approach to healing
and health. It uses touch to influence the human engery system, specifically the energy that surrounds
the body, and the energy flow from the fields to the physical body. Healing Touch is a biofield (magnetic
field around the body) therapy that is an energy-based approach to health and healing. The goal of
Healing Touch (HT) is to restore balance in clients’ energy field, therefore allowing them to self-heal. HT
uses noninvasive techniques using the hand and gentle touch to clear, energize, and balance the human
and environmental energy fields affecting physical, emotional, mental and spiritual health to facilitate
healing. Several studies have been done to identify if HT helps facilitate healing and decrease anxiety in
various illnesses. Although there is research on HT, there is no research on the effects of HT on anxiety
levels in nursing students. The purpose of this study is to determine if a Healing Touch session will lower
junior nursing students' anxiety.
Methods: A convenient sample of 88 junior nursing students consented to participate in this quasi-
experimental research study. Because of student & Healing touch pratictitioner availability, 37 junior
nursing students received the Healing Touch session. Prior to the session, the students responded to
Spielberger’s State Trait Anxiety Inventory (STAI). The State Trait Anxiety Inventory (STAI) is a valid and
reliable measurement of anxiety used in numerous research studies. The Healing Touch session was
performed by a certified Healing Touch practitioner, who happened to be a registered nurse. The Healing
Touch session lasted approximately 50 minutes. After the session, the students were given a second
copy of the STAI. They were asked to fill it out between 3 and 7 days after the Healing Touch session,
and to return it to the primary investigator. Thirty three of 37 students returned the second STAI to the
primary investigator.
Results: Descriptive statistics on the total scores reviewed the students’ pre state anxiety scores ranged
from 33-57 and their post state anxiety scores ranged from 36-79. When a paired t-test was computed on
the state anxiety scores, a statistically significant increase (mean = 2.79, p =.001) was found between the

pre & posttest scores. The students’ pre trait anxiety scores ranged from 26-63 and their post trait
anxiety scores ranged from 26-55. When a paired t-test was computed on the trait anxiety scores, a
statistically significant decrease (mean = -3.41, p = .001) was found between the pre & posttest trait
anxiety scores.
Conclusions: The statistically significant increase in state anxiety scores may be attributed to a variety of
issues including: clinical experiences, testing in courses perceived as difficult, or circumstances not
identified such as personal challenges. The statistically significant reduction in the trait anxiety scores
may be attributed to the effects of the Healing Touch session. Limitations include a convenient sample of
junior nursing students from one university was studied. Due to student & Healing Touch practitioner
availability, only 37 students received the Healing Touch session and only 33 students returned the
complted second STAI form to the primary investigator. Although statistically significant findings occurred,
more research in this area is warranted.
References
Anderson, J. G., & Taylor, A. G. (2011). Effects of healing touch in clinical practice. A systematic review of
randomized clinical trails. Journal of Holistic Nursing, 29(3), 221-228. Ratanasiripong, P., Sverduk, K., Hayashino, D.,
& Prince, J. (2010). Setting up the next generation biofeedback program for stress and anxiety management for
college students. A simple and cost effective approach. College Student Journal, 44(1), 97-100.
Contact
[email protected]

H 10 - Perceptions: Variations from Patients to Staff
Knowledge, Attitudes, and Perceptions of Preeclampsia Among First-Generation
Nigerian Women in the United States
Christine Okpomeshine, PhD, RN, WHNP, USA
Purpose
remedy the misinformation acquired from mothers, grandmothers, aunts, and mothers-in-law, of first-
generation Nigerian women living in the United States of preeclampsia thus improving the educational
standard among any group of women with ancestral beliefs and may influence their decisions to seek
early prenatal care in their next pregnancy.
Target Audience
to educate healthcare providers and the public about the cultural beliefs, attitudes, and perceptions of
preeclampsia among women of different ethnic group in the United States; and women to better
understand how to make positive healthcare decisions, without allowing cultural beliefs, attitudes, and
perceptions to influence prospective choices.
Abstract
Purpose: Although numerous studies have documented the need for early recognition and treatment of
preeclampsia to attain a good prognosis, first-generation Nigerian women living in the United States tend
to seek obstetrical care after the first trimester (12 weeks), by which time prompt recognition may be
missed. The purpose of this study was to measure the knowledge, attitudes, and perceptions about
preeclampsia and limitations that determine the delay in seeking obstetrical treatment in early pregnancy
among first-generation Nigerian women living in the United States.
Methods: This cross-sectional quantitative study consisted of 180 first-generation Nigerian women in the
United States recalling their experiences of being diagnosed with preeclampsia and experiencing
preeclampsia. The health-belief model served as the conceptual framework to predict the health
behaviors of first-generation Nigerian women regarding their experiences in early recognition of signs and
symptoms of preeclampsia. Data were collected through an online survey and analyzed using binary and
ordinal logistic regression.
Results: The results indicated no statistical significance relation between knowledge, attitudes and
perceptions of preeclampsia and demographic characteristics, socioeconomic status, acculturation, and
access to healthcare.
Conclusion: Despite the non significance, these findings will help women better understand how to make
positive health decisions and support the efforts of public health departments to produce and distribute a
booklet on preeclampsia to all healthcare providers regarding the importance of early detection. This
study contributes to positive social change by bringing awareness of preeclampsia, risk factors, and the
need for early recognition and prompt treatment to first-generation Nigerian women living in the United
States.
References
Bonney, E. A. (2007). Preeclampsia: A view through the danger model. Journal of Reproductive Immunology, 76, 68–
74. doi:org/10.1016/j.jri.2007.03.006 Brichant, G., Dewandre, P. Y., Foidart, J. M., & Brichant, J. F. (2010).
Management of severe preeclampsia. Acta Clinica Belgica, 65(3), 163–169. Bridges, E. J., Womble, S., Wallace, M.,
& McCartney, J. (2003). Hemodynamic monitoring in high-risk obstetrics patients, II: Pregnancy-induced hypertension
and preeclampsia. Critical Care Nurse, 23(5), 52–57.
Contact
[email protected]

Understanding Hospital Staff Needs and Perceptions in the Provision of Palliative
Care
Gail Ross-Adjie, RN, PhD, Australia
Purpose
The purpose of this presentation is to discuss study findings which sought to investigate staff perceptions
and experiences of palliative care in an acute hospital environment.
Target Audience
The target audience of this presentation is all hospital clinical staff who will, at some time provide
palliative or end of life care in an acute hospital setting.
Abstract
Purpose: The primary aim of this study was to investigate hospital staff perspectives and experiences
regarding palliative care provision. Secondary aims were to assess staff views about death and dying,
their awareness of common causes of death in Australia and their assessment of which patients most
warrant a palliative care approach.
Methods: All medical, nursing, allied health and pastoral care staff working in a large private hospital in
Perth, Western Australia were invited to complete a combined quantitative and qualitative survey. The
validated survey tool, previously used in other healthcare settings, used a combination of Likert-type
scales and open ended questions. Descriptive statistics and intergroup comparisons were made for all
quantifiable variables, while formal content analysis was used for text responses. In addition, four focus
groups were held across different hospital areas allowing for more detailed discussion of the provision of
palliative care.
Results: We had a pleasing 51% response rate (N = 302) with most staff reporting only working
knowledge of palliative care but clinical proficiency in symptom control. Confidence in palliative care
provision was lower amongst nursing than medical staff but educational needs were similar. Cancer
diagnoses were consistently overestimated, and dementia and chronic obstructive pulmonary disease
underestimated, as the most common causes of death.
Conclusion: Our study suggests that although clinical staff expressed confidence regarding symptom
management in palliative care, they lacked understanding of the patients in whom a palliative approach
could be applied and sought further education in areas such as end-of-life communication and ethical
issues. Specific training and clinical interventions in palliative care provision would seem to be needed
and justified.
References
1. World Health Organisation. WHO Definition of Palliative Care 2006 [14th January]; Available from:
http://www.who.int/cancer/palliative/definition/en/. 2. Stefanou N and Faircloth S. Exploring the concept of quality care
for the person who is dying. British Journal of Community Nursing. 2010; 15: 588-93. 3. NHS Education for Scotland.
An evolving process. Snapshots of palliative and end of life care in acute care settings in Scotland. Scotland: 2011. 4.
Disler R and Jones A. District nurse role in end-stage COPD: a review. British Journal of Community Nursing. 2010;
15: 428 - 33. 5. Palliative Care Australia. Standards for Providing Quality Palliative Care for all Australians. Canberra
2005. 6. Lorenz K, Lynn J, Shugarman L, et al. Evidence for Improving Palliative Care at the End of Life: A systemic
Review. Annals of Internal Medicine. 2008; 148: 147-59. 7. Aoun S, Monterosso L, Kristjanson L and McConigley R.
Measuring Symptom Distress in Palliative Care: Psychometric Properties of the Symptom Assessment Scale (SAS).
Journal of Palliative Medicine. 2011; 14: 315-21. 8. Lewin G, Haslehurst P and Smith J. Symptom pathways from
referral to death: measuring palliative care outcomes. International Journal of Palliative Nursing. 2008; 14: 58-64. 9.
Abrahm J. Promoting symptom control in palliative care. Seminars in Oncology Nursing. 1998; 14: 95-109. 10.
Aspinal F, Addington-Hall J, Hughes R and Higginson I. Using satisfaction to measure the quality of palliative care: a
review of the literature. Journal of Advanced Nursing. 2003; 42: 324-39. 11. Lorenz K and Lynn J. End-of-Life Care
and Outcomes. California: Southern California Evidence-Based Practice Center, 2004 Contract No.: Number 110. 12.
Ersek M, Kraybill B and Hansberry J. Assessing the educational needs and concerns of nursing home staff regarding

end-of-life care. Journal of Gerontological Nursing. 2000; 26: 16-26. 13. Llamas K, Llamas M, Pickhaver A and Piller
N. Provider perspectives on palliative care needs at a major teaching hospital. Palliative Medicine. 2001; 15: 461-70.
14. Selman L, Harding R, Beynon T, et al. Improving end-of-life care for patients with chronic heart failure: Let's hope
it'll get better, when I know in my heart of hearts it won't". Heart. 2007; 93: 963-7. 15. Gysels M and Higginson I.
Access to Services for Patients with Chronic Obstructive Pulmonary Disease: The Invisibility of Breathlessness.
Journal of Pain and Symptom Management. 2008; 36: 451-60. 16. Palliative Care Australia. Facts about morphine
and other opioid medicines in palliative care. Canberra 2006. 17. McIlfatrick S. Assessing palliative care needs: views
of patients, informal carers and healthcare professionals. Journal of Advanced Nursing. 2006; 57: 77-86. 18. Green
E, Gardiner C, Gott M and Ingleton C. Exploring the Extent of Communication surrounding Transitions to Palliative
Care in Heart Failure: The perspectives of health care professionals. Journal of Palliative Care. 2011; 27: 107-16. 19.
Gott M, Ahmedzai S and Wood C. How many inpatients at an acute hospital have palliative care needs? Comparing
the perspectives of medical and nursing staff. Palliative Medicine. 2001; 15: 451-60. 20. Ho L, Engelberg R, Curtis R,
et al. Comparing clinician ratings of the quality of palliative care in the intensive care unit. Critical Care Medicine.
2011; 39: 975-83. 21. Spence A, Hasson F, Waldron M, et al. Professionals delivering palliative care to people with
COPD: qualitative study. Palliative Medicine. 2009; 23: 126-31. 22. Addington-Hall J and Karlsen S. A national survey
of health professionals and volunteers working in voluntary hospice services in the UK. Attitudes to current issues
affecting hospices and palliative care. Palliative Medicine. 2005; 19: 40-8. 23. Lukin W, Douglas C and O'Connor A.
Palliative care in the emergency department: An oxymoron or just good medicine? Emergency Medicine Australasia.
2012; 24: 102-4. 24. Todd K. Practically speaking: Emergency medicine and the palliative care movement.
Emergency Medicine Australasia. 2012; 24: 4-6. 25. Burt J, Shipman C, White P and Addington-Hall J. Roles, service
knowledge and priorities in the provision of palliative care: a postal survey of London GPs. Palliative Medicine. 2006;
20: 487-92. 26. An evolving process. Snapshot of palliative and end of life care in acute care settings in Scotland.
Scotland: NHS Education for Scotland, 2011. 27. Marx T. Partnering With Hospice to Improve Pain Management in
the Nursing Home Setting. JAOA Supplement. 2005; 105: S22-S6. 28. Wotton K, Borbasi S and Redden M. When All
Else Has Failed Nurses' Perception of Factors Influencing Palliative Care for Patients With End-Stage Heart Failure.
Journal of Cardiovascular Nursing. 2005; 20: 18-25. 29. Tolhurst H, Baker L, Murray G, Bell P, Sutton A and Dean S.
Rural General Practitioner experience of work-related violence in Australia. Australian Journal of Rural Health. 2003;
11: 231-6. 30. Kingston M, Evans S, Smith B and Berry J. Attitudes of doctors and nurses towards incident reporting:
a qualitative analysis. Medical Journal of Australia. 2004; 181: 36-9. 31. Powell R and Single H. Methodology Matters
V Focus Groups. International Journal for Quality in Health Care. 1996; 8: 499-504.
Contact
[email protected]

Who Are the Family Caregivers?: Epidemiologic Research
Maria Joana Campos, RN, MScN, Portugal
Abel Paiva Silva, PhD, MScN, RN, Portugal
Purpose
Characterize families with dependent people and Describe the intensity and regularity of care provided by
families towards the quality of care.
Target Audience
nurses, researchers and educators
Abstract
Background: Nowadays, many numbers of family members assume a great responsibility for taking care
of a dependent person at home.
Taking care of a dependent person is not an easy task; it involves a new kind of skills and knowledge to
be prepared for this new role.
Oliveira and Colleagues (2011) comparing patients with readmissions in hospital settings, and found less
acute diseases (19.8%) and ontological diseases (5.5%), but more infections (44.0%) and exacerbation of
chronic diseases (25.3%). These kinds of health problems may be associated with family caregiving skills
or lack of preparedness to caregiver role.
So, we need to know more about it to provide professional care for family caregivers.
Caregivers dispend a lot of time on care, which has implications in its own health and dependent person´s
health (Campos, 2008).
Purpose: So, we proposed a study with the main objective:
• Characterize families with dependent people: income, household, the attributes of de person with
dependence and the attributes of caregiver.
• Describe the intensity and regularity of care providing by family caregivers and the perceptions of
self-efficacy in role acquisition
Methods: Quantitative research was used. We use an epidemiological study using a random sample. We
used the formula published by WHO (Lwanga e Lemeshow, 1991) (n = Z2 p (1-p) /d) for these kind of
studies.
Our sample is 2351 classic families. We have used a Geographical Database Referencing Information,
which allows knowing the geographic distribution of households, and geographically stratified random
selection of sub-regional accomplished through a system Geographic Information, using Arcgis®.
The data were collect by a form. Data were analyzed using the Statistical Package for Social Sciences -
SPSS (version 18.0, SPSS Inc, Chicago, USA).
Results: Of these 2351 households, 1745 (74.22 %) had someone at the time of data collection opened
the door, but 143 (8.2%) refused to answer the preliminary inquiry. We have identified 121 dependent
people at home, 100 have one family caregiver and 20 have more than one.
Regarding the primary family caregiver, they are mostly women (81 % , n = 81 ) , the age ranges are from
18 to 83 years , with an average 59.51 ( SD = 13.66 ) . The findings shows us that 70.2 % (n = 66) of the
caregivers feels very competent, 19.1% (n = 18) moderately competent, 9.6 % (n = 9) competent and (n =
1) incompetent in relation of perception of self-efficacy.
Conclusion: In the context of home care and with regard to family caregivers , although the perception of
self-efficacy does not refer to the skills that people have , but the idea they have about what they can do (

Bandura , 1986; Le Boterf 2003 ) , this may be a predictor of behaviour. However, to realize the
competence of caregivers, other variables will have to enter the equation.
Must be developed a full range of services, including home care for support family caregivers in is needs
and prepare for new role.
References
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ:
Prentice-Hall, Inc.. CAMPOS, MJ (2008) - A integração na família de uma pessoa dependente no auto-cuidado –
impacte da acção do enfermeiro no processo de transição. Dissertação de mestrado apresentada ao Instituto de
Ciências da Saúde da Universidade Católica do Porto. Le Boterf, G. (2003). Desenvolvendo a competência dos
profissionais. 3ª ed. Porto Alegre: Artmed. LWANGA, S.K.; LEMESHOW, S. (1991) - Sample size determination in
health studies: a practical manual. Geneva, World Health Organization. MELEIS, A.; SAWYER, L.; IM, E.; MESSIAS,
D.; SCHUMACHER, K. (2000) – Experiencing Transitions: An Emerging Middle-Rang Theory. Advanced Nursing
Science; 23(3), 12-28: NAING, L.; WINN, T.; RUSLLI, B. (2006) – Pratical Issues in Calculating the Sample Size for
Prevalence Studies. Medical Statistics. Archieves of Orofacial Sciences; 1:9-14. Oliveira,M. Campos,M., Padilha,J.
Pereira,F. & Sousa, P. (February 2011). Exploring the family caregiving phenomenon in nursing documentation.
Online Journal of Nursing Informatics (OJNI), 15(1), Available at http://ojni.org/issues/?p=137 Aspen Publishers, Inc
Contact
[email protected]

I 03 - Global Cuturally Diverse Pediatric Concerns
Systematic Evaluation of the Psychometric Properties of Pain Assessment Scales
for Use in Chinese Children: Where Are We?
Jinbing Bai, PhD(c), MSN, RN, USA
Nan Jiang, MSN, RN, China
Purpose
The purpose of this presentation is to discuss the psychometric properties and feasibilities of pain
assessment scales for use in Chinese children
Target Audience
The target audience of this presentation is clinical nurses and pain-related researchers, as well as nurse
managers who are interested in children's pain management.
Abstract
Purpose: Many children experience moderate to severe pain during hospitalization. Systematic pain
assessment using reliable and valid pain scales is the foundation for adequate pain management in
children. The psychometric properties of pain measures used with children in China are still largely
unknown relative to their properties when used in children in Western countries. The purpose of this study
was to systematically evaluate the psychometric properties of pain assessment scales used in Chinese
children.
Methods: We searched Chinese-language databases (e.g., CNKI, Wanfang, VIP and SinoMed) and
English-language databases (e.g., PubMed, CINAHL, Health and Psychosocial Instruments and
PsycINFO) from its inception to December 2013. Studies were eligible for inclusion if the psychometric
properties of pain measures were examined in Chinese children (aged 0-18 years). Two independent
bilingual reviewers screened search results based on title, abstract and full article for eligibility. Both
reviewers used an 11-item coding system developed by Zwakhalen et al. (2006) to evaluate the
psychometric properties of pain scales in the eligible studies. Total scores (range 0-20) of this coding
system were categorized into four levels: very good (15-20), good (12-14.9), acceptable (10-11.9), and
unacceptable (< 10).
Results: Our initial literature search identified 352 and 434 potential articles from Chinese-language and
English-language databases. According to the inclusion criteria, a total of six studies were identified in
this review. Six pain scales were evaluated: the Face, Legs, Activity, Cry, and Consolability (FLACC)
Scale, COMFORT-Behavior Scale, Asian Oucher Scale, Pain Observation Scale for Young Children,
Neonatal Facial Coding System and Pain Assessment Scale for Preterm Infants. Four of these scales
were adapted from Western countries and two were developed in Taiwan. These identified scales were
mostly examined in children undergoing invasive painful procedures pain after surgery. Results showed
that the FLACC, COMFORT-Behavior Scale, and Pain Assessment Scale for Preterm Infants had very
good psychometric qualities when administered in Chinese children, with a total score of 18.2, 16.4, and
17.3, respectively. The Asian Oucher Scale and Pain Observation Scale for Young Children showed
acceptable to good psychometric qualities, with a total score of 14.6 and 11.8. The Neonatal Facial
Coding System had unacceptable psychometric qualities, with a total score of 7.3.
Conclusion: Pain measures whose psychometric properties were examined had acceptable to good
psychometric properties for pain assessment in Chinese children, even though few had been validated in
Chinese children. The development and validation of pain assessment scales for Chinese children is still
far behind the Western countries (Bai 2013; Sun et al., 2013a, 2013b), indicating that there is still a big
gap of pain assessment in Chinese children compared with the international standards. Future studies
should validate these measures and self-report pain scales in particular among Chinese children of
various age groups and in different pain situations.
References

Bai J. (2013). Why is the validation of children’s pain scales in China far behind the Western countries? Pain, in
press, doi: 10.1016/j.pain.2013.08.008; Sun, R., Zhao, W.Y., Hao, Q.S., Zhang, H.J., Tian, H.L., Tian, J.H., Yang,
K.H. (2013a). Frequency and use of pain assessment scales in Chinese clinical trials in pediatric population. Chinese
Journal of Evidence-Based Pediatrics, 8(3): 186-191 (in Chinese); Sun, R., Zhao, W.Y., Tian, H.L., Zhang, H.J., Xiao,
X., Tian, J.H., & Yang, K.H. (2013b). Standardized translation and posttranslation validation of pain scales are
needed: What Chinese studies tell us. Pain, in press, doi: 10.1016/j.pain.2013.04.034; Zwakhalen, S.M., Hamers,
J.P., Abu-Saad, H.H., & Berger, M.P. (2006). Pain in elderly people with severe dementia: a systematic review of
behavioural pain assessment tools. BMC Geriatrics, 6(3): 1-15.
Contact
[email protected]

I 03 - Global Cuturally Diverse Pediatric Concerns
The Experience of Dysmenorrhea and Its Related Self-Care Behaviors Among
Adolescent Girls
Cho Lee Wong, RN, MSc (HlthCr), Hong Kong
Wan Yim Ip, RN, RM, BN, MPhil, PhD, China
Lai Wah Lam, RN, BN, MPhil, PhD, Hong Kong
Purpose
The purpose of this presentation is to explore the experience and self-care behaviors among adolescent
girls with dysmenorrhea in Hong Kong
Target Audience
The target audience of this presentation is school nurses or nurses work with adolescents
Abstract
Purpose: To explore the experience and self-care behaviors among adolescent girls with dysmenorrhea
in Hong Kong.
Methods: This study had two phases – a survey in phase I and semi-structured interviews in phase II.
This abstract presents phase II of the study. Based on the phase I results, purposive sampling was
employed to recruit 24 adolescent girls with very high and very low levels of self-care behaviors using the
Adolescent Dysmenorrhic Self-Care Scale. Semi-structured interviews were conducted with the help of an
interview guideline to understand adolescent girls’ experience of dysmenorrhea and their self-care
behaviors towards dysmenorrhea. All interviews were tape-recorded. Interview data were transcribed and
analyzed using qualitative content analysis.
Results: Four categories were emerged: perceptions of dysmenorrhea, impact of dysmenorrhea,
managing dysmenorrhea, and educational needs. The findings revealed that adolescent girls perceived
dysmenorrhea as pain but normal. They experienced inability to concentrate on studies and change of
family relationship during the painful days. Girls preferred to manage dysmenorrhea by lifestyle changes,
seeking advice and endurance. Besides, girls also expressed their educational needs for dysmenorrhea
self-care.
Conclusion: Understanding self-care behaviors towards dysmenorrhea from adolescent girls’
perspectives was important, as it could assist nurses in the development of culturally sensitive
intervention to promote self-care behaviors of adolescent girls with dysmenorrhea.
Contact
[email protected]

I 04 - Diabetic Management and Health Promotion
The Influence of the Social Determinants of Health on Diabetes Self-Management
in Rural Appalachia
Myra Leslie Clark, PhD, RN, NP-C, USA
Purpose
The purpose of this descriptive phenomenological study was to explore the influence of the social
determinants of health as they relate to diabetes self-management in rural Southern Appalachia.
Target Audience
The target audience of this presentation are researchers and public health professionals who work with
rural uninsured individuals diagnosed with type 2 diabetes.
Abstract
Purpose: Diabetes, a worldwide public health concern, has been linked with lower socioeconomic status,
obesity, poor nutrition, membership in certain racial and / or ethnic groups, and family history of diabetes
– factors often present in both urban and rural regions. Researchers are finding that greater knowledge of
the relationship between social determinants of health and diabetes may provide insight into individuals’
health outcomes related to diabetes. The purpose of this descriptive phenomenological study was to
explore the social determinants of health as they relate to diabetes self-management in a rural United
States population.
Methods: This qualitative analysis is part of a study to gain insight into the individual’s perspective on
living with diabetes given the social determinants of her/his situation. Recruitment of 10 adults was
accomplished through key community contacts, local physicians, and posted flyers. Participants were
both male (n=6) and female (n=4), on average 46.5 years of age, and had been diagnosed with diabetes
for about 11 months (range 2-18 months). For purposes of this study, qualitative data were collected from
digitally-recorded sessions and then analyzed using constant comparison and procedures to avoid bias.
Identified themes were extracted to provide insight into individuals’ perspectives of living with diabetes.
Results: Data analysis revealed three major themes related to the influence of the social determinants of
health on the individual’s perspective on living with diabetes: (1) importance of work; 2) importance of
social connectivity/support; and (3) importance of family and sense of place in self-definition.
Conclusion: Diabetes is a nationwide public health concern in the United States; however, individuals in
rural communities often face unique barriers or challenges. Results of this qualitative study offer
healthcare providers helpful insight about facilitators and barriers to living with diabetes among a sample
of rural residents from Southern Appalachia, United States. Findings illustrate the influence of external or
upstream social determinants on the individual’s health. Further research to determine the influence of
social determinants on diabetes self-management will help to improve individuals’ health outcomes.
Contact
[email protected]

I 04 - Diabetic Management and Health Promotion
Effectiveness of Community-Based Multifaceted Intervention (STOP-DM)
Designed for Korean-Americans with Type 2 DM
Miyong T. Kim, RN, PhD, FAAN, USA
Hae-Ra Han, PhD, RN, USA
Kim B. Kim, PhD, USA
Purpose
The purpose of this presentation is to report the clinical outcomes of a randomized clinical trial to test the
effectiveness of a community based, multifaceted intervention that designed to meet cultural and social
needs of Korean Americans with type 2 Diabetes mellitus (DM).
Target Audience
The target audience of this presentation are clinicians and researchers who are seeking methodological
insights in developing effective, culturally sensitive diabetes management programs for socially and/or
linguistically isolated minority groups in the US or patients residing communities with limited resources
across the world.
Abstract
Purpose: The primary objective of this translational study was to conduct an effectiveness trial of a
community-based glucose control intervention program for Korean American immigrants (KAI) with type-2
DM. The self-help intervention program for Korean Americans (SHIP-DM) focuses on the self-help aspect
of DM control by empowering patients through enhanced knowledge of DM and diet, utilizing available
technology to develop the ability to self –monitor their glucose control status, facilitating better
communication with their health care providers, and enhancing health literacy and general problem-
solving skills. Background: Type 2 diabetes mellitus (DM) is a serious health problem in Asian-American
communities, including the Korean American immigrant (KAI) community. KAI, one of the most
underserved and understudied minority populations in the US, are at particularly high risk of developing
type 2DM, a problem that is compounded by the fact that Asians who have emigrated to the West tend to
gain weight after immigration. Our previous community research experience has indicated that an
overwhelming number of KAI suffer not only from uncontrolled DM but also from a loss of self-confidence
and social isolation stemming from language and cultural barriers. Like other immigrant ethnic minorities,
they often have limited access to health care and information. Also, more than 50% of KAI have no
health insurance and rarely receive routine checkups. As a result, KAI with asymptomatic chronic
diseases, such as DM, go undiagnosed and inadequately treated. These health risks are further
compounded by low health literacy levels: 90% of first-generation KAI adults are monolingual (Korean
only), and more than 70% report having trouble understanding medical terminology, even when using
materials that have been translated into Korean. These factors lead to high rates of undetected,
undertreated, or poorly managed chronic illnesses, often with costly and tragic consequences. KAIs with
type 2 DM urgently need effective interventions that help them achieve better glycemic control and
restore their self-confidence with regard to diabetic management. To address this critical need within the
KAI community, we designed a community-based clinical trial to test the effectiveness of a multifaceted
DM management program (STOP-DM) that was designed to address the cultural and social needs of KAI
with type 2 DM.
Methods: Using a community-based randomized control design with delayed intervention, we have
recruited and enrolled 250 KAI (130 in intervention group, 120 in control group) with following eligibility
criteria: (a) Age between 35 and 80; (b) having the type 2 DM, (c) being able to read Korean; (d) being at
high risk of DM as measured by hemoglobin A1c at 7.0 or above; and (e) being able to stay in the
program for at least a year. By providing our intervention to every participant (with different timeframes),
we can be sensitive to the community’s reasonable concern: not to use vulnerable immigrants with limited
resources as research subjects without giving them any direct benefit. The 3 interventions were 6 week-
long education on DM management focusing on comprehensive self-care skills including health literacy,

followed by telephone counseling and home glucose monitoring for 12 months. Main outcomes were
measured at baseline, 3, 6, 9, 12 months.
Results: Among 250 enrolled, 209 (mean age, 58.9 ± 8.4 years) completed the 12 month–long follow-up
data collection; 105 in the intervention and 104 in the control group. The majority of these participants
were married (89%); the average length of stay in US was 23 years, and the majority had at least high
school education at their home land. The average monthly income was $4,269 and 52% did not have any
access to health care.
Evaluation of the primary end point, the level of HgA1c reveled significant between differences at each
measurement point. (Table 1).
GroupPeriod Baseline Month 3 Month 6 Month 9 Month 12
Intervention (A) 8.9 (1.95) 7.9 (1.50) 7.7 (1.44) 7.7 (1.46) 7.6 (1.17)
Usual Care (B) 8.7 (1.58) 8.4 (1.55) 8.3 (1.49) 8.2 (1.48) 8.1 (1.41)
Diff (A-B) 0.2 -0.5 -0.6 -0.5 -0.5
Prob(A-B) ≠ 0 0.31 0.01 0.00 0.02 0.01
Significant changes were observed over time in some psycho-behavioral outcomes, including self-efficacy
for DM control, medication adherence behavior, DM related health literacy, diet pattern (p < 0.05). In
addition, the intervention and control group showed a significant difference in DM knowledge and the
level of depression.
Conclusion: The study findings highlighted the importance of placing systematic efforts to developing
tailored intervention to address the unique need of a target cultural group. While the methodological
discussion regarding the effectiveness of the intervention of this kind is limited, especially in ethnic
minority groups, we strongly believe that the systematic strategies and methodologies we used in this
study are transferrable to other underserved communities. More importantly, lessons learned from our
community-based trial using CBPR principles and community partners will be shared in the context of
addressing the sustainability issue of this kind of program.
References
1. Kim MT, Han HR, Song H, Lee JE, Kim J, Ryu JP, Kim KB. (2009). A community-based, culturally tailored
behavioral intervention for Korean Americans with diabetes. Diabetes Educator, 35(6), 986-994. 2.Song HJ, Han HR,
Lee JE, Kim J, Kim KB, Nguyen T, Kim MT (2010). Translating Current Dietary Guidelines into a Culturally Tailored
Nutrition Education Program for Korean American Immigrants with Type 2 Diabetes. Diabetes Educ. 36(5), 752-761.
PMID:205651099 1. Kim HR,Song HJ, Han HR, Kim BK, Kim MT. (2012). Translation and validation of the Dietary
Approaches to Stop Hypertension for Koreans (K-DASH) intervention: Culturally tailored dietary guidelines for Korean
Americans with high blood pressure. Journal of Cardiovascular Nursing [ Epub ahead of print] PMID : 22964589
Contact
[email protected]

I 05 - Cultural and Language Barriers in Nursing
Navigating Cultural Waters: Experience of Western Patients Being Cared for by
Chinese Nurses in Beijing
Chanell Jan C. Concepcion, PhD, RN, China
Purpose
The purpose of the presentation explored the patients’ experience of being cared for by nurses who are
culturally different from their own. This research presents Western patients’ experience of care by
Chinese nurses in China. It provides insight into knowing persons in caring in the midst of cultural
diversity.
Target Audience
The target audience of this presentation is nurses in the clinical setting and nurse educators who
encounter cultural diversity in nursing care settings. Nurses interested in Caring in Nursing and
Transcultural nursing would also benefit from this session.
Abstract
Purpose: There is a paucity of studies that examine the nursing care received by patients who are
considered ‘foreigners’ or are non-native to the country where they receive care. As China emerges as a
major player in world economy, there is also a rise in the number of foreigners visiting and living in the
country in the past decade. In the 2010 census, there are over one million foreign and non-mainland
Chinese nationals living in China. About a quarter (23%) is from Western countries such as the United
States, Canada, Australia and European countries such as France and Germany. This study aimed to
explore the lived experience of patients from Western that were being cared for by Chinese nurses in
Beijing, China. It specifically aims to look into the patients’ experiences related to culture and care
expectations.
Methods: Face-to-face interviews were conducted among 10 patients from countries considered to be
“Western” (i.e. United States, Canada, and Europe). These participants were inpatients at an
international-standard hospital in Beijing, China who has experienced being cared for by Chinese nurses
for at least 3 days. Interviews were done in the English language and audio recordings were made and
transcribed thereafter. The findings were analyzed and interpreted according to the philosophical
framework congruent with hermeneutic phenomenology, particularly Van Manen’s phenomenological
approach and Munhall’s (Munhall, 2012) stepwise approach as guide for the methodology of the study.
Results: Four primary themes emerged from the data pointing towards cultural diversity: navigating
cultural differences, negotiating care expectations, pain management expectations and knowing persons
through caring (Locsin, 2010, Boykin, & Schoenhofer, 2001).
Conclusion: The participants described how they find themselves navigating through cultural difference
and negotiate their care expectations, including management of pain. As individuals who are experiencing
health issues while away from their home countries, the Western patients have fears and uncertainties,
which later turned to trust and confidence as they are being cared for by the Chinese nurses. In the
process of caring, both nurse and patient celebrated their humanness by knowing persons in caring.
Caring is created as an expression of the wholeness of persons and not just arising from a deficit or
culture-related problem.
The study has potential to transform nursing practice within a sensitivity that is grounded in caring
implicating disciplinary, professional, and practice perspective in settings such as Beijing, China.
Implications of this study are incorporated in nursing training program in the study setting. The findings
also provide implications for nursing research and education.
References
Munhall, P.L. (2012). Nursing research: A qualitative perspective (5th ed.). Sudbury, MA: Jones & Bartlett Learning.
Locsin, R. (2010). Rozzano Locsin’s Technological Competency as Caring and the Practice of Knowing Persons in

Nursing. In M. E. Parker & M. C. Smith (Eds.).Nursing theories & nursing practice (3rded.) (pp. 372-471).
Philadelphia, PA: F.A. Davis. Boykin, A., & Schoenhofer, S. O. (2001b). Nursing as caring: A model for transforming
practice. Sadbury, MA: Jones and Bartlett Publishers and National League of Nurses.
Contact
[email protected]

I 06 - Clinically Relevant Global Nursing Education
Are Nurses Prepared for a Radiological Disaster?: Assessing the Knowledge of
Nursing Students to Support the Need of Integrating Radiological/Disaster
Content into Nursing Curricula
Cary Brown, MSN, BSN, RN, USA
Purpose
The purpose of this presentation is to provide further evidence of the need for integrating radiological
disaster preparedness content into nursing education curricula by assessing current knowledge of
radiological emergency preparedness among licensed and pre-licensed nursing students using the
Emergency Preparedness Information Questionnaire (EPIQ) survey revised for radiological emergencies
(R-EPIQ).
Target Audience
The target audience of this presentation is international nursing education faculty.
Abstract
Purpose: The purpose of this project is to provide further evidence of the need for integrating radiological
disaster preparedness content into nursing education curricula by assessing current knowledge of
radiological emergency preparedness among licensed and pre-licensed nursing students using the
Emergency Preparedness Information Questionnaire (EPIQ) survey revised for radiological emergencies
Methods: Undergraduate licensed and pre-licensed nursing students attending the University of West
Florida completed the survey (N=60). Pre-licensed students received a radiation instructional intervention
and completed the survey post-intervention.
Results: Nursing students have a low level of self-reported knowledge of radiological emergency
preparedness. Pre-licensed students had a greater awareness of preparedness for a radiological disaster
after the intervention.
Conclusion: The inclusion of the radiation content in a class lecture can significantly prepare nursing
students for a radiological emergency as demonstrated by improved post-intervention survey results. Low
pre-intervention EPIQ scores and high post-intervention scores suggest there is a need to incorporate
radiological/disaster content into nursing education curricula.
References
Bond, E. F. (2005). Disaster nursing curriculum development based on vulnerability assessment in the Pacific
Northwest. The Nursing Clinics of North America, 40(3), 441-447. doi:10.1016/j.cnur.2005.04.010 Conway-Welch, C.
(2002). Nurses and mass casualty management: Filling an educational gap. Policy, Politics, & Nursing Practice, 3(4),
289-293. doi: 10.1177/152715402237440 Garbutt, S. J., Peltier, J. W., & Fitzpatrick, J. J. (2008). Evaluation of an
instrument to measure nurses familiarity with emergency preparedness. Military Medicine, 173(11), 1073-1077.
Retrieved from CINAHL Plus with Full Text. Gebbie, K., & Qureshi, K. (2002). Emergency and disaster preparedness:
Core competencies for nurses. American Journal of Nursing, 102(1), 46-51. Retrieved from
http://www.jstor.org/stable/3522700 Hilton, C., & Allison, V. (2004). Journal of Continuing Education in Nursing.
Disaster preparedness: An indictment for action by nursing educators, 35(2), 59-65. Retrieved from ProQuest. Hsu,
E. B., Thomas, T. L., Bass, E. B., Whyne, D., Kelen, G. D., & Green, G. B. (2006). Healthcare worker competencies
for disaster training. BMC Medical Education, 6(19), 230-239. doi:10.1186/1472-6920-6-19 James, D. C. (2006).
Radiation emergencies: A nurse can lead. Journal of Radiology Nursing, 25(4), 101-105.
doi:10.1016/j.jradnu.2006.10.003 Kuntz, S. W., Frable, P., Qureshi, K., & Strong, L. L. (2008). Association of
Community Health Nursing Educators: Disaster preparedness white paper for community/public health nursing
educators. Public Health Nursing, 25(4), 362-369. doi:10.1111/j.1525-1446.2008.00717.x McKibbin, A. E., Sekula, K.,
Colbert, A. M., & Peltier, J. W. (2011). Assessing the learning needs of South Carolina nurses by exploring their
perceived knowledge of emergency preparedness: Evaluation of a tool. The Journal of Continuing Education in
Nursing, 42(12), 547-558. doi: 10.3928/00220124-20111003-04 Melnyk, B. M., & Fineout-Overholt, E. (2011).
Evidence-based practice in nursing & healthcare (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Miller, P.
(2011). An assessment of emergency department staff knowledge of emergency preparedness (Master's thesis).

Available from ProQuest LLC. (UMI 1490471) Mitchell, C. J., Kernohan, W. G., & Higginson, R. (2012). Are
emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents? International
Emergency Nursing, 20(3), 151-161. Retrieved from PubMed (PMID: 22726947). National Student Nurses
Association (2008). House of Delegates Resolution: in support of including disaster-preparedness, response, and
pre-certification in nursing curricula. Retrieved from http://www.nsna.org/Activities/Factsheet/NursingCurricula.aspx
Nursing Emergency Preparedness Education Coalition (2003). Educational competencies for Registered Nurses
responding to mass casualty incidents. Retrieved from http://www.nursing.vanderbilt.edu/incmce/competencies.html
Potter, M., & Miner, K. (2007). 2006-2007 ASPH/CDC Evidence-Based Gaps Collaboration Group. Retrieved from
http://www.asph.org/cphp/CPHP_ResourceReport.cfm. Powers, R., & Daily, E. (2010). International Disaster Nursing.
New York, NY: Cambridge University Press. Rose, M. A., & Larrimoire, K. L. (2002). Knowledge and awareness
concerning chemical and biological terrorism: Continuing education implications. Journal of Continuing Education in
Nursing, 33(6), 253-258. Retrieved from
http://search.proquest.com.ezproxy.lib.uwf.edu/docview/220149595/fulltextPDF?accountid=14787 Schmidt, C. K.
(2007). Strategies to prepare nursing students to respond to disasters. Dean's Notes National Student Nurses
Association, 8(3), 1-3. Retrieved from CINAHL Plus with Full Text. Smith, R. P. (2007). Making a case for integration
of disaster-preparedness content in associate degree nursing programs. Journal of Teaching and Learning in
Nursing, 2, 100-104. doi:10.1016/j.teln.2007.08.001 Steed, C. J., Howe, L. A., Pruitt, R. H., & Sherrill, W. W. (2004).
Integrating bioterrorism education into nursing school curricula. Journal of Nursing Education, 43(8), 362-367.
Retrieved from CINAHL Plus with Full Text. Veenema, T. G. (2003). Chemical and biological terrorism preparedness
for staff development. Journal for Nurses in Staff Development, 19(5), 215-222. Retrieved from Ovid. Veenema, T. G.
(2007). Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other
hazards (2nd ed.). New York, NY: Springer Publishing Company, LLC. Waeckerle, J. F., Seamans, S., Whiteside, M.,
Pons, P. T., White, S., Burstein, J. L., & Murray, R. (2001). Executive summary: Developing objectives, content, and
competencies for the training of emergency medical technicians, and emergency nurses to care for casualties
resulting from nuclear, biological, or chemical (NBC) incidents. Annals of Emergency Medicine, 37(6), 587-601.
doi:10.1067/mem.2001.115649 Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency
preparedness curriculum in nursing schools in the United States. Nursing Education Perspectives, 26(6), 334-339.
Retrieved from
http://ezproxy.lib.uwf.edu/login?url=http://search.proquest.com.ezproxy.lib.uwf.edu/docview/236603020?accountid=1
4787 Whitty, K. K. (2006). Factors influencing the importance of incorporating competencies regarding mass casualty
incidents into baccalaureate-degree nursing programs as perceived by currently employed faculty. Dissertation
Abstracts International: Section A. Humanities and Social Sciences, (). Williams, G., & Williams, E. (2010). A nursing
guide to surviving a radiological dispersal device. British Journal of Nursing, 19(1), 24-27. Retrieved from CINAHL
Plus with Full Text. Wisniewski, R., Dennik-Champion, G., & Peltier, J. (2004). Emergency preparedness
competencies: Assessing nurses' educational needs. Journal of Nursing Administration, 34(10), 475-480.
doi:10.1097/00005110-200410000-00009 World Health Organization (2008). Integrating emergency preparedness
and response into undergraduate nursing curricula. In Health Systems and Services. Health Action in Crisis (pp. 1-
40). Geneva, Switzerland: WHO Press. Retrieved from
http://whqlibdoc.who.int/hq/2008/WHO_HAC_BRO_08.7_eng.pdf Worrall, J. (2012). Are emergency care staff
prepared for disaster? Emergency Nurse, 198(9), 31-37. Retrieved from CINAHL Plus with Full Text.
Contact
[email protected]

Evidence of Moving on: Education and Evidence-Based Practice
Donna Louise Waters, PhD, MPH, BA, RN, Australia
Purpose
to promote awareness that understanding fundamental variations in how research and evidence-based
practice is taught can improve curriculum design and the reliability and validity of competency
assessment for evidence-based healthcare.
Target Audience
educational researchers, curriculum designers, teachers of research and evidence-based practice.
Abstract
Purpose: Since 2006, competency standards for Australian registered nurses have required
demonstration of the ability to practice within an evidence-based framework, use the best available
evidence in decision-making, and contribute to research and quality improvement (NMBA 2006). While
these standards clearly articulate a vision for using research in practice, expectations around preparing
nurses to provide evidence-based care and the skills required for contribution to research are much less
clear.
Currently, undergraduate preparation for competence in EBP is presented and assessed in a variety of
ways, neither of which have a strong evidence-base nor criteria against which to judge competence.
Foundation learning for evidence-based practice (EBP) should begin with a clear articulation of what
evidence means for nursing and an understanding of when and how research and other evidence can be
used to improve patient care.
Methods: This paper will discuss findings from a documentary analysis of research and EBP units of
study within nursing curricula from 10 universities offering undergraduate nursing programs in New South
Wales between 2004 and 2013.
Results: These documents reflect a large variation in approaches to teaching research and EBP across
this state, but also show evidence of maturation in the way these units of study have been presented over
time. Progress towards designing a specific tool for measuring competence for EBP in nursing is
presented as further evidence that nursing education for EBP may indeed be moving on. An example is
used where these learnings are applied to the redesign of a pre-registration nursing curriculum.
Conclusion: Preparation for research and EBP are often not a high priority in the crowded
undergraduate nursing curriculum. It is concluded that an agreed foundation level of skill and a common
approach to the promotion of EBP must be adopted before it can be possible for nursing graduates to
effectively translate evidence for nursing practice. The style and content of EBP subjects should parallel
the level of undergraduate orientation to clinical practice. These subjects should include strategies to
assist graduates to initially seek out EBP champions and networks within the clinical setting in which they
will work rather than assume immediate competence as a researcher.
References
Nursing and Midwifery Board of Australia (2006), National competency standards for the registered nurse.
Melbourne. Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-
Guidelines.aspx#competencystandards
Contact
[email protected]

Continuing Education Ensures Competence to Practise and Assures Public
Safety
Rachael A. Vernon, RN, PhD, New Zealand
Mary Chiarella, RN, LLB (Hons), PhD, Australia
Purpose
The purpose of this presentation is to discuss the notion that continuing education ensures continuing
competence to practise and therefore assures public safety. Preliminary research data collected in a
cross country study (Australia and New Zealand) will be presented and discussed to support this
hypothesis.
Target Audience
The target audience for this presentation are nurse educators, nurse researchers, policy makers, nurse
leaders and regulators.
Abstract
Purpose: The purpose of this research is to determine what evidence exists to support or refute the
hypothesis that continuing education ensures continuing competence to practise and assures public
safety. The research builds on a previous international study (Vernon, 2013) that focused on the
development of an international consensus view for the assessment of continuing competence.
Methods: The research has been undertaken using a three stage mixed method evaluation
design. Each stage of the research has been completed sequentially. Stage One focuses on a critical
analysis of current Case law related to nurse competence notifications. Stage Two, an analysis of data
competence notification data received and processed by regulatory authorities, and Stage Three,
interviews with key staff employed by regulatory authorities to process these cases. Triangulation of data
has occured to derive the overarching outcomes from this study.
Results: A common indicator of continuing competence, required by regulatory authorities is continuing
education or continuing professional development. However, does continuing education ensure
continuing competence and assure public safety? Whilst continuing competence is agreed by regulatory
authorities to be necessary to protect the public in health professional regulation (Secretary of State for
Health (UK), 2007, Vernon et al., 2013b, National Council of State Boards of Nursing, 2009). Definitions
of continuing competence within legislation and policy across developed nations have strong similarities,
international research (Vernon, 2013) indicates that there is confusion over the level to which continuing
competence needs to be demonstrated, the criteria against which continuing competence should be
assessed and the role of continuing competence frameworks in ensuring public safety (Chiarella and
White, 2013, Vernon et al., 2013a). In this presentation the preliminary research findings and opinion will
be presented and discussed.
Conclusion: This research has sought to understand and dtermine the relationships between continuing
education, continuing competence requirements for nurses in New Zealand and Australia, and the
relevant legislation with regard to assuring public safety, and as a result the implication for nurses in
terms of their continued safety to practice.
References
CHIARELLA, M. & WHITE, J. 2013. Which tail wags which dog? Exploring the interface between professional
regulation and professional education. Nurse Education Today, 1-5. NATIONAL COUNCIL OF STATE BOARDS OF
NURSING 2009. Assuring competence: a regulatory responsibility. In: NATIONAL COUNCIL OF STATE BOARDS
OF NURSING (ed.). Chicago, USA: National Council of State Boards of Nursing. SECRETARY OF STATE FOR
HEALTH (UK) 2007. Trust, assurance and safety - The regulation of health professionals in the 21st century. In:
DEPATMENT OF HEALTH, U. K. (ed.). London: The Stationery Office Limited on behalf of the Controller of Her
Majesty’s Stationery Office ID5501492 02/07. VERNON, R., CHIARELLA, M. & PAPPS, E. 2013a. Assessing the
continuing competence of nurses in New Zealand. Journal of Nursing Regulation, 3, 19-24. VERNON, R.,

CHIARELLA, M., PAPPS, E. & DIGNAM, D. 2013b. New Zealand nurses' perceptions of the continuing competence
framework. International Nursing Review, 60, 59-66. VERNON, R. A. 2013. Relationships between legislation, policy
and continuing competence requirements for registered nurses in New Zealand. Doctor of Philosophy, University of
Sydney.
Contact
[email protected]

I 10 - Promoting Health in Multiple Disease Processes
Differences in Scores on the Midlife Women's Symtom Index Between Women
with and without Cardiovascular Disease
Youjeong Kang, MPH, CCRN, USA
Ok Kyung Ham, PhD, RN, South Korea
Timothy J. Sowicz, MSN, CRNP, USA
Wonshik Chee, PhD, USA
Eun-Ok Im, RN, MPH, PhD, CNS, FAAN, USA
Purpose
The purpose of this presentation is to discuss the differences in scores on the Midlife Women’s Symptom
Index between midlife women with and without cardiovascular disease.
Target Audience
The target audience of this presentation is researchers and healthcare providers who are interested in the
prevention of cardiovascular disease and self-care.
Abstract
Purpose: Menopause in midlife women is a risk factor for cardiovascular disease (CVD) due to changes
in estrogen levels which may cause hypertension (Ashraf & Vongpatanasin, 2006; Colditz et al., 1987;
Markovitz, Matthews, Wing, Kuller, & Meilahn, 1991; Rosano, Vitale, Marazzi, & Volterrani, 2007).
Although menopause is not a disease, low levels of estrogen are associated with hardening of the
arteries ('American Heart Association', Oct 1, 2013). Declines in estrogen are also associated with
elevations in LDL cholesterol and triglycerides ('American Heart Association', Oct 1,2013).
Biological measures such as serum estrogen levels and lipids are one method for assessing CVD risk in
humans; however, these require a prescription from a health care provider. While these measures may
yield important data on risk factors and markers of CVD and should be assessed based on current
screening recommendations, women’s self assessment and interpretation of their menopausal symptoms
may be a self-care strategy that provides early signs and symptoms of CVD. The Midlife Women’s
Symptom Index (MSI) is a self-administered instrument to assess menopausal symptom frequency and
severity (Im, Lee, Chee, Brown, & Dormire, 2010; Lee, Im, & Chee, 2010). Comparisons of the MSI
scores between midlife women with and without CVD have not been reported in the literature. This study
provides evidence that the MSI may not only be used to assess menopausal symptoms, but as a
screening tool for CVD in midlife women. Thus, the purpose of this study is to compare the MSI scores
between midlife women with and without CVD.
Methods: This is a secondary analysis of the data from a cross-sectional web-based survey on
menopausal symptom experiences of 542 midlife women aged 40 to 60 years in the United States.
Participants from the parent study were recruited through the Internet using convenience sampling. Data
were collected using the MSI, which contains two subscales measuring prevalence and severity of
menopausal symptoms (Lee et al., 2010). Both subscales are further divided into physical, psychological
and psychosomatic menopausal symptom items (Lee et al., 2010). Prevalence is dichotomized (yes or
no) and severity is reported using a Likert scale (Lee et al., 2010). Measures of central tendency and
dispersion were performed for all included variables. To assess for differences between groups (midlife
women with and without CVD), continuous variables were compared using one-way ANOVA. Categorical
variables were compared using chi-square tests. For all analyses, p < 0.05 was considered statistically
significant. A linear regression using the Genmod procedure in SAS was employed, and a multiple linear
regression model was built to examine differences between groups in reporting menopausal symptoms
with adjustment for significant demographic variables.
Results: In the participants with CVD, mean age was 50 years (p=0.0112), with 96% of using health
advice from doctor’s office, clinic or health center (p=0.0016), 60% married (p=0.0027), 70% reporting
being healthy (p=0034), and 49% being absence of period for one or more years (p=0.0198). The

racial/ethnic composition of women differs between groups (p=0.0040). Blacks (30.37%) had the highest
prevalence of CVD compared to Hispanics (18.90%), Asians (13.82%) and Whites (16.56%).
Differences in the prevalence and severity of the MSI scores by group were analyzed without controlling
for demographic variables. The participants with CVD reported higher prevalence and severity scores in
menopausal symptoms than those without CVD. There were significant differences in the prevalence and
severity scores between groups except for the severity of psychological symptoms (p=0.0889).
The scores for the prevalence and severity subscales controlling for statistically significant demographic
variables (age, health advice, marital status, racial/ethnic group, self-rated health and menopausal status)
were analyzed. Those with CVD reported higher MSI prevalence and severity scores than participants
without CVD while controlling for statistically significant demographic variables. There were significant
differences in the prevalence and severity scores between groups except for the prevalence (p=0.1344)
and severity of psychological symptoms (p=0.3491).
This study found significant differences in age, using health advice, self-rated health status, menopausal
status, and racial/ethnic background between groups. Women with CVD were approximately two years
older than women without CVD which is similar to data reported by Gold et al. (2001) which demonstrated
age is related to all-cause mortality.
It is well documented that the experience (Freeman et al., 2001; Im et al., 2010) , perception and
tolerance of physical symptoms of menopause (Gold et al., 2001; Im et al., 2010) differ by ethnicity in
U.S. women. In addition, Gold et al. (2006) demonstrated that Black women reported the highest rates of
vasomotor symptoms; consistent with the findings from the present study.
The overall findings of this study show that there are differences in physical and psychosomatic
menopausal symptom severity scores between groups. Overall, women with CVD reported higher MSI
prevalence and severity scores compared to women without CVD. Thus, future research is needed to test
MSI scores focused on specific types of CVD such as hypertension or heart failure using a larger sample.
Conclusion: Measurement of physical and psychosomatic severity symptom scores using MSI as a self-
care tool may be reliable to predict CVD in midlife women. Recognizing symptoms of menopause as
predictors of CVD risk may prompt women and health care providers to undertake measures to prevent
CVD or slow its progression if diagnosed. Using the MSI as a self-screening tool allows women to use
information gleaned from common signs and symptoms experienced during menopause to seek care
from health care providers to protect themselves from CVD.
Acknowledgement: This analysis was conducted as a part of a larger study funded by NIH/NINR
(1R01NR010568-01) entitled "Ethnic-Specific Midlife Women's Attitudes Toward Physical Activity.”
References
References 'American Heart Association'. (Oct 1,2013). Retrieved 12/01, 2013, from
http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Menopause-and-Heart-
Disease_UCM_448432_Article.jsp# Ashraf, M. S., & Vongpatanasin, W. (2006). Estrogen and hypertension. Current
Hypertension Reports, 8(5), 368-376. Colditz, G. A., Willett, W. C., Stampfer, M. J., Rosner, B., Speizer, F. E., &
Hennekens, C. H. (1987). Menopause and the risk of coronary heart disease in women. The New England Journal of
Medicine, 316(18), 1105-1110. doi:10.1056/NEJM198704303161801 Freeman, E. W., Grisso, J. A., Berlin, J.,
Sammel, M., Garcia-Espana, B., & Hollander, L. (2001). Symptom reports from a cohort of african american and
white women in the late reproductive years. Menopause (New York, N.Y.), 8(1), 33-42. Gold, E. B., Bromberger, J.,
Crawford, S., Samuels, S., Greendale, G. A., Harlow, S. D., & Skurnick, J. (2001). Factors associated with age at
natural menopause in a multiethnic sample of midlife women. American Journal of Epidemiology, 153(9), 865-874.
Gold, E. B., Colvin, A., Avis, N., Bromberger, J., Greendale, G. A., Powell, L., . . . Matthews, K. (2006). Longitudinal
analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study
of women's health across the nation. American Journal of Public Health, 96(7), 1226-1235.
doi:10.2105/AJPH.2005.066936 Im, E. O., Lee, B., Chee, W., Brown, A., & Dormire, S. (2010). Menopausal
symptoms among four major ethnic groups in the united states. Western Journal of Nursing Research, 32(4), 540-
565. doi:10.1177/0193945909354343; 10.1177/0193945909354343 Lee, B., Im, E. O., & Chee, W. (2010).
Psychometric evaluation of the midlife women's symptom index in multiethnic groups. Western Journal of Nursing
Research, 32(8), 1091-1111. doi:10.1177/0193945910362066; 10.1177/0193945910362066 Markovitz, J. H.,
Matthews, K. A., Wing, R. R., Kuller, L. H., & Meilahn, E. N. (1991). Psychological, biological and health behavior
predictors of blood pressure changes in middle-aged women. Journal of Hypertension, 9(5), 399-406. Rosano, G. M.,

Vitale, C., Marazzi, G., & Volterrani, M. (2007). Menopause and cardiovascular disease: The evidence. Climacteric :
The Journal of the International Menopause Society, 10 Suppl 1, 19-24. doi:10.1080/13697130601114917
Contact
[email protected]

I 10 - Promoting Health in Multiple Disease Processes
Nursing Services for the Prevention and Control of Non-Communicable Diseases
Lourdes Marie S. Tejero, RN, BSN, MA, PhD, Philippines
Josefina A. Tuazon, RN, BSN, MN, DrPH, Philippines
Vanessa Manila, RN, MA-HPS, Philippines
Purpose
The purpose of this presentation is to explore the role of the nurse in the control of non-communicable
diseases. With sharing of ideas from international nurses’ experiences and systems in their countries,
these will guide our courses of action towards strengthening the role of nurses in NCD control.
Target Audience
The target audience of this presentation is nurse practitioners involved with non-communicable diseases
(NCDs). We also hope to get administrators involved in programs for the control of NCDs.
Abstract
Purpose: There is a global increase in the prevalence rate of noncommunicable diseases (NCDs) not
only in the in the Philippines but all over the world. As such, this gained attention from the public health
sector, more especially that the trend is not only true in the urban population, which it was significantly
identified in the past, but also to the lower socioeconomic groups. In response to this alarming healthcare
situation, several health packages and programs had been developed in all levels of care.
Multidisciplinary in nature, nurses have played a role in bridging gaps between health care needs and
present services delivered.
The study aims to explore both national and international policies, programs and standards in prevention
and control of NCDs where nurses play a vital role. It seeks to identify the status of the local NCD
program in selected urban and rural communities with nurses’ involvement. It compares current practice
to that of the standard expressed in literature and policies. As the role of nurses may be maximized in this
approach, barriers and opportunities are determined and a recommended package of nursing service and
delivery are described.
Methods: Exploratory investigation was conducted considering the elements of policy research. Policies,
standards and practice in different nations in Africa, Europe, South Asia and United States, to name a
few, were reviewed. Data collection done in 2013 consisted of two phases. First phase was done though
a focused group discussion with the different local nursing organizations. Independent roles of nurses and
package of nursing services, both documented and undocumented, were determined. The second phase,
through interviews, records review, observations, studied the pilot areas for the NCD program status in
the Philippines: the municipality of Pateros in Manila for the urban setting, and the province of Guimaras
for the rural setting.
Results: Results of the study show that the national and international standards and policies on NCDs
have a common objective to reduce mortality and morbidity due to NCDs by targeting population in the
pre-disease stage and providing appropriate healthcare packages to those with NCDs. Through the
policy and standard reviews majority of these countries’ essential healthcare packages are geared
towards deliverable and affordable hence, financially feasible and cost effective services.
In different countries, similarities seen in nurse led community based interventions involving promotion of
physical activity, weight and salt intake reduction, lowering frequency of tobacco use and risk
management. Nurse led clinics are increasingly the most commonly seen set-up. The services are being
coordinated with doctors and other health professionals, thus multidisciplinary in approach. Seen also are
nurses whose roles are strengthened by specialized trainings which were further empowered to practice
though having a recognized set of roles and responsibilities in the team. Through this, family based care
is possible which is more accessible to the population. In contrast to the local setting, the PHNs (Public
Health Nurses) do not have any explicit roles as described in protocols in NCD prevention programs in
health centers. Among their usual tasks include assisting consultation and providing care, community

coordination and clerical tasks. Special nurses however serve at the primary level rather than employed
in any agency. Most, just like the PDNs, ostomy nurses, and diabetes nurses contract their services with
the patients with the referral of the physicians.
Generally, the project done in both pilot areas of study reflected positive outcomes, from increasing
awareness of people on healthy lifestyle to incorporating risk assessment to routine history taking and
improving instruments in screening, prevention and treatment. Investing in human resource for health
such as utilizing the current oversupply of nurses, and delegating to midwives and trained health workers
do minor tasks, are an important strategy in the promoting effectiveness and efficiency of the NCDs
programs.
As the trend in chronic illness management not only involves tertiary care but preventive care and risk
management, nurses also moved to a higher level of practice. These kinds of professional development
are seen in many countries. Here in the Philippines, as there is no legal barrier in forming groups of
nurses practicing specialized care, it will be beneficial both on the side of healthcare service delivery and
on the nurses to have this recognized, organized and systematized. Among the specialty groups are
diabetes nurses, emergency care nurses, ostomy nurses, rehabilitation and cardiovascular nurses who
can all practice in the hospital, clinic and community settings independently.
Conclusion: To be able to render expanded nursing services, as in the case of NCDs, crucial program
inclusions are strategies in information dissemination and education, organization of services and
specialized personnel training. As such, trainings should be rendered by a competent body of nursing
recognized and certified by the regulatory commission. As one of the prominent issues in the pilot
community is affordability, health insurance can also subsidize the package of nursing services of the low
socio-economic classes, i.e., reimbursement of nursing services by PhilHealth. Similarly, these are also
areas of improvements that can be further refined to make the nursing care packages more deliverable
and effective.
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Contact
[email protected]

J 03 - Health Promotion in the Pediatric Population
Factors Associated with Physical Activity in Kindergarten Children
Carol L. Hammonds, PhD, RN, CNE, USA
Janet C. Meininger, PhD, RN, FAAN, USA
Purpose
To identify factors associated with the duration of physical activity (PA) at different levels of intensity as
measured by accelerometry in 4 to 7 year old children in the public kindergarten setting in preparation for
global interventions to aid in preventing and reducing the pandemic obesity phenomena.
Target Audience
Health care providers, educators, and parents worldwide. Health care providers are the leaders in
continuing research to aid in preventing and reducing obesity. Parents and educators provide the
influence to instill healthy behaviors and to integrate these behaviors in the educational environment as
well as home environment of the child.
Abstract
Purpose: Reversing obesity is an urgent public health need for children: worldwide, in 2011 more than 40
million children under the age of five were overweight 1. Increasing intensity and duration of physical
activity (PA) is a strategy to aid in preventing and reducing obesity. According to limited available
research, PA in kindergarten children is decreasing below recommended guidelines and sedentary
behavior is increasing 2;the potential to change the obesity trajectory, however, is greater in early
childhood when healthy behaviors are “imprinted” and entrenched 3. More than 11,207,000 children in
the United States attend preschool/kindergarten programs that primarily provide sedentary activity, a level
highly associated with childhood obesity 4-7.
A lack of research to describe physical activity precisely and to identify factors associated with PA
regarding obesity of children fostered this study of a small population of children to help determine and
clarify such patterns and factors. The purpose of this study was two-fold, first to describe the patterns and
duration of daily PA of kindergarten children at different levels of intensity (sedentary, light, moderate-to-
vigorous, and vigorous) during a normal day in public kindergarten. Second, to identify the most
predictive enabling factors (body mass index (BMI), motor skills, playtime on play equipment) and
supporting factors (parental self- efficacy, parent modeling, teacher modeling, perceptions of
competence, and enjoyment of PA) associated with duration of objectively measured moderate to
vigorous and vigorous physical activity during the school day in 4 to 7 year old kindergarten children while
controlling for demographic factors (age, gender, and ethnicity).
Methods: A cross-sectional observational study identified and described factors associated with the
duration of PA at different levels of intensity. A sample of 38 children in a full day public kindergarten
setting from five classrooms of one elementary school in southeast Texas was studied between
September 2011 thru May 2012 school year.
Rather than observational measurements, an Actigraph GTX3+ accelerometer more accurately and
objectively measured the duration of PA at different levels of intensity. Questionnaires and other factor-
specific tools measured factors including body mass index (BMI), motor skills, duration of access to play
equipment, parental support, and parental perceptions of competence and enjoyment, and parent and
teacher PA behaviors. This study used the Preschool and Kindergarten Physical Activity Promotion
Model modified by this researcher for the younger child from Welk’s Youth Physical Activity Promotion
Model 8 to conceptualize these factors.
PA was measured and averaged from three 6-hour school days in 15-second epochs for an average daily
measurement. Each epoch was categorized by intensity levels with the following cut-points per 15-second
epoch: < 373 counts for sedentary (S), ≥ 373 to <420 counts for light (L), ≥ 420 to < 824 counts for
moderate to vigorous(MV) and ≥ 824 counts/15 second epochs for vigorous (V). Anthropometric
measures and motor skills were measured on the same school day the following week. Anthropometric

measurements followed Lohman, Roche, and Martorell 9 procedures. Motor skills measurement followed
Williams 10 protocol for the Children’s Motor Skill Tool. The Questionnaire on Physical Activity for Parents
of Kindergarten Children and the Questionnaire on Physical Activity for Teachers of Kindergarten
Children, were developed by the researcher based on McMinn’s 11 Southampton Women’s Survey and
were used to measure other factors.
PA was described by the average daily duration of PA at different levels of intensity by gender and
classroom and a time series approach was used to describe the patterns of PA over the 6-hour school
day. Pearson Correlation was used to identify factors correlated with MV and V PA. Multiple regression
was used to identify predictive factors.
Results: The 38 children’s ages ranged from 5.14 to 7.1 years old with a mean age of 6.12 ±0.142 years.
Females represented 60% of the sample. The prevalent ethnicity was African American (93%). Forty-
seven percent of children lived with both mother and father. Based on BMI using U.S. norms (normal BMI
14-17 m/kg2for 4-7 year-olds, age and gender specific);16% were overweight and 16% were obese.
Mothers’ mean BMI was 30 (SD 5.03) and teachers’ mean BMI was 27.79 (SD 8.6).
The PA intensity measurements of the children were sedentary/light for 91% of the school day. The
overall mean duration of moderately vigorous (MV)/and vigorous (V) PA was 36 minutes (95% CI 31 to
40). Patterns analyses indicated an increase in MV and V from 10 a.m. to 11 a.m. (free play) and from 1
p.m. to 2:30 p.m. (classroom guided PA and dismissal preparation, including turns at toileting and free
play).
Enabling factor child’s zBMI ranged from -1.77 to 2.27 with a mean of 0.59 (SD 1.06). Females (0.79) had
a higher average zBMI than males (0.29). For motor skills, males and females total mean score was
129.4 (SD 13.29) and 119.22 (SD 14.76). The factor access to play equipment had little variability and
was not used in subsequent analyses.
Supporting factor parental self-efficacy scored 4.06 (SD 0.74) on a 5-point Likert scale. Parent modeling
and teacher modeling self-report mean of 178 minutes/day and 84 minutes/day, respectively. Parent self-
report data was out of range of probability and was not used for further analyses. Supporting factors
parental perceptions of their child’s competence and enjoyment of PA and were measured using a
dichotomous, and a 5-point Likert scale respectively. Seventy- four percent of the children were rated
more active than their peers and the mean of child’s PA enjoyment mean was 4.49 (SD 0.77). Exploratory
ANOVA analysis to investigate statistical significance between classrooms and MV and V PA as the
dependent variable were F (4) = 6.439 with a significance of p = 0.001 between classrooms.
Ethnicity was the only demographic factors with a p< 0.20 and was retained to control for
confounding. The remaining enabling and supporting factors were entered into a regression
analysis. Teachers PA hr/day was the only statistically significant variable retained with 14% of the
variance in MV and V PA can be explained by teacher PA while controlling for ethnicity.
Conclusion: This is one of the first studies to describe the patterns and duration of daily PA of
kindergarten children at different levels of intensity during a normal day in public kindergarten
using accelerometers. The two main findings were the patterns and duration of physical activity
associated with brief periods of scheduled playtime;and the statistical significance of teacher PA
predicting MV and V PA. While primarily sedentary during the school day, short durations of increased
PA intensity spiked during free and guided play and dismissal preparation highlighting the need to
incorporate increases of higher intensity level PA at other times during the school day. The significant
variation in minutes of MV and V PA among classrooms, and the association of the teacher’s self-
reported PA on the dependent variable point to the potential for increasing children’s PA by intervening
with teachers and the need to take into account the clustering effect within classrooms in future
studies. Limitations of the study include the small sample size and lack of racial/ethnic
diversity. Strengths of the study include precision of PA measurement and use of an age-appropriate
conceptual model. Further research is needed to replicate this study in a larger, more diverse
sample. Questions remain regarding predictive factors to increase and influence PA levels among
children not meeting recommended intensity levels of PA in kindergarten settings.
References

1. World Health Organization. Obesity and overweight Fact sheet no 311.
http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 12 08 13, 2013. 2. Beets MW, Bornstein D, Dowda
M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: Measurement and
interpretation. Pediatrics. 2011;127(4): 658-664. 3. Council on Sports Medicine Fitness and School Health. Active
healthy living: Prevention of childhood obesity through increased physical activity. Prevention. 2006;117(5): 1834-
1842. 4. Pate RR, O'Neill JR, Mitchell J. Measurement of physical activity in preschool children. Medicine and
Science in Sports and Exercise. 2010;42(3): 508-512. 5. Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M.
Physical activity among children attending preschools. Pediatrics. 2004;114(5): 1258-1263. 6. Pfeiffer KA, McIver KL,
Dowda M, Almeida MJ, Pate RR. Validation and calibration of the actical accelerometer in preschool children.
Medicine & Science in Sports & Exercise. 2006;38(1): 152-157. 7. Vale SM, Santos RM, da Cruz Soares-Miranda
LM, Moreira CM, Ruiz JR, Mota JA. Objectively measured physical activity and body mass index in preschool
children. Int J Pediatr. 2010;2010. doi: 479439 [pii] 10.1155/2010/479439. 8. Welk GJ. The youth physical activity
promotion model: A conceptual bridge between theory and practice. Quest. 1999;51(1):5-23. 9. Lohman TG, Roche
AF, Martorell R. An Anthropometric Standardization Reference Manual. Champaign, IL: Human Kenetics;1988. 10.
Williams HG, Pfeiffer KA, Dowda M, Jeter C, Jones S, Pate RR. A field-based testing protocol for assessing gross
motor skills in preschool children: The children's activity and movement in preschool study motor skills protocol.
Measurement in Physical Education & Exercise Science. 2009;13(3):151-165. 11. McMinn AM, van Sluijs EM, Harvey
NC, et al. Validation of a maternal questionnaire on correlates of physical activity in preschool children. Int J Behav
Nutr Phys Act. 2009;6:81. doi: 1479-5868-6-81 [pii] 10.1186/1479-5868-6-81.
Contact
[email protected]

The Family Partners for Health Study: A Randomized Cluster Control Trial for
Child and Parent Weight Management
Diane C. Berry, PhD, ANP-BC, FAANP, USA
Todd A. Schwartz, DrPH, USA
Robert G. McMurray, PhD, USA
Madeline Neal, BS, USA
Emily Gail Hall, BS, USA
Natnaree Aimyong, MSc, USA
Dean J. Amatuli, BS, USA
Gail D'Eramo Melkus, EdD, C-NP, FAAN, USA
Purpose
The purpose of this presentation is to present the results of the Family Partners for Health study.
Target Audience
The target audience of this presentation is researchers and health care providers including nurses, nurse
practitioners, registered dietitians, and those interested in community-based public health.
Abstract
Purpose: The purpose of this study was to test a two-phased nutrition and exercise education, coping
skills training, and exercise intervention for overweight or obese low-income ethnic minority 2nd to 4th
grade children and their parents in rural North Carolina, U.S.
Methods: A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a
parent (n = 358). General linear mixed models were used to determine the effects of the intervention on
weight, adiposity, health behaviors and eating and exercise self-efficacy by examining changes in
children and parents from baseline to completion of the study (18 months).
Results: At 18 months, children in the experimental group did not have a significantly decreased BMI
percentile (P = 0.470); however, they had slowed the increase of their triceps (P = 0.001) and
subscapular skinfolds (P < 0.001), improved their dietary knowledge (P = 0.018), and they drank less than
one glass of soda per day (P = 0.052) compared to the control group. Parents in the experimental group
had decreased their BMI (P = 0.001), triceps (P < 0.001) and subscapular skinfolds (P < 0.001),
increased their nutrition (P = 0.003) and exercise (P < 0.001) knowledge and more often drank water or
unsweetened drinks (P = 0.029). At 18 months, children in the experimental group did not have a
significant improvement in eating (P = 0.956) or exercise self-efficacy (P = 0.976). Experimental parents
demonstrated improved socially acceptable eating self-efficacy (P = 0.013), however did not significantly
improve their emotional eating self-efficacy (P = 0.155) or exercise self-efficacy (P = 0.680).
Conclusion: The results suggest that including children and parents in the same intervention is an
effective way to decrease adiposity and improve nutrition behaviors in both children and parents and
improve weight and eating self-efficacy in parents.
Contact
[email protected]

An Ecological Approach to Understanding Health Promoting Behaviors of
Children from Low-Income Families: A Multi-Level Analysis
Jiyoung Park, PhD, RN, South Korea
Hee Soon Kim, PhD, RN, FAAN, South Korea
Tae Wha Lee, PhD, RN, South Korea
Hyeonkyeong Lee, PhD, RN, South Korea
Chung-Mo Nam, PhD, South Korea
Chulhee Kang, PhD, South Korea
Ja-yin Lee, BS, RN, South Korea
Purpose
The purpose of this presentation is to investigate the ecological factors influencing health promoting
behaviors of children from low income families.
Target Audience
The target audience of this presentation is health care providers including community nurses and school
nurses who are interested in health disparities among children. Members of community organizations,
policy makers and administrators working for health promotion of children are also invited.
Abstract
Purpose: 'Health disparity' is becoming a serious issue worldwide. The practice of health promoting
behaviors (HPB) among childhood is influenced not only by individual factors but also by diverse
environmental factors including family, peer relationship, school, and community organization. The
purpose of this study was to investigate the ecological factors influencing HPB of children from low
income families.
Methods: Participants of the study included 297 fourth to sixth grade elementary school students from
low-income families, 297 caregivers, and 68 community children center teachers. Data was collected by
structured self-report survey, and a multi-level regression analysis was conducted.
Results: The mean score of HPB of children was 3.16, and the highest point was in injury prevention
whereas the lowest point was in exercise. The factors that influence HPB of children were as follows: self-
efficacy and self-regulation among intrapersonal factors; caregivers’ health instruction behaviors and peer
relationship among interpersonal factors; and the period of operation, perceived environments by
children, and disabled children/teacher ratio among institutional factors.
Conclusion: This study emphasized the importance of creating healthy environment for promoting health
of children from vulnerable social groups and suggested that multi-level interventions would be more
effective than interventions targeting a single level.
Contact
[email protected]

J 04 - Global Research Regarding Undergraduate Nursing Students
Educational Efforts for Enhancing Global Health Competencies Among
Undergraduate Nursing Students in South Korea
Kihye Han, RN, PhD, South Korea
Purpose
The purpose of this presentation are 1) to introduce educational efforts from a 4 year nursing school in
Korea, which aimed to enhance global health competencies among undergraduate nursing students, and
2) to share research findings on associations of taking the courses with increased global health
competencies among them.
Target Audience
The target audience of this presentation includes nursing educators, especially for global health nursing.
Abstract
Purpose: Globalization happens everywhere. Many of culture, information, resources, and workforces
can be easily exchangeable without national boundaries. In South Korea, special demands are noted for
nurses and nursing students. Domestically Korea currently goes multicultural very fast. To take care of
patients/clients with different background, global health care industries are drastically expanding now and
demanding health care providers, especially nurses, who have global competencies. Internationally, since
Korea came to reverse its position from a recipient to a donor of Official Development Assistant in the
1990s, it is required to share experiences, resources and workforces, including health care systems and
workers, with developing countries. To meet these domestic and international demands to Korean nurses,
nursing schools start to put educational efforts for nursing students to be prepared. This study introduced
educational efforts from a 4 year nursing school in Korea, which aimed to enhance global health
competencies among undergraduate nursing students. In addition, it examined associations of taking the
courses with increased global health competencies among them.
Methods: Since nursing schools have been initiating global health movements in Korea, two courses
were taught to undergraduate nursing students in a 4-year nursing school: ‘multicultural health’ for the 1st
year nursing students, and ‘global leadership’ for the 2nd year ones (both were 2 credits). The course
‘Multicultural health’ provides an overview about multicultural societies and related policies and health
issues. The course contents include theory and concepts of multi-culture, examples of multicultural
societies, law and policy on multi-culture, and concepts and issues of multicultural health. The ‘Global
leadership’ course is designed to provide the concept of leadership within the contexts of global health
systems. More specifically, this course provides an overview of major issues affecting global population
health and the leadership roles of nursing in global health. In the 2013 Fall semester, the 1st year students
were taught multicultural health and the 2nd year ones received the lectures of the global leadership
course. The 2nd year students took multicultural health last year (in 2012). Otherwise, the 3rd and 4thyear
students were not received any of those. These differences allowed to examine associations of taking the
courses with increased global health competencies among nursing students. For this, a cross-sectional
survey was conducted to all nursing students in this school at the end of the semester (November and
December 2013). Global health competencies were measured for 1) knowledge and interests in global
health and health equity (11 Likert-type items, scale range 11-33) , 2) global health skills (4 Likert-type
items, scale range 4-20), and 3) learners’ needs about global health (7 Likert-type items, scale range 7-
42), using Veras and colleagues’ (2013) global health competencies instrument for health professionals
and students. The survey instrument showed reliable (all Cronbach alphas>0.80 for the 3 subscales).
Additional data were also accessed on 1) whether they had ever lived abroad in the past 10 years, 2)
whether they had ever participated in student exchange programs, and 3) whether they had ever met any
patients/clients with different (multicultural) background in their clinical practicums. Global health
competencies were examined for their means by the school years using ANOVA with Tukey post hoc
tests.

Results: Out of the 698 undergraduate nursing students, 578 completed the survey (252 freshmen, 199
sophomore, 79 junior, and 48 senior) yielding the response rate of 83%. The students were average 20
years old (range 18-28) and mostly female (91%). Out of the students, 13% had lived abroad in the past
10 years. While overall 10% of the students had participated in student exchange programs, higher year
students tended to have more experiences in the programs: 5% of the 1st year, 11% of the 2ndyear, 19%
of the 3rd year and 23% of the 4th year students. Among the 3rd and 4th year students (n=127), 65% had
met patients/clients with different background in their practicums. The 2nd year nursing students reported
higher knowledge and interests in global health and global equity than the 1st and 4th year students (22.8
for the 2nd year students vs 20.1 for the 1st year and 21.0 for the 4th year students, F=16.56, p<0.01). The
3rd year students showed higher knowledge and interest than the 1styear students. There were no
differences in global health skills and learners’ need about global health despite more experiences of and
exposure to patients/clients with different background and international social contacts with students in
other countries.
Conclusion: Educational efforts through the two courses focusing on global health may have positive
effects on enhancing global health competencies, especially on knowledge and interests in global health
and health equity, for undergraduate nursing students. Experiences of and exposure to contacts with
students and clients with different background may increase students’ concerns to global health issues.
Study findings should be interpreted with limitations. As the data were all self-reported, respondents might
respond to the socially acceptable way. This was a cross-sectional design, and the study findings could
not be confirmed for their causal relationships. Due to unbalanced sample sizes across the school years,
statistical analysis could inflate the findings. Nonetheless, Welch F test, which corrects violation of
homogeneity of variance in ANOVA, showed the same results. In conclusion, structured courses
designed to increase global health competencies for nursing students may be a good strategy to meet
social demands for nurses’ roles in the globalized society in South Korea.
References
Veras M, Pottie K, Welch V, Labonte R, Eslava-Schmalbach J, Borkhoff CM, Kristjansson EA, Tugwell P. Reliability
and validity of a new survey to assess global health competencies of health professionals. Glob J Health Sci. 2012
Oct 22;5(1):13-27. doi: 10.5539/gjhs.v5n1p13.
Contact
[email protected]

J 04 - Global Research Regarding Undergraduate Nursing Students
Undergraduate Nursing Students' Beliefs and Readiness to Implement Evidence-
Based Practice
Janelle L. B. Macintosh, PhD, RN, USA
Katreena Merrill, PhD, RN, USA
Christopher I. Macintosh, RN, USA
Purpose
The purpose of this presentation is to disseminate findings of a study regarding nursing students’ beliefs
and readiness implement EBP. Student nurses’ EBP beliefs and skills will directly influence the clinical
setting including local, regional and global heath care.
Target Audience
The target audience is nursing faculty and clinical nurses.
Abstract
Purpose: Evidence based practice (EBP) is the use of the best evidence combined with clinical
experience and patient preferences to provide quality nursing care (Melnyk & Finout-Overholt,2010).
Despite the fact that utilizing EBP results in improved patient outcomes, it still takes years to implement
new evidence into clinical practice. This is due in part to the fact that students and clinical staff are taught
research and EBP strategies in a classroom setting, which are often not translated into `real world'
practice. Additionally, nurses report being overwhelmed with the amount of literature presented and the
ability to critique it. To move beyond the theoretical to concrete implementation, new educational tactics
are needed. While there are multiple frameworks to implement EBP, there still remains a gap between
evidence and practice (Melnyk, Finout-Overholt, Giggleman, & Cruz, 2010; Newhouse & White, 2011).
The purpose of this study was to explore nursing students' perceptions of EBP before and after
implementation of innovative teaching methods in an undergraduate scholarly inquiry course. It was
hypothesized that following the implementation of innovative teaching methods to teach evidence based
practice and research; students would increase their belief and implementation of EBP and describe their
experiences as more positive regarding the teaching methods.
Methods: A convenience sample of 120 student nurses currently enrolled in a scholarly inquiry course,
during two separate semesters, were approached to participate in this study. At the beginning and at the
end of the course students were given the EBP Beliefs Scale, the EBP Implementation Scale and
demographics. The EBP Beliefs Scale is a 16-item questionnaire measuring general beliefs about the
usefulness of EBP rated on a 1-5 Likert scale (Strongly Disagree to Strongly Agree). The EBP
Implementation scale is an 18-item questionnaire that measures application of EBP activities in the 8-
weeks prior. The questions are rated on a 0-4 scale (0 = No Application and 4 = Applied this Principle 8
or More Times). Validity and reliability statistics are previously reported (Melnyk, Fineout-Overholt, &
Mays, 2008). Data were entered into an Excel (Mocrosoft, 2007) spreadsheet. All analyses were
performed using SPSS version 16 (SPSS Inc., 2007). All variables were reviewed for missing data and
outliers using appropriate descriptive statistics and plots. Paired t-tests were used to assess
pretest/posttest changes in EBP belief and implementation scores. Students received weekly instruction
as part of the course. Innovative teaching methods included PowerPoint presentations, video clips,
interactive games, hands-on activities and a scenario-based written paper about implementation of EBP.
Results: A total of 109 participants (Response rate 91%) completed questionnaires (106 at pretest, 101
at posttest), with a total of 98 completing questionnaires at both time points. Particpants were young and
female (M= 20.7 years; 91% female). The average reported grade point average was 3.8 and 56% of the
students reported working part–time in addition to attending school. EBP belief scores were negatively
skewed and EBP implementation scores were positively skewed with univariate outliers noted in pretest
scores for EBP Beliefs and EBP Implementation. Cronbach’s alpha for the EBP Beliefs scale was .85 at
pretest and .82 at posttest. Cronbach’s alpha for the EBP Implementation scale was .87 at pretest and

.85 at posttest. Paired t-tests were conducted to assess changes from pretest to posttest for both EBP
belief scores and EBP implementation scores. The test for EBP belief was significant t (97) = -12.67, p <
.001, d = 1.4. EBP belief scores increased from pretest (M = 53.7, SD = 6.9) to posttest (M = 62.7, SD =
5.6). The test for EBP implementation was significant t (97) = -14.59, p < .001, d = 1.6. EBP
implementation scores increased from pretest (M = 8.2, SD = 6.2) to posttest (M = 19.6, SD = 8.0). As
skewness and outliers were noted in pretest scores for both EBP belief and implementation scores, the
analysis was repeated with the outliers deleted with similar results. Nonparametric comparisons also
yielded significant results.
Conclusion: Utilization of innovative teaching strategies were successful in improving the beliefs and
implementation of EBP in undergraduate nursing students. The hypothesis was supported. These
findings are corroborated by previous studies in the clinical setting that reported improved EBP beliefs
and implementation following educational interventions (Wallen et al., 2010). More research is needed in
the effect of EBP education strategies in nursing students and the long term retention of EBP beliefs and
implementation.
This study was conducting using a convenience sample of relatively young and primarily female student
nurses from one university. Therefore, the results may not generalize well to male or older populations of
student nurses.
The use of the latest evidence in nursing practice is essential for the provision of high quality care. EBP
beliefs are an important precursor to successful implementation. These beliefs need to be fostered in the
early stages of undergraduate nursing education. In addition, in order to ‘hard wire’ EBP concepts into
practice, students need opportunities to apply EBP principles in their practice. It is therefore essential for
faculty to collaborate with clinical sites and promote innovative teaching strategies to successfully engage
the student in long-life learning of EBP principles.
References
Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). Correlates among cognitive beliefs, EBP
implementation, organizational culture, cohesion and job satisfaction in evidence-based practice mentors from a
community hospital system. Nursing Outlook, 58(6), 301-308. doi:10.1016/j.outlook.2010.06.002. Melnyk, B. M.,
Finout-Overholt, E., & Mays, M. Z. (2008). The evidence-based practice beliefs and implementation scales:
Psychometric properties of two new instruments. Worldviews of Evidence Based Practice, 54(4), 208-216.
doi:10.1111/j.1741-6787.2008.00126.x. Microsoft. (2007). Microsoft Excel 2007. Redmond, WA: Microsoft.
Newhouse, R.P., & White, K.M. (2011). Guiding implementation: Frameworks and resources for evidence translation.
Journal of Nursing Administration, 41(12), 513-516. doi:10.1097/NNA.0b013e3182378bb0. SPSS Inc. (2007). SPSS
for Windows (Version 16.0). Chicago: SPSS Inc. Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout-Overholt, E.,
Miller-Davis, C., Yates, J., & Hastings, C.(2010). Implementing evidence-based practice: effectiveness of a structured
multifaceted mentorship programme. Journal of Advanced Nursing, 66(12), 301-308. doi:10.1111/j.1365-
2648.2010.05442.x
Contact
[email protected]

J 05 - Inspiring Nurse Leaders
Executive Perspective on the DNP
Mary Terhaar, DNSc, RN, USA
Martha Sylvia, PhD, MBA, RN, USA
Purpose
to present the findings of interviews with executives about the contributions of DNPs, to consider their role
in the success of the strategic plan, and to evaluate outcomes to date
Target Audience
executives contemplating employing DNPs, nurses considering becoming DNPs, and educators who
teach them
Abstract
Purpose: To describe what Chief Nurse Officers who employ or intend to employ DNPs think about the
education, the contribution and the potential of the DNP in their organization and in health care
Methods: Semi-structured interviews (60 – 90 minutes in length) were conducted, in-person or by
telephone, by an impartial interviewer with a total of seven respondents. Five (5) Chief Nursing Officers,
one (1) director of nursing research and practice, and one (1) designee participated. These respondents
represented academic teaching institutions, magnet facilities, and community hospitals. All were recorded
and transcribed with interviewee consent.
Interviewees were asked to describe their thoughts about the DNP degree; the skills they would expect all
DNP graduates to have in the areas of leadership, quality improvement, translation and dissemination of
research and practice evidence. Respondents were asked to identify the critical competencies and
skillsthey believed indicate DNP education had been effective. CNOs were asked to describe their
experiences working with DNPs; as well as how returning DNP graduates have been able to apply their
education to improve practice, outcomes and organizational performance.
CNOs were asked to describe how DNPs could benefit their organizations, with emphasis placed on
identifying measurable outcomes. They were also asked to describe ways in which the DNP program
could support graduates to increase the application and translation of educational outcomes. A final open-
ended question invited participants to offer any perspective, suggestions or insight unique to the
organization or their experience with DNPs.
Interview transcripts were analyzed by an evaluator and two faculty members blinded to the identity and
practice setting of respondents.
Results: Several themes were identified from analysis of the interview transcripts these include:
• DNPs are making important contributions in their organizations. They are serving in traditional
advanced practice roles (NP & CNS) and in assorted leadership roles as well (Managers, Directors,
and Educators). Some have assumed leadership roles in informatics, quality improvement, and
interdisciplinary functions.
• There is considerable variability in the performance 0f DNPs from program to program and from one
DNP to the next.
• Many DNPs are helping bring evidence to bear on practice. Their approach is variable and so are
the outcomes.
• Both graduates and programs are maturing and the outcomes are evident. Early graduates were not
comfortable working with the data required to evaluate outcomes. More recently, graduates are
comfortable and skilled with analytics. Likewise, early graduates were unsuccessful in efforts at
dissemination. More recent graduates are increasingly successful.
• Confusion surrounds the role. Physicians and other disciplines are unclear about the purpose and
contribution of the DNP. Graduates need to be prepared to teach others about the potential of the
role and to demonstrate value.

• The value for traditional scholarship and publication in peer-reviewed journals was mixed. although
the expectation that DNP graduates should be disseminating lessons-learned widely (through
teaching in the hospital or at conferences, presentations at meetings, development of best-practices
or policy guidelines, etc.) was unanimous. Participants believed these presentations should begin
during the DNP program.
• Participants encourage collaboration between DNPs and PhDs, both during their training and upon
graduation.
• All participants recognized and valued the DNP graduate’s experience and expertise finding and
reviewing evidence. They observe and report that many graduates use these abilities effectively to
improve clinical practice and outcomes..
• Without exception, all interviewees suggested that more attention be given to the screening of
potential DNP students, consideration of their baseline in critical skills areas (such as leadership and
writing), establishing an expectation that planning for translation of learning should happen at the
start of the DNP program, and increased focus on mentoring. All respondents expressed
appreciation for the current evaluation that is fully engaging key stakeholders: DNP graduates and
the CNO’s who will employ them.
Conclusion: Some are concerned that DNP education may be more effective in the preparation of
Advanced practice nurses than nurses administrators or executives.
The competencies most valued by participants include: ability to adopt a broad systems-perspective to
quality improvement; political “savvy” to understand how to lead strategic change; tactical expertise
specific to the rapidly evolving health care setting; experience with inter-professional initiatives; ability to
motivate teams at all levels through expert communication and teaching of evidence-based practice
concepts mastered in the DNP; the ability and discipline to envision and implement translation projects
proactively; at least an intermediate knowledge of evaluation and how to demonstrate effectiveness; a
commitment to life-long learning; willingness to seek out and partner with academic institutions for
research or quality improvement projects; strong leadership skills; the ability to take carefully considered
and monitored risks; and viewing themselves as a change agent. The need for academic writing skills
was emphasized.
Concern was expressed about the rigor of projects required in the early DNP cohorts. All respondents
knew many changes had been made to increase the level of rigor. Respondents also commended the
program for its commitment to quality and responsiveness to evaluation.
Work in progress that rsulted from this evaluation includes the following
1. An on-line survey is being deployed to employers of graduates and to nurse Executives across
the state.
2. A DNP council has been established to provide support and opportunities for collaboration across
the enterprise.
3. Participants endorsed the development of a forum in which graduates. We could continue to
interact with each other and possibly other experts.
References
Apold S. (2008). The Doctor of Nursing Practice: Looking back, moving forward. The Journal for Nurse Practitioners,
4 (2): 101-107. ISSN 1555-4155, 10.1016/j.nurpra.2007.12.003. Clinton P, & Sperhac AM. (2009). The DNP and
unintended consequences: an opportunity for dialog. Journal of Pediatric Health Care, 23(5): 348-351. Cronenwett L,
Dracup K, Grey M, McCauley L, Meleis A, & Salmon M (2011). The Doctor of Nursing Practice: A national workforce
perspective. Nursing Outlook, 59 (1): 9-17. Doi:10.1016/j.outlook.2010.11.003. Dearholt S, & Dang D. (2012). Johns
Hopkins Nursing Evidence-Based Practice: Models and Guidelines. Sigma Theta Tau International, Indianapolis, IN.
Dracup K, Cronenwett L, Meleis AI, & Benner PE. (2005). Reflections on the doctorate of nursing practice. Nursing
Outlook, 53: 177-182. Fulton JS, & Lyon BL. (September 30, 2005). "The Need for Some Sense Making: Doctor of
Nursing Practice". Online Journal of Issues in Nursing, 10 (3): Manuscript 3. Available:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005
/No3Sept05/tpc28_316027.aspx Institute Of Medicine, (1999). To Err is Human: Building a Safer Health System.
National Academy of Sciences. Washington, DC. Kirschling, JM (2013). Designing DNP Programs to meet required
competencies – context for conversation. American Association of Colleges of Nursing. Washington, DC
http://www.aacn.nche.edu/dnp/JK-2013-DNP.pdf Meleis A, & Drakup K. (2005). The case against the DNP: History,
timing, substance, and marginalization. Online Journal of Issues in Nursing. 10; 3.

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005
/No3Sept05/tpc28_216026.aspx Nykamp D, Murphy JE, Marshall LL, & Bell A. (2010). Pharmacy students’
participation in a research experience culminating in journal publication. American Journal of Pharmaceutical
Education, 74(4): 47-58. Potempa K. (2011). The DNP serves the public good. Nursing Outlook, 59 (1) 123-125.
Project Management Institute (2012). Project Management Book of Knowledge (5th Edition). O’Sullivan AL, Carter M,
Marion L, Pohl JM, & Werner KE. (2005). Moving forward together: the practice doctorate in nursing. The Online
Journal of Issues in Nursing, 10 (3): Manuscript 4. Available
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005
/No3Sept05/tpc28_416028.aspx Shenhar AJ, & Dvir D,(2007). Reinventing Project Management: A diamond
approach to successful growth and innovation. Harvard Business School Press. Boston, MA. Udlis, KA, & Mancuso
JM. (2012). Doctor of Nursing Practice programs across the United States: A benchmark of information. Part I
program characteristics. Journal of Professional Nursing. 28(5): 265-273. Wolf A, Budd G, & Bhattacharya A. (2011).
Clinical experiences for Doctor of Nursing Practice students – A survey of postmaster’s programs. Journal of
Professional Nursing. 27(3): 145-152.
Contact
[email protected]

For the Love of Nursing: Person-Centred, Ever Changing and Self-Fulfilling.
Nursing-People, Change, Growth
Anthony G. Tuckett, BN, MA, PhD, Australia
Fiona Bogossian, PhD, Australia
Purpose
to present qualitative research findings from an international electronic e-cohort study exemplifying what
is great about nursing according to new graduates.
Target Audience
nurse educators, nurse managers and researchers interested in what the neophyte nurse, our
profession's future workforce, prizes most about the work they do.
Abstract
Purpose: Qualitative evaluation of graduate nurses reasons for 'loving nursing'.
Methods: Graduate nurses from the Graduate Nurses e-cohort Study of Australian, New Zealand and
United Kingdom, provided electronic responses to the open ended-question: "I love nursing because...".
Data was then subjected to qualitative content analysis.
Results: Graduate nurses place great value on nursing work as a profession about people. Their
language exemplifies this when they describe their love of nursing for its person-centric qualities where
they can fully participate in patient care, help, and support. This person centeredness extends to include
the family of their patients.
Graduate nurses additionally identify as part of the people that makes nursing work appealing, their co-
workers. They enjoy working with a team, developing networks, and working with great people.
Overall, the quality that makes nursing so appealing is outside the self or beyond the ‘i’. That is, external
to the Graduate nurse.
Graduate nurses cherish nursing work’s variability. The fact that every work day is different,
unpredictable, never boring and always offering something new to learn makes nursing work wonderful.
They love the challenge and challenges nursing work brings.
Graduate nurses know that nursing work offers them opportunity to travel and work abroad. Nursing work
offers mobility.
This mobility provides opportunities that diversify employment at a ward level and beyond; and offers
career choices and job security. Graduate nurses identify as a work characteristic they cherish, its
flexibility in terms of shift work and making their work fit into their lives.
Overall, the quality that makes nursing so appealing is it offers them movement within and without.
Graduate nurses love that nursing work makes them think critically and problem solve. They are able to
continue to learn, increasing their knowledge & skills whilst also passing on new knowledge and skills to
others. To this end, they grow as a person and professionally.
Nursing work is furthers self-development and worth because of its capacity to inspire and motivate;
provide them confidence and competence; earn them respect and they perceive they are respected;
nursing work allows a degree of autonomy and leadership. It gives them joy.
Graduate nurses find their chosen profession rewarding. This is understood by those they care for simply
saying: “Thank you” and the graduate recognises their work is appreciated and fulfilling.
For a minority, the quality of nursing is measured by its alignment with a ‘calling’ or the work of God. For
the majority, however, the power of what they do is gauged by its capacity to impact society. They love

making a difference, changing peoples’ lives, affecting care and having a lasting impact on those they
care for. Nursing work is for the greater good.
Overall, the quality that makes nursing so appealing is internal or for the ‘i’. That is, internal and for the
Graduate nurse.
Conclusion: The views of graduate nurses facilitates critical reflection on current practices and systems.
Whilst the nurse clinician will benefit from these shared views, so too will nurse educators, nurse leaders
and nursing workforce planning representatives.
Contact
[email protected]

A Program of Nursing Clinical Supervision in Primary Healthcare: Strategies to
Implement
Regina Maria Pires, MS, RN, Portugal
Filipe Miguel Soares Pereira, MD, RN, PhD, Portugal
Purpose
The purpose of this presentation is the dissemination of research undertaken in Portugal, in the
implementation of programs of clinical supervision in nursing, reflect on the topic of clinical supervision
and the process of qualitative research.
Target Audience
The target audience of this presentation are the nurses of clinical practice, managers, researchers and
academics of this area.
Abstract
Purpose: In Portugal the discussion and research on clinical supervision in nursing has deepened in the
last decade, it being understood that this is a formal process of professional support, facilitating the
development of nurse’s cognitive, technical, communication, attitudinal and ethical responsibilities and
skills through formative, restorative and normative functions, promoting the quality of professional
practice.
The interest in promoting quality health care in an integrated perspective that takes into account the
simultaneous development of organizations, professionals and practices, has led to deeper reflection
about clinical supervision and its adoption in clinical practice. In this sense, in portugal, we have sought to
develop programs of clinical supervision, which from our point of view, in our reality, should result from
the work of clarification and legal construction, emerging contexts result of the work and involvement of all
stakeholders, to they make sense.
The aim of this research is to contribute to the design of a nursing clinical supervision program in the
context of primary health care by identifying a set of strategies of clinical supervision to integrate in it.
Methods: We carried out a exploratory study anchored in the qualitative paradigm. Data collection was
done using half-structured interviews, with a sample of 16 nurses from a primary health care center, from
a Cluster of Health Centers of the north of the country, between may and december of 2012.
We used the audio recording as a resource for the documentation of the data collected, with the
permission of the participants in the written informed consent model. After transcription of the recorded
data, we proceeded to its analysis, through content analysis according to the principles of the grounded
theory method using the program Nvivo10.

About respect for the ethical questions that guided the study, was requested and obtained the favorable
opinion of the Ethics Committee for Health of the North Regional Health Authority, and also by Executive
Director and Nurse Supervisor at a Cluster of Health Centers of the north of the country.
Results: Nurses who participated in the study understand that clinical supervision program to implement
in the primary health center should include strategies for professional guidance including in complex
clinical situations; individual supervision sessions to discuss sensitive topics with supervisor, avoiding
exposure in the group; group supervision sessions to share opinions, feelings and emotions, the working
group as a support member; practices; observation by the supervisor; reflection on clinical practice;
demonstration; continuing education; individual and group case analyze, self supervision; record analyze;
reflexive report; feedback; emotional support from the supervisor; learning about coping strategies; safety
of health care and prevention of error (standards and guidelines); supervision strategies for distance
(phone, mobile and skipe).
Conclusion: In Portugal the implementation of clinical supervision programs in health services is an
emerging issue. In this sense we understand that the supervision programs to implementing should not
be imported from other realities and cultures. From the existing models, nurses should reflect and work to
build models or programs for their own institutions from the work, reflection and involvement of all
stakeholders, to they make sense.
Being nursing clinical supervision a process that allows exploring innovative strategies to promote
excellence in nursing practice, we understand that this research contributes in this direction by identifying
a set of strategies that nurses consider to be included in a program of clinical supervision in the context of
care primary health.
References
BRUNERO, S.; STEIN-PARBURY, J. – The effectiveness of clinical supervision in nursing: an evidenced based
literature review. Australian Journal of Advanced Nursing. Vol. 25, nº 3 (2008) p. 86 – 94. BRUNT, B.; Critical thinking
in nursing: an integrated review. The journal of continuing education in nursing. Vol. 36, n. º 2 (2005), p. 60-67.
DEPARTMENT OF HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY – Clinical Supervision for mental health
nurses in Northern Ireland: best practice guidelines. Nursing and Midwifery advisory group. 2004. Belfast.
DONABEDIAN, A. – Na introduction to quality assurance in health care. New York: Ed. By Bashshur, Oxford
University Press, 2003. GARRIDO, A.; LINDO, J.; PIRES, R. - Supervisão clínica em enfermagem: perspetivas
práticas. Universidade de Aveiro, 2008. HYRKÄS, K.; APPELQVIST-SCHMIDLECHNER, K.; HAATAJA, R. – Efficacy
of Clinical Supervision: influence on job satisfaction, burnout and quality of care. Journal compilation. (2006) p. 521-
535. JONES, A. - Clinical supervision: what do we know and what do we need to know? A review and commentary.
Journal of Nursing Management. Vol. 14 (2006) p. 577-585. KOIVU, A.; SAARINEN, P.; HYRKÄS, K. - Stress relief of
practice development: varied reasons for attending clinical supervision. Journal of Nursing Management. Vol. 19, nº 1
(2011) p. 644-654. MCCOLGAN, K.; RICE, C. - Clinical supervision: the development of an online resource for
supervisee training. Nursing Standard. Vol. 26, nº 24 (2012) p. 35-39. PATON, B.; BINDING, L. – Keeping the center
of nursing alive: a framework for preceptor discernment and accountability. The Journal of Continuing Education in
Nursing. Vol. 40, nº 3 (2009) p. 115-120. POLIT, D.; BECK, C. – Fundamentos de pesquisa em enfermagem:
avaliação de evidências para a prática da enfermagem. 7ªed. Porto Alegre: Artmed, 2011. PROCTOR, B. – Training
of the supervision alliance attitude, skills and intention. In Fundamental Themes in Clinical Supervision. London:
Routledge Editions, 2006. SILVA, R.; PIRES, R.; VILELA, C. – Supervisão de estudantes de enfermagem em ensino
clínico: revisão sistemática da literatura. Revista de Enfermagem Referência. Vol. 3 (2011) p. 113-122. STRAUSS,
A.; CORBIN, J. - Basics of Qualitative Research. Techniques and procedures for developing grounded theory. 2ª
Edition. California : SAGE Publications, 1998. STRAUSS, A.; CORBIN, J. - Pesquisa Qualitativa. Técnicas e
procedimentos para o desenvolvimento de teoria fundamentada. [trad.] Luciane de Oliveira da Rocha. 2ª. Porto
Alegre : Artmed, 2008. 978-85-363-1043-5. WRIGHT, J. – Clinical supervision: a review of the evidence base.
Nursing standard. Vol. 27, nº 3 (2012) p. 44 – 49.
Contact
[email protected]

J 06 - Global Women's Health Concerns
Do Nurses Have Worse Pregnancy Outcomes?
Hui-Ju Yang, MS, RN, Taiwan
Feng-yu Kao, Taiwan
Yiing-Jenq Chou, PhD, Taiwan
Kuang-Yi Chang, PhD, Taiwan
Purpose
The purpose of this presentation is the learner will be able to aware of the higher risk associated with
nursing job. The learner will be able to aware of that nurse have the higher risk of tocolysis, cesarean
section, and preterm birth than non-nurse.
Target Audience
The target audience of this presentation are clinical nurse, academic nurse, and administrative nurse who
are interested in the reproductive health of nurse.
Abstract
Purpose: Nurses encounter multiple occupational exposures in their daily work which may harm their
reproductive health. The purpose of the study was to compare pregnancy complications and outcomes
including cesarean deliveries, tocolysis, abortion, and preterm births between female nurses and non-
nurse comparative women in Taiwan.
Methods: This nationwide population-based study was performed using the National Health Insurance
Research Database from 1997 to 2008. We identified 3,656 pregnancies among 2,326 nurses and
111,889 pregnancies among 74,919 non-nurses. Generalized estimating equation was used to compare
risks between the two groups.
Results: The rate of tocolysis (28.61% vs. 22.30%), abortion (6.21% vs. 5.37%), and preterm birth
(8.07% vs. 5.66%) were significantly higher among nurses than non-nurses. After adjustment for
background differences, nurses had significantly higher risk for cesarean section (adjusted OR=1.12, 95%
confidence interval [CI] 1.03-1.22), tocolysis (OR=1.18, 95% CI 1.09-1.29), and preterm birth (OR=1.46,
95% CI 1.28-1.67). When labor/delivery morbidities were further adjusted for, risk for cesarean section
became insignificant, while the risk for tocolysis and preterm birth remained.
Conclusion: Nurses are at higher risk for tocolysis, cesarean section, and preterm birth than non-nurses.
Occupational exposures related to those adverse pregnancy outcomes should be examined. Strategies to
decrease the risk should be developed in order to improve reproductive health among nurses.
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3. Momeni M, Danaei M, Askarian M. How do nurses manage their occupational exposure to cytotoxic drugs? A
descriptive survey in chemotherapy settings, Shiraz, Iran. Int J Occup Environ Med. 2013; 4(2):102-6. 4. Liu QL, He
XZ, Liang K, Xie R, Fang HP, Zhu KJ, Fan YM. Prevalence and risk factors for latex glove allergy among female
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10.1179/2049396712Y.0000000012. 5. Le Moual N, Varraso R, Zock JP, Henneberger P, Speizer FE, Kauffmann F,
Camargo CA Jr. Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study. J
Occup Environ Med. 2013; 55(8):973-7. doi: 10.1097/JOM.0b013e318297325b. 6. Musak L, Smerhovsky Z,
Halasova E, Osina O, Letkova L, Vodickova L, Polakova V, Buchancova J, Hemminki K, Vodicka P. Chromosomal
damage among medical staff occupationally exposed to volatile anesthetics, antineoplastic drugs, and formaldehyde.
Scand J Work Environ Health. 2013; 39(6):618-30. doi: 10.5271/sjweh.3358. 7. Flo E, Pallesen S, Åkerstedt T,
Magerøy N, Moen BE, Grønli J, Nordhus IH, Bjorvatn B. Shift-related sleep problems vary according to work
schedule. Occup Environ Med. 2013; 70(4):238-45. doi: 10.1136/oemed-2012-101091. 8. Al-Eisa E, Al-Abbad H.
Occupational back pain among rehabilitation nurses in Saudi Arabia: the influence of knowledge and awareness.

Workplace Health Saf. 2013; 61(9):401-7. doi: 10.3928/21650799-20130816-91. 9. Yassi A, Lockhart K. Work-
relatedness of low back pain in nursing personnel: a systematic review. Int J Occup Environ Health. 2013; 19(3):223-
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or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome. Liver Int.
2010;30(5):765-70. 12. Whelan EA, Lawson CC, Grajewski B, Hibert EN, Spiegelman D, Rich-Edwards JW. Work
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CM, Whelan EA, Lividoti Hibert EN, Grajewski B, Spiegelman D, Rich-Edwards JW. Occupational exposures among
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Contact
[email protected]

J 06 - Global Women's Health Concerns
Changing Cultural Beliefs Contributing to Breast Cancer Deaths
Carol Estwing Ferrans, PhD, RN, FAAN, USA
Garth Rauscher, PhD, USA
Marilyn Willis, MS, USA
Purpose
to report research showing that (1) cultural beliefs clearly contribute to breast cancer deaths, and (2)
these beliefs could be changed by viewing a short film on DVD followed by a question and answer
session, in a community-based setting, providing a simple, cost-effective technique that could be widely
disseminated.
Target Audience
Researchers and clinicians interested in (1) improving health disparities in breast cancer; (2) changing
cultural beliefs in breast cancer; (3) identifying models for community change applicable to other
illnesses; (4) cross-cultural work to improve beliefs and health behaviors; (5) examples of effective
community-wide interventions.
Abstract
Purpose: Chicago has one of the largest disparities in breast cancer mortality in the nation, with African
American death rates twice that of Caucasians at its peak. Previous work of our team showed that the
cultural beliefs we identified were associated with (1) longer delays after finding a suspicious breast
symptom, (2) later stage of breast cancer at diagnosis, and (3) longer delays between diagnosis and the
start of treatment for African American women. The purpose of this study was to determine whether
cultural beliefs about breast cancer could be changed by viewing a short film on DVD followed by at
question and answer session, which would provide a simple, cost-effective technique that could be widely
disseminated.
Methods: A 14-minute film on DVD was produced, in which five African American cancer survivors
address the cultural beliefs identified in our earlier work, speaking compellingly in their own words. A
pretest-posttest design was used to evaluate the DVD, with 260 African American women participating in
community settings. Cultural beliefs were evaluated by questionnaire before and after watching the DVD,
and again after a question and answer period led by an African American nurse, all in one continuous
session lasting 90 minutes.
Results: Changes in beliefs were found for the entire intervention (DVD plus Q&A), with the largest
change occurring after watching the DVD, as shown by logistic regression (p <.0001). Significant changes
were found for total cultural belief scores, as well as specific beliefs. One of the most important beliefs
that increased was endorsement of idea that breast cancer can be cured if treated correctly, even for poor
women. There was a decrease in the belief that breast cancer would grow faster if it were cut open in
surgery. Examples of faith-based beliefs that changed were faith in God can protect you from breast
cancer and prayer can make breast lumps disappear. Ninety-nine percent considered the DVD to
be worth watching, and 79% stated that it helped them decide to get screened for breast cancer (other
women reported that they were already participating in screening).
Conclusion: This is the first study we are aware of that demonstrated that cultural beliefs about breast
cancer can be changed by viewing a short film on DVD. This DVD provides a simple, cost-effective
technique that can be easily used for wide dissemination, with the goal of reducing disparities in breast
cancer mortality. Our team is currently conducting a dissemination project focused on the south side of
Chicago with the DVD. To date more than 8,500 women have participated in the project. The film has
been endorsed by the American Cancer Society and was selected for a national Telly Award.
This work was funded by the U.S. National Institutes of Health: National Cancer Institute, National
Institute on Aging, and National Institute on Minority Health and Health Disparities.
Contact

[email protected]

J 10 - Exploring Technology to Improve Patient Care
Exploring Nursing Cost Using Patient Level Data
Peggy A. Jenkins, PhD, RN, USA
Purpose
The purpose of this presentation is to share a contemporary methodology for measuring nursing cost at
the patient level. Patient assignment software linking patients to nurses was used to quantify the
variability in direct nursing cost per acute care episode and to explore the relationships among nursing
characteristics and cost.
Target Audience
The target audience of this presentation is nursing scientists, leaders, administrators interested in new
methodologies for nursing cost research. Standardizing nursing cost measurement at the patient level
provides a common approach for nurses worldwide to benchmark direct nursing cost and gives nursing a
more informed voice in resource allocation discussions.
Abstract
Purpose: A focus in the American healthcare system is on value-based delivery of services. Payment
models will reward hospitals that can efficiently and effectively care for patients. Since nursing is the
largest labor segment in the hospital, understanding this very important input is imperative in delivering
high quality care at an affordable price. Traditional methods of accounting for nursing services have
included measuring nursing hours per patient day, which is a unit level measurement that does not
include variability in nursing care at the patient level. Nursing administrators, healthcare leaders, payers,
and patients should be interested in understanding the cost of nursing service at the patient level. To
benchmark patient level costs, hospitals need to move beyond current unit level measurements of cost to
analytics linking individual patients to nurses. Using patient level data in nursing research provides a
source capable of answering many unrequited questions about individual nursing contributions to patient
outcomes. The current science of nursing cost will evolve and evidence can be provided through which
value based healthcare is better built across the world.
The purpose of the study was 1) to explore the variability of nursing cost per acute care episode for
patients with similar DRGs with and without major complications; 2) to investigate the relationship among
patient characteristics, nurse characteristics, nursing intensity, and nursing cost as a patient outcome.
Four research questions included:
1. What is the variation in nursing cost per acute care episode for patients with the same DRGs
without complications, with complications, with major complications?
2. What is the relationship among nursing characteristics (age, years of service, educational degree)
on nursing cost per acute care episode?
3. What are the characteristics of nurses assigned to patients with complications and major
complications?
4. What is the average nursing cost per day measured at the patient level?
Methods: A retrospective, exploratory, cost study using secondary patient level de-identified data was
completed. The study site was one general medical surgical unit in a large academic medical center
located in the Central United States. The study site organization has earned Magnet designation. Sample
was 3111 patients and 150 nurses on the unit over a two-year period.
Important and time-consuming steps in secondary data analysis included data acquisition and
management. The collaborative data acquisition process was complex and took almost two years to
accomplish. The source of data was Clairvia® Care Value Management Patient Assignment software plus
medical management and human resources databases. De-identification of data was completed before
the researcher obtained data. Staff time to de-identify data was negotiated via conference calls and on-
site meetings by the researcher with the president of the software company and the nurse scientist and
other significant staff from the study site.

The researcher used a model for data management consisting of four steps; 1) planning, 2) organization,
3) computing, 4) documentation. 9 Stata do-files provided a tool to systematically record commands for
each step of the data management and analysis process.
Forty-five variables were collected, cleansed, and new variables were constructed for a total of forty-nine
final study variables. Data were analyzed at the shift level, day level, and patient episode of care level
according to the research question. Shift level patient and nursing intensity data were one original source
of data, which were aggregated to patient episode of care to understand nursing cost per acute episode.
Patient and nurse characteristic data were another source of data that were merged with shift level data.
The conceptual definition of nursing cost per acute care episode (NCACE) was comprised of lower level
elements (NI-nursing intensity) that were aggregated to form the emergent model (summation of
individual nurse intensity per patient multiplied by individual nurse hourly wage).
NCACE =ΣNI*NW
NCACE represents Nursing Cost per Acute Care Episode, which was defined as the summation of the
product of nursing intensity (NI) and nursing hourly wage (NW).
NI= f (time spent with patient) + (skill level of nurse)
Nursing intensity was a function of time spent with the patient measured using Clairvia demand-driven
patient assignment software. Nursing intensity was calculated in the patient assignment software based
on the following methodology. The acuity score was a 1-12 point scale derived from an outcomes-driven
model grounded in the Pesut and Herman conceptual framework, the Outcome-Present State-Test Model
of Clinical Reasoning. 10 Nurses rated patients every shift or when condition changed on several
outcomes using a 1-5 point scale that contributes to an algorithm producing the nursing intensity score. A
monthly audit was completed to assure interrater reliability of acuity measurement and the result was
86% accuracy. Skill level of the nurse was recorded in the Clairvia software as RN, LPN, and Patient
Care Associate.
NW= f (experience, years of service, education, certification)
Nursing wage was operationalized using actual hourly wage for each nurse providing direct care.
The principle diagnosis was measured through the DRG. Complications were measured using a four level
variable “compcode”. The four value labels of the variable were 0 = no drg, 1= without complications, 2 =
with complications, 3 = with major complications. Using the same DRG without, with, and with major
complications allowed for a comparison of nurses assigned to increasingly complex patients. Nurse
characteristics were measured and analyzed in relationship to cost of nursing care.
Variables describing the nursing unit that are contextual included unit type, number of beds, average
acuity per patient, unit skill mix. Nurse characteristics measured included skill level, age, education level,
years of service at institution, years of service on the unit, and float.
De-identified data from three databases were merged into a single file and analyzed using Stata software.
Correlation analysis and regression analysis were used to explore relationships among patient
characteristics, nursing characteristics, and nursing cost per acute care episode. Microeconometric
measurement was used to determine the elasticity of nursing characteristics on patient acuity and direct
nursing cost per patient.
IRB expedited approval and continuation was obtained from the study site and the researcher’s
University.
Results: Key findings included 1) patients with the same diagnosis have large variability in nursing
intensity and nursing cost by shift, day and acute care episode (i.e. cost per day range DRG 192 $5.68-
287.37, 191 $5.96-257.56, 190 $10.06-366.86); 2) nurses may not be assigned patients based on
experience and education level; 3) direct nursing cost per patient on the study unit was $96.48 on
average per day, which was only 5.8-7.3% of the daily room and board charge.
Conclusion: There is large variability in direct NCACE for patients with similar DRGs. An example is
patients with COPD without complications (NCACE range $54-1570, M $325, SD $242); COPD with
complications (NCACE range $17-3674, M 408, SD $427); COPD with major complications (NCACE

range $132-1455, M $462, SD $316). Nurse scientists have provided evidence for variability in nursing
cost for patients with similar DRGs for decades, yet hospitals in America continue to be reimbursed under
an assumption that patients with similar DRGs receive the same amount of nursing care.
11,12,13,14 This study refutes the assumption.
RN years experience in the organization was the nurse characteristic most associated with direct nursing
cost. A 10% increase or 9.3 total nurse years experience in the organization for the patient episode of
care is associated with a 9.9% or $34.92 increase in direct cost of nursing care per episode for patients
on the study unit holding all other variables constant.
Data did not support the hypothesis that nurses with greater experience or education level are assigned
sicker patients. Average RN experience assigned per patient episode was not significant when regressed
on average patient acuity. Percent of BSN nurses assigned was significant in the model with nominal
effect.
The mean nursing direct cost per day for all patients in the study was $96.48 (SD $55.73, range $.33-
600.81). The room and board charge for each patient in a medical/surgical unit at the study hospital
ranges from $1321-1650 per day. Therefore, the direct nursing cost per day is only 5.8-7.3% of the daily
room and board charge. Direct nursing care is a small percent of the cost, but patients don’t know this
because direct nursing cost is included in the room and board charge and not itemized on the patient bill.
Limitations of the study include de-identified data from a secondary source were used and cases with
missing data were excluded. Data from large databases have been entered by multiple sources so
threats to reliability and validity of data exist. Overtime and differential wage data were not obtained due
to burden of extraction. The study was completed using data from a single unit in a one organization;
hence the results of the study are not generalizable beyond the study unit. The methodology of using
patient level data to explore direct nursing cost can be replicated and expanded using all units the patient
is on during an acute care episode. Innovative patient assignment software provides a convenient source
of data for nurse scientists and nurse leaders to use in creating next generation nursing science.
References
1. Diers DJ, Bozzo & RIMS/Nursing Acuity Project Group. Nursing resource definition in DRGs. Nurs Econ.
1997;15(3):124-130,137. 2. Edwardson SR, Giovannetti PB. A review of cost-accounting methods for nursing
services. Nurs Econ. 1987;3:107-117. 3. Pappas SH. Describing costs related to nursing. JONA. 2007;37(1):32-40. 4.
Aiken LH, Clarke SP, Sloane DM. Hospital staffing, organizational support, and quality of care: Cross-national
findings. Int J Qual Health Care. 2002;14(1): 5-13. 5. Blegen MA, Goode CJ, Reed L (1998). Nurse staffing and
patient outcomes. Nurs Res. 1998;47:43-50. 6. Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ (2007). The
association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Med
Care. 2007;45(12):1195-1204. 7. Needleman J, Buerhaus P, Pankratz VS, et al. Nurse staffing and inpatient hospital
mortality, N Engl J Med. 2011;364(11):1037-1045. 8. Welton JM, Zone-Smith L, Bandyopadhyay D. Estimating
nursing intensity and direct cost using the nurse-patient assignment. JONA. 2009;39(6):276-284. 9. Long JS. The
Workflow of Data Analysis Using Stata. College Station, TX: StataCorp.; 2009. 10. Eck Birmingham S, Nell K, Abe N.
Determining staffing needs based on patient outcomes versus nursing interventions. In: Current Issues in Nursing.
Philadelphia, PA: Elsevier; 2010. 11. Chiang B. Estimating nursing costs-A methodological review. Int J Nurs Stud.
2009;46:716-722. 12. Naylor MD, Munro BH, Brooten DA. Measuring the effectiveness of nursing practice. Clin Nurs
Spec. 1991;5(4):210-215. 13. Thompson JD, Diers D. DRGs and nursing intensity. Nursing & HealthCare. 1985;6:
434-439. 14. Wilson L, Prescott PA, Aleksandrowicz L. Nursing: A major hospital cost component. H Serv Res.
1988;22(6):773-795.
Contact
[email protected]

J 10 - Exploring Technology to Improve Patient Care
Using Social Network Analysis to Depict the Structure of Research Collaborations
Beth Baldwin Tigges, PhD, RN, CPNP, BC, USA
Shana Lane, MA, USA
Richard S. Larson, MD, PhD, USA
Purpose
to describe the results of a social network analysis of cross-departmental research collaborations within
one university on clinical and translational science pilot grants over three years.
Target Audience
researchers interested in the use of social network analysis to depict network structures
Abstract
Purpose: The purpose of this study was to examine the structure of internal pilot grant collaborations in
the first three years of the University of New Mexico Health Sciences Center (UNM HSC) Clinical and
Translational Science Center (CTSC) in the U.S. using social network analysis. Research funding
agencies are increasingly prioritizing research that involves collaboration across multiple disciplines or
specialties, institutions, or geographical locations. Social network analysis is one analytic tool that is
useful for depicting the structure of collaboration and changes over time. In the U.S., initiatives such as
the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program aim to
transform academic health science centers and increase the speed with which basic scientific discoveries
become widely disseminated health care interventions. Two of the strategies used by many institutions
with CTSAs to meet this aim are campus-wide pilot grant programs that provide preliminary data for
extramural awards and structured opportunities for cross-disciplinary and -institutional
collaboration. Team science is viewed as one possible catalyst for rapid outcomes from translational
research; team members can work on multiple different, yet complementary aspects of a scientific clinical
problem simultaneously. Pilot grant applications with multiple collaborators are often viewed more
favorably by reviewers than single investigator proposals because of their potential for facilitating the
formation of long-standing research teams. Yet little is known about the characteristics of such teams,
including their composition. This study examined the structure of these collaborative research teams at
one CTSA-funded institution in the U.S.
Methods: Study Design: The study was a secondary analysis based on retrospective document review
of three years of awarded pilot grant applications at the UNM HSC NIH-funded CTSC. The pilot grant
program is open to principal investigators from any of the three colleges or schools at the UNM HSC
(College of Nursing, College of Pharmacy, 19 departments from the School of Medicine).
Sample: 80 awarded pilot grant applications (Year 1 = 24, Year 2 = 34, Year 3 = 40)
Procedures: Two separate reviewers evaluated the face pages and biosketches of the applications to
identify the college or departmental affiliation of collaborators (inter-rater agreement = 90%). The primary
author determined final inclusion when there was disagreement. Only internal UNM collaborations were
included in this study. Collaborators were defined as any faculty or post-doctoral fellow who was either
listed as a co-investigator on the face page of the application or had an included
biosketch. Biostatisticians were not included if they did not have a faculty title or had a solely technical
role in data analysis. An instance of collaboration was defined as two collaborators from two different
UNM colleges or departments, either inside or outside of the UNM HSC. Collaborations within a single
college or department were not counted. Multiple collaborators from the same college or department on a
single application, who were collaborating with someone from another college or department, were
counted as one instance of collaboration only.
Measures: Research collaborations were depicted visually using sociograms. Each node in the
sociogram represented a university college or department. Edges in the sociogram (the lines between
the nodes) represented collaborations on pilot grants. Thicker edges depicted more

collaboration. Density was the number of total edges (collaborations) between colleges or departments
divided by the maximum number of possible collaborations (normalized range 0-1, with 1 representing a
“complete network”). Degree centrality was the percent of all the direct collaborations that involved a
given college or department. Betweeness centrality measured the number of times a college or
department needed a given college or department to reach another. It measured position in the
network. College and departments were rank ordered in terms of their betweeness centrality.
Analysis: Data matrices of collaboration counts were developed and entered into UCiNet software for
analysis of network density, degree centrality, betweeness centrality, and generation of sociograms using
compatible NetDraw software.
Results: Sociograms illustrated increased cumulative number and variety of research collaborations
between colleges and departments over three years. Stepped cumulative density increased from .10
(Year 1), to .22 (Years 1, 2), to .29 (Years 1, 2, 3) demonstrating new partnerships with each successive
year and increasing network cohesion over time. Collaborations were primarily within the UNM HSC, but
there were collaborations within the broader UNM campus between a HSC college or department and
UNM departments of Physics and Astronomy; Electrical and Computer Engineering; Psychology; or
Health, Exercise, and Sports Science. Departments that consistently had the highest degree centrality
(for two or more of the three years) and had key roles in collaborations were all from the School of
Medicine: Internal Medicine (18% Year 1, 25% Year 2), Neurology (21% Year 1, 13% Year 3), and
Pediatrics (15% Year 1, 13% Year 2). These collaborations tended to be with physicians of different
specialties, rather than with PhD-prepared basic scientists, pharmacists, or nurses. Radiology (12% Year
1), Biochemistry and Molecular Biology (10%), Molecular Genetics and Microbiology (17%), and
Psychiatry (13%) also had high degree centrality in one year each. The College of Pharmacy and the
School of Medicine departments of Internal Medicine, Pediatrics, Molecular Genetics and Microbiology
were the organizations with the most frequent betweeness centrality and the most strategic positions for
facilitating collaboration. The College of Nursing increased in density, degree centrality, and betweeness
centrality between Years 1 and 3. Nursing faculty collaborated with colleagues from Psychology, Internal
Medicine, and Emergency Medicine. Cumulative overall network centrality increased from 11% in Year 1
to 20% in Year 3. Likewise, cumulative overall network betweeness increased from 13% in Year 1 to
35% in Year 3.
Conclusion: In the initial three years of a clinical and translational science pilot grant program at one
CTSA-funded university in the U.S., new collaborations between investigators from different colleges and
department continued to form and certain colleges and departments were consistently central to the
formation of those partnerships. Social network analysis is a useful tool for researchers from around the
world for depicting the structure of research collaborations. Feedback from the analyses may also be
effective in encouraging investigators and organizations to either initiate collaboration for the first time or
take a leadership role in facilitating collaboration within the institution.
This project was supported in full by the U.S. National Center for Research Resources and the U.S.
National Center for Advancing Translational Sciences of the U.S. National Institutes of Health through
Grant Number UL1 TR000041 (R. Larson, PI). The content is solely the responsibility of the authors and
does not necessarily represent the official views of the NIH
Contact
[email protected]

J 11 - Integrating Global Community Mental Health Services
Integrated Community Mental Health Services (ICMHS): Quality of Life and Patient
Satisfaction
Vico C. L. Chiang, PhD, MHA, GDipMgtSt, BN, RN, MACN, FHKAN (CritCr), Hong Kong
M. Y. Chan, BB, Hong Kong
H. C. Li, BA (Hons), Hong Kong
W. L. Lin, BA (Hons), Hong Kong
W. M. Wong, BSS (Hons), Hong Kong
W. S. Wong, Hong Kong
Purpose
There is a paucity of outcome studies on integrated community mental health service (ICMHS). The
purpose of this presentation is to share with the international audience about the findings of QOL and
patient satisfaction after ICMHS in Hong Kong. This may contribute to further development of ICMHS.
Target Audience
The target audience of this presentation are mental health professionals, in particular multi-disciplinary,
who provide care and support to mentally ill clients in the community.
Abstract
Purpose: There is no fixed definition of integrated community mental health service (ICMHS) (England &
Lester, 2005; Kodner & Spreeuwenberg, 2002); and a review of the literature indicated a paucity of
studies in evaluating the outcomes of this service. Various yet segregated approaches of mental health
services have been utilized in Hong Kong in the community. In this connection, the government has
established the Integrated Community Centre for Mental Wellness (ICCMW) since October 2010 in all
districts with a view to enhance the multi-disciplinary community support to patients and re-integrating
them better into the community. It is necessary to investigate the outcomes of this newly introduced
ICHMS with patient-defined outcomes for further service development.
This study aimed to investigate and enhance the understanding of patients’ quality of life (QOL) and
patient satisfaction after discharge from an ICCMW.
Methods: The design was a quantitative descriptive and correlational study. The setting was one of the
24 ICCMWs out of 18 districts in Hong Kong. Upon receiving informed consent of the participants, the
study was conducted by face-to-face interview or phone interview with the Lehman Quality of
Life Interview – Brief Version (QOLI – BV) (Lehman, Kernan, & Postrado, 1995) plus demographics
collection (Section A) of the Full Version (Lehman, 1983); and the Risser Patient Satisfaction Scale –
Chinese Version (RPSS – CV) (Chan & Yu, 1993; Risser, 1975).
There were a total of 206 clients discharged from the identified ICCMW with at least one psychiatric
diagnosis categorized by DSM-IV who were discharged from March 2011 to March 2013. Among these
patients, 169 were contacted and 53 patients agreed to participate in the study.
Results: There were 67.9% of the participants who expressed satisfaction in General Life Satisfaction
subscale of the QOLI – BV with an overall mean of 4.86 (SD 1.19) at the level of neutral tending to
satisfied. The overall Patient Satisfaction was also neutral tending to satisfied (mean 3.66, SD 0.27). For
QOLI – BV, gender (p = 0.017) and household composition (p = 0.033) contributed to significant
differences in the sub-scale of Satisfaction with Social Relations; while there was a significant difference
in General Life Satisfaction between different household compositions (p = 0.044). The areas of patient
satisfaction with the service of ICCMW included genuine and welcoming staff; professional and diligent
staff; popular group events and follow-up services; and the instrumental and psychosocial support.
Patients also raised several areas for improvement: to increase frequency and duration of contacts, to
maintain continuity of services, to enhance promotion of events, to expand services and resources, and to
improve professionalism of staff. No significant correlation was found between QOL and patient
satisfaction.

Conclusion: From the results of this study, there is room for improvement in educating about the
treatment and progress of specific mental illnesses for individual patients who attended the service of
ICCMW. Increased attention should be paid to the needs of patients, particularly for those without a
partner in the community. More efforts may be put in improving patients’ social relations, such as to set up
a daytime drop-in service in ICCMW. For future studies, a specific QOL and patient satisfaction scale for
ICMHS may be developed to better evaluate the outcomes of such service. Furthermore, qualitative
studies should be conducted in order to better understand the experience and outcomes of post-ICCMW
community life for the mental health patients.
Contact
[email protected]

J 11 - Integrating Global Community Mental Health Services
Implementation, Cultural Acceptability, and Impact of a Mental Health Program for
Haitian Healthcare Workers Developed after the 2010 Earthquake
Carole Wilkinson, DNP, RN, USA
Emma Mitchell, PhD, RN, USA
Debbie Anglade, BSN, USA
Marie Guerda Nicolas, PhD, USA
Purpose
The purpose of this presentation is to describe the implementation, the cultural acceptability, and the
impact of a Mental Health Training Program conducted in the north of Haiti after the 2010 earthquake.
Target Audience
This presentation is aimed at nurses and other professionals working in global health interested in the
development of culturally-specific interventions that target mental health issues after a disaster.
Abstract
Purpose: The purpose of this presentation is to describe the implementation, the cultural acceptability,
and the impact of a Mental Health Training Program conducted in the north of Haiti after the 2010
earthquake.
Methods: A qualitative descriptive approach was used to elicit information from 2 focus group (n=15) with
Haitian health care workers who had participated in the Mental Health Training Program (MHTP). The
researchers obtained information through group discussion using a semi-structured guide. Two focus
groups were conducted with eight (8) MHTP trainers in one group and eight (8) MHTP trainees in the
other group (in total 113 health care workers participated in the MHTP). Discussions centered on the
cultural factors related to the design and implementation of the MHTP training as well as professional
impact and acceptability of the training program. This study used qualitative content analysis to identify
and define the major themes that emerged from the focus groups. Content analysis is used to recognize
code and categorize patterns from text data. More specifically, when analyzing the transcripts directed
content analysis was used. This approach is recommended when there is prior literature related to the
phenomenon of interest that can benefit from further description. NVIVO (9) was used to conduct the
analysis and to facilitate data storage. Two research team members, working independently, read through
and coded each transcript. A codebook and coding sheet were developed to facilitate
coding.
Results: The majority of the 16 participants were women (83.3%), with a mean age of 36 [1] 10.0 years
(range = 24–54 years). Eight participants (50%) were single, 5 (31.3%) were married and 3 (18.7%) were
in a relationship. Two participants (12.5%) reported working with no salary, 3 (18.7%) worked part-time, 8
(50.0%) worked full-time and 3 (18.7 %) worked in multiple locations or sites. Eight (50%) participants
were nurses, 6 (37.5 %) were physicians and 2 (12.5%) were in other professions. Only one of the
participants had formal training in mental health. All participants recognized the need for increasing MH
services and the barriers that exist to implement mental health programs in Haiti. Especial consideration
was given to stigma and culturally influenced perceptions of mental health. Personal impact of the MHTP
was described not only in terms of HCWs’ personal lives, but also in terms of their personal development
as healthcare providers. The training allow the HCWs to give quality service to the population by
providing them with more specialized skills in identifying and addressing mental health issues. Many
changes have been made were the MHTP trainers now focus on dialogue, support, and follow ups with
the patients. Participants were not only motivated to participate actively in the MHTP but also were readily
engaged to apply knowledge in practice.

Conclusions: The study findings contribute to the knowledge base on mental health training among
HCWs in Haiti. Given the lack of research on mental health in Haiti, it is indispensable to improve our
understanding of the personal and professional impact and acceptability of the MHTP. This knowledge
will help us implement the MHTP in other parts of Haiti as well as in other countries. The MHTP changed
the HCWs perceptions about MH issues and provided them with the knowledge and skills to respond to
growing community MH needs. The interdisciplinary nature of the MH calls for collaborative research
efforts nationally and internationally. The MHTP can be applicable to other countries in the region and can
prepare nurses to recognize and address the immediate and longer term mental health needs arising
from catastrophic events. By increasing disaster response awareness, nurses can develop appropriate
interventions to combat the negative mental health effect of natural disaster.
References
Cianelli R.,Wilkinson C., Mitchell E., Anglade D., Nicolas G., Mitrani V. & Peragallo N. (2013) Mental health training
experiences among Haitian healthcare workers post-earthquake 2010. International Nursing Review 60, 528–535
Cianelli, R. (2012) Increasing mental health capacity in Cap-Haitien in response to the Haiti earthquake [El Centro:
Haiti – The Collaborative Work Developed by the University of Miami School of Nursing and Health Studies].
Symposium conducted at the XIII Pan American Nursing Research Colloquium, Miami, Florida, 5–7 September 2012.
Desrosiers, A. & St. Fleurose, S. (2002) Treating Haitian patients: key cultural aspects. American Journal of
Psychotherapy, 56, 508–521. Dubois, L. (2012) Haiti: The Aftershocks of History. Metropolitan Books, New York, NY.
Duggleby,W. (2005) What about focus group interaction data? Qualitative Health Research, 15, 832–840. Freeman,
K., O’Dell, C. & Meola, C. (2001) Focus group methodology for patients, parents, and siblings. Journal of Pediatric
Oncology Nursing, 18, 276–286. Lecomte, Y. & Raphaël, F. (2010) Santé mentale en Haïti: La pensée critique en
santé mentale. Revue Santé Mentale au Québec, Montreal, Canada. Nasrabadi, A.N., Naji, H., Mirzabeigi, G. &
Dadbakhs, M. (2007) Earthquake relief: Iranian nurses’ responses in Bam, 2003, and lessons learned. International
Nursing Review, 54, 13–18. Nicolas, G., Arntz, D.L., Hirsch, B. & Schmiedigen, A. (2009a) Cultural adaptation of a
group treatment for Haitian American adolescents. Professional Psychology: Research and Practice, 40, 378–384.
Nicolas, G., DaSilva, A.M., Houlahan, S. & Beltrame, C. (2009b) Culturally authentic scaling approach: a multi-step
method for culturally adapting measures for use with ethnic minority and immigrant youths. Journal of Youth
Development, 4, 81–95. World Health Organization (2010a) Mental Health in Haiti: A Literature Review.World Health
Organization, Geneva, Switzerland. World Health Organization (2010b) mhGAP Intervention Guide for Mental,
Neurological and Substance-Use Disorders in Non-Specialized Health Settings. World Health Organization, Geneva,
Switzerland. Yang, Y.N., et al. (2010) Chinese nurses’ experience in the Wenchuan earthquake relief. International
Nursing Review, 57, 217–223.
Contact
[email protected]

J 12 - Psychiatric Research in the Pediatric Population
The Relationship Between ADHD and School Attendance, School Behavior, and
School Performance
Nancy M. H. Pontes, PhD, RN, APN, FNP-BC, USA
Manuel C. F. Pontes, PhD, USA
Purpose
The purpose of this presentation is to show the relationship of Attention Deficit Hyperactivity Disorder
(ADHD)to increased school absences, and greater problems with school behavior and schoolwork using
U.S. nationally-representative data from the Medical Expenditure Panel Survery 2008-10 (MEPS). A
multidisciplinary intervention team will be proposed to improve student outcomes.
Target Audience
The target audience for this presentation is school nurses, nurse practitioners, pediatric and family health
care providers.
Abstract
Purpose: Previous research has shown that Attention Deficit Disorder (ADHD) is negatively associated
with school attendance and school performance, and positively associated with school behavioral
problems. However, these studies were conducted with samples drawn from individual schools or school
districts. Few studies were conducted with nationally representative samples. One such study from the
National Health Interview Survey (NHIS) was based on parent report, and did show a positive association
between ADHD and missed days of school. The purpose of this research is to investigate the relationship
between ADHD and school attendance, school behavior, and school performance of school-aged children
in the US using a large nationally representative sample.
Methods: Multivariate analyses were used to examine the relationship between ADHD and school
attendance, school behavior and school performance. Data are from the Medical Expenditure Panel
Survey 2008-11 (MEPS), using a complex survey design. The Columbia Impairment Scale (CIS) was
used to measure problems with school behavior and school work. The analysis was done by SAS
version 9.2, using proc surveymeans, surveyfreq and surveylogistic for data analyses.
Results: ADHD had a significant positive relationship to increased school absences, and greater
problems with school behavior and schoolwork. Analyses with health insurance, family income, family
structure, and gender as covariates showed that ADHD had a significant positive relationship with
increased school absences and problems with schoolwork.
Conclusions: These data illustrate the significant burden of ADHD on school performance. While some
research has shown that better management of ADHD in school settings improve outcomes, further
research is needed. More specifically, multidisciplinary teams with advanced practice nurses such as
nurse practitioners in school-based health centers should be further explored to see if their intervention is
associated with improved school performance in these children.
Contact
[email protected]

Factors Affecting the Timing of an Autism Spectrum Diagnosis
Ashley Darcy Mahoney, PhD, NNP-BC, USA
Melinda Higgins, PhD, USA
Bonnie Minter, MS, CPNP, USA
Purpose
To address the  question of whether late-preterm (LPT, 34-36 weeks) infants carry the same risk for ASD
as full-term infants and address how maternal education, race, age, marital status and neonatal factors
collectively affect the timing of when a child is diagnosed with ASD, realizing that early diagnosis
improves outcomes.
Target Audience
Nurses, Nurse Practitioners, and faculty
Abstract
Purpose: The prevalence of children with autistic spectrum disorders (ASD) has increased over the past
two decades. Over this same time period, the number of infants born preterm has also increased. Early
diagnosis of ASD enables interventions that improve the functioning of children with ASD. To address the
 question of whether late-preterm (LPT, 34-36 weeks) infants carry the same risk for ASD as full-term
infants, this study explored possible relationships between gestational age and ASD diagnosis.
Additionally, this study addressed how maternal education, race, age, marital status and neonatal factors
collectively affect the timing of when a child is diagnosed with ASD, realizing that early diagnosis
improves outcomes.
Methods: A retrospective cohort analysis of 664 children was undertaken at the largest Autism research
and treatment center in the country. The application of Bayes rule was used given that we do not have
sufficient information about the joint probabilities related to prematurity and autism. Using the estimated
gestational age proportions within ASD diagnosis, plus national estimates of ASD and prematurity,
probabilities for ASD within a given gestational age were calculated. For all variables, comparisons were
made between infants diagnosed with ASD and those not diagnosed with ASD using independent group
t-tests, non-parametric tests, and chi-square tests. The final predictive logistic regression model selected
used forward stepwise likelihood ratio variable selection to create the best ASD predictive model for
timing of diagnosis.
Results: On average, the 664 children in this cohort were 38.1 (SD 3.3) weeks with 7.1% Early Preterm
(EPT, <33 weeks) and 13.9% LPT. Sixty-one percent of the infants seen (406/664) were diagnosed with
ASD. Forty-six percent were Caucasian and 34% were African American. In comparison to full term
infants, EPT infants were significantly more likely to be diagnosed with ASD (1.9 times higher risk (95%
CI [1.3, 2.5] significant at α=.05). We observed an elevated prevalence of ASD among children born LPT
(1.2 times higher risk (95% CI [0.9, 1.5] not significant at α=.05), the magnitude of the elevation was not
statistically significant. Reviewing the hazard ratios, older, married parents were associated with a having
a child diagnosed with ASD at a younger age. Male infants and African American infants had a higher
probability of an earlier ASD diagnosis than female infants and Caucasian infants, respectively. No
statistically significant difference of timing of ASD diagnosis was found in infants across gestational age
groups.
Conclusion: EPT infants were significantly more likely to be diagnosed with ASD as compared to their
term counterparts. Our study identified a two-times greater risk among children born EPT. We observed
an elevated prevalence of ASD among children born LPT, the magnitude of the elevation was not
statistically significant. This study also demonstrates that children are more likely to have an earlier ASD
diagnosis if their parents are older, if the child’s gender is male, and if the child’s parents are married.
Early identification of risk factors offers an avenue for early diagnostic evaluation and referral.

References
Baio, J. & CDC’s Autism and Developmental Disabilities Monitoring Network (2012). Prevalence of Autism Spectrum
Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Surveillance
Sumaries, 51 (SS03); 1-19. March of Dimes 2006. PeriStats. Available at:
http://www.marchofdimes.com/peristats/pdflib/195/99/pdf. Accessed September 1, 2011. Mandell, D., Novak, M.,
Zubritsky, C. (2005). Factors associated with age of diagnosis among children with Autism Spectrum Disorders.
Pediatrics, 116 (6): 1480-1486. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data. Natl Vital Stat Rep.
2009;57(7):1–104. Wiggins, L., Baio, J., Rice, C. (2006). Examination of the time between first evaluation and first
autism spectrum diagnosis in a population-based sample. Developmental and Behavioral Pediatrics: 27 (2): S79-S87
Larsson HJ, Madsen KM, Vestergaard M, Olesen AV, Agerbo E, Schendel D, Thorsen P, Mortensen PB. Risk factors
for autism: perinatal factors, parental psychiatric history, and socioeconomic status. American Journal of
Epidemiology 2005; 161(10): 916-925.
Contact
[email protected]

Understanding the Families' Needs: Interventions for Family Members of
Adolescents with Disruptive Behavior Disorders
Ukamaka Marian Oruche, PhD, RN, USA
Purpose
The purpose of this study was to describe what family members of adolescents with Disruptive Behavior
Disorders(DBD) said they need for support from mental health professionals.
Target Audience
The target audience of this presentation is nurse researcher and clinicians who are interested in
psychaitric-mental health.
Abstract
Purpose: Adolescents with Disruptive Behavior Disorders (DBD) including Oppositional Defiant Disorder
and Conduct Disorder present unique challenges to their families. DBD are prevalent and serious mental
disorders first diagnosed in childhood. DBD are characterized by hostile, aggressive, defiant, and
antisocial behaviors. These adolescents are at risk to drop out of school, abuse drugs, or be arrested.
Therefore, family members of adolescents with DBD experience overwhelming and unrelenting stress
related to the difficult challenges of managing the adolescents' behavior problems and interacting-often
on a daily basis-with the mental health, schools, child welfare, and juvenile systems. While most
emperically-supported treatments for DBD are family-based, the emphasis is typically on the behavior of
the child rather than on the life challenges and the resultant distress experienced by the family members.
To develop interventions to address the needs of family members, a better understanding of what mental
health services they desire is needed. The purpose of this study is describe what multiple family members
including those rarely considered (i.e., fathers, siblings, and other adult family members) need for support
from mental health professionals.
Methods: The Double ABCX Model of Family Stress and Adaptation by McCubbin and Patterson (1983)
was used to guide the study. The model proposes that families experience life events or stressors such
as the serious illness of a family member. The stressor may overwhelm available family resources and
lead to hardships that affect all family members. Based on this model, we anticipated that caring for an
adolescent with DBD is a demand that will likely exceed the family's capacity to meet the demand and
therefore could result in altered family functioning, emotional stress, and the need for outside support.
Fifteen families of adolescents (13 - 18 years old) with DBD were recruited from a large publicly funded
community mental health center in Midwestern United States. Data were gathered from participants
(parents or primary caregivers, adolescents with DBD, siblings, and other adult family memebrs) using in-

depth individual interviews and a focus group interview (three parents or primary caregivers). Interviews
were analysed by standard content analytic procedures.
Results: The sample included 15 parents (14 females and one male, average age 45 years), 10 other
adult family members (four females and eight males, average age 37 years), 15 adolescents with DBD
(five females and 10 males, average age 15 years), and 12 siblings (four females and eight males,
average age 14 years). The racial breakdown of the 52 participants was 61% African American, 16%
Caucasian, and 23% biracial (mostly African American/Caucasian). The average annual household
income for the families was less than $30,000. Most of the data was provided by parents and other adult
family members but a few of the adolescents with DBD and their siblings also gave their opinion about
mental health interventions. Families said that they would prefer multi family groups that included both
psychoeducational sessions led by professionals and the time to network with other families that share
their challenges, and offered in their own neigborhoods. Families described a number of issues or topics
they would like professionals to address, including managing the adolescents' disruptive behaviors, family
communication and conflict resolution, education about the disorders, strategies to manage the
adolescents' care and service use, the personal issues and feelings of family members, and positive
outcomes experienced by families.
Conclusion: Findings provide the foundational data to begin the development of an emperically
supported intervention for family members of adolescents with DBD. The findings also suggest that
psychiatric nurses and other clinicians can clearly address some of the needs expressed by the family
members in the context of everyday clinical practice.
References
American Psychological Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text
Revision. Arlington, VA: American Psychological Association. Handwerk, M., Field, C., Dahl, A., & Malmberg, J.
(2012). Conduct, oppositional defiant, and disruptive behavior disorders. In P. Sturmey & M. Hersen (Eds.),
Handbook of evidence- based practice in clinical psychology, Vol 1: Child and adolescent disorders. (pp. 267- 301).
Hoboken, NJ US: John Wiley & Sons Inc. Gerkensmeyer, J. E., Johnson, C. S., Scott, E. L., Oruche, U., Lindsey, L.,
Austin, J. K., & Perkins, S. M. (2013). Problem solving intervention for primary caregivers of children with mental
health problems. Archives of Psychiatric Nursing. 27(3), 112-120. doi: 10.1016/j.apnu.2013.01.004 Heflinger, C., &
Humpherys, K. L. (2008). Identification and treatment with oppositional defiant disorders: A case study of one state's
public service system. Psychological Services, 5(2), 139-152. Kilmer, R., Cook, J., Munsell, E., & Salvador, S. (2010).
Factors associated with positive adjustment in siblings of children with severe emotional disturbance: The role of
family resources and community life. American Journal of Orthopsychiatry, 80(4), 473-481. Oruche, U.,
Gerkensmeyer, J., Stephan, L., Wheeler, C. & Hanna, K. (2012). Described experiences of caregivers of children with
mental health problems. Archives of Psychiatric Nursing, 26(5), 382- 39. PMCID: PMC3697759. McCubbin, H. I., &
Patterson, J. M. (1983). The family stress process: The double ABCX model of adjustment and adaptation. Marriage
& Family Review, 6(1-2), 7-37. doi: 10.1300/J002v06n01_02 Petitclerc, A. R. (2009). Childhood disruptive behaviour
disorders: Review of their origin, development, and prevention. Les troubles de comportement perturbateur de
l'enfance : une revue deleur origine, de leur développement et de la prévention. 54(4), 222-231. Rosenzweig, J. M., &
Kendall, J. (2008). Inside the family: Insights and experiences of family members. Work, Life, and mental health
system of care: A guide for professionals supporting families (57-87).
Contact
[email protected]

K 01 - Global Theoretical Issues in Healthcare
Using Diaries to Explore the Lived Experiences of Primary Healthcare Clinic
Nursing Managers in Two South African Provinces
Pascalia Ozida Munyewende, BSc (Hons), MA, South Africa
Purpose
to discuss and explore the lived experiences of primary health care clinic nursing managers in two South
African provinces using the diary method. It will also discuss the usefulness and limitations of using the
diary as a research method with nursing managers.
Target Audience
Nursing practitioners/managers, supervisors, policy makers, academics and or researchers and other
relevant conference attendees.
Abstract
Purpose: There is global recognition of the importance of the health workforce illustrated by the 2013
Global Forum on Human Resources for Health which asserted that the foundation for Universal Health
Coverage and the post-2015 development agenda focuses around health care workers. Locally and
internationally nurses are majority of health care providers in any health care system. In South Africa the
majority of primary health care (PHC) clinics are managed by nurses. Currently, South Africa is on the
brink of another wave of major health system reforms that underscore the centrality of PHC. Nurses will
play a critical role in these reforms, requiring new leadership, management skills and competencies.
There has been limited use of the diary method in nursing management contexts, particularly in low and
middle income settings. Diary methods involve, “intensive, repeated self reports that aim to capture
events, reflections, moods, pains or interactions near the time they occur” (Iida M 2012). Reflexive diaries
can unravel the successes, ambiguities or challenges faced by nursing managers. This paper discusses
and explores the lived experiences of primary health care clinic nursing managers in two South African
provinces using the diary method.
Methods: During 2012, a sub-set of 22 nursing managers were selected from a larger survey sample in
two South African provinces. After informed consent, participants were requested to keep individual
diaries for a period of six weeks, using a clear set of diary entry guidelines. Nursing managers were
asked to write about one thing that happened at work that week that really had an effect on them with
specific instructions that said: please write a date whenever you make an entry about: (1) What was the
event? (2) Why did it stand out for you or why did it stick in your mind? (3) How did it make you feel? (4)
What did you learn from it? (5) How will it affect the way you work in the future? Reminders consisted of
weekly short message service reminders and telephone calls. Diary entries were analysed using
thematic content analysis and MAXQDA version 11. A diary feedback meeting was held with all the
participants to validate the findings.
Results: Fifteen diaries were received, five were lost by the courier company and two nursing managers
did not participate in the diary study representing a 98% response rate. The majority of respondents were
female, aged 31 to 60 years with at least five years of work experience. Most participants made their diary
entries at home. Diary entries largely reflect negative emotions and were dominated by primary health
care nursing managers’ reflections on: staff shortages or challenges; patient care or community issues;
excessive workload; unsupportive supervision; and health system deficiencies. Key text from the diaries
relating to the themes were extracted, below is a brief description of the themes: Staff shortages is a
theme that occurred when shortages of professional nurses, nursing assistants, clerks, pharmacists,
doctors, social workers, gardeners etc were mentioned. It also includes staff shortages induced by
absenteeism, abuse of sick leave, staff leave, study leave, actual resignations and lack of staff retention.
Patient care/Community related to PHC nursing managers concern about any aspect of patient care,
disease programme management, patient complaints about perceived dedication and commitment of
staff, political expectations from the community and long waiting times. Excessive workload includes
diary entries that were made relating to overtime, taking work home, missing tea and lunch breaks and

neglecting admin work over patient consultations, doing what is perceived to be other people's work, e.g.
ordering drugs is pharmacist role, being blamed when things go wrong, as well as a focus on the actual
practise environment in PHC clinics. Unsupportive supervision related to negative remarks made by the
clinic supervisor to the clinic manager, tensions between supervisors, vertical communication or
leadership, delays in supporting clinic managers when requests for relief staff are made, missing
appointments, disorganisation and the resultant confusion in clinic managers' schedules caused by clinic
supervisors because of poor coordination and lack of planning. The fifth theme on health system
deficiencies included issues such as management inefficiencies and lack of attention to human
resources for health, lack of delegation and authority leading to disempowerment, paralysis caused by
role confusion, high level decisions on operational issues that affect clinic management but are made
without managers’ consultation, disabling practice environment, problems with infrastructure, shortages of
consumables, drugs and water.
Conclusion: The diary entries reveal the complexities, nuances and ambiguities of nursing management
at the PHC level especially staff shortages and how they impact negatively on all clinic management
activities. For research purposes, diaries are an innovative method in capturing the nature and dynamics
of nursing management. The results from our study show that diaries were used as a tool for reflection
and provided sufficient empirical information on nursing management experiences at the PHC level as
well as the reality that they experience in the workplace vs. theory of nursing management. Diaries as a
research method also provided nursing managers with a space for anonymity and confidentiality often not
possible with other qualitative research methods. Nursing managers were able to write about sensitive
information and experiences relating to specific aspects around which organisational norms in PHC clinic
settings are organised. The results apply to the local South African context but may also be applied in an
international context because most of the issues that concerned clinic managers such as staff shortages
or challenges; patient care or community issues; excessive workload; unsupportive supervision; and
health system deficiencies are universal. Therefore, the expressed concerns of nursing managers must
be addressed to ensure the success of PHC re-engineering reforms and health systems strengthening at
the PHC level.
References
1) Iida M., Shrout P E, Laurenceau J P, Bolger N. Using diary methods in psychological research. In: Cooper H CPM,
.Long D L,. Panter A T,. Rindskopf D,. & Sher K J,. editor. APA handbook of research methods in psychology.
Washington, DC, US: American Psychological Association; 2012. p. 277-305. 2) Verbrugge LM. Health diaries.
Medical Care 1980;18:73–95. 3) Bolger N, Davis A, Rafaeli E. Diary methods: capturing life as it is lived. Annual
review of psychology. 2003;54:579-616. 4) WHO, The Global Health Workforce Alliance. WHO Workforce Alliance.
Geneva, 2006.
Contact
[email protected]

K 01 - Global Theoretical Issues in Healthcare
Psychometric Properties of a Short Version of Effort-Reward Imbalance in Blue-
Collar Workers
Won Ju Hwang, MPH, PhD, RN, South Korea
OiSaeng Hong, PhD, RN, FAAN, USA
Purpose
The purposes of this study were to test psychometric properties of a short version of Effort Reward
Imbalance (ERI) questionnaire and to identify its relationship with job demand in blue-collar workers.
Target Audience
The target audience of this presentation is researchers and nurses related to occupatioinal health,
specifically interested in job stress.
Abstract
Purpose: The purposes of this study were to test psychometric properties of a short version of Effort
Reward Imbalance (ERI) questionnaire and to identify its relationship with job demand in blue-collar
workers.
Methods: In this study, we sought to translate the ERI short form into Korean and to examining the
psychometric properties in a sample of 250 blue-collar workers who are working at small companies. The
internal consistency reliability, structural validity, and criterion (content) validity were analyzed.
Results: The Cronbach’s alpha for the three scales were 0.75, 0.74, and 0.72, respectively. Confirmatory
factor analysis showed a good fit of the data with the theoretical structure (RMSEA = 0.07, CFI = 0.84).
Evidence of criterion validity was demonstrated. A significant synergistic interaction effect of ERI and
overcommitment on Job stress (demand) was observed (synergic effect 7.35, CI 2.89-18.52).
Conclusion: The short version of the ERI questionnaire demonstrated good psychometric properties with
Korean blue-collar workers. This supports further use of the instrument in future research and practice for
working population in Korea.
Contact
[email protected]

K 03 - Uses of Complementary and Alternative Medicine
Use of Honey for Healing Pressure Ulcers: An Integrative Review
Katherine Ricossa, RN, MS, USA
Purpose
The purpose of this presentation is to share research findings from the last decade as an Integrative
Review of the Literature examining an international approach for healing pressure ulcers using honey as
complementary and alternative method.
Target Audience
The target audience is to provide evidence based practice to the following nurses: those who provide
direct patient care; work in the area of wound care; and/or can influence decisions to a multidisciplinary
team about treatment modalities in the area of wound healing.
Abstract
Purpose: Using Complementary and Alternative Methods (CAM) offers a holistic approach of caring for
those with pressure ulcers. The purpose of this paper is to examine the caring and the healing process
using CAM to examine a Systematic Integrated Review of 9 randomized clinical trials on the use of honey
and the healing of pressure ulcers.
The costs of wound healing continue to escalate. It is important to explore alternative holistic modalities
which are cost effective and achieve the desired outcome of wound healing. Honey is the ideal substance
to provide effective wound healing properties: antibacterial, antimicrobial, anti inflammatory, wound
cleansing and debridement.
Methods: Several databases were examined: Natural Standard, Cochrane Library, PubMed, and Google
Scholar. Internationally 8 randomized clinical trials were identified using honey for wound healing of
pressure ulcers. No clinical trials were identified in the United States.
Results: In the last 10 years, internationally 6 randomized clinical and 1 Intervention Review have been
published on clinical trials examining the effectiveness of honey to treat and heal pressure ulcers as well
as other wounds. Each sample size was different based on the geographical area where the study was
conducted and different types of honey were used to determine the effectiveness on wound healing.
Honey was not always effective on some wounds, but the evidence indicates that honey is effective in
wound healing.
Conclusion: Few studies have been conducted on the effectiveness of wound healing with honey
internationally. It is suggested that honey is nature’s perfect substance for wound healing for pressure
ulcers. It is difficult to generalize on the effectiveness of honey based on these randomized clinical trials
with heterogeneous samples and wound types. Based on these studies, honey is effective on healing
pressure ulcers. However, additional research must be conducted using homogenous samples and
pressure ulcer types to establish a basis for practice.
References
Adams, J. (2007). Researching Complementary and Alternative Medicines. London and New York: Routeldge.
London and New York. Ahmed, A. K., Hoekstra, M. J., Hage, J. J., and Karim, R. B. (2003). Honey-medicated
dressing: Transformation of an ancient remedy into modern therapy. Annals of Plastic Surgery. 50(2), 143-147. Al
Waili, N. S. (2003). Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or
psoriasis: partially controlled, single-blinded study. Complementary Therapies in Medicine, 11(4), 226-234. Al Waili,
N. S. (2004). Investigating the antimicrobial activity of natural honey and its effects on the pathogenic bacterial
infections of surgical wounds and conjunctiva. Journal of Medicinal Food, 7(2), 210-222. Alcaraz, A. and Kelly, J.
(2002). Treatment of an infected venous leg ulcer with honey dressings. British Journal of Nursing, 11(13), 859-6. Ali,
A. T., Chowdhury, M. N., and al Humayyd, M. S. (1991). Inhibitory effect of natural honey on Helicobacter pylori.
Tropical Gastroenterology, 12(3), 139-143. Allen, K.L., Molan, P.C. & Reid, G.M. (1991). A survey of the antibacterial
activity of some New Zealand honeys. Journal of Pharmacy and Pharmacology, 43, 817-822. doi:
10.1111/j.2042.7158.1991,tb03186x. Bansal, V., Medhi, B., & Pandhi, P. Honey: A remedy rediscovered and its

therapeutic utility. Kathmandu University Medical Journal, 3(3)11, 305-309. Biglari, B., Vd Linden, P.H., Simon A.,
Aytac, S, Gerner, H.J., and Moghaddam, A. (2012). Use of medihoney as a non-surgical therapy for chronic pressure
ulcers in patients with spinal cord injury. Spinal Cord, 50(2), 165-169. doi: 10.1038/sc.2011.87 Brem, H., Maggi, J.,
Nierman, D., Rointzky, L., Bell, D., Rennert, R., Golinko, M., Yan, A., Lyder, C., & Vladeck, B. (2010). High Cost of
stage IV pressure ulcers. American Journal of Surgery, 200(4), 473-477. doi: 10.1016/j.amjsurg.2009.12.021.
Ceyhan, N. & Ugur, A. (2001). Investigation of in vitro antimicrobial activity of honey. Rivisti di.Biologica. 94(2), 363-
371. Conceição de Gouveia Santos V.L., Sellmer, D., & Elias Massulo, M.M. (2007). Inter rater reliability of Pressure
Ulcer Scale for Healing (PUSH) in patients with chronic leg ulcers. Latin American Journal of Nursing, 15(3), 391-396.
doi.org/10.1590/S0104-11692007000300005. Cooper, R. A., Molan, P. C., & Harding, K. G. (1999). Antibacterial
activity of honey against strains of staphylococcus aureus from infected wounds. Journal of the Royal Society of
Medicine. 92(6), 283-285. Elbagoury, E. F. and Rasmy, S. (1993). Antibacterial action of natural honey on anaerobic
bacteroides. Egyptian Dental Journal, 39(1), 381-386. Foss Durant, A. (2010). Exploring the relationship between
caring sciences and the care experience strategy. Northern California: Kaiser Permanente Caring Consortia,
Presentation. Gethin, G.T., Cowman, S, & Conroy, R.M. (2008). The impact of Manuka honey dressing on the
surface pH of chronic wounds. International Wound Journal, 5(2), 185-194. Grey, J.E., Harding, K.G., & Enoch, S.
(2006). ABC of wound healing: pressure ulcers. British Medical Journal, 332(7539): 472–475. doi:
10.1136/bmj.332.7539.47 Honey. (2012). Natural Standard. Retrieved on April 24, 2012.
http://naturalstandard.com/databases/herbsupplement/honey.asp. Jull, A., Walker, N., Parag, V., & Rodgers, A.
(2008). Randomized clinical trial of honey-impregnated dressing for venous leg ulcers. British Journal of Surgery
Society Limited, 95, 175-192. Jull, A.B., Rodgers, A., & Walker, N. (2008). Honey as a topical treatment for wounds
(Review).The Cochrane Collaboration, 8(4)1-47. Kajiwara, S., Gandhi, H., & Ustunol, Z. (2002). Effect of honey on
the growth of and acid production by human intestinal bifidobacterium spp: An in vitro comparison with commercial
oligosaccharides and insulin. Journal of Food Protection,65(1), 214-218. Khan, F.R., Abadin, Z.U., & Rauf, N. (2005).
Honey: Nutritional and medicinal value. International Journal of Clinical Practice, 61(10), 1705-1707. Kingsley, A.
(2001). The use of honey in the treatment of infected wounds: case studies. British Journal of Nursing, 10(22
Supplement) 13-6, S18, S20. Lee, D.S., Sinno, S., & Khachemoune, A. (2011). A honey and wound healing: An
overview. American Journal of Clinical Dermatology, 12(3), 181-190. Lusby, P. E., Coombes, A., & Wilkinson, J. M.
(2002). Honey: a potent agent for wound healing? Journal of.Wound.Ostomy.Continence.in Nursing, 29(6):295-300.
McGinnis E, Stubbs N. (2011). Pressure-relieving devices for treating heel pressure ulcers.Cochrane Database
Systematic Review. 9, CD005485. Malika, N., Mohamed, F., & Chakib, E.A. (2005). Microbiolological and physio-
chemical properties of Moroccan honey. International Journal of Agriculture and Biology, 7(5),773-775. Molan, P.
(1999). The role of honey in the management of wounds. Journal of Wound Care,8(8), 414-418. Molan, P. (2001).
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16, 2013, http://www.worldwidewounds.com/201/november /Molan/honey-as-topical-agent.html. Molan, P. (2001).
Potential of honey in the treatment of wo unds and burns. American Journal of Clinical Dermotology, 2(1), 13-19, doi
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use of honey as a wound dressing. Seminar Review, 40-54. doi: 10.1177/1534734605286014. Molan, P. (2006). The
evidence supporting the use of honey as a wound dressing. Lower Extremity Wounds, 5(5), 40-54. Obi, C. L., Ugoji,
E. O., Edun, S. A., Lawal, S. F., & Anyiwo, C. E. (1994). The antibacterial effect of honey on diarrhea causing
bacterial agents isolated in Lagos, Nigeria. African Journal of Medicine and Medicinal Sciences, 23(3), 257-260.
Onat, F. Y., Yegen, B. C., Lawrence, R., Oktay, A., & Oktay, S. (1991). Mad honey poisoning in man and rat.
Reviews on Environmental Health, 9(1), 3-9. Pieper, B. (2009). Honey-based dressings and wound care: An option
for care in the United States. Journal of Wound Ostomy Continence Nursing, 36(1), 60-66. PUSH tool 3.0. (2013).
The National Pressure Ulcer Advisory Panel- NPUAP. Retrieved on January 26, 2013.
http://www.npuap.org/resources/educational-and-clinical-resources/push-tool/push-tool/. Reddy, M. (2011). Pressure
ulcers. Clinical Evidence. 1901. Robson, V., Dodd, S. & Thomas, S. (2009) Standardized antibacterial honey
(Medihoney) with standard therapy in wound care: Randomized clinical trial. Journal for Advances in Nursing, 65(3),
565-575. Somerfield, S. D. (1991). Honey and healing. Journal of the Royal Society of Medicine, 84(3), 179. Sato, T.
& Miyata, G. (2000). The pharmaceutical benefit, part iii: honey. Nutrition, 16(6), 468-469 Schaum, K.D. (2011). How
does a home health agency get reimbursed by medicare? Advancs in Skinand Wound Care, 24(8), 348-354.
Shrivastava, R. (2011). Clinical evidence to demonstrate that simultaneous growth of epithelial and fibroblast cells is
essential for deep wound healing. Diabetes Research Clinical Practice, 92(1), 92-99. Steinberg, D., Kaine, G., and
Gedalia, I. Antibacterial effect of propolis and honey on oral bacteria. American Journal of Dentistry.1996; 9(6):236-
239. Tonks, A. J., Cooper, R. A., Jones, K. P., Blair, S., Parton, J., & Tonks, A. (2003). Honey Stimulates
inflammatory cytokine production from monocytes. Cytokine, 21(5):242-247. Van der Weyden, E.A. (2003). The use
of honey for the treatment of two patients with pressure ulcers. British Journal of Community Nursing, 8(12), 1-20.
Watson, J. (1995). Nursing’s caring-healing paradigm as exemplar for alternative medicine? Alternative Therapy
Health Medicine, 3, 64-69. Watson, J. (2008). Nursing: The philosophy and science of caring: Revised Edition
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Nagubib, H.H., El-Banna, N.M. & Marzouk, S. (1991). Comparing the effects of 2 dressing techniques on healing low

grade pressure ulcers. Journal of Medical Research Institute,12(2), 259-278. Yapucu, G.U. & Eser. I.. (2007).
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385.
Contact
[email protected]

Use of Complementary and Alternative Medicine by Nurses in Nepal
Marcia Rucker Shannon, MSN, RN, USA
Andrea M. Winne, BSN, USA
Merina Dongol, MBBS, Nepal
Unisha Shrestha, BSc (Nsg), Nepal
Purpose
The purpose of this presentation is to describe the utilization of Complementary and Alternative
Medicine(CAM) by nurses in Nepal. CAM is a priority research area in Nepal according to the Nepal
Health Research Council. There are no studies using nurses, so this descriptive study added to the body
of knowledge.
Target Audience
The target audience for this presentation is nurses interested in alternative and complementary medicine
usage in developing countries, specifically Nepal. Those wanting to explore international collaboration on
research studies among nursing students will also be interested in this presentation.
Abstract
Purpose: The purpose of this research was to describe the utilization of Complementary and Alternative
Medicine ( CAM) by nurses in Nepal. The use of Complementary and Alternative medicine is a 2103
priority research area in Nepal according to the Nepal Health Research Council. There are currently no
studies using this population, so this descriptive study added to the body of knowledge on CAM use in
Nepal.
Methods: A 32 item questionnaire was used to collect data from a convenience sample of 223 practicing
nurses, from 2 hospitals in the Kathmandu Valley in Nepal. The questionnaire collected data on types of
CAM used, for what health problems, frequency of use, and if CAM was used alone or in conjunction with
allopathic medicine. Reasons for recommending/using CAM were also collected.
Results: The most common type of CAM utilized was Ayurveda (35%) but this was followed closely by
Naturopathy( 34.1%). The most common health problem for which CAM was used was fever, followed
closely by digestive problems, back problems and respiratory ailments. 24% of the respondents reported
using self- CAM methods monthly or yearly, while 2.6% used some form of self-CAM daily or
weekly. 49.6% reported using self-CAM every time they experienced a health problem. Frequency of use
under a trained CAM provider was slightly different. 40% never used a trained provider, while 37.6%
report using a trained CAM provider every time they have a health problem. Many nurses combined CAM
with allopathic medicine. 54.9% reported using CAM even when taking allopathic medicine, while 40.2%
do not. Overall 62.1% would recommend CAM to others while 14.7% would not. The reasons for
recommending CAM included the belief that it is safe, easy to use, has minimal side effects and allows
easy self-treatment with minimal guidance.
Conclusion: In many countries across the world, CAM is a common form of medical treatment, and
Nepal is no exception. In Nepal, nurses use a wide range of CAM treatments and providers for a wide
variety of health problems, alone and in conjunction with allopathic medicine. It is clear that nurses need
to be aware of their own biases when discussing treatment decisions with patients, so as not to influence
the outcomes. Further research is needed to determine the use of CAM in a variety of populations. More
Evidence Based Practice research is needed on this topic.
References
References American Association of Naturopathic Physcians. (2013). Definition of Naturopathic Medicine. Retrieved
from http://naturopathic.org/content.asp?contentid=59 Aryal, K. (2010). Complementary and alternative medicine:
Utilization in Nepal; associated factors with its use. Nepal: Lambert Academic Publishing. Barnes, P.M., Bloom, B.
(2008). Complementary and alternative medicine among adults and children: United States. National Health Statistics
Reports, 12, 1-23. Central Intelligence Agency. (2013). The world factbook southeast Asia: Nepal. Retrieved from

https://www.cia.gov/library/publications/the-world-factbook/geos/np.html DeKeyser, F.G., Cohen, B.B., Wagner, N.,
(2001). Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine.
Journal of Advanced Nursing 36(1), pages 41-8. Gewali, M.B. (2008). Aspects of traditional medicine in Nepal.
Japan: Institute of National Medicine University of Toyama. Kadayat, T. M., Parajuli, A., Bist, G., Karki, R., Shrestha,
N., and Dhami, N. (2009). Complementary and alternative medicine in Nepal: a case study. The Journal of Medicine
in Developing Countries, 1(4), 3-13. Retrieved from
http://www.academia.edu/1182406/Complementary_and_alternative_medicine_in_Nepal_a_case_study Koirala,
R.R.. Present status of traditional medicine in Nepal. National Aryurveda Association,Nepal. Retrieved from
http://www.aifo.it/english/resources/online/books/other/tradmedicine06/TradMedicine-koirala.pdf U.S. Department of
Health & Human Services. (2013). Complementary, alternative, or integrative health: what’s in a name?. Retrieved
from http://nccam.nih.gov/health/whatiscam Nepal Health Research Council (2012). Traditional Medicine.Retrieved
from http://www.nhrc.org.np/index.php?option=com_content&view=article&id=66&Itemid=6 2 Shankar P.R., Paudel,
R., & Giri, B.R. Healing traditions in Nepal. JAAIM-Online, Retrieved from
http://www.aaimedicine.com/jaaim/sep06/Healing.pdf
Contact
[email protected]

The Effects of Ballroom Dance on Blood Pressure, Heart Rate, Weight, Waist
Circumference, and Body Mass Index Among Filipino-Americans: A Feasibility
Study
Alona Angosta, PhD, APRN, NP-C, USA
Purpose
The purpose of this presentation is to discuss the effects of 3-months ballroom dancing on blood
pressure, heart rate, weight, waist circumference, and body mass index among Filipino American adults.
Target Audience
The target audience of this presentation is: nurses, nurse practitioners, nursing educators, researchers
Abstract
Background:Physical activity decreases the risk of obesity and hypertension, thereby reducing the risk of
cardiovascular disease. Lack of regular physical activity is a common health problem among Filipino
Americans and it is associated with the increased prevalence of hypertension, diabetes, and dyslipidemia
in this population. There are several reasons for physical inactivity. The most common reasons given for
physical inactivity in this population are lack of interest, dissatisfaction with the type of activity they are
engaged in, and lack of time due to family and work obligations.
Purpose: The purpose of this feasibility study was to examine the effects of 3-month ballroom dance on
resting blood pressure, heart rate, weight, waist circumference, and body mass index of Filipino American
adults.
Methods: This quasi-experimental research used a single group pre and post intervention
design. Thirty-seven Filipino Americans between 35-65 years old living in the southwestern part of the
United States participated in the ballroom dance program during the fall of 2012. The ballroom dances
that were selected were cha-cha and salsa due to the moderate physical effort required, and rumba due
to its popularity among Filipino Americans. Participants danced every week for two hours. Resting blood
pressure, heart rate, weight, waist circumference, and body mass index were measured pre dance
intervention (week1) and post dance intervention (week 12); results were compared. The paired sample t-
test was used to determine the significant differences in the sample mean score pre and post dance
intervention.
Results: Group means of resting blood pressure (BP), heart rate (HR), weight (WT), waist circumference
(WC), and body mass index (BMI) post- intervention are slightly lower than those of pre-intervention
(except for WC and BMI), but the group means change are not statistically significant: BP (pre)127/80
mmHg and (post)124/79mmHg; HR (pre) 72 and (post) 73; WT (pre) 68.18 kg and (post) 67.73 kg; WC
(pre) 89.59 cm and (post) 90.53 cm; BMI (pre) 26.15 and (post) 26.01.
Conclusion: Cardiovascular disease is the leading cause of death among Filipino Americans and lack of
regular physical activity has been linked to this problem. This study examined the effectiveness of
ballroom dance as another form of physical activity among Filipino Americans and tested the
hemodynamics and anthropometric effects of ballroom dance. Although the results are not statistically
significant, this study revealed a slight improvement in the BP, HR, and WT scores of the sample. Larger
sample and/or longer dance intervention may be considered in future studies. This study can be used to
further explore ballroom dance and similar types of activity that will benefit and motivate Filipino
Americans and other populations to engage in regular physical activity.
References
Dalusung- Angosta, A. (2013). Coronary heart disease knowledge and risk factors among Filipino Americans
connected to primary care services. Journal of the American Association of Nurse Practitioners. doi: 10.1002/2327-
6924.12039 Dalusung-Angosta, A. & Gutierrez, A. (2013). Prevalence of metabolic syndrome among Filipino
Americans: A cross-sectional study. Applied Nursing Research, 26(4), 192-197. Belza, B., Walwick, J., Shiu-

Thornton, S., Schwartz, S., Taylor, M., LoGerfo, J. (2004). Older adult perspectives on physical activity and exercise:
Voices from multiple cultures.Preventing Chronic Disease, 1(4), 1-11. Ceria-Ulep, C. D., Serafica, R., Tse, A. (2011).
Filipino older adults’ beliefs about exercise activity. Nursing Forum 46(4), 240-244. Dalusung-Angosta, A. (in press).
Coronary heart disease knowledge and risk factors. Journal of the American Academy of Nurse Practitioners. Dela
Cruz, F. & Galang, C.B. (2008). The illness beliefs, perceptions, and practice of Filipino Americans with hypertension.
Journal of the American Academy of Nurse Practitioners, 20(3), 118-127. Mullen, S. P., Olson, E. A., Phillips, S. M.,
Szabo, A. N., Wojcicki, T. R., Mailey, E. L., Gothe, N. P., Fanning, J. T., Kramer, A. F., & McAuley, E. (2011).
International Journal of Behavioral Nutrition & Physical Activity, 8(103), 1-9. Physical Activity Guidelines for
Americans (2008). (6 December, 2012). Retrieved from http://www.health.gov/PAGuidelines/pdf/paguide.pdf San
Juan, C. (2001). Ballroom dance as an indicator of immigrant identity in the Filipino community. Journal of American
& Comparative Cultures, 24(3-4), 177-181. Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7) (6, February 2013). Retrieved from
http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf Vahabi, M., Beanlands, H., Sidani, S., & Fredericks, S.
(2012). South Asian women’s beliefs about physical activity and dancing as a form of exercise. Journal of Immigrant
& Refugee Studies, 12(2), 139-161.
Contact
[email protected]

K 04 - Behavioral and Self-Care of the Heart Failure Patient
Illness Representations and Self-Care Behavior of Patients with Heart Failure
Jen-Chen Tsai, RN, PhD, Taiwan
Yen-Ting Wang, RN, MSN, Taiwan
Pei-Shan Tsai, PhD, Taiwan
Purpose
The purpose of this presentation is to investigate the relationship between illness representations and
self-care behaviors of patients with heart failure and to identify important factors related to illness
representations and self-care behaviors among these patients.
Target Audience
The target audience of this presentation is clinical practice nurses and/or case managers in cardiac care
specialty.
Abstract
Purpose: The purpose of this presentation is to investigate the relationship between illness
representations and self-care behaviors of patients with heart failure and to identify important factors
related to illness representations and self-care behaviors among these patients.
Methods: This study was conducted based on the self-regulation model. Patients with heart failure were
recruited from a medical center in northern Taiwan. A descriptive correlational research design was used.
Three questionnaires were administered to the study participants, including the illness representations
questionnaire-revised (IPQ-R), the heart failure symptoms experience questionnaire, and the self-care
behaviors questionnaires. Data were analyzed using independent t-test, Pearson’s correlations and
hierarchical regression.
Results: A total of 100 patients completed this study (mean age = 64.7±12.3). Age, education levels, and
cardiac functional class were significant correlates of illness representation experienced by patients with
heart failure. Emotional representation and perceived control of the illness were significantly related to
self-care behaviors. Hierarchical regression analyses showed perceived personal control of the illness
was the most powerful predictor, explaining 27% of the variance of self-care behaviors in patients with
heart failure.
Conclusion: Patients may show better self-care behaviors if they perceived greater personal control for
their diseases. Results of this study suggest that the development of personalized health education or
intervention programs is needed to promote illness representations of patients with heart failure.
References
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Jr., Drazner, M. H., . . . Wilkoff, B. L. (2013). 2013
ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology
Foundation/American Heart Association Task Force on practice guidelines. Circulation, 128(16), e240-319. doi:
10.1161/CIR.0b013e31829e8776 Chen, S. L., Tsai, J. C., & Chou, K.R. (2009). Illness perceptions and adherence to
therapeutic regimens among patients with hypertension: A structural modeling approach. International Journal of
Nursing Studies, 48, 235-245. doi: 10.1016/j.ijnurstu.2010.07.005 Diefenbach, M. A., & Leventhal, H. (1996). The
common-sense model of illness representation: Theoretical and practical consideration. Journal of Social Distress
and the Homeless, 5(1), 11-38.
Contact
[email protected]

K 04 - Behavioral and Self-Care of the Heart Failure Patient
The Effectiveness of a Patient Education Program on Promoting Self-Care in
Patients with Heart Failure
Hsing-Mei Chen, PhD, RN, Taiwan
Shyh-Jong Wu, PhD, Taiwan
Liang-Miin Tsai, MD, Taiwan
Chee-Siong Lee, MD, Taiwan
Hsueh-Wei Yen, MD, Taiwan
Purpose
The purpose of this presentation is to introduce a patient teaching program and the effectiveness of the
program on promoting self-care, depression, sleep, quality of life, and readmission in patients with heart
failure.
Target Audience
The target audience of this presentation is 1.To understand the heart failure patient teaching program
including material and intervention modality. 2.To understand the effects of the patient teaching on
promoting patient outcomes.
Abstract
Purpose: Self-care is fundamental to effective management of heart failure. However, patients with heart
failure (HF) report poor self-care behaviors. Patient education is the best way to promote self-care.
However, healthcare providers do not provide sufficient self-care information to the patients due to heavy
working routines and poor quality of teaching materials. In considering many patients with HF are elderly
or have vision or cognition impairments, a HF home self-care brochure with 8 topics was developed. The
purpose of this study was to examine the effectiveness of a nurse-led self-care intervention on self-care
behaviors, health-related quality of life, depression, sleep disturbances, and readmission in patients with
HF from hospitalization to one month after discharge from hospital.
Methods: A quasi research design with a non-probability sampling was used. Participants were recruited
from two medical centers located in southern Taiwan. Inclusion criteria were as follows: 1) a diagnosis of
HF with NYHA functional class II and above; 2) age 20 or older; 3) able to communicate either by
speaking or writing Mandarin; and 4) willing to participate in this study. Instruments included demographic
questionnaire, heart failure characteristics questionnaire, Patient Outcome Questionnaire-9, Pittsburgher
Sleep Quality Index, Kansas Cardiomyopathy City Questionnaire, and revised HF Self-Care Behavior
Scale. After completing the questionnaires at baseline, participants in the experimental group were asked
to receive a pre-discharge education session and a telephone follow-up or an outpatient follow-up.
Control group received usual hospital discharge teaching. The posttest was done in one month after their
discharges. T-tests were used to examine the differences between two groups.
Results: The results showed that 34 participants were assigned in the experimental group and 32 were in
the control group. no statistical differences were found in demographic data, HF characteristics, sleep
quality, depression, self-care, and quality of life between the experimental and control groups at the
baseline. Among the three self-care variables, self-care maintenance was the lowest and the only one
had score lower than the cut-off point of 70 in both groups (57.13 for experimental group vs. 64.84 for
control group, p= .080). At the posttest, the experimental group had significantly higher score in self-care
maintenance (76.64 vs 66.09, p= .003). However, there were no differences in the other major variables
between the two groups. For the readmission, there was one readmission for the experimental group and
three readmissions for the control group.
Conclusion: The study supports the effectiveness of the patient education program on promoting self-
care maintenance in patients with HF one month after discharge from hospital. The study findings can be
served as a reference for healthcare providers and researchers to promote self-care and conduct
research studies in people with heart failure.

References
1.DeWalt, D., Broucksou, K., Hawk, V., Baker, D., Schillinger, D., Ruo, B., . . . Pignone, M. (2009). Comparison of a
one-time educational intervention to a teach-to-goal educational intervention for self-management of heart failure:
design of a randomized controlled trial. BMC Health Services Research, 9(1), 99. 2.Driscoll, A., Davidson, P., Clark,
R., Huang, N., & Aho, Z. (2009). Tailoring consumer resources to enhance self-care in chronic heart failure. [doi: DOI:
10.1016/j.aucc.2009.05.003]. Australian Critical Care, 22(3), 133-140. 3.Riegel, B., Moser, D. K., Anker, S. D., Appel,
L. J., Dunbar, S. B., Grady, K. L., . . . Outcomes Research. (2009). State of the science: Promoting self-care in
persons with heart failure: A scientific statement from the American Heart Association. Circulation: Cardiovascular
Quality and Outcomes 120(12), 1141-1163. doi: 10.1161/circulationaha.109.192628
Contact
[email protected]

K 05 - Self-Management of Chronic Illnesses
Predictors of Self-Management for Chronic Low Back Pain
Jennifer Kawi, PhD, MSN, APRN, FNP-BC, USA
Purpose
The purpose of this presentation is to increase understanding of predictors of self-management in chronic
low back pain, a very prevalent worldwide problem. It is likely that certain subgroups of the population
respond better to self-management interventions. Hence, identifying these predictors are essential to
effective chronic pain management.
Target Audience
The target audiences for this presentation are all stakeholders involved in the area of chronic low back
pain especially since self-management is an international initiative recommended for chronic illnesses.
However, self-management may not be as effective to certain subgroups of the population.
Abstract
Purpose: This research study aimed to: (a) identify variables that best predict self-management (SM) of
chronic low back pain (CLBP), and (b) evaluate differences in these variables between individuals in
specialty pain centers and primary care clinics.
CLBP is a continuous or intermittent discomfort persisting for at least three months. It affects about 10%
of the world population and is becoming increasingly prevalent. Globally, the ranking of CLBP increased
from being the 12th leading cause of years of life lost and years lived with disability in 1990, to number 7 in
2010 (Murray & Lopez, 2013). SM strategies are strongly recommended internationally and in several
chronic pain care guidelines to help address the major health and economic challenges in this patient
population. SM is described as the performance of tasks and skills with self-efficacy to activate individuals
in making appropriate decisions and engage in health-promoting behaviors (Lorig & Holman, 2003). SM
has been shown to improve health outcomes in several chronic illnesses. However, the evidence of SM
effectiveness in CLBP remains unclear. It is likely that SM programs are most effective only in certain
subgroups of the chronic pain population. Hence, it is essential to identify variables that best predict SM
in CLBP.
Methods: This research study is a secondary analysis of data collected from two previous CLBP
research studies in specialty pain centers and primary care clinics (N = 230). These two studies described
several pain and patient-related variables in adults with non-malignant CLBP but did not address the
predictors of SM. Descriptive statistics and general linear modeling were conducted for data analysis.
Results: Overall, five variables were found to be significant predictors of SM: age, education, overall
health, SM support, and helpfulness of pain management. Those who were younger, had higher
educational level, had better overall health, perceived more support from their healthcare providers, and
perceived benefits from their pain management modalities were more likely to respond to SM. In specialty
pain centers, SM support, support received from other than healthcare providers, religion or spirituality,
and overall health were identified as significant predictors of SM. In primary care clinics, income, overall
health, and SM support were significant predictors of SM.
Conclusion: Findings provide essential information to healthcare providers in intervening appropriately
toward engaging CLBP patients in SM. Promoting healthy living through effective SM despite CLBP is a
vital component of care since overall health has been consistently identified as a significant predictor of
SM. Further, since nurses are in the forefront of chronic pain care, increasing our knowledge and skills in
providing SM support is necessary. Adequate evaluation of individual’s willingness and abilities to engage
in SM, addressing psychosocial concerns that impact SM and pain, and advocating for healthcare system
changes to increase availability of chronic pain care resources in the community are all essential
considerations to enhance effective SM. Interprofessional collaboration is equally important to facilitate
comprehensive management of the complexity of CLBP. Consequently, other strategies need to be
identified for those who do not respond adequately to SM strategies.

References
Lorig, K. R., & Holman, H. R. (2003). Self-management education: History, definition, outcomes, and mechanisms.
Annals of Behavioral Medicine, 26, 1-7. Murray, C. J. L., & Lopez, A. D. (2013). Measuring the global burden of
disease. New England Journal of Medicine, 369, 448-457.
Contact
[email protected]

Self-Management in Chronic Illness: From Theory to the Practice
Fernanda S. Bastos, PhD, MsC, Portugal
Alice Brito, RN, McN, PhD, Portugal
Filipe Miguel Soares Pereira, RN, MD, PhD, Portugal
Purpose
The purpose of this presentation is disseminating a tool built to identify the style of self-management as a
contribution to more appropriate nursing interventions according to the vulnerability profile and promote
the knowledge of the nursing theory of self-management, built in a empirical basis.
Target Audience
The target audience of this presentation is nursing researchers, nursing graduate and postgraduates
nursing students.
Abstract
Chronic disease is responsible in the world, and particularly in Europe, for much of the mortality and
morbidity, it is expected an increase of this scenario in the coming years. Often, chronic disease and its
comorbidities, represent the cause of episodes of hospitalization for lack of disease control or its
consequences. Intervention core to reduce health costs and promote quality of life is increase capacity for
self-management in people with chronic illness.
The study issues on disease management and treatment regimen, as a self-care activities (self-
management), assuming that the way the health/disease transition is experienced influences the way the
adaptive processes move on, the development of mastery and a fluid identity, that incorporates the
disease as part of the "self". In this context, we conceptualize “self-management style” as a synthesis of
personality, attitudes and health behaviors.
Purpose: create an intervention model of self-management promotion in persons with chronic illness
based on individual style and vulnerability profile.
The aim for this presentation is to disclose the development of the instrument to characterize self-
management style.
Methods: The wider project is developed in three phases:
Phase 1 (ended) - Construction of an explanatory theory about self-management in chronic illness;
Phase 2 - Development of an instrument to characterize self-management style;
Phase 3 (in progress) - Construction and application of a model of intervention and follow up according
the self-management style from each client and vulnerability profile.
Protocols with institutional partners were established for longitudinal study’s, aiming to induce specific
models of accomplishment according specific diseases and vulnerability profiles.
At this conference we propose to present the explanatory theory as the basis for construction of the tool
for self-management lifestyle characterization and vulnerability profile of each client.
This instrument was pre-tested and four researchers evaluated each item for appropriateness, clarity and
relevance. Suggestions for change was made, in special, about "how to put the question" on perspective
of researcher and respondents. Finaly a consensus version was obtained on a focus group, with seven
experts.
Results: As self-management grounded theory identifies the categories, their properties and dimensions
and, supporting by Nursing Outcomes Classification (NOC), the instrument had three different parts:

1. Identity traits and attitudes towards illness and treatment regimen questionnaire. This part of
questionnaire had forty-five items, and identifies personal features and different ways of living
with the disease.
2. Self-report perception of behavior towards the therapeutic regimen. Thirteen items indicate
different behaviors related to the treatment of disease.
3. Self-management style characterization questionnaire in nurses perception. Fifteen items clarify
different behaviors related to how each client manage his therapeutic regimen.
The scale ranges from 1 to 5 for strongly disagree to strongly agree.
Conclusion: This instrument is ready to be applied to contribute to greater positive discrimination based
on personal characteristics and therefore the appropriateness of therapeutic nursing intensity and
intentionality that allows them to be more significant for people with chronic disease.The instrument is
being implemented expeditiously, taking on average about twenty minutes, is well accepted by customers
and nurses. Suggests clinical application and known results suggest good internal consistency.
References
Bastos, Fernanda e Silva, Abel. A pessoa com doença crónica. Uma teoria explicativa sobre a problemática da
gestão da doença e do regime terapêutico. Dissertation application to a PhD degree in Nursing, submitted to the
Portuguese Catholic University, Institute of Health Sciences – Porto, 2012. Meleis, A, et al. Experiencing transitions:
an emerging middle-range theory. Adv Nurs Sc. 23, 2000, Vol. 1, 12-28. Yin, R. Estudo de caso- Planejamento e
métodos. [trad.] Daniel Grassi. 3ª Edição. Porto Alegre : Bookman, 2005. ISBN 85-363-0462-6. Strauss, A e Corbin,
J. Basics of Qualitative Research. Techniques and procedures for developing grounded theory. 2ª Edition. California :
SAGE Publications, 1998.
Contact
[email protected]

Level and Predictors of Self-Care Behaviors (SCB) Among Educated and
Uneducated Patients with Heart Failure (HF) in Pakistan
Ambreen Amirali Gowani, BSN, MSN, Pakistan
Purpose
The purpose of this presentation is to share the information on self care from a developing country. so
that in future,sustainable educational programs for the literacy challenged poor poulation can be
developed and the burden of poor quality of life due to heart failure can be decreased.
Target Audience
The target audience of this presentation are cardiology nurses, student nurses, community nurses. all
those health care providers who are related to the field of cardilogy and research.
Abstract
Purpose: Self-care among heart failure patients is found to be affected by several factors including
education as one of the most significant predictor. Prior studies on self-care, from western countries have
revealed that higher the education better is the self-care. But the level of self-care and its predictors are
yet un explored in developing countries like Pakistan. Therefore, this study aimed to compare the level of
self-care and its associated factors among educated and uneducated HF patients of a country which has
lowest literacy rates.
Methods: 230 HF patients (115 educated and 115 uneducated) were recruited in the study. Their level of
self care behaviors and its associated factors were assessed using European heart failure self-care
behavior scale (EHFSCBs). via a cross sectional survey.
Results: The overall level of Self-care behavior was significantly higher among educated HFpatients as
compared to their uneducated counterparts (p=0.005). However, income was significantly associated with
better self-care among educated patients (p=0.001) whereas, chronicity of HF diagnosis appeared as
strong predictor of self care among the uneducated HF patients (p=0.024).
Conclusion: The results of the study imply that continuous supportive-educative interventions by the
health care providers may enhance the experiential learning and level of self-care among the uneducated
population with heart failure.
Contact
[email protected]

K 06 - Infection Control Through Global Research and Health
Promotion
A Preliminary Report on the Effectiveness of a Physical Anti-Microbial Dressing
in Preventing Tenckhoff Catheter (TC) Exit Site Infection (ESI)
Mee Ling Bonnie Tam, MSoSc, Hong Kong
Purpose
To explore the effectiveness of a nanotechnology anti-microbial dressing in preventing Tenckhoff
Catheter (TC) Exit Site Infection (ESI) for the peritoneal dialysis patients.
Target Audience
The target audience of this presentation are the healthcare professional caring both hospital-based and
community based peritoneal dialysis therapy patients.
Abstract
Purpose: According to the ‘Peritoneal Dialysis (PD) First Policy’, around 80% of renal dialysis patients
are putting on different mode of PD therapy in Hong Kong.(1) For most patients receiving peritoneal
dialysis (PD), there is evidence showing that their satisfaction and quality of life has been increasing.
(2) However, the Tenckhoff Catheter (TC) can become a potential source of infection and peritonitis. If exit
site infection (ESI) is not well managed it can lead to peritonitis or require removal of the TC (3). Peritonitis
is a well known cause of mortality in PD patients (4). Consequently, suspending treatment due to access
failure may affect patients’ overall health status. The purpose of routine exit site care is to prevent ESI.
There is a large volume of information focused on the prevention of ESI, with different approaches being
proposed. The practice guidelines and protocols from institutions are varied and have not been
adequately evaluated, although large volumes of data have been published on the prevention of ESI (5).
Several recent trial studies showed that the application of JUC Physical antimicrobial Spray Dresssing,
has proven to be effective in prevention of lower urinary tract infection (6,7), treatment of post-operative
infection for oral cancer (8),open wound treatment in emergency clinic(Shen & Li, 2006) (9,10) and managing
radiation-induced acute skin reactions (Li, Lin, Cheng & Li, 2006)(10). It is also an alternative to antibiotic
treatment on wound management for patients with methicillin-resistant Staphylococcus aureus (MRSA)
infection (11). JUC spray dressing was developed in China in 2002 and registered as a dressing product by
the United States Food and Drug Administration in 2006. It consists of 2% organosilicon quaternary
ammonium salt and 98% distilled water, and is safe for application, even for contact with eyes and
mucous membranes. The antimicrobial dual sided, nano-film forms a positively charged film that absorbs
and neutralizes the negatively charged pathogenic microorganisms. The pathogenic micro-organisms are
killed by the electrostatic force created between the positive and negative charges (Li et al, 2011)(12).
Proper exit site care is of paramount importance in reducing TC associated infection and subsequent
catheter loss. In current practice, patients having TC are usually advised to use the traditional antiseptic,
0.05% Gluconate Chlorhexidine in exit site care. In this study, JUC spray was applied to the TC exit site
to compare the incidence of ESI with conventional care. In addition to ESI, the existence of skin allergy,
catheter damage, and time spent on exit site dressing were examined.
Methods: The study was carried out through a randomized controlled trial. Seventy four patients were
recruited from the renal unit of an acute regional hospital in Hong Kong with 1,700 beds. We reviewed
patients whose TC had been in place for at least three months. To compute the sample size, we referred
to Li’s paper(11) on the effectiveness of JUC spray to prevent ventilator-associated pneumonia. To have
80% power, with 5% alpha, to detect a 27.9% reduction in incidence of bacterial colonization in
pharyngeal cavity in experimental group as compare with control group, a sample size of 35 subjects for
each group was required. Those patients who did not receive oral or external antibiotics and who had a
TC in situ for at least three months were recruited sequentially. Patients presenting with signs and
symptoms of exit site infection and poor healing of exit site were excluded. The same type of PD
catheters was used for both groups of patients. A total of 78 patients were randomized into study or

comparison group using computer generated numbers. Baseline data were collected before
randomization. The patients were not blind to the group assignment while the data collector was blind to
group allocation. The study group patients used JUC spray dressing while the comparison group used
0.05% Chlorexidine dressing daily for standard wound care. Skin tests with JUC spray and Chlorhexidine
were carried out prior to intervention for both group patients. Coaching was provided by the nurses to
ensure that the patients were able to perform the procedures correctly. The study team called the patients
on the first three days and they were instructed to report any abnormalities they noticed to the nurses,
such as signs and symptoms of infection, skin allergy, and damage of TC. They were treated with
antibiotics if diagnosed for ESI and were continued with the study after treatment. Clinical efficacy was
assessed for a period of six months after implementation of intervention. According to the study unit
protocol, the presence of two out of three equivocal signs and symptoms of exit site infection were
diagnosed as acute exit site infection, which included redness around the exit site, with 3-4 mm
measurement from the edge and purulent discharge.(13)
Results: A total of 74 patients, with 37 from the study and comparison groups were included in the final
analysis. The patients in the study group were significantly younger than the comparison group. Other
demographic and clinical information, such as gender, presence of diabetes, abnormal albumin level, and
previous history of ESI were examined and no significant difference was found between the two groups.
See Table 1 for details. Table 1. Demographic Data and Clinical Characteristics of the Study Population
(n=74)
Study group (n=37) Comparison group p-value
(n=37)
Age 56 (47.5 – 74) 72 (60 – 75.5) *0.011
Duration of TC insertion (month) 25 (11 – 46) 17 (10.5 – 54.3) 0.94
Gender Male Female 18 (48.6%) 19 14 (37.8%) 23 (62.2%) 0.348
(51.4%)
Diabetes Yes No 10 (27%) 27 14 (37.8%) 23 (62.2%) 0.321
(73%)
Normal Albumin Yes No 14 (37.8%) 23 21 (56.8%) 16 (43.2%) 0.103
(62.2%)
Previous ESI Yes No 16 (43.2%) 21 15 (40.5%) 22 (59.5%) 0.814
(56.8%)
*p<0.05
ESI developed in two patients (5.4%) in the study group and nine patients (24.3%) in the comparison
group. The results was significant (p=0.022) for the two groups. Amongst the nine patients of the
comparison group, ESI occurred twice during the six month period in two patients. No allergic reactions
were reported for either group of patients. It was considered important to report whether the new
treatment caused damage to the TC. One patient in the comparison group reported damage to the
catheter as confirmed by the physician. Time spent on TC dressing was significantly shorter in the study
group (median: two minutes) than in the comparison group (median: ten minutes). The study group
patients were all satisfied with the new treatment. The cost for Chlorexidine dressing was HK$3.00
(equivalent to US$0.38) per dressing, while the cost for JUC spray was HK$0.5 per application. See
Table 2 for results.
Table 2. Results at six months post-intervention
Study group (n=37) Comparison group (n=37) p-value
Allergy No 37 (100%) 37 (100%) ----
Exit site infection Yes No 2 (5.4%) 35 9 (24.3%) 30 (75.7%) *0.022
(94.6%)
TC damage Yes No 0 (0%) 37 (100%) 1 (2.7%) 36 (100%) 1
Time used for dressing 2 (1 – 8) 10 (2 – 15) *<0.001
(minutes)
Treatment cost (HK$) 0.5 3.00
*p<0.05

Eleven samples were taken from the infected exit sites for bacteria analysis. Staphlococci, Diphtheroid
bacillus, Pseudomonas and Streptococcus Salivalir were found mostly in the wounds of the comparison
group. While Acinetobacter Species and the Pseudomonas species were found in the JUC group.
Discussion :Proper exit site care is of paramount importance to reducing TC-associated infections and
subsequent catheter losses. Adequate immobilization of the catheter and daily exit site care are the
significant issues to be investigated. Our study demonstrated that JUC spray can replace traditional
disinfectants for exit site care as it does not cause adverse effects and can counter the problem of drug
resistance. The results demonstrated that the incidence of ESI in the treatment group was significantly
lower than that in the comparison group. Once JUC is sprayed on the skin surface, it dries almost
instantly, thus reducing the time, effort, and discomfort of exit site care. Patients enjoy better quality of
life, as daily exit site care is no longer a burden. However, our results on time savings need to be
interpreted with caution as patients in the study group were significantly younger; and the younger
patients may perform faster in daily activities than older patients, depending on the nature and severity of
their respective conditions. Antibiotics resistance may be the result of extensive use of antibiotics for the
end stage renal failure patients with compromised immune systems. The use of JUC spray can play an
important role in exit site management for patients who may sensitive to Chlorhexidine and/or
antibacterial agents. The use of JUC spray to replace traditional dressing materials and methods could
reduce the financial burden on Hong Kong’s health care system by reducing medication expenses.
Conclusion: TC is the life line of PD therapy patient. TC care at least daily is highly recommended
and JUC spray is a safe, simple and sustainable (3S) dressing alternative to the traditional TC care.
Further studies are required using a larger sample size to investigate and fully understand the
applicability of JUC in exit site care in hospital renal units and the community setting.
References
1. The Central Renal Committee (2010). Statistical report of 2009. Hong Kong: Hospital Authority. 2. Tokgoz B.
Clinical advantages of peritoneal dialysis. Perit Dial Int 2009; 29 (Suppl 2):S59-61. 3. Lui SL, Yip KC, Lam MF, Lai
KN, Lo WK. Treatment of refractory pseudomonas aeruginosa exit-site infection by simultaneous removal and
reinsertion of peritoneal dialysis catheter. Perit Dial Int 2005; 25: 560-63. 4. Fontan MP, Rodriguez-Carmona A,
Garcia-Naveiro R, Rosales M, Villaverde P, Valdes F. Peritonitis-related mortality in patients undergoing chronic
peritoneal dialysis. Perit Dial Int 2005; 25: 274-284. 5. Bender FH, Bernardini J, Piraino B. Prevention of infectious
complications in peritoneal dialysis: best demonstrated practices. Int Soc Nephro 2006; 70: S44-54. 6. Wu L, Dai YT,
Wang LM, Cheng B, Sun ZY. Study on prevention of catheter associated urinary tract infection by using JUS long-
acting antibacterial material. Nation J Andro 2005; 11: 581-3. 7. He W, Wang D, Ye Z, Qian W, Tao Y, Shi X et al.
Application of a nanotechnology antimicrobial spray to prevent lower urinary tract infection: a multicenter urology trial.
J of Trans Med 2012; 10(Supp 1): S14. 8. Zeng Y, Deng R, Yeung B, Loo W, Cheung M, Chen JP et al. Application of
an antibacterial dressing spray in the prevention of post-operative infection in oral cancer patients: A phase 1 clinical
trial. Afr J Biotechnol 2008; 7: 3827-31. 9. Shen, M., & Li, Z. (2006). JUC long-acting antimicrobial material in
adjuvant treatment of 129 cases of open wound. Herald of Medicine, 25(2), 138-139. 10. Li, Y., Lin, G., Cheng, H., &
Li, D. S. (2006). Observation on therapeutic effect of JUC in treatment 29 patients with acute radiological dermatitis.
Dermatovenereology, 20(5), 285-286 11. Wan K, Ng MY, Wong YT. New horizon on community-acquired methicillin
resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infection: nanotechnology antimicrobial spray. HK
J.emerg.med 2011; 18:432-436. 12. Li W, Ma X, Peng Y, Cao J, Loo TY, Hao L, Cheung MN, Chow LW, Jin L.
Application of a nano-antimicrobial film to prevent ventilator-associated pneumonia: A pilot study. Afr J Biotechnol
2011; 10: 1926-31. 13. Guidelines of caring Tenckhoff Catheter exit site (2009). Hong Kong: Queen Elizabeth
Hospital, Kowloon Central Cluster, Hospital Authority. 14. NMS Technologies Company Limited . (2010a).
Mechanism. Retrieved from http://www.juc360.com/juc/parameter/130.html
Contact
[email protected]

Promotion
Successful Institution-Wide Sustained Reduction in Central Line Associated
Bloodstream Infection (CLABSI) Using a Multidisciplinary Approach
Katherine Pakieser-Reed, PhD, RN, USA
Sylvia Garcia-Houchins, RN, MBA, USA
Megan Miller, MD, USA
Purpose
The purpose of this presentation is to demonstrate the multidisciplinary team approach utilized across the
continuum of patient care to reduce institution-wide CLABSI rates, and to share successful strategies
used to maintain the low CLABSI rates initially achieved.
Target Audience
The target audience of this presentation is organizational nursing leaders, managers, and administrators
in clinical practice, education, quality, and research, in addition to direct care provider nurses.
Abstract
Purpose: Central Line Associated Bloodstream Infection (CLABSI), a significant cause of morbidity and
mortality in hospitalized patients, has been identified as a never event (CDC NHSN, 2013). The Centers
for Medicare and Medicaid Services no longer reimburse for CLABSI-associated costs of care as an
incentive to improve the quality of care and reduce healthcare costs (Kuhn, 2008). In countries with
limited resources, rates of healthcare-associated infections including CLABSI are three to five time higher
than those in the U.S., and CLABSI reduction has been identified as a priority for the International
Nosocomial Infection Control Consortium (Rosenthal, Maki, & Graves, 2008). Many CLABSI prevention
initiatives focus on sterile insertion technique and are limited to ICU settings or specific patient
populations (Berenholtz et al., 2004; Southworth, Henman, Kinder, & Sell, 2012; McMullan et al., 2013).
Despite initial efforts to reduce rates in ICUs and high-risk patients, CLABSIs continued to be an area of
concern for our organization. In FY12, our goal was to reduce our institution-wide CLABSI rate by at least
10% through a multidisciplinary initiative that focused on the standardization of practices across the
continuum of patient care. In FY13, our objective was to sustain low CLABSI rates via targeted education
and reinforcement of successful clinical practices.
Methods: The CLABSI taskforce included leaders and staff from nursing, infection prevention, patient
safety, supply chain, clinical documentation, and providers. Subjects were all hospitalized neonatal,
pediatric, and adult patients with a CLABSI by the CDC definition between July 2011 and June 2013.
CLABSI rates were calculated and communicated to each patient care unit on a monthly basis. In FY12, a
“Scrub the Hub” protocol for accessing and maintaining central lines was taught via computer based
training (CBT) and reinforced with 1:1 return demonstration for all registered nurses (RNs) from clinics,
procedural areas, inpatient units, emergency departments, and home health services. The same protocol
including CBT and return demonstration was added to monthly orientation for newly hired nurses across
the institution. Custom-built standardized kits for central line insertion and dressing changes were
adopted for each patient population and type of line. Providers were educated on proper line placement
via CBT, followed by simulation validation for designated housestaff. The procedure for central line
placement was modified to include both an “observer” and an “inserter”, with sterile technique highlighted
and audited. An electronic checklist tool requiring documentation by both the observer and inserter was
implemented.
In FY13, monthly unit-specific CLABSI rates were reported across the medical center in adult and
pediatric hospitals. Each CLABSI case underwent a collaborative quality review by representatives from
infection prevention, nursing unit staff and managers, providers, and ancillary staff involved in central line
maintenance. Specific gaps in care and opportunities for improvement were identified. These included
targeted re-education for nursing staff on units with higher CLABSI rates and 1:1 return demonstration as
needed to validate skills for accessing and maintaining central lines. Providers were encouraged to

reassess each patient’s need for a central line daily and to remove central lines as soon as no longer
required. The “Scrub the Hub” protocol was reviewed during annual nursing competency sessions for
nursing staff and continued during monthly new hire orientation. CBT training on central line placement
was required as part of orientation for all incoming housestaff in FY13 and monthly simulation validation
sessions are ongoing.
Results: In FY12, 1452 RNs from all patient care areas across the institution completed the CBT and 1:1
return demonstration of skills for accessing and maintaining central lines. A total of 559 providers
completed the CBT on proper central line placement, including 368 residents, 61 fellows, and 130 faculty
members. Eighty-five housestaff (62 residents, 23 fellows) from the departments of medicine, surgery,
emergency medicine, anesthesia, critical care, and pediatrics participated in the simulation validation
sessions.
In FY13, multidisciplinary quality reviews were performed for all 26 CLABSI cases. Timely and unit-
specific data improved the awareness of nursing staff and managers and renewed their responsibility for
CLABSI prevention. Increased attendance and participation from all practitioners involved in each case
helped identify actionable items, such as the need for re-education on standardized practices,
improvements in documentation, and changes to local systems. During annual competency sessions in
FY13, 698 nurses from medical-surgical and critical care units were re-validated on the on the “Scrub the
Hub” protocol. In addition, 317 newly hired nurses underwent training with successful return
demonstration. A total of 217 new housestaff completed the CBT on proper line placement as part of
FY13 orientation, and 96 have participated in the simulation validation exercise.
Institution-wide CLABSI rates decreased from 1.06/1000 central line days in FY11 to 0.6/1000 central line
days in FY12 (p = 0.01). In FY13, the annual rate further decreased to 0.5/1000 central line days (p <
0.001 compared to FY11). The CLABSI rate was reduced by 43% from FY11 to FY12 and an additional
17% from FY12 to FY13. The mean number of monthly CLABSI cases was 4.5 in FY11 (range 1-9), 2.6 in
FY12 (range 1-8), and 2.2 in FY13 (range 0-5). Since the inception of our multidisciplinary team approach
in July 2011, an overall reduction in CLABSI rates of greater than 50% has been achieved and sustained
across the medical center in all patient populations.
Conclusion: Clinical education coupled with institution-wide standardization of procedures and supplies
led to a statistically significant decrease in CLABSI from FY11 to FY12, reducing rates by 40% to surpass
our initial goal. In contrast to other CLABSI prevention initiatives limited to the ICU setting, our
multidisciplinary approach spanned all patient care areas in adult and pediatric hospitals. An early focus
on uniform protocols for central line access and maintenance with education and return demonstration
helped drive success. Readily accessible supply bundles for central line placement and dressing changes
in all patient care areas streamlined workflows. Modifying the central line insertion procedure to include
an observer empowered nursing staff to ensure proper sterile technique and improved communication
with providers. Provider education and simulation validation on proper central line placement were critical
to address gaps in knowledge and skills for housestaff.
In FY13, the communication of unit-specific data across the institution increased transparency regarding
our CLABSI rates. Quality reviews of each case were instrumental in bringing all practitioners together to
identify areas for improvement. Feedback informed interventions that generated clinical impact for
specific nursing units and patient populations. Investment at the individual and unit levels was particularly
valuable in preventing CLABSIs and sustaining low rates across the medical center. We learned that
training for newly hired nurses and housestaff, while essential, must be supplemented with continuing
education and validation to maintain skills for all practitioners involved in central line care.
Elements critical to the success of our institution-wide 50% reduction in CLABSI rates included the
multidisciplinary team approach, standardization of supplies and practices, and support at every level of
patient care and leadership. Our methodology could be readily adopted by other national and
international organizations challenged with patient safety and quality improvement initiatives such as
CLABSI reduction.
References
Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Farley, J. E. . . . . . Perl, T. M. (2004).
Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32(10), 2014-

2020. Centers for Disease Control & National Healthcare Safety Network (CDC & NHSH). (2013, July). CDC/NHSN
Protocol Clarifications Central Line-Associated Bloodstream Infection Events. Retrieved September 18, 2013 from
http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Kuhn, H. (2008). Never Events. Retrieved
September 18, 2013 from http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD073108.pdf
McMullan, C., Propper, G., Schuhmacher, C., Sokoloff, L., Harris, D., Murphy, P., & Greene, W. H.(2013). A
multidisciplinary approach to reduce central line–associated bloodstream infections. The Joint Commission Journal
on Quality and Patient Safety, 39(2), 61-69. Rosenthal, V. D, Maki, D. G, & Graves, N. (2008). The International
Nosocomial Infection Control Consortium (INICC): Goals and objectives, description of surveillance methods, and
operational activities. American Journal of Infection Control, 36(9), e1-12. Southworth, S. L., Henman, L. J., Kinder, L.
A., & Sell, J. L. (2012). Culture change in an intensive care unit: The journey to zero central catheter-associated
bloodstream infections. Critical Care Nurse, 32(2), 49-54.
Contact
[email protected]

Promotion
Clean or Not to Clean: A Comparison of Urine Collection Techniques
Shu-Fang Su, MS, RN, Taiwan
Yueh-Yen Fang, PhD, RN, Taiwan
Wan-Wen Chiu, RN, Taiwan
Yao-Mei Chen, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to compare the accuracy of urine collection between clean-catch
midstream technique and non-cleansing midstream technique in females.
Target Audience
The target audiences of this presentation are nurses, nurse managers, and nursing faculty.
Abstract
Purpose: The purpose of this study was to compare the validity of urine collection between clean-catch
midstream technique and non-cleansing midstream technique in females.
Methods: Meta-analyses were conducted to compare urine contamination rates between samples
collected from females by using clean-catch midstream technique (CCMS) and non-cleansing midstream
technique (NCMS). Four English and one Chinese electronic databases were used to search literature up
to June , 2013. MeSH terms ‘urine specimen collection’ and ‘urine collection’ were used to search
published studies. References addressed in included studies were also screened. Studies that provided
comparisons on urine sample contamination rates between NCMS and CCMS were included. To promote
validity of data abstraction, data were extracted by two researchers independently. Disagreement on data
abstraction was resolved by complete consensus between researchers. Study quality was evaluated by
the Johns Hopkins Nursing Evidence-based Practice Quality Rating Scale. Data analysis was performed
by using the random effect model.
Results: Six studies that provided seven comparisons were identified from 2812 citations.The total
subjects involved were 1181 patients. Four studies were conducted in the United States, and two studies
were conducted in the England. Two studies used a single group pre-post design; four studies applied a
two group experimental design. Only two studies randomized study subjects into groups. Study qualities
of included studies ranged from Ib to IIc. The result of meta-analysis on two studies with one group pre-
post design suggested no difference in contamination rates of urine samples collected by either NCMS or
CCMS techniques (OR=.962, p=.608). The meta-analysis of four studies with two independent groups
also presented a similar result (OR=.892, p=.638).
Conclusion: The CCMS technique was recommended since early 1950s. It is also a practice standard
recommended by many authorities. However, the CCMS requires a time-consuming instruction, and is
frequently performed not correctly. It is also costly for supplies. This meta-analysis study suggested that
results of current urine collection studies consistently supported no variation in validity between NCMS
and CCMS techniques. Because of lower study quality of included studies, this study encouraged more
high quality studies to be conducted before having the NCMS technique as the clinical practice guideline
for urine collection.
Contact
[email protected]

K 10 - Health Promotion in the Healthcare Industry
Migraine Triggered Following Endoscopic Foreheadplasty Surgery
Julia Lassegard, RN, CRNA, MS, USA
Purpose
to inform for the first time, women experiencing headache pain following endoscopic foreheadplasty
surgery (EFS) meets migraine diagnosis criteria. EFS migraine is commonly experienced in women
following EFS. Similar to migraine, those with EFS migraine experience deteriorating emotional and
functional status postoperatively. Hormone replacement therapy influenced postoperative experience and
incidence.
Target Audience
all research and clinical health care professional involved with patient assessment, evaluations, and pain
management.
Abstract
Purpose: The purpose was to examine headache pain experienced by women following EFS, an
extracranial surgical dissection involving the trigeminal nerve. Specifically, this study described: 1)
intensity, location, quality, and duration of headache pain; 2) compare headache experience following
EFS with migraine; 3) examine medication use and perceived relief; 4) to evaluate the relationship
between headache pain and a) emotional status and b) functional status; and 5) to evaluate the effect of
estrogen levels on headache for women following endoscopic foreheadplasty surgery (EFS).
Methods: Forty-two women (44-74 years of age) undergoing EFS were recruited from ten cosmetic
surgeon private practice offices in three southern California counties. Four telephone interviews were
conducted on postoperative days 1, 3, 7, and 30 using two questionnaires, the Acute Short-Form 12v2
and Headache Questionnaire.
Results: Most women experienced bilateral headache (97%), with the majority reporting severe to
moderate pain (71%), which was not consistently relieved with prescriptive strategies. Most women 78%
(N=33) experience pain with symptoms meeting International Headache Society Criteria for migraine or
probable migraine for. Physical health scores were significantly below normal on postoperative days
(POD) 1, 3 and 7 (p<0.05), and had recovered on POD 30. Mental health scores were below normal on
postoperative days 1 and 3, returning to baseline by POD seven. These study findings present for the first
time evidence that migraine can occur from extracranial events.
Conclusion: Women experience pain following EFS, which is usually similar to migraine. This similarity
suggests that, for some patients, migraine preventives may benefit management of postoperative
headache pain. With regards migraines outside of the context of EFS, these findings raise the possibility
that some episodes are initiated by extracranial events activating the trigeminovascular system. This
study also offers more evidence that HRTs and with a history of migraine both influenced headache
episodes and characteristics. It would be of interest to explore if HRTs and history of migraine has
influence on other medical conditions and surgical procedures with and without pain. The findings of
major influences of HRT and migraine family history on pain experience suggest these factors may
predict varying pain responses to other medical conditions or procedures. In summary, management of
EFS patients postoperatively should address pain which may last for up to a month, and which may not
be well controlled with standard medications.
References
Burstein, R., Collins, B., & Jakubowski, M. (2004). Defeating migraine pain with triptans: A race against the
development of cutaneous allodynia. Annals of Neurology, 55(1), 19-26. Burstein, R., Jakubowski, M.,
Garciaâ€ Nicas, E., Kainz,
sensitization V., Bajwa,
transforms Z., Hargreaves, R., et al.
localized
pain into widespread allodynia. Annals of Neurology, 68(1), 81-91. Burstein, R., Jakubowski, M., Michael J. Aminoff,
F. B., & Dick, F. S. (2010). Managing migraine associated with sensitization Handbook of Clinical Neurology (Vol.
Volume 97, pp. 207-215): Elsevier. Burstein, R., Yarnitsky, D., Goor-Aryeh, I., Ransil, B. J., & Bajwa, Z. H. (2000). An

association between migraine and cutaneous allodynia. Annals of Neurology, 47(5), 614-624. Charles, A. (2009).
Advances in the basic and clinical science of migraine. Annals of Neurology, 65(5), 491-498. Craft, R. M. (2007).
Modulation of pain by estrogens. Pain, 132(Supplement 1), S3-S12. Dodick, D., & Silberstein, S. (2006). Central
Sensitization Theory of Migraine: Clinical Implications. Headache: The Journal of Head and Face Pain, 46(s4), S182-
S191. Dworkin, R. H., Backonja, M., Rowbotham, M. C., Allen, R. R., Argoff, C. R., Bennett, G. J., et al. (2003).
Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Archives of neurology,
60(11), 1524. Dworkin, R. H., O'Connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., et al.
(2007). Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain, 132(3), 237-251.
Goadsby, P. J. (2009). Pathophysiology of Migraine. Neurologic Clinics, 27(2), 335-360. Holroyd, K., Drew, J.,
Cottrell, C., Romanek, K., & Heh, V. (2007). Impaired Functioning and Quality of Life in Severe Migraine: The Role of
Catastrophizing and Associated Symptoms. Cephalalgia, 27(10), 1156-1165. Isse, N. G. (1995). ENDOSCOPIC
FOREHEAD LIFT - EVOLUTION AND UPDATE. [Article]. Clinics in Plastic Surgery, 22(4), 661-&. Jakubowski, M.,
McAllister, P. J., Bajwa, Z. H., Ward, T. N., Smith, P., & Burstein, R. (2006). Exploding vs. imploding headache in
migraine prophylaxis with Botulinum Toxin A. Pain, 125(3), 286-295. Jakubowski, M. P., Silberstein, S. M. D.,
Ashkenazi, A. M. D., & Burstein, R. P. (2005). Can allodynic migraine patients be identified interictally using a
questionnaire? [Article]. Neurology, 65(9), 1419-1422. Jones, B. M., & Grover, R. (2004). Endoscopic Brow Lift:: A
Personal Review of 538 Patients and Comparison of Fixation Techniques. Plastic and Reconstructive Surgery,
113(4), 1242-1250. Keller, G. S., & Mashkevich, G. (2009). Endoscopic Forehead and Brow Lift. Facial plast Surg,
25(04), 222,233. Lipton, R., Bigal, M., Diamond, M., Freitag, F., Reed, M., & Stewart, W. (2007). Migraine prevalence,
disease burden, and the need for preventive therapy. Neurology, 68(5), 343-349. Lipton, R. B., Stewart, W. F.,
Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and Burden of Migraine in the United States: Data
From the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41(7), 646-657. Loder, E.,
Rizzoli, P., & Golub, J. (2007). Hormonal management of migraine associated with menses and the menopause: a
clinical review. Headache: The Journal of Head and Face Pain, 47(2), 329-340. Messlinger, K. (2009). Migraine:
Where and how does the pain originate? Experimental Brain Research, 196(1), 179-193. Olesen, J., Burstein, R.,
Ashina, M., & Tfelt-Hansen, P. (2009). Origin of pain in migraine: evidence for peripheral sensitisation. The Lancet
Neurology, 8(7), 679-690. Rami Burstein, B. C., Moshe Jakubowski, (2004). Defeating migraine pain with triptans: A
race against the development of cutaneous allodynia. Annals of Neurology, 55(1), 19-26. Ramirez, O. M. (1994).
Endoscopic techniques in facial rejuvenation: An overview. Part I. Aesthetic Plastic Surgery, 18(2), 141-147.
Silberstein, S. D., Elkind, A. H., Schreiber, C., & Keywood, C. (2004). A randomized trial of frovatriptan for the
intermittent prevention of menstrual migraine. Neurology, 63(2), 261-269. Silberstein, S. D., Loder, E., Forde, G.,
Papadopoulos, G., Fairclough, D., & Greenberg, S. (2006). The impact of migraine on daily activities: effect of
topiramate compared with placebo. Current Medical Research and Opinion, 22(6), 1021-1029. Stewart, W. F., Lipton,
R. B., Celentano, D. D., & Reed, M. L. (1992). Prevalence of Migraine Headache in the United States. JAMA: The
Journal of the American Medical Association, 267(1), 64-69. Wolff, H. G., Silberstein, S. D., Lipton, R. B., & Dalessio,
D. J. (2001). Wolff's headache and other head pain: Oxford University Press, USA.
Contact
[email protected]

Tobacco Smoke Pollution and Compliance Before and After Passage of a
Comprehensive Statewide Smoke-Free Law
Kelly Buettner-Schmidt, PhD, RN, USA
Blake Boursaw, MS, BMS, USA
Marie L. Lobo, PhD, RN, FAAN, USA
Mark J. Travers, PhD, MS, USA
Purpose
The purpose of this presentation is to disseminate results of an evaluation of a comprehensive statewide
smoke-free law on tobacco smoke pollution in hospitality venues(n=65). A statistically significant
reduction in pollution levels occurred; compliance with the law varied; results were also analyzed by
rurality. Policy implications and recommendations are described.
Target Audience
The target audience of this presentation are nurses interested in policy development, implementation, and
evaluation for health policies and behaviors influenced by policies.
Abstract
Purpose: The purpose of this study was to determine to what extent the passage of North Dakota’s
comprehensive statewide smoke-free law has influenced the quantity of tobacco smoke pollution in
hospitality venues statewide.
Methods: This post-law study included selected pre-study venues that had been chosen by random
sampling, a statistical best practice rarely used in studying indoor tobacco smoke pollution. The indoor air
quality indicator of particulate matter 2.5 μm aerodynamic diameter or smaller (PM2.5) was assessed in
65 restaurants and bars using a modification of Roswell Cancer Park Institute’s protocols.
Results: A statistically significant 83% average reduction in tobacco smoke pollution levels occurred in
hospitality venues studied after passage and jmplementation of North Dakota’s comprehensive statewide
smoke-free law. Compliance with North Dakota’s new law varied. An analysis of tobacco smoke pollution
levels from pre-law to post-law by rurality revealed statistically significant reductions in each of the rural
categories. After passage of the comprehensive statewide smoke-free law, no statistical difference
by rurality occurred. This was in contrast to the pre-law study. Additionally, compliance did not differ by
rurality.
Conclusion: A policy implication is the objective support of the effectiveness of North Dakota’s
comprehensive statewide smoke-free law to dramatically decrease the levels of tobacco smoke pollution
both in bars and restaurants. These decreases remained true across the levels of rurality. Although
overall compliance with the comprehensive statewide law was varied it did not differ by level of rurality. A
strong recommendation, based upon the low compliance rates with some of the new law’s requirements,
is to intensify education and enforcement efforts to increase compliance with the law. Ongoing
assessment studies and enforcement similar to the Synar requirements to prevent tobacco sales to
minors, are recommended to determine and increase compliance. A study of outdoor compliance should
be repeated after sufficient time for education and enforcement has passed and with consideration of
identifying seasonal differences. Future statewide studies within North Dakota should be conducted to
determine continuing effectiveness of the law to protect the public against the dangers of exposure to
tobacco smoke pollution.
References
References Americans for Nonsmokers’ Rights Foundation. (2013a, April ). Overview list – how many smokefree
laws? Retrieved from http://www.nosmoke. org/pdf/mediaordlist.pdf Americans for Nonsmokers’ Rights Foundation.
(2013b, April) U.S. 100% Smokefree laws in non-hospitality workplaces and restaurants and bars. Retrieved from
http://www.no-smoke.org/pdf/WRBLawsMap.pdf. Avila-Tang, E., Travers, M. J.,& Navas-Acien, A. (2010). Promoting
smoke-free environments in Latin America: A comparison of methods to assess secondhand smoke exposure. Salud

Publica Mexico, 52(S2), S138-S148. Buettner-Schmidt, K., Mangskau, K.M, & Boots, C. (2007). An observational
study of compliance with North Dakota’s smoke-free law. Retrieved from
http://www.ndhealth.gov/tobacco/Reports/Compliance_Report_2007.pdf Buettner-Schmidt, K. (2013). A rural tobacco
smoke pollution study. (Unpublished doctoral dissertation). University of New Mexico, Albuquerque, NM. Chapter 23-
12: Public Health, Miscellaneous Provisions. North Dakota Century Code. § 23-12-09 – 23-12-11. Retrieved from
http://www.legis.nd.gov/cencode/t23c12.pdf Compliance. (2012). In Oxford English dictionary. Retrieved from
http://www.oed.com.libproxy.unm.edu/view/Entry/37698?redirectedFrom=compl iance&print Hyland, A., Travers,
M.J., Dresler, C., Higbee, C., & Cummings, K.M. (2008). A 32- country comparison of tobacco smoke derived particle
levels in indoor public places. Tobacco Control, 17(3), 159-165. International Agency for Research on Cancer.
(2009). IARC Handbooks of Cancer Prevention, Tobacco Control: Vol. 13. Evaluating the effectiveness of smoke-free
policies. Lyon, France: International Agency for Research on Cancer. Johnsson, T., Tuomi, T., Riuttala, H.,
Hyvärinen, M., Rothberg, M., & Reijula, K. (2006). Environmental tobacco smoke in Finnish restaurants and bars
before and after smoking restrictions were introduced. Annals of Occupational Hygiene, 50(4), 331-341. Klepeis, N.
E., Apte, M. G., Gundel, L. A., Sextro, R. G., & Nazaroff, W. W. (2003). Determining size-specific emission factors for
environmental tobacco smoke particles. Aerosol Science and Technology, 37, 780-790. Klepeis, N.E., Ott, W.R., &
Switzer, P. (2007) Real-time measurement of outdoor tobacco smoke particles. ,Journal of Air and Waste
Management Association, 57, 522-534. Lee, J.-M., Jeong, J.-H., Lee, J.-H., Moon, J.-H., Chung, U.-S., & Kim, K.-H.
(2011). The analysis of PM2.5 and associated elements and their indoor/outdoor pollution status in an urban area.
Indoor Air, 21, 145-155. Marin, H. A., & Diaz-Toro, E. (2010). The effect of the smoke-free workplace policy in the
exposure to secondhand smoke in restaurants, pubs, and discos in San Juan, Puerto Rico. Puerto Rico Health
Sciences Journal, 29(3), 279-285. Nebot, M., Lopez, M. J., Ariza, C., Pérez-Ríos, M., Fu, M., Schiaffino, A., …
Fernandez, E. (2009). Impact of the Spanish smoking law on exposure to secondhand smoke in offices and
hospitality venues: before and after study. Environmental Health Perspectives, 117, 344-347. 42 Pope, C. A., &
Dockery, D. W. (2006). Health effects of fine particulate air pollution: Lines that cross. Journal of the Air & Waste
Management Association, 56, 709 – 742. Repace, J. L. (2004). Respirable particles and carcinogens in the air of
Delaware hospitality venues before and after a smoking ban. Journal of Occupational Environmental Medicine, 46(9),
887-905. Repace, J., Hughes, E., & Benowitz, N. (2006). Exposure to second-hand smoke air pollution assessed
from bar patrons’ urinary cotinine. Nicotine & Tobacco Research, 8(5), 701-711. Rosen, L. J., Zucker, D. M., Rosen,
B. J., & Connolly, G. N. (2011). Second-hand smoke levels in Israeli bars, pubs and cafes before and after
implementation of smokefree legislation. European Journal of Public Health, 21(1), 15-20. doi:10.1093/eurpub/ckp243
Travers, M. J. (2010a). Bismarck air quality monitoring study. Buffalo, NY: Department of Health Behavior, Roswell
Park Cancer Institute. Travers, M. J. (2010b). Indoor air monitoring protocol (12/20/2010 ed.). Buffalo, NY: Roswell
Cancer Park Institute. Travers, M. J., Cummings, K. M., Hyland, A., Repace, J., Babb, S., Pechacek, T., & Caraballo,
R. (2004). Indoor air quality in hospitality venues before and after implementation of a clean indoor air law - Western
New York, 2003. Morbidity and Mortality Weekly Report, 53(44), 1038-1041. Travers, M. J., & Dobson, K. A. (2008).
North Dakota air monitoring study: Effect of the Fargo smoke-free air ordinance. Buffalo, NY: Department of Health
Behavior, Roswell Park Cancer Institute. Travers, M. J., & Vogl, L. (2010). Minot, North Dakota air quality monitoring
study. Buffalo, NY: Department of Health Behavior, Roswell Park Cancer Institute. Travers, M. J., & Vogl, L. (2011).
Grand Forks, North Dakota air quality monitoring study. Buffalo, NY: Department of Health Behavior, Roswell Park
Cancer Institute. U.S. Census Bureau. (2009). Population Estimates. Annual Estimates of the Resident Population for
Counties: April 1, 2000 to July 1, 2008. Table 1: Annual Estimates of the Resident Population for Counties of North
Dakota: April 1, 2000 to July 1, 2008 (CO-EST2008-01-38). Retrieved from
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American Fact Finder. P1. Total population. Universe: Total population.2010 Census Summary File 1. Retrieved from
the U.S. Census Bureau FactFinder website:
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=DEC_10_SF1_P1&prodType=table U.S. Department of Agriculture. (2011). Data for rural analysis. Retrieved from
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Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the
Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health. U.S. Department of Health and Human Services. (2010). Summary health
statistics for U.S. adults: National health interview survey, 2009. Vital and health statistics. Series 10, Number 249.
Table 25, p. 89. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_249.pdf U.S.
Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2011a). Healthy
People 2020. Washington, DC. Retrieved from
http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41 U.S. Department of Health and Human
Services. (2011b). The health and well-being of children in rural areas: A portrait of the nation. 2007. U.S.
Department of Health and Human Services. Health Resources and Services Administration. Maternal and Child
Health Bureau. Retrieved from http://mchb.hrsa.gov/nsch/07rural/moreinfo/pdf/nsch07rural.pdf U.S. Environmental

Protection Agency. (2009a, January 15). 40 CFR Parts 51 and 58: [EPA-HQ – OAR- 2007-0195; FRL-RIN 2060-
AO11. Air quality index reporting and significant harm level for fine particulate matter. Retrieved from
http://www.epa.gov/pm/pdfs/20090115fr.pdf U.S. Environmental Protection Agency. (2009b, June 28). Fact sheet.
Proposed revisions to air quality index reporting and significant harm level for fine particulate matter. Retrieved from
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Register, Vol. 78 No. 140 Part II. 40 CFR Parts 50, 51, 52 et al. National ambient air quality standards for particulate
matter; Final rule: [EPA-HQ – OAR- 2007-0492; FRL- 9761-8] RIN 2060-AO47. Retrieved from
http://www.gpo.gov/fdsys/pkg/FR- 2013-01-15/pdf/2012-30946.pdf U. S. Environmental Protection Agency (2013,
March 18). Particulate matter: Basic information. How big is particle pollution? Retrieved from
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ambient air quality standards for particle pollution. Revised air quality standards for particle pollution and updates to
the air quality index (AQI). Retrieved from http://www.epa.gov/airquality/particlepollution/2012/decfsstandards.pdf
U.S. Environmental Protection Agency. (n.d.b.). The national ambient air quality standards for particle pollution.
Particle pollution and health. Retrieved from http://www.epa.gov/pm/2012/decfshealth.pdf World Health Organization.
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http://www.who.int/tobacco/global_report/ 2011/en/
Contact
[email protected]

The Role of Hypothalamic-Pituitary-Adrenal Axis Responsivity in Accumulative
and Sustained Paclitaxel-Induced Mechanical Hypersensitivity in Male and
Female Rats: A Three-Strain Comparison
Sharon Kozachik, RN, MSN, PhD, USA
Gayle G. Page, RN, DNSc, USA
Purpose
The purpose of this presentation is to articulate the hypothalamic-pituitary-adrenal axis and sex
differences that are implicated in the accumulative and sustained neuropathic pain consequences of
paclitaxel therapy.
Target Audience
The target audience of this presentation includes nurse researchers and clinicians whose area of
research/practice interest is oncology
Abstract
Purpose: The purpose of this presentation is to articulate the hypothalamic-pituitary-adrenal axis and
sex differences that are implicated in the accumulative and sustained neuropathic pain consequences of
paclitaxel therapy.
Cancer pain is a significant issue, reaching global proportions. Recognizing the enormity of cancer pain,
the International Society for the Study of Pain named 2008-2009 the Global Year Against Cancer Pain.
1.6 million Americans were diagnosed with cancer in 2013 (American Cancer Society), many of whom
underwent chemotherapy. Paclitaxel, a commonly prescribed chemotherapy for solid tumor and lymphoid
cancers, is associated with a painful, dose-limiting neuropathy that can persist long after adjuvant therapy
is completed (Dougherty et al., 2004; Marupudi et al., 2007). Approximately 20% of all patients
undergoing a paclitaxel protocol require dose reductions of upwards to 25%; an additional 6% have
premature cessation of treatment secondary to neuropathy and neuropathic pain (Mielke et al., 2003).
Despite these alarming numbers, little is known about the risk and resilience factors in the precipitation
and perpetuation of paclitaxel-induced neuropathic pain. The purpose of this study was to determine
whether there were sex- or hypothalamic-pituitary-adrenal (HPA) axis responsivity differences in
paclitaxel-induced mechanical hypersensitivity.
Methods: This reverse-translational, bedside to bench study employed 82 adult, male and female rats
(n= 29 Sprague Dawley, n = 26 Lewis, n = 27 Fischer 344 [F344]). The in-bred F344 and Lewis rats were
employed due to their HPA axis hyper- and hypo-responsivity, respectively (Sternberg et al., 1992). Rats
were entered into the study at 14-16 weeks. Rats were maintained on a 12:12-hr light:dark cycle (lights
on at 0800), in an environmental temperature of 23o C (+ 2o), with standard rat chow and water available
ad libitum.
Baseline blood withdrawal per tail tip clip was performed during the latter half of the dark phase; no less
than 48 hours later, rats were video recorded undergoing the novel stress apparatus Elevated Plus Maze
(EPM) for 5 minutes. This testing was conducted during the latter half of the dark phase in a room
illuminated with dim red lighting. At the conclusion of EPM testing, rats were returned to the vivarium.
Post EPM blood withdrawal was conducted 30 minutes after removal from the EPM apparatus. All blood
was collected in a heparinized tube, centrifuged, aliquoted and stored at -80o C. Corticosterone levels
were measured in duplicate using corticosterone Enzyme Immunoassay kits from Enzo Life Sciences
(Plymouth Meeting, PA).
von Frey Hair testing (VFH) was used to operationalize mechanical hypersensitivity. VFH filaments, also
used to measure neuropathy in humans, are a series of small monofilaments of incrementally increasing
bending force, ranging from 0.45 to 16.69 gms. The 8-middle VFH filaments were used in this study. Rats
sat in small plexiboxes, atop wire mesh. The middle VFH was applied to the plantar hindpaw, between
footpads, with force applied to bend it. If a brisk paw withdrawal resulted, the next lower VFH was applied

next; in the absence of response, the next higher VFH was applied. This resulted in 4-9 perturbations to
each foot. 50% paw withdrawal threshold (PWT), the measure of mechanical hypersensitivity, was
calculated according to the methods of Dixon (1980). To be eligible for study entry, rats had to exhibit
bilateral 50% PWT of 10 grams. Rats underwent VFH testing daily throughout the protocol, during the
latter half of the light phase.
Paclitaxel (Henry Schein) was diluted in 0.9% bacteriostatic saline, just prior to administration, to a
concentration of 1 mg/kg; vehicle-injected rats were injected with 0.9% bacteriostatic saline. Rats were
weighed on the evening prior to injections. Rats were injected every other day for 7 days (days 1, 3, 5, 7);
the next 7 days (8 – 14) were drug free. Injections were completed before lights on. This 14-day cycle
was repeated twice (days 15 – 28 and 29 – 42) to model a clinical chemotherapy protocol.
50% PWT data were log transformed to meet normality assumption. Two Repeated Measures ANOVA
models were run: (1) to determine the accumulative (post 4, 8, and 12 mg/kg) effects of paclitaxel, in
addition to sex and rat strain on mechanical hypersensitivity, and (2) to determine the sustained (7 days
after 4, 8, and 12 mg/kg) effects of paclitaxel, in addition to sex and rat strain on mechanical
hypersensitivity. Linear regression was run to determine whether HPA axis responsivity was a predictor of
paclitaxel induced mechanical hypersensitivity.
This study was approved by the Johns Hopkins Animal Care and Use Committee, Protocol # RA08M267.
Results: There were no significant strain differences in baseline corticosterone level. Following the 5
minute novel stressor EPM, Lewis rats exhibited significantly reduced corticosterone response compared
to F344 (p < 0.001) and Sprague Dawley rats (p < 0.02). Female rats exhibited significantly greater
corticosterone response to stress (p < 0.05). Neither baseline corticosterone, nor post-stress
corticosterone levels significantly predicted 50% PWT.
The accumulative effects of PAC resulted in significant reductions in 50% PWT (F(1,80) = 50.77, p <
0.001) and there was a significant strain by drug interaction (F(2,79) = 4.75, p < 0.05), with Sprague
Dawley rats demonstrating greater PAC-induced mechanical hypersensitivity than Lewis or F344 rats.
The sustained effects of PAC resulted in significant reductions in 50% PWT (F(1,80) = 9.53, p < 0.01),
and there were significant interaction effects including sex by strain (F(2,79) = 3.34, p < 0.05), with
Sprague Dawley male and Lewis female rats exhibiting significantly reduced 50% PWT compared to their
strain counterparts; and strain by drug (F(2,79) = 7.35, p < 0.01), with PAC-injected Sprague Dawley rats
(both sexes pooled) exhibiting significantly reduced 50% PWT compared to both in-bred rat strains. PAC-
injected F344 rats did not exhibit sustained effects secondary to paclitaxel and exhibited 50% PWT that
were not statistically different from their VEH-injected counterparts.
Conclusions: To our knowledge, this is the first rodent study of paclitaxel-induced mechanical
hypersensitivity to employ a paclitaxel paradigm that modeled a clinical chemotherapy protocol that a
person with cancer might undergo. Compared to baseline, PAC-injected rats exhibited significantly
reduced 50% PWT at the completion of each active drug phase. Compared to the in-bred F344 and Lewis
rats, known for their HPA axis hyper- and hypo-responsivity, respectively, the out-bred Sprague Dawley
rats exhibited significant, sustained, adverse effects on 50% PWT that were maximized 7 days after
receipt of 12 mg/kg cumulative. HPA axis responsivity was not a significant predictor of mechanical
hypersensitivity. The a priori hypothesis was that female F344 rats would exhibit significantly greater
PAC-induced mechanical hypersensitivity, but our data did not support this hypothesis. The F344 rats
nearly returned to baseline 50% PWT levels during the recovery week of each paclitaxel cycle,
demonstrating the ability to recover from the adverse effects of the paclitaxel. Work in other labs suggests
that the F344 rat’s hyper-responsive HPA axis with its resultant enhanced glucocorticoid and the
influence of corticotrophin-releasing hormone on immune response may contribute to the resilience
against certain types of pain (Webster et al., 2002), or possibly due to upregulation of brain-derived
neurotrophic factor mRNA in the dorsal root ganglia (Herradon et al., 2007).
Paclitaxel receipt is associated with a painful and debilitating neuropathy that can begin early in treatment
or weeks after treatment cessation, and it may last for many months. This painful and dose-limiting
peripheral neuropathy can adversely affect a cancer patient’s ability to perform activities of daily living,
engage in usual roles, and ultimately worsen their quality of life (Bakitas, 2007; Bezjak et al., 2004).
Nurses are well-positioned to educate patients and families on the early signs and symptoms of

paclitaxel-induced neuropathic pain, as well as assess patients at each chemotherapy appointment. As
the prevalence of cancer survivors grows, it is imperative that we better understand the long term pain
consequences conferred by paclitaxel therapy and learn the means through which paclitaxel-induced pain
onset can be averted or delayed, and/or pain severity reduced. If these findings hold in humans, future
research can be conducted to determine: (1) Mechanisms that may confer resilience against
chemotherapy-induced neuropathic pain, and (2) Whether therapies targeted at altering HPA axis
responsivity show promise in attenuating paclitaxel-induced neuropathic pain.
References
American Cancer Society (2013). Cancer facts & figures- 2013. Author: Atlanta. Bakitas, M. A. (2007). Background
noise: The experience of chemotherapy-induced peripheral neuropathy. Nursing Research, 56, 323-331. Bezjak, A.,
Tu, D., Bacon, M., Osoba, D., Zee, B., Stuart, G. et al. (2004). Quality of life in ovarian cancer patients: comparison of
paclitaxel plus cisplatin, with cyclophosphamide plus cisplatin in a randomized study. Journal of Clinical Oncology,
22, 4595-4603. Dixon, W.J. (1980). Efficient analysis of experimental observations. Annual Review of Pharmacology
and Toxicology, 20, 441-462. Dougherty, P.M., Cata, J.P., Cordella, J.V., Burton, A., & Weng, H-R. (2004). Taxol-
induced sensory disturbance is characterized by preferential impairment of myelinated nerve function in cancer
patients. Pain, 109, 132-142. Herradon, G., Ezquerra, L., Nguyen, T., Wang, C., Siso, A., Franklin, B., Dilorenzo, L, et
al. (2007). Changes in BDNF expression correlate with rat strain difference s in neuropathic pain. Neuroscience
Letters, 420 273-276. Marupudi, N. I., Han, J. E., Li, K. W., Renard, V. M., Tyler, B. M., & Brem, H. (2007). Paclitaxel:
A review of adverse toxicities and novel delivery strategies. Expert Opin Drug Saf., 6(5), 609-621. Mielke, S., Mross,
K., Gerds, T. A., Schmidt, A., Wasch, R., Berger, D. P., Lange, W., & Behringer, D. (2003). Comparative neurotoxicity
of weekly non-break paclitaxel infusions over 1 versus 3 h. Anti-Cancer Drugs, 14, 785-792. Sternberg, E. M. ,
Glowa, J. R., Smith, M. A., Calogero, A. E., Listwak, S. J., Aksentijevich, S., Chrousos, G. P., Wilder, R. L., & Gold, P.
W. (1992). Corticotropin releasing hormone related behavioral and neuroendocrine responses to stress in Lewis and
Fischer rats. Brain Research, 570, 54-60. Webster, E. L., Barrientos, R. M., Contoreggi, C., Issac, M. G., Ligier, S.,
Gabry, K. E., Chrousos, G. P., McCarthy, E. F., Rice, K. C., Gold, P. W., & Sternberg, E. M. (2002). Corticotropin
releasing hormone (CRH) antagonist attenuates adjuvant induced arthritis: Role of CRH in peripheral inflammation.
The Journal of Rheumatology, 29, 1252-1261.
Contact
[email protected]
K 12 - Nursing Research to Improve Clinical Quailty Strategies

Which Clinical Supervision in Nursing Strategies Nurses Wish to be Implemented
in Their Health Contexts?: Construction and Validation of an Questionnaire
Inês Alves da Rocha e Silva Rocha, MS, RN, Portugal
Maria Margarida Reis dos Santos Ferreira, MS, RN, PhD, Portugal
Purpose
To introduce and analyze the phenomenon of Clinical Supervision in Nursing in Portugal, through the
application of the Questionnaire of Frequency Assessment of Clinical Supervision in Nursing Strategies
that enables to identify the strategies that nurses wish to be more implemented in both hospital and
primary health care settings.
Target Audience
Nursing teachers and practitioners, since the supervisory process can be applied in the supervision of
students (mentorship), induction to the profession (preceptorship) or professional supervision (clinical
supervision in nursing).
Abstract
Purpose: This research aims to improve the quality of care through the identification of clinical
supervision in nursing strategies that nurses wish to be more implemented in the supervisory processes
in use in the different contexts of health. With this study we intended to achieve the following objectives:
build and validate an instrument to assess the frequency in which nurses wish the clinical supervision in

nursing strategies were implemented; identify the clinical supervision in nursing strategies nurses wish
that were more often implemented in health services and identify the clinical supervision in nursing
strategies nurses wish that were never implemented in health services.
Methods: This research is part of a quantitative paradigm and it is a comparative descriptive, exploratory
and cross study. The non-probabilistic sample consists in 273 nurses of different wards and institutions in
Portugal. Data were collected through the application of the Questionnaire of Frequency Assessment of
Clinical Supervision in Nursing Strategies, from may to september of 2012, and the analysis
was performed using descriptive and inferential statistics. During the development of this research, all
ethical issues were taken into consideration.
Results: Nurses working in the health context report that the clinical supervision in nursing strategy they
wish to be more implemented is observation (48,0%; n=131) and the reflective report is the strategy they
wish to be less (4,8%; n=13). Nurses also said they wish the strategy support was more implemented in
their health context (38,5%; n=105). The clinical supervision in nursing strategy that nurses more wish
never to be implemented is the distance supervision by skype® (38,5%; n=105). On the contrary,
feedback is the strategy that nurses wish less to never be implemented (1,1%; n= 3). In the hospital
setting, observation is also the strategy that nurses wish to use more (46,3%; n=81) and the reflective
report the strategy they wish to use less (4,6%; n=8). In this context, nurses wish the supervisory group
sessions strategy was less implemented (12,0%; n=21) than individual supervision sessions (17,7%; n=
31). In the primary health care setting, observation is still the strategy nurses wish to be more
implemented (51,5%; n=50) and the supervisory group sessions the strategy nurses wish to be less
implemented (4,1%; n=4). If we compare the results obtained in the hospital setting with the primary
health care setting, in one hand we can conclude that nurses from the primary health care setting wish
feedback, reflective report and the three supervision at distance strategies were more implemented. On
the other hand, nurses from the hospital setting wish case analysis with the supervisee, supervisory
group sessions and case analysis in group strategies were more implemented. There are statistically
significant differences (p<0,05) between primary health care and hospital nurses' desire to implement
reflective report (U=7299,0; p=0,044), supervision at distance by phone (U=6957,0; p=0,012) and
supervision at distance by email (U=6885,0; p=0,008) strategies: nurses from the primary health care
want to use more those clinical supervision in nursing strategies than nurses who work at the hospital
setting. The Cronbach alpha coefficient was calculated to assess the internal consistency of the
Questionnaire of Frequency Assessment of Clinical Supervision in Nursing Strategies. Once all clinical
supervision in nursing strategies obtained a Cronbach alpha value greater than 0.90, we may say that
there is a good internal consistency of the instrument.
Conclusion: As conclusion of the study we highlight that the clinical supervision in nursing strategies that
nurses wish to be more frequently implemented in health services are observation, demonstration and
support. We may also conclude that there are statistically significant differences (p<0,05) in reflective
report, supervision at distance by phone and supervision at distance by email strategies: nurses from the
primary health care want to use more those clinical supervision in nursing strategies than nurses who
work at the hospital setting. The Questionnaire of Frequency Assessment of Clinical Supervision in
Nursing Strategies has reliability and content validity, therefore it can be used in the context of
Mentorship, Preceptorship or Clinical Supervision in Nursing.
Contact
[email protected]
K 12 - Nursing Research to Improve Clinical Quailty Strategies

Nursing Preparation of the Caregiver By Continuous Care Teams: Quality
Indicators
Joana Isabel Vieira, RN, Portugal
Maria Margarida Reis dos Santos Ferreira, MS, RN, PhD, Portugal
Purpose

The purpose of this presentation is to disseminate the knowledge produced about the caregiver,
contributing to the development of nursing
Target Audience
Practice nurses, managers and academics in nursing
Abstract
Purpose: The progressive aging of the population associated with the cumulative effect of declining
fertility and mortality has resulted in increased life expectancy, along with an improvement in the health
status of the population (Decreto-Lei, 2006). It is estimated that the population have become
progressively more aging across the European Union (European Comission, 2010). According to data
released by the National Statistics Institute (INE, 2011) regarding the 2011 Census of Portugal, for every
100 young people there are 131 elderly (65 years old and over), verifying an increase in the elderly
dependency ratio of 25 to 30 per 100 people of working age. Appear linked growing dependence levels
either by economic or social factors, whether by disease situations, increasingly a concern for the society
to create a network of support that is responsive to the needs of citizens dependent of a third person.
Although there is an improvement in the health status of our population over the last 40 years there has
been a parallel increase in the prevalence of people with chronic and disabling diseases, so there are
gaps at the national level (Portuguese national level ) in providing long-term care (Decreto-Lei, 2006).
Family was established as a privileged mean of supportive care to health and life of its members
(Figueiredo, 2009). Nurses, especially those working in primary care, cause the nature of the relationship
and proximity of the families may contribute to the improvement of the performance of the caregiver and
subsequent lower levels of burden. Caregiver can be understood as "the one who assists in the
identification, prevention, or treatment of illness or disability that meets the needs of a dependent"
(Conselho Internacional de Enfermeiros, 2010, p.115). It is necessary to prepare the caregiver for his role
and for the promotion and maintenance of the quality of life of both, the dependent person and the
caregiver's own, so it is crucial the share of information, training and support provided to the caregiver
(Guedes, 2011).
To meet these needs the Portuguese government has created the so-called Continuous Care Teams
(ECCI). These "direct their multidisciplinary intervention to people experiencing functional dependence,
terminal illness, or in process of recovery, with the social support network, whose condition does not
require hospitalization" (UMCCI, 2011, p.10). Their mission also support the qualification of caregiving by
family members or informal caregivers (UMCCI, 2011).
It has been difficult to objectively translate the contribution of nurses to the gains of their clients' health in
the preparation of caregivers, since there is a lack of indicators of their professional practice (Petronilho,
2008). The supervisory dynamics have been proving to be a key factor in the improvement of the quality
of care provided by nurses, so that in recent decades have been argued about the relevance of the
implementation of policies to promote and improve the quality of professional practice, involving the
clinical supervision in nursing as a process that contributes to this goal, governed for this purpose by
quality indicators of the clinical practice.
This study comes as part of a project entitled Design of a program of clinical supervision in nursing in the
context of primary health care, aiming to provide an input to the construction of a program of clinical
supervision in nursing, through the identification of quality indicators of professional practice in the
preparation of the caregiver in the primary health care area.
Methods: The paradigm of research is grounded in qualitative perspective, having a descriptive cross-
sectional nature. The study population are the nurses of the ECCI 's Cluster Health Centers of the Alto
Tâmega and Barroso, and the participants were selected through a process of non-probability sampling of
convenience .
Data were collected through a focus group interview addressing the areas of the preparation of the
caregiver, quality indicators and nursing clinical supervision, and lasted about two hours. We used the
audio recording as a resource for the documentation of the data collected, with the permission of the
participants in the written informed consent model. After transcription of the recorded data, we proceeded
to its analysis, through content analysis according to Bardin (2009). From the data analysis emerged

around 32 indicators, such as effectiveness in the diagnostic of risk of caregiver’s stress; gains expressed
in support perceived by the informal caregiver; gains in knowledge of the caregiver about the treatment
management; gains in learning skills of the caregiver to manage the treatment, among others.
In order to respect the ethical principles for conducting this research was requested and obtained the
favorable opinion of the National Commission for Data Protection, the Ethics Committee for Health of the
North Regional Health Authority, and also by Executive Director and Nurse Supervisor at Cluster Health
Centers Alto Tâmega and Barroso.
Results: After completion of the study it was found that there are still many reserves on the use of quality
indicators in nursing, and especially many uncertainties with regard to the implementation of nursing
clinical supervision programs. It is safeguarded the importance that the indicators have been assuming in
everyday health organizations, however, the results obtained from their use, and method of application
are dubious for participants. Nevertheless, several indicators were considered essential by participants in
the preparation of caregivers. These indicators are based primarily on gains in knowledge and learning
skills of the caregiver in various areas relating to the care of the dependent person and the preparation of
the caregiver to the performance of his role, as well as indicators related to the caregiver’s stress. It is
noteworthy that the main emphasis is attributed to the involvement and satisfaction of the caregiver, being
considered by participants as key areas that should be identified as indicators in their clinical practice.
Conclusion: With the identification of these indicators we are intended to provide guidance for the work
performed by nurses in preparation of the caregiver in ECCI's, in order to highlight the work done by such
units with customers, respective families and caregivers, translating it into gains in health and in
clarification to the contribution of nurses to the health of their customers.
References
Bardin, L. (2009). Análise de Conteúdo. (4ª ed.). Lisboa: Edições 70. Conselho Internacional de Enfermeiros (2010).
Classificação Internacional para a prática de enfermagem CIPE: versão 2. Lisboa: Ordem dos Enfermeiros. Decreto-
Lei nº 101/2006. Diário da República I Série-A. Nº 109 (2006-06-06), 3856-3865. European Comission (2009). 2009
Ageing Report: Economic and budgetary projections for the EU-27 Member States (2008-2060). [Online]. Eurostat.
Available: http://ec.europa.eu/economy_finance/publications/publication14992_en.pdf>. Instituto Nacional de
Estatística (INE), IP. Censos 2011 – Resultados Provisórios. Lisboa: INE, 2011. Figueiredo, M. (2009) Enfermagem
de Família: um contexto do cuidar. Porto: Instituto de Ciências Biomédicas Abel Salazar. Guedes, S. (2011) Cuidar
de Idosos com Dependências em Contexto Domiciliário: Necessidades Formativas dos Familiares Cuidadores. Tese
de Mestrado, Porto. Petronilho, F. (2009) Produção de indicadores de qualidade: a enfermagem que queremos
evidenciar. Sinais Vitais, 82, 36-44. Unidade de Missão para os Cuidados Continuados Integrados (UMCCI) (2011)
Manual do Prestador: Recomendações para a Melhoria Contínua. [Online], Lisboa, Available: http://www.umcci.min-
saude.pt/SiteCollectionDocuments/UMCCI-RNCCI_Manual_do_Prestador.pdf>.
Contact
[email protected]

L 03 - Global Care of the Dialysis Patient
Living with End-Stage Renal Disease: Perceived Impact of Treatment in a Mexican
Hemodialysis Clinic
Luxana Reynaga-Ornelas, PhD, MSN, RN, Mexico
Carol M. Baldwin, PhD, RN, AHN-BC, FAAN, USA
Christian Rodríguez-Pérez, RN, Mexico
Midhael Todd, PhD, USA
Karla Susana Vera-Delgado, MS, RN, Mexico
Purpose
The purpose of this presentation is to describe how persons with end-stage renal disease in Mexico
perceive their quality of life and health status while depending on the hemodialysis treatment to live.
Results encourage nursing strategies based on evidence to improve their health-related quality of life.
Target Audience
The target audience of this presentation is nurses from all over the world who work with patients with
chronic diseases and/or end of life issues and are engaged in the holistic perspective in nursing practice.
Abstract
Purpose: End-stage renal disease (ESRD) has great impact in patients’ health-related quality of life (HR-
QOL), which is globally considered as a reliable measure of health outcome. In Mexico, the prevalence of
type 2 diabetes, the leading cause of ESRD, is 14.4%; it is predicted that 18% of the adult population in
Mexico will have type 2 diabetes by 2025. In 2006, Mexico reported the prevalence and incidence rates of
ESRD of 510.4 and 345.9 per million population, respectively. The lack of a formal national registry
system in Mexico, however, could result in underestimation of these rates.
Methods: Sixty-nine Mexican patients attending a hemodialysis clinic in Central Mexico where
interviewed about their HR-QOL and disease impact in their daily lives based on the MEI adaptation of
ENH's Spanish KDQOL 1.3 version (Benjamin Arnold). The KDQOL-SF assesses the functioning and
well-being of people with kidney disease and on dialysis. It consists of 80 items divided into 19
dimensions: SF-36 (8 dimensions/36 items; 1 health transition item), kidney-disease-targeted items (11
dimensions/43 items). Scores presented are the Physical Component Summary (PCS), the Mental
Component Summary (MCS), the health transition item and the 11 kidney-disease-targeted. The scores
range from 0 to 100, with higher scores reflecting better HR-QOL. Data were analyzed using SPSS
software (V21).
Results: Demographic data showed participants to be 43 ±19 years old, female (64%), married (49%),
5.±3 years of education, without monthly salary (40%), with health insurance (91%). Predominant
comorbidity was diabetes (27%) and they attend to the clinic mostly mornings (45%) and evenings (43%),
two-three (36%-62%) times a week, from three to four hours connected to the hemodialysis machine
(96%) ; vascular access were a catheter (55%) and arterio-venous fistula (45%) installed less than a year
(43%) or two (36%) ago. Forty-six percent of them reported at least one hospitalization during the last
year from 1-3 days (43%); 71% referred to take hypertensive medications.
Low scores showed impairment in both physical and mental dimensions (PCS=439.9±10, MCS=40.3±8),
as well as when questioned about health status compared with last year (26±33). Work status (36±37),
burden of kidney disease (39±34), quality of social interaction (49±15) and effects of kidney disease on
daily life (59±20) were found to be the most affected dimensions of HR-QOL for this population.
Interestedly, dialysis staff encouragement (88±22) and social support (85±24) were the best scored
dimensions in contrast with the health status reported in PCS and MCS scores. Factors related to this
phenomena in PCS were years of education (p<0.01), marital status (p<0.05), comorbidity (p<0.01) and
age (p<0.001). Factors related with MCS scores were marital status (p<0.01), hospitalization (p<0.01),
antihypertensive medication (p<0.05). The health transition item was related with factors as insurance
(p<0.05), comorbidity (p<0.01) and hospitalization (p<0.05).

Conclusion: In this population, there is a high impact of disease and treatment on HR-QOL of persons
with ESRD treated with hemodialysis. It is imperative to structure evidence-based and holistic-oriented
health care strategies based in order to address best health outcomes.
Contact
[email protected]

Age Difference in Adherence to a Renal Therapeutic Regimen: The Perspectives
of Chinese Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Lai Wah Lam, RN, BN, MPhil, PhD, Hong Kong
Purpose
The purpose of this presentation is to share with healthcare professionals the age difference in adherence
to a renal therapeutic regimen so as to facilitate them to support patients with different age groups to live
with the chronicity of end-stage renal disease and its related treatment.
Target Audience
The target audience of this presentation is healthcare professionals taking care of patients with chronic
illnesses, particularly those looking after patients with end-stage renal disease and undergoing
continuous ambulatory peritoneal dialysis.
Abstract
Purpose: Patients suffering from end-stage renal disease (ESRD) have to rely on renal replacement
therapy (RRT) to sustain life. Due to global shortage of donor organs (Baid-Agrawal & Frei, 2007), all new
patients requiring RRT are prescribed continuous ambulatory peritoneal dialysis (CAPD) in Hong Kong
unless this is contraindicated (Li & Szeto 2008). It is generally believed that successful management of
ESRD and its related treatment depends on patients’ continuous adherence to the four components of the
renal therapeutic regimen, which include dietary and fluid restrictions, and medication and dialysis
prescriptions (Denhaerynck et al., 2007). As such, studies have been conducted to investigate patients’
adherence rates to different components of the renal therapeutic regimen and factors associate with their
adherence. In addition to the various adherence rates reported, younger patients are persistently found to
be more non-adherent than older patients (Kara et al., 2007; Kugler et al., 2005; Lam et al., 2010). Due to
the study design, patients were not asked to provide explanations for their adherence. This study aimed
to identify age difference in adherence to a renal therapeutic regimen from the perspectives of Chinese
patients undergoing CAPD.
Methods: A qualitative exploratory design was employed. Purposive sampling was used to recruit
participants from a renal unit of an acute hospital in Hong Kong. The inclusion criteria were adult patients
who were performing home CAPD independently. Thirty-six participants of different genders (18 male
participants), ages (35–76 years), and lengths of dialysis experiences (11–103 months) were recruited.
Semi-structured one-to-one interviews were conducted using an interview guide. Examples of the
interview questions are: “After the commencement of CAPD, what changes have taken place in your daily
living?” and “How do you feel about having to adhere to all the advice that you have been given?” The
interviews were conducted in individual participant’s home with each lasted for 40 to 80 minutes. Content
analysis was employed to analyse the transcribed data. Data collection and analysis were conducted
simultaneously. Subgroup analysis was carried out to identify age difference in adherence to the
therapeutic regimen. The 36 participants were categorised into 2 groups, with age below 60 as the
younger group and age equal to or above 60 as the older group. There were 21 and 15 participants in the
younger and older groups, respectively. Findings from both groups were compared to identify similarities
and differences.
Results: Participants in both groups unanimously described how they sacrificed their freedom to struggle
to live with strict adherence, particularly in the first few months of dialysis. Participants in the younger
group expressed more intense feelings about “disruption of social life” after the commencement of
dialysis and “the need for permanent strict adherence”. Being fixed up by the dialysis schedules, younger
participants complained about the inability to maintain their previous lifestyles, such as joining social
gathering with friends and travelling aboard. Although the majority of these participants’ primary hope for
the future was to receive a kidney transplant, they also realised that the chance was very slim.
Anticipating that they had to undergo long-term dialysis , the younger participants kept saying that
permanent strict adherence was impossible. Most of them perceived life as boring and expressed that

they seemed to live for doing dialysis. Despite realising the need for long-term strict adherence, younger
participants provided more justifications for “adopting an easy-going approach to adherence” and
“modifying their treatment regimen more readily”. Participants in the older group were comparatively more
concerned about maintaining their stable health condition to avoid becoming ill. Several older participants
repeatedly claimed that longevity was not their priority and they were not afraid of death. Instead, their
major concern was not to suffer from a prolonged process of death and become a burden to their family.
Therefore, they were more willing to endure hardship in order to adhere to instructions to prevent
complications.
Conclusion: This is the first study to explain from patients’ perspectives the reasons why younger
patients are more non-adherent to the renal therapeutic regimen than older patients. The participants’
journey of learning to live with adherence was full of thorns and obstacles. To adopt strict adherence,
regardless of patients’ age, they have to make radical changes to their former lifestyles and endure
hardship (Lam et al., in press). The traditional Chinese culture of submission to authority might have
caused the older participants to conform more readily (Bond, 1991). On the contrary, participants in the
younger group were more concerned about the restrictions imposed on them and attempted to regain
their normality. After receiving dialysis for several months, participants in both groups started to adopt an
easy-going approach of various degrees to adherence by trial and error. To facilitate patients to come to
terms with the extensive lifestyle limitations imposed by the disease, additional professional support is
needed, particularly in the initial stage of dialysis. While devising guidelines for patients to adhere,
healthcare professionals have to take into consideration individual patients’ personal needs, lifestyles and
goals for care. Allowing some flexibility in the regimen enables patients to participate in their former social
activities. Helping them integrate the therapeutic regimen into their daily living facilitate them to live with
the disease with greater ease.
References
Baid-Agrawal, S., & Frei, U. A. (2007). Living donor renal transplantation: Recent developments and perspectives.
Nature Clinical Practice Nephrology, 3(1), 31-41. Bond, M. H. (1991). Beyond the Chinese face: Insights from
psychology. Hong Kong: Oxford University Press. Denhaerynck, K., Manhaeve, D., Dobbels, F., Garzoni, D., Nolte,
C., & De Geest, S. (2007). Prevalence and consequences of nonadhernece to hemodialysis regimens. American
Journal of Critical Care, 16(3), 222-236. Kara, B., Caglar, K., & Kilic, S. (2007). Nonadherence with diet and fluid
restrictions and perceived soical support in patients receiving haemodialysis. Journal of Nursing Scholarship, 39(3),
243-248. Kugler, C., Vlaminck, H., Haverich, A., & Maes, B. (2005). Nonadherence with diet and fluid restrictions
among adults having haemodialysis. Journal of Nursing Scholarship, 37(1), 25-29. Lam, L. W., Lee, D. T. F., & Shiu,
A. T. Y. The dynamic process of adherence to a renal therapeutic regimen: Perspectives of patients undergoing
continuous ambulatory peritoneal dialysis. International Journal of Nursing Studies (2013). DOI:
10.1016/j.ijnurstu.2013.10.012. Lam, L. W., Twinn, S., & Chan, S. W. C. (2010). Self-reported adherence to a
therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. Journal of Advanced
Nursing, 66(4), 763-773. Li, P. K. T., & Szeto, C. C. (2008). Success of the peritoneal dialysis programme in Hong
Kong. Nephrology Dialysis Transplantation, 23(5), 1475-1478.
Contact
[email protected]

Outcomes of a Nurse-Led Case Management Program on Home Exercise Training
for Hemodialysis Patients
Xingjuan Tao, MSc, RN, China
Susan Ka Yee Chow, RN, BN, MPHC, PhD, China
Frances Kam Yuet Wong, RN, BSc, MA, PhD, China
Purpose
The purpose of this presentation is to report the outcomes of a nurse-led case management program on
home exercise training for hemodialysis patients.
Target Audience
The target audience of this presentation is clinical nurses and researchers who are interested in
designing and implementing case management program or exercise program for patients with chronic
diseases.
Abstract
Purpose: The purpose of this study was to examine the effects of a 12-week nurse-led case
management program on home exercise training for maintenance hemodialysis patients. The
interventions aimed at increasing physical function, improving patients’ perceived exercise benefits,
removing perceived exercise barriers, enhancing health-related quality of life, and relieving depressive
symptom for the patients.
Methods: The study was a two-group randomized, controlled trial. Ninety participants were recruited from
the hemodialysis units of two tertiary hospitals in Nanjing, China in 2013. They were randomly assigned
to either study group (n = 45) or comparison group (n = 45). Participants in both groups received the in-
center exercise training (20 minutes) before hemodialysis sessions weekly for 6 weeks and were
instructed to perform exercise at home. The in-center training was conducted by the researcher with a
group of four to six participants focusing on flexibility and strengthening exercise only. Patients were
encouraged to have cardiovascular exercises at home which will improve their cardiovascular conditions
and endurance. The list of cardiovascular exercise included brisk walking, bicycling, jogging. Participants
in the study group were instructed to start walking or brisk walking at low duration and gradually progress
to a maximum of 30 minutes daily per week. To facilitate exercise progression, the nurse case managers
discussed exercise benefits, explored exercise barriers and developed mutual goals with patients. The
nurse will motivate them and check the exercise behaviors to ensure adherence to the recommended
exercise regime. The nurse case managers interviewed the study group patients weekly for six weeks
and biweekly for another six weeks. Participants in the comparison group only participated in the in-center
exercise training. The control group patients received usual care from the nurse without the interviews
and mutual goals developed. Gait speed (both normal gait speed and fast gait speed), 10-repetition sit-to-
stand (10-STS), health-related quality of life, perceived exercise benefits and barriers, and depressive
symptom were measured at baseline,6- and 12-week. Data were analyzed by the two-way repeated-
measures ANOVA with an intention-to-treat analysis. Missing values were replaced by the last observed
values from the same participants.
Results: For fast gait speed test, Repeated-measures ANOVA showed a significant difference between
groups across the three time points (F=4.79, p=0.031). For 10-STS performance, significant within-group
effect (F=21.91, p=0.000) was observed for both groups. For health-related quality of life, a significant
difference was found between the groups in the subscale for Symptoms of Kidney Disease (F=5.60,
p=0.020), and significant within-group differences were noted from the study group in the subscale for
Burden of Kidney Disease (F=3.51, p=0.041) and Mental Component Summary (F=3.37, p=0.037). There
were significant within-group differences in the perceived benefits and perceived barriers scores
(F=15.55, p=0.000; F=13.79, p=0.000, respectively), and both the study group and comparison groups
seemed to improve over time; while no significant difference for the between-group effects. The scores for

Depressive symptom decreased for both groups, there were no significant differences for between and
within group effects. No injuries were observed during the program.
Conclusion: The findings reinforce the notion that exercise is safe and beneficial for hemodialysis
patients. The structured 12-week nurse-led case management program on home exercise training is
practical and effective to improve the physical function and health-related quality of life of thepatients.
Contact
[email protected]

L 04 - Health Promotion and Prevention for the Obese Patient
Population
Comparison of Family Eating Habits and Activity Practices Among Blacks,
Hispanics, and Filipinos: Implications for Prevention and Control of Overweight
and Obesity
Luz S. Porter, PhD, MSN, BSN, ARNP, FAAN, FAANP, USA
Purpose
The purpose of this study is to compare and analyze family eating habits and physical activity practices
among Filipinos, Blacks, and Hispanics to provide a comprehensive database for development of
culturally sensitive public health education programs, and raise public awareness of the increasing
prevalence of obesity in the global community.
Target Audience
The target audience of this presentation are nurses, nurse practitioners, nursing educators, public health
educators, school health educators, nursing students. and family physicians.
Abstract
Purpose: The purpose of this study is to compare and analyze the eating habits and physical activity
practices among Filipino, Black, and Hispanic families. Overweight and obesity among children and
adults is well-documented as an escalating problem. Concern about this rise centers on the link between
obesity and increased health risks that translate into increased medical care and costs. Preventing
childhood obesity is a national priority. Findings of earlier studies point to the interplay between/among
personal attributes and environmental factors in development of overweight and obesity in childhood and
adolescence.
Methods: This descriptive study was conducted on a sample of 78 mother-child dyads, comprised of 22%
Black, 50% Hispanic, and 16% Filipinos, aged 7- 17 years (children) and 24-55 years (mothers). The
data, collected via self-administered questionnaires and guided interview (Family Eating and Activity
Habits Questionnaire and Background Information Questionnaire), were analyzed via descriptive and
inferential statistics (t-tests, ANOVA, linear regression). Findings significant at p <.05 are interpreted as
statistically significant; findings falling between p=.05 and p=.10 are interpreted as showing trends.
Results: Findings revealed differences in eating and activity practices between Blacks and Hispanics or
Filipinos. There was an inverse correlation between the mothers’ or children’s weight and activity level.
Overweight mothers tend to have overweight children. Mother-child dyads were similar in eating
pace. The 3 ethnic groups spend most of their physical activity time in TV viewing and computer usage.
Conclusion: Research findings may raise public awareness of the increasing prevalence and
consequences of overweight and obesity in mothers and children, particularly among Hispanics and
Blacks. Study findings provide a database for nurse practitioners and other health service providers for
the development of culturally sensitive, focused public health education programs.
References
Cullen, KW., Baranowski, T., Rittenberry, L., Olvera, N.( 2000). Social-environmental influences of children’s diets:
Results from focus groups with African-, Euro- and Mexican-American children and their parents. Health Educ Res.
15:581-590. Cullen, KW., Lara, KM., de Moor, C. (2002). Familial concordance of dietary fat practices and intake.
Fam Comm Health.25:65-75. Gordon, K. H., Castro, Y., Sitnikov, L., & Holm-Denoma, J. M. (2010). Cultural body
shape ideals and eating disorder symptoms among white, Latina, and black college women. Cultural Diversity and
Ethnic Minority Psychology, 16(2), 135-143. doi: 10.1037/a0018671 Javier, J. R., Huffman, L. C., & Mendoza, F. S.
(2007). Filipino child health in the United States: do health and health care disparities exist? Public Health Research,
Practice, and Policy, 4, 1-20. Johnson-Koslow, M., Matt, G. E., Rock, C. L., de la Rosa, R., Conway, T. L., & Romero,
R. A. (2011). Assessment of dietary intakes of Filipino-Americans: implications for food frequency questionnaire
design. Journal of Nutrition, Education, and Behavior, 43, 505-510.

Contact
[email protected]

Population
The Association of Inflammation with Obesity and Depressive Symptoms Among
People with Multiple Cardiovascular Disease Risk Factors
Kyoung Suk Lee, PhD, RN, MPH, USA
Debra K. Moser, DNSc, RN, FAAN, USA
Terry A. Lennie, PhD, RN, FAHA, FAAN, USA
Gia Mudd-Martin, PhD, MPH, RN, USA
John M. Novak, BDS, LDS, MS, PhD, USA
Baretta R. Casey, MD, MPH, FAAFP, USA
Alison L. B. Ailey, MD, USA
Purpose
The purpose of this presentation is to examine combined effects of obesity and depression on the
inflammatory marker in people with multiple Cardiovascular disease risk factors
Target Audience
The target audience of this presentation is practitioners and researchers.
Abstract
Purpose: Obesity and depression are associated with inflammation. Inflammation is a biological
mechanism underlying cardiovascular disease (CVD). Obese people with depression may be at a greater
risk for CVD due to increased inflammation, compared to obese people without depression or non-obese
people with depression. However, potential combined effects of obesity and depression on inflammation
have not been investigated. The purpose of this study was to examine combined effects of obesity and
depression on the inflammatory marker, high sensitivity C-reactive protein (hs-CRP), in people with
multiple CVD risk factors.
Methods: A total of 859 people (52 yrs, 75% female) provided blood for serum hs-CRP and had height
and weight measured for body mass index (BMI=kg/m2). The Patient Health Questionniare-9 (PHQ-9)
was used to measure depressive symptoms. Hierarchical regression was used to examine whether the
interaction of BMI and depressive symptoms (BMI*PHQ-9) predicted hs-CRP levels after controlling for
covariates (age, gender, HbA1C, and smoking history). In Step 1, covariates and depressive symptoms
were entered, followed by BMI in Step 2. In Step3, the interaction of BMI and PHQ-9 scores (BMI*PHQ-9)
was added.
Results: In Step 1, PHQ-9 scores independently predicted hs-CRP levels. In Step 2, BMI, but not PHQ-9
scores, independently predicted hs-CRP levels. In Step 3, there was no BMI* PHQ-9 interaction; only BMI
predicted hs-CRP levels (Table).
Conclusions: In the company of obesity, depressive symptoms do not significantly contribute to
increased inflammation in people with multiple CVD risk factors. This study suggests that obesity is more
strongly linked with inflammatory processes relevant to cardiovascular risk than depressive symptoms in
this population.
Table. Predictors of hs-CRP (N=859)
Outcome= hs-CRP(log-transformed)
Step 3 Unstandardized ß standardized ß p-value
PHQ-9 scores (depressive symptoms) .03 .97 .33
Body mass index (BMI) .06 8.50 <.001

BMI * PHQ-9 scores -.001 -.10 .46
Note. Covariates included in the model (Step 3): age, gender, HbA1C, and smoking history
Contact
[email protected]

Population
Nurses' Commitment and Motivation to Improved Personal Health: The Role of
Hospital Administration
Carey Marie Phelan, BA, USA
Purpose
The purpose of this presentation is to convey the most effective interventions that employers could
institute to motivate nurses to increase their physical health status, particularly in three major facets:
decrease BMI, increase physical exercise and eat healthier, more nutritious foods. Increased health of
nurses would impact entire healthcare systems.
Target Audience
The target audience of this presentation is anyone involved with the implementation of healthcare;
particularity administrators and policy makers will benefit from the study as well as nurses looking to make
a difference in their institutions.
Abstract
Purpose: As nurses comprise the largest sect of the healthcare industry, their health affects the overall
effectiveness of health systems. Nurses are highly educated, yet, for many there is a disconnect between
knowledge and the status of their physical health. Thus, it is important to investigate what could motivate
nurses to improve their health, particularly in three major facets: decrease BMI, increase physical
exercise and eat healthier. The purpose of the research is to ascertain the most effective interventions
that employers could institute to motivate nurses to increase their physical health. Currently, there is a
drastic lack of knowledge related to how nurses are motivated. This research will bridge the gap between
intrinsic motivation and extrinsic interventions.
Methods: The study was a mixed design, containing both quantitative and qualitative data. Subjects read
and signed a consent form, then completed a demographics questionnaire. Specific questions on the
demographics sheet included: how much physical exercise they participate in, if weight loss was a goal
for them and if they believed that their diet was healthy. The 139 participants were all nurses and lived in
the Northwest region of the United States at participating facilities.
Subjects were given a case study generated by the researcher. The case study involved Nurse X and
how Nurse X had gained weight and had become less active. Nurse X subsequently decided that she/he
wanted to improve their health status. The participants were asked to transpose themselves as Nurse X
and rate (on a Likert Scale) which of the given scenarios would best motivate and gain their commitment
to increase their health status. The scenarios ranged from employers offering more healthy food choices
to reductions in health insurance premiums for improved health.
Furthermore, the subjects also responded to the following three open-ended questions: 1) name three
factors that have impeded you from obtaining your optimal health, 2) describe three interventions that
employers could provide to help you improve your health, 3) what additional thoughts do you have about
achieving optimal health.
A partition was set up to guarantee the anonymity of the subjects taking the survey. Next to the partition
were two sealed drop boxes; one for the signed consent forms and one for the subject’s surveys;
materials were set up in break-rooms. There was no direct participant contact. The survey and
demographics tool were used in a pilot study to test the validity and the accuracy of the tool.
Results: Data presented represents results from 139 surveys collected over a five month time period.
The majority of subjects were female (84.0%). For 53.9% of the respondents, weight loss was a goal. The
majority (78.4%) responded that their diet was healthy and nutritious. Quantitative data is displayed in
Table 1.

Table 1. Kruskal-Wallis non-parametric statistical test
Mean
Response to Degrees of Ranks
Intervention H Value Number Probability
intervention Freedom
OverweightObeseNormal
Facility offering Motivation H= 7.72 df= 2 136 P= 0.0211* 58.0 87.1 70.3
healthier food choices Commitment H= 4.22 df= 2 137 P= 0.1212 65.0 85.3 66.7
Motivation H= 5.35 df= 2 137 P= 0.0689 60.2 84.6 69.7
Onsite workout facilities
Commitment H= 0.80 df= 2 137 P= 0.6703 64.8 68.5 71.6
Group weight loss Motivation H= 25.95 df= 2 137 P=0.0001* 63.8 109.5 60.5
program Commitment H= 25.59 df= 2 137 P< 0.0001* 62.7 109.3 61.2
Decreased health Motivation H=29.23 df= 2 137 P< 0.0001* 80.6 101.0 53.0
insurance premiums Commitment H= 19.97 df= 2 137 P< 0.0001* 74.1 99.9 57.1
Cash for losing Motivation H= 1.37 df= 2 137 P= 0.5143 74.6 68.8 65.8
percentage of body fat Commitment H= 1.42 df= 2 137 P= 0.4916 74.1 71.4 65.3
Paid an hourly wage to Motivation H= .57 df= 2 133 P= 0.7520 70.2 68.8 64.7
work out Commitment H= .49 df= 2 133 P= 0.7827 69.9 68.7 64.9
Note. H Value = The Kruskal-Wallis Test. P-value of 0.05 or less was selected as statistically significant, depicted
using an asterisk (*).
Six qualitative themes emerged in response to the open-ended questions:
• Theme I: Lack of Time -- Nurses described a lack of time both on the job and at home as barriers to
their optimal physical health status. Examples of this included: “There are only 24 hours in a day and
I already have too much on my plate.” “I cannot even find time in the day to use the bathroom, let
alone take a break. I am still on orientation, so I hope it doesn’t last too much longer like this or I will
die.” This poignant depiction of this nurse schedule was mirrored by several other subjects.
• Theme II: Twelve Hour Work Schedules and Lack of Breaks Affect the Quality of Life -- Thirty-eight
percent of subjects described the twelve hour shifts as barriers to their optimal health in addition to
the issues with contractual break allowances. Nurses overwhelmingly described that breaks were
not restful, but, in fact were just an opportunity to catch up on tasks. The dichotomy between patient
safety and the health of the nurse was a common thread woven into this theme.
• Theme III: Physical Demands of Nursing -- Respondents described the emotional and physical
demands of the nursing profession. Examples of this included: “I give everything to my patients, by
the time that I can go home, I am mentally and physically drained.” Subjects also described physical
pain caused by nursing.
• Theme IV: Lack of a Supportive Work Environment -- Forty-two percent of nurses commented on
what they believed was both a lack of support from their employer as well as employer created
obstacles to optimal health. “Hospitals in general only care about the bottom line, they do not see the
benefit of prevention.” Nurses reported the hypocrisy of teaching patients about prevention and
health promotion when the institution that they work for does not champion or sponsor employee
health.
• Theme V: Personal Accountability -- Subjects acknowledged their own roles in obtaining and
maintaining optimal health. Respondents described either not caring about health, committing
sabotaging behaviors, or poor self-control. Nurses used eating to mitigate hard days at work, “I
comfort myself with food.” An obese nurse responded that, “I am apathetic to being a bit overweight.”
• Theme VI: Being Overweight is a Benefit to the Nursing Profession -- Qualitative findings were
segmented into three groups as a function of BMI (normal, overweight and obese). No significant
qualitative differences were found between the overweight and the normal weight groups. However,
responses from the obese group were thematically distinctive. Several nurses within the obese
category responded that being overweight helped them to be better nurses, “my weight doesn’t
affect my nursing, I am healthy,” and the idea that, “if I did not have some extra weight, I could never
do this job.” In addition to nurses feeling that being overweight did not interfere with their ability to

deliver effective patient care, several respondents noted that they felt as if being obese was
important for communication and the nursing process. One indicated that, “I think that having a few
extra pounds makes me more approachable than the ‘skinny nurses’.” Commonly, nurses explained
that being overweight was a bonus and almost a necessity to provide exceptional nursing care. A
morbidly obese nurse responded that, “My weight doesn’t affect my nursing, I am healthy.” 24.0% of
the respondents in the obese category responded that they believed they were healthy.
Conclusion: If an employer was to institute a health promotion intervention, this research would help to
guide them to design the most effective strategies. The two ways that this study could guide an
administration are to supply the most effective intervention as indicated by self-reported levels of
commitment and motivation as well as to help employers focus their attention on a specific weight group
(i.e. overweight). The most effective interventions for all three weight groups were related to financial
incentives; this included a decrease in insurance premiums, a cash incentive for a percentage of weight
loss as well as paid time to work out. This is believed to be related to the financial incentive related to
each and the tangible reward for a health improvement.
This research suggests that employers should emphasize resources on the overweight group who were
the most motivated and committed towards the interventions proposed. The obese group was the least
motivated and less committed towards improving their health. The obese group was the only group to
respond to the research materials using profanity and expletives. The obese group also reported that they
were believed themselves to be healthy. It is suspected that this was attributed to the frustration related to
their body weight. Some subjects responded with a tone of helplessness and futility. With the upcoming
nursing shortages and healthcare being dramatically remodeled in the United States, supporting nurses’
health becomes paramount. Patients look to nurses for information on health promotion and disease
prevention. If a nurse is obese, the nurse loses credibility and reliability. Employers, patients and nurses
can all benefit from improving nurses’ health.
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Contact

[email protected]

L 05 - Family Health Promotion
The Risk Demographic Predictors of Low Health Promotion Lifestyles in
Caregivers of Children with Disabilities
Jen-Kuei Ko, MSN, RN, Taiwan
Jih-Yuan Chen, PhD, RN, Taiwan
Ying-Hui Lin, EdD, RN, Taiwan
Ming-Hong Yen, Taiwan
Purpose
The purpose of this presentation is to present and share our academic works, concepts and new
discoveries for the health promotion demands in caregivers of disabled children.
Target Audience
The target audience of this presentation is interdisciplinary professional staffs,families of disabled
children, teachers, researchers and anyone else who will care the health promotion in caregivers of
disabled children.
Abstract
Purpose: The purpose of this study is to investigate the risk demographic factors is related to the risk of
low Health Promotion Lifestyles scale and subscales scores in caregivers of disabled children. We can
early find the groups of risk demographic factors and provide those who have risk factors about the health
promotion information and intervention.
Methods: A total of 251 caregivers for health promotion assessment in the department of pediatric
psychology and hereditary counseling and a setting of Taiwan muscular dystrophy association at
southern Taiwan. Health-promoting lifestyle Scale in Chinese version was used to collect data, this HPL
scale include six subscales of nutrition, exercise, health responsibility, stress management, social support
and life appreciation. These data were analyzed by multiple logistic regression model and used the SPSS
statistics softwave.
Results: In order to compare the low HPLs (Health promotion lifestyle scale) scores and high HPLs
scores groups from demographic factors, while adjusting for other effects in the multiple logistic
regression model, we find that individuals with higher risk of low HPLs are those who under junior high
school ( OR=5.18, p=0.004, CI=1.69~15.85) higher than people who are graduate degree, no married (
OR=4.81, p=0.000, CI=2.13~10.86) higher than people who are married, and who are living in urban (
OR=2.40, p=0.007, CI=1.27~4.54) higher than people who are living in rural and town, overall prediction
accuracy of this model is 79.3%. In the subscale of Nutrition, we find that individuals with higher risk of
low Nutrition subscale are those who are monthly income under 30,000 NT dollars (OR=4.14, p=0.000,
CI=2.02~8.50) higher than people who are monthly income over 50,000 NT dollars, overall prediction
accuracy of this model is 76.9 %. In the subscale of Exercise, we find that individuals with higher risk of
low Exercise subscale scores are those who are no married ( OR=4.14, p=0.000, CI=2.02~8.50) higher
than people who are married, and who are living in urban ( OR=2.65, p=0.003, CI=1.41~4.99) higher than
people who are living in rural and town, prediction accuracy of this model is 78.90%.In the subscale of
Health responsibility, we find that individuals with higher risk of low Health responsibility subscale scores
are those who are living in urban ( OR=2.28, p=0.007, CI=1.25~4.15) higher than people who are living in
rural and town, and male( OR=2.13, p=0.015, CI=1.16~3.91) are higher than female , overall prediction
accuracy of this model is 76.1 %. In the subscale of Stress Management, we find that individuals with
higher risk of low Stress Management subscale scores are those who are monthly income under 30,000
NT dollars ( OR=2.27, p=0.018, CI=1.18~6.04) and monthly income between 30,000 ~50,000NT dollars (
OR=3.09, p=0.006, CI=1.39~6.86) higher than people who are monthly income over 50,000 NT dollars,
overall prediction accuracy of this model is 82.1 %. In the subscale of Social Support, we find that
individuals with higher risk of low Social Support subscale scores are those who are no married (
OR=2.94, p=0.005, CI=1.39~6.22) higher than people who are married, overall prediction accuracy of this
model is 75.5 %.In the subscale of Life Appreciate, we find that individuals with higher risk of low Life

Appreciate subscale scores are those who are monthly income under 30,000 NT dollars ( OR=2.79,
p=0.004, CI=1.38~5.65) high than who are monthly income over 50,000 NT dollars, overall prediction
accuracy of this model is 78.9 %.
Conclusion: Summary the results of this study, the implications in clinic practice, the caregivers of
children with disabled those who are lower income, no married, male, lower education level and living in
urban must be provided support and intervention for nutrition, exercise, stress management, social
support, health responsibility, and life appreciation.
References
Chen JY, Clark, MJ. ( 2010). Family Resources and Parental Health in Families of Children with Duchenne Muscular
Dystrophy. Journal of Nursing Research. 18(4):239-248。 Chen JY, Clark, MJ. (2007). Family function in Families of
children with Duchenne muscular dystrophy. Family & Community Health Journal. 30(4) 296-403. Chen, M. (1999).
The effectiveness of health promotion counseling to family caregivers. Public Health Nursing, 16(2), 125-132. Hall, J.
(2002). Assessing the health promotion needs of informal carers. Nursing Older People, 14(2), 14. Killeen, M. (1989).
Health promotion practices of family caregivers. Health Values: The Journal of Health Behavior, Education &
Promotion, 13(4), 3-10. Plant, K. M., Sanders, M. R. . (2007). Predictors of care-giver stress in families of preschool-
aged children with developmental disabilities. Journal of Intellectual Disability Research, 51(2), 109-124. doi: doi:
10.1111/j.1365-2788.2006.00829.x Sisk, R. J. (2000). Caregiver burden and health promotion. International Journal
Of Nursing Studies, 37(1), 37-43. Taveras, E. M., LaPelle, N., Gupta, R. S., & Finkelstein, J. A. (2006). Planning for
health promotion in low-income preschool child care settings: focus groups of parents and child care providers.
Ambulatory Pediatrics: The Official Journal Of The Ambulatory Pediatric Association, 6(6), 342-346. Tucker, C. M.,
Butler, A. M., Loyuk, I. S., Desmond, F. F., & Surrency, S. L. (2009). Predictors of a health-promoting lifestyle and
behaviors among low-income African American mothers and white mothers of chronically ill children. Journal of the
National Medical Association, 101(2), 103-110.
Contact
[email protected]

Supportive Education and Follow-Up for New Fathers
Terri L. Newsom, MSN, RN, USA
Terry Throckmorton, PhD, RN, USA
Purpose
present the results of a study designed to evaluate the impact of a specialized multi-modal program for
new fathers on their expectations of the baby, depression, anxiety, and stress (DASS21), and quality of
life.
Target Audience
men whose wives/significant others were pregnant.
Abstract
Purpose: The purpose of this study was to evaluate the efficacy of a specialized multi-modal program for
new fathers on their expectations of the baby, depression, anxiety, stress (DASS21), and quality of life.
Methods: This exploratory study employed a one group, repeated measures design to evaluate a
facilitated program to educate and support new fathers during the transition into fatherhood. Prospective
fathers were recruited from the rosters for the antenatal classes taught at a medical center hospital
system in Texas. Fathers who agreed to participate in the study had the study explained and were
consented. They were asked to attend a three and a half hour session including content on: the first
issues for new fathers, challenges in forming a parenting team, the fathering role, Kangaroo Care, caring
for mom, caring for the infant, capabilities of the infant, finding support systems, available resources for
fathers, and safety issues. The class was taught in the prenatal period. Once the baby was born, the
facilitator visited the fathers with their babies on the postpartum unit. The facilitator answered questions,
demonstrated any skills that the fathers requested, and allowed the fathers to voice concerns regarding
the new role. After discharge, the facilitator contacted the father by phone at 1 week, 1 month, and four
months to allow the father to ask questions and discuss issues. Prior to the class, at one month and at
four months, the father was asked to complete the Self Efficacy in Infant Care Scale and the What Being
a Parent of a New Baby is Like scale to measure self efficacy and satisfaction with parenting. The fathers
were asked to evaluate the program on a 1-10 scale in terms of meeting their needs, accessibility of the
information, and usefulness in assuming the new role.
Results: Eighty four dads completed the study. They were primarily Caucasian, Catholic or Protestant,
and married. Their ages varied from 19 to 47. Five were high school graduates, 47 had baccalaureate or
masters degrees, six had PhDs, and 21 had some college or an AD. Time with partner varied from 0.83
years to 12. Infant care experience varied from zero to care of own child. Forty seven (56%) had
attended child birth classes. Fifty six (67%) accessed pregnancy/childbirth/parenting information 2-4 times
per month. Satisfaction scores for the class varied from moderate to high satisfaction. There was a
significant difference in infant expectations before and after the class (T40.8; p 0.0). Quality of life scores
dropped slightly from pre-test to post delivery, but the difference was not significant. DAS21 scores
remained the same from pre- to post-delivery as did relationship assessment scores. The full
presentation will provide a more detailed overview of the scales and subscales.
Conclusion: The course was well received by the fathers. The results indicated that this approach was
feasible and beneficial to the fathers.
References
Bogels, S. & Phares, V. (2007). Fathers’ role in the etiology, prevention and treatment of child anxiety: A review and
new model. Clinical Psychology Review, 28, 539-558. Boot Camp for New Dads. Retrieved on October 30, 2009 from
www.bootcampfornewdads.org. Burlingham, D. (1973). The preoedipal infant-father relationship. Psychoanalytic
Study of the Child, 28, 23-47. Bryan, A.A. (2000). Enhancing parent-child interaction with a prenatal couple
intervention. MCN, The American Journal of Maternal/Child Nursing, 25(3), 139-145. Deave, T., Johnson, D., &
Ingram, J. (2008). Transition to parenthood: the needs of parents in pregnancy and early parenthood. BMC

Pregnancy and Childbirth, 8(30), 1471-2393. Donovan, J. (1995). The process of analysis during a grounded theory
study of men during their partners’ pregnancies. Journal of Advanced Nursing, 21, 708-715. Elek, S.M., Hudson D.B.,
& Bouffard, C. (2003). Marital and parenting satisfaction and infant care self-efficacy during the transition to
parenthood: the effect of infant sex. Issues in Comprehensive Pediatric Nursing, 26, 45-57. Fascaroli, F. (2004).
Paternal involvement in child caregiving and infant sociability. Infant Mental Health Journal, 25,509-521. Fletcher, R.,
Silberberg, S., & Galloway, D. (2004). New fathers’ post-birth views of antenatal classes: satisfaction, benefits, and
knowledge of family services. Journal of Perinatal Education, 13(3), 18-26. Fletcher, R., Vimpani, G., Russell, G., &
Keating, D. (2008). The evaluation of tailored and web-based information for new fathers. Child: care, health and
development, 34(4), 439-446. Fletcher, R., Vimpani, G., Russell, G., & Sibbritt, D. (2008). Psychosocial assessment
of expectant fathers. Archives of Women’s Mental Health, 11, 27-32. Friedwald, M., Fletcher, R., & Fairbairn, H.
(2005).All-male discussion forums for expectant fathers: evaluation of a model. Journal of Perinatal Education, 14(2),
8-18. Kotelchuck, M. (1981). The infant’s relationship to the father: Experimental evidence. In M.E. Lamb (Ed.), The
role of the father in child development. New York: Whiley. Ladan, A., (1985). Over vaders en werk [About fathers and
work]. In A. Ladan, P.J.G. Mettrop, & W.H.G. Wolters (Eds.), De betekenis van de vader: Psycho-analytische visies
op het vaderschap (pp. 53-68). The meaning of the father: psycho-analytic perspectives on fathership, Meppel:
Boom. Lamb, M.E. (1977). Father-infant and mother-infant interaction in the first year of life. Child Development, 48,
167-181. Lee, J. & Schmied, V. (2001). Fathercraft. Involving men in antenatal education. British Journal of Midwifery,
9(9), 559-561. McElligott, M. (2001). Fathercraft. Antenatal information wanted by first-time fathers. British Journal of
Midwifery, 9(9), 556-558. Paquette, D., Carbonneau, R., Dubeau, D., Bigras, M., & Tremblay, R.E. (2003).
Prevalence of father-child rough-and- tumble play and physical aggression in preschool children. European Journal of
Psychology of Education, 18, 171-189. Prasopkittikun, T., Tilokskulchai, F., Sinsuksai, N., & Sittimongkol, Y. (2006).
Self-efficacy in Infant Care Scale: Development and psychometric testing. Nursing and Health Sciences, 8, 44-50.
Premberg, A., & Lundgren, I. (2006). Father’s experiences of childbirth education. Journal of Perinatal Education,
15(2), 21-28. Pridham, K. and Chang, A. (1989). What being the parent of a baby is like: Revision of an instrument.
Research in Nursing and Health, 12, 323-329. Robertson, A. (1999). Get the fathers involved! The needs of men in
pregnancy classes. Practising Midwife, 2(1), 21-22. Smith, N. (1999). Antenatal classes and the transition to
fatherhood: a study of some fathers’ views. MIDIRS Midwifery Digest, 9(4), 463-468. Sons to Dads. Retrieved on
October 30, 2009 from www.sonstodads.com. Tiller, C. (1995). Fathers’ parenting attitudes during a child’s first year.
Journal of Obstetric, Gynecological, and Neonatal Nursing, 24, 508-514. Waterston, T., & Welsh, B., (2006). Helping
fathers understand their new infant: a pilot study of a parenting newsletter. Community Practitioner, 79(9), 293-295.
Contact
[email protected]

Relationship Between Families Perception of Health and Family Support in
Vulnerable Children Care
Jih-Yuan Chen, PhD, RN, Taiwan
Hong-Sen Chen, PhD, Taiwan
Meng-Chi Liu, MSN, Taiwan
Mei-Chyn Chao, MD, Taiwan
Purpose
The purpose of this presentation is to provide the knowledge about relationship between families
perception of health and family support in vulnerable children care
Target Audience
The target audience of this presentation is health professional staffs, nursing faculties, doctoral students,
and master students.
Abstract
Background: Family support in care of vulnerable children is rarely discussed yet has a major impact on
family member health. The vulnerable children care setting is characterized by a rare disease of genetic,
behaviors disturbed, or disability health. Family perceptions of health in relation to various outcomes of
the children have including family health and family support has not been explored exclusively in
outpatient care.
Aim: First, assess families’ perception of health associate with their children in different vulnerable
care. Second, examine families’ perception of health with a defined sample of vulnerable children in
psychiatric clinic, genetic counseling clinic, and muscular dystrophy institute, using the Duke Health
Profile (DUKE). Third, explore the relationship between 286 families’ perception of health and family
support in vulnerable children care.
Methods: The study used secondary data to present the study aims. An aggregated data used for this
research was part of three studies funded by a southern Medical University Hospital in Taiwan that
constructed family health promotion model aimed at improving vulnerable children care health and family
support of two clinics in one hospital and one setting in an Institute. Multiple unit/clinic comparisons were
analyzed by ANOVA. The final was explored using regression model for the data measuring by the DUKE
and Family APGAR (FAPGAR).
Results: The sample of parents/family members/patients included family have children with muscular
dystrophy attention deficiency and hyperactivity disorder (ADHD) and chromosomal abnormality. The
Cronbach’s α of the DUKE and the FAPGAR are .71 and .88. Significant differences between
clinics/setting were noted for the subscales of physical health, mental health, perceived health, and the
overall score. Self-esteem received highest score, social health receiving the second higher score in the
sample. Significant differences between the three study period/different samples were noted for the
subscales of physical health, perceived health, and the overall score (F = 5.90, 9.11, and 3.26; P = .01,
.01, and .04, respectively). Significant differences in family support score, and subscale of adaptation
and partnership score were noted between setting/clinics (F = 2.57, 3.12 and .16; p = .05, .03, and .03,
respectively). The final regression model, social health is predictor accounting for 31% of the variance in
family support. Adjust variance attributable to the social health was .28, which was significantly different
from zero, F 10,275 = 12.09, p = .001.
Conclusion: The internal consistency of subscales of positive health were higher than the DMD and SMA
group, the ADHD group, and in 1999 and 1997’s. Hgher scores in subscales of negative health/ anxiety,
depression, and anxiety-depression for DMD and SMA group compared with ADHD or chromosome
abnormal group. In 2007, DMD group’s caregiver perceived higher scores in physical health, perceived
health, and overall health than DMD and SMA group in 2012. DMD and SMA group reported higher
scores in adaptability and partnership than those ADHD group. The results were impressive, perceived

health and perceived self-esteem exists in muscular dystrophy group or ADHD were lower than the
chromosome abnormal group. DMD and SMA group reported higher scores in adaptability and
partnership than those ADHD group.
References
1. Parkerson, G. R. Jr. (Ed.). (2002). User's guide for Duke Health Measures. Durham, NC: Department of
Community and Family Medicine, Duke University Medical Center. 2. Smilkstein, G. (1978). The Family APGAR: A
proposal for a family function test and its use by physicians. Journal of Family Practice, 6(6), 1231-1239. 3. Chen, J.
Y., & Clark, M. J. (2007). Family function in families of children with Duchenne muscular dystrophy. Family
Community Health Journal 30(4 ), 296-304.
Contact
[email protected]
L 06 - Psychosocial Issues in Family Health

Family Reintegration Experiences of Soldiers with Combat-Related Mild
Traumatic Brain Injury
Kyong S. Hyatt, PhD, FNP, RN, USA
Purpose
The purpose of this presentation is to describe the family reintegration experiences, including challenges
and management strategies of soldiers and their spouses following mild traumatic brain injury.
Target Audience
The target audience of this presentation is healthcare providers as well as general public to increase
awareness of symptoms of mild traumatic brain injury and rehabilitation needs.
Abstract
Purpose: Approximately 12% to 22% of service members (more than 325,000) returning from Iraq and
Afghanistan are estimated to have sustained some level of mild traumatic brain injury (mTBI) and it is
among the most widespread and undertreated injury of the conflicts. Mild traumatic brain injury (mTBI)
affects not only the injured individuals, but also their families. A major gap in the current literature on
family reintegration/adjustment following an mTBI is the absence of an empirically derived framework for
describing and understanding family reintegration experiences and coping processes. Clearly, there is a
compelling need to understand the unique family reintegration process in order to help researchers and
clinicians develop more effective support programs and devise outcome measurements of their
effectiveness. Therefore, the purpose of this study is to explore the problems and challenges of military
family reintegration following a combat-related mTBI. This study is one of the first to examine
reintegration experiences of both injured soldiers and their spouses.
Methods: Participants were recruited by self-referral, healthcare provider referral from the TBI clinic at a
large Army Medical Center, or direct approach in the clinic. If prospective dyads met the study inclusion
criteria, the spouse was contacted by phone to get verbal consent and scheduled a face-to-face meeting.
Participants were active duty soldiers with deployment-related mTBI and their legally married civilian
spouses who spoke English. All soldiers were between 2 and 24 months post-deployment. Strauss and
Corbin’s grounded theory methodology was used to collect and analyze the data. Sampling was directed
by theoretical sampling methods, which means that recruitment of study participants was guided by
emerging and theoretically relevant constructs drawn from analysis of collected data. This sampling
strategy allowed the investigator to broaden and refine emerging categories during the theory building
phase.
This study received approval from the Institutional Review Board of a large Southeastern university. The
primary method for data collection was face-to-face, semi-structured interviews. Conjoint interviews were
conducted first to determine each dyad’s shared views of family reintegration. These shared views were
further explored during separate individual interviews. Nine dyads yielded a total of 27 interviews (9

conjoint soldier-spouse interviews, 9 spouse interviews, and 9 soldier interviews). During the first part of
each interview, the investigator used broad, open-ended queries, such as: Tell me about your family’s
experiences of being reunited after deployment.Separate face-to-face interviews, first with the soldier and
then with the spouse, were conducted approximately 1 week after the initial joint interview.
In both joint and separate individual interviews, the open-ended questions were influenced by the ongoing
analysis, and the direction of subsequent interviews was guided by the emerging theory. Participants
were recruited and interviewed until data saturation was reached, that is, until no new themes of family
reintegration challenges or coping strategies were identified. Quality control and rigor of data collection
was maintained through the use of mentor-guided interview techniques and established data collection
protocols. These included independent coding corroboration with colleagues and 100% auditing of the
first five joint interview transcripts by two expert mentors. Dependability of the data was assured through
participant validation of the key points of the interview at its conclusion and explicit procedures for data
selection, analysis, and synthesis.
Results: Majority of soldier participants (n=8) were male. More than 50% of the soldiers (n=5) and 75% of
the spouses (n=7) were White. The soldiers’ rank ranged from specialist to field grade officers. More than
65% of couples (n=6) had 1 or 3 children at home. Fifty-six percent (n=5) and 44% (n=4) of soldiers
reported clinically significant depression and anxiety symptoms, defined as a score 11 or greater of each
of the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS). Ten
percent (n=1) of spouses disclosed clinically significant anxiety symptoms based on the HADS subscale
score. Fifty-six percent (n=5) of soldiers reported unsatisfactory marital relationship, as indicated by a
score of less than 100 on Marital Adjustment Test (MAT); whereas, 22% of the spouses (n=2) reported
dissatisfaction with their marriage. Sixty-seven percent of soldiers revealed clinically significant
Posttraumatic Stress Disorder (PTSD) symptomotology on the PCL-M scale, represented by a score of 50
or above.
Overarching theme of reintegration experience was finding the new normal. A new normal was defined by
participants as the couple’s new, post-mTBI expectation of the family unit or family routine. The idea of a
new normal is supported by the following themes: facing up to the soldier’s unexpected homecoming,
managing unexpected changes in the family routine, experiencing mismatched expectations, and
adjusting to new expectations for the family. First, when the soldier returned home with an mTBI, the
couples encountered unexpected changes from their normal family routines and often indicated that these
changes were unlike any past experiences. This finding may be unique to these study participants since,
unlike civilians with mTBI, these soldiers sustained their mTBI while they were separated from their
families, thus presenting them and their spouses with a series of delayed (and unexpected) changes
upon their return. Second, couples were required to manage the challenges of day-to-day life and
somehow try to fit the injury-related changes into their daily family routine. This finding was congruent
with findings of both Naalt and Miles, who suggest there is significant post-mTBI impact on the marital
relationship as married couples go through a process of adjustment. Third, couples needed to resolve
mismatched expectations of the soldiers’ post-mTBI functional capabilities, which created family conflict.
Finally, couples who successfully negotiated household roles and responsibilities accepted post-mTBI
changes and recognized limitations with the soldiers’ functional capabilities. These couples looked toward
rebuilding a new normal for their family.
Almost all couples indicated that post-mTBI symptoms had impacted their marital relationship. This study
supports findings from previous studies indicating that after mTBI, both partners have to adapt to new life
situations and renegotiate their roles and responsibilities. In particular, this study shows how changes in a
soldier’s mood and short-term memory loss can impact a couple’s communication and relationship. These
findings support Blais and Boisvert’s research findings showing that spousal perceptions of the injured
individual’s communication skills have significant effects on both psychological and marital satisfaction. In
the present study, the post-injury alterations in couple communication resulted in the uninjured spouse
avoiding communication and the soldier blaming him or her for the problems, which caused further
deterioration in the relationship.
The way couples managed unexpected changes in the soldier and post-mTBI family reintegration
appears to have been influenced by the spouse’s prior reintegration experiences and the soldier’s length
of service in the military. Soldiers with more years of service and who were senior ranking appeared to

accept the post-mTBI changes as being one of the risks or costs of serving in the military, whereas
soldiers with fewer than 10 years of service viewed the post-injury changes as a loss of their career and
of the lifelong dream of being a career soldier. In general, soldiers with more time in the Army and longer
marriages adjusted to the new normal better than soldiers whose Army careers had just begun and/or
who had newer marriages. Couples with more mature marriages (marriages of at least 10 years) adjusted
to post-injury changes faster and better than couples with more recent marriages (less than 10 years). All
spouses who had been married longer than 10 years indicated that they did not have clear boundaries
about family roles or responsibilities; instead, these couples worked as a team and shared whatever tasks
that needed to be done. These spouses appeared to be experienced homemakers who maintained their
homes independently while their soldier spouses were gone. At the same time, they were willing to give
up part of their independence upon the soldier's return.
The study findings suggest that the process of post-mTBI family reintegration—finding a new normal—is
an evolving process that includes facing reality and accepting changes. This study provides a basic
understanding of the needs of soldiers and their spouses following mTBI. Unlike other studies that
focused exclusively on the view of the spouse, this study offers views of both injured individuals and their
spouses, thus providing a more comprehensive understanding of how married couples manage the
challenges of post-mTBI changes.
Conclusion: Individuals with mTBI and their families may benefit from interventions that directly address
mismatched expectations and promote the acceptance of new normal. Due to mTBI’s lack of visible
injury, soldiers may confuse their mTBI symptoms with those of other deployment-related injuries and
therefore delaying treatment. Future studies with longitudinal designs that examine mTBI symptoms as
they evolve over time may provide a deeper understanding of how injured individuals and their uninjured
spouses experience the variable nature of mTBI. These studies may illuminate how couples can achieve
a successful recovery over time and can thus provide a basis for creating effective rehabilitation and
support programs. In addition, future research that explores individual and family coping post mTBI could
provide a foundation for developing interventions that are tailored to family post-injury adjustment
challenges.
Contact
[email protected]

African-American Grandmothers Raising Grandchildren: Results of an
Intervention to Reduce Caregiver Psychological Distress
Susan J. Kelley, PhD, FAAN, USA
Deborah M. Whitley, MPH, PhD, USA
Peter E. Campos, PhD, USA
Purpose
The purpose of this presentation is to describe the results of an intervention to improve the well-being of
African American grandmothers who are raising grandchildren in the absence of birth parents. More
specifically, we will discuss the results of a home-based intervention designed to reduce psychological
distress.
Target Audience
The target audience of this presentation includes nurses practicing in a variety of clinical settings, as well
as nurse researchers.
Abstract
Purpose: Globally, millions of grandmothers are assuming full-time caregiving responsibilities for
grandchildren when birth parents are unable to do so. While the reasons for this caregiving arrangement
vary by global region, they often include HIV/AIDS, child maltreatment, workforce migration, mental health
issues, and substance abuse. The purpose of this study is to determine the results of an intervention to
improve the well-being of grandmothers who are raising grandchildren in parent-absent homes. More
specifically, we examine the role of a home-based, interdisciplinary intervention in reducing psychological
distress in caregiving grandmothers.
Methods: The sample comprised 549 predominantly low-income, African American grandmothers raising
an average of 2.47 (range 1-8) grandchildren. The mean age of the caregiver was 56.3 years, with a
range of 33 to 83 years. The study intervention was designed to improve the psychological and physical
well-being of caregiving grandmothers; it included home visitation by registered nurses and social
workers, participation in support groups and parenting classes, as well as legal service referrals and early
intervention services for children aged 5 years and younger. Data were collected at baseline and at
completion of the one year intervention. Psychological distress was measured with the 51 item, Brief
Symptom Inventory (BSI) (Derogatis, 1993).
Results: The major reasons the children were being raised by participants included substance abuse,
abandonment, and neglect. Overall psychological distress, as measured by the Global Severity Index
(GSI) of the BSI, decreased significantly from baseline to post-test (p < .001). Furthermore, there were
significant decreases across all nine symptom dimensions of the BSI (p < .01). Results based on select
demographic variables will also be presented.
Conclusion: Study findings suggest that the intervention model is a promising approach to improving the
well-being of this caregiving population. Practice, policy, and research implications of study findings will
be presented.
References
Drogatis, L.R. (1993). Brief inventory manual. Towson, MD: Clinical Psychometric Resarch. Kelley, S.J., Whitley, S.J.
& Campos, P.E. (2013). Psychological distress in African American grandmothers raising grandchildren: The
contribution of child behavior problems, physical health, and family resources. Research in Nursing and Helath, 36,,
373-385.
Contact
[email protected]

A Reflection on Psychosocial Assessment and Support As a Component of
Routine Holistic Antenatal Care
Johanna M. Mathibe-Neke, PhD, MCur, BACur, South Africa
Purpose
The purpose of this presentation is to highlight the importance of psychosocial care for pregnant women
in an attempt to design care that is holistic and comprehensive. The holistic approach offers an
opportunity for midwives to adress the needs of the pregnant woman as an individual
Target Audience
The primary target audience are Midwifery Care Practitioners both in Education and Clinical Practice but
the information/ presentation is extended to all categories of nurses as holistic and psychosocial care is
applicable to all health care disciplines.
Abstract
Purpose: The purpose of the presentation is to address the importance of pregnant womens'
psychological status to the benefit of her foetus and her pregnancy and postnatal wellbeing. This can be
achieved through the introduction of an antenatal risk assessment program that would identify and
manage women during pregnancy as they are psychosocially at risk. The final outcome would be the
provision of a holistic antenatal care to women.
Methods: Qualitative and quantitative research designs were used by way of methodological
triangulation. Triangulation was further achieved through the use of multiple data sources. The qualitative
method was used as preliminary to the quantitative method. An interpretive qualitative approach was
used to validate quantitative data by providing a different perspective on psychosocial care.
Results: A screening tool was developed in response to the findings from the midwives’ focus group
discussions, the cross-sectional survey results from midwives, midwifery experts, the responses of self
administered questionnaires for pregnant women, and the information obtained through the review of the
antenatal records used by women during antenatal care. Responses from focus group discussions with
midwives and indepth interviews with midwifery experts further recommended that a tool that
incoporate psychosocial care during pregnancy should be developed and implemented. The tool was
piloted in the partipating sites and thematic responses of its use by midwives will be shared in the
presentation
Conclusion: An ideal option for effective antenatal care is the incorporation of psychosocial care as a
component of antenatal care, acknowledging women’s own experiences of pregnancy. Midwifery, which
means “to be with women”, is based upon a philosophy of care in which the management of pregnancy is
shared between the midwife and the woman, with a focus on informed choice, shared responsibility,
mutual decision-making and women articulating their health needs.
References
Brooker C, Waugh A 2007. Foundations of Nursing Practice. Fundamentals of Holistic Care. Chapter 2.Mosby:
Elsevier. Toronto. Clinical Guideline 2003. Antenatal care routine care for the healthy pregnant woman. National
Collaborating Centre for Women’s and Children’s Health Commissioned by the National Institute for Clinical
Excellence: Royal College of Obstetricians and Gynaecologists Press, London. 26-40. Oakley A 1984. The captured
womb: A history of the medical care of pregnant women. Oxford Blackwell Publishers. Ltd. New York. Patterson EF
1998. The philosophy and physics of holistic health care: spiritual healing as a workable interpretation. Journal of
Advanced Nursing 27(2):287-293. Tierney G 2006. Opportunities in Holistic Health Care Careers. McGraw-Hill
Professional.pp160.
Contact
[email protected]

L 07 - Utilizing Social Networks in Healthcare
Strategies for Data Collection and Analysis Using the Online World: Trials and
Tribulations
Judy Mannix, RN, BEd (Nsg), MN (Hons), Australia
Purpose
The purpose of this presentation is to report on strategies employed to develop a suitable on-line survey
that sought nurses’ views on aspects of clinical leadership. In addition, various methods of recruitment
using social media and on-line announcements will be critiqued.
Target Audience
The target audience of this presentation includes nurse researchers from the clinical setting and the
academy involved in research (with limited funds), interested in using the on-line world for data collection,
and seek to maximise potential participants for their study.
Abstract
Purpose: The purpose of this presentation is to report on strategies employed to develop a suitable on-
line survey that sought nurses’ views on aspects of clinical leadership. In addition, various methods of
recruitment using social media and on-line announcements will be critiqued.
Methods: The development of the on-line survey tool involved the adaptation of existing instruments. The
survey comprised 47 items requiring participants to respond using a 5 point Likert scale. A short
demographic profile was requested at the beginning of the survey – seeking information about their
nursing career. A third part of the survey provided participants the opportunity to describe in a text box an
example from their practice of aesthetic leadership. Once developed, the survey tool was tested by an
expert panel of experienced registered nurses. Following expert panel feedback, minor adjustments were
made to the survey and it was loaded onto an existing on-line software program. A link was created to the
survey which was included in all recruitment announcements. Recruitment announcements were sent out
using email, Facebook and Twitter inviting nurses to complete the survey.
Results: Using an existing on-line survey software program facilitated the ease with which the survey
was made available in the study. It also enabled the number of respondents to the survey to be monitored
after different methods of on-line announcements were utilised. Overall, while all forms of on-line
announcements yielded completed surveys, more were completed following an announcement on Twitter.
The recruitment strategies employed exposed the survey to a large number of potential respondents,
without necessarily a guarantee of who completed the survey. However, analysis of the responses from
participants, as well as the completed demographic data did enable a degree of certainty as to whether
the survey was completed by a nurse.
Conclusion: Seeking information using on-line technologies is not for the faint-hearted. A certain degree
of persistence and endurance is required to ensure that a reasonable response rate is elicited for data
analysis. The use of on-line announcements and social media has the potential to maximise exposure for
the collection of research data.
Contact
[email protected]

Researching with Young People As Participants: Issues in Recruitment
Ainsley M. James, BN, GradCertPaeds, GradCertHigherEd, MN, Australia
Purpose
The purpose of this presentation is to present issues encountered while recruiting 16-24 year old males
and females for a project on their lived experiences of having type 1 diabetes living in rural Australia.
Insights and strategies will be presented to assist researchers recruiting young people to their research.
Target Audience
The target audience of this presentation is those researchers recruiting young people (aged 16-24 years)
to their research
Abstract
Purpose: An essential element of human research is the successful recruitment of participants, because
without participants there can be no research. Many researchers appear to be able to recruit participants
quickly and without significant issues, while other researchers encounter challenges. When researching
the lived experience of young people aged 16-24 years, with type 1 diabetes living in a rural setting, we
assumed that gaining ethics approval to interview the 16-18 year old participants would be a challenge.
Ethics approval was granted following minimal changes to the application. Participant recruitment
however presented a significant challenge. This paper presents some issues we encountered when
recruiting participants for this phenomenological research project. Insights and strategies are presented to
assist researchers when recruiting young people to their research.
Methods: Recruitment of participants began with advertisements in organisations such as medical clinics
and community health centres that employed a paediatrician and/or a diabetic educator. Permission was
also sought from Diabetes Australia to provide information of the research project in their communications
(i.e. newsletters) to clients and families who met the selection criteria. When potential participants
responded to the invitation, an explanatory statement and consent form were provided and any questions
were answered. Once consent was obtained, a mutually agreeable time and place was arranged for the
interview to be conducted. After little success in recruiting participants further organisations were
contacted; a regional tertiary institution, a government department, additional medical clinics,
organisations specific to type 1 diabetes including Diabetes Victoria and the Juvenile Diabetes Research
Foundation, and a number of social networking sites. As a result of recruiting no participants, it became
apparent that an additional recruitment strategy was required to reach the 16-24 year old age group and
successfully recruit them to the research. Traditional recruitment techniques were rethought and adjusted
to entice and encourage 16-24 year olds to contact the researchers. In today’s technologically advanced
society and with the age group sought for this research, utilising social networking became a viable option
Results: Our experiences from the recruitment phase of this research have led us to insights and
recommendations for improvement in relation to recruiting young people to a project. The insights and
recommendations include; the importance of knowing your participant/s, the relevance and use of the
traditional poster/flyer, and also in addressing the questions of: ‘What’s in it for me? Why would I want to
contact a stranger?’
Conclusion: Recruitment of participants can make or break a research project and also influence the
quality of the final outcomes. Knowing the where and how to recruit participants is essential for quality
research. This paper has discussed the issues we experienced while recruiting participants for a
phenomenological research study, investigating the lived experience of young people with type 1 diabetes
living in a rural setting. From our experience the utilisation of the social network medium Facebook was a
successful strategy for recruiting young people to research. Suggestions from our insights have been
offered to researchers for recruiting young people to their projects.
References

Baker, S.E., & Edwards, R. (2012). How many qualitative interviews is enough? Expert voices and early career
reflections on sampling and cases in qualitative research. Accessed from
http://eprints.ncrm.ac.uk/2273/4/how_many_interviews.pdf Bolton, R., Parasuraman, A., Hoefnagels, A., Migchels, N.,
Kabadayi, S., Gruber, T.,Komarova Loureiro, Y., & Solnet., D. (2013). Understanding Generation Y and their use of
social media: a review and research agenda. Journal of Service Management, 24(3), p. 245-267. doi:
10.1108/09564231311326987 Facebook. (2013). Key facts. Accessed from http://newsroom.fb.com/Key-Facts
Fenner , Y., Garland, S., Moore, E., Jayasinghe, Y, Fletcher, A., Tabrizi, S., Gunasekaran, B., & Wark, J. (2012).
Web-Based Recruiting for Health Research Using a Social Networking Site: An Exploratory Study. Journal of Medical
Internet Research, 14 (1), p. 1-14. doi:10.2196/jmir.1978 Fraser, J. (2009). Practice integrity: advocacy, ethics and
legal issues (59-73), in M. Barnes & J. Rowe (Eds) (2009). Child, youth and family health: strengthening
communities. Churchill Livingstone: Sydney National Health & Medical Research Council (NHMRC). (2007). Section
4: ethical considerations specific to participants, Chapter 4.2: children and young people in the National Statement on
Ethical Conduct in Human Research. Accessed from http://www.nhmrc.gov.au Nursing & Midwifery Board of Australia
(2008a). The code of ethics for nurses in Australia. Accessed from http://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Codes-Guidelines.aspx. Nursing & Midwifery Board of Australia (2008b). The code of
professional conduct for nurses in Australia. Accessed from http://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Codes-Guidelines.aspx. Office of the Public Advocate (OPA). (2010). Medical consent.
Accessed from http://www.publicadvocate.vic.gov.au/medical-consent/ Ramo, D., & Prochaska, J. (2012). Broad
reach and targeted recruitment using facebook for an online survey of young adult substance use. Journal of Medical
Internet Research, 14(1), p. 1-10. doi: 10.2196.jmir.1878 Spriggs, M. (2010). Understanding consent in research
involving children: the ethical issues: a handbook for human research ethics committees and researchers (version 4).
Children’s Bioethics Centre. Accessed from http://www.mcri.edu.au/media/62539/handbook.pdf Steinbeck, K.,
Nguyen, B., Shrewsbury, V., Kohn, M., Lee, A., Shah, S., & Baur, L. (2010). Challenges and Techniques in Recruiting
Adolescents for the Loozit Healthy Active Lifestyle Weight Loss Intervention, Journal of Adolescent Health, 46(2),
Supplement 1, February 2010, S41-S42. doi10.1016/j.jadohealth.2009.11.099 Taylor, B., & Francis, K. (2013).
Qualitative research in health sciences: methodologies, methods and processes. Routledge: Abingdon, Oxon van
Manen. M. (1990). Researching lived experience: human science for an action sensitive pedagogy. Althouse Press:
Ontario, Canada Victorian Healthcare Association (VHA). (2009). Informed consent for treatment/intervention. VHA
clinical governance in community health. Discussion paper March 2009. Accessed from
http://www.vha.org.au/?c_id=1012 Wilson, R., Gosling, S., & Graham., L. (2012). A Review of Facebook Research in
the Social Sciences. Perspectives of Psychological Research, 7(3), 203-220. doi: 0.1177/1745691612442904
Contact
[email protected]

Engagement and Emotional Connection with Virtual Communities Among
Nursing Students
Ying-Hsiu Chen, RN, Taiwan
I-Ching Wang, RN, Taiwan
Wen-Ting Chen, RN, Taiwan
Purpose
The purpose of this presentation is to share the findings of a study that investigated nursing students’
engagement and emotional connection with virtual communities, as well as benefits students had
perceived through participating virtual communities.
Target Audience
The target audience of this presentation is nursing faculty.
Abstract
Purpose: The purposes of this study were to investigate nursing students’ engagement and emotional
connection with virtual communities, as well as benefits they had perceived through participating virtual
communities.
Methods: Based on the theory of planned behavior and innovation diffusion theory, a survey was
developed to collect data. 300 students enrolled in a baccalaureate nursing program in Taiwan were
invited to participate in this study. 290 students had completed the survey. Data were analyzed by both
descriptive and comparative statistics.
Results: All students responded the survey had participated at least one virtual community (VC). 142
(49%) had joined 2 VCs, and 97 (33%) had joined 3 VCs. Facebook was the most popular VC, it attracted
289 (99.7%) students. Line was ranked the second popularity, 269 (92.8%) students joined this VC. Most
students (270; 93.1%) joined VCs that provided social support; only 47 (16.2%) students utilized VCs that
were designed for exchanging learning information. Participating VC was an important social connection
with others. 258 (89%) students participated VC before sleeping. The average participation time before
sleeping was 1.23 hours; the daily average participating time was 5.95 hours. Most students (254; 87.6%)
used mobile phones to participate VCs. Major benefits of participating VCs that students perceived were
entertainment and emotional comfort. 62.1% students expressed that they would feel boring if they did
not participate VC. Without VC, 21.4% students would feel empty, 11% students would be anxious, 9%
students did not know what to do, 7.9% students would feel lonely, and 5.5% students would be panic.
Students from lower school year valued more positively than senior students in VC’s functions of self-
actualization, entertainment, emotional health, and interpersonal communication (p<.05). They also spend
more time in participating VCs (p<.05).
Conclusion: The computer and information technology not only brings an impact on knowledge
development but also plays an indispensable role in human communication and emotional connections.
Using virtual communities to enhance learning is an emerging paradigm in nursing education. However,
knowledge related to how nursing students are engaged in and value virtual communities is limited. In this
study, time that nursing students spent on VC and the acceptance of VCs by the younger generation
suggest that integrating VC into nursing education is an inevitable trend. Students’ long-hour engagement
and emotional connection with VCs as well as their insufficient use of VCs in learning activity challenge
nursing education. Future studies are encouraged to investigate VCs’ impact on students’ academic and
professional performances and link the findings to curriculum reform.
Contact
[email protected]

L 10 - Staff Related Clinical Nursing Leadership
Improving the Experiences of Night Shift Nurses in Australian Regional Public
Hospitals: An Action Research Project
Idona N. Powell, RN, RM, MHlthSc (Man), PGDipClinN (Psychiatry), Australia
Greg Fairbrother, RN, BA, MPH, PhD, Australia
Purpose
to describe an action research approach that was able to explore recommendations from a qualitative
case study and to successfully move these recommendations into action strategies to improve the night
shift experience, enhance delivery of patient care and thus facilitate organisational improvement.
Target Audience
administrators, nurse leaders, nurse managers, nurse educators, night shift and non-night shift nurses
working in acute 24 hour facilities.
Abstract
Purpose: To develop a participatory plan to improve the working experience of night shift nurses and
enhance delivery of patient care in Australian regional acute inpatient facilities.
Methods: A participatory action research approach was utilised to take up the findings of an initiating
qualitative research study which explored the expressed needs and experiences of regional Australian
night shift nurses. The original research study was conducted by the presenting author in 2011. A study
reference group consisting of night shift clinical nurses and nurse managers took a problem solving
approach to working with the data from the initial study. Key areas for potential action/change were
identified. In 2012, the reference group invited nurses from four regional hospitals to contribute their
ideas via focus groups (primary data source), email or anonymous open-ended questionnaire. Separate
focus groups were held for managers and nurses. Focus group facilitators were not in organisational or
managerial relationships with focus group participants. Focus group discussions and open-ended
questionnaires were organised around the key potential action/change domains derived from the initiating
study. These domains were: professional development; leadership and support; interdepartmental
cooperation; communication and valuing the night shift role. Specific action steps were developed within
each domain.
Results: Sixty-nine nurses and nurse managers attended focus groups across the four hospital sites, 54
questionnaires were returned and four emails were received. Opportunistic conversations were held
between reference group members and nurses during this phase of the study period. A constructivist
paradigm was employed in the interpretation of all study data in order to develop solutions to problems of
both a practical and professional-cultural nature. Nurse empowerment was a key interpretive lens used
to derive potential changes and solutions from the data. A spectrum of findings evolved that grouped
naturally into two categories based on a locus of approval for change. Five potential actions required
changes to nursing related legislation (Category 1). Sixty-four primary action steps and 36 secondary
action steps that were within the scope of control of local health district managers or their staff were
identified (Category 2).
Conclusion: Some of the changes sought by the night shift nurses could only be achieved through
extensive lobbying and legislation. Many more identified positive change areas were actionable locally. A
number of these changes were potentially cost neutral. The views of the nurses and nurse managers
relating to identified changes were not always in agreement. Nonetheless, through mutual consideration,
major improvements for the night shift are being planned and actioned. This workplace improvement
project is ongoing and the action research reference group continues to meet and inform/guide cycles of
localised change as they develop.
References
Powell,I.(2013)Can you see me? Experiences of nurses working night shift in Australian regional hospitals: a
qualitative case study.Journal of Advanced Nursing 69(10), 2172-2184. doi:10.1111/jan.12079

Contact
[email protected]

Use of Temporary Nursing Staff and Nosocomial Infections in Intensive Care
Units, a Pilot Study
Sung-Heui Bae, PhD, MPH, RN, USA
Purpose
The purpose of the present study is to describe the nature and prevalence of the use of temporary
nursing staff and to examine relationships between the use of temporary nursing staff and nosocomial
infections in the ICUs.
Target Audience
The target audience of this presentation will be registered nurses, nurse managers, and health policy
makers who are concerned about the use of temporary nursing staff in the intensive care units and its
impacts on nosocomial infections.
Abstract
Purpose: The use of this temporary nursing staff is controversial issues. Although hiring temporary
nursing staff can help to increase staffing levels, it can also affect other nursing staff as well as care
process, which leads to poorer patient care (Alonso-Echanove et al., 2003; Castle, 2009). Higher use of
temporary staff can increase administrative burdens, disrupt routines and teamwork, and require
additional supervision by permanent staff (Bae, Mark, & Fried, 2010). In a similar vein, empirical findings
in this topic are also mixed. Some studies found that use of temporary nurses was related to the spread
of nosocomial infection among patients (Alonso-Echanove et al., 2003), back injuries among nurses and
patient falls (Bae et al., 2010). On the other hand, other studies found no relationships between the use of
temporary nursing staff and quality indicators (Aiken, Shang, Xue, & Sloane, 2013; Xue, Aiken, Freund, &
Noyes, 2012). Arguments behind this relationship are that temporary nursing staff are not less qualified
than permanent staff (Aiken et al., 2013; Aiken, Xue, Clarke, & Sloane, 2007; Xue, Smith, Freund, &
Aiken, 2012). An empirical study found that using temporary nursing staff were not related to poor quality
of patient care, but poor work environments are the factor contributing to poor quality of care (Aiken et al.,
2013; Xue, Aiken, et al., 2012). Although the intensive care units (ICU) are the work setting where
temporary nursing staff spent most of their time, in the previous studies, researchers did not distinguish
temporary and permanent nursing staff in their nurse staffing measures. Therefore, the purpose of the
present study is to describe the nature and prevalence of the use of temporary nursing staff and to
examine relationships between the use of temporary nursing staff and nosocomial infections in the ICUs.
Methods: A secondary data analysis was conducted with data from the Western New York Center for
Nursing Workforce and Quality. This data consisted of nursing unit level data on 14 ICU from 6 hospitals
located in New York State. All data were collected monthly. A total of 144 ICU-month data points were
used for the analysis sample. Nosocomial infections include central line associated blood stream
infections (CLABSI), ventilator associated pneumonia (VAP), and total number of nosocomial infections
combining those two. The use of temporary nursing staff was measured by nursing care hours per patient
day provided by temporary nursing staff (in total & only by registered nurses). Also other nursing unit
characteristics (nurse staffing, skill mix, unit size, and practice environment) were collected as control
variables. Logistic regression models were used to examine the relationship between the temporary
staffing and nosocomial infections.
Results: The monthly means of CLABSI and VAP were 1.89 per 1,000 central line days and 2.18 per
1,000 ventilator days. In total, 2.73 nosocomial infections per 1,000 patient days occurred monthly. On
average, 0.30 temporary nursing care hours per patient day were provided and 0.26 care hours by only
temporary RNs. From the logistic regression models, we found that the use of temporary RN staff was not
related to neither CLABSI nor VAP after controlling for other nursing unit characteristics.
Conclusion: The findings of this pilot study suggests that the use of temporary nursing staff in ICUs was
not related to nosocomial infections. As more temporary nursing staff are used to increase nurse staffing

levels in ICUs, it is important to evaluate the impact of those temporary nurse staffing on patient
outcomes. To make a conclusive decision about this relationship, future studies need to use a larger
sample with other control variables which might affect both the use of temporary nursing staff and
nosocomial infections.
References
Aiken, L. H., Shang, J., Xue, Y., & Sloane, D. M. (2013). Hospital use of agency-employed supplemental nurses and
patient mortality and failure to rescue. Health Serv Res, 48(3), 931-948. doi: 10.1111/1475-6773.12018 Aiken, L. H.,
Xue, Y., Clarke, S. P., & Sloane, D. M. (2007). Supplemental nurse staffing in hospitals and quality of care. J Nurs
Adm, 37(7-8), 335-342. Alonso-Echanove, J., Edwards, J. R., Richards, M. J., Brennan, P., Venezia, R. A., Keen, J., .
. . Gaynes, R. P. (2003). Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk
for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol, 24(12), 916-925. doi:
10.1086/502160 Bae, S. H., Mark, B., & Fried, B. (2010). Use of temporary nurses and nurse and patient safety
outcomes in acute care hospital units. Health Care Manage Rev, 35(4), 333-344. doi:
10.1097/HMR.0b013e3181dac01c Castle, N. G. (2009). Use of agency staff in nursing homes. Res Gerontol Nurs,
2(3), 192-201. doi: 10.3928/19404921-20090428-01 Xue, Y., Aiken, L. H., Freund, D. A., & Noyes, K. (2012). Quality
outcomes of hospital supplemental nurse staffing. J Nurs Adm, 42(12), 580-585. doi:
10.1097/NNA.0b013e318274b5bc Xue, Y., Smith, J., Freund, D. A., & Aiken, L. H. (2012). Supplemental nurses are
just as educated, slightly less experienced, and more diverse compared to permanent nurses. Health Aff (Millwood),
31(11), 2510-2517. doi: 10.1377/hlthaff.2011.1297
Contact
[email protected]

Nursing Support Workers and Tasks Performed, Delayed or Not Completed
Michael A. Roche, RN, PhD, MHSc, BHSc, DipAppSc, CertMHN, Australia
Christine Duffield, RN, PhD, Australia
Purpose
To develop an understanding of the importance of effective integration of nursing support workers in the
acute hospital setting and the potential impact for patient and nurse outcomes.
Target Audience
The target audience of this presentation is nurses interested in understanding the integration of nursing
support workers and licensed staff in the acute hospital setting.
Abstract
Purpose: Direct patient care has been undertaken by a combination of licensed and unlicensed nurses
for many years. However, persistent nursing workforce shortages and increased patient acuity and
throughput has led to increased employment of large numbers of nursing support workers internationally
(Bureau of Labor Statistics, 2013; Health Workforce Australia, 2012; NHS, 2013). Concurrently, tasks
formerly completed by registered nurses have moved to the nursing support worker (Gillen & Graffin,
2010; Plawecki & Amrheim, 2010). This change has raised questions regarding the role and effective
utilization of support workers. However, there has been limited research on the impact of these workers in
the acute hospital workplace. This paper compares the nature of tasks performed, delayed or not
completed by nursing support workers and licensed nurses, and the factors associated with these
outcomes.
Methods: This paper reports a secondary analysis of data collected in three studies of medical and
surgical units across three states of Australia. Data from a recently completed project were combined with
that from two previously reported studies (Duffield et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa,
2012). In total, data were collected on 132 randomly selected units in 25 public general acute hospitals
across three Australian states between 2004 and 2010. Data collection procedures in all studies were
similar. All direct personal care workers on the selected wards were asked to complete a survey
anonymously. An overall response rate of 60.4% was achieved (3945 of 6528 potential consenting
respondents). The survey included demographic items, employment characteristics, six questions on
specific tasks performed, and 11 questions on direct-care interventions delayed or left undone at the end
of the most recent shift. The survey also included the Practice Environment Scale (Lake, 2002) and the
Environmental Complexity Scale (O'Brien-Pallas, Irvine, Peereboom, & Murray, 1997; O'Brien-Pallas,
Meyer, & Thomson, 2005). In addition, a profile of each unit that included bed numbers, support services
and other characteristics was obtained. Analyses explored differences between groups and potential
explanatory factors via regression models.
Results: Significant differences were found between nursing support workers and licensed nurses in
tasks undertaken, delayed and not completed. As expected, nursing support workers undertook more
tasks such as delivering meal trays and housekeeping, although also undertaking some tasks that may
have been out of their scope of practice. Nursing support workers also reported fewer tasks delayed
(completion of vital signs, responses to call bell, routine mobilization and documenting nursing care). Unit
support services, the practice environment, violence towards nurses and overtime were important
explanatory factors in relation to tasks delayed or not completed for both licensed nurses and support
workers.
Conclusion: Increasingly, nursing support workers are providing direct care to patients in the acute
hospital setting and this may have implications for patient safety and quality of care. Along with effective
delegation of tasks, an important consideration is the model of care (i.e. a substitutive or supportive
model) adopted when support workers are included in the staff mix. The ongoing shortage of registered
nurses and increased use of support workers challenges nursing unit managers to effectively integrate

these staff into their workplace and to confirm these support workers are operating within their scope of
practice.
References
Bureau of Labor Statistics. (2013). Occupational Outlook Handbook. Retrieved 15th September, 2013, from
http://www.bls.gov/ooh/healthcare/nursing-assistants.htm Duffield, C., Diers, D., O'Brien-Pallas, L.L., Aisbett, C.,
Roche, M. A., King, M., & Aisbett, K. (2011). Nursing staffing, nursing workload, the work environment and patient
outcomes. Applied Nursing Research, 24(4), 244-255. Gillen, Patricia, & Graffin, Sean. (2010). Nursing delegation in
the United Kingdom. Online Journal of Issues in Nursing, 15(2). doi:10.3912/OJIN.Vol15No02Man06 Health
Workforce Australia. (2012). Health workforce 2025: Doctors, nurses and midwives - volume 1. Adelaide, SA: Health
Workforce Australia Retrieved from http://www.hwa.gov.au/sites/uploads/health-workforce-2025-volume-1.pdf. Lake,
E. T. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing &
Health, 25(3), 176-188. doi: 10.1002/nur.10032 NHS. (2013). Health Care Assistant. from
http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-
support-staff/healthcare-assistant/ O'Brien-Pallas, L. L., Irvine, D., Peereboom, E., & Murray, M. (1997). Measuring
nursing workload: understanding the variability. Nursing Economic$, 15(4), 171-182. O'Brien-Pallas, L. L., Meyer, R.,
& Thomson, D. (2005). Workload and productivity. In L. McGillis-Hall (Ed.), Quality Work Environments for Nurse and
Patient Safety (pp. 105-138). Sudbury, MA: Jones and Bartlett. Plawecki, L. H., & Amrheim, D. W. (2010). A question
of delegation: unlicensed assistive personnel and the professional nurse. Journal of Gerontological Nursing, 36(8),
18-21. Roche, M. A., Duffield, C., Aisbett, C., Diers, D., & Stasa, H. (2012). Nursing work directions in Australia: Does
evidence drive the policy? Collegian, 19, 231-238. doi: 10.1016/j.colegn.2012.03.006
Contact
[email protected]

L 12 - Care of the Depressed/Suicidal Patient and Family
Individuals Use to Promote Healing after a Suicide Attempt: Action/Interaction
Strategies
Fan-Ko Sun, PhD, Taiwan
Ann Long, PhD, United Kingdom
Mei-Ting Chi, RN, Taiwan
Ti Lu, MD, MS, Taiwan
Purpose
The purpose of this presentation is to inform an audience of psychiatric nurses about action/interaction
strategies and how to help patients use them to promote healing after a suicide attempt.
Target Audience
The targets audience of this presentation are the psychiatric nurses whom evaluative suicidal patients.
Abstract
Purpose: It is a very difficult task to recover following a suicide attempt. Individuals struggle with
numerous difficulties following a suicide attempt. Some individuals can recover from a suicide attempt but
other individuals re-attempt or commit suicide. The aim of this study was to develop a theory to guide the
healing and recovering process, which human-beings traverse following a recent suicide attempt and the
main aim of this paper was to discover the action/interaction strategies that they use on this life journey.
Methods: A qualitative approach using Grounded theory was used in this research. Data were collected
in a medical centre hospital in Taiwan from 2011 to 2012. Theoretical sampling was used to guide the
selection of participants. The final number of interviews conducted to achieve data saturation was 14
patients who had recovered from a suicide attempt and returned to normal life at least one year later.
Data were analysed using the constant comparative method together with NVivo Version 9 to aid the
process of data analysis.
Results: A theory was developed to guide the suicidal individuals to help in healing after their suicide
attempt. Three categories and eight subcategories surfaced in relation to the ‘action/interaction strategies’
used. They were: becoming flexible and diverse thinking (Imaginative thinking, Hopeful thinking); re-
building and re-gaining self (Changing myself, Believing in self, Self affirmations, Retrieving the value of
life), and trying to enjoy the pleasures of life (Looking for methods to cope with stress, Looking for happy
times).
Conclusion: Nurses could use the findings of this paper as a guide to help people recover following a
suicide attempt and, perhaps, help prevent further attempts.
Contact
[email protected]

L 12 - Care of the Depressed/Suicidal Patient and Family
The Factors Associated with the Caregivers of Suicidal Patients Stress, Attitude
and Ability: A Path Analysis
Chun-Ying Chiang, RN, PhD, Taiwan
Fan-Ko Sun, RN, PhD, Taiwan
Chu-Yun Lu, PhD, RN, Taiwan
Hung-Yen Lin, MD, Taiwan
Purpose
The purpose of this presentation is to inform an audience of nurses on the findings of a study that
examined the extent of caring stress of caregiver has direct/indirect effects on suicide care ability and
suicidal attitude.
Target Audience
The target audience of this presentation is nurses who taking care of suicidal individuals and their family
members.
Abstract
Purpose: The purpose of this study was to examine the extent of caring stress of caregiver has
direct/indirect effects on suicide care ability and suicidal attitude.
Methods: This is a cross-section correlational study. We recruited 164 caregivers of suicidal patients.
The inclusion criteria included: primary caregiver of suicidal patient, at least 18 years old, and no obvious
mental impairment. All the participants were recruited from a Suicide Prevention Center and two
psychiatric hospitals. There were 3 instruments administered to the participants: the Caring Stress Scale
(CSS), the Suicidal Attitudes Scale (SAS), and the Suicidal Caring Ability Scale (SCAS). Data was
analyzed by using SPSS and AMOS 19.0. Bivariate analyses include correlation, t test, and analysis of
variance. Path analysis is employed using structural equation modeling (SEM) approach to analyze the
relationships among caregiving stress, attitude, and ability toward caring for suicidal patients. Data were
collected in 2009 and 2010.
Results: The average age of the participants was 43.9 years (SD =13.84). The majority of participants
had religious beliefs (n=132, 80.5%), lived with suicidal patients (n=127, 77.4%). More than half of
participants were female (n=101, 61.6%), married (n=89, 54.3%), working more than 20 hours per week
(n=93, 56.7%). The results of bivariate analyses indicated age and suicidal attitude was
negatively correlated (r = -.16, P = .048), suggesting the older of caregivers, the less positive attitude
toward suicidal patients. Female caregivers had higher level of stress than male caregivers (83.1 vs. 77.0,
P = .02), but no difference in suicidal attitude and suicide care ability. Caring stress was treated as an
exogenous variable and suicide care ability and suicidal attitude were endogenous variable. In the final
model, being female caregiving status increased the level of caring stress (b = .20, P = .02). Caring
stress had a direct effect on suicidal attitude (b = .27, P = .01), but not on suicide care ability (b = .15, P =
.11). The association between suicidal attitude and suicide care ability was significant (r = .65, P < .001).
Results indicated that female caregiver would have higher levels of caring stress, caring stress could
prompt the attitude toward caring for suicidal patients, and positive attitude toward suicidal patients would
be associated with ability to care for suicidal patients.
Conclusion: Age and sex are the factors associated with caregivers’s attitudes toward suicidal patients.
Nurses can consider these factors into nursing intervention when they are taking care of patients who
attempted suicide.
Contact
[email protected]

M 01 - Using Quality to Impact Global Nursing Leadership
Current Assessments of Quality and Safety Competencies in Registered
Professional Nurses: An Examination of Nurse Leader Perceptions
Elaine Smith, EdD, MSN, MBA, BS, RN, NEA-BC, ANEF, USA
Purpose
to report the findings of a mixed methods study undertaken to determine the degree to which U.S. nurse
leaders are satisfied with the practice of registered nurses with respect to the QSEN quality and safety
competencies.
Target Audience
nurse administrators and nurse educators interested in knowing more about the status of quality and
safety competencies in practicing registered nurses.
Abstract
Purpose: The purpose of this study is to determine the degree of satisfaction nurse leaders possess with
respect to the six Quality and Safety Education for Nurses(QSEN) core competencies :use of evidence-
based practice; teamwork and collaboration; patient-centered care; quality improvement; safety ;and the
use of informatics. Are these competencies reflected in the practice of new graduate registered nurses
and in the practice of their incumbent experienced staffs? Nurse leaders differentiated their responses
based on the educational level and experience level of the nurses. Additionally, teaching and learning
resources within healthcare facilities related to the domains were identified. Facilitators of and barriers to
quality and safety learning were explicated.
The research questions included:
1. To what extent are nurse executives and managers satisfied with their new graduate registered
nurses’ practice related to each of the six QSEN core competencies for nursing?
2. Are there perceived differences based on educational preparation of the new graduate?
3. To what extent are nurse executives and managers satisfied with their experienced registered
nursing staff’s practice related to each of the six QSEN core competencies?
4. Are there perceived differences based on educational preparation of the experienced nurse?
5. What types of learning opportunities that support the six QSEN core competencies are available
to existing registered nurses employed in their clinical agency?
6. What are the barriers to and facilitators of learning experiences for nurses related to the six
QSEN core competencies within healthcare facilities?
Methods: This mixed methods study used survey methodology and focus group meaning making
activities. The survey was developed based on literature review and content expert opinion. It was fielded
with 3 groups of nurse leaders with iterative revisions. The instrument was constructed in Survey Monkey
to facilitate blinded data collection and aggregation .The survey contained 12 forced response items with
open- ended comments permitted. Demographic data on respondent title and years of experience,facility
location and size were also collected. Following IRB approval, the survey was launched via the American
Organization of Nurse Executives email blast to their membership with an invitation to participate. The
survey was open for 3 weeks with two email requests to participate. 110 nurse leaders responded. Two
focus groups of nurse leaders from two major tertiary care hospitals were recruited. A total of 11 nurse
leaders participated in the 90 minute focus groups. After obtaining informed consent and participant
permission, the sessions were audio-taped and field notes were taken. Participants were given the
aggregated responses from the electronic survey and asked to discuss the findings using a structured
interview guide. Tapes were transcribed and thematic analysis conducted. Focus group findings were
reviewed by an external expert reviewer for validation of the emergent themes. Focus group data were
presented in content analytic tables with representative comments. Focus groups alone answered
research question four.

Results: Differences in nurse leader satisfaction across the six domains were identified among the
groups based on education and experience. Nurse leader levels of satisfaction with staff quality and
safety competencies do vary based on level of experience and degree type. The competencies rated
most highly overall included: patient-centered care; teamwork and collaboration; and safety. Satisfaction
with quality improvement was rated lowest for all categories of nurses except experienced associate
degree for whom evidence –based practice was lower. New graduate nurses prepared at the associate
degree/diploma level received the lowest satisfaction scores across five of the six domains. Only in the
area of informatics did they score slightly higher than experienced ADN staff members. Baccalaureate
prepared nurses both experienced and new graduates receive higher levels of satisfaction than their
associate degree counterparts in all six domains. Striking differences were noted in the dimensions of
evidence-based practice, informatics and quality improvement. Satisfaction ratings for these three
domains were considerably lower for the experienced associate degree/diploma nurse when compared to
their experienced BSN counterparts. In fact, BSN new graduates surpass the experienced associate
degree nurses in each of these three competencies. With increasing use of technology, it is encouraging
to note that new graduate baccalaureate nurses also slightly exceed their BSN experienced counterparts
in the areas of informatics.
As a subset of experienced nurses, clinical preceptor proficiency in the six quality and safety
competencies ,regardless of educational preparation, is cause for concern given the predominance of
this model for promoting skill acquisition in nurses. Without addressing preceptor knowledge and skill in
the QSEN competencies and their ability to successfully impart it, an ineffective teaching/learning dyad is
reinforced.
A wide variety of learning opportunities are available within healthcare facilities to promote quality and
safety competency development. Orientation and preceptor- led clinical experiences are the most widely
reported methods. One unexpected finding was the relatively low utilization of new graduate residency
programs reported by leaders. These programs are noted to be very effective in the overall professional
development and retention of new graduate nurses.
Several barriers to and facilitators of quality and safety learning in healthcare facilities were identified.
Given the complexity and acuity of healthcare environments, the most frequently cited barrier is the lack
of time practicing staff nurses have available in the work environment for learning activities. Leaders have
a large role to play in facilitating quality and safety learning. Setting clear expectations for continued
growth and professional development and establishing supportive unit cultures promotes the
development of these critical competencies.
Conclusion: This study has provided insight on nurse leader satisfaction with the quality and safety
competencies of their registered nurse staffs. The findings have illustrated areas of strength and limitation
for both new graduate and experienced nurses. Differences are noted in the performance of associate
degree/diploma prepared nurses and baccalaureate prepared nurses particularly in the domains of
evidence based practice and quality improvement. These differences have several implications and calls
for action by nurse leaders and educators. It has been learned that quality and safety education is
provided through an array of educational strategies inside healthcare facilities but that more emphasis
needs to be placed on learning activities to promote development of quality improvement expertise. It is
hoped by focusing attention on patient-centered care, teamwork and collaboration, quality improvement,
evidence- based practice, safety, and informatics that the practice of incumbent registered nurses can be
enhanced to promote safer patient care and to improve the healthcare environments in which they work.
Nursing has a significant role to play in the provision of high quality, safe patient care and it requires the
joint forces of academic and service partners to assure that healthcare becomes safer than it is.
References
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., …& Taylor, D. (2007). Quality and
safety education for nurses. Nursing Outlook, 55(3), 122-131. Cadmus, E., Van Wynen, E.A., Chamberlain, B.,
Steingall, P., Killgallen, ME., Holly, C.,& Gallagher-Ford, L. (2008). Nurses’ skill level and access to evidence-based
practice. Journal of Nursing Administration, 38(11), 494-503. Dycus, P., & McKeon, L. (2009). Using QSEN to
measure quality and safety knowledge, skills, and attitudes of experienced pediatric oncology nurses: an international
study. Quality Management in Healthcare, 18(3), 202-208. Fetter, M. (2009). Graduating nurses’ self-evaluation of
information technology competencies. Journal of Nursing Education, 48(2), 86-90. Flood, L.S., Gasiewicz, N., &
Delpier, T. (2010). Educational innovations: integrating information literacy across a BSN curriculum. Journal of

Nursing Education, 49 (2), 101-104. doi:10.3928/01484834-20091023-01 Institute of Medicine. (2003). Health
professions education: A bridge to quality. Washington, DC: National Academies Press.
Contact
[email protected]

Nurses' Scope of Practice and the Implication for Quality Nursing Care
Lizeth Roets, PhD, MSocSc (Hons), BSocSc, South Africa
Johanna Catharina (Irene) Lubbe, PhD, MSocSc (CritCrNsg), AdvDipEducMgmt, BSocSc, South Africa
Purpose
The purpose of this presentation is to provide an overview of the implications for patients’ health status
and care needs when assessments are performed by nurses not licensed or competent to perform this
task. The “Waterlow™ scale” scenario is used as a practice example to illustrate this case.
Target Audience
The target audience of this presentation is nurse managers, nurse educators and nurse practitioners.
Abstract
Purpose: The purpose of this presentation is to give an overview of the implications for patients’ health
status and care needs when assessments are performed by nurses not licensed or competent to perform
this task. The “Waterlow™ scale” scenario is used as a practice example to illustrate this case.
Methods: A retrospective quantitative study was utilised. A checklist was used to perform an audit on a
random sample of 157 out of an accessible population of 849 patient files. Data was gathered in May
2012 and the analysis was done using frequencies and percentages for categorical data. Reliability and
validity were ensured and all ethical principles were adhered to.
Results: Eighty percent of risk assessments were performed by nurses not licensed/enrolled to perform
this task unsupervised. Areas such as tissue malnutrition, neurological deficits and medication were
inaccurately scored, resulting in fifty percent of the Waterlow™ risk-assessment scales, as an example,
being incorrectly interpreted. This has implications for quality nursing care and might put the patient and
the institution at risk.
Conclusion: Lower-category nurses and student nurses should be allowed to perform only tasks within
their scope of practice for which they are licensed or enrolled. Nurses with limited formal theoretical
training are not adequately prepared to perform tasks unsupervised, even in the current global nursing
shortage scenario.
To optimise and ensure safe and quality patient care, risk assessments should be done by a registered
professional nurse, who will then coordinate the nursing care of the patient with the assistance of the
lower category of nurses.
References
Magnan, M., & Maklebust, J. (2009). The nursing process and pressure ulcer prevention: making the connection.
Advances in Skin & Wound Care, 22(2), 83-92. doi:10.1097/01.ASW.0000345279.13156.d0 NYSED.gov. (2013). The
differentiated scope of practice of licensed practical nurses (LPNs) and registered professional nurses (RNs). Office
of the Professions. Practice information. Retrieved from http://www.op.nysed.gov/prof/nurse/nurse-scope-lpn-rn.htm
Contact
[email protected]

Leveraging Data to Drive Quality Patient Care: The Value of a Unit-Specific
Nursing Performance Dashboard
Lianne P. Jeffs, RN, BScN, MSc, PhD, Canada
Susan Beswick, RN, MN, Canada
Joyce Lo, RN, BScN, MN, Canada
Heather Campbell, RN, MS, Canada
Ella Ferris, RN, MBA, Canada
Purpose
The purpose of this presentation is to explore the perceptions and experiences of front-line nurses and
managers associated with the implementation of a unit-level dashboard.
Target Audience
The target audience of this presentation is clinical nurses, educators, clinical leaders/managers.
Abstract
Purpose: Performance data can be used to monitor and guide interventions aimed at improving the
quality and safety of patient care.[1-4] Nursing plays an important role in quality management and
performance improvement at the clinical level due to their interactions with patients and at an operational
level nurse leaders have a key role in informing resource allocation and patient safety monitoring.[1,3,4]
To use performance data effectively, nurses need to understand how to interpret and utilize data in
meaningful ways to guide practice.Unless clinical nurses have knowledge about performance
improvement measures, exposure to data reporting mechanisms, and shared accountability for quality, it
may be difficult for them to participate in data-driven care.[1] One mechanism to provide feedback on
patient outcomes, experiences, and processes of care is the use of dashboards. In this context, one
hospital developed a unit specific dashboard aligned with the implementation of the Registered Nurses
Association of Ontario’s Best Practice Guidelines. A study was undertaken to explore the perceptions and
experiences of front-line nurses and managers associated with implementation of a unit-level dashboard.
Methods: A qualitative study was undertaken to explore the perceptions and experiences of front-line
nurses and managers associated with the implementation of a unit-level dashboard, referred to as the
CUE dashboard. The CUE dashboard initiative was implemented throughout a large, urban teaching
hospital in Toronto, Ontario, Canada and involved six hospital units (outpatient mobility, emergency
department, general internal medicine, general surgery, cardiac intensive care, and respirology). Data
was analyzed using a directed content analysis approach.
Results: A total of 61 interviews (56 front-line nurses and 5 unit managers) were conducted from the
following clinical units: general internal medicine (n = 12); general surgery (n =11); respirology (n =10);
out-patient mobility (n = 5); emergency (n = 12); and coronary care unit (n=6). Key themes
emergedaround the enablers and barriers associated with implementation that included learning in a
supportive work environment and finding times amidst clinical care priorities.
Conclusion: The study findings highlight how front-line nurses and managers viewed implementation of
a unit-specific dashboard. This study also provided insight into the experiences nurses and managers had
during this process as well as key recommendations on how it could be better utilized. Based on these
results, nurse leaders may consider investing in the use of dashboards as a quality improvement strategy,
or may use study findings to optimize the use of performance data by using dashboards in their
organizations.
References
1.Albanese M.P., Evans D.A., Schantz C.A., Bowen M., Moffa J.S., Piesieski P., &Polomano R.C. (2010). Engaging
clinical nurses in quality and performance improvement activities. Nurs Admin Quar 34(3):226-245. 2.Chassin, M.,
Loeb, J.M., Schmaltz, S. & Watcher, R.M. (2010). Using measurement to promote quality improvement. New England
Journal of Medicine 363:683-688. 3.St. Pierre, J. (2006). Staff nurses' use of report card data for quality improvement:

first steps. Journal of Nursing Care Quality, 21(1), 8-14. 4.Mick, J., (2011). Data-driven decision making a nursing
research and evidence based practice dashboard. Journal of Nursing Administration, 41(10), 391-393.
Contact
[email protected]

M 02 - Educational Support of New Staff
Research on the Sense of Coherence (SOC) of Newly Graduated Nurses in Japan
within Their First Sixth Month of Employment
Yasue Yamazumi, MSN, RN, Japan
Akira Kitagawa, MSN, RN, Japan
Chie Ikoma, RN, Japan
Fumiko Yasukata, RN, PhD, Japan
Purpose
The purpose of this presentation is newly graduated nurses in terms of SOC (sense of coherence),
stressors, and social support six months after starting employment, and to identify factors that influence
the SOC of newly graduated nurses.
Target Audience
The target audience of this presentation is nursing manager of hospital and academic faculty staff.
Abstract
Purpose: According to the Japanese Nursing Association, the newly graduated nurse’s turnover rate
continued to decrease between 2008 and 2012. The turnover rate of newly graduated nurses in 2012 was
7.5%.
7.5% of newly graduated nurse’s amounts to 3900 graduates from 50 nursing colleges all over Japan in
2013.The total number of graduates from all colleges and universities in Japan who started working in
2013 was 50,200.
Compared to the turnover rate of 11.4% for all new hires who graduated from college in 2009 this
turnover rate for nurses is not particularly high. However, considering that one in nine new employees in
the specialized profession of nursing leaves his or her job, measures designed to prevent nurses leaving
their jobs are clearly necessary.
The reason of this is not only the support system in the workplace, but also more complex causes such
as stressors and a lack of stress coping abilities in individuals.
To research the status of newly graduated nurses in terms of SOC (sense of coherence), stressors, and
social support six months after starting employment, and to identify factors that influence the SOC of
newly graduated nurses.
Methods: Survey requests were made to directors of the nurses at accredited hospitals of the Japan
Council for Quality Health Care Hospital Evaluation Program with 300 beds or more in the Tokyo
metropolitan area, Osaka and Fukuoka Prefectures.
Self-administered questionnaires were distributed to 914 novice nurses hired in 2012 at 37 facilities from
which consent was obtained. Returning the questionnaire constituted consent to participate in the study,
and responses were collected from 283 individuals by mail (response rate 30.9%). After excluding the
questionnaires of three individuals due to missing data, 280 individuals were subjected to analysis (valid
response rate 98.9%).
The questionnaire surveyed basic attributes such as age, sex, and basic educational background,
comprised the 13 items in the simplified Japanese sense of coherence scale and the Brief Job Stress
Questionnaire.
The 13 question items from the sense of coherence involved selecting 1 of 7 answers from “I completely
agree” to “I completely disagree,” with the lowest possible score being 13 points and the highest score 91
points. The sense of coherence is composed of the three subordinate concepts of meaningfulness,
comprehensibility, and manageability. The Cronbach's alpha was 0.78.

The Brief Job Stress Questionnaire comprises the following nine stressors: “the psychological strain from
work (volume),” “the psychological strain from work (quality),” “subjective degree of physical stress,”
“stress in interpersonal relationships in the workplace,” “stress caused by work environment,” “degree of
control in your job,” “degree of utilization of technical skills,” “perceived adequacy of your job” and “job
satisfaction.” The Cronbach's alpha was 0.75.
An additional scale measured the following four stress relaxation factors: support from from “family and
friends,” “colleagues”, “superiors,” and “social support.” The Cronbach's alpha was 0.78.
Multiple linear regression analysis was performed using SOC as the dependent variables and basic
attributes, Job Stress and stress relaxation factors as independent variables.
In regard to ethical considerations, we explained the following to subjects: responding to the
questionnaire constituted consent to participate in the study; subjects would not suffer any disadvantages
by refusing to participate; and identities would be protected by making questionnaires anonymous.
This survey was conducted with the approval of the ethics committee of Fukuoka Prefectural University.
Results: I think there are three reasons why the survey questionnaire recovery rate is low.
1) There are 16 pages of questions, which is probably too many.
2) Subjects may not have answered the high number of personal questions out of concern for their
privacy.
3) The survey objectives may not have been communicated clearly to the respondents.
Subjects’ mean age was 25.6±6.0 (mean ± S.D.), ranging from 20 to 49 years old. Males comprised 5.7%
while females comprised 94.3%. Basic education was obtained from universities 30%, junior colleges
61% and other 9%.
The average SOC score for all respondents was 50.4±10.6. Four factors that influenced SOC were
extrapolated as follows:
1) “perceived adequacy of your job (β=0.290***)”,
2) “job satisfaction (β=-0.232***)”,
3) “satisfaction with job and life balance (β=0.249***)”
4) “the degree of utilization of technical skills (β=0.101**)”. (Adjusted R-square= 0.341) (***p<0.001,
**p<0.01, *p<0.05)
Conclusion: Based on this research, it was ascertained that in the current study the respondents’ ability
to cope with stress was high.
Data from respondents with high sense of coherence (SOC) scores was compared to those with low
scores. It was considered that those with higher scores were able to deal well with stress and were better
at acquiring support from workplace colleagues as they were highly capable at seeking help.
Newly graduated nurses tend to be in the early stages of adulthood, which is the period when SOC is
formed and developed.
Further, it was felt that they were able to smoothly establish an occupational identity and had a strong
sense of self-efficacy. The formation and development of sense of coherence (SOC) is important in
preventing resignations and workplace burnout, so going forward it is necessary to enhance workplace
support for this group, to carry out a phased expansion of their discretionary powers, and to conduct
measures to encourage them to have successful experiences of coping with stress.
Acknowledgment: This work was supported by JSPS KAKENHI Grant Number 24593237.
References
1) Anne Fothergill, Deborah Edwards, Philip Burnard. (2004): Stress, Burnout, Coping and Stress Management in
Psychiatrists: Findings from a Systematic Review. International Journal of Social Psychiatry, vol. 50, no.1: p.54-65. 2)
Antonovsky A. (1996): The sence of coherence. An historical and future perspective. Israeli Journal of Medical
Sience, no.32, p.170-178. Beecroft,P.C., & Santner CS., & Mary Lee Lacy, M.L.,&
F. i2006jFNew
Advanced Nursing Graduate Nurses' Perceptions
-Cvol.55,
of Mentoring.
no.6, p.73
747 3) Japan Nursing Association: g2013 survey on supply and dema
http://www.nurse.or.jp/up_pdf/20130307163239_f.pdf (accessed on 2013/05/10). 4) Jelena Ogresta, Silvia Rusac,

Lea Zorec. (2008): Relation between burnout syndrome and job satisfaction among mental health workers. Croat
Med J, no.49: p.364-374. 5) Teruichi Shimomitsu: Stress measurement study group report, gFiscal Year 1999
Ministry of Labor research report on stress in the field of research and its impact on health in regard to the prevention
of work-related diseases, h Ministry of Labo
Self-expression attitude of senior nurses toward novice nurse from the aspect of assertion theory. The Japanese
journal of mental health, vol.22, no.2: p.66-79. 7) Taisuke Togari.(2008): Social determinants and developmental
factors of sense of coherence in 20 to 40 years old population, Discussion Paper Series, University of Tokyo Institute
of Social Science Panel Survey, no.5 : p.1-43 8) Yoshihiko Yamazaki, Taisuke Togari, Junko Sakano (2008): Sense
of Coherence SOC, Tokyo: Yusindo
Contact
[email protected]

Peer Support in Research Capacity Development
Gisela H. Van Rensburg, DLittetPhil, South Africa
Purpose
The purpose of the presentation is to provide educators with information that could facilitate peer support
to enhance research capacity development. Peer support could contribute to an enriching learning
environment within which students’ and researchers’ experiences and potential are enriched.
Target Audience
research supervisors and nurse educators
Abstract
Purpose: The purpose of the presentation is to provide educators with information that could facilitate
peer support to enhance research capacity development. Peer support could contribute to an enriching
learning environment within which students’ and researchers’ experiences and potential are enriched.
Methods: This presentation addresses an objective that is part of a larger study that focuses on
innovative support strategies to enhance postgraduate research capacity. A qualitative approach was
used to explore the peer support practices of postgraduate students at a distance learning institution.
Data were collected from two samples of postgraduate students using semi-structured narrative essays.
The eight steps suggested by Tesch were used to analyse the data. The data obtained is discussed
within the specific context of an open distance learning environment.
Results: The results provided significant insights into the value of peer support as a strategy to develop
research capacity. The findings pointed to the mutual support and thus participative learning that peer
support provides. Both formal and informal peer support encourage critical reflection on their research
capacity and assist in addressing shortcomings and hidden assumptions. Peer support could be both
direct and indirect, providing various opportunities to develop as researchers in a safe environment.
Conclusion: The recommendations include the use of peer support in diverse groups of postgraduate
students in an open distance learning context. Peer support could offer a type of support that is not
necessarily part of the open distance learning context. It may address some of the issues experienced in
such a context by alleviating the feeling of ‘distance’ and ‘aloneness’ when doing postgraduate studies at
an open distance learning institution.
Contact
[email protected]

Bridging the Education-Practice Gap: Integration of Current Clinical Practice into
Education on Transitions to Professional Practice
Cheryle G. Levitt, PhD, MSN, BSN, RN, USA
Purpose
This purpose of this presentation is to share results from a study that solicited content topics from nurse
clinicians to be used to develop a core course in transitions to professional practice in a RN-BSN
program. Direct input from practitioners creates a partnership to bridge the education-practice gap.
Target Audience
The target audience of this presentation is nursing educators in baccalaureate programs throughout the
global nursing community, as well as nursing clinicians. The involvement of clinicians for direct input into
course development provides a dynamic and realistic partnership that enhances nursing education.
Abstract
Purpose: There is an acknowledged gap between the content in undergraduate nursing education
programs and the expected performance standards and roles of nursing in the healthcare setting. The
continual changes in the healthcare system are not sufficiently reflected in basic nursing education, and
the gap results in graduates that may not be sufficiently prepared for the current role expectations for
nurses in various settings. Nursing education is charged with preparing graduates to integrate into
reconceptualized roles that include areas such as collaboration, leadership, quality management, use of
technology, and care management. The Institute of Medicine study on the Future of Nursing (2011)
identifies this gap as an issue for improvement for nursing education in order to create an effective
transition for graduate nurses to a range of practice settings. To address this, faculty in a RN-BSN
program contacted clinicians in various healthcare settings to seek their input for topics to guide course
development, in order to provide an opportunity for a direct connection from the field into the classroom.
This descriptive study sought to bridge this gap by providing suggestions directly from practitioners in the
field to contribute to course development in an online RN-BSN program, for a core course in transitions to
professional practice. The study queried practitioners for the content topics they deem essential for
nursing students to learn, in order to transition into professional nurses. A secondary purpose was to
reveal and identify differences between clinicians vs. faculty recommendations for areas of content.
Methods: This study, approved by the university IRB, collected information via an electronic survey, from
experienced BSN and MSN nurses (93% with > 5 years experience) in a diverse selection of roles and
clinical areas, faculty currently teaching in a RN-BSN program, and graduates of a RN-BSN
program. Clinical roles of participants included staff, preceptors, managers, and administrators in acute
care facilities, both rural and metropolitan, in teaching and community hospital settings, long term care,
and outpatient settings. Participants (total respondents: n=206) were asked to identify and prioritize, from
a list of topics provided, the pertinent content areas to include in a core foundational course for transition
to the roles of professional nursing. Topics were selected using standards for professional practice,
evidence from the literature, and texts on professional practice. Participants were invited to add their own
content ideas and further suggestions for the subject areas of the course.
Results: Results were analyzed with descriptive statistics and for differences, using a series of Kruskal
Wallis tests. The survey was piloted prior to distribution. Participants were asked to choose their top ten
topical areas and to rank them in order of priority. The top content areas were: accountability and
autonomy; collaboration and coordination in caring; critical thinking, clinical reasoning; ethical principles
and standards; evidence based practice; informatics and technology; leadership and management;
professional communication; professional nursing concepts; quality improvement. No significant
differences in mean importance rankings for any of the nursing curriculum topics were found according to
age. A significant result was found for history of nursing (χ²=7.846, 2 df, p=.020) where it was found to be
at the bottom of the ranked list, for leadership and management principles (χ²=14.061, 5 df, p=.029), for
critical thinking, clinical reasoning (χ²=8.790, 2 df, p=.012) and for professional nursing concepts:

philosophy, identity, standards, roles, behaviors (χ²=6.213, 2 df, p=.045). No significant differences in
mean importance rankings were found according to highest degree earned by the participant, for
geographic location, between rural and metropolitan groups, according to clinical setting, or between
clinicians, faculty, and recent graduates. Significance for excluding nursing history, previously in the
course, was highest among less experienced nurses.
Conclusion: The results identified priority content areas, that were combined with standards for
baccalaureate education, and applied directly into course development for a core transitions to
professional nursing course, as well as integrated into other courses within the program. The course was
developed and launched within 4 months of the results of the study, thus providing rapid utilization of the
results. The study sought to help to prepare nurses with realistic content that can assist them to be
effective practitioners in the present and future healthcare environment, to reduce a gap between
education and practice, and to provide faculty with the pertinent content to enable this outcome. The
congruence in results between clinicians and faculty was gratifying. The faculty felt that the course was
the most current possible, and was supported by clinicians who would likely be working with graduates of
the program at a future date. It is recommended to use this collaborative approach for development of
other courses in the baccalaureate curriculum.
References
Boychuk Duchscher, J. E. (2009). Transition shock: The initial stage of role adaptation for newly graduated
Registered Nurses. Journal of Advanced Nursing, 65(5), 1103-1113. doi:10.1111/j.1365-2648.2008.04898. Hatlevik,
I. K. R. (2012). The theory-practice relationship: Reflective skills and theoretical knowledge as key factors in bridging
the gap between theory and practice in initial nursing education. Journal of Advanced Nursing, 68(4), 868-877. doi:
10.1111/j.1365-648.2011.05789.x The Institute of Medicine. (2011). The Future of Nursing: Leading Change,
Advancing health. Washing, DC: National Academies Press.
Contact
[email protected]

M 03 - Global Nursing Leadership Initiatives
The Relationships Among Leadership Style, Safety Climate, Emotional labor and
Intention to Stay for Clinical Nursing Staff in Taiwan
Hui-Yu Liang, RN, Taiwan
Purpose
The purpose of this presentation is to identify the relationships among leadership style, safety climate,
emotional labor, and intention to stay for nursing staff in Taiwan.
Target Audience
The target audience of this presentation is nurse, administrator, and policy makers in hospitals.
Abstract
Purpose: Nurses shortages is global issues, stable nursing workforce and improving nursing practice
environment are important for the current policy of retention. Organizational factors are becoming more
important for intention to stay among nurses. The purpose of the study was to identify the relationships
among leadership style, safety climate, emotional labor, and intention to stay for nursing staff in Taiwan.
Methods: A cross-sectional research design was conducted in this study. Subjects were selected by
using a purposive sampling method. A satisfactory reliability and validity structured-questionnaire was
used to collect data and completed by 202 subjects with a response rate of 73.3%.
Results: The finding indicated that most of the nurse staff intent to stay in nursing workforce (the mean
score was 3.27 out of a possible score of 5; SD = 0.74) and 46.5% nurses staff express higher degree of
intention to stay. Leadership style (r= 0.31, p<0.01) and safety climate (r=0.48, p<0.01) revealed positive
relationships with intention to stay; emotional labor revealed a negative relationship with intention to stay
(r= -2.52, p<0.01). The finding of multiple regression analysis indicated that nurses staff working
experience (β= -0.24, t= -352, p=0.01, 95% CI= -3.89 to -1.09), leadership style (β=0.31, t=4.64, p<0.01,
95% CI=0.05 to 0.11), safety climate(β=0.48, t=7.78, p<0.01, 95% CI=0.11 to 0.18) and emotional labor
(β= -0.25, t= -3.68, p<0.01, 95% CI= -0.05 to -0.02) were significant predictors of intention to stay and
explained 32.9 % of the total variance.
Conclusion: Job related emotional labor is recognized in this study which can contribute to developing a
program to decrease first-line nurses emotional stress. Besides, based on our findings, we suggest that
create positive workforce, effectiveness of leadership style, culture of safety climate should be
established.
Contact
[email protected]

M 03 - Global Nursing Leadership Initiatives
Nurses' Perceptions of Ethical Issues in an Academic Hospital Setting
Linda E. Jensen, PhD, RN, MN, USA
Christine Swanson, MA, USA
Purpose
The purpose of this presentation is to: 1.Discuss methodology and stakeholders to involve when
assessing perceptions of nurses about ethical consultation services 2.Identify barriers to ethical
consultation and needs for inservice education as perceived by registered nurses in an academic hospital
in a rural area of the U.S.
Target Audience
The target audience of this presentation is nursing administrators, clinical educators, researchers, and/or
ethics committee members concerned about measuring nurses’ perceptions of ethical dilemmas and their
abilities to protect their patients and improve patient and family-centered care.
Abstract
Purpose: Today’s healthcare organizations are becoming increasingly accountable for the many ethical
issues and challenges that have arisen as a result of corporate management, technological advances,
reproduction issues, genetic healthcare, and the demands of cost containment affecting the delivery of
safe and effective cares (Cooper, 2002). With such changes and challenges in the healthcare system,
studies have found that the once traditional ethical principles of autonomy, beneficence, and justice
provided by today’s healthcare professionals are being severely tested (Cooper, 2002, p. 331). In
addition, despite the Joint Commission on Accreditation of Healthcare Organization accreditation
standard requiring healthcare organizations to develop and operate under a code of organization ethics,
and the imperative need for healthcare professionals’ to perform in an ethical manner, research has found
that there are still barriers between the clinical and organization ethics within the hospital systems.
Despite the prevalence and the identification by recent studies regarding the ethics consultative services
vital role in resolving ethical disputes, little research has been conducted to evaluate the effectiveness
and or barriers to the ethics consultation services within university or community hospitals as perceived
by the nurses working in that institution. Studies have further recognized that there is significant lack of
data on “the effectiveness of ethics committees and the committee members’ lack of education and skills
for effective participation in case consultation.
Research Question: What are the perceptions of the registered nurses about common ethical dilemmas
and the services of the Ethics Consultation Services (ECS) within an academic hospital setting?
Methods: Any person who is concerned about a potential clinical ethics issue at that academic
hospital could request an ECS consult: patient, family member or friend, student, health care provider,
administrator, or other hospital employee. Typically the consultant would ask the caller to describe the
ethical issue(s) and elicit background information. If the query is a straightforward request for information,
the telephone call may suffice. If a formal consult appears to be indicated, the ECS consultant would
address the patients’ primary medical physician to ask whether he/she is aware of the consult. If the
primary medical physician is not aware, the inquiring individual and the consultant may negotiate who will
alert the primary physician. The ECS consultant would then discuss the case with the appropriate
individuals (primary physician, relevant consulting services, nursing, social work, significant others and
patient), conduct a chart review, and pursue any other information needed to frame the issues. The ECS
consultant may hold a formal case conference if needed. At the conclusion of the consult, the ECS
member will document a brief description in the patients’ medical chart including actions taken, and
recommendations made or agreements reached. The ECS consultant will further allude to the
appropriate personnel that they are an advisory service; its recommendations are not enforceable.
Ethics consultant’s services were available 24 hours a day and seven days a week. A dedicated ECS
pager was available for members of the ethics consultation services who do not carry their own

pagers. The ECS members were assigned to ethics services based from a rotation schedule that is set
on a quarterly basis with assistance from the Medical Executive Office. The administrative assistant
entered the rotation in the hospitals e-call system and communicates any schedule changes to the ECS
members. The ECS chair served as back-up call. The ECS consultants were able to ask for assistance
on a case from one another, from hospital administration (e.g., chaplaincy, social work, patient relations,
risk management, administrator on call, legal counsel), and from other medical services (e.g., ECS might
recommend a consultation by psychiatry, palliative care, etc.). In addition, the ECS consultants were able
to converse with medical personnel, family members, primary care physicians and other sources of
information on the patient's goals, values, preferences, medical status, and treatment options.
A 10-item survey was designed to determine the extent to which nurses witnessed specific ethical issues,
take actions to increase the involvement of ethics consultation services, and also to evaluate the RNs’
perceptions of the ethics consultation services. In addition, the survey included questions that measured
the nurses perception regarding requesting an ethics consultation. A four-point Likert scale extending
from ‘always’, which was scored as 1, to ‘rarely’, which was scored as 4, yes and no questions, and a
five-point Likert scale extending from ‘very important’, which was scored as a 1, to ‘not at all’, which was
scored as a 5, were utilized within the study. An open ended question was also provided at the end of the
survey to elicit detailed comments and or recommendations about ethical issues or the ethics consultation
services. Validity of the survey was developed as the team sat with a member from the ethics committee.
The questions were changed several times to measure what the nurse “perceives” the ethics consultation
to be. In addition, several nurse administrators at the hospital, the college Institutional Review Board
(IRB), and the hospital IRB, also approved the questionnaires and the research methodology. Data
collection was conducted with an online survey software tool which sent a survey to all registered nurses
at the academic health center.
Results: Analysis of the data from 282 registered nurses showed most nurses perceived adequate
support from the administration and the physicians in ethical dilemmas, however 69% of the participants
responded as having no prior experience with the ethics consultation services at the hospital, and 32%
were not aware of the ethics consultation services. Over thirty percent found the concerns for retaliation
from a coworker, the time required for an ethics consult, the perception by some providers that an ethics
consult suggests wrongdoing or failure, and the difficulty of asking for a consult were important barriers to
asking for an ECS consult. In addition, several qualitative responses were provided by the nurse
participants elaborating on the experiences they have had with concerns for retaliation from a
coworker. Additional results will be discussed.
Conclusion: A recommendation was made to include ethics consultation education in the general
orientation process as well as within yearly in-services held by the Ethics Consultations Committee.
Furthermore, it was recommended that nurses within the inpatient hospital setting should become more
aware of the ethical resources available to them within their hospital work environments and the
appointed ethics consultation services available to them so that they utilize the ECS more in resolving
ethical dilemmas or disputes, improving patient care by responding to healthcare professional’s requests,
and assisting in the debate and resolution of ethical cases and ethical policies. In addition, to allow for a
more thorough evaluation, further studies to evaluate the perceptions of ethics consultation services by
various disciplines within the academic hospital setting (patients, family, other health care team members)
should be conducted.
References
Ethics Presentation References Alexander, L. and Moore, M. (2007). Deontological Ethics. Stanford Encyclopedia of
Philosophy. Retrieved November 11, 2010 from http://plato.stanford.edu/ Aulisio, M., & Arnold, R. M. (2008). Role of
the Ethics Committee; Helping to Address Value Conflicts or Uncertainties. CHEST Journal 134:417–424. Cooper, R.
W., Frank, G. L., Gouty, C. A., & Hansen, M. C. (2002). Key ethical issues encountered in healthcare organizations;
perceptions of nurse executives. JONA 32 (6): 331-337. Corley, M., Elswick, R., Gorman, M., & Clor, T. (2001).
Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250-256. Dodd, S. J.,
Jansson, B. S., Satlzman-Brown, K., Shirk, M., & Wunch, K. (2004). Expanding nurses’ participation in ethics: an
empirical examination of ethical activism and ethical assertiveness. Nursing Ethics 11 (15): 15-27. DuVal, G.,
Clarridege, B., Gensler, G., & Danis, M. (2004). A national survey of U.S.internists’ experiences with ethical dilemmas
and ethics consultation. The Journal of General Internal Medicine 19,251–258. Goldman, A. & Tabal. N. (2010).
Perception of ethical climate and its relationship to nurses’ demographic characteristics and job satisfaction. Nursing

Ethics, 17(2), 233-246. Lachman, V. (2012). Applying the ethics of care to your nursing practice. MEDSURG
NURSING, 21(2), 112- Malloy, D., Hadjistavropouos, T., McCarthy, E., Evans, R., Zakus, D., Park, I., Lee, Y., &
Williams, J. (2009). Culture and organizational climate: Nurses’ insights into their relationship with physicians.
Nursing Ethics, 16(6), 719-733. McGee, G., Caplan, A. L., Spanogle, J. P., & Asch, D. A. (2001). A national study of
ethics committees. The American Journal of Bioethics, 1 (4), 60-64. Noureddine, S. (2001). Development of the
ethical dimensions in nursing theory. International Journal of Nursing Practice, 7(1): 2-7. Pauly, B. Varcoe, Colleen,
Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics,
16 (5), 561-573. DOI: 10.1177/0969733009106649 Schluter, J., Winch, S., Holzhauser, K. & Henderson, A. (2008).
Nurses’ moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15(3), 303-321 Swetz, K. M.,
Crowley, B. E., Hook, C., Mueller, S. (2007). Report of 255 clinical ethics consultations and review of the literature.
Mayo Clinic Proceedings. 82 (6):686-691. Zuzelo, P.R. (2007). Exploring the moral distress of the registered nurses.
Nursing Ethics 14 (3O), 344-359.
Contact
[email protected]

M 04 - Using Online Technologies for Education
Utilizing the Technology Acceptance Model (TAM) for Predicting Usage and
Adoption of an iBook© in Online Graduate Nursing Courses
Maria E. Lauer, PhD, RN, MSN, USA
Mary Judith Yoho, PhD, RN, CNE, USA
Leah M. Phillips, MSN, RN, USA
Desirae Freeze, MSN, RN, USA
Purpose
The purpose of this presentation is to share research outcomes related to the degree faculty would adopt
an iBook© for online nursing programs. The Technology Acceptance Model (TAM) was used to examine
perceptions of usefulness, attitude and preferences to predict faculty acceptance of the iBook© format in
online nursing courses.
Target Audience
The target audience of this presentation is undergraduate and graduate faculty interested in expanding
technological modalities and strategies with the use of an interactive textbook, which can potentially
change the way educators and learners meet learning objectives.
Abstract
Purpose: Little is known about the use of iBooks©, in fact, “Inspiring Future Nurse Educators” is
currently the only known iBook native to the iAuthor©software. As with any new technology, it is vital to
assess the likelihood of adoption by faculty and learners. This study adapted the Technology Acceptance
Model (TAM) (Ventakesh and Bala, 2008). to examine perceptions of usefulness, attitude and
preferences in an effort to predict faculty acceptance of the iBook© format. The purpose of this
presentation is to share research outcomes related to the degree faculty would adopt an iBook© for use
in online graduate nursing programs. The Technology Acceptance Model (TAM) was used to examine
perceptions of usefulness, attitude and preferences to predict faculty acceptance of the iBook© format.
Methods: A survey method design was used to study the research hypotheses.
H1: Perceived usefulness (PU) will have a significant influence on attitude towards usage (ATU).
H2: Perceived ease of use (PEOU) will have a significant influence on attitude towards usage (ATU).
H3: Perceived ease of use (PEOU) will have a significant influence on perceived usefulness (PU).
H4: Attitude towards usage (ATU) will have a significant influence on users’ behavioral intention to use
(BIU) an iBook.
Results: The iBook was reviewed by faculty who teach online courses. Faculty downloaded the iBook
onto their ipads so they would have full access to the interactive links. Faculty varied in experience from
novice to very experienced in using iBooks to novice users, with 64% reporting they are advanced users
of technology.
Once reviewing the iBook, 100% faculty stated they were generally favorable attitude toward using
iBooks, and found the iBook easy to use. 79% of faculty stated they intend to use iBooks frequently for
teaching.
Conclusion: The iBook was positively received by faculty who teach online courses. Interactive
textbooks may have the potential to change the way educators and learners meet learning
objectives. Comments provided by the study participants will be implemented in the editing and updating
of the iBook. A replicated study is planned to include a larger pool of faculty teaching at other online
nursing programs.
References

Venkatesh, V. (2000). Determinants of perceived ease of use: integrating control, intrinsic motivation, & emotion into
the technology acceptance model. Information Systems Research, 11(4), 342-365. Davis, F. D. (1989). Perceived
usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319-339.
Contact
[email protected]

Using an Online Learning Module to Improve Australian Palliative Care Nurses'
Pain Assessment Competencies and Patients' Reports of Pain
Jane L. Phillips, RN, BS, PhD, Australia
Louise D. Hickman, BN, RN, MPH, PhD, Australia
Nicole Heneka, MHumNut, Australia
Lawrence T. Lam, PhD, MPubH, MAppPsy, BSc (Hons), Hong Kong
Tim Shaw, BSc (H1), PhD, Australia
Purpose
is to report the results of a translational research project utilising QStream, a novel on-line learning
platform on palliative care nurses’ pain assessment capabiliites (knowledge, skills and clinical practices)
and patient reported pain outcomes.
Target Audience
nurses interested in translating evidence into practice.
Abstract
Purpose: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health
system factors. Even within specialist cancer and palliative care settings where pain is almost always
universally experienced by patients, there is often poor compliance with routine pain screening and
assessment practices, with patient reported pain intensity ratings frequently not documented.1 2
Effective pain management in these specialist care settings cuts across professional boundaries, with
failure to screen and assess contributing to the burden of unrelieved pain.
Translating evidence into practice and changing behaviour in dynamic clinical environments is
challenging, and requires a systematic and critical analysis of priorities and presumed causes. A range of
predisposing, enabling and reinforcing factors are known to shape clinicians pain assessment practices,
including: their assessment knowledge, skills and practices (competencies)3; understanding of suitable
assessment tools; commitment and capacity to integrate pain assessment findings into clinical decision
making4; communication skills; and capacity to address their patients’ care needs within the context of
multi-professional practice.5 While numerous education interventions have been developed to address
these gaps in the cancer or specialist palliative care settings6, few have targeted pain assessment as a
distinct and separate learning component, with most embedding assessment into the overall pain
management intervention.1 Implementing an intervention that increases nurses’ pain assessment
capabilities is required to improve patient reported pain outcomes.
Qstream is an on-line learning platform, that takes advantage of the psychological finding that education
encounters which are ‘spaced’ and ‘repeated over time’ result in more efficient learning and improved
retention compared to a bolus distribution learning format.7 The Qstream learning platform delivers
clinical content questions to participants via regular email. In over 12 randomised controlled trials,
Qstream has been demonstrated to: increase health professionals’ clinical knowledge and competencies;
promote active learning and retention in specialist areas; impact on clinical practice; and change
clinicians’ behaviour.8-10
The primary aim of this study was to test the impact of a Qstream pain assessment learning module on
specialist palliative care nurses’ pain assessment competencies, and to determine if this education
impacted positively on palliative care patients’ reported pain ratings.
Methods: This quasi-experimental (pre-post-test) pilot continuing professional development intervention
study was conducted at two Australian specialist palliative care services in 2012. All of the 103 registered
and enrolled nurses (nurses) employed for more than 16 hours per week at these services were invited to
participate.

The continuing professional development intervention consisted of 11 case based pain assessment
scenarios developed by a multidisciplinary expert panel delivered to participants via Qstream over 28
days. The ‘Self-Perceived Pain Assessment Competencies’ (Self-PAC) survey and chart audit data
(n=60), including patient reported pain intensity ratings, were collected pre (Time 1) and post intervention
(Time 2) and analysed using inferential statistics to determine key outcomes.
The Self-PAC-Survey has three distinct sub-scales, with Cronbach alpha reporting acceptable internal
consistency reliability: seven item pain assessment knowledge (0.944); three item pain assessment tool
knowledge (0.846); and seven item pain assessment confidence (0.919) scales.
Independent sample t-test were used to compare the ‘responders’ (participants who completed the Time
1 and Time 2 survey’s and the intervention) and ‘non-responders’ (participants who only completed the
Time 1 survey). A paired sample t-test was used to determine if there was a difference between nurses’
pain assessment: knowledge, tool awareness and confidence scores at Time 1 and Time 2. The
difference in number of documented pain ratings in the medical records by Qstream participants between
Time 1 and Time 2 was calculated and the association between Qstream participation and assessments
at the two time points was examined using Pearson chi-square test. Differences in patient reported pain
rating between admission and audit date were examined using paired t-test. A significance level of 5%
was used for all hypothesis testing.
Results: The results reported conform to the STROBE Guidelines. Thirty Four nurses out of the 74 who
enrolled in the study completed the intervention and the Time 1 and Time 2 surveys. Participants felt
more confident documenting their pain assessment findings following the learning module (mean 7.52 to
8.17) with participants also more confident undertaking a comprehensive pain assessment at the end of
the program compared to baseline (mean 7.27 vs. 8.24). Participants were more likely to document pain
intensity scores in patient’s medical records than non-participants (95% C.I.=7.3% - 22.7% , p=0.021).
Qstream participants increased their knowledge of comprehensive pain assessment elements,
assessment tools and confidence to undertake a pain assessment (p<0.001). There was also a significant
reduction in the mean patient reported pain ratings between the admission and audit date at post-test
(mean=2.4) compared to pre-test (mean=3.9) (t=1.51,df= 82, p<.0010).11
Conclusion: This pilot confirms the Qstream delivery method as an online learning format with the
capacity to improve specialist palliative care nurses’ pain assessment practices and reduce patient rated
pain intensity scores. Given the central role nurses play in pain assessment processes this is an
important result. Especially as determining the best way of managing the patients’ pain is dependent
upon systematic and robust assessment, identification of the underlying pain mechanism, and integration
of appropriate multi-modal approaches tailored to address each patient’s pain requirements.
An adequately powered larger pragmatic trial with a larger sample is required to confirm these results.
There is potential for Qstream to be integrated into larger multi-faceted translational research
interventions targeting nurses’ knowledge, attitudes and practices.
This project was funded by the Curran Foundation and The St Vincent’s Clinic Multi-disciplinary Research
grants, Sydney Australia.
References
1. Franck LS, Bruce E. Putting pain assessment into practice: why is it so painful? Pain Res. Manag. 2009;14(1):13-
20. 2. Miaskowski C. Outcome Measures to Evaluate the Effectiveness of Pain Management in Older Adults With
Cancer. Oncol. Nurs. Forum 2010;37:27-32. 3. Herr K, Titler M, Fine P, Sanders S, Cavanaugh J, Swegle J, et al.
Assessing and treating pain in hospices: current state of evidence-based practices. J. Pain Symptom Manage.
2010;39(5):803-19. 4. Luckett T, Davidson PM, Boyle F, Liauw W, Agar M, Green A, et al. Australian survey of
current practice and guideline use in adult cancer pain assessment and management: Perspectives of oncologists.
Asia Pac. J. Clin. Oncol. 2013 (in press). 5. Carr ECJ, Brockbank K, Barrett RF. Improving pain management through
interprofessional education: evaluation of a pilot project. Learning in Health and Social Care 2003;2(1):6-17. 6. de
Rond MEJ, de Wit R, van Dam FSA, Muller MJ. A pain monitoring program for nurses: effects on communication,
assessment and documentation of patients' pain. J. Pain Symptom Manage. 2000;20(6):424-39. 7. Kerfoot BP,
Lawler EV, Sokolovskaya G, Gagnon D, Conlin PR. Durable improvements in prostate cancer screening from online
spaced education a randomized controlled trial. Am. J. Prev. Med. 2010;39(5):472-78. 8. Kerfoot BP. Adaptive
spaced education improves learning efficiency: a randomized controlled trial. J Urol. 2010;183(2):678-81. 9. Shaw T,
Long A, Chopra S, Kerfoot BP. Impact on clinical behavior of face-to-face continuing medical education blended with

online spaced education: a randomized controlled trial. J. Contin. Educ. Health Prof. 2011;31(2):103-08. 10. Shaw TJ,
Pernar LI, Peyre SE, Helfrick JF, Vogelgesang KR, Graydon-Baker E, et al. Impact of online education on intern
behaviour around joint commission national patient safety goals: a randomised trial. BMJ Quality & Safety
2012;21(10):819-25.
Contact
[email protected]

Exploration of Personality Traits of Online and On-Campus Family Nurse
Practitioner Students
Kaye I. Bultemeier, PhD, MSN, APRN/BC, USA
Dustin Wattenberger, MSN, BS, USA
Purpose
to provide a summary of personality traits of students who enroll in Family Nurse Practitioner programs.
The results reveal traits of online and on-campus cohorts to assist educators as they prepare advanced
practice nurses
Target Audience
faculty of family nurse practitioner and advanced practice programs. Special interest for those moving
toward online education formats.
Abstract
Personality types and specialty selection have been identified in physicians who select family
practice. However data is not available for nurses who select Family Nurse Practitioner as their
specialty. There is a 10% attrition of students who enter on-campus education programs and a 20%
attrition rate for online students. Personality types of nurse in general and family nurse practitioner
students specifically have not been conducted.
Purpose: To explore the personality types of Family Nurse Practitioner students. Additional exploration of
differences between online and on-campus students is explored.
Methods: Non-experimental exploratory study of 109 newly enrolled family nurse practitioner students. A
two site cohort study with cohort one a large private northeaster US university and cohort two a small
private university in the southern part of the United Stated. Fifty students were enrolled in an online
program and 59 were enrolled in on-campus program. Instrument was Myers-Briggs, Form M personality
inventory. The profile was completed anonymously as students were directly to the Myers-Briggs web
site.
Results: Sample: Males (7 on-campus, 13 online). Average age 31.7 years online and 33.29 on-
campus.
Chi square analysis revealed a significant difference was found in the personality trait of Sensing vs
Intuition (p.000)
A significant difference was noted with students judging vs Perceiving (p.013). The sample was too small
to calculate a difference between the 16 total personality types
Conclusion: The results indicate that FNP students are predominately judging and Sensing. There is
need to determine if similar traits are noted in practicing Family Nurse Practitioners. Additional long term
studies to look at job satisfaction and successful completion of the education program differs with
educational program.
References
Bayram, s.,Deniz,L., & Erodogan, Y. (2008). the role of personality traits in web based education. Turkish Online
Journal of Educational Technology. 7(2). Harrtington, R.& Loffredo, D.A. (2010). MBTI personailty type and other
factors that relate to perference for online versus face-to-face instruction. Internet and Higher Education. 12(1-2), 89-
95 Gihatm N, (2008). Personality and specialty interest in medical students. Medical Teacher, 30(4). 400-406.
Contact
[email protected]

M 05 - Traumatic Issues in the Pediatric Population
Robbing the Cradle: An Analysis of Trends in Infant Abduction in the United
States
Teresa W. Ryan, DNS, USA
Purpose
to inform healthcare practitioners of trends in infant abduction and prevention practices. As security in
hospitals and maternity centers becomes increasingly stringent, potential abductors have employed other
methods, including violence, to obtain newborn children.
Target Audience
nurses, nurse practitioners, midwives, and childbirth educators who are involved with expectant women
from the early prenatal period to post-delivery must be knowledgeable about trends in infant abduction
and be able to educate expectant women and their families about infant abduction and how best to
safeguard themselves and their babies.
Abstract
Purpose: Abduction of an infant by a nonfamily member is an extremely rare event but it is an event that
can devastate families and caregivers alike. Hospitals and birthing centers in the United States have
successfully employed procedures, from parental education to high-tech security perimeters, to thwart
infant abductions so that while abductions from hospital or other healthcare facilities has decreased,
abductions from the home or public places, has risen and often times the perpetrators have resorted to
violence to overcome and incapacitate parents. Of note is the rise in “fetal abductions”, where term or
near-term fetuses are removed from their mother’s uterus by crude cesarean sections, endangering both
mother and child. Perpetrators of hospital or nonhospital abductions tend to conform to a strikingly
common profile that should be known to all healthcare workers who care for women and children. Nurses
are at the forefront of maternal-newborn care and can contribute to the safety and security of expectant
women and their children by having a thorough knowledge of abduction risks and developing parental
education programs for parents that start with the first prenatal visit and continue through the postpartum
period.
Methods: A literature review on infant abduction in the United States was performed to obtain statistics
on the incidence of abduction, common characteristics of perpetrators of infant abduction, and successful
techniques for the prevention of infant abduction.
Results: Statistics reveal a trend away from hospitals to less secure venues for infant abduction, due to
the use of technology and strict identification procedures commonly enacted in maternal-newborn units.
The profile of an infant abductor remains relatively unchanged although there is a new and alarming
willingness to resort to violence in order to obtain a child.
Conclusion: Although infant abduction rates are statistically small, the safety and security of mothers and
newborns remains a high priority for nurses. By being aware of physical security of maternal-newborn
units, educating expectant parents on the methods used by potential abductors, and working with
community resources, these tragic incidents can be prevented.
References
Ankrom, L.G., & Lent, C.J. (1995). Cradle robbers: A study of the infant abductor. FBI Law Enforcement Bulletin,
64(9), 12-17. Baker, T, Burgess, A.W., Rabun, J.B., & Nahirny, C. (2002). Abductor violence in nonfamily infant
kidnapping. Journal of Interpersonal Violence, 17(11). 1218-1233. Cesario, S. K. (2003). Selecting an Infant Security
System. AWHONN Lifelines,7, 236–242. doi: 10.1177/1091592303255720 Goodwin, A.B. (2001). Striving for a
secure environment: A closer look at hospital security issues following the infant abduction at Loyola University
Medical Center. Annals of Health, 245-278. Nahirny, C. (2002). Trends in infant abduction. Journal of Healthcare
Protection Management, 18(2), 30-34. Porter, T. (2010). Cesarean kidnapping: Maternal Instinct, malingering and
murder. In A.Ruthven & G.Mádlo (Eds.), Illuminating the dark side (3-18). Oxford, United Kingdom: Interdisciplinary

Press. Vincent, J. L. (2009). Infant hospital abduction: Security measures to aid in prevention. Maternal-Child
Nursing, 34(3), 179-183.
Contact
[email protected]

Parents Reactions to Multi-Disciplinary Perinatal Palliative Care during Pregnancy
with a Lethal Fetal Diagnosis
Denise Cote-Arsenault, PhD, RN, USA
Purpose
to describe parents’ reactions to interactions with care providers from multi-disciplines during pregnancy
with a known lethal fetal diagnosis. This naturalistic, longitudinal study of 16 couples include helpful and
non-helpful interactions, and various forms of care coordination. Using quotes from both parents,
recommendations for perinatal palliative care will be presented.
Target Audience
care providers and researchers focused on care of parents experiencing pregnancy with poor prognosis
or perinatal loss. Those interested in longitudinal naturalistic research methods will also find this
informative.
Abstract
Purpose: Some parents learn through prenatal testing that their wished-for child has abnormalities that
are incompatible with life. Their fetal diagnoses launch them into appointments with sonographers,
obstetricians, genetic counselors, perinatologists, maternal-fetal medicine specialists, bereavement
nurses, perinatal palliative care programs, hospice, and neonatologists. The purpose of this presentation
is to describe parents’ reactions to interactions with care providers from multi-disciplines during such
pregnancies and to make recommendations of useful interaction styles to care providers.
Methods: Naturalistic, longitudinal. Inclusion criteria: currently pregnant mothers and their willing partners
who intend to continue their pregnancy, are 18 years of age or older, speak English and do not have a
multiple gestation. Recruitment was done through care providers who obtained permission to contact for
us. The goal was to have two interviews with both parents during pregnancy and two more after the
birth/death of the baby. The PI conducted all of the interviews either in-person, on the phone, or via video-
conference; all interviews were recorded, professionally transcribed, and transcripts were carefully
verified. Field notes were included in the transcripts, then entered into Atlas.ti for data management.
Analysis was an iterative process that began at the interview, then moved to transcript texts; done
independently and then with the research team. Memos were written, categories and themes were
identified; exemplar quotes were extracted.
Results: 16 mothers and 14 partners were interviewed; most were interviewed 3 times over 6 months.
Interviews lasted 1-2 hours. Parents were interviewed together and separately, to gain their unique views.
Parents found that compassionate, straight forward, and non-judgmental care providers were very helpful.
Unhelpful approaches included silence, withholding information, absent of hope, making assumptions, not
asking about personal preference, and only focusing on the baby’s abnormalities.
Interactions with care providers that were helpful led to parental understanding of their baby’s condition,
assisted them with birth planning, supported their grief, and facilitated their relationship with their baby,
and their personal growth. Unhelpful interactions caused emotional distress, anger, frustration, and
increased grief. Care coordination across disciplines was seen as very helpful, supportive, and caring.
Using quotes from both parents, recommendations for care providers and perinatal palliative care will be
presented.
Conclusion: Parents’ journey drastically changes course after learning their fetal diagnosis. Interactions
with multiple care providers can be stressful or helpful. Coordination of care could reduce the stress and
provide helpful support for parents. Given the painful situation parents are in, the best possible care
should be given that honors the baby and facilitates healthy grieving of the parents.
References

Côté-Arsenault, D., & Denney-Koelsch, E. (2011). “My baby is a person”: Parents’ experiences with life threatening
fetal diagnosis. Journal of Palliative Medicine 14 (12).doi: 0.1089/jpm.2011.0165* Denney-Koelsch, E.M., Lemcke-
Berno, E., & Côté-Arsenault, D. (in review). “That’s when it all begins:” Parents’ Perceptions of Interactions with
Sonographers in Lethal Fetal Diagnosis
Contact
[email protected]

Family Structure; Process of Family Life, Communication Patterns and
Prevalence of Smoking, Alcohol and Illicit Drug Use Among Primary Children
Yim Wah Mak, PhD, RN, RM, BSc, MSc, Hong Kong
Alice Yuen Loke, PhD, RN, Hong Kong
Purpose
This study examined the family structure; process of family life, communication patterns and patterns of
smoking, alcohol and illicit drug use among primary children in a deprived district in Hong Kong.
Target Audience
those who are interested in adolescent health, prevention of health risk behaviours such as smoking,
alcohol use or illicit drug use.
Abstract
Purpose: This study examined the family structure; process of family life, communication patterns and
patterns of smoking, alcohol and illicit drug use among primary children in a deprived district in Hong
Kong.
Methods: A two-stage random sample of primary five and six school children aged 10-12 years were
recruited from 5 schools in two deprived districts in Hong Kong. Children from the schools were
completed structured questionnaires in the classroom. Their family life (structure, parenting patterns and
process), communication patterns and practices of health risk behaviors (smoking, alcohol and illicit drug
use).
Results: The prevalence of experimentation with smoking, alcohol use and illicit drug use among primary
5 -6 children were 1.1%, 28% and 0.1% among the 796 children who have completed the questionnaire.
Most of the participated children were males (53.8%), living with fathers (85.3%), mothers (93.5%) or
siblings (66.8%). The study shows that near half of the fathers (47.3%) and the mothers (61%) were
perceived had communicated with their children about consequences of smoking, alcohol or drug
use. Children who perceived “authoritarian” or “neglecting” parents reported more experimentation with
smoking, alcohol or illicit drug use.
Conclusion: The results of the present study suggest that prevalence of smoking and illicit drug
experimentation is congruent between children from the deprived districts and the general Hong Kong
population. However, our data revealed a significant higher ever use of alcohol among children from the
two districts than the general population. Perceptions of young children on family life which are
importance for their experimentation with health risk behaviors.
Contact
[email protected]

M 06 - Health Promotion in an Aging Society
Longitudinal Comparison of ADL Function Between Green House Nursing Home
and Traditional Nursing Home Residents
Ju Young Yoon, PhD, RN, USA
Barbara Bowers, PhD, RN, FAAN, USA
Purpose
The purpose of this presentation is to share the study findings on the effects of a small-scale nursing
home model from the longitudinal health outcome trajectories.
Target Audience
The target audience of this presentation is researchers, practitioners and policy makers who are
interested in improving the quality of nursing home care.
Abstract
Purpose: In the past few decades, many traditional nursing homes have attempted to transform
themselves from hospital-like environments to be more homelike. This model change is generally referred
to as a nursing home culture change which includes comprehensive efforts to redesign nursing home
environments and transform care delivery to residents. Although care outcomes are significant and
ultimate evidence that shows the effects of the new models, research findings about the resident
outcomes are still limited and mixed. The purpose of this study is to investigate the effects of a small-
scale nursing home model from the longitudinal health outcome trajectories. This study used Green
House (GH) homes in the U.S as a representative small-scale nursing home model, and compared the
change patterns of activities of daily living (ADLs) over time in GH homes and traditional nursing homes.
There were two specific research questions in this study: (1) Does the facility type (whether GH homes or
traditional nursing homes) influence the change in ADL function over time? (2) Does the facility type
(whether GH homes or traditional nursing homes) predict different patterns of change in ADL function
over time?
Methods: This study is a retrospective longitudinal analysis using minimum dataset (MDS). The total
sample included 95 GH home residents and 146 traditional nursing home residents. The health outcome
was measured with ADL function indicating higher scores are more dependent (range: 0 – 40). Growth
curve modeling (GCM) was utilized to examine the effect of the facility type on the mean ADL function
trajectories between the two groups controlling for age, comorbidity score, cognitive function and
depressive symptoms. Growth mixture model (GMM) was employed to identify different patterns of
change in ADL function over time and examine the effect of facility type on predicting different patterns of
change in ADL over time. After deciding the latent classes (number = 2 in this study), the logistic
regression was applied to examine the effect of facility type to predict the class membership controlling
for age, comorbidity score, cognitive function and depressive symptoms.
Results: Major study findings are: (1) the ADL function of both groups were reported to become worse
over time (slope = 0.56, p=0.017), but no statistically significant differences of the overall pattern of
change in ADL function over time between the two groups controlling for age, comorbidity score, cognitive
function and depressive symptoms at baseline. (2) Two different patterns of change in ADL function were
identified using GMM including persistent independent group (n=41, intercept = 8.34 [p = 0.049], slope = -
0.78 [p = 0.199]) and persistent dependent group (n=200, intercept = 19.70 [p = 0.000], slope = 0.61 [p =
0.823]). Again, higher ADL scores were more dependent status. After controlling age, comorbidity score,
cognitive function and depressive symptoms at baseline, the facility type factor staying in the GH homes
did not predict the resident’s likelihood of being in the persistent independent group than being the
persistent dependent group at the statistical level (Odds ratio = 1.19, 95% Confidence interval = [0.58,
2.46]).
Conclusion: As a conclusion, the changes in ADL function over time were not different between the two
types of nursing home residents whether in GH homes or traditional nursing homes. The essential

elements of small-scale nursing homes include private rooms and bathrooms in a small-scale unit, and
encouraging independence for residents, so a physical environment that inspires self-care in private
areas is generally expected to improve ADL function in small-scale nursing homes. Furthermore, GH
nursing homes philosophically emphasize communal eating in the dining area like a family and self-care
in their private rooms and bath-rooms, which may encourage mobility or walking with or without
assistance compared to other types of nursing homes. However, while there are positive aspects to
private rooms, isolation has been identified as a potential problem in the GH nursing home model
because many residents who are not cognitively intact spend more of their time in their rooms. In
addition, the limited involvement in structured activities may lead nursing home residents to not have
many opportunities to improve or maintain physical or ADL functions in small-scale nursing homes. Thus,
further replication studies to examine the effectiveness of small-scale nursing home models using larger
number of sample size are necessary. In addition, as concrete strategies of care processes are important
to provide practical information to improve residents’ functional status, the kinds of care processes that
may influence the maintenance or improvement of ADL function of nursing home residents need to be
explored together in the future.
Contact
[email protected]

The GREAT Program: Promoting Physical, Psychological and Economic Health in
an Aging Population
Joseph DeRanieri, DM, MSN, RN, USA
Ingrid Pretzer-Aboff, PhD. MSN, RN, USA
Purpose
to demonstrate that therapeutic exercise is a cost effective method to significantly increase activity,
function and quality of life for people with Parkinson’s disease (PD) and stroke. And that this program has
the potential to improve function in other segments of the population.
Target Audience
nurses and other clinicians who work with patients with chronic diseases and stroke patients who are
seeking to learn a new cost effective community based model to improve and maintain function and
increase quality of life.
Abstract
Purpose: Lack of activity is a major risk factor for the aging population. This is particularly true for the 1.5
million individuals with Parkinson’s disease (PD) and 4.4 million stroke survivors whose daily function,
mobility and communication are often impaired leading to a sedentary and isolating lifestyle. Each year
the United States spends over $25 billion dollars treating PD patients and over $65 billion dollars a year
to treat stroke patients. There is growing evidence that therapeutic exercise is an effective method to
significantly increase physical activity, function and quality of life for people with stroke and PD and to
also decrease the overall utilization of health care services. However, the availability of appropriate
community programs is rare. Our aim was to test the feasibility and impact of a unique tri-therapeutic
program that physical, occupational, with speech language therapy techniques. And to also track resulting
health care utilization. This program fills a gap that exists in the rehabilitation spectrum between
traditional therapy and community gyms in an effort to improve function and activity levels.
Methods: This study utilized a single group repeated measures design; one group for PD patients and
one group for stroke patients. Testing was completed at baseline, 3, and 6 months post start of group
exercise. Fifteen volunteers with PD and 12 volunteers with stroke were enrolled into a one hour (2x per
week) group session run by physical or occupational therapy assistants under the supervision of licensed
therapists. This 12 week program incorporated vocalizations, breathing exercises, memory and
recognition, fine and gross motor mobility exercises for extremities and trunk, balance activities and
progressive distance walking techniques. We also tracked patients for one year following the 12 week
intervention, to assess hospital admissions and overall utilization of health care services.
Results: Our preliminary results show a significant increase in balance, speech volume, quality of
communication, walking speeds, and improved cognition. Significant improvements were seen in walking
speed (6 meter walk test), voice loudness, quality of life (PDQ-39, communication), cognition (MOCA),
and disability (UPDRS, total). Additionally, subjects reported improved clarity of voice. Post intervention
interview indicated that socialization was exceedingly important to the group’s adherence. Results of our
preliminary study indicate the potential for reduced admissions to acute care, rehabilitation and nursing
facilities as well as reduced utilization of other health care services.
Conclusion: People with PD and stroke benefit from this tri-therapeutic program. The PT, OT and
speech components were easy to integrate during all exercise classes and demonstrated significant
clinical benefits. The researchers were also able to demonstrate a decrease in hospital admissions and a
decrease in utilization of health care services.
Contact
[email protected]

Health-Related Quality of Life and Its Relationships with Poor Exercise Capacity
and Dyspnea in Thais with COPD
Naiyana Noonil, PhD, RN, Thailand
Purpose
This study aims to explore the health-related quality of life (HRQL) and its relationship with exercise
capacity and dyspnea of the southern Thai patients with stable COPD.
Target Audience
staff nurse and student
Abstract
Purpose: This study aims to explore the health-related quality of life (HRQL) and its relationship with
exercise capacity and dyspnea of the southern Thai patients with stable COPD.
Methods: The methodology was the cross-sectional descriptive study. The sample consists of 126
patients with COPD attending the outpatient pulmonary clinic of Thasala hospital. The patients were
assessed the HRQL by the Saint George's Respiratory Questionnaire (SGRQ), age, BMI, dyspnea by the
Modified Medical Research Council (MMRC), exercise capacity by the 6-min walk distance (6MWD), and
hospital utilization.
Results: The results found that most patients were male 84%; they had a mean(SD) of age 69.6(9.5)
years, FEV1 70.0(9.6) % predicted, and BMI 21.9(4.4). The HRQL indicated moderate impairment:
symptom 47.0(22.2), activity 49.7(30.3), impact 41.9(21.2) and total scores 45.1(21.7). The regression
analysis shows that HRQL were the most affected by 6MWD and dyspnea, hospitalization, age
respectively (β = -.429, .295, .172, and -.152; R2 = .443, p < .001). Also, patients with poor exercise
capacity (6MWD <350m) and dyspnea scored significantly higher (greater impairment) on all dimensions
of SGRQ.
Conclusion: Stable COPD patients should be motivated to exercise for promoting exercise capacity
(6MWD) and also HRQL.
Contact
[email protected]

M 07 - Global Health Practices in the Psychiatric Population
Qualitative Assessment of Answer Letters of Patients with Chronic Fatigue and a
Psychiatric Disorder
P. Vermeir, RN, MPM, MBA, MPA, Belgium
S. Degroote, MS, Belgium
D. Vogelaers, MD, Belgium
E. Tobback, PhD, Belgium
L. Delesie, RN, Belgium
D. Vandijck, PhD, Belgium
Purpose
The purpose of this presentation is to stress the importance of an efficient communication between health
care providers.
Target Audience
The target audience of this presentation is people interested in quality and safety, communication and
improvement initiatives by nurses.
Abstract
Purpose: Care delivery is a complex process, involving many different actors (physicians, nurses,…).
Appropriate communication between those actors is of key to guarantee qualitative and thus safe care.
Referral letters are one of the most important means of communication between care providers. The aim
of this study was to perform a qualitative assessment of the content of referral letters (second to first level
providers) of patients with chronic fatigue and a psychiatric disorder.
Methods: The study was conducted by the head nurse of the department of General Internal Medicine of
Ghent University Hospital. Based on a comprehensive search of the literature, a checklist of respectively
24 quality indicators was developed assessing the content and way of interdisciplinary communication
between -second and first level providers. Indicators were considered as dichotomous variables
(present/absent). All referral letters (June 2010–February 2011) of 126 patients with chronic fatigue and a
psychiatric disorder were considered.
Results: The study cohort consisted of 108 (85.7%) females, mean age was 39.3±11.1 years. Of the 24-
item checklist, on average 18.7±2.1 of the indicators were present. Telephone number of the referring
physician was never included 0% (0/126), reason of initial referral was not mentioned in 96%(121/126) of
the letters. Information about allergic status was missing in 42.9%(54/126), current medication in
17.5%(22/126), surgical and medical history in 34.1%(43/126) and 9.5%(12/126) of the cases.
Psychosocial information was not included in 22.2%(28/126) and 63.5%(80/126) of the letters did not
mention the dates investigations were performed. Average time-delay between consultation with
secondary care provider and sending the referral letter was 44.2±47.7 days .
Conclusion: In this patient sample, referral letters from secondary to primary care level providers often
lack crucial information that is of key to ensure high quality of patient care. Targeted interventions aimed
at improving communication inefficiencies between multidisciplinary care levels are warranted.
Contact
[email protected]

M 07 - Global Health Practices in the Psychiatric Population
Caregiver Satisfaction and Its Correlates Among Taiwanese Families Living with
Schizophrenia
Chiu-Yueh Hsiao, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to provide healthcare providers with an understanding of positive
caregiver satisfaction and its correlates in the care of relatives with schizophrenia. Finding from this study
would contribute to the development of family-centered care for meeting individual and family needs.
Target Audience
The target audience of this presentation is healthcare providers who work with the affected families living
with mental illness
Abstract
Purpose: The aim of this study was to investigate the degree of caregiver satisfaction and its
determinants in Taiwanese families of individuals with schizophrenia.
Methods: A cross-sectional, descriptive correlation design was used. Data were collected using
questionnaires with a convenience sample of 140 families (243 individual family caregivers) of individuals
with schizophrenia. Descriptive statistics and a mixed linear modeling were used for data analysis.
Participants were individually interviewed to complete questionnaires regarding demographic information,
pile-up of demands, sense of coherence, mutuality, and caregiver satisfaction.
Results: The primary source of caregiver satisfaction was the cared-for person, especially keeping the
individual clean, comfortable, and well turned out. In interpersonal dynamics, family caregivers mostly
rooted their source of satisfaction in their way of expressing love to the cared-for person. As for
satisfaction relating to the family caregiver, the majority of the family caregivers expressed being satisfied
with fulfilling sense of duty. Female caregivers, greater sense of coherence, and increased mutuality were
found to significantly increase caregiver satisfaction.
Conclusions: Family caregivers living with schizophrenia may have positive experiences. Supportive
interventions need to focus on tapping into amplifying resiliency factors (e.g., sense of coherence and
mutuality) and promoting the sense of satisfaction with caregiving for assisting family caregivers.
References
Baronet, A. M. (2003). The impact of family relations on caregivers’ positive and negative appraisal of their caretaking
actives. Family Relations, 52(2), 137-142. Folkman, S., & Moskowitz, J. T. (2000). Positive affect and the other side
of coping. The American Psychologist, 55(6), 647-654. Kuuppelomäki, M., Sasaki, A., Yamada, K., Asakawa, N., &
Shimanouchi, S. (2004). Family carers for older relatives: Sources of satisfaction and related factors in Finland.
Internaitonal Journal of Nursing Studies, 41(5), 497-505. McCubbin, H. I., Thompson, A. I., & McCubbin, M. A.
(1996). Family assessment: Resiliency, coping and adaptation-Inventories for research and practice. Madison, WI:
University of Wisconsin System. Nolan, M., Grant, G., & Keady, J. (1996). Understanding family care. A
multidimensional model of caring and coping. Buckingham & Philadelphia: Open University Press.
Contact
[email protected]

M 10 - Researching Issues Early in Patient's Life
Obtaining Required Childhood Vaccinations: The Latino Immigrant Experience
Barbara deRose, PhD, MSN, NP-C, USA
Purpose
The purpose of this presentation is to present findings of the Latino immigrant experience in obtaining
required childhood vaccinations for their children. Issues in obtain vaccinations will be discussed from the
immigrant perspective. The audience may wish to compare these findings to the immigrant vaccination
experience in their respective countries.
Target Audience
The target audience of this presentation: persons involved in global health, public health, refugee or
immigrant health, and those persons who are instrumental in vaccination practice reform and/or health
disparities research. The presentation may be of interest to persons working on the World Health
Organization vaccination project.
Abstract
Vaccinations are an important step in preventing childhood illnesses and disease outbreaks in the
community. Complete immunizations before school assure eligibility for enrollment and protect children
against severe illness. The fact that foreign-born children of Latino immigrants face health disparities in
receiving vaccinations is well documented. However, there is little information in the literature about the
actual experience of immigrants facing the complexities of the health system, and through their eyes,
which factors ultimately affect vaccination rates of immigrant Latino children.
Purpose: The purpose of this study was to give voice to Latino immigrant families who recently
immigrated to the United States, in terms of the issues they encountered when engaging the health care
system for vaccinations.
Methods: A convenience sample consisting of eleven Latino immigrant parents was obtained from
information-rich participants of the immigrant Latino population, identified through clinics and churches.
Each participant experienced seeking immunizations for their foreign born children during their first five
years residing in the United States. Interpretative phenomenology guided the framing of the broad
interview questions, probes, and data collection methods. Heideggerian hermeneutics guided the
interpretation of the Latino parents’ world with regard to seeking immunizations for their children from the
picture they provided. By sharing their experiences, the immigrant parents provided a glimpse of their
world with regard to childhood immunizations and the effects of individual, community and policy factors.
Results: The importance of trust in patient-provider relationships was the overarching finding of this
study. Trust also emerged as a major factor in vaccinations practices i.e., causing revaccinations in
situations where the medical provider mistrusted foreign documentation. Subthemes that emerged under
the umbrella of trust were health literacy, health disparities, finding a medical home, and preserving the
family unit. The subthemes provided a framework to examine the immigrant journey from arrival to the
United States, settling into a community, and projection into the family’s future.
Conclusion: Implications for nursing practice stemming from these findings are the further exploration of
vaccination practices, improvements in health provider cultural competency, and nursing advocacy in the
arena of health policy. The broader goal of this study is to inform providers who review the study, and to
improve outcomes for this vulnerable population.
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Contact
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Safe Sleep Advice to Safe Sleep Action: Pilot of the Pepi-Pod Program in
Indigenous Communities
Jeanine Young, PhD, BSc (Hons), RN, Australia
Leanne Craigie, BSc, GradDipEduc, GradDipIndgHlthPromo, Australia
Lauren Kearney, PhD, IBCLC, GradDipClinNsg (ChAdolHlth), BSN, Australia
Karen L Watson, RN, GradDipCritCr, MS, Australia
Stephanie Cowan, MEd, BSc, Dip (Tch), New Zealand
Purpose
The purpose of this presentation is to describe an innovative strategy that reduces Indigenous infant
mortality by combining practical real-time support with a health promotion intervention that uses
community networks used by vulnerable families, values cultural and individual family parenting practices,
while promoting safety and wellbeing of vulnerable infants.
Target Audience
The target audience of this presentation includes all nurses, midwives and Indigenous health workers
who care for families with young infants, and have a role in parent education about safe infant care
practices and health promotion strategies.
Abstract
Purpose: Background:Sharing sleep spaces with babies is a common infant care practice in Australia [1],
and the cultural norm in many Indigenous communities [2]. While forms of co-sleeping may reduce risk of
sudden unexpected death in infancy (SUDI) and enhance breastfeeding in some cultural groups, some
shared sleep environments are extremely hazardous for infants [3]. Aboriginal and Torres Strait Islander
babies currently die suddenly and unexpectedly at a rate almost four times higher than non-Aboriginal
and Torres Strait Islander infants (252.1 deaths per 100,000 compared with 66.4 deaths per 100,000
respectively). A considerable proportion of infant deaths are associated with co-sleeping environments
[3]. Innovative strategies which allow for the benefits of bed-sharing, respect cultural norms and infant
care practices, whilst also enabling the infant to sleep in a safe environment are necessary if a reduction
in SUDI is to be achieved amongst Aboriginal and Torres Strait Islander communities.
The Pēpi-pod Program is a safe sleep space combined within a targeted safe sleeping health promotion
initiative for families with known risk factors for SUDI. Cowan and colleagues, who implemented the Pēpi-
pod Program in New Zealand amongst a sample of Maori families displaced during the Christchurch
earthquakes (n=642) have reported positive interim findings [4]. Feedback from participants (n=100)
identified that the Pēpi-pod Program was beneficial for: having baby close; peace of mind; safe bed-
sharing; portability and infant settling. The program in New Zealand has been expanded to include 4000
vulnerable families throughout selected health boards across the country. Acceptability or effectiveness of
portable sleep spaces for co-sleeping Indigenous families have not been previously reported but is an
area Indigenous families have identified as being important for investigation [5].
Aim:The purpose of this study was to determine the acceptability of the Pēpi-pod Program, a portable
infant sleep space embedded within safe sleep health promotion, within a sample of Aboriginal and
Torres Strait Islander families in Queensland, Australia.
Methods: Design:An exploratory descriptive design was used to report parent experiences of using the
Pēpi-pod Program to support safe infant sleep practices.
Population, Sample and Participant Selection: Families were purposively selected through four health
services in Queensland which provide antenatal and maternity care services to Aboriginal and Torres
Strait Islander families. These services include metropolitan, rural and remote areas of Queensland:
1) Ngarrama Antenatal and Birthing Project
2) Townsville-Mackay Medicare Local – New Directions: Bubba’s Business
3) Woorabinda Multi-Purpose Health Service

4) Logan Aboriginal and Torres Strait Islander Community Health Service (ATSICHS) Mums and
Bubs Clinic
Eligible participants were parent/s and/or carers of a baby (ideally <1 month of age) with the presence of
one or more known SUDI risk factors [3] including:
• identification as Aboriginal and/or Torres Strait Islander (at least one parent)
• maternal smoking, during pregnancy and/or post-natal
• intention to bed-share (regularly/irregularly)
• recent drug use, including prescribed medications that may affect consciousness
• alcohol use
• pre-term birth (≤36 weeks)
• low-birth weight (<2500 grams).
Eligible families were identified by their health care worker through usual health assessments and
referred to the Pēpi-pod Program facilitator, with family permission. Eligible families were provided with an
information sheet and if willing to participate in the study, consent form to complete. Ideally families were
identified prior to their baby’s birth, however were recruited up to an infant age of 8 weeks or 2 weeks
post discharge from hospital if born prematurely.
Intervention: The Pēpi-pod program
The Pēpi-pod Program was delivered as three interlinked components:

1) Safe Space: was a general purpose polypropylene box transformed into an infant bed through
addition of a culturally suitable fabric cover, an upholstery-density, fabric covered, tight fitting
mattress; and bedding: mattress protector, base slip-on sheet, wrap around sheet, light blanket.
The Pēpi-pod provides a zone of physical protection around baby wherever they sleep where
suffocation risk is heightened, e.g. on adult beds, couches or makeshift beds.
2) Safe Care: parent education includes a ‘Rules of Protection’ [1] safety briefing and practical safe
infant sleeping information for families to adapt for their family situation. Safe Space + Safe Care
= Protection. Rules of Protection Messages included a poem for parents to facilitate recall of the
messages: On the back, face clear; Only baby in here; Every sleep, everywhere; Always
breathing, smoke free air; Drugs and drinking nowhere near; Own space, best care.
3) Role of family: families were asked to make a commitment to spread what they had learned about
protecting babies as they sleep. Giving families a role as well as the Pēpi-pod Sleep Space is
intended to empower, entrust and extend the influence of the program within priority networks
[5,6].
Data Collection: Data collection included acceptability and use of the Pēpi-pod Sleep Space. Parent
questionnaires were administered face to face or by telephone [6] within 2 weeks of receiving the Pēpi-
pod; then monthly thereafter until pod use ceased at approximately 4-6 months dependent upon baby’s
growth and development. Questions included:
• Knowledge of SUDI risk factors and strategies to enhance safety
• Circumstances of pod utilisation
• Usual baby care ‘yesterday’ and ‘last night’
• Infant care enhanced by pod use
• Limitations/adverse events associated with pod
Results: The target of five eligible families (infant age 8 days to 9 weeks) were recruited and followed up
each month to pilot study methods and documentation. Demographic characteristics included; 3 of the 5
families were partnered; all were of Aboriginal background apart from one mother who identified as Maori
whose partner was Aboriginal; all families had the intention or need to bed share and the presence of two
or more risk factors for SUDI. Four of the five families identified that they had utilised the Pēpi-pod as an
infant sleep space. The acceptability of the Pēpi-pod as a safe sleep space for babies was supported by
parent responses that related to three key themes: safety, convenience and portability.

Examples of parent reports related to these themes are provided by the following quotes under these
three headings.
• Safety
o “Can have it (the Pēpi-pod with baby) in the bed and not worry” (mother of baby 8 week 3
days)
• Convenience
o “Easy to pack away”
o “Baby can be in Pēpi-pod on the couch until falls asleep; I find this convenient – don’t
have to disturb him”; “..don’t have to touch him”; .father can carry him into bedroom
without waking him.”
o “Baby can be in Pēpi-pod while Mother cleaning in the lounge or “doing stuff” – “don’t
always have a bouncer” (Mother of baby 8 weeks)
• Portability
o “Can take to (baby’s mother’s) mother’s house”
o “Especially good when they go out to friends BBQ (for example) – they live out of town a
bit.” (Mother of baby 8 weeks, 6 days)
One mother indicated that knowing about the Pēpi-pod as soon as possible would have been useful:
“Like it, would have been good to know about it sooner than I did. Good to have known about it earlier to
have straight out of hospital” (Mother of baby 8 weeks)
Conclusion:
The Pēpi-pod program was accepted as a portable sleep space for infants and used appropriately by
parents living in several communities in Queensland. Responses relating to use, acceptability,
convenience and safety of the infant sleep space were positive. Pilot results from this study have
informed the design of a larger trial (n=300) of the Pēpi-pod Program within six communities across
Queensland being conducted during 2013-2014.
Implications for practice: Health services have a responsibility to follow through from simply informing
about safe infant sleep practice to enabling safe infant sleep action. Evaluating innovative and culturally
respectful strategies to reduce SUDI risk will better inform the evidence-base used by educators,
clinicians, researchers and policy makers in supporting parents to use safe infant sleeping strategies.
References
References 1.Young J., & Thompson, J. (2009). Recommendations for real life: the nature of shared sleep
environments in Queensland and implication for effective safe infant sleeping messages. Forensic Science, Medicine
and Pathology, 5(2): 115. 2.Young J, Watson K, Ellis L, & Raven L. (2012). Responding to the evidence: Breastfeed
baby if you can - the sixth public health recommendation to reduce the risk of sudden and unexpected death in
infancy. Breastfeeding Review, 20(1): 7-15. 3.Commission for Children and Young People and Child Guardian
Queensland. (2012). Annual Report: Deaths of children and young people Queensland 2011-2012. Brisbane:
Queensland Government. 4.Cowan S, Bennett S, Clarke J, & Pease A. (2013) An evaluation of portable sleeping
spaces for babies following the Christchurch earthquake of February 2011. Journal of Paediatrics and Child Health,
49(5): 364-8. doi: 10.1111/jpc.12196. Epub 2013 Apr 11. 5.Dodd, J. (2012). Evaulation of the Department of Health
Western Austrlian Operational Directive Satewide Co-sleeping / Bed-sharing Policy for WA Health Hospitals and
Health Services. Collaboration for Applied Research and Evaluation. Telethon Institute for Child Health Research
under contract with the Department of Health, WA. 6.Cowan S, Bennett S, Clarke J. (2012). Pēpi-Pod Tool Kit.
Change for Our Children Limited, Christchurch, New Zealand. [ISBN 978-1-877512-07-0].
Contact
[email protected]

Mindfulness Intervention for Perinatal Grief: A Pilot and Feasibility Study in Rural
India
Lisa R. Roberts, DrPH, MSN, FNP, RN, USA
Susanne Montgomery, PhD, MPH, USA
Purpose
The purpose of this presentation is to raise awareness of the effects of perinatal grief among poor, rural
women in Central India and inform attendees of the mixed-methods research process undertaken to pilot
test an intervention. Feasibility, cultural adaptation, and results will be discussed.
Target Audience
The target audience of this presentation is nursing professionals and those interested in international
research.
Abstract
Purpose: India is among the ten countries that contribute 67% of all stillbirths globally. The 2009 national
stillbirth rate of India was estimated at 15-24.9/1000 births. However, there are great variances in
stillbirth rates within the country, with rates of 66/1000 births or higher in Central India. A small rural
hospital in Central India even reported a stillbirth rate of 330 in 2006. At this hospital in 2010 and 2011
the stillbirth rate was 103 and 118, respectively. While still high, this sharp decrease occurred with the
use of cardiotocograph and increases in staff available for emergency Cesarean sections. (Unfortunately,
mothers typically present for delivery after failing to give birth at home.)
After experiencing stillbirth, these women suffer significant perinatal grief. Factors that contribute to
perinatal grief include traditional social norms, and perceived lack of social support. An understanding of
women’s perceptions and social norms for women in this context guided the development of a culturally
rooted intervention designed to positively impact their ability to cope, utilizing mindfulness modalities.
Mindfulness based stress reduction (MBSR) is an empirically supported 8-week intervention effective in
helping individuals cope with clinical and non-clinical problems. There are five facets of mindfulness:
observing, describing, acting with awareness, non-judging of inner experience, and non-reacting to inner
experience. Mindfulness has been defined as a state of moment-to-moment awareness without judging
one’s experience. A state which can be cultivated with practice. The purpose of this pilot study was to
explore the feasibility and fit of a mindfulness-based intervention for perinatal grief, among poor, rural
women in Central, India.
Methods: Data were collected in two phases. Phase one (N = 16) involved qualitative data collection to
explore concept acceptability, receptivity, and modality. Phase two involved the actual implementation of
a subsequently developed mindfulness-based intervention and was delivered to women in a village
referred by snowball technique from a phase one participant. It consisted of a brief version of the 8-week
intervention delivered to 22 participants over two lengthy sessions, one week apart, with daily practice
between sessions. (None of the participants in phase one participated in phase two.) Pretest included a
validated perinatal grief scale, Cronbach’s alpha for this sample = 0.95 (n = 13). Pre and posttest included
validated scales for mindfulness, satisfaction with life, social support, religiosity, depression, and anxiety;
Cronbach’s alpha ranged from 0.68 to 0.84 (n = 6). Program evaluation consisted of twelve Likert-type
items and three open-ended questions.
Results: Phase one: Key informant interviews (n = 10) were conducted with a doctor, a staff nurse and
women of reproductive age that had experienced stillbirth (< 1 year to 17 years prior). A focus group (n =
6) was conducted with women of reproductive age who had a stillbirth history (< 1 year to 8 years since
event). Data indicated concept acceptance and acknowledged need for an intervention. High receptivity
for the proposed intervention was indicated by enthusiastic response and requests for immediate
intervention delivery. Intervention modality was carefully explored and helpful suggestions for cultural
adaptation received for didactic materials. Phase two: Participants in the first session (n = 13) had

experienced stillbirth within the last one to seven years; with an average of 19.31 months (SD 21.34)
since the event, and had high levels of perinatal grief; mean perinatal grief index score 106.39 (SD 22.68)
where ≥ 91 indicates a high degree of grief. Nine women who had experienced stillbirth attended the
second session, however, only six of these women had attended the first session and were eligible to
complete the posttest. Statistically significant changes were noted on paired t-tests (n = 6) for Overall
Religious Coping (p = .025) and Describing (p = .024). All participants indicated daily practice of
mindfulness skills. Pilot evaluation results indicate strong modality fit, women’s appreciation of what they
had learned and their intent to attend 8-weekly sessions if given the opportunity to participate in the full
intervention. However, we also learned that women lacked the ability to follow through on their desire to
attend, due to intervening life events and family expectations.
Conclusion: Perinatal grief, particularly prolonged perinatal grief such as noted in this sample, puts
women at risk for mental health issues, somatic symptoms, and decreased function. This prolonged grief
places these Indian women at further risk for domestic violence and displacement from her family or
community, and other social issues, particularly if she has failed to produce a child, preferably a son.
Stigmatization of mental health and reproductive issues plus a strong cultural belief in the inter-
relatedness of mind, body, and spirit, in addition to a lack of mental health resources points to
mindfulness as a possible solution. This mindfulness-based intervention utilizing yoga and meditation was
well suited and well received among these women suffering with perinatal grief. However, delivery of the
intervention proved problematic. It is not feasible for these women to attend weekly sessions, even when
provided in the village, within walking distance. Their time is structured by familial duties; work dictated
by environmental variations, such as harvesting; and community events, such as weddings and
festivals. Additionally, the women lack autonomy, therefore, to attend a session was considered only
after all other obligations and family concerns had been satisfied.
Although the sample size in this pilot limits interpretation of the quantitative findings, the preliminary
reliability and relationship tests suggest that the tools will adequately measure and show significance in a
larger study. Additionally, mindfulness is a culturally acceptable intervention. However, while results are
promising, a full MBSR intervention is not feasible. Though the women are enthusiastic about the
intervention, note that they need it, and want it, given the realities of their lives the rigorous schedule of
MBSR will be impossible to deliver. Given our results we have continued wrestling with how to deliver the
intervention to women in this rural Indian context, and have come upon a one-day intensive mindfulness
intervention that may be adaptable yet effective. Additionally, we intend to provide childcare and run a
concurrent mother-in-laws group to better accommodate the limited autonomy and resources of these
women. Also, moving to this intensive one day format we feel it is critical to conduct individual follow-up
sessions with participants and plan to accomplish this by partnering with local staff nurses and nursing
students doing their community health rotations. The follow-up sessions will be used to reiterate
mindfulness concepts, monitor progress, promote continued practice of mindfulness skills, and receive
feedback. This partnership will be instrumental to the success of implementing and sustaining the
intervention in the future.
References
Bennett, S. M., Litz, Brett T., Lee, Barbara Sarnoff, & Maguen, Shira. (2005). The Scope and Impact of Perinatal
Loss: Current Status and Future Directions. Professional Psychology: Research and Practice, 36(2), 180-187.
Cousens, S., Blencowe, H., Stanton, C., Chou, D., Ahmed, S., Steinhardt, L., . . . Gupta, S. (2011). National, regional,
and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. The Lancet,
377(9774), 1319-1330. Davis, D., & Hayes, J.A. (2011). What are the benefits of mindfulness? A practice review of
psychotherapy-related research. Psychotherapy, 48(2), 198-208. Grossman, P., Niemann, L., Schmidt, S., & Walach,
H. (2004). Mindfulness-based stress reduction and health benefits:: A meta-analysis. Journal of psychosomatic
research, 57(1), 35-43. Gupta, Vidya Bhushan. (2010). Impact of Culture on Healthcare Seeking Behavior of Asian
Indians. Journal of Cultural Diversity, 17(1), 13-19. Horowitz, MJ, Siegel, B, Holen, A, Bonanno, GA, Milbrath, C, &
Stinson, CH. (2003). Diagnostic criteria for complicated grief disorder. Focus, 1(3), 290-298. Joshi, Archana,
Dhapola, Mrinalika, & Pelto, Pertti J. (2008). Gynaecological Problems: Perceptions and Treatment-seeking
Behaviors of Rural Gujarati Women. In M. Koenig, S. Jejeebhoy, J. Cleland & B. Ganatra (Eds.), Reproductive Health
in India: New Evidence (pp. 133-158). New Delhi: Rawat Publications. Lawn, Joy E., Blencowe, Hannah, Pattinson,
Robert, Cousens, Simon, Kumar, Rajesh, Ibiebele, Ibinabo, . . . Stanton, Cynthia. (2011). Stillbirths: Where? When?
Why? How to make the data count? Lancet, 377(9775), 1448-1463. Roberts, Lisa R., Anderson, Barbara A., Lee,
Jerry W., & Montgomery, Susanne. (2012). Grief and Women: Stillbirth in the Social Context of India. International

Journal of Childbirth, 2(3),187-198. Roberts, Lisa R., & Lee, Jerry W. (2013). Autonomy and Social Norms in a 3
Factor Grief Model Predicting Perinatal Grief in India. Health Care for Women International. Roberts, Lisa R.,
Montgomery, Susanne, Lee, Jerry W., & Anderson, Barbara A. (2012). Social and Cultural Factors Associated with
Perinatal Grief in Chhattisgarh, India. Journal of Community Health, 37(3), 572-582. World Health Organization.
(2011). 2.6 Million Stillbirths in 2009 (D. o. R. H. a. Research, Trans.) Policy Brief (pp. 4): WHO.
Contact
[email protected]

M 12 - Using Research to Promote Outcomes
Barriers and Facilitators to Utilizing Nursing Research
Jessie M. Colin, PhD, RN, FRE, FAAN, USA
Purpose
The purpose of this presentation is: 1) explore nurses perceptions of barriers of research utilization; 2)
explore nurses perceptions of the facilitators of research utilization; and 3) determine if there is a
significant difference among the nurses perceptions of barriers and facilitators in utilizing nursing research
within a multi-hospital system
Target Audience
The target audience of this presentation are nurses in clinical practice, nurse managers, nurse leaders,
nurse educators and researchers.
Abstract
Purpose: Nursing research has been shown to improve patient outcomes and decrease length
of hospital stays. The purpose of this research is to: 1) explore nurses perceptions of the barriers of
research utilization; 2) explore nurses perceptions of the facilitators of research utilization; and 3)
determine if there is a significant difference among the nurses perceptions of barriers and facilitators in
utilizing nursing research within a multi-hospital system.
Methods: This research project is a non-experimental descriptive study, involving a multi-hospital system
(5) in a South Florida. Upon approval from the International Review Board (IRB) at Barry University and
the healthcare system, a convenience sample of 150 nurses complete the Barrier Survey. A researcher
designed demographic questionnaire was used to collect data to describe the population.
Results: The data was analyzed using construct validity of the instrument using an exploratory factor
analysis. Internal consistency and reliability of the instrument was assessed using cronbach’s alpha
coefficient. Multiple linear regression analyses depending on the level of measurement of the outcome
variables was be used to compare differences between the nurses at the sites. A t-test was to calculate
the four sub-scales of the Barrier Scale. The demographic characteristics of the sample was analyzed
using frequencies, percentages and measures of central tendencies and measures of variabilities based
on level of measurement.
Conclusion: Transferring research findings into practice is crucial for the development of nursing and for
improving patient outcomes and decrease length of stay. This study will identify barriers and facilitators to
practicing nurses utilizing research in the clinical arena. This research may ultimately enable healthcare
organizations in identifying strategies to support the utilization of nursing research and thereby decrease
the barriers perceived by the staff nurses.
References
Funk, D., G., Champagne, M., T., Wiese, R., Tornquist, E.(1991). Barriers Scale. Applied Nursing Research. 4(1):39-
45 Kajermo1,K., N., Boström, A., Thompson4, Hutchinson A. M.,5, Carole A Estabrooks, C. A., Wallini. L. (2010). The
BARRIERS scale -- the barriers to research utilization scale: A systematic review. Implementation Science, 5:32
doi:10.1186/1748-5908-5-32 Dunne, M. (2011). Barriers and Facilitators to Research Use Among Allied Health
Practitioners: A Mixed-Method Approach to Assessment.Evidence Based Library and Information Practice 6, 4 41-56
Contact
[email protected]

The Red Box Strategy for Contact Precautions
Melissa A. Pollard, DNP, RN-BC, ARNP, USA
Kathleen Wickens, BSN, RN, CCRN, USA
Purpose
Disseminate the results of research completed including findings on the effects of using the Red Box
Strategy on healthcare giver compliance with personal protective equipment and potential cost savings.
Target Audience
Nurses in direct patient care, those working in leadership and infection prevention, and those with an
interest in bedside nursing research.
Abstract
Purpose: This work originated in a small community hospital who committed to achieving Magnet
designation. As part of this commitment, an identified need was to develop a means to promote and
support nursing research in our organization which did not have any university affiliations. Our Magnet
Journey was successful, and this presentation reflects work done by one of our first direct care staff
nurses with the support of the nursing research committee.
Contact precaution policy requires healthcare personnel to always put on Personal Protective Equipment
(PPE) before entering a contact precaution room. Although instituted to prevent hospital-acquired
infections (HCAIs), this process takes a significant amount of time, causing delays that produce patient
anxiety, frustration and dissatisfaction with care. Research shows that health care workers spend less
time with patients in isolation. Contact precautions decrease the quality and frequency of interactions
provided by staff to patients and decrease compliance with precaution policies. There is significant cost
associated with the use of PPE. Previous research has shown that contact precautions can be modified
to promote interaction between patients and care givers without increasing the risk of spreading HCAIs. A
previous study conducted by Trinity Regional Medical Center, a Magnet Hospital in Illinois, showed that a
“Safe Zone” created at the contact precaution room doorway allowed staff to safely enter a short distance
into the room without putting on PPE for the purpose of interacting with the patient. The objectives
included to evaluate the effects of “The Red Box Strategy” for contact precautions on patient and
healthcare giver satisfaction with the contact precaution process, healthcare giver compliance with
personal protective equipment (PPE), and potential cost savings of personal protective equipment.
Methods: Likert Survey was performed for patient and healthcare giver satisfaction of contact
precautions before and after instituting “The Red Box Strategy”. A Mann-Whitney test for independent
samples was performed to examine the relationship between satisfaction of the contact precaution
process before and after instituting “The Red Box Strategy”. Data collection was performed on personal
protective equipment compliance of 4 different caregiver types on hand hygiene, gowns, and gloves
before and after instituting “The Red Box Strategy”. A Chi-Square test was performed to examine the
relationship between compliance with the contact precautions process before and after implementing
“The Red Box Strategy”. The frequency of the use of “The Red Box Strategy” by caregivers was
measured and the potential cost savings of gowns was estimated.
Results: A statistically significant relationship was found between pre and post implementation survey
responses. Patient and healthcare giver satisfaction increased for contact precautions after “ The Red
Box Strategy was implemented. A statistically significant relationship was found for all aspects of PPE
measured for compliance when “The Red Box Strategy” was used for contact precautions by RN’s,
LNA’s, and RT’s. A statistically significant relationship was found for hand hygiene compliance upon
entering a room for MD’s but not for hand hygiene out, gown on and tied and gloves worn for MD type.
For all healthcare giver types hand hygiene compliance for entering a room increased 32%, hand hygiene
compliance when exiting a room increased 11%, gowns on and tied increased 16%, and gloves worn
increased 4%. Data collected for evaluating “The Red Box Strategy” affect on potential cost savings was
insufficient to analyze, so further analysis of the data is being undertaken.

Conclusion: Using “The Red Box Strategy” increased patient and caregiver satisfaction with the contact
precaution process. The strategy increases compliance for many aspects of PPE for most caregiver
types. The exceptions to this were no relationship was found between the strategy and MD compliance
with hand hygiene upon room exit, gown and gloves worn. “The Red Box Strategy” staying power
demonstrated consistency with the trial’s findings, with compliance rates holding at 6 months post
implementation.
References
1. Franck JN, Behan AZ, Herath PS, Mueller AC, Marhoefer KA. The Red Box Strategy: An Innovative Method to
Improve Isolation Precaution Compliance and Reduce Costs. Am J Inf Cont 2011; June: E208. 2. Centers for Disease
Control and Prevention. NHSN. Overview of the Patient Safety Component, Device-associated module (CLABSI,
VAP, CAUTI). http://www.cdc.gov/nhsn/wcOverviewNHSN.html. 2010. 3. Abad C, Fearday A, Safdar N. Adverse
Effects of Isolation in Hospitalized Patents: A Systematic Review. J Hosp Inf 2010; 76: 97-102. 4. Zastro RL. The
Contact Precautions Controversy: Automatic Assignment of Contact Precautions May Do More Harm Than Good. Am
J Nursing Mar 2011 Vol 111, No 3 47-53. 5. Kirkland KB, Weinstein JM. Adverse Effects of Contact Isolation. Lancet
1999 Oct 2; 354 (9185):1177-8. 6. Evans HL, et al. Contact Isolation in Surgical Patients: A Barrier to Care? Surgery
2003; 134(2): 180-188. 7. Saint S, et al. Do Physicians Examine Patients in Contact Isolation Less Frequently? A
Brief Report. Am J Inf Cont 2003; 31(6): 354-356. 8. Morgan DJ, Day HR, Harris AD, Furuno JP, Perencevich EN.
The Impact of Contact Isolation on the Quality of Inpatient Hospital Care. Plos One July, 2011 Vol 6, Issue 7,1-7. 9.
Morgan DJ, Pineles L, Shardell M, Graham MM, et al. The Effect of Contact Precautions on Healthcare Worker
Activity in Acute Care Hospitals. Infect Cont Hosp Epi 2013; 34(1): 69-73. 10. Morgan DJ, Diekema DJ, Sepkowitz K,
Perencevich EN. Adverse Outcomes Associated with Contact Precautions: A Review of the Literature. Am J Inf Cont
2009; Mar, 37(2):85-93. 11. Gasink LB et al. Contact Isolation For Infection Control in Hospitalized Patients: Is Patient
Satisfaction Affected? Inf Cont Hosp Epidem 2008; 29 (3): 275-278.
Contact
[email protected]

Building Sustainable Community-Based Participatory Research
Linda F. Samson, PhD, RN, BC, NEA, BC, USA
Purpose
Discuss the process and outcomes of a program of community engaged participatory research in an
underserved community.
Target Audience
Nurse clinicians and researchers conducting community based research designed to improve health
outcomes for underserved populations.
Abstract
Purpose: The purpose of the study was to develop a model of community-based participatory research
as a part of a larger Center of Excellence in Health Disparities Research. Demographic data indicated
increased incidence of chronic health conditions in the community including diabetes, hypertension,
obesity, and other cardiac disorders. At the start of the planning efforts for project development
community members expressed distrust based on previous experiences where researchers would come
into the community, determine what they wanted to do to or for the community and then intervene and
leave. Community members made it clear from initial efforts that their purpose in participating was to play
a key role in determining what needs the community had and finding ways to address those needs.
Methods: The interdisciplinary researcher team that developed the Center application was located in a
suburban underserved community in the Midwestern United States. The PI and her team worked with a
coalition of community groups to determine willingness to collaborate. After agreeing on shared goals for
the research a smaller group wrote the first application. The community group provided an outline for the
development of the Community Engagement Core in the application, detailing the agreed conduct of that
Core. Work with the community continued in the post-submission and pre-funding period. After funding,
the Community Engagement Core began its work as detailed in the project and the work plan. The Core
Director, a member of the Community and a member of the grant leadership team was given the authority
and budget to implement the research plan. Community Advisory Board Members monitored the
research, evaluated outcomes, met with stakeholders, and modified agenda.
Results: Successes achieved during the first grant period led to submission and funding of a subsequent
five year project. The partnerships continued during the second grant period and have been sustained
even after the completion of eight years of NIH funding. The community has been able to actively engage
in identification of health care needs, develop projects to address those needs, and conduct
comprehensive evaluations that have allowed the PI/researcher to better understand how to improve
health outcomes in minority communities. The continuing partnership is developing new models of
community collaborative research driven by community identified needs.
Conclusion: Building the processes for community-based participatory research requires time
commitment and a willingness to change the way that researchers have traditionally conducted their
research. To be successful in this venture, researchers must seek to learn from the community, take the
time to build trust in the relationships and trust that the community, if you have the right people at the
table, understands its needs better than outsiders do. As a researcher, the PI has gained enormous
understanding and insights into health disparities and social determinants of health through the lived
experience of CBPR. The processes and outcomes achieved in this project would not have been
possible without the dynamic leadership of one key community activist who has committed over 40 years
to helping her community address its health needs. The PI was extremely fortunate that she and I have
become kindred spirits.
* Work funded in part by NCMHD grant # 1 R24 MD00509-01 and NIMHD grant # 1 P20 MD001816-01
References

Allen, K., Zoellner, J., Motley, M., & Estabrooks, P. A. (2011). Understanding the Internal and External Validity of
Health Literacy Interventions: A Systematic Literature Review Using the RE-AIM Framework. Journal Of Health
Communication, 1655-72. doi:10.1080/10810730.2011.604381 Bryant, A. (2011). Low health literacy affecting client's
ability to receive adequate health care education. JOCEPS: The Journal Of Chi Eta Phi Sorority, 55(1), 7-11. Centers
for Disease Control and Prevention (2011). Surveillance of Health Status in Minority Communities — Racial and
Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009.
MMWR. Surveillance Summaries / Vol. 60 / No. 6. Accessed July 31, 2013, from:
http://www.cdc.gov/mmwr/pdf/ss/ss6006.pdf Clement S, Ibrahim S, Crichton N, et al. (2009). Complex interventions
to improve the health of people with limited literacy: a systematic review. Patient Educ Couns. 75(3): 340–351.
Heinrich, C. (2012). Health literacy: The sixth vital sign. Journal Of The American Academy Of Nurse Practitioners,
24(4), 218-223. doi:10.1111/j.1745-7599.2012.00698.x Joshi, P., Marino, M., Bhoi, A., & McCoy, N. (2012). Reducing
the burden of cardiovascular diseases: A qualitative assessment of Louisiana health disparities collaboratives.
Journal of Cardiovascular Disease Research, 3(4), 305-309. doi:10.4103/0975-3583.102711 Samson, L. (2013).
Interprofessional Collaboration to Reduce Health Disparities. Unpublished paper for Southland Community Care
Partners Wilson, C., Alam, R., Latif, S., Knighting, K., Williamson, S., & Beaver, K. (2012). Patient access to
healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a
systematic review. Health & Social Care In The Community, 20(1), 1-19. doi:10.1111/j.1365-2524.2011.01017.x
Contact
[email protected]

N 01 - Global Reflections on Nursing Education
Reflecting on International Nursing Programs
Dalit Wilhelm, RN, MA, Israel
Cheryl Zlotnick, RN, MS, MPH, DrPH, Israel
Purpose
The purpose of this study was to conceptualize the patterns, processes and knowledge development of
international students placed in clinical settings.
Target Audience
The target audience of this presentation is educators, administrators of study abroad programs, and
researchers in transcultural nursing.
Abstract
Purpose: "Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage …,"
states the Expert Panel on Global Nursing. The evidence is clear. As Leininger argues in her theoretical
framework, self-reflection is an integral part of nursing education as it promotes self-awareness and
assists us to gain cultural-based knowledge. Culture influences the manner in which we obtain, process,
and conceptualize (i.e., epistemic beliefs) new knowledge. This qualitative study explores the written
reflections of international students who worked on surgical units, and illustrates the impact that culture
has on the patterns, processes and knowledge development of students placed in a very different
international setting.
Methods: Data consist of reflective materials that international students wrote to describe their clinical
experience. Content analysis was used to examine their writings. Reflective journals (n=30) were
analyzed from international students working in surgical rotations.
Results: "I am clearly used to a different culture…," wrote one international student. Two main core
categories were identified in the narratives: patterns and processes.
Within the patterns, we noted several themes including habits, self-perceptions, impressions and
assumptions. One written impression was, "In the clinic I saw a lot of family members, patients and staff
with different skin colors and clothing, and the general atmosphere felt a lot different than a Norwegian
hospital." The students also held many assumptions. For example, one student queried, "It was clear
that they were from different ethnicities. How can we care for a patient unable to express his own
needs?"
Processes included comparisons, interactions and generalizations. Written in the reflections was, "we
didn't have to ask her all the questions we had set up because she answered them before we got to ask
her." Introductions in this new culture were very different. "…we didn't shake hands. We always do that
we present ourselves in Norway."
Conclusions: International students used the frameworks they knew – the ones' from their own
culture. Faced with the Israeli environment, international students struggled to make sense of this
dissimilar population, rhythm of clinical practice, atmosphere, and ways of acting and reacting. This
caused dissonance.
Norwegian students grew up in a homogeneous and collective culture, and consequently, were
comfortable learning in that environment. They relied on their culture to support the development of their
knowledge. They repeatedly spoke about how "we" understand, act or do things. They expressed
themselves as a collective unit. This contrasted dramatically with the very different heterogonous Israeli
population, with strong Jewish and Moslem ethnic groups and idiosyncratic environment. This different
environment colored the lens through which they learned.
Reflections are a useful and important method for learning; however, the target of the reflections may
differ based on culture. While some students benefit from reflecting on personal experiences in clinical
practice, that is not the ideal method of developing transcultural and clinical knowledge for Norwegian
students. They benefit more from structured information using established sources to build logical thinking
and focusing on evidence-based knowledge would be a better mode of reflection. Understanding the way
that different cultures learn and develop knowledge is vital for teaching international students.

References
Bråten I, Gil L, Strømsø HI, Videal-Abarca, E. (2009) Personal epistemiology across cultures: exploring Norwegian
and Spanish university students' epistemic beliefs about climate change. Social Psychology Education, 12, 529-560.
Dhal TI, Bals M, Turi AL. (2005) Are students' beliefs about knowledge and learning associated with their reported
use of learning strategies? Britihs Journal of Educational Psychology, 75, 257-273. Leininger M. (1967). The culture
concept and its relevance to nursing. The Journal of Nursing Education, 6(2), 27-37. Leininger M. (1991).
Transcultural care principles, human rights, and ethical considerations. Journal of Transcultural Nursing, 3(1), 21-23.
Contact
[email protected]

Reflections of Second Year Nursing Students in Australia on Improving Their
Cultural Competence in Relation to Aboriginal and Torres Strait Islander Health
Glenda E. McDonald, PhD, BSocSc, Australia
Leanne Hunt, RN, Australia
Sharon Patricia Hillege, RN, RM, BHS, PGCert, PhD, Australia
Purpose
This presentation reports on the key findings of an investigation into the development of cultural
competence through a narrative learning experience. Study participants were second year nursing
students in Australia studying an Indigenous health unit.
Target Audience
The target audience would be nurse educators, clinicians and researchers with an interest in cultural
competence.
Abstract
Purpose: Nursing students around the world require the capacity to provide nursing care in a culturally
competent manner, given the complex patterns of migration and the increasingly multicultural nature of
our societies and health system populations. In particular, nursing students need to understand the social
and political aspects of majority and minority groups within societies and the impact they have on health
access and outcomes.
Methods: This qualitative research study investigated the development of cultural competence in 76
culturally diverse, second-year nursing students in a metropolitan region of Australia, while they studied a
compulsory unit about Australian Indigenous health issues. Students were asked to reflect on the
development of their cultural competence and propose ways they could personally engage in culturally
competent nursing care. Thematic analysis of two reflective writing excerpts from a workbook
assessment task, denoting an earlier and later phase of student learning, was conducted.
Results: Major themes were revealed of students’ improved knowledge of the social, historical and
cultural determinants of health for Australian Indigenous peoples, and greater confidence in their abilities
to communicate sensitively and provide culturally competent health care. Findings revealed additional
insights about self-awareness and critical reflection in nursing education, and the role of narrative
reflective strategies in the enhancement of cultural competence skills.
Conclusion: The implications for future nursing practice and the educational relevance of acknowledging
one’s own cultural filters and visualizing personal propositions for malparara – people working and
walking together as friends – will be highlighted.
Contact
[email protected]

Capacity Building Partnership for Global Nursing
Faye I. Hummel, PhD, RN, CTN-A, USA
Sara L. Jarrett, RN, EdD, CNS, USA
Kathleen Whitney, RN, MS, USA
Purpose
The purpose of this presentation is to communicate the process and structure of capacity building in the
development of a graduate nursing education program in a underserved country where nursing seeks to
be acknowledged and recognized as a fully contributing health care profession as defined by international
standards.
Target Audience
The target audience for this presentation is nursing educators who seek to be engaged in education
development partnerships across the globe. Nurses involved in capacity building in their organizations are
a target audience.
Abstract
Purpose: Strengthening nursing capacity and enhancing the knowledge of nurses worldwide is
recognized as a global imperative by the World Health Organization. Strengthening the nursing education
infrastructure is essential to building nursing capacity as well as improving patient care outcomes. The
purpose of this presentation is to communicate the process and structure of capacity building in the
development of a graduate nursing education program in a underserved country where nursing seeks to
be acknowledged and recognized as a fully contributing health care profession as defined by international
standards.
Methods: The first master in science of nursing program in Vietnam is the result of a partnership between
a nongovernmental organization (NGO) in the United States and a public university in Vietnam
(University). The process and structure of the development of a graduate nursing education program
including curriculum planning and revisions, implementation, and evaluation rely on the strengths and
resources of each partner. Nursing faculty from the United States with expertise in graduate nursing
education and research teach nursing courses and serve as research mentors. Vietnamese university
faculty teach non-nursing courses and serve as research mentors. Program logistics, management and
evaluation are successfully achieved through communication and collaboration between three members
of the NGO steering committee and leadership at the University. Details of the curriculum structure,
exemplars of teaching learning activities including distance education strategies will be discussed. The
essential dimensions of and challenges to effective collaboration in global education will be discussed.
Results: Methodologies for program monitoring with measurement of progress and achievement of
outcomes will be reported as well as program outcomes. Program outcome results, quantitative and
qualitative of graduate nursing program will be reported. Outcomes related to human resource capacity
building will be provided. Outcomes are linked to generation of nursing knowledge development and
capacity building in nursing education and practice.
Conclusion: International nursing education partnerships are productive and mutually benefit all
stakeholders. Obstacles are minimized by the synergy of the collaborative efforts by members of the
partnership. Future nursing education development needs to focus on resources availability and
sustainability.
Contact
[email protected]

N 02 - Exercising the Chronically Ill
The Impact of Yoga Education Among Postmenopausal South Asian Women at
Risk for Cardiovascular Disease: A Family Affair
Amandah L. Hoogbruin, RN, BScN, MScN, PhD, Canada
Purpose
The purpose of the presentation is to provide information about the relevance of this randomized, clinical,
pilot study for a target population at risk for cardiovascular disease, and to share how study participants’
families influenced their capacity to learn yoga properly.
Target Audience
The target audience of this presentation is health care team members who are interested in applying a
conceptual model about applying yoga to prevent heart disease, and learning how central the families of
the study participants were in supporting the women to learn and practice yoga regularly
Abstract
Purpose: The purpose of the study is to determine the efficacy of using a random controlled design to
measure the effects of a gentle 12 week structured Hatha yoga progam on lipid profile (fasting blood
cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides) and blood
pressure, as primary outcomes. Other related indices of cardiovascular risk including measures of
visceral adiposity (waist circumference, waist-hip ratio, body mass index (BMI)); insulin sensitivity (fasting
glucose/insulin); inflammation (C-reactive protein (CRP); sympathetic activity (resting heart rate, heart
rate; and perceived stress, mood, and sleep will be examined as secondary outcomes.
The yoga program is based on hatha yoga that has been adapted by the use of props and standardized,
scripted poses that can be easily replicated and readily performed by individuals who are elderly,
overweight, unfit, or who suffer from a chronic illness.
Methods: In Canada, the third largest group of South Asians is located in Surrey, British Columbia. In
February, 2013, a 12 week pilot study was implemented consisting of 33, postmenopausal, sedentary,
South Asian women who were randomly assigned to participate in either weekly Hatha Yoga education
and individual at home yoga sessions, or a no yoga, the control group. Screening assessments were
done to at the beginning of the study to obtain baseline data about quality of life and specific markers
related to physiological and psychological indices of CVD risk. Repeat screening assessments were
done at the end of the yoga intervention (@ 3 months); and at 6 months. Final screening sessions were
completed in late September.
Results: Applying a yoga intervention and study procedures in a community setting posed unique
challenges and required cultural sensitivity. All the study participants indicated that their role as the
primary family caregiver greatly influenced their capacity to practice yoga regularly. At the same time, all
of them agreed that their families were instrumental in enabling them to attend yoga classes regularly.
Conclusion: This pilot study is among the first in Canada to rigorously examine the specific effects of
yoga therapy on CVD risk profiles among postmenopausal, sedentary, South Asian women. Given the
nature of the intervention (involves lifestyle modification), factors affecting study participants, (i.e., the role
of family and its influence on regular yoga practice in the home), need to be considered when
implementing a more extensive, clinical trial.
Contact
[email protected]

The Effectiveness of Exercise Program for Aerobic Fitness in Adults with
Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis
Mei-Ling Wu, MSN, Taiwan
Purpose
The purpose of this presentation is to review current knowledge concerning the effectiveness of exercise
program for cardiopulmonary function among systemic lupus erythematosus patients by performing a
meta-analysis.
Target Audience
The target audience of this presentation is to those who focus on the research in exercise program and/or
systemic lupus erythematosus.
Abstract
Purpose: The purpose of this research aims to review current knowledge concerning the effectiveness
of exercise program for cardiopulmonary function among systemic lupus erythematosus (SLE) patients.
Furthermore, a meta-analysis was performed to examine the cumulative evidence of aerobic fitness.
Methods: Studies were identified through a systemic search process. The keywords used were exercise,
physical exercise, therapeutic exercise, supervised exercise, exercise therapy, physical fitness, physical
activity, exercise training, aerobic training, walking, bicycling, yoga, dancing, or jogging in combination
with lupus or systemic lupus erythematosus. Inclusion criteria were experimental study, the intervention
consists of a physical exercise program with at least 8 weeks duration, the outcome measures including
any cardiopulmonary function parameter, and was an original study. Age under 18, animal study, not
English, no control group or qualitative study were excluded. The databases searched were PubMed,
CINAHL, Cochrane Library, and PsychINFO from their inception to November 2013. The quality of each
selected study was assessed by CONSORT checklist. Data was analyzed using Cochrane
Collaboration’s Revman 5.2.
Results: Five RCTs and one quesi-experimental study with 234 subjects were included in this systemic
review. In addition, four studies with 194 subjects were included in the meta-analysis. Five studies
conducted supervised exercise program and one study conducted home based exercise program.
Walking was the primary exercise type. Meta-analysis showed that exercise could improve exercise
tolerance (mean difference (MD) 1.95, 95% CI 1.66,2.24 , p-value 0.00), maximum O2 consumption
(VO2max) (MD 0.83, 95% CI 0.31,1.35, p-value 0.002), and maximum pulmonary ventilation (VEmax) (MD
2.56, 95% CI 1.14,3.98, p-value 0.00).
Conclusion: The present data indicate that at least 8 weeks exercise program benefits cardiopulmonary
function among SLE patients. However, there is limited study and subjects. It was not possible to make
recommendation on exercise type and exercise program. In the future research, large sample size and
different type of exercise are needed.
Contact
[email protected]

Stand up for Health: Using Yoga as a Transitional Platform to Increase Physical
Activity Levels in Sedentary Adults
Kyeongra Yang, PhD, MPH, RN, USA
Amanda Lefkowitz, MA, BSN, RN, USA
Purpose
The purpose of this presentation is to present a study which investigated whether a mind-body exercise
program was an effective tool to increase PA levels among sedentary overweight adults.
Target Audience
The target audience of this presentation is clinicians and researchers who are working with sedentary
overweight adults.
Abstract
Physical inactivity is linked to debilitating chronic diseases (Neal, 2013; Dwyer-Lindgren et al., 2013) and
deaths and disability-adjusted life-years (US Burden of Disease Collaborators, 2013). Despite best efforts
to promote physical activity (PA) in the last decade, research found very minimal improvement in the
percentage of adults increasing PA levels (Carlson et al., 2010) and physical inactivity remains highly
prevalent in the U.S. (CDC, 2010a; CDC, 2010b; CDC, 2013). Research confirmed weight status was
significantly associated with physical inactivity (Dorsey et al., 2011; Young et al., 2009); accordingly, the
chronically sedentary may find it especially difficult to adopt and maintain an active lifestyle. As such,
radical adjustments and new strategies to increase PA among sedentary adults must be explored. One
alternative form of PA that may be an effective intervention in the fight against physical inactivity is yoga
(Bernstein et al., 2013; Bryan et al., 2012). Weekly yoga among sedentary adults led to improved health
outcomes (Groessl et al., 2013). Hatha yoga, the most accessible form of yoga, can improve strength and
flexibility, lower obesity and reduce physiological/psychological distress (Dhananjai et al., 2013). Yoga
participation and mastery can also improve the degree of exercise self-efficacy, and perhaps, lead to
adherence to a PA program and its attendant benefits (Yang et al., 2011; Oleshansky, 2004).
Purpose: The purposes of this 6-month pilot study were to investigate whether a mind-body exercise
program was an effective tool to increase PA levels and whether the delivery method of the program,
either instructor-based or self-guided, influenced the level of change among community-dwelling
overweight sedentary adults.
Methods: The yoga program used in this study consisted of 2-months of an intervention period in which
participants practiced 90-minute weekly sessions of Hatha yoga either directly by guidance from an
instructor [Face Group] or indirectly by self-learning from a DVD [DVD Group], followed by 4-months of
self-reported PA maintenance. Participants were screened for age, family history of diabetes, and medical
and/or physical conditions that would prevent them from exercise in order to ensure safety of the
intervention. Measurements were recorded at baseline, 2, 4, and 6 months. Program adherence was
measured by self-reported minutes/week of PA; sedentary behaviors/levels of PA were monitored by the
Modifiable Activity Questionnaire. Descriptive statistics and nonparametric tests were used to describe
the sample and examine differences by group and time.
Results: Fourteen adults (10 White, 4 Non-white) participated in the study. Their mean age was 58.6
years (SD = 5.4) and 12 (85.7 %) was female. Their mean years of completed education was 15.0 (SD =
2.1) and the mean BMI was 31.8 ± 5.8 kg/m2. There was no significant differences in demographic
variables between groups. Results showed significant changes in PA levels from baseline to each
measurement point (p < .05). Although both groups in this pilot study showed increased PA, the DVD
Group showed higher levels of PA at each interval than the Face Group (statistical significance occurring
at 4 months). The participants of this study also reported yoga increased their strength, flexibility,
balance, and mind-body awareness.

Conclusion: Our results indicate that a yoga program, either instructor-based or self-guided, may be
used as a transitional platform to increase regular PA among overweight sedentary adults. Further
research with a larger sample is needed to evaluate the efficacy of this program, with a particular focus
on the use of the self-guided method.
References
Bernstein, A. M., Bar, J., Ehrman, J. P., Golubic, M., & Roizen, M. F. (2013). Yoga in the management of overweight
and obesity. American Journal of Lifestyle Medicine. X, 1-9 Bryan, S., Pinto Zipp, G. and Parasher, R. (2012). The
effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study. Alternative
Therapies in Health and Medicine, 18(5), 50-59. Carlson, S. A., Fulton, J. E., Schoenborn, C. A., & Loustalot, F.
(2010). Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. American
Journal of Preventive Medicine, 39(4), 305-313. Centers for Disease Control and Prevention (2013). Adult
participation in aerobic and muscle-strengthening physical activity- United States, 2011. Morbidity and Mortality
Weekly Report, 62, 326-330. Centers for Disease Control and Prevention. (2010a). Behavioral Risk Factor
Surveillance System: prevalence and trends data. Retrieved April 1, 2012, from
http://apps.nccd.cdc.gov/BRFSS/age.asp?cat=EX&yr=2010&qkey=4347&state=UB. Centers for Disease Control and
Prevention. (2010b). Physical activity statistics. Retrieved April 1, 2012, from
http://www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm. Dhananjai, S., Sadashiv, S. T., Dutt, K., & Kumar,
R. (2013). Reducing psychological distress and obesity through Yoga practice. International journal of yoga, 6(1), 66.
Dorsey, K. B., Herrin, J. and Krumholz, H. M. (2011). Patterns of moderate and vigorous physical activity in obese
and overweight compared with non-overweight children. International Journal of Pediatric Obesity, 6(2-2), e547-555.
Dwyer-Lindgren, L., Freedman, G., Engell, R. E., Fleming, T. D., Lim, S. S., Murray, C. J., & Mokdad, A. H. (2013).
Prevalence of physical activity and obesity in US counties, 2001--2011: a road map for action. Population Health
Metrics, 11(1), 7. Groessl, E. J., Schmalzl, L., Mazzi, M., & Iszak, F. (2013). Yoga for low-income older adults: silver
age yoga. Journal of Yoga & Physical Therapy, 3(1), 131 Neal, B. (2013). Fat chance for physical activity. Population
Health Metrics, 11(1), 9. Oleshansky, M. B. (2004). The effects of Hatha yoga on stress and coping (Doctoral
dissertation, Alliant International University, 2004). Dissertation Abstracts International, 65(4-B), 2106. US Burden of
Disease Collaborators. (2013). The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
JAMA, 310(6), 591-608. Yang, K., Bernardo, L. M., Sereika, S. M., Conroy, M. B., Balk, J., & Burke, L. E. (2011).
Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study. Evidence-Based
Complementary and Alternative Medicine, 2011. Young, D. R., Jerome, G. J., Chen, C., Laferriere, D. &Vollmer, W.
M. (2009). Patterns of physical activity among overweight and obese adults. Preventing Chronic Disease, 6(3), A90.
Contact
[email protected]

N 03 - Health Promotion for the Cardiac Patient
Sensitivity, Specificity, and Sex Differences in Symptoms of Acute Coronary
Syndrome
Holli A. DeVon, PhD, RN, FAHA, FAAN, USA
Anne Rosenfeld, PhD, RN, FAHA, FAAN, USA
Alana Steffan, PhD, USA Mohamud Daya, MD, MS, USA
Purpose
The purpose of this presentation is to provide the latest evidence for the sensitivity, specificity, and
predictive value of 13 symptoms for a diagnosis of acute coronary syndrome in women and men.
Target Audience
The target audience of this presentation is emergency department nurses, other clinicians caring for
cardiac patients, and cardiovascular researchers, particularly those interested in symptoms and
measurement challenges.
Abstract
Purpose: Clinical symptoms are part of the risk stratification approaches used in the emergency
department (ED) to evaluate patients with suspected acute coronary syndrome (ACS). The purpose of
this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a
diagnosis of ACS in women and men.
Methods: The sample included 736 patients admitted to four EDs with symptoms suggestive of ACS.
Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic
regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for
a diagnosis of ACS, adjusting for age, obesity, stair climbing ability, and diabetes.
Results: Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7 ±
14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest sensitivity for
ACS in both women (66%, 67%, and 66%) and men (63%, 69%, and 72%). Six symptoms were specific
for a non-ACS diagnosis in both women and men. The predictive value of shoulder (OR = 2.06, 95% CI =
1.09-3.87) and arm pain (OR 2.27, 95% CI = 1.20-4.35) in women was nearly twice that of men (OR =
1.14, 95% CI = 0.69-1.87 and OR = 1.24, 95% CI = 0.76-2.02). Shortness of breath (OR = 0.44, 95% CI =
0.28-0.71) and unusual fatigue (OR = 0.62, CI = 0.40-0.99) predicted a non-ACS diagnosis in men.
Conclusions: There were more similarities than differences in symptom predictors of ACS for women
and men. Shortness of breath, arm pain, and shoulder pain may be key symptoms which add predictive
value to an ACS diagnosis for women.
Contact
[email protected]

Fibromyalgia and Risk of Coronary Heart Disease: A Population-Based Cohort
Study
Purpose
to present evidence supporting the predicting role of fibromyalgia and the risk of developing coronary
heart disease.
Target Audience
nurses who frequently encountered patients who suffer from chronic pain, nurses who work in
cardiovascular units, and nursing scientists who are interested in conducting population-based research
using claims database.
Abstract
Purpose: Prospective cohort studies have shown that depression is associated with an increased
subsequent risk of CHD. Depression and chronic pain, such as that in fibromyalgia, often occur
simultaneously, and studies have suggested that the two diseases may share common pathogenic
mechanisms. This study examined whether fibromyalgia patients have an increased risk of adverse
coronary events, compared with age- and sex-matched control patients. We hypothesized that
fibromyalgia increases the risk of coronary heart disease (CHD).
Methods: Using a matched-cohort study design, we analyzed data retrieved from the Longitudinal Health
Insurance Database (LHID) 2000 released by the National Health Research Institutes, Taiwan. The
LHID2000 includes medical claims data and registration files for 1 million enrollees randomly selected
from the 2000 Registry for Beneficiaries (n = 23.72 million) of the National Health Insurance program.
Patients treated for fibromyalgia at least once a month for 3 consecutive months following their initial
diagnosis were enrolled in our study. The primary endpoint was the composite of CHD events, including
percutaneous coronary intervention and coronary artery bypass grafting procedures. The hazard ratios
(HRs) and the 95% confidence intervals (CIs) were estimated using multivariate Cox proportional-hazards
regression models.
Results: After adjusting for the prognostic factors that differed significantly between the fibromyalgia and
comparison cohorts, including diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive
pulmonary disease, antidepressant use, non-steroids anti-inflammatory drug use, cardiovascular drug
use, and the number of cardiology visits, the patients with fibromyalgia showed a significantly higher
subsequent risk of a CHD event (HR = 2.19, 95% CI = 1.52 - 3.17, P<0.001) than the patients without
fibromyalgia.
Conclusion: Patients with fibromyalgia had at least twice the risk of a subsequent coronary event when
compared to those without fibromyalgia.
Contact
[email protected]

Factors Associated with Prehospital Delay in Acute Coronary Syndrome, Among
Men and Women in Karachi, Pakistan
Saleema Mansoor Allana, MScN, BScN, Pakistan
Purpose
The purpose of this presentation is to disseminate the findings of a study done on Pakistani Acute
Coronary Syndrome (ACS) patient population, aimed at identifying the gender differences in the pre
hospital delay time, its components, and in the factors of delay among ACS patients.
Target Audience
The target audience of this presentation is nurses and physicians, who work either in primary, secondary
or tertiary care settings, and who frequently encounter cardiology patients. Educators and administrators
are also part of the audience as implications of the findings are quite related to nursing and medical
education and administration.
Abstract
Purpose: Prehospital delay in Acute Coronary Syndrome (ACS) is the time from the onset of ACS
symptoms till the patient‘s arrival at the hospital‘s Emergency Department (ED). Despite the known
significance of prehospital delay time (PDT) in determining clinical outcomes in ACS, quite prolonged
delay times have been reported among ACS patients, globally. Gender differences in PDT and its
associated factors have been explored internationally; however, this phenomenon has not been studied
before in Pakistan. The current study aimed to identify gender differences in the PDT, its components,
and in the factors of delay among ACS patients. The study also aimed to explore the independent
correlates of the PDT, among men and women with ACS.
Methods: This analytical, comparative, cross-sectional study was conducted on 249 ACS patients at the
Aga Khan University Hospital and at the Karachi Institute of Heart Diseases, between February and April,
2011. Data was collected through the modified ‗Response to Symptoms Questionnaire‘, and it was
analyzed using comparative and regression analyses.
Results: The median PDT of women was found to be 7 hours, as opposed to 3.5 hours among men (P-
Value: 0.001). Women had a median decision delay‘ of 3 hours, versus 1.5 hours among men (P-Value:
<0.001). The median physician-to-hospital delay‘ was 4.5 hours among women, versus 2 hours among
men (P-Value: 0.008). Significantly prolonged delay times were observed when patients consulted
general physicians (GPs). Moreover, most women delayed due to social factors, like responses of
attendants to the patients‘ symptoms‘ (P-Value: 0.002), delayed because was worried about expenses
required for the treatment‘(P-Value: 0.002), and not wanting to trouble others‘(P-Value: 0.1); whereas,
most men delayed due to individual related factors, like waiting for symptoms to subside‘(P-Value:
<0.001), not recognizing the symptoms as cardiac‘(P-Value: <0.001), and behavioral response to the
symptoms‘(P-Value: 0.08). Having anxiety‘ and lack of knowledge about symptoms‘ were associated with
extended PDT among both genders.
Conclusion: This study concludes that women delayed more than men in reaching the hospital, and both
the genders had different factors of delay. The findings of the current study may be of value for other
international studies on the subject. With respect to Pakistan, this possibly seminal baseline study may
provide important insights for designing empirical and interventional studies, in the future.
References
Banks, A. D., & Dracup, K. (2006). Factors associated with prolonged prehospital delay of African Americans with
acute myocardial infarction. American Journal of Critical Care, 15, 149-156. Banks, A. D., & Dracup, K. (2007). Are
there gender differences in the reasons why African Americans delay in seeking medical help for symptoms of an
acute myocardial infarction? Ethnicity & Disease, 17, 221–227. Deifenbach, M., & Leventhal, H. (1996). The
commonsense model of illness representation: Theoretical and practical considerations. Journal of Social Distress
and the Homeless, 5, 11-38. De Luca, G., Suryapranata, H., Ottervanger, J. P., & Antman, E. M. (2004). Time delay

to treatment and mortality in primary angioplasty for acute myocardial infarction: Every minute of delay counts.
Circulation, 109 (10), 1223–1225. DeVon, H. A., & Zerwic, J. J. (2003). The symptoms of unstable angina: Do men
and women differ? Nursing Research, 52 (2), 108-118. Fukuoka, Y., Dracup, K., Ohno, M., Kobayashi, F., &
Hirayama, H. (2006). Predictors of in-hospital delay to reperfusion in patients with acute myocardial infarction in
Japan. Journal of Emergency Medicine, 31(3), 241-245. Habib, S., Noor, A., Madni, A., & Zaman, K. S. (2006).
Delays in thrombolytic therapy among patients with ST-elevation myocardial infarction presenting to a tertiary care
hospital. Pakistan Journal of Cardiology, 17, 29-39. Hart, P. L. (2005). Women‘s perceptions of coronary heart
disease: An integrative review. Journal of Cardiovascular Nursing, 20, 170-176. Khan, M. S., Jafary, F. H., Faruqui,
A. M., Rasool, S. I., Hatcher, J., Chaturvedi, N., & Jafar, T. H. (2007). High prevalence of lack of knowledge of
symptoms of acute myocardial infarction in Pakistan and its contribution to delayed presentation to the hospital. BMC
Public Health, 7, 1-8. Lefler, L. L. (2004). Perceived risk of heart attack: A function of gender? Nursing Forum, 39, 18-
26. Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of compliance. Patient Education and
Counseling, 10, 117–138. McKinley, S., Moser, D. K., & Dracup, K. (2000). Treatment-seeking behavior for acute
myocardial infarction symptoms in North America and Australia. Heart & Lung, 29, 237-247. Moser, D. K., McKinley,
S., Dracup, K., & Chung, M. L. (2005). Gender differences in reasons patients delay in seeking treatment for acute
myocardial infarction symptoms. Patient Education and Counseling, 56, 45–54. Noureddine, S., Arevian, M., Adra,
M., & Puzantian, H. (2008). Response to signs and symptoms of acute coronary syndrome: Differences between
Lebanese men and women. American Journal of Critical Care, 17, 26- 35. Okhravi, M. (2002). Causes for pre-
hospital and in-hospital delays in acute myocardial infarction at Tehran teaching hospitals. Australian Emergency
Nursing Journal, 5, 21-26. Ottesen, M. M., Dixen, U., Torp-Pedersen, C., & Kober, L. (2004). Prehospital delay in
acute coronary syndrome—An analysis of the components of delay. International Journal of Cardiology, 96, 97-103.
Shaikh, B. T., & Hatcher, J. (2004). Health seeking behavior and health service utilization in Pakistan: Challenging
the policy makers. Journal of Public Health. 27 (1), 49-54. doi:10.1093/pubmed/fdh207 Walsh, J. C., Lynch, M.,
Murphy, A. W., & Daly, K. (2004). Factors influencing the decision to seek treatment for symptoms of acute
myocardial infarction: An evaluation of the self-regulatory model of illness behavior. Journal of Psychosomatic
Research, 56, 67-73. Xavier, D., Pais, P., Devereaux, P. J., Xie, C., Prabhakaran, D., Reddy, K. S., … Yusuf, S.
(2008). Treatment and outcomes of acute coronary syndromes in India (CREATE): A prospective analysis of registry
data. Lancet, 371, 1435-1442.
Contact
[email protected]

N 04 - Nurses' Perceptions from Student Through Clinician
Exploring Registered Nurses' Attitudes Towards Post Graduate Education in
Australia: A Pilot Study
Linda C. Ng, LLB, BN, MN (CritCr), Australia
Anthony G. Tuckett, BN, MA, PhD, Australia
Stephanie Fox-Young, RN, BA (Hons), GradDipEd, MEd, PhD, Australia
Victoria Kain, PhD, RN, Australia
Robert M. Eley, BSc, MSc, PhD, FSB, CBiol, CSci, Australia
Purpose
The purpose of this presentation is to assist the profession in evaluating the functions and benefits of
postgraduate education for specialty practice. The findings of this study will also inform and thus assist in
improving the education of specialty nursing.
Target Audience
The target audience of this presentation is academic, clinical and administrative staff. The findings of this
study will assist the academic and administrative in encouraging the interest of registered nurses in
pursuing specialty nursing education.
Abstract
Purpose: Nursing education is a dynamic process designed to enable nurses to competently meet the
healthcare needs of society. Health system restructuring has been associated with diminishing
postgraduate specialist nursing numbers worldwide.
The transfer of Australian postgraduate specialty nursing education from hospitals to the tertiary (higher
education) sector took place in the late-90s (Chaboyer, Dunn, & Najman, 2000). Postgraduate education
in nursing has continued to grow over the years but the benefits to students, employers, patients and
overall impact on practice remains unclear (Gijbels et al., 2010; Griscti & Jacono, 2006; Pelletier,
Donoghue, & Duffield, 2005). Valid instruments that monitor and evaluate nurses concerns are a central
component in planning effective education, and are currently unavailable.
The objective of this study is to describe the development and design of an instrument to measure the
Registered Nurses Attitudes Towards Post Graduate Education (NATPGE) in a representative sample of
registered nurses in Australia.
Methods: Items on the NATPGE were drawn from the literature review which was used to inform the
content and the structure of the NATPGE questionnaire. A number of processes have been undertaken
to ensure the validity and reliability of the NATPGE questionnaire.
1. Content validity is a crucial factor in instrument development that addresses item rigour- that is,
whether an item adequately measures a desired domain of content (Grant & Davis, 1997; De Vaus,
2002). Four content experts (CE) who specialised in: specialist-nurse education, psychometric scales;
development and analysis of instruments were selected to undertake judgment-quantification and agree
on the final version of the NATPGE survey-instrument prior to testing its face validity.
2. Face validity, sometimes referred to as representative validity, is the degree of accuracy with
which a measurement instrument represents what it is trying to measure (Bowling, 2002; Polit, Beck, &
Hungler, 2001). A convenience sample of 25 Registered Nurses (RNs) was selected from four major
Queensland tertiary hospitals to assess the instrument content readability and relevance.
3. Reliability is the consistency of a set of measurements or of a measuring instrument (Polit & Beck,
2010). Pilot studies are used in different ways in social science research and one of it can be the pre-
testing or 'trying out' of a particular research instrument (Baker 1994 pp 182-3) including testing its
reliability. A random sample of 100 RNs from the Nurses and Midwives e-Cohort Study (NMeS) were
invited to participate in a test-retest pilot as part of the process of assessing the reliability of the online

NATPGE. To gauge the test-retest reliability, the instrument was administered at two different time
points, 3 weeks apart, under similar conditions
Results: The content and face validity was assessed using descriptive statistics. For the test-retest
reliability the 15 NATPGE questions were analysed on an item by item basis to calculate the intra-rater
reliability using the weighted kappa (kw) statistic and its standard error (SE). The kw implicitly assumes
that all disagreements are equally weighted as are all agreements. The reference values for the strength
of agreement are in accordance with Altman (1991) (0.0- 0.2 as poor, 0.21-0.40 as fair, 0.41-0.60 as
moderate, 0.61-0.80 as good and 0.81-1.00 as a very good agreement). Data were analysed using Stata
12 (StataCorp. 2011, TX: StataCorp LP.).
Content and face validity - Overall both the CE and the RNs ranked the NATPGE, using the CVI, as a
realistic training platform that would be useful for evaluating RNs’ attitudes towards postgraduate
education. The comments received from the CE resulted in some minor changes to the wording of some
items for better clarity and simplicity. No particular concerns were raised about any of the items by the
CE. The CE was agreeable that the items were arranged in a positively and negatively worded sequence,
which was intentional as to prevent response bias.
Reliability: Pilot Test - Complete data is available and was analysed for 36 of the 100 (36%) sample of
RNs who completed the test-retest reliability of the NATPGE instrument. Overall the results display an
80% fair to moderate kappa (kw = 0.29-0.57) agreement; however, there is some variability (kw = 0.0 to
0.79) between the test and retest kw for each individual question (Graph 1).
Conclusion: The present research indicates very good content and face validity and whilst the test-retest
reliability overall was moderate, several individual questions did have poor kappa values. As such, we
plan to refine the instrument, before its validation in a larger sample using factor analysis. This work is
currently being undertaken.
References
Altman, D. G. (1991). Practical statistics for medical research. London: Chapman & Hall Baker, T. L. (1994). Doing
social research. New york: McGraw-Hill Inc Bowling, A. (2002). Research methods in health: Investigating health and
health services (2nd ed.). Buckingham: Open University Press Chaboyer, W., Dunn, S., & Najman, J. (2000).
Developing specialty knowledge: The case of Australian critical care nursing. Intensive and Critical Care Nursing, 16,
13- 17 De Vaus, D. (2002). Surveys in Social Research (5th ed.). Spanish (International) Sort; Sydney, Australia:
Allen & Unwin Gijbels, H., O’Connell, R., Dalton-O’Connor, C., & O’Donovan, M. (2010). A systematic review
evaluating the impact of post-registration nursing and midwifery education on practice. Nurse Education in Practice,
10, 64- 69 Grant, J., & Davis, L. (1997). Selection and use of content experts for instrument development. Research
in Nursing and Health, 20, 269-274 Griscti, O., & Jacono, J. (2006). Effectiveness of continuing education
programmes in nursing: Literature review. Journal of Advanced Nursing, 55(4), 449- 456 NMeS http://nurses.e-
cohort.net/ Pelletier, D., Donoghue, J., & Duffield, C. (2005). Understanding the nursing workforce: A longitudinal
study of Australian nurses six years after graduate study. Australian Journal Of Advanced Nursing, 23(1), 37-43 Polit,
D., & Beck, C. (2010). Essentials of nursing care: Methods, appraisal and utilization (7th ed.). Philadelphia: Lippincott
Williams and Wilkins Polit, D., Beck, C., & Hungler, B. (2001). Essentials of nursing research: Methods, appraisal and
utilization (5th ed.). Philadelphia: Lippincott Williams and Wilkins
Contact
[email protected]

Nurses' Attitudes Toward Restraint Use in Japanese Hospitals
Miho Matsui, RN, PhD, Japan
Purpose
The purpose of this presentation is to investigate nurses’ attitudes towards restraint use and related
factors.
Target Audience
The target audience of this presentation is nurses and care workers taking care of older adults.
Abstract
Purpose: The use of restraints is a controversial issue that may present nurses with legal, ethical and
practical dilemmas. Restraint use can result in numerous problems for the patients, including death by
strangulation, falls injuries, deconditioning, skin breakdown, incontinence, constipation and psychological
effects such as agitationand emotional distress. The aim of this study was to investigate nurses’ attitudes
towards restraint use and related factors.
Methods: A descriptive study was conducted to measure nurses’ attitudes toward restraint use. Nurses
employed in areas of internal, surgical, and sanatorium wards of three hospitals received the
questionnaire. Japanese Version of Perceptions of Restraint Use Questionnaire (PRUQ), which is 17 item
questionnaire measures nurses’ attitudes toward restraint use, was used. Each item is ranked on a 5-
point Likerttype scale. A higher score indicates that the item is considered to be an important justification
for the use of physical restraints. The instrument was judged to have face and content validity by a panel
of gerontology nurse experts.
Results: The questionnaire was sent to a total of 227 nurses and was returned by 205, giving a response
rate of 90.3%. The sample had a mean age of 35.8 years (range 20–62 years, SD 10.1) and had been
nursing for an average of 7.6 years (range 0.4–34years, SD 7.4). As expected, the majority of
respondents were women (94.6%). Nearly half of the respondents (45.1%) worked in internal wards, and
surgical wards (24.4%) or sanatorium wards (25.4%). The mean score on the PRUQ was 2.897(possible
range 1–5), indicating that respondents in this sample had a slightly negative attitude toward the use of
restraints. Positive attitudes were shown about items such as preventing a patient from breaking open
sutures and pulling out a catheter, feeding tube, and IV. Twelve of 17 items were significantly different
due to type of ward, especially surgical wards indicated positive attitudes.
Conclusion: Nurses’ attitudes toward restraint use showed positive about preventing from pulling out
catheter, feeding tube, and IV, moreover, different attitudes were observed among three wards.
References
University of Pennsylvania School of Nursing. Perception of Restraint use Questionnaire (PRUQ), 2010. Akamine Y,
Yokota Y, Kuniyoshi M, et al. Reliability and Validity of the Japanese Version of Physical Restraint Use
Questionnaire. Ryukyu Med J, 22(1,2) 21-28, 2003.
Contact
[email protected]

Nursing Students' Perception of the Clinical Learning Environment in Macao
Wai Sha Poon, RN, BN, MSc, United Kingdom
Purpose
The purpose of this presentation is to emphasize the influence of the clinical learning environment on
student learning on placement.
Target Audience
The target audience of this presentation is mainly aimed at nurse educators, mentors and nurses who
involved in the clinical learning process.
Abstract
Background: Nursing is a practice based discipline. Clinical placements provide a social context for
nursing students to engage in the profession and apply their knowledge to practice. However, the clinical
learning environment is not primarily designed for education purposes. It is therefore essential to
understand students’ expectation and their experience in the clinical learning environment.
Purpose: The aim of this study was to investigate students’ expectation and perception towards the
clinical learning environment in Macao.
Methods: A survey using the Clinical Learning Environment Inventory (CLEI) was conducted in the
academic year 2012-2013. The CLEI is a 42-item self-report inventory measuring students’ perception of
the psycho-social aspect of the clinical learning environment. It consists of 6 subscales (individualization,
innovation, involvement, personalization, task orientation and satisfaction), and the subscale satisfaction
is used as an outcome measure. The inventory was translated to Chinese and administered to all second
to fourth year students of a nursing college in Macao. Participants were invited to complete the preferred
form of the CLEI before placement commencement and the actual form on the last day of placement.
SPSS version 21 was employed to analyse the data.
Results: A total of 147 preferred forms and 150 actual forms were returned, with 88% and 90% response
rate respectively. The mean scores of the subscales of the preferred form ranged from 19.71 to 23.44 and
from 16.22 to 20.66 for the actual form. Personalization was found to be the most important domain on
both preferred and actual clinical learning environment. Paired sample t-test demonstrated that the
subscale scores of the actual form were significantly different from the preferred form (p < 0.001). Effect
sizes were large for individualization, innovation and personalization, and medium for student involvement
and task. The result of multiple linear regression showed that student involvement, task orientation and
individualization are the predictors of the model, and account for 54% of the variance of student
satisfaction in the actual clinical learning environment. The Cronbach’s alpha of the subscales for the
preferred and actual form ranged from 0.54 to 0.81 and 0.39 to 0.83 respectively.
Conclusion: The study shows that there are significant differences between students’ expectation and
their perception towards the actual clinical learning environment. A thorough investigation on the
influence of the clinical learning environment on student learning will be essential to maximize learning
outcome on placements.
Contact
[email protected]

N 05 - Evaluations of Global Nursing Faculty
Nurse Teachers' Accounts of Their Perceptions and Practices of Written
Feedback
Raisa Gul, PhD, MHA, BScN, RM, RN, Pakistan
Sajid Iqbal, RN, BScN, MScN, Pakistan
Purpose
The purpose of this presentation is to share findings of a research study, undertaken in Karachi, which
explored nurse teachers’ accounts of their perceptions and practices of written feedback.
Target Audience
The target audience of this presentation is teachers/educator, school administrators, and students of any
level
Abstract
Purpose: Written feedback is an important aspect of students’ assessment and learning. Although the
phenomenon of written feedback has been studied in various countries, most of the studies have focused
on students’ perceptions or on the analysis of teachers’ marked papers. This study aimed to explore the
nurse teachers’ perceptions of their practices of written feedback. Moreover, the factors that affected
teachers’ practices of written feedback were also investigated.
Methods: A descriptive exploratory design was employed in the study. A purposive sample of 12
teachers from public and private nursing institutions in Karachi, Pakistan, participated in the study. Using
a semi-structured guide, in-depth interviews were conducted with the participants, between February-
May, 2013. The interviews were tape recorded and transcribed verbatim. The data were manually coded
and categorized.
Results: Analysis of the data led to four categories and sub-categories. The main categories were:
teachers’ perceptions about written feedback, effects of written feedback on students from the teachers’
perspectives, teachers’ practices of providing written feedback on students’ assignments, and factors that
affect the teachers’ practices of providing written feedback to their students. The findings indicated that
although the teachers realize the importance of written feedback and its impact on students’ learning,
several factors, including teachers’ competence and commitment, students’ receptivity, and contextual
barriers, affected their practices.
Conclusion: Overall, this study has implications for teachers, students, and higher education institutions.
To actualize the potential role of written feedback, the contextual factors must be known and addressed
by the stakeholders.
Contact
[email protected]

Evaluation of Teaching Competence in Taiwan Nurse Educators: Presence and
Value
Jiun-Ying Liang, MS, BS, Taiwan
Purpose
The purpose of this presentation is to explicate current status of professional education knowledge and
skills among Taiwan nurse educators and identify learning needs in professional education knowledge
and skills for yourself.
Target Audience
The target audience of this presentation is nurse educators of colleges and universities.
Abstract
Purpose: Teaching as a profession was addressed by the United Nations Educational, Scientific and
Cultural Organization (UNESCO) in 1966. The core content of the statement insisted that a teacher
should be equipped with professional teaching competence before he/she is able to deliver professional
knowledge to students. The academic preparations of nursing faculty who work for college or university
are mainly professional nursing knowledge and research methodology, not professional teaching
knowledge and skills. This study aimed to assess and understand the current status and value in teaching
competence among nursing faculty in Taiwan.
Methods: Based on a review of literature, a survey questionnaire was constructed and distributed to 353
nursing educators employed in 24 universities and colleges in Taiwan.
Results: A response rate of 64.3% was achieved.The study results showed that teaching competence
varied by the educator’s seniority of teaching, academic position, and the major teaching subjects.
Faculty with higher seniority presented better teaching competence in both knowledge and skills than
those with lower seniority. However, all nursing educators expressed a lack of knowledge in history,
philosophy, and sociology of education. Regarding the impact of academic positions on teaching
competence, faculty with professorship contained better knowledge in educational theory, instruction
principle, curriculum design, and assessment of teaching outcomes and situations, as well as teaching
skills in linguistic expression and communication, than lecturers.
Conclusion: Analysis of nursing educators’ value in learning teaching knowledge and skills showed a
higher learning needs in education philosophy, sociology, psychology, and theory, as well as classroom
management, but lower attention in curriculum design and teaching strategy related competence.
Contact
[email protected]

Adapt or Sink: Exploring the Nurse Educator-Student Relationship in Democratic
South Africa
Theresa Sheila Mokoboto-Zwane, PhD, MCur, BCur IetA, RN, RM, South Africa
Purpose
The purpose of this presentation is to share a description of the lived experience of nurse educators and
nursing students in South Africa regarding their relationship with each other with a view to urging the
nursing education system to introduce policies that enhance adaption to changes in the political climate
Target Audience
The target audience of this presentation includes policy-makers in the nursing education system,
Management of nursing schools, colleges and universities, nurse educators, as well as other interested
parties/stakeholders.
Abstract
Purpose: The purpose of this presentation is to provide insight into the nurse educator-nursing student
relationship by describing their lived experience of interacting with one another in a large nursing college
within the context of a new democratic dispensation in South Africa, and to urge policymakers in the
nursing education system to introduce policies and programmes that promote adaptation to changes
brought about by the socio-economic and political climate.
Methods: A qualitative study was conducted in a large nursing college in South Africa. Data was
collected utilizing in-depth phenomenological interviews which were transcribed and analysed using
Tesch’s method. A protocol was designed and given to an independent coder who is doctorally qualified
in qualitative studies, with a request to also analyse the data, using the same method. A purposive
method was used for sampling participants. Because of the sensitive nature of the phenomenon under
study, in addition, snowball sampling was also used to allow participants to suggest other willing
participants who met the criteria. The size of the sample depended on saturation of the data. Data
satuaration was reached after 19 participants were interviewed, 10 nurse educators and 9 nursing
students. Ethical rigor was ensured by obtaining approval from the Research Ethics Committee, the
Hierarchy and Management of Nursing College concerned, as well as informed consent from individual
participants following a briefing session which focused on beneficence, respect for human dignity and
justice. A pilot interview was conducted first using the following central question for students: "Please
describe to me how you experience relationship with your nurse educators, based on your interaction with
them," and for nurse educators: "Please describe to me how you experience relationship with your
students, based on your interaction with them."
Results: The two groups of participants provided rich, dense and detailed accounts of their experiences
of interacting with one another and their relationships. These were grouped into two main categories,
namely Facilitative Elements and Stumbling Blocks. Within the Facilitative Elements were Positive
Interaction and Positive Feelings, whilst Stumbling Blocks entailed what was perceived as Negative
Interaction and Negative Feelings. A third category was identified as Variable, where participants reported
a mixture of both positive and negative experiences. Findings reflected positive relationships experienced
by the majority of nursing students, with a few reporting negative experiences. These largely positive
relationships are a product of positive interaction, and concomitant positive feelings. Similarly, negative
relationships were found to be a product of negative interaction and concomitant negative feelings
between these two groups. Nurse educators on the other hand, also enjoyed positive relationships with
their students. A few highlighted that their relationship with students was sometimes variable
Conclusion: Nurse educators should provide opportunities for professional and personal time with their
students, and trust them enough to include them in decision-making. They should also make time to
understand the evolving politics and dynamics in the country and integrate these in the teaching
programs. Policymakers should review the preparation and evaluation of nurse educators in line with the

political and socio-economic changes that are taking place in the country. They should consider in-service
training and workshops that lead to higher levels of student satisfaction. To increase job satisfaction and
fulfilment, they should also provide support programmes that include mentoring and coaching for nurse
educators.
References
1. Brockman, JL, Nunez, AA & Basu, A (2010). Effectiveness of a conflict resolution training program in changing
graduate student style of managing conflict with their faculty advisors. Innov High Educ 35:277-293 2. Gillespie, M
(2005)Student-teacher connection: a place of possibility. Journal of Advanced Nuring, 52(2), 211-219 3. Harrison, TR
(2007). My Professor is so unfair: Student attitudes and experiences of conflict with faculty. Conflict Resolution
Quarterly 24(3):349-368
Contact
[email protected]

N 06 - Health Promotion in Nursing Practice
Engaging Nurses Across Disciplinary, Organizational and Sectoral Boundaries
for the Health of Vulnerable Populations: A Systemic Model of an Unfolding
Interface Nursing Practice in Quebec (Canada)
Lauralie Richard, RN, BS, Canada
Purpose
The purpose of this presentation is to describe a systemic model of an unfolding nursing practice
operating at the interface of Health and Social Service Centres (HSSC) in Quebec (Canada) and
community resources with the aim of reducing social vulnerability and health inequalities for vulnerable
populations.
Target Audience
The target audience of this presentation is nurses as well as other health care professionals interested in
primary care practices aiming to reduce social vulnerability and health inequalities for vulnerable
populations.
Abstract
Purpose: It is internationally renowned that primary care nurses are key actors in public health programs
that are dedicated to vulnerable populations. In Québec (Canada), such programs provide opportunities
to develop a nursing practice at the interface of Health and Social Service Centres (HSSC) and
community resources in order to reduce social vulnerability and health inequalities. Some nurses are now
crossing their disciplinary, organizational and sectoral boundaries to engage in what we refer to here as
interface nursing practice. Yet, to our knowledge, no study has documented this unfolding practice. The
objective of this study was to produce a systemic model of interface nursing practice in the context of
social vulnerability.
Methods: A qualitative exploratory study was undertaken in three urban HSSCs. Fifteen primary care
nurses participated in semi-structured interviews, followed by one year of direct and participant
observation of the interface practice of two nurses. During this time, informal interviews with
administrators, interprofessional teams and community actors, as well as an analysis of program and
governmental documents, were conducted to further our understanding of the context of interface nursing
practice. Thematic analysis was initiated during data collection, whereas Le Moigne’s systemic modelling
methodology was instrumental throughout the interpretive process of qualitative analysis and for the
representation of our study results and further theoretical elaboration.
Results: Four inter-related themes qualify interface nursing practice. First, this practice is guided by a
goal that is articulated as a social obligation for vulnerable populations, that of becoming autonomous.
Second, relational processes are central as nurses interconnect vulnerable individuals with various actors
and resources in the community. The third theme depicts interface nursing practice as strategic action.
Finally, the fourth theme highlights opposing or contradictory processes that are experienced by nurses
engaged in interface practice and that appear to change their sense of professional identity.
Conclusion: This study demonstrates the relevancy of creating coherent linkages with knowledge from
various disciplines to strengthen our capacity to theorize nursing practice as well as intervention in the
context of social vulnerability in order to reduce health inequalities. Further examination of our results, at
the intersection of nursing knowledge and social science theories, underscores fundamental dimensions
of the concept of practice that are essential to consider in nursing theory development: the central
concepts of care and environment, in addition to those of knowledge and projects.
Contact
[email protected]

The Use of Allostatic Load for Health Promotion with New Graduate Nurses in the
U.S.
David P. Hrabe, PhD, RN, USA
Jaclyn Buck, PhD, RN, NE-BC, USA
Janet A. Gatto, MS, MPS, RN, USA
Loraine Sinnott, PhD, USA
Purpose
to provide an overview of how allostatic load can be used to calculate lifetime risk of developing chronic
diseases.
Target Audience
Clinicians who work in non-acute, employee health or academic settings will benefit from attending this
session.
Abstract
Purpose: With over 2.6 million practicing Registered Nurses in the U.S., nurses represent the largest
sector of the health professions (American Nurses Association, 2011; Bureau of Labor Statistics, 2010).
While nurses’ education prepares them to promote the health of the patients and families they serve, too
often they fail to adequately care for themselves and engage in unhealthy lifestyle behaviors. Some of the
profession’s most vulnerable populations, new graduate nurses, often struggle between the transition
from school to work. Successful transition of newly licensed nurses into practice is essential for safe
nursing practice (Roth, 2010). Yet, the transition of nursing graduates to their first position often results in
very high turnover: 35-60 percent of new graduates leave their first nursing position within the first year
(Advisory Board Company, 2006) and up to 25% of new graduate nurses leave nursing altogether
(Hwang, 2004). Nurse internship/residency programs have been created to address the new graduate
nurse dilemma and have been somewhat successful in reversing these trends. Our university hospitals
sponsor a robust program in which Nurse Interns participate in a year-long program that is designed to
increase new graduate confidence, autonomy, and satisfaction. This study is focused on determining if
the integration of a two-day workshop about personal health and well-being conducted during the Nurse
Intern residency improves health behaviors in new graduate nurses.
Methods: A descriptive correlational design was used with baseline data from new graduate nurses
attending the two-day Nurse AthleteTM program, a workshop that focuses on nutrition, energy
management and physical activity (some results reported previously). Among the psychosocial and
biometric markers that have been collected on this population of new graduate nurses, a relatively new
measure, the Allostatix Load TestTM, has been collected and analyzed. Allostatic load is the
physiological wear and tear on the body that results from ongoing adaptive efforts to maintain stability
(homeostasis) in response to stressors. Typical health risk assessments do not predict future health
problems well; in fact, Sacks’ seminal 1980 article on the reliability of the health hazard appraisal found
that only 15% of participants studied gave consistent answers at baseline and follow up, giving little
accuracy to what is likely to happen to an individual’s health in the future. More than 20 years ago, a
group of noted scientists from UCLA, Rockefeller University, Princeton, and the University of Wisconsin
began a decades-long study of the application of allostatic load to predicting future health. Thousands of
individuals were followed for many years as they developed diseases or died. The subjects were between
18 and 70 years of age at the start of the studies. Several peer-reviewed research papers have been
published from these data, illustrating the clear efficacy of using allostatic load as a reliable measure of
future health (Carr, et al., 2005; Seeman, Karlamangia & Singer, 2006; Seeman, et al, 2004). The
Allostatix LoadTM (AL) test score is calculated by combining the results of various blood and physiologic
tests, chosen to provide information on the functioning of multiple body systems. Individual test results
are combined algorithmically to produce a single score that represents the cumulative impact of stress on

the individual at the time of the tests. The algorithm takes into consideration the full range of test results,
not just whether the results are within or outside the standard reference ranges, as well as the
interactions among the test results from a whole body system perspective.
Results: For allostatic load, we tested whether there was an on average difference in baseline and six
month scores. Change scores for participants (n= 38) were computed by subtracting the baseline score
(Time 1) from the six-month (Time 3) score. Overall, there was no significant difference between Time 1
and 3 (-1.26, SD = 24.96, p = -.76).
Conclusion: Analysis of allostatic load is another indicator of overall health with predictive ability. The
findings so far in this study have not been significant regarding the impact of the Nurse
AthleteTM intervention upon allostatic load. The test itself, however, provides additional information that
could be used as a motivational tool in promoting improvement in health behaviors. More research is
needed to explore this facet of the data.
Contact
[email protected]

Evaluation of a Government Deployment Project for Unemployed Nurses as Input
to Policy and Programmatic Directions
Josefina A. Tuazon, RN, BSN, MN, DrPH, Philippines
Purpose
The purpose of this presentation is to evaluate implementation and outcomes of a government
deployment project for unemployed nurses called Projects RNHEALS to underserved hospitals and
community centers in terms of enhancing clinical and public health competencies and potential
employability of deployed nurses as input to policy and programmatic directions.
Target Audience
The target audience of this presentation is nurses in key administrative positions both in academe and
practice who can gain from this study in developing programs in terms of deployment of nurses as well as
the methods employed in evaluating this Project.
Abstract
Purpose: At the peak of nurse unemployment in 2011 with the US and global financial crisis, the
Philippine Department of Health organized a training-cum-deployment project for nurses to be fielded in
underserved government hospitals and rural health centers called Project RNHEALS. The Project aimed
to enhance competencies of nurses in clinical and public health nursing and augment access to health
care in underserved communities. This study is a program evaluation focusing on assessing
implementation and outcomes of the Project as input to policy and programmatic directions. Specifically, it
(1) assessed recruitment, selection, deployment process and incentives within the context of the project
objectives and guidelines and (2) determine whether the training program enhanced competencies of
participating nurses.
Methods: This study used a mixed-method design. Records review, key informant interviews, focus
group discussion, a self-administered questionnaire, and an online competency assessment called Nurse
MetriX were the main methods of data collection measured at the beginning of the deployment and at 10
months. Competencies of RNH nurses were measured at 3 points: prior to deployment and at 3 and 10
months of deployment. Through a multi-stage stratified random sampling with probability of selection
proportional to size sampling technique, 7 provinces including NCR in 4 regions of the country were
covered with a total of 729 RNHEALS nurses from both hospital and rural health units. A total of 172
implementers of the project were also included as key informants. These included chief nurses, assistant
chief nurses, training coordinators, senior hospital staff nurses, city/municipal health officers, senior public
health nurses, DOH representatives, as well as DOH-HRDU personnel.
Results: This report will focus on results of process evaluation and RNH nurse competencies at 3-
months of deployment. 72% of the RNH nurses had prior nursing experience with 52% as volunteers in
hospitals and only 6% in community centers called RHUs.
Generally, the process of recruitment, selection and deployment varied according to region, province, and
institution, with biggest variability in the hospitals. DOH gave an option to hospitals to include institutions'
standards and criteria like interviews, competency examinations, hospital experiences, trainings, and
medical examination for screening RNheals candidates. There was a common perception that final
selection was not based on objective criteria.
In terms of the guidelines re the Training Program, there was varying compliance with greatest variability
in hospitals. Almost all hospital-assigned RNheals nurses were rotated in general wards. Only a few
rotated in the OPD as well as other special areas. Most RHU-assigned nurses were assigned to
Barangay Health Stations, supervised by Public Health Midwives. This gave rise to some problems
related to supervision, not being allowed to give injections and immunizations, and some interpersonal
difficulties for the RNH nurses. A few had opportunity to be assigned in birthing clinics depending on the
availability of the facility.

In reviewing changes in the DOH guidelines from batch I to IV, there were major changes that led to
some confusion in the implementation of the Project, as well as expectations of the RNH nurses and the
implementers.
Problems identified included delay in release of their monthly allowance, confusion re PhilHealth
insurance registration causing delay, lack of supervision in the hospitals, supervision by the Midwife in the
RHUs limiting their achievement of competencies, clamor for a certificate of employment to increase their
employability, difficulty of local government units to provide the additional monetary incentive given their
resources and the number of RNH nurses. There was a strong sentiment that the number and distribution
of RNH nurses deployed should be reviewed and be based on actual need, and to solicit the inputs more
of the LGUs and the DOH Representatives who know their community better. The RNH nurses also
resented to some extent being referred to as RNHEALS nurses and trainees as this undermined them
and tended to be treated as students rather than RNs.
Despite these concerns, assessment of competencies based on self-report showed significant increase
by 3-months into the program. For hospital nurses, there was significant improvement in all 11 domains
(p <0.05, paired samples t-test) except in two items related to preparing patients for procedures and
endorsing patients. For RHU nurses, competencies were based on involvement in public health
programs. As such, although there was reported improvement on most competencies, several or most
items related to “care during childbirth”, “postnatal care”, and “essential newborn care” did not. On
“emergency services”, there was no improvement in terms of the item of “providing basic life support and
first aid.” This was consistent with reports that the nurses had limited opportunities in these areas, and
depended greatly on availability of the facility and services. The domains related to childbirth and
newborn care were also mainly performed by midwives at the health centers or community.
Reports from other sources such as their supervising nurses were consistent with this self-report. RNH
nurses also reported satisfaction with the project and would apply again given the chance. For the RNH
nurses deployed in community centers, there was the added benefit of the nurses viewing public health
nursing more positively, and during the FGDs, indicated that some were interested to apply to such
positions in the future.
Conclusion: At 3 months, clinical and public health competencies of RNH nurses improved. In general,
RNH nurses were satisfied with the Project, particularly in providing them nursing work experience with
allowance. In terms of program implementation, although there was some variability, in general the
Project was implemented according to the set guideline. There were problems related to delayed
allowance and other incentives, selection and supervision particularly at RHUs where there is only one
Public Health Nurse so most of the supervision was by Midwives. Deployment in both hospitals and RHUs
even by 3 months showed significant improvement and enhanced employability. Preliminary
recommendations for the improvement of the project include transforming the Project from a training
program into regular employment even with a decrease in number who can be employed. This will
address issues of employability, certificates and compensation. On the service side, it will provide
continuity and better services with improved competency of the nurses. The number and distribution of
RNHEALS nurses or additional positions for nurses in the RHUs should be improved and be based on
need of the community/hospital or LGU as well as resources. Deployment in the RHUs also increased
positive interest in public health nursing.
Contact
[email protected]

N 07 - Diverse Implications of Nursing Research
From CBPR to RCT: Lessons Learned Over 10 years with Interventions in Public
Housing
Jeannette Andrews, PhD, RN, FAAN, USA
Martha S. Tingen, PhD, RN, FAAN, USA
Martina Mueller, PhD, USA
Purpose
The purpose of this presentation is to describe the lessons learned after 10 years of community engaged
tobacco cessation interventions with women in public housing in the Southeastern US.
Target Audience
The target audience of this presentation is clinicians and scientists interested in community health in high-
risk populations, community based participatory and behavioral nurse scientists, and nurses interested in
social determinants of health in high risk communities.
Abstract
Purpose: The purpose of this presentation is to describe the lessons learned after 10 years of community
engaged tobacco cessation interventions with women in public housing in the Southeastern US. The
original academic-community partnership in one Southeastern US metropolitan region identified the
health area of interest, assessment of need, and developed an overall plan of action, including a multi-
level and ecological based intervention at the neighborhood, peer group, and individual level. Primary
outcomes measured were smoking abstinence at 6 and 12 months post intervention.
Methods: A community based participatory research (CBPR) approach was used to develop, implement
and evaluate a culturally tailored intervention strategy to assist women in public housing to quit smoking
. A feasibility study (n=10 women) was conducted in one public housing neighborhood, followed by a pilot
study (n=103 women) in two public housing neighborhoods. With promising 6 month tobacco abstinence
outcomes (39% treatment condition vs. 11.5% control ) and other behavioral and psychosocial measures,
funding was received for a larger randomized controlled trial (RCT) in 16 neighborhoods (n=410 women)
across two states. In the RCT, the tobacco abstinence outcomes were less promising, with 12 month
abstinence rates of 12% in treatment neighborhoods vs. 5% in control neighborhoods. Additional
analyses and discussions ensued to better understand the outcomes and lessons learned.
Results: A CBPR approach was used with mutual interest of both the community and academic partners
in the initial two neighborhoods. The partnership worked together over 3 years to develop strategies,
methods, and materials, which fostered the interest and buy-in of the participating neighborhoods. With
the implementation of the RCT in expanded regions in two states, neighborhoods were selected based on
inclusion criteria, initial interest, with 2-3 months of time to cultivate relationships and trust. Lessons
learned in working with high risk vulnerable populations and implementation of CBPR developed RCT's
include: 1) Time to cultivate relationships and interest varies, but the longer positive history, the more
likelihood of trust and engagement; 2) Community and organizational readiness vary from neighborhood,
residents, and housing authority managers to include goodness of fit, capacity, and operations; 3)
Challenges with maintaining intervention fidelity in real world community based interventions with differing
readiness levels; and 4) Influence of neighborhood moderators to include social and environmental
context and changes in impoverished public housing communities (crime and violence, neighborhood
stress, social cohesion) over time.
Conclusion: Outcomes in randomized controlled trials in community-based clusters (i.e., neighborhoods,
churches, schools, clinics) will likely vary according to stakeholder engagement, readiness, and
social/environmental contexts. Further considerations regarding methods, approaches, and funding
sources are needed with the implementation of community-engaged interventions based on these and
other factors as we attempt to eliminate disparities in these high-risk vulnerable communities.
References

Andrews JO, Mueller M, Newman S, Magwood G, Ahluwalia JS, Wewers ME, Tingen M. (in review). Association
between individual and neighborhood level factors and smoking prevalence among African American women living in
subsidized housing. Addictive Behaviors. Tingen MS, Andrews JO, Heath J, Turnmire A, Waller J, Treiber F. (2013).
Comparison of Enrollment Rates of African American Families into a School-Based Tobacco Prevention Trial Using
Two Recruitment Strategies in Urban and Rural Settings. American Journal of Health Promotion 27[4]: 91-100. Spruill
I, Leite R, Fernandes I, Kamen D, Ford M, Jenkins C, Hunt K, Andrews JO. (2013). Successes, challenges, and
lessons learned: Community engaged research with South Carolina’s “Gullah” population. Gateways: International
Journal of Community Engagement and Research, 6:150-169. Andrews JO, Cox M, Newman S, Gillenwater G,
Warner G, Winkler J, White B, Wolf S, Leite R, Ford, M, Slaughter S. (2013). Training partnership dyads for CBPR:
Strategies and lessons learned from the Community Engaged Scholars Program. Health Promotion & Practice, 14
[4]: 524-533. Leite RS, Hudson C, West L, Carpenter B, Andrews JO. (2013). Assessment of oral health disparities
among the Gullah population of Hollywood, SC – Hollywood Smiles. Progress in Community Health Partnerships,
7(2): 201-208. Thrasher J, Carpenter M, Andrews JO, Gray K, Alberg A, Navarro A, Friedman D, Cummings M.
(2012). Cigarette warning label policy alternatives and smoking-related health disparities. American Journal of
Preventive Medicine, 43, 6: 590-600. Andrews JO, Newman SD, Heath J, Williams L, Tingen MS. (2012). Community
based participatory research and smoking cessation interventions: A review of the evidence. Nursing Clinics of North
America, 47(1): 81-96 Andrews JO, Newman SD, Meadows O, Cox MJ, Bunting S. (2012). Partnership readiness for
community-based participatory research. Health Education Research, 27(4), 555-571. Magwood G, Andrews JO,
Zapka J, Cox MJ, Newman S, Stuart G. (2012). Institutionalization of community partnerships: The challenge for
Academic Health Centers. Journal of Healthcare for Poor and Underserved, 23:1512-1526. Andrews JO, Tingen MS,
Jarriel SC, Caleb M, Simmons A, Brunson J, Mueller M, Ahluwulia J, Newman SD, Cox MJ, Magwood G, Hurman C.
(2012). Application of a CBPR framework to inform a multi-level cessation intervention in public housing
neighborhoods. American Journal of Community Psychology. 50(1-2):129-40. Andrews JO, Cox ME, Newman SD,
Meadows O. (2011). Development and evaluation of a toolkit to assess partnership readiness for community based
participatory research. Progress in Community Health Partnerships, 5(2): 183-188. Newman S, Andrews JO,
Magwood G, Jenkins C, Cox MJ, Williamson D. (2011). Community advisory boards for community based
participatory research: Synthesis of best practices. Preventing Chronic Disease, May; 8(3): A70. Andrews JO,
Bentley G, Brown A, Marion L, Pretlow L, & Tingen MS. (2007). A multi-level intervention to promote smoking
cessation in public housing neighborhoods: the Sister to Sister study. American Journal of Health Behavior, 31,6,
704. Andrews JO, Felton G, Wewers M, Waller J, & Tingen M. (2007). The effect of a multi-component smoking
cessation intervention with African American women in public housing neighborhoods. Research in Nursing & Health,
30:1, 45-60. Andrews JO, Bentley G, Crawford S, Pretlow L, Tingen M. (2007). Using community based participatory
research to develop a culturally sensitive smoking cessation intervention for African Americans in Public Housing
Neighborhoods. Ethnicity & Disease, 17, 331-337. Tingen MS, Gramling LF, Reimche DL, Andrews JO, & Chappell
K. (2007). Use, acceptance, and perceived benefits of an anti-tobacco socialization intervention in African American
parents. Annuals of Behavioral Medicine, 33, S074. Heath J & Andrews JO. (2006). Using evidence-based
educational strategies to increase knowledge and skills in tobacco cessation. Nursing Research, 55, 4S, S44-50.
Andrews JO, Felton G, Wewers M, Waller J, & Humbles P. (2005). Sister to Sister: assisting Southern low-income
women to quit smoking. Southern Online Journal of Nursing Research, 6(5), 2-23. Andrews JO. (2004). Sister to
sister: A community partnered tobacco cessation intervention in low-income housing developments. Dissertation
Abstracts International, 65 (12). 6286B. (UMI No. 3157115). *Heath J, Andrews JO, Kelly J. (2004). Caught in the
middle: Experiences of nurses who smoke. American Academy of Nurse Practitioners, 16 (9), 396-401. *Andrews JO,
Felton G, Wewers M, & Heath J. (2004). The use of community health workers in health research with ethnic minority
women. Journal of Nursing Scholarship, 36 (4), 358-365. *Tingen MS, Andrews JO, Waller J, & Daniel S. (2004). A
multi-component intervention targeting utilization of the Treating Tobacco Use and Dependence Guideline in a
primary care setting. Southern Online Journal of Nursing Research, 5(5), 2-23. Heath J, Andrews JO, & Andres K.
(2003). Tobacco control: An update to influence policy-making decisions. Policy, Politics, & Nursing Practice, 4(1),
36-44.
Contact
[email protected]

N 07 - Diverse Implications of Nursing Research
An Investigation of the Influence of Fish Oil Supplementation on IL-8: A Possible
Protection Against Preeclampsia
Sara Mitchell Edwards, RN, CNM, MN, MPH, USA
Purpose
The purpose of this presentation is to discuss the influence of maternal fish oil supplementation during
pregnancy upon the production of IL-8, suggesting a possible protective mechanism against
preeclampsia.
Target Audience
The target audience of this presentation are nurses and nurse-midwives in clinical practice and in
research.
Abstract
Purpose: Ten million women develop preeclampsia each year around the world. Of those, about 76,000
pregnant women will die from preeclampsia and related hypertensive disorders. Further, the annual
infant mortality rate from these disorders is estimated to be approximately 500,000. Land-locked or
mountainous regions of the globe, and thus with less oily ocean fish available in the diet, tend to have
higher rates of preeclampsia. Poor women are also more vulnerable to the disease. A woman is seven
times more likely to develop preeclampsia in a developing country than a woman in an industrialized
country.
Preeclampsia is an insidious disease with a long pre-clinical phase followed by a phase when maternal
systemic effects of proteinuria and elevated blood pressure appear, mainly due to endothelial
dysfunction. The current hypothesis of the etiology of preeclampsia is an exaggerated maternal
inflammatory response to fetal antigens which causes a cascade of events culminating in the release of
pro-inflammatory cytokines into the maternal circulation. Specifically, Interleukin-8 (IL-8) levels have been
found to be higher in women who develop preeclampsia in pregnancy.
Interleukin-8 (IL-8) is a chemokine that regulates pathologic angiogenesis and tumor growth. It also plays
a role in endothelial cell proliferation. Abnormal endothelial cells cause the majority of internal organ
dysfunction in preeclampsia. IL-8 attracts and activates neutrophils and is elevated in multiple systemic
inflammatory diseases. It is plausible that IL-8 either contributes to or could be used as a marker of
inflammation and endothelial dysfunction in early preeclampsia due to the abnormal cytokine response
involved in the progression of this systemic disease.
There are two main types of bioactive polyunsaturated fatty acids (PUFAs), the omega-6 (n-6) series, and
the omega-3 (n-3) series (linolenic acid [ALA], eicosapentaenoic acid [EPA], docosahexaenoic acid
[DHA]). They are important constituents of all cell membranes and essential for the survival of all
mammals. PUFAs cannot be synthesized in the body and can only be obtained from our diet, thus they
are called essential fatty acids. The cardio-protective action of anti-inflammatory eicosanoid levels
(derived from omega 3 fatty acids in fish oil) is believed to occur via enhanced endothelial production of a
vascular-relaxing factor. This results in vasodilatation which leads to a reduction in blood
pressure. Reduced platelet aggregation is another potential benefit of fish oil supplementation in
pregnancy and both actions could counteract or limit the preeclampsia-related hypertension and
hypercoagulability.
The aim of this analysis was to investigate the reported use of fish oil supplementation during pregnancy,
the factors that predict its use, and any association with serum levels of IL-8.
Methods: A total of 189 pregnant women in Colorado and Ohio who met inclusion criteria (e.g. general
good health, no chronic medications, non-smokers) were enrolled in a longitudinal study during their 3rd
trimester and followed through 6 months postpartum. This analysis only examined the single prenatal
time point. Fish oil supplementation was determined by self-report with a yes/no. Demographic

information (age, status of government support from the Special Supplemental Nutrition Program for
Women, Infants, and Children [WIC], marital status, race/ethnicity) was collected through self-report
survey. Plasma levels of pro- and anti-inflammatory cytokines were collected to measure inflammatory
response.
Results: Logistic regression was performed to assess for possible factors (age, BMI, Caucasian race or
other, WIC status) on the likelihood a woman would supplement with fish oil in pregnancy. The full model
containing all 4 predictors was statistically significant, Chi-square (6, N=188) =23.43, p<.000, indicating
the model was able to distinguish between respondents who reported they did or did not take fish
oil. Women who used fish oil supplements were more likely to be older (p<.01), thinner (p=.03),
Caucasian (p=.02) and not on WIC (p<.001). While the model as a whole only explained between 11.7
and 17.8 % of the variance in fish oil intake, it correctly classified 76.6% of cases. Only one of the
variables, WIC status, made a unique, statistically significant contribution to the model. The odds ratio of
.20 for WIC status indicated that subjects on WIC were .20 times less likely to take fish oil than those
without WIC. There were only 7 women who were underweight, with a BMI less than 18.5, so they were
removed from the analysis to improve the strength of the findings related to the other BMI
categories. After controlling for Caucasian or other race, WIC status and normal/overweight/obese status
(all but underweight), linear regression analysis revealed IL-8 levels were significantly lower among
women taking fish oil supplementation (p=.03) compared to those not taking this supplement.
Conclusion: Analysis was limited by how fish oil intake was reported. The subjects were merely asked if
they were taking a fish oil supplement, and it was recorded as yes/no. No amount or frequency of dose is
known. Despite this limitation, there were significant associations with fish oil use: higher age, higher
income, lower weight, and Caucasian race. Fish oil supplements are expensive and elective so they are
unlikely to be consumed unless it is considered affordable and necessary. There is no current
recommendation for fish oil supplementation as there are minimal and conflicting findings of beneficial
use in pregnancy. Given the growing global incidence of preeclampsia, closer study of fish oil
supplementation in pregnancy may prove to reduce risk or severity of the disease. Prenatal surveillance
of IL-8 levels may serve as an early marker or risk factor of the disease. Intervention before maternal
and fetal effects have progressed is needed to improve the devastating outcomes of preeclampsia in
pregnancy.
References
Assies, J., Mocking, R. J., Pouwer, F. C. O. N. J. O., & Pmid. (2011). Maternal depression and child development
after prenatal DHA supplementation. JAMA : the journal of the American Medical Association, 305(4), 360; author
reply 360-361. Calder, P. C. (2010). Omega-3 fatty acids and inflammatory processes. Nutrients, 2(3), 355-374.
Carlson, S. E., Colombo, J., Gajewski, B. J., Gustafson, K. M., Mundy, D., Yeast, J., . . . Shaddy, D. J. (2013). DHA
supplementation and pregnancy outcomes. The American journal of clinical nutrition, 97(4), 808-815. Cousens S,
Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunçalp O, Balsara ZP, Gupta S, Say L, Lawn
JE. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic
analysis. Lancet, 2011, Apr 16;377(9774):1319-30. Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal
morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American
Journal of Obstetrics and Gynecology, 2004. 192:342–349. Donahue, S. M., Rifas-Shiman, S. L., Olsen, S. F., Gold,
D. R., Gillman, M. W., & Oken, E. (2009). Associations of maternal prenatal dietary intake of n-3 and n-6 fatty acids
with maternal and umbilical cord blood levels. Prostaglandins, leukotrienes, and essential fatty acids, 80(5-6), 289-
296. Emmett, R., Akkersdyk, S., Yeatman, H., & Meyer, B. J. (2013). Expanding awareness of docosahexaenoic acid
during pregnancy. Nutrients, 5(4), 1098-1109. Genuis, S. J. C. I. N. R. T. J., & Pmid. (2008). To sea or not to sea:
benefits and risks of gestational fish consumption. Reproductive toxicology (Elmsford, N.Y.), 26(2), 81-85. Mocking,
R. J., Ruhe, H. G., Assies, J., Lok, A., Koeter, M. W., Visser, I., . . . Schene, A. H. (2013). Relationship between the
hypothalamic-pituitary-adrenal-axis and fatty acid metabolism in recurrent depression. [Journal Article].
Psychoneuroendocrinology, 38(9), 1607-1617. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos
T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health
data. Lancet, 2009, 374:881–892. Villar J, Say L, Gulmezoglu AM, Meraldi M, Lindheimer MD, Betran AP, Piaggio G;
Eclampsia and pre-eclampsia: a health problem for 2000 years. In Pre-eclampsia, Critchly H, MacLean A, Poston L,
Walker J, eds. London, RCOG Press, 2003, pp 189-207. Ronsmans C, Graham WJ on behalf of the Lancet Maternal
Survival Series steering group, “Maternal mortality; who, when, where and why.” The Lancet, Maternal Survival,
September 2006. Preeclampsia: A Decade of Perspective, Building a Global Call to Action. Preeclampsia
Foundation, Melbourne, Florida, Nov 2010. Kuklina EV, et al. Hypertensive Disorders and Severe Obstetric Morbidity
in the United States. Obstet Gynecol 2009; 113:1299-306. Maternal mortality in 2005: estimates developed by WHO,

UNICEF, UNIFPA and the World Bank, Geneva, World Health Organization, 2007. Lack of Preeclampsia Awareness
Increases Risk of Infant Mortality, Press Release, Preeclampsia Foundation, May 8, 2008. Ross, B. M. (2009).
Omega-3 polyunsaturated fatty acids and anxiety disorders. [Evaluation Studies Journal ArticleReview].
Prostaglandins, leukotrienes, and essential fatty acids, 81(5-6), 309-312.\ World Health Organization Fact Sheet, May
2012.
Contact
[email protected]

N 10 - Considerations in Global Nursing Education
Breaking Bad News: Confronting Interdisciplinary Bias
Rita Ann Dello Stritto, PhD, RN, USA
Peggy A. Landrum, PhD, RN, CS, USA
Purpose
To describe an inter-professional education project designed to facilitate collaboration by nursing,
medical, and pharmacy students in a simulated medication error scenario; to discuss findings in the
processing groups following the simulations; and to generate dialogue that addresses the biases that
exist on inter-professional health care teams.
Target Audience
Academic, clinical and administrative health care professionals who are interested in inter-professional
biases among nursing, medical, and pharmacy students, in the communication strategies used when they
work together in a challenging medication error simulation, and in their change perceptions following the
simulation exercise.
Abstract
Purpose: A critical component of safe patient care in today’s health care system is effective teamwork.
Teams composed of members from various health care disciplines depend upon successful
interprofessional collaboration under stressful conditions to achieve desired health outcomes. The
purpose of Phase I of this multifaceted project was to bring together healthcare students from multiple
disciplines – including nursing, medicine, and pharmacy: a) to collaborate on planning and implementing
an approach to managing a challenging patient care situation, and b) to identify their own
biases, challenges, and successes with interprofessional communication.
Methods: In teams of 3, one from each discipline, students are asked to engage in a two-stage
simulated patient family encounter, and then participate in a debriefing discussion with clinical educators
from each discipline. Prior to the simulation, team members have ten minutes to learn about each other’s
discipline and professional culture. The simulated scenario, using Standardized Patient (SP) Model,
involves a serious medication error. Educators provide a description of the error and each team
member’s responsibility for the error. The patient has survived and has been transferred to the medical
intensive care unit. The task for the team is to discuss the error with the patient’s family member. The
team has ten minutes to plan how they will approach the family member. In the next stage, the team has
a 15-minute meeting with the family member during which a trained actor (SP) portrays a family member
who is emotional, either angry or sad, about the error that has occurred. During the debriefing phase,
the clinical educators attempt to elicit perceptions of responsibility for the error, in a safe environment,
and encourage students to discuss the challenges of the interdisciplinary experience.
Results: During the debriefing, students were able to recognize the expertise each profession brings to
patient care delivery, to openly demonstrate respect and trust for the other members of their team, and to
clearly identify what they would do differently ‘next time. The students often reported a greater
appreciation at the breadth of knowledge held by their colleagues in other professions. Additionally, they
reported several points of identification with each other that often resulted in a higher degree of respect
and trust for the other disciplines. The students acknowledged that an increase in trust and respect for
each other would lead to improved patient outcomes. Finally, students reported greater comfort in
communicating with their team members about patient care and potential errors following the simulation
when compared to before the collaboration.
Conclusion: The simulated experience was useful, in that it gave the students from different disciplines
and three different universities an opportunity to identify interdisciplinary biases that each had towards
one another. This led to an understanding of how to conquer the biases and provided a pathway towards
improved communication strategies, which will indirectly promote patient safety and improved patient
outcomes.

References
1. Lockyer J, Gondocz ST, & Thivierge RL. (2004) Knowledge translation: The role and place of practice reflection. J
Contin.Educ Health Prof., 24, (1) 50-56. 2. Van Der Vegt GS & Bunderson JS. (June 2005) Learning and
performance in multidisciplinary teams: The importance of collective team identification. The Academy of
Management Journal, 48(3), 532-547.
Contact
[email protected]

N 10 - Considerations in Global Nursing Education
A Qualitative Study Exploring the Use of Visual Thinking Strategies with Nursing
Students
Meg Moorman, PhD, RN, WHNP-BC, USA
Purpose
The purpose of this presentation is to present results of a study revealing the meaning of Visual Thinking
Strategies (VTS) for nursing students. Information about VTS and how students used it in care of patients
will be presented and highlights of how it informed the researcher’s teaching will be discussed.
Target Audience
The target audience of this presentation is nurse educators interested in innovative teaching techniques
using art as a mode for developing communication skills. They will also be interested in VTS as a way to
employ interprofessional communications with students who may then transfer these skills to their work
as nurses.
Abstract
Purpose: Nurse educators are called upon to provide creative, innovative experiences for students in
order to prepare nurses to work in complex healthcare settings. As part of this preparation, teaching
observational and communication skills is critical for nurses and can directly affect patient
outcomes. Visual thinking strategies (VTS) are a teaching method that has been studied in primary
education to develop communication and observational skills. The purpose of this study was to explore
the meaning of Visual Thinking Strategies with nursing students. The students also discussed how they
used VTS in caring for their patients.
Methods: Students enrolled in a 6th semester obstetrics course at a large midwestern university were
given an option to experience VTS as a homework option. Those students were then recruited during
their 7th semester to participate in the research study. Nine students volunteered and informed consent
was obtained. These students participated in two 60-minute VTS experiences at a local art museum,
facilitated by an art museum educator trained in VTS. Students were then interviewed by the researcher
and these interviews were audio taped. These interviews were transcribed and analyzed for common
themes. Heideggarian hermeneutics was used as the research method for analysis in this qualitative
study. Interviews were conducted based on the following questions: What meaning does VTS have for
nursing students? How do students who have experienced VTS use it in their care of patients? Themes
were identified during data analysis and verified by a research team experienced in Heideggarian
hermeneutics. The researcher also did a literature review following the data analysis to validate and
expand findings. Heideggarian hermeneutics was also the philosophical framework for the study.
Results: Two themes emerged from data analysis of transcripts from participants: Feeling safe in
learning and Seeing differently. Also revealed in the findings were themes from the perspective of the
researcher; validation, mutual respect, and reformulation of the VTS process into clinical practice. The
term "facilitative teaching" was created from this data.
Participants in VTS were able to link their interactions with the artwork directly to patient care
metaphorically. They also used the process of questioning by the facilitator to question both patients and
family members in order to develop a more clear understanding. This ability to translate an educational
experience into a real-world experience was identified in the theme of reformation of VTS processes to
clinical practice. The VTS facilitator asks participants to take a moment and observe a work of art. After
that observation, the facilitator asks the group “What is going on in this painting?” A follow-up question of
“What are you seeing that makes you say that?” requires the participant to give visual evidence for what
they are seeing and back it up. Educators can pose this question to students in a myriad of ways, without
casting judgment or criticism. This question and the attentive listening that occurs afterward are
important as one attempts to understand what was said and also requires the student to provide
evidential reasoning. At the same time, the facilitator/educator is demonstrating a sincere attempt to

understand the response or answer. Students can use this line of questioning in their clinical practice as
part of an assessment, or to gain more insight into how patients are thinking. The importance of listening
attentively and paraphrasing back cannot be emphasized enough, as these components demonstrate
respect from the facilitator/educator. Mutual respect in education can increase the likelihood that
students participate and speak up. Finding a voice is an important component of nursing care and
communications.
The act of looking at a work of art as a whole picture, then breaking it down into smaller pieces and then
stepping back and gaining perspective from viewing the whole is a metaphor for how students can view
clinical situations. This act of looking enhances students’ abilities to assess and observe in clinical
situations. Participants in this study were able to translate the experience of VTS into their clinical
practice and “see the big picture”. Nurse educators can incorporate this into their teaching by projecting
an image of a complicated work of art onto a screen and asking students “What is going on in this
picture?” By following the VTS facilitator questions, students can learn the process of the line of
questioning. Then the educator might show a picture of a complicated patient and have students practice
breaking the components of the scenario into smaller pieces. This process can model for students how to
systematically assess and question, increasing the likeliness that they use this same systematic process
in caring for patients. Students can learn to look critically and think systematically. The nurse educator
can also model for students how to question and seek understanding without judgment or criticism.
The facilitator asked students to take a moment and observe the work of art. The simple act of taking a
moment to examine the artwork showed the students that their opinions were going to be considered
carefully and that she was going to invite them to participate. She did not call on participants; she simply
asked “What is going on in this work of art?” and then allowed students to volunteer. This invitation was
important in that it showed a level of mutual respect and recognition that participants were invited to join
the discussion, not required to participate. Again, this invitation demonstrates a level of respect for the
student, not commonly done by educators. Inviting participation is more respectful than demanding an
answer or calling on someone who was not ready to respond. The act of inviting participation is a subtle
way for nurse educators to demonstrate respect for students instead of putting them on the spot or
making them feel pressured to respond. Mutual respect from nurse educators can be provided by
attentive listening, paraphrasing, and seeking further understanding. Nurse educators can provide
respect for students by suspending judgment and encouraging expansion of thought. This process can
reveal student thinking, at the same time demonstrating mutual respect and collegiality. Again, modeling
for students can increase the likelihood that they will use these same techniques in their nursing.
In summary, participant interviews revealed aspects of the role of facilitator that nurse educators can
incorporate into the classroom. The facilitative teacher can promote mutual respect and validate
students, which increases the likelihood that they will participate and find their voice. The facilitative
teacher can also expand student thinking by inviting participation and seeking understanding from
students about how they understand a concept. As the facilitative teacher listens attentively and
paraphrases, she promotes a mutual respect in the classroom. This mutual respect can enhance
learning and encourage participation, which helps students to find their voice and be more likely to speak
out. As students translate these skills into their clinical practice, they synthesize these concepts into their
nursing care. Students who speak out in class and question may be more likely to incorporate that voice
into their work as nurses. Nurses who speak out are more likely to communicate with other healthcare
workers, which may enhance patient outcomes. Facilitative teaching strategies are realistic and easy to
incorporate in any clinical, classroom, or laboratory setting. Information about basic concepts, rationale
for use, and ways to incorporate into learning settings are included in the table below.
Table 3. Facilitative Teaching in Action
Themes that Emerged from Educational Rationale for Practice How nurse educator can implement these concepts
Researcher Perspective about into practice
VTS
Validation Promotes speaking out Paraphrase student response

Ask “Tell me how you came to that conclusion” and

paraphrase back to student.
Ask “Did I understand you correctly?”
Reformation of VTS Formulation/Reformulation Display complicated work of art during class and
Processes in Clinical Practice ask “Tell me what’s going on in this picture”
Ask “What are you seeing that made you say that”
Paraphrase back
Provide picture of complicated patient scenario and
repeat above questioning like VTS
Mutual Respect Mutual respect in learning and Invite participation (don’t require it), seek
education understanding of student’s view, ask for rationale
and how they came to the conclusion, paraphrase
and seek understanding of response, model mutual
respect through direct questioning without judgment
or criticism.
Conclusion: Themes of feeling safe in learning and thinking and seeing differently were identified and
the term “Facilitative teaching” came from these results. These themes revealed that students were able
to explore their thoughts and question because of the way the facilitator questioned them in a safe
environment. They were also able to see their work with art and formulate a method to approach their
care with patients in hospital settings. Nurse educators can use this teaching method (VTS)
inexpensively and promote interdisciplinary educational work with other medical disciplines, as called for
by the NIH. Further studies are suggested that would include nursing students working with other
disciplines in art museums. Medical, social work, respiratory therapy, and public health students could all
be included to develop interdisciplinary educational studies that promote communication and
observational skills.
References
Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford,
CA: Jossey-Bass. Housen, A. (2001). Eye of the beholder: Research, theory and practice. Visual Understanding in
Education (VUE), 1-26. Retrieved from
http://www.vtshome.org/system/resources/0000/0006/Eye_of_the_Beholder.pdf Housen, A., & Yenawine, P. (2002).
Aesthetic thought, critical thinking and transfer. Arts and Learning Research Journal, 18, 99-131. Retrieved from
http://www.vtshome.org/system/resources/0000/0014/Aesthetic_thought.pdf Klugman, C. M., Peel, J., & Beckmann-
Mendez, D. (2011). Art rounds: Teaching interprofessional students visual thinking strategies at one school.
Academic Medicine, 85, 1266-1271. doi:10.1097/ACM.0b013e31822c1427 Landorf, H. (2006). Perspectives on
teaching: What’s going on in this picture? Visual thinking strategies and adult learning. New Horizons in Adult
Education and Human Resource Development, 20(4), 28-32. doi:10.1002/nha3.10267 Moorman, M. (2013). The
meaning of Visual Thinking Strategies for nursing students. Available on Proquest. Vygotsky, L. (1978). Mind in
society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. Vygotsky, L.
S. (1993). The collected works of L.S. Vygotsky, Vol. 2. New York: Plenum Press.
Contact
[email protected]

N 12 - Culturally Diverse Health Behaviors
Chronic Health Conditions and Behaviors Among Persons Entering Maximum
Security Prison
Elaine Larson, RN, BSN, MA, PhD, USA
Dhritiman Mukherjee, PhD, USA
Montina B. Befus, BS, MPH, USA
Jennifer Bai, BS, MPH, USA
Zoltan L. Apa, BS, USA
Franklin D. Lowy, BA, MD, USA
Purpose
The purpose of this presentation is to describe the chronic health conditions and behaviors among
persons entering maximum security prison
Target Audience
The target audience of this presentation is clinicians and health care providers, particularly those working
with vulnerable populations.
Abstract
Purpose: To describe health conditions and risk behaviors among persons entering maximum security
prison in New York State.
Methods: Between January 2011 and March 2013 as part of a study to assess the prevalence of
methicillin-resistant Staphylococcus aureus (MRSA), male (n=426) and female (n=404) inmates at intake
to two New York State maximum-security prisons were interviewed regarding demographic, social, and
health issues, their medical records were reviewed, and anterior nares and oropharyngeal samples were
collected. The majority (>96%) were entering from other jails or prisons.
Results: Approximately one-third each were aged <30, between 30-40, or >40 years; 47% were black,
24% white, 20% Hispanic, and 8% other. The largest proportion (44%) had <high school education, 36%
completed high school, and 20% had some college education; the majority (80%) rated their health as
excellent or good. The estimated prevalence of medical conditions was: asthma (31.4%), hypertension
(14.1%), hepatitis C (9.1%), diabetes (6.9%), HIV (5.9%), renal disease (2.7%). For health-related
behaviors, prevalence was: cigarette smoking (74.2%), illicit drug use ever (83.8%), marijuana use ever
(76.6%), cocaine use ever (41.3), tattoos (59.1%). Antibiotic use within the previous 6 months was
reported by 17.7%. All medical conditions and most behavioral risk factors except tattooing were reported
with greater frequency among women than men. Overall, >50% of inmates were colonized with S.
aureus; 5.9% of men and 10.6% of women were colonized with MRSA, a rate approximately 10 times
higher than in the general population.
Conclusion: Men and women entering prison have high rates of chronic health conditions and behaviors
that increase their risk of disease and infection. Adequate provision of health services in prison is
important to reduce morbidity and prevent transmission of infectious diseases within the prison and after
parole.
Contact
[email protected]

N 12 - Culturally Diverse Health Behaviors
Engaging Chinese-Americans in Advance Care Planning: A Pilot Study
Mei Ching Lee, PhD, RN, USA
Katherine A. Hinderer, PhD, RN, USA
Purpose
Implement a culturally sensitive seminar to engage community-dwelling Chinese Americans in advance
care planning (ACP). The aims of the study were to examine the effectiveness of a culturally sensitive
ACP seminar on (1) Advance directive (AD) knowledge and (2) engagement of Chinese Americans in
ACP and AD completion.
Target Audience
nurses and other health professionals
Abstract
Purpose: Implement a culturally sensitive seminar to engage community-dwelling Chinese Americans in
advance care planning (ACP). The aims of the study were to examine the effectiveness of a culturally
sensitive ACP seminar on (1) Advance directive (AD) knowledge and (2) engagement of Chinese
Americans in ACP and AD completion.Advance care planning is the process through which individuals
consider the types of medical treatments and decisions they would want if they were no longer able to
speak for themselves.1 Advance directives, an element of ACP, allow individuals to document their
treatment preferences when they are no longer able to speak for themselves.2 In the United States (US),
overall AD completion is approximately 18-36%. This rate is even lower in ethnic minority groups
including Asian Americans.3 Identified barriers to ACP and AD completion are lack of knowledge about
ACP and AD4-5 and cultural values. Minority groups, including the Chinese Americans, were found to have
significantly less ACP knowledge and were less engaged in ACP.3 Chinese culture embraces collectivism
and a family-centered approach to decision-making; autonomy, a central principle in the ACP process, is
not highly valued in Chinese culture.6 In the US, the Chinese American population is quickly increasing,
thus emphasizing the need for ACP engagement in this population.7
Methods: This study was a quasi-experimental, repeated-measures, pre-test, post-test design. After
institutional review board approval, a convenience sample of community-dwelling Chinese Americans
was recruited. A culturally sensitive bilingual (English and Mandarin) educational seminar on ACP and AD
was conducted. The nurse-led seminar included an overview of the ACP process, definitions of terms
commonly used on ADs, and a step-by-step guide to completing an AD. Participants were asked to
complete a background survey, the Advance Directive Knowledge Survey (ADKS), and the Advance
Directive Questionnaire (ADQ) before and after the seminar. Data were collected immediately before
(time 1), immediately after (time 2) and one month after (time 3) the seminar. Data were analyzed using
SPSS version 19.0. Descriptive statistics were used to describe sample characteristics, AD knowledge
scores, AD completion rates, and engagement in ACP conversations with family and loved ones. Pearson
correlations and Chi-square tests were used to explore the relationship between demographic variables
and engagement in ACP. Inferential statistics were used to examine the effectiveness of the seminar on
AD knowledge and engagement in ACP.
Results: The sample size was 72. We had a 99% (n= 71) response rate at time 1, a 100% (n= 72)
response rate at time 2, and an 88% (n= 63) response rate at time 3. Participant age ranged from 32 to
87 with mean age of 61 years (SD = 12.2). The majority of participants were female (63.9%, n=46) and
were born in China (65.3%, n= 47). Many participants (44.44%, n=32) were college educated. Prior to the
seminar (time 1), mean knowledge scores, as assessed by the ADKS, were 7.11(SD =
1.98). Immediately after the seminar (time 2) knowledge scores increased to 9.20(SD = 1.07), and at
one-month follow-up (time 3), they were about the same at 9.22 (SD = 1.17). When comparing time 1
and time 2 ADKS scores, there was a significant increase in mean knowledge scores [t (70) = -8.380, p <
0.000]. Advance directive completion and ACP discussions were significantly higher one month (time 3)
after the seminar as compared to pre-seminar (time 1) [t (49) = -3.5, p = 0.01] and [t (37) = -5.187, p =

0.000] respectively. Several variables were significantly related to ACP at time 3. Age was positively
related to AD completion and ACP discussions (r =.397, p=0.001; r=.295, p=0.019). Sex was related to
ACP discussion only (χ2 =4.67, p=.031).
Conclusion: It is feasible to conduct a nurse-led educational seminar on ACP in a community-dwelling
population of Chinese. Chinese in this study were open to the topic and showed a willingness to learn
about ACP. This study supported previous research that found age and female gender was positively
related to engagement in ACP.8 Research is needed to examine the reasons for differences in AD
completion and ACP discussions. This culturally sensitive educational seminar significantly increased
participants’ AD knowledge. Knowledge levels remained high 1 month after attending the seminar.
Participants’ engagement in ACP significantly increased after the seminar as evidenced by reported AD
completion rates and ACP discussions on the time 3 follow up survey. Our results have global
implications for the importance of developing culturally sensitive nurse-led educational
interventions. Future research could incorporate similar models to improve the ACP engagement in
different cultural and ethnic groups.
References
1.Levi, B., & Green, M. (2010). Too soon to give up: re-examining the value of advance directives. Am J Bioeth,
10(4):3-22. 2.McCune, S. (2014). Worlds of connection: Applying an Interdisciplinary Relational Model of Care to
advance care planning. In L. Rogne & S. L. McCune (Eds.), Advance care planning: Communicating about matters of
life and death (pp. 139-154). New York: Springer. 3.U.S. Department of Health and Human Services. (2008).
Advance directives and advance care planning : Report to congress. Retrieved on June, 2013. From
http://aspe.hhs.gov/daltcp/reports/2008/ADCongRpt.pdf 4.Durbin, C., Fish, A. F., Bachman, J. A., & Smith, K. (2010).
Systematic review of educational interventions to increase advanced directive completion. Journal of Nursing
Scholarship, 42, 234-241 5.Johnson, R., Zhao,Y., Newby,L., Granger,C., & Granger,B. (2012). Reasons for
noncompletion of advance directives in a cardiac intensive care unit. America Journal of Critical Care, 21 (5), 311-20.
6.Fischer S., Sauaia, A., Min, S., & Kutner, J. (2012). Advance directive discussions: lost in translation or lost
opportunities? J Palliat Med, 15(1):86-92. 7 Pew Research Center (2013). The rise of Asian Americans.
http://www.pewsocialtrends.org/files/2013/04/Asian-Americans-new-full-report-04-2013.pdf 8.Black, K., Reynolds, S.,
& Osman, H. (2008). Factors associated with advance care planning among older adults in Southwest Florida.
Journal of Applied Gerontology, 27 (1), 93-109 DOI: 10.1177/0733464807307773
Contact
[email protected]

Part V: Evidence-Based Practice Poster Presentations
EBP PST 1 - Evidence-Based Practice Posters Session 1
Improving Neurologic Outcomes of Cardiac Arrest Patients Through Therapeutic
Hypothermia
Alfie Jay C. Ignacio, DNP, MSN, RN, USA
Purpose
The purpose of this project is to implement and evaluate the effectiveness of a therapeutic hypothermia
program on neurological outcomes and survival rate of post cardiac arrest patients.
Target Audience
The target audiences of this presentation are Critical Care Nurses, Emergency Department Nurses,
Managers, and Directors.
Abstract
Problem/Issue: Post cardiac arrest patients have a high mortality rate and poor neurologic outcomes in
spite of standard post resuscitation care and intensive critical care monitoring. Out of 164,000 cardiac
arrests occurring in the United States annually, 65-95 % dies. Those that survive suffer adverse health
outcomes including physical disabilities, physiologic instability, and systemic complications.
Background: The American Heart Association recommends initiation of therapeutic hypothermia to
patients who remain comatose after resuscitation from sudden witnessed out-of-hospital cardiac arrest.
Therapeutic hypothermia is an intervention that cools the post arrest patient to a temperature of 32-34°C
with iced saline or other surface cooling measures after the return of spontaneous circulation. The
temperature is maintained for a period of 18-24 hours. Research has shown that patients who undergo
therapeutic hypothermia are more likely to survive to hospital discharge compared to standard post-
resuscitation care. Therapeutic hypothermia has been shown to improve neurologic outcomes and
decrease mortality following cardiac arrest.
Purpose: To implement and evaluate the effectiveness of therapeutic hypothermia on neurological
outcomes and survival rate of post cardiac arrest patients.
Methods: A policy and protocol was developed by the clinical nurse specialist in collaboration with the
ED and ICU nursing staff, ED physicians, respiratory therapy, physical therapy, pharmacy, and clinical
informatics which outlined the approach for instituting immediate hypothermia in patients remaining
comatose following out-of –hospital cardiac arrest. The goal was to start therapeutic hypothermia within
six hours after return of spontaneous circulation and to keep the patient’s temperature at 33° C for a
period of 18-24 hours. Staff was educated about the protocol and a therapeutic hypothermia kit was
provided to the ED and ICU which contain the protocol and supplies to initiate hypothermia.
Results: Findings were based on mortality rate and neurologic outcomes. Modified Rankin Scale (MRS)
was used to measure neurologic outcomes. An MRS score of two or lower indicates a good functional
outcome. There were 43 patients who met the criteria for therapeutic hypothermia since the program
started in 2011. Twenty patients survived and twenty-three patients died following hypothermia. Of the 20
patients who survived, seventeen patients survived with good neurologic outcomes (MRS score of 1-2),
and 3 were discharged with neurologic deficit (MRS score of 3 and above).
Implications: Results suggest therapeutic hypothermia decreases mortality rate and improves neurologic
outcomes. However, continuing educational needs exist among staff to master the skills in the provision
of therapeutic hypothermia. A well developed policy will guide nurses in instituting hypothermia as
indicated.
References

References: American Heart Association (2010). Highlights of the 2010 American Heart Association Guidelines for
CPR and ECC. Retrieved from http://static.heart.org/eccguidelines/index.html Bernard SA, Gray TW, Buist MD, et. al.
(2002).Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. New England
Journal of Medicine. 346; (8):557-563. EEC Committee, Subcommittees, and Task Forces of the American Heart
Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care (2005). Circulation.112( suppl 24):IV1-203. The Hypothermia After Cardiac Arrest Study Group.
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest (2002). New England Journal of
Medicine. 346(8):549-556.
Contact
[email protected]

Assessing Reliability and Validity of the Chinese Version of the Functional
Independence Measure on Stroke Patients
Shu-Chen Hsiao, MSN, RN,, China
Purpose
The purpose of this presentation is to be use the scale to measure functional performance in a sample of
Stroke participants in southern of Taiwan.then to provide evidence exists that FIM scores can be used as
an accurate predictor of outcomes in stroke patients and carrying out their daily activity.
Target Audience
The target audience of this presentation is can be an effective means of connecting with health providers
used to identify patients with stroke carrying out the daily activity.
Abstract
Background: Functional Independence Measure (FIM) is one of the most widely used measures of self-
care performance. However, this scale has not been used to assess healthcare providers in Taiwan.
Purpose: Study purposes were to: (a) translate the FIM into Chinese, (b) examine validity and reliability
of the translated scale, and (c) use the scale to measure functional performance in a sample of Stroke
participants in southern of Taiwan.
Methods: Researchers used a backward translation approach to translate the FIM into Chinese in order
to ensure translation accuracy. Researchers then administered the FIM Chinese version to107
participants were enrolled from three hospitals in southern Taiwan. The study analyzed face validity,
construct validity, internal consistency, item analysis, and criterion-related validity.
Results: 1.The Content Validity Index of the Chinese version of Functional Independence Measure Scale
was.81; 2. The criterion related validity of Barthel Index scale were found to be statistically significant. (r
=.904; p < .001); 3. Exploratory factor analysis with principal components analysis indicated the FIM
revealed moderate inter correlations between subscales and high factor loadings also helped to clarify the
psychometric meaning. 4. Reliability estimates the Cronbach's alpha and correlation coefficients, were
0.95 and 0.80.
Conclusion: The reliability and validity data were outlined for the study support using the Chinese
version of the FIM as a research instrument in measuring the patients with stroke in the Chinese
population. It can be provide evidence exists that FIM scores can be used as an accurate predictor of
outcomes in stroke patients and carrying out their daily activity.
References
Alemdaroglu, E., Ucan, H., Topcuoglu, A. M., & Sivas, F. (2012). In-hospital predictors of falls in community-dwelling
individuals after stroke in the first 6 months after a baseline evaluation: a prospective cohort study. Arch Phys Med
Rehabil, 93(12), 2244-2250. doi: 10.1016/j.apmr.2012.06.014 Chumney, Douglas, Nollinger, Kristen, Shesko,
Kristina, Skop, Karen, Spencer, Madeleine, & Newton, Roberta A. (2010). Ability of Functional Independence
Measure to accurately predict functional outcome of stroke-specific population: Systematic review. The Journal of
Rehabilitation Research and Development, 47(1), 17. doi: 10.1682/jrrd.2009.08.0140 de Morton, N. A., & Lane, K.
(2010). Validity and reliability of the de Morton Mobility Index in the subacute hospital setting in a geriatric evaluation
and management population. J Rehabil Med, 42(10), 956-961. doi: 10.2340/16501977-0626 Fioravanti, Andrea M.,
Bordignon, Candace M., Pettit, Susan M., Woodhouse, Linda J., & Ansley, Barbara J. (2012). Comparing the
responsiveness of the Assessment of Motor and Process Skills and the Functional Independence Measure. Canadian
Journal of Occupational Therapy, 79(3), 167-174. doi: 10.2182/cjot.2012.79.3.6 Sun, T., Chiu, S., Yeh, S., & Chang,
K. (2006). Assessing reliability and validity of the Chinese version of the stroke scale: scale development.
International Journal of Nursing Studies, 43(4), 457-463. Gerevich, J., Bacskai, E., Ko, J., & Rozsa, S. (2005).
Reliability and validity of the Hungarian version of the European Addiction Severity Index. Psychopathology, Dodds,
T. A., Martin, D. P., Stolov, W. C., & Deyo, R. A. (1993). A validation of the Functional Independence Measurement
and its performance among rehabilitation inpatients. Archive Physical Medical Rehabilitation, 74, 531-536. Dromerick,

A. W., Edwards, D. F., Diringer, M. N. (2003). Sensitivity to changes in disability after stroke: A comparison of four
scales useful in clinical trials. Journal of Rehabilitation Research and Development, 40(1), 1-8.
Contact
[email protected]

The Efficacy of Care Model of Group Home for Caring the Elderly with Dementia:
A Systematic Review
Meng-Chin Chen, RN, Taiwan
Li-Wei Lin, PhD, RN, Taiwan
Li-Yen Yang, PhD, RN, Taiwan
Purpose
The purpose of this presentation is systematic review will be to critically appraise published clinical trial
studies to evaluate the effects of group home to caring for the elderly with dementia.
Target Audience
The target audience of this presentation is Long Term Care Nurse and nurse student.
Abstract
Background: The group home is one of the dementia care model and many studies have been
discussed for this issue. However, the effectiveness of group home is different because of different
research designed or method limitations (e.g. no measurement of long-term outcomes, and the lack of a
control group). Therefore, the effectiveness of group home currently has not complete evaluation in
clinical practice.
Purpose: The aim of this study was to appraisal critically the effectiveness of group home of group home
for caring the elderly with dementia.
Methods: Literature search included English and non-English reports in the Medline, PubMed, CINAHL
Plus with Full Text, Health Source, Cochrane library, Ageline, Academic Search Complete, ProQuest
Health and Medical, MEDLINE Complete, ProQuest Nursing and Allied Health Source, Chinese
Electronic Periodical Services (CEPS), Chinese Journal, Thesis Index and so on. Keywords including
dementia, Alzheimer’s disease and group home were keyed in and the search was limited to articles
published before June 2012. Literature search and quality assessment were conducted by two
independent reviewers. A total of 608 articles that matched search criteria were extracted. The quality
assessment was assessed by using modified Jadad Scale.
Results: Eleven articles met study inclusion criteria. The quality score of the 11 studies was between 1
and 3. Patients with dementia living group home in their daily living activity, walking ability and quality of
life were better than other long-term care institutions. Residents in group home have more independence
autonomy and motility and less use of psychotropic drugs and have a high frequency of interaction with
staff. The rates of survival and hospitalization for different care model have not significant difference in
cognitive status and problem behaviors for three-year follow-up.
Conclusions : Empirical results demonstrated that the care model of group home is effective for
dementia patients and offers recommendations of research design for future research so that to improve
the quality of care for dementia.
Keywords: group home, dementia, systematic review
References
Annerstedt, L. (1993). Development and consequences of group living in Sweden. A new mode of care for the
demented elderly. Soc Sci Med, 37(12), 1529-1538. Annerstedt, L. (1994). An attempt to determine the impact of
group living care in comparison to traditional long-term care on demented elderly patients. Aging (Milano), 6(5), 372-
380. Heron, M., Hoyert, D. L., Murphy, S. L., Xu, J., Kochanek, K. D., Tejada-Vera, B., et al. (2009). Deaths: Final
data for 2006. National Vital Statistics Report, 57(14), 1-135. Jadad, A. R., Moore, A., Carroll, D., Jenkinson, C.,
Reynolds, D. J., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical
trials: Is blinding necessary? Controlled Clinical Trials, 17, 1-12. James Lindesay, Kate Briggs, Matthew Lawes,
Alastair MacDonald, Joe Herzberg. (1991). The domus philosophy: A comparative evaluation of a new approach to
residential care for the demented elderly. International Journal of Geriatric Psychiatry, 6(10), 727-736. Kasl, G. J, &

Gatz, M. (2000). Psychosocial interventions for individuals with dementia: An integration of theory, therapy, and a
clinical understanding of dementia. Clinical Psychology Review, 20(6), 755-82. Nakanishi M, Nakashima T,
Sawamura K. (2012). Quality of life of residents with dementia in a group-living situation: an approach to creating
small, homelike environments in traditional nursing homes in Japan. Nihon Koshu Eisei Zasshi, 59(1), 3-10. Oremus,
M., Wolfson, C., Perrault, A., Demers, L., Momoli, F., & Moride, Y. (2001). Interrater reliability of the modified Jadad
quality scale for systematic reviews of Alzheimer’s disease drug trials.Dementia and Geriatric Cognitive Disorders,
12(3), 232-236. Rooij, A, HPM., Luijkx. K. G., Declercq, A. G., & Schols, J. MGA. (2011). Quality of life of residents
with dementia in longterm care settings in the Netherlands and Belgium: Design of a longitudinal comparative study in
traditional nursing homes and small scale living facilities. BMC Geriatrics, 11(20), 1-9. Selma te Boekhorst, A. M. P.,
Marja Depla, Dieneke Smit, Jacomine de Lange & Jan Eefsting. (2008). Group living homes for older people with
dementia: The effects on psychological distress of informal caregivers. Aging & Mental Health, 12(6), 761-768. Selma
te Boekhorstab, A. M. P., Marja Depla, Dieneke Smit, Jacomine de Lange & Jan Eefsting. (2009). The effects of
group living homes on older people with dementia: a comparison with traditional nursing home care. International
Journal Geriatric Psychiatry, 24, 970-978. Sandman PO, Wallblom A. (1996). Characteristics of the demented living
in different settings in Sweden. Acta Neurol Scand Suppl.168, 96-100. Saxton, J., Silverman, M., Ricci, E., Keane, C.,
& Deeley, B. (1998). Maintenance of mobility in residents of an Alzheimer special care facility. Int Psychogeriatr,
10(2), 213-224. Suzuki, M, K. M., Yasuda, M., & Oshiro, H. (2008). One-year follow-up study of elderly group-home
residents with dementia. American Journal of Alzheimer's Disease and other Dementias, 23(4), 334-343. te
Boekhorst, S., Depla, M. F., de Lange, J., Pot, A. M., & Eefsting, J. A. (2009). The effects of group living homes on
older people with dementia: a comparison with traditional nursing home care. Int J Geriatr Psychiatry, 24(9), 970-978.
doi: 10.1002/gps.2205 Van Zadelhoff, E., Verbeek, H., Widdershoven, G., Van Rossum, E, & Abma, T. (2011). Good
care in group home living for people with dementia. Journal of Clinical Nursing, 20 (17-18), 2490-2500. Verbeek, H.,
Rossum, E. V., Zwakhalen, S. M. G., Ambergen, T., Kempen, G. IJM., & Hamers, J. PH. (2009). The effects of small-
scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a
longitudinal, quasi-experimental study. BMC Geriatrics, 9(3), 1-10. Verbeek H, Z. S., Rossum E. V., Ambergen, T.,
Kempen, G. I, & Hamers, J.P. (2010). Effects of small-scale living facilities on residents, their family caregivers, and
staff. Journal of the American Medical Directors Association, 1(9), 662-670. Verbeek, H., Rossum, E. V., Zwakhalen,
S. M. G., Ambergen, T., Kempen, G. IJM., & Hamers, J. PH. (2010). Small-scale, homelike facilities versus regular
psychogeriatric nursing home wards: a cross-sectional study into residents’characteristics. BMC Health Services
Research, 10(30), 1-7. Verbeek, H., Zwakhalen, S. M., van Rossum, E., Ambergen, T., Kempen, G. I., & Hamers, J.
P. (2010). Dementia care redesigned: Effects of small-scale living facilities on residents, their family caregivers, and
staff. J Am Med Dir Assoc, 11(9), 662-670. doi: 10.1016/j.jamda.2010.08.001 Warren, S., Janzen, W., Andiel-Hett, C.,
Liu, L., McKim, H. R., & Schalm, C. (2001). Innovative dementia care: functional status over time of persons with
Alzheimer disease in a residential care centre compared to special care units. Dement Geriatr Cogn Disord, 12(5),
340-347. doi: 51279 Wimo, A., Adolfsson, R., & Sandman, P. O. (1995). Care for demented patients in different living
conditions. Effects on cognitive function, ADL-capacity and behaviour. Scand J Prim Health Care, 13(3), 205-210.
Yokota O, F. Y., Takahashi, J., Terada. S., Ishihara, T., Nakashima, H., Oshima, E., Kugo, A. Ata. T., Ishizu, H.,
Kuroda, S., & Sasaki, K. (2006). Effects of group-home care on behavioral symptoms, quality of life, and psychotropic
drug use in patients with frontotemporal dementia. Journal of the American Medical Directors Association, 7(5), 335-
337.
Contact
[email protected]

Sepsis Mortality Reduction Project at Contra Costa Regional Medical Center &
Health Center
Lai Ping Atalanta Wan, MS, RN, CNS, CCRN, USA
Purpose
The purpose of this presentation is to describe our improvement journey of the sepsis mortality reduction
project at Contra Costa Regional Medical Center in California, United State, and the outstanding results
that we have accomplished using Early Goal Directed Therapy guidelines and an interdisciplinary
approach.
Target Audience
The target audience of this presentation is nurses, physicians, infection control practitioners, advanced
nurse practitioners, health care managers, health care administrators, and other disciplines who have
interest in evidence-based practice.
Abstract
Why Is This Important: Sepsis is a complex syndrome that is difficult to define, diagnose, and treat. It is
a range of clinical conditions caused by the body’s systemic response to an infection. If it develops into
severe sepsis complicated with single or multiple organ dysfunction or failure, sepsis may lead to death.
Sepsis is a common leading cause of death in the United States, and the mortality rate of severe sepsis
ranges from 28% to 50% (Daniels, 2011).
Improvement Journey: The “Stomp Out Sepsis” (SOS) initiative began at Contra Costa Regional
Medical Center (CCRMC) in October 2009. Its roll-out began in January 2010 with refinements continuing
to this day. A multidisciplinary team involves physicians, nurses, lab personnel, infection control
practitioners, pharmacist, and other drawn from throughout the hospital to implement the SOS project.
The team utilized classic quality management techniques, such as standardized work (checklists and
standard sepsis order sets), inter-departmental collaboration, staff education, team building, frontline
nurse champions, and close monitoring to ensure continuous improvement towards our goals.
What Are We Trying to Accomplish: By June 30, 2015, we will reduce mortality due to sepsis at
CCRMC at least 15% by increasing early sepsis recognition and increased compliance with Early Goal
Directed Therapy (EGDT) guidelines (Dellinger et al., 2013). Achieve 95% compliance in the use of the
severe sepsis screening tool with all patients, and achieve at least 85% compliance in the use of the
EGDT bundle.
Inclusions: All patients age 18 years and older presenting to the emergency department (ED) or
inpatients on acute care units.
Exclusions: Inpatients on the hospital skilled nursing facility(SNF) units, OB patients, patients transferred
to ICU with severe sepsis or septic shock, patients who are “Do not Resuscitation” (DNR), “Do not
Intubation”(DNI), comfort care or palliative care on admission or ordered within 24 hours, and patients
who signed out “Against Medical Advice” (AMA), left the ED without being seen (LWBS), or who refuse
care.
Results: Up to date, September 2013, we reduce mortality due to sepsis at CCRMC to less than 15%,
and achieve above 50% compliance with the EDGT bundle (lactate, blood culture, antibiotic, fluid bolus)
within the first hour.
Lessons Learned/Challenges:
• Development and implementation of sepsis screening tool.
• Implementation of ISTAT lactate for ED patients.
• Institution of nurse stat lactate order protocol.
• Physicians reluctant to give fluid bolus when patients have multiple comorbidities.
• Blood collection supplies not easily accessible for inpatient nurses to draw STAT lactates.

• Confusion regarding which sepsis order set to use.
References
Daniels, R. (2011). Surviving the first hour in sepsis: Getting the basics right (an intensivist’s perspective). Journal of
Antimicrobial Chemotherapy, 66(Supplement 2), ii11-ii23. Dellinger et al. (2013). Surviving sepsis campaign:
International guidelines for management of sever sepsis and septic shock: 2012. Critical Care Medicine, 41(2), 580-
637.
Contact
[email protected]

Beyond Clickers: Enhancing Students' Engagement with the Use of Online
Polling
Jennie Chang De Gagne, PhD, DNP, RN-BC, CNE, USA
Jina Oh, RN, PhD, South Korea
Purpose
The purpose of this presentation is to examine the main themes derived from the available studies on the
use of clickers in health-related disciplines and present available web-based technologies that can be
used in online learning beyond clickers.
Target Audience
The target audience of this presentation is conference participants who are involved in nursing education
as faculty members at various colleges and universities.
Abstract
Active engagement can bring deeper understanding of knowledge and greater knowledge retention while
stimulating higher cognitive processes and critical thinking skills (Conrad & Donaldson, 2004).
Consequently, mastering the art of engaging students in the learning process is essential to successful
learning outcomes (Bain, 2004). Clickers, also known as classroom response systems, are widely used
across disciplines, and their effectiveness has been demonstrated in higher education (Bruff, 2009). The
synthesis of the literature related to clickers in nursing, medicine, and allied health education identified
that clickers have the unique capability not only to foster students’ satisfaction but also to enhance learner
engagement and participation. That is, the main characteristics of clickers include: interactivity, active
participation, learner satisfaction, formative assessment, and contingent teaching (De Gagne, 2011).
Moving from in-classroom into online teaching technologies, nurse educators can generate equally
effective learning outcomes from using clickers when utilizing web-based polling technologies in their
online teaching. Although virtual polling is not new to education, it is one of the teaching strategies that
can promote active learning and critical thinking in nursing students online. Nurse educators who teach
online must understand the scope of available technologies and plan each course and session based on
the instructional needs of the intended audience (De Gagne, 2011). In this presentation, various web-
based polling technologies will be reviewed and discussed in a way of enhancing nursing students’
engagement in an online learning environment.
References
Bain, K. (2004). What the best college teachers do. Cambridge, MA: Harvard University Press. Bruff, D. (2009).
Teaching with Classroom Response Systems: Creating Active Learning Environments. Jossey-Bass, San Francisco,
CA. Conrad, R. M., & Donaldson, J. A. (2004). Engaging the online learner: Activities and resources for creative
instruction. San Francisco, CA: John Wiley & Sons. De Gagne, J. C. (2011). The impact of clickers in nursing
education: A review of literature. Nurse Education Today, 31(8), e34-e40.doi:10.1016/j.nedt.2010.12.007
Contact
[email protected]

The Practice of Skill Training for Dialectical Behavior Therapy
Yasuko Koyano, PhD, RN, PHN, Japan
Purpose
The purpose of this presentation is to Intoroduce dialectical behavior therapy.
Target Audience
The target audience of this presentation is psychiatric nurses and nursing researchers.
Abstract
Introduction: The suicide rate in Japan is 24 per 100,000 population, the highest among the seven most
developed countries, and Japan even ranks 9th even among the countries of the world as a whole. In
2010, the Ministry of Health, Labour and Welfare organized a “Suicide and depression management
project team” as an approach to reducing the more than 30,000 suicides that occur in the country
annually, and it has vigorously promoted measures to combat suicide. Cases in which patients take
excessive amounts of psychotropic drugs prescribed by their physician for the treatment of depression,
etc., have been pointed out, and the government has issued notices calling attention to the matter.
Moreover, the existence of a situation in which multiple drugs are prescribed for psychiatric care in Japan
in comparison with other countries has also been pointed out. Faced with this situation, there is a need for
interventions designed to enhance psychosocial treatment with the goal of preventing suicide and
depression without placing a disproportionate emphasis on drug therapy.
Dialectical behavior therapy is one of the psychosocial treatments that has been attracting attention in the
US in recent years. This therapy was developed by M. Linehan of the University of Washington as a
treatment program for borderline personality disorder (BPD), and clear evidence of the efficacy of this
intervention has been presented. The therapy is applicable to a wide range of diseases, from eating
disorders to anxiety disorders. Conventional cognitive-behavioral therapy focuses on “changes” in the
patients’ cognition, therefore, the dropout rate from this therapy is considerable. Dialectical behavior
therapy adopts Hegel’s dialectical philosophy and incorporates elements of “change” and “acceptance,”
i.e., behavior therapy to solve problems and avoidance of value judgment focusing attention on the
present moment, with mindfulness as the core of the therapy. Mindfulness aims at establishing a state of
mind not affected by emotions by observing the present distressed thinking and emotions, physical
reactions and the feelings arising from such thinking, and acquiring the skills to accept unpleasant events.
It is derived from the traditional Japanese teachings of Buddha and is, in particular, influenced by the Zen
philosophy. Dialectical behavioral therapy consists of 4 modules, including 3 skills training modules,
namely, “distress tolerance,” “emotion regulation” and “interpersonal effectiveness,” and mindfulness.”
The authors have been conducting an Emotional Literacy Program since 2009, held once a week for 90
minutes per session targeting patients of the day treatment center (day/night care) of an outpatient
psychiatric unit. The program adopts an open group style with the maximum number of 10 participants
per group, and any patient who wishes to participate can do so. At the beginning, the program was based
on the Emotional Intelligence theory by Salovey and Mayer, but currently, it also introduces skill training
with dialectic approach.
The structure of the basic sessions: Ninety-minute basic sessions, each consisting of a warm-up, lecture,
exercise and sharing, are held weekly. Mindfulness, bridging from the previous session, checking
homework assigned in the previous session, lecture and work on the day’s theme, the day’s homework
and looking back are included in each session, referring to the structurization of cognitive therapy.
The first basic session provides an orientation in which the participants are explained about the course, to
deepen their understanding of the dialectical approach. Basic sessions consist of 4 DBT skills training
units, “distress tolerance skills,” “emotion regulation skills,” “interpersonal relationship skills” and
“mindfulness.” Of these, mindfulness is added to the introduction of the other 3 skills training units each
time, resulting in a structure made up of 3 modules.

Conclusion: The skills training influenced the consciousness of the patient and contributed to the control
of feelings, correction of thoughts, and change of actions. As a result, the patient adopted a new role in
society and a new outlook of life to lead a healthy and realistic life.
It is hoped that application of the program in psychiatric outpatient clinics and psychiatric day hospitals
will serve as a useful intervention method aimed at altering feelings and as a system for enhancing self
coping skills that will support living in the community and improve the quality of life of the parties
concerned.
References
Yasuko Koyano(2013), Qualitative analysis of the process of emotional transformation in a patient with difficulty in
controlling emotions - Effectiveness of skills training for “distress tolerance” and “mindfulness” using a dialectical
approach-,Journal of Health Care and Nursing, 10(1), 29-37.(in Japanease)
Contact
[email protected]

A Project of Applying PDCA Cycle to Improve New Nurse Medication Error in
Surgical Ward
Li Hua Lee, BS, Taiwan
Hsiu Hui Lei, MA, Taiwan
Wei-Ping Cheng, BS, Taiwan
Purpose
According to the literature survey that new staff is the majority number of medication mistakes whereas
issuing medication is the most important part of nursing work.The purpose of the study was to describe
medical error problems and prevent new staff from abnormal medication administration.
Target Audience
The target audience of this presentation is clinical nurses and related supervisors.
Abstract
Purpose: Medical errors are common problems in types of medical negligence. Medicine behavior is the
most activating part of nursing work every day.
When accidental events happen, they affect patients’ safety, worsen patients’ condition, prolong the
length of days in hospital and even result in death.The purpose of the study was to describe medical error
problems and prevent new staff from abnormal medication administration.
Method: The study used actual medication auditing process, abnormal analysis and interview for new
staff.The data collection period was from March, 2013 to October, 2013. Our investigation has shown that
new nurse's incorrect medication administration revealed as follows F(1) lack of standard t
courses (2) lack of medication auditing process for internal reference (3) lack of knowledge and skills in
medication administration (4) similar medicine were placed close to each other.
Resolution: The Plan- Do- Check- Action (PDCA ) cycle was applied and multiple intervention
strategies implemented, including Plan-(1)Hold continuing medication administration education (2) case
studies of abnormal medication administration events (3) make DVDs of proper medication administration
(4) redesign the location of similar medicine; Do- create a medication auditing process for internal
reference only; Check- implement new target supervise system; Action- revise operating standards of
medication administration flowchart
Results: New nurses following the PDCA process have made less mistakes from the 24 abnormal
medication administration events down to 11 ones. Auditing process rate has reached 100 percent, which
represents the new staff could issue medication correctly.
Conclusions: By implementation of this project, nurse should be able to amend the accuracy of general
medication and elevate the safety of using medication. As a result, patients will receive a better quality of
nursing and share this sort of problem with other new staff.
References
Davis, P., Lay-Yee, R., Briant, R., & Scott, A. (2003). Preventable in-hospital medical injury under the “no fault”
system in New Zealand. Quality Safety Health Care, 12(4), 251-256. Krichbaum, K., Diememert, C., Jacox, L ., &
Jones, A.(2007).Complexity Compression: Nurse under fire. Nursing Forum, 42(2), 86-87. Ronda, G. H., & Eduardo,
O. (2005). Medication errors: Why the happen, and how they can be prevented. American Journal of Nursing, 105(3),
14-24.
Contact
[email protected]

Effects of Tai Chi Exercises on Adults with Metabolic Syndrome: A Systematic
Review
Yuen Ling Leung, HMS, SD, CIEH, MSc, MBA, BHSc, RN, Hong Kong
Purpose
The purpose of this poster presentation is to describe in detail the methods for conducting a systematic
review of effectiveness of Tai Chi exercises on community-dwelling adults with metabolic syndrome.
Target Audience
The target audience of this poster presentation is nurses, physicians, and allied health care providers
Abstract
Background: Metabolic syndrome is a cluster of metabolic disturbances that increases the likelihood of
developing cardiovascular diseases, type 2 diabetes mellitus, and mortality. The economic burden of
metabolic syndrome in individuals with hypertension is projected to rise by 179% by 2020 (Wille et al.,
2011). Although pharmacological and non-pharmacological management options including herbal
medicine and lifestyle and dietary modifications appear to be effective, the numerous potential adverse
effects may deter its use (Mallappa et al., 2011).
Aim: This systematic review aims to present the best available research evidence related to the
effectiveness of Tai Chi Exercises on community-dwelling adults with metabolic syndrome. The specific
review questions to be addressed include the effectiveness of Tai Chi exercises on physiological and
psychosocial outcomes among community-dwelling adults with metabolic syndrome; and the
effectiveness of different types, duration, and frequency of Tai Chi exercises on client outcomes.
Methods: All published and unpublished studies in both English and Chinese will be searched using a
three-stage approach. The English databases to be searched include MEDLINE, CINAHL, Allied and
Complementary Medicine, British Nursing Index, EBSCOhost, EMBASE, Health and Medical Complete,
Health Sciences, ProQuest, PsycINFO, PsycArticles, Science Citation Index, Science Direct, Scopus, and
SPORTDiscus. The Chinese databases to be searched include China Journal Net, Chinese Biomedical
Literature Database, MyRead, Taiwan Electronic Periodical Services, and WanFang Data. Two reviewers
will independently review the articles and chose those to be included based on the inclusion and
exclusion criteria. The methodological quality of included studies will be assessed and details of all
included studies will be extracted by two reviewers. If appropriate, quantitative results of comparable
studies will be pooled in statistical meta-analysis. Narrative summary will be provided when statistical
pooling is not possible.
Conclusion: This systematic review protocol describes the methods and steps necessary to conduct a
systematic review on the effectiveness of Tai Chi Exercises on client outcomes. The review will provide
useful guidance for healthcare providers to choose the most suitable and effective alternative intervention
for the community-dwelling adults with metabolic syndrome.
References
Mallappa RH, Rokana N, Duary RK, Panwar H, Batish VK, Grover S. Management of metabolism syndrome through
probiotic and prebiotic interventions. The Indian Journal of Endocrinology and Metabolism 2012; 16(1): 20-27. doi:
10.4103/2230-8210.91178 PMCID: PMC3263193. Wille E, Scholze J, Alegria E, Ferri C, Langham S, Stevens W,
Jeffries D, Uhl-Hochgraeber K. Modeling the cost of care of hypertension in patients with metabolic syndrome and its
consequences, in Germany, Spain and Italy. The European Journal of Health Economics 2011; 12(3): 205-218.
Contact
[email protected]

Psychometric Testing of the Mandarin Chinese Version of the Fatigue Severity
Scale (CFSS) in Patients with Major Depressive Disorder
Mei-Yeh Wang, PhD, Taiwan
I-Chao Liu, MD, DSc, Taiwan
Purpose
The purpose of this presentation is to report the results of the psychometric testing of the Mandarin
Chinese version of the Fatigue Severity Scale (CFSS) in MDD patients
Target Audience
The target audience of this presentation is healhcare professionals who is interested in issues related to
clinical screening for fatigue in patients with major depressive disorder.
Abstract
Background: Fatigue is a symptom that is highly prevalent in patients with major depressive disorder
(MDD) and as one of the most common residual symptoms that occurs in MDD.
Aim: The aim of the present study was to examine the psychometric properties of the Mandarin Chinese
version of the Fatigue Severity Scale (CFSS) in MDD patients.
Methods: A total of 179 participants (101 MDD patients and 78 healthy controls) were included. The
MDD patients were recruited from an outpatient department of psychiatry and currently under
antidepressant treatment. The psychiatric diagnosis was confirmed by a psychiatrist based on the
diagnostic criteria for major depression stipulated in the DSM-IV. The correlations with a visual analogue
scale for fatigue (VASF), the Chinese versions of the Beck Depression Inventory (CBDI), the CBDI loss of
energy item, CBDI fatigue item, and the vital subscale of the Short Form-36 Health Survey (SF36-vit)
were used to assess the concurrent validity of the CFSS. To measure the discriminate validity of CFSS,
we examined the differences in CFSS scores between MDD patients and healthy controls. The level of
agreement between CFSS and VASF was assessed using Bland-Altman analysis.
Results: Reliability analysis revealed that CFSS had satisfactory internal consistency (Cronbach's alpha
coefficient = 0.93). The significant item-item correlation (r=0.34-0.82, all p<0.001) and item-scale
correlation (r=0.41-0.83, all p<0.001) were observed. The correlation coefficients among the CFSS and
VASF, CBDI, and CBDI-loss of energy item, and BDI -fatigue item were 0.66 (p <0.001), 0.59 (p <0.001),
0.53 (p <0.001), and 0.57 (p <0.001), respectively. The CFSS also negatively correlated with the SF36-vit
(r=-0.59, p <0.001). The CFSS scores were significantly different between MDD patients and healthy
controls (p<0.001). Most of the difference between CFSS and VASF lied between the limits of agreement
as seen in the Bland-Altman plot. The Bland-Altman plot also revealed that no specific pattern of
differences between CFSS and VASF was observed
Conclusions: The 9-item scale presented satisfactory internal consistency, concurrent and discriminated
validity. The agreement between fatigue severity assessed by CFSS and VASF was acceptable. This
preliminary validation study of the CFSS proved that it is a valid and reliable Mandarin-language
instrument for measuring fatigue severity in MDD patients.
References
Arnold LM. Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics 2008;
49:185-190. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients
with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46:1121-1123.
Contact
[email protected]

Effectiveness of the Molloy Bridgeport Observation Scale in Predicting Increased
Intraocular Pressure during da Vinci Robotic Procedures
LaDean J. Livingston, DNP, CRNA, USA
Anne Wojner Alexandrov, PhD, RN, CCRN, FAAN, USA
Purpose
Postoperative vision loss has been associated with ^ intraocular pressure resulting in decreased ocular
perfusion during Trendelenburg positioning for abdominal da Vinci robotic procedures. The Molloy Bridge
Observation Scale has been suggested as a method for anesthesia providers to recognize signs of
increased IOP without use of tonometry.
Target Audience
To provide a tool for anesthesia providers to accurately correlate the critical threshold of 40mmHg.
Understanding the correlation between the length of time and position as it relates to increases in IOP.
Abstract
Background and purpose: Postoperative vision loss (POVL) has been associated with increased
intraocular pressure (IOP) resulting in decreased retinal perfusion during 15-30o Trendelenburg
positioning for abdominal da Vinci robotic procedures. The Molloy Bridge Observation Scale (MBOS) has
been suggested as a method for anesthesia providers to recognize the signs of increased IOP without
use of an expensive tonometry unit; however, the generalizability of this method has not been studied in a
large number of centers. Therefore, we aim to assess the comparative effectiveness of the MBOS in
relation to tonometry readings to determine the presence of increased IOP.
Methods/Purpose: Institutional Review Board approval is underway for the conduct of a prospective
observational study that will serially compare use of the MBOS to actual tonometry readings in patients
undergoing abdominal surgery using the da Vinci robot. Consecutive cases will be enrolled that meet the
following inclusion criteria: Age > 19 years, and elective abdominal surgery using the da Vinci
robot. Subjects with a history of glaucoma will be excluded. Concurrent measures will be taken by two
investigators blinded to each other’s findings, with one performing an assessment using the MBOS and
the principal investigator measuring actual tonometry pressures every 30 minutes for the duration of
Trendelenberg positioning. A surgical “time out” will occur with the patient returned to 0o HOB elevation, if
IOP exceeds 40 mm Hg. This is a documented measure at which blood flow to the ocular nerve has
ceased, potentially causing ischemic nerve damage. Data will be entered/analyzed in SPSS.
Results: This study is awaiting IRB approval with an anticipated start date of Summer2014.
Conclusion: While use of the da Vinci robot has revolutionized the approach to a number of surgical
procedures, increased IOP is an unfortunate associated finding. This study will allow for comparative
assessment of the effectiveness of 2 approaches that aim to reduce the risk of POVL in this patient
population.
References
References Awad, H., Santilli, S., Ohr, M., Roth, A., Yan, W., Fernandez, S.,...Patel, V. (2009). The Effects of Steep
Trendelenburg Positioning on Intraocular Pressure during Robotic Radical Prostetectomy. Anesthesia & Analgesia,
109, 473-478 Hague, S., & Hill, D. W. (1988). Postural changes in perfusion pressure and retinal arteriole calibre.
British Journal of Ophthalmology, 72, 253-257 Hirvonen, E. A., Nuutin, L. S.., and Kauko, M. (1995). Hemodynamic
changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy. ACTA
Anaesthesiologica Scandinavica, 39, 949-955. doi: 10.111/j.1399-6576.1995.tb04203x Irvine, M., & Patil, V. (2009,
June 25). Anaesthesia for robot-assisted laparoscopic surgery. Continuing Education in Anaesthesia, Critical Care &
Pain, 1-5. doi: 10.1093 Kalmar, A. F., Heeremans, E. H., Foubert, L., Dewaele, F., Struys, M. M., & Absalom, A. (n.d).
ch 7, Study of the cerebral haemodynamic physiology during steep Trendelenburg position and CO2
pneumoperitoneum. British Journal of Anaesthesiology Molloy, B. (January 1, 2010). A Preventative Intervention for
Rising Intraocular Pressure: Development of the Molloy/BAA Observational Scale. Retrieved from
http://digitalcommons.uconn.edu/dissertation/AA13485431 Molloy, B. L. (2011). Implications for Postoperative Visual

Loss: Steep Trendelenburg position and effects on Intraocular Pressure. American Association of Nurse Anesthetist
Journal, 79, 115-121 Park, E. Y., Koo, B.-N., Min, K. T., & Nam, S. H. (2009, March 23). The effet of
pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. ACTA Anesthesiologica
Scandinavica, 53, 895-899. doi: 10.1111/j.399-6576.2009.01991.x Phong, S., & Koh, L. (2007, April). Anaesthesia for
robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesthsia and
Intensive Care, 35, 281-285 Schaefer, E. M., Loeb, S., & Walsh, P. C. (2010). The Case for Open Radical
Prostatectomy. Urology Clinic of North America, 37, 49-55. doi: 10.1016/j.ucl.2009.11.008 Weber, E. D., Colyer, M.
H., Lesser, R. L., & Subramanian, P. S. (2007). Posterior Ischemic Optic Neuropathy after Minimally Invasive
Prostatectomy. Journal of Neurology and Opthamology, 27(4), 285-287
Contact
[email protected], [email protected]

Development of Fast Track System for Severe Trauma Patients Using Six Sigma
Technique
Jiin Kim, PhD, RN, RNM, South Korea
Purpose
Today's business requires innovative management in order to obtain excellent results and to fulfill the
diverse needs of customers in a highly competitive industry. So, the purpose of this study was to develop
of a fast track system for severe trauma patients by using 6 Sigma methodology.
Target Audience
The target audience of this presentation is nursing staff in hospital and nursing professor who is
interested in quality improvement and patient safety or evidence-based practice in hospitals.
Abstract
Purpose: Today's business requires innovative management in order to obtain excellent results and to
fulfill the diverse needs of customers in a highly competitive industry. So, the goal of this study was to
develop of a fast track system for severe trauma patients by using 6 Sigma.
Methods: The sample for this study consisted of all trauma patients who visited to emergency medical
unit(EMC) of general hospital located in Gyunggi Province. Data were analyzed using frequency,
percentage, mean, standard deviation, ANOVA and capability test. For data analysis, the SPSS/PC 12.0
program and Minitab 14+ PC program.
Results: The results of this research show as following; First, this study revealed the success factors and
the length of stay in EMC have an affirmative impact. Second, there were different success factors from
the respective of business performance for 6 Sigma. Third, meaningful factors for reducing the length of
stay were call time, admission decision making time and consultation rate.
Conclusion: The result of this study indicate that fast track system can help reducing mortality as well as
complications in severe trauma patients, therefore, it is intended through this study to present a treatment
guideline for severe trauma patients which can be utilized as th fundamental data for ultimate decrease of
the mortality.
References
Kang, H. Y., Park, H. I.. (2010). The Empirical Study that 6-Sigma has an Effect on Firms' Financial Performance.
Journal finance and Accounting Information, 11(1), 147-168. Hahn. G. J. (2005). "Six Sigma : 20 Key Lessons
Learned A; Experience shows what works and does not work". Quality and Reliability Engineering International.
64(1), 12-40. Yoon, J. H. (2008). A Study on the Relationship between Operations Strategy and Critical Success
Factors of Six Sigma in Service Industry. Korean Industrial Economics Association, 21(5), 2225-2244. Yun, Y. O.,
Kim, M. Y., Kim, W. J., Kang, Y. J., Park, J. O., & Park, K. H. . (2011). Reduction of Length of stay in Emergency
Room by Using Critiacal Pathway for Stroke Patients. The Journal of Korean Nursing Administration Academic
Society. 17(1), 66-73.
Contact
[email protected]

A Systematic Review on Problem-Solving Training for Community Schizophrenia
Patients
Kuen-Tai Lee, MSN, RN, Taiwan
Jiin-Ru Rong, PhD, RN, Taiwan
Su-Ping Hsu, BS, RN, Taiwan
Purpose
The purpose of this presentation is to analysis the current design and methodology of problem-solving
therapy used for community schizophrenia patients. In addition, analysis the results of problem-solving
training used for community schizophrenia patients.
Target Audience
The target audience of this presentation is those clinical, academic and nursing faculty those interested in
developing and evaluating the problem solving training for promoting psychiatric care.
Abstract
Background and purposes: Problem-solving skill training is an important therapy to promote the
psychological functioning for schizophrenia patients, and it affects the ability of the patient to live
independently in society as well. In recent years, a number of studies emphasis has been placed on the
problem-solving skill of schizophrenia patients. However, inconsistency is still present with regards to the
result of using such therapeutic training on schizophrenia patients. Moreover, for fit the cognitive function
impairment of schizophrenia patients, the design of these problem-solving interventions comes with
various new concepts and features.
Nevertheless, there is limited integrated literature pertaining to the problem-solving intervention’s design
and methodology used for the treatment of community schizophrenia patients, and needless to say on the
results of these interventions. Therefore, this study aims to fill the insufficiency by conducting a systematic
review on the following: 1. Analysis current design and methodology of problem-solving therapy used for
community schizophrenia patients. 2. Analysis the results of problem-solving training used for community
schizophrenia patients.
Method: This study adopted CHINAHL, MEDLINE, and PUBMED as the electronic database of foreign
literature. In addition, the Index to the Taiwan Periodical Literature System and the National Digital library
of theses and dissertations in Taiwan served as the databases for domestic literature. According to the
standard literature screening procedures, some articles were selected and analyzed separately by two
co-authors. Criteria of inclusion literature: (1) Randomized clinical trials, (2) intervention focus on problem-
solving, (3) diagnosis of schizophrenia (section F2 of ICD-10). (4) language FEnglish or Chinese.
Exclusion Criteria: (1) treatments exclusively pharmacological, (2) interventions carried out in inpatient
settings, (3) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). (4)
not intervention study
Results: A total of 6 articles were eligible after screening. The patients were mainly from the day hospital
and psychological health care centers. The scope of the problem solving training were mainly with
regards to social skills training in the early years, and it has been expand to the problems solving with
daily lives, symptoms, emotions and etc., in recent years. Virtual scenarios were stimulated in laboratories
to mimic real live events for practical training. The training methods involved theoretical lessons;
moreover, it has evolved to basic cognitive functional trainings in recent years. The total training time,
duration and frequency various drastically according to the complexity of the task, and most sessions
lasted 60 or 90 minutes. The major indicators to demonstrate the outcomes of problem solving training
were problem-solving skill, social functions, psychological symptoms, and cognitive functions. With
regards to the evaluation of the result, the AIPSS chart was used to evaluate the problem-solving skill,
and the SFS and PSP were used for the evaluation of social functions. With regards to the psychological
symptoms, PANSS measure were used in most cases and computer designed measuring tools were

used for the evaluation of cognitive functions. In general, schizophrenia patients performed more poorly
with respect to the execution and application of problem solving skills. Problem-solving trainings were
able to ameliorate negative symptoms but a discrepancy was noted with regards to the social function
improvement.
Conclusions/Implications for Practice: The results of the study can provide evidence-based
information to develop the problem solving training for the schizophrenia patients. Enhancing patients’
problem solving ability remains as the major focus of the problem-solving training. For patients, by using
real-life situation rather than simulated scenarios to practice problem solving skills. In addition, studies
result shown that the training can decrease the negative psychiatric symptoms, but the different studies
shown that the training effect on social functions in discrepancy.
Contact
[email protected]

Evidence of Culturally-Tailored Diabetes Management Program for Asian-
American Immigrant Population: A Systematic Literature Review
Jee Young Joo, PhD, RN, USA
Hae-Kyung Lee, PhD, RN, South Korea
Purpose
The purpose of this systematic literature review is to examine the effectiveness of culturally-tailored
diabetes management programs and outcomes for Asian immigrants in the community.
Target Audience
The target audience of this presentation is community-based nursing researcher and community health
workers.
Abstract
Background: In the United States, Asian immigrants’ populations are growing rapidly. In addition, Asian
immigrants have a higher prevalence of diabetes diagnosis due to change of diet and lifestyle than other
ethnicities. Many hospitals and clinics have offered diabetes programs, but care to ethnic minorities still
remains inadequate, ineffective, and inaccessible. Language barriers and lack of health care insurance
are the main contributing factors for the lack of effective programming. For these populations, a culturally-
tailored diabetes intervention is needed.
Cultural tailoring is defined as “employing the native language, integrating cultural dietary preferences,
encouraging family participation and support, and holding open discussions of cultural beliefs and
treatment practices for diabetes (e.g., home remedies, oriental medicine).”
A culturally-tailored diabetes program is imperative because the increasing numbers in minority
populations with diabetes in the United States. In a west-coast state such as California, which has a large
population of Asian immigrants, the prevalence of diabetes is growing fast.
To date, several studies have shown that a culturally sensitive diabetes program results in benefits to
Hispanics and Asian immigrants. Some studies showed that culturally adapted education programs were
associated with increases in Asian immigrants’ heath behavior and increase use of clinic services. In the
local community health centers and churches, a culturally tailored diabetes program has been offered to
Korean American, Chinese American, and Hispanic diabetics.
However, the study of culturally-tailored program is still on developing stages especially for Asian
immigrants, thus, a critical review of its effectiveness is needed. The effectiveness of these programs
needs to be systematically reviewed to ensure the evidence-based nursing practice for those immigrant
populations.

Purpose: The purpose of this systematic literature review is to examine the effectiveness of culturally-
tailored diabetes management programs and outcomes for Asian immigrants in the community. Through
this review, the study seeks to assess evidence-based culturally-tailored diabetes practice effectiveness.
Methods: To examine effectiveness of culturally-tailored diabetes programs, a literature review was
conducted with PubMed, CINAHL, and PsycINFO to retrieve primary studies published from 1999 to
2013. The key words to search the literature included: Asian immigrant, Asian-American, ethnic minority,
diabetes mellitus, culturally-tailored, intervention, education, program, and community-based participatory
research. The study search was limited to English-language and empirical studies.
Results: The initial search strategies retrieved 259 articles. All retrieved articles were reviewed abstract
first and then fully examined and reviewed for the purpose of this study. In total 12 Asian immigrant
studies were selected for critical review.
Quality of studies was assessed by methodological quality tool. All 12 studies show moderate to low
quality. Five studies were randomized controlled trials and the rest of studies were pilot or quasi-
experimental studies.
Among twelve studies, nine studies were conducted in the United States with Korean-American, Chinese-
American, and South-Asian immigrants. Three studies were conducted with South Asian immigrants in
the United Kingdom and Canada. The total sample included in the 12 studies included sample size under
100 (n = 7) and over 100 (n = 5). All twelve studies’ population was adults who are more than 40 year old.
The culturally-tailored programs consisted with culturally sensitive diabetes education, behavioral
intervention, diet-specific program, counseling, and self-management education. Most interventions were
delivered by bilingual nurses and the duration of interventions varied from 6 weeks to 8 months.
Retrieved studies showed two common benefits from culturally-tailored programs: 1) improvements in
objective clinical outcomes and 2) positive psychobehavioral outcomes. Most of studies reported that
culturally-tailored interventions were significantly effective in improving glycemic control, HbA1c. Also,
there are significant reductions in body mass index and blood pressure in intervention group compared to
control group. Retrieved studies reported that patients who engaged the intervention were highly
satisfied, emotional support, high quality of life scores, and increased diabetes knowledge.
Conclusion: There is an evidence based effectiveness of culturally-tailored diabetes intervention with
Asian immigrant population. This systematic review displays that culturally-tailored diabetes program is
effective improving patients’ objective clinical outcomes and patients; emotional support. Also, patients
were satisfied with bilingual health care professions and bilingual education materials.
Implications: Asian immigrants are fast increasing in the United States and prevalence of diabetes with
those populations is continuously rising. Asian immigrants may underestimate to their health status and
risk for chronic illnesses, however, there is increasing burden of health care cost related to diabetes in
Asian Americans. Nevertheless, these populations have limited access to health care management
services because of financial difficulties and English deficiency,
Culturally-tailored diabetes intervention is a culturally sensitive, efficient, and effective management for
immigrant populations, thereby reducing health disparities. This program is imperative to management
because the populations of minority diabetes are increasing and those populations have different social,
cultural, and behavioral factors.
Under the Affordable Care Act, this culturally-tailored diabetes program is an important initiative for ethnic
minority community, but further research is needed with large Asian subgroup with longitudinal analysis.
References
Agency for Healthcare Research and Quality (AHRQ). (2011). Diabetes care quality improvement: Resource guide.
Retrieved October 31, 2013, from http://www.ahrq.gov/qual/diabqual/diabqguide.pdf American Diabetes Association
(ADA). (2011a). Diabetes statistics. Retrieved May 25, 2012, from http://www.diabetes.org/diabetes-basics/diabetes-
statistics/ American Diabetes Association. (2011b). Standards of medical care in diabetes—2011. Diabetes Care,
34(1), S11–S61. Brown, S. A., Blozis, S. A., Kouzekanani, K., Garcia, A. A., Winchell, M., & Hanis, C. L. (2005).
Dosage effects of diabetes self-management education for Mexican Americans. Diabetes Care, 28(3), 527-532.
California Office of Binational Border Health. (2007). 2007-2008 Border health status. Retrieved October 25, 2013,

from http://www.cdph.ca.gov/programs/cobbh/Documents/BHSR-2007-2008-final.pdf Choi, S. E., & Rush, E. B.
(2012). Effect of a short-duration, culturally tailored, community-based diabetes self-management intervention for
Korean immigrants: A pilot study. The Diabetes Educator, 38(3), 377-385. Fujiwara, Y., Kishida, K., Terao, M.,
Takahara, M., Matsuhisa, M., Funahashi, T., . . . Shimizu, Y. (2011). Beneficial effects of foot care nursing for people
with diabetes mellitus: An uncontrolled before and after intervention study. Journal of Advanced Nursing, 67(9), 1952-
1962. Hepke, K. L., Martus, M. T., & Share, D. A. (2004). Costs and utilization associated with pharmaceutical
adherence in a diabetic population. American Journal of Managed Care, 10(Part 2), 144-151. Hinchliffe, R. J., Valk,
G. D., Apelqvist, J., Armstrong, D. G., Bakker, K., Game, F. L., . . . Jeffcoate, W. J. (2008). A systematic review of the
effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes/metabolism
Research and Reviews, 24(S1), S119-S144. Ibrahim, I. A. (2005). Diabetes mellitus. In D. L. Huber (Ed.), Disease
management: A guide for case managers (pp. 81–99). St Louis, MO: Elsevier. Joo, J. Y., & Huber, D. L. (2012). An
integrative review of case management for diabetes. Professional Case Management, 17(2), 72-85. Kim, M. T., Han,
H. R., Song, H. J., Lee, J. E., Kim, J., Ryu, J. P., & Kim, K. B. (2009). A community-based, culturally tailored
behavioral intervention for Korean Americans with Type 2 Diabetes. The Diabetes Educator, 35(6), 986-994. Krapek,
K., King, K., Warren, S. S., George, K. G., Caputo, D. A., Mihelich, K., . . . Livengood, K. B. (2004). Medication
adherence and associated hemoglobin A1c in Type 2 Diabetes. The Annals of Pharmacotherapy, 38(9), 1357-1362.
Kumar, S., Fernando, D., Veves, A., Knowles, E., Young, M., & Boulton, A. (1991). Semmes-weinstein
monofilaments: A simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot
ulceration. Diabetes Research and Clinical Practice, 13(1-2), 63-67.
Contact
[email protected]

Promoting Discharge Planning Satisfaction in the Surgical Ward
Mei-Huei You, RN, Taiwan
Ya-Ching Cheng, RN, Taiwan
Yu-Chen Kuo, RN, Taiwan
Purpose
The purpose of this presentation is to promote satisfaction of discharge planning.
Target Audience
The target audience of this presentation is to improve self-care issues at home.
Abstract
Purpose: The aim of the project is to promote satisfaction of discharge planning in a surgical ward and
therefore, to improve self-care issues at home that may arise.
Methods: Referrals to our discharge planning unit are mostly those who need to go home with catheters
in situ post surgery and require extra care for. Yet, the average satisfaction of the service provided in
2012 was only 46.8%. The number of calls received regarding caring for catheters within 24 hours after
discharge were 59. Based on the issue, the dedicated project team was formed aiming to improve the
care between February 2013 and August 2013. Reasons of low satisfaction on discharge planning were
analyzed and found out to be nursing staff not implementing service properly, lacking assessment tools
on service demands, inappropriate case management and phone follow-ups and a lack of
multidisciplinary inputs. To improve satisfaction on discharge planning service, interventions were
established as follows: in-services, developing discharge planning assessment tools, setting up case
referral management and implementation protocols, discharge planning meetings and practicing
multidisciplinary inputs properly.
Results: Satisfaction rate on discharge planning service increased to 84.5% from 46.8% after the
intervention of the project was implemented during the interval of January 2013 until November 2013. In
addition, the number of calls received concerning care problems within 24 hours after discharge reduced
to 12 from 59.
Conclusion: Satisfaction rate on discharge planning has an increase of 37.7%. The result of that has not
only improved the staff’s recognitions on discharge planning but expanded the extent of service provision
and improved the quality of service. Therefore, patients and their families can receive a more
comprehensive discharge planning service.
Contact
[email protected]

Development of an Evidence-Based Surgical Decision Making Algorithm for
Bladder Exstrophy Related Continence Procedures
Marlo Ann Michelle Eldridge, RN, MSN, USA
Zeina Khouri-Stevens, RN, PhD, USA
John Phillip Gearhart, MD, USA
Purpose
The purpose of this presentation is to disseminate information about the current progress on the
development of an evidence-based decision making algorithm for surgical continence procedures in
children with bladder exstrophy.
Target Audience
The target audience of this presentation is pediatric urologist and pediatric advanced practice nurses who
care for children with bladder exstrophy preparing for their pinnacle surgical continence procedure.
Abstract
Bladder exstrophy (BE), is a rare congenital malformation that occurs 1:40,000 live births, (Nelson, 2005).
Occurring during the tenth week of pregnancy, BE manifests as failure of the abdominal wall to close and
results in the protrusion of the anterior bladder through the lower abdominal wall.
In the modern staged repair, the abdominal wall portion of the defect is ideally closed in the first 72 hours
of life. The staged approach then requires a continence procedure, typically undertaken in the middle
elementary years. There are two main continence procedures, the bladder neck reconstruction (BNR),
and the continent urinary diversion, (CUD). The former is designed to achieve continence through urethral
voiding while the latter provides continence with urinary emptying occurring via a continent catheterizable
channel created through the abdominal wall into the bladder. While CUD is performed by a large number
of surgeons throughout the world for a variety of diagnosis, BNR is performed by only a few select
individuals due to it’s high level of technical difficulty.
The use of functional reconstruction in bladder exstrophy has resulted in dramatic improvement in the
success of reconstruction, (Gearhart, Mathews, 2012). However, even in the most experienced and
successful hands BNR failure rates are approximately 30%. The procedure requires a high level of
technical surgical acumen and it is important to remember that urinary retention is the most common
symptom after BNR surgery, (Surer, et al., 2001). Children plagued by post BNR urinary retention
typically experience pain and suffering due to bladder spasms, readmissions, increased anesthesia
inductions, increased medication requirements, prolonged length of stay, and recalcitrant incontinence.
We know that incontinence may have a negative impact on social function and self esteem, (Gearhart,
2001).
It is well documented that two of the most reliable predictors of eventual urinary continence are the size of
the bladder template at birth and a successful primary closure, (Gearhart, Mathews, 2012). However,
through the appraisal of additional measures that began to be formally evaluated at the author's institution
in 2005, there are a number of additional variables significantly affecting continence outcomes post
BNR. These include but are not limited to pelvic floor strength, pelvic floor relaxation ability, and post
voiding urinary residual. Currently, an evidence-based tool to incorporate all variables in the surgical
decision making process does not exist. Lack of such a tool increases the risk of incorrect surgical
candidate choice, thus increasing the risk of surgical failure and continued incontinence.
An exhaustive literature search focused on decision-making and algorithm development resulted in a
modest but valuable yield of 36 total articles. Further critique of quality and appropriateness further
narrowed the findings to 15 readily translatable articles. The final cut included no Level I evidence, and
only two Level II articles both describing quasi-experimental studies. The majority of the evidence was
Level III, non-experimental , represented by 10 articles, a mix of A and B quality. No Level IV evidence
was identified but there were 3 Level V articles that provided evidence on algorithm development.

The evidence discovered through the search process established that there is a means by which to
extract and evaluate the data that exists in the patient charts at the author's institution in order to create
decision making points to guide and aid providers in an exceedingly difficult decision.
The evidence repeatedly pointed to data mining (DM) as a means to extract patient data in order to
ascertain which data points end in failed BNR and which result in a successful BNR outcome. The
protection of patients, their privacy and their rights remain the utmost importance. The evidence
overwhelmingly favors retrospective chart review, extracting data and utilizing appropriate statistical
analysis to evaluate data in order to draw meaningful conclusions. Most commonly cited in the literature
was multivariate logistic regression analysis. Also utilized were Fisher’s exact test and Wilcoxon rank
sum. Some univariant analysis such as Mann-Whitney U test was utilized to compare attributes of
survivors vs. non-survivors in one cancer related study. Also in that study, tumor grade and survival was
evaluated through Pearson X2. However, such studies dealt with concrete outcome measures such as
tumor markers. Decision making points in bladder exstrophy patients is less exacting and will include
variability from patient to patient. Recursive partitioning was evaluated in several studies, with the most
complete description from Shaikh, N., et al., 2012 , in which they developed a decision making tree
through CART analysis, (one specific tool that utilizes recursive partitioning), of a previous cohort study
and then validated the tree by applying it to a different data set.
Evaluation of numerous studies, their statistical analysis, and their application setting clearly indicate that
CART analysis is likely the most applicable and effective tool to address the challenge of surgical
decision making faced by Johns Hopkins department of pediatric urology. Evaluation of various
multivariate regression models illustrates that the goal will be to evaluate multiple variables and analyze
each separately but also in simpatico, as they relate to one another. Such analysis will clarify and define
the importance and impact of each variable as a stand alone, as well as in conjunction with one
another. Traditional statistical methods are poorly suited for this sort of multiple comparison, (Lewis, R.,
2000). According to Lewis, CART analysis is superior to many traditional multivariate techniques in that it
does not require that predictor variables be evenly distributed and still performs well when different
groups of patients have significantly different degrees of variance. In addition, traditional multivariate
regression models in the literature concentrate on probabilities, which is not consistently applicable in
clinical practice. In addition CART analysis is able to accurately manage a large number of variables in
building a model, whereas traditional linear regression has difficulty with large numbers of variables.
The evidence clearly points in the direction of algorithm creation derived out of DM from the only existing
set of inclusive data points available, those at the author's institution department of pediatric
urology. With data mining complete and statistical analysis firmly underway, the completion of the
evidence-based surgical decision making algorithm is on time and on target to be complete and ready for
presentation, dissemination and implementation by March 15, 2014.
References
Gearhart, J. (2001). The bladder exstrophy-epispadius-cloacal exstrophy complex. In J. Gearhart, R. Rink & P.
Mouriquand (Eds.), Pediatric urology (pp. 511). Philadelphia, Pennsylvania: WB Saunders Company. Gearhart, J., &
Matthews, R. (2012). Exstrophy-epispadius complex. Campbell's urology (pp. 3325). Philadelphia, Pennsylvania:
Elsevier Saunders. Lewis, R.J. (2000). An Intorduction to Classification and Regression Tree (CART) Analysis.
Annual Meeting of the Society for Academic Emergency Medicine, San Francisco, CA, 2000. Nelson, C., Dunn, R., &
Wei, J. (2005). Contemporary epidemiology of bladder exstrophy in the united states. The Journal of Urology, 173(5),
1728-1731. Novak, T., Costello, J., Orosco, R., Sponseller, P., Mack, E., & Gearhart, J. (2009). Failed exstrophy
closure: Management and outcome. Journal of Pediatric Urology, 6, 381. doi: 10.1016/j.jporol.2009.10.009 Shaikh, N.
M.,MPH., Hoberman, A. M., Rockette, H. P., & Kurs-Lasky, M. (2012). Development of an algorithm for the diagnosis
of otitis media. Academic Pediatrics, 12(3), 214. Surer, I., Baker, L., Jeffs, R., & Gearhart, J. (2001). Modified young-
dees-leadbetter bladder neck reconstruction in patients with successful primary bladder closure elsewhere: A single
institution experience. The Journal of Urology, 165(6), 2438-2440. doi: 10.1016/s0022-5347(05)66224-6 Yerkes, E.,
Adams, M., Rink, R., Pope, J., & Brock, J. (2000). How well do patients with exstrophy actually void? The Journal of
Urology, 164(3), 1044-1047. doi: 10.1016/s0022-5347(05)67426-1
Contact
[email protected]

Lifelong Physical Activity as a Predictor in Exercise Beliefs Among Community-
Dwelling Adult over 55 Years of Age
Chiung-Fang Ho, PhD, Taiwan
Purpose
The purpose of this study is to understand perceptions of exercise beliefs, barriers and self-efficacy and
to determine their predictors.
Target Audience
This study would be of interest to health professionals since this is one of the first studies to investigate
lifelong physical activity as a predictor which influences both exercise self-efficacy and exercise benefits,
barriers among community-dwelling adults over 55 years of age.
Abstract
Background: Previous studies appear to have focused mainly on various predictors that affect exercise
behavior rather than exploring people’s beliefs on exercise and factors that relate to those beliefs. An
increased understanding of exercise beliefs and their related factors may increase people’s participation
in exercise.
Objective: We aimed to improve our understanding of the factors that influence exercise beliefs because
this knowledge could help explain low levels of exercise and aid the design of more effective
interventions. Thus, the purpose of this study is to identify: (1) the perceived exercise benefits, barriers,
and efficacy in community dwelling adults over 55 years of age; (2) to examine the relationship between
lifelong physical activity and the perceived benefits, barriers, and efficacy of exercise; and (3) to explore
the best predictors of perceived exercise benefits, barriers and self-efficacy.
Method: A cross sectional prospective study enrolled a total of 86 Taiwanese aged 55 and older. Multiple
regressions were utilized to determine predictors of exercise benefits/barriers and self efficacy when
considering demographic, and lifelong physical activity. Outcome variables were measured by the
Exercise Benefits/Barriers Scale and the Exercise Self-Efficacy Scale.
Results: Findings revealed that lifelong physical activity, living arrangements, and gender significantly
predicted exercise self-efficacy (R2=26.2). Further, lifelong physical activity was the only significant
contributor to perceived exercise benefits and barriers (R2 = 13.2).
Discussion: This study is novel in that we found that lifelong physical activity is an important predictor
influencing benefits, barriers and self-efficacy of exercise. Living arrangement and gender were also
found to be significant contributors to self-efficacy. Health professionals need to assess lifelong physical
activity among community-dwelling adults in an effort to improve exercise participation.
Contact
[email protected]

Improving Health Outcomes for Surgical Patient in Nicaragua: Empowering
Nurses Participating in a Multidisciplinary Cleft Lip and Palate Team
Implementing Evidence-Based Practice Solutions
Teresa A. Pfaff, MPH, MSN, RN, USA
Anina Terry, MSN, RN, USA
Maria Julia Perez, RN, Nicaragua
Carmen Maria Urruita Gomez, RN, Nicaragua
Purpose
The purpose of this presentation is discuss nurses roles in a multidisciplinary cleft lip and palate team in
Managua, Nicaragua.
Target Audience
The target audience of this presentation is public health nurses, surgical nurses and nurse researchers
working in developing countries.
Abstract
In Nicaragua, the increase in those suffering from the congenital malformation of cleft lip and palate has
bee seen across a diverse range of socioeconomic levels. Although the World Health Organization
estimates that cleft lip, with or without palate involvement, affects almost 1 in every 600 newborns
worldwide, the Nicaraguan Ministry of Health has not updated statistical data of the percentage of
children with this congenital malformation.
These children encounter challenges with maternal and familial acceptance, in addition to multiple
surgeries and visits to healthcare providers required in the first few years of life to achieve optimal growth
and development.
Aproquen, a Nicaraguan foundation, works with these families, employing a multidisciplinary team model
to address the complex needs of the families of cleft lip and palate children in this developing country.
Aproquen’s team initiates care for these children at birth with a nutritional assessment and continued
follow-up. Consultation with the medical doctor introduces the multidisciplinary program and covers the
growth and general health of the child. The psychologist addresses parents’ social concerns and
questions, in addition to extensive surgical preparation. Later when the child begins to develop language
skills, a speech therapist will work the family to improve their oral skills and enhance language
ability. The role of the nurse transcends this entire process; providing specialized medical care through
each stage of treatment and addressing families’ psychosocial needs at the intersection of customs,
beliefs, values and inherited attitudes. In this unique role, nurses work to educate families on feeding
techniques, personal hygiene, and integration into society; optimizing health outcomes for cleft lip and
palate children and their families. This presentation explores current practices used to empower and
enable Aproquen nurses to provide evidence-based information and education in this unique, influential
role.
References
Cioffi, J., Wilkes, L., Cummings, J., Warne, B., and Harrison, K. (2010). Multidisciplinary teams caring for clients with
chronic conditions: experiences of community nurses and allied health professionals. Contemporary Nurse. 2010
Aug-Oct;36(1-2):61-70. doi: 10.5172/conu.2010.36.1-2.061 World Health Organization (2003). WHO Meetings on
International Collaborative Research: Global Epidemiology of Health Burden for Craniofacial Anomalies. Retrieved on
October 10, 2012 from: http://www.nidcr.nih.gov/NR/rdonlyres/01C6A99C-BE0D-48B9-A786-
8F90742F7A87/0/CraniofacialAnomaliesCh02.pdf
Contact
[email protected]

Perceptions of Aging and Interaction Self-Efficacy with Older Adults Among
Nursing Students through the Intergeneration Service-Learning Program
Jiin-Ru Rong, PhD, RN, Taiwan
Shu-Chen Hsu, RN, MSN, Taiwan
Purpose
The purpose of this presentation is to examine the effectiveness of intergenerational service-learning
program (IGSLP) to promote positive aging attitude, interaction and communication skills with older adults
among nursing students.
Target Audience
The target audience of this presentation is those clinical, academic and nursing faculty those interested in
developing and evaluating the service-learning nursing education program for promoting gerontological
care.
Abstract
Purpose: In today's society, the young people lack of opportunities interact with community-dwelling
older adults. Many young adults, even including nursing students, may have negative attitude toward
aging and have no confidence or no interest in interaction with elderly people. The healthy aging attitude
and gerontological caring skills are essential competences for nurses in providing humanity gerontology
care. In this study, the intergenerational service-learning program (IGSLP) was provided for nursing
students to promote positive attitude to aging, interaction and communication skills with older adults.
Methods: This was a two-group pre and post-test quasi-experimental study design. The IGSLP group
activities were performed in the community at Taipei. Participants were 118 community-dwelling older
adults and 133 undergraduate nursing students in this study. The experimental group of Nursing student
(N=62, mean 19.77 years old) and community older adults (N=55, mean 71.13years old) participate in
eight weeks of IGSLP together. The IGSLP was designed to promote students understanding of aging
social issues and the communication and interaction skills with older adults. The IGSLP program was
provided for experimental group by using group dynamic to promote the intergenerational collaboration
activities, sharing the life stories, conduct daily activities, debate upon social issues, and discuss personal
value and belief. The comparison group of nursing student (N=71, mean 20.03 years old) received eight
weeks regular service-learning course only, and most students participate service activities at hospital or
long term care institutions. And community older adults of the comparison group (N=63, mean70.37 years
old) did not participate in any other community’s interventional activities.
Results: The outcomes of nursing students were to evaluate the attitude to older adults and
communication and interaction self-efficacy with elderly adults. Both two groups of nursing students were
significant progress in the attitude to aging and elderly people (p <
001; p=.004), and elderly
communication and interaction self-efficacy (p<001; p=.001), from pre-test to post-test. And the
experimental group was significantly superior than comparison group in the attitude to elderly people
(t=3.31 p=.01), but the elderly communication self-efficacy not achieve a statistically significant difference.
The experimental group of older adults were significantly superior than comparison group in the attitude
to elderly (t=3.02, p=.003) and happiness level (t=3.82,p<001)
Conclusions: Through the activities of IGSL and reflection, students can work with older adults, initiative
to health care, creative, cooperative, responsible services activities. Moreover, the IGSL activities
promote the nursing students’ interaction and communication self-efficacy, and positive attitude toward
elderly people. In this study, the experimental elderly subjects had positive aging attitude and higher
levels of the happiness than their comparison counterparts. Moreover, the elderly subjects reported that
the IGSL program provides very meaningful experiences to them, because they can make friends with
young people, increase health knowledge and improve emotional adaptation. The IGSLP provide a good

foundation for nursing students in the future of professional services, and also can become a part of
geriatric nursing and family nursing course are supported.
Contact
[email protected]

Enhancing the Volume of Psychiatric Home Care Service
Yu-Chen Lin, MCN, RN, ICN, PMHCNS, PMHNP, Taiwan
Hsiu-Chu Liu, RN, BS, Taiwan
Kuei-Ching Lin, RN, BS, Taiwan
Purpose
The purpose of this presentation is to increase the service volume of psychiatric home care through
action research.
Target Audience
The target audience of this presentation is home care nurses who work in the psychiatric hospital or
psychiatric institution.
Abstract
The purpose of this presentation is to increase the service volume of psychiatric home care through
action research. Our home care service was limited to referral sources and shortage of professionals
manpower, the total of service recipients was held at around 600-650 person-times each month over a
long period. However, 720 person-times each month of psychiatric home service was applied by our
institution. Hence, the action research method was used to explore the factors which may cause low
service volume and the way to increase the service volume of psychiatric home care.
According to the analysis of the questionnaires and monthly reports done by nurse staffs experienced in
home care, the main causes were the lack of home visit doctors, insufficient knowledge on home care,
and the restriction of service due to less referral sources.
The strategies were included the low referral rate was announced to doctors, increase the home visit
doctors and holding in-service training for nurses, formulating a standardized list, revising the standard
operation procedure and expand service areas into the communities.
Eventually, the numbers of home care recipients rose from 600-650 person-times to 700-706 person-
times per month, thus nearly achieving the goal of this study. This study may be used as a reference to
other hospitals that are in the process of establishing a psychiatric home care service.
References
Gitlin, M., Nuechterlein, K., & Subotnik, K. L. (2001). Clinical outcome following neuroleptic discontinuation in patients
with remitted recent-onset schizophrenia. The American Journal of Psychiatry, 158, 1935-1942. Nose, M., Barbui, C.,
Gray, R., & Tansella, M. (2003). Clinical interventions for treatment non-adherence in psychosis: Meta-analysis. The
British Journal of Psychiatry: The Journal of Mental Science, 183, 197-206. Thome, B., Dykes, A. K., & Hallberg, I. R.
(2003). Home care with regard to definidion, care recipients,content and outcome：Systematic literature review.
Journal of Clinical Nursing, 12(6), 860-872.
Contact
[email protected]

The Effects of an Education Program of Lymphedema for Breast Cancer Patients
Eunkyung Hwang, RN, South Korea
Min Young Kim, RN, MSN, PhD, OCN, KOAPN, South Korea
Young Mee Kim, RN, PhD, South Korea
Purpose
The purpose of this presentation is to evaluate the effectiveness of education program consisting of three
kinds of group education and one kind of personal education on lymphedema prevention and coping
strategy.
Target Audience
The target audience of this presentation is nurses who are in charged of counseling and educating breast
cancer patients
Abstract
Objectives:To evaluate the effectiveness of education program consisting of three kinds of group
education and one kind of personal education on lymphedema prevention and coping strategy.
Methods:A cross-sectional survey design was utilized. The data were collected by the questionnaires
from 125 breast cancer patients about general and medical characteristics, experience of education,
anxiety, depression and knowledge for lymphedema management at one university hospital in Seoul,
Korea. The data were analyzed using chi-square test, t-test and ANOVA.
Results:The mean age of the participants was 52.3 (SD=8.8). 69.6% of them participated in one or more
kinds of education programs. Among group education programs, the participants attended education of
‘lymphedema’ most (50.4%), followed by ‘management after breast cancer surgery’ (45.6%), and
‘Understanding breast cancer' (39.2%). 22.4% of them received the personal education from an education
specialized nurse. The participants who had an experience to be educated had higher knowledge about
lymphedema (p<.001). And according to the education experience, there was a significant difference in
knowledge about coping with lymphedema - that is to say, applying decongestive stokings, exercise for
lymphedema prevention and skin management. However, there was no significant difference for
occurrence of lymphedema according to the education experience. The participants who were educated
personally by an education specialized nurse had a significantly lower score of anxiety or depression than
those who were not (p<.005).
Conclusion: The results of this study suggest that both group and personal education programs for
breast cancer patients can raise knowledge and coping skills to improve understandings of and to prevent
lymphedema. Therefore education about lymphedema for breast cancer patients should be incorporated
into breast cancer nursing care. And especially, nurse’s personal education can play a pivotal role than
group education in psychological aspects.
Contact
[email protected]

The Effect of Pelvic Floor Biofeedback Training for Urinary Incontinence in
Prostate Cancer Survivors: A Meta-Analysis of Randomized Controlled Trials
Lan-Fang Hsu, MSN, Taiwan
Purpose
The purpose of this presentation is to determine the effect of PFBT in prostate cancer survivors with
urinary incontinence.
Target Audience
The target audience of this presentation is nurse,clinician, and academic.
Abstract
Background: Urinary incontinence (UI) is a distressing problem after radical prostatectomy (RP) and
impairs the quality of life of prostate cancer survivors. Pelvic floor biofeedback training (PFBT) is a
treatment intended to improve UI.
Objective: To determine the effect of PFBT in prostate cancer survivors with UI.
Method: A systematic search of CINAHL, Cochrane Library, BioMed, Pubmed/Medline, and Web of
science was carried out. Randomized controlled trials (RCTs) studying the effects of PFBT on UI in
comparison to pelvic muscle training (PMT) alone in prostate cancer survivors were included. The
Cochrane Handbook for Systematic Review of Intervention 5.1.0 was used to assess the methodological
quality of included RCTs. Self-reported UI was the primary outcome measure. Data were analyzed using
the Comprehensive Meta Analysis software 2.0.
Results: Seven RCTs involving 460 prostate cancer survivors with UI were included. Overall, the post-
treatment and the long-term effects (up to the 3rd and 6th month) of PFBT on self-reported UI were not
statistically significant (mean ES= -0.084, -0.303, and -0.366, respectively) in compared to PMT without
biofeedback. Moderator analyses showed that included studies of high quality had larger and significant
long-term effects on self-reported UI in the 3rd month (mean ES, -0.860; 95% CI, -1.35, -0.37) and 6th
month (mean ES, -0.764; 95% CI, -1.27, -0.25) in comparison with those of poor quality (P=0.002 and
0.021). No heterogeneity or publication bias was found across individual studies.
Conclusion: Based on available evidence, this review evidence suggests that PFBT did not yield
significant effect on improving UI in prostate cancer survivors in comparison with PMT without
biofeedback. However, when only studies of high quality were analyzed, PFBT significantly improved self-
reported UI in prostate cancer survivors. Additional high quality studies for further investigating the
efficacy of PFBT on UI are needed.
References
Assessment and treatment of urinary incontinence. (2000). The Lancet, 355(9221), 2153-2158. doi:
http://dx.doi.org/10.1016/S0140-6736(00)02389-8 Burkhard, F. C., Kessler, T. M., Fleischmann, A., Thalmann, G. N.,
Schumacher, M., & Studer, U. E. (2006). Nerve Sparing Open Radical Retropubic Prostatectomy—Does It Have an
Impact on Urinary Continence? The Journal of Urology, 176(1), 189-195. doi: http://dx.doi.org/10.1016/S0022-
5347(06)00574-X DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3),
177-188. doi: http://dx.doi.org/10.1016/0197-2456(86)90046-2 Foote, J., Yun, S., & Leach, G. E. (1991).
Postprostatectomy incontinence. Pathophysiology, evaluation, and management. Urol Clin North Am, 18(2), 229-241.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analysis.
British Medical Journal, 327, 557-560. Hunter, K. F., Moore, K. N., Cody, D. J., & Glazener, C. M. (2004).
Conservative management for postprostatectomy urinary incontinence. Cochrane Database Syst Rev(2), Cd001843.
doi: 10.1002/14651858.CD001843.pub2 Khan, Z., Mieza, M., Starer, P., & Singh, V. K. (1991). Post-prostatectomy
incontinence. A urodynamic and fluoroscopic point of view. Urology, 38(5), 483-488. Martin, J. L., Williams, K. S.,
Abrams, K. R., Turner, D. A., Sutton, A. J., Chapple, C., . . . Cheater, F. (2006). Systematic review and evaluation of
methods of assessing urinary incontinence. Health Technol Assess, 10(6), 1-132, iii-iv. Norton, P., & Brubaker, L.

(2006). Urinary incontinence in women. Lancet, 367(9504), 57-67. doi: 10.1016/s0140-6736(06)67925-7 Tang, J.-L.,
& Liu, J. L. Y. (2000). Misleading funnel plot for detection of bias in meta-analysis. Journal of Clinical Epidemiology,
53(5), 477-484. doi: http://dx.doi.org/10.1016/S0895-4356(99)00204-8 Terrin, N., Schmid, C. H., & Lau, J. (2005). In
an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. Journal of Clinical
Epidemiology, 58(9), 894-901. doi: http://dx.doi.org/10.1016/j.jclinepi.2005.01.006
Contact
[email protected]

Clinical Nursing Practice Guideline: Oral Care for Patients with an Artificial
Airway Intubation
Nongnapas Phanjam, RN, MNS, Thailand
Suthathip Kasedluksame, RN, MNS, Thailand
Thanat Rudyung, RN, MNS, Thailand
Purpose
The purpose of this presentation is update guideline to improve the oral assessment and care for patients
with an artificial airway intubation.
Target Audience
The target audience of this presentation is nurse and critical care nurse.
Abstract
Purpose: Patients with an artificial airway intubation cannot be cleaned orally manually. Complications
with the mouth can be caused easily, especially regarding the high risk of pneumonia. Evidence-based
practice (EBP) provides nurses with a method of using critically-appraised and scientifically-proven
evidence for delivering quality oral care. The primary purpose of this updated guideline was to improve
the oral assessment and care for patients with an artificial airway intubation.
Methods: The method of this EBP guideline was as follows: 1) the PICO format for finding specific
questions; P (Populations) – adult patients, critical-ill patients, ventialted patients, neurocritical care; I
(Interventions) – oral care intervention, tooth brushing; O (Outcomes) – oral health hygiene, ventilator
associated pneumonia; 2) evaluating the appropriate evidence using the work of Melnyk & Fineout-
Overholt (2013); 3) an oral care guideline from a synthesis of the best practice presented at a public
hearing in a hospital; and 4) all steps of this guideline were discussed with experts in the area of nursing.
Results: A computerized literature search of the online databases MEDLINE, CINAHL, and the Cochrane
Library (2008-2012) was conducted. A total of 36 recommendations were identified, and 24 articles were
eligible for inclusion. This oral care guideline has three parts: 1) preparing patients and equipment,
especially 0.12 % Chlorhexidine gluconate (C-20) or 0.9% Normal saline; 2) the process of oral care by
circular motion; and 3) evaluating oral care using the brushed assessment model.
Conclusion: Oral care for patients with an artificial airway intubation must be discussed by nurse that
follows the appropriate guidelines because it was specific oral care for patients with an artificial airway
intubation. A variance protocol for oral care which was implemented in the clinic also affected the
guideline implementation. Thought, the best guideline should be implementing with well plane that put
effort vial organization.
Contact
[email protected]

An Endotracheal Suctioning Guideline for Adults with an Artificial Airway
Chanya Thanomlikhit, RN, MNS, Thailand
Suthada Kanha, RN, MNS, Thailand
Pavadee Likitwong, RN, MS, Thailand
Purpose
The purpose of this presentation is update evidence-based recommendations for endotracheal suctioning
and the prevention of atelectasis for adults with an artificial airway .
Target Audience
The target audience of this presentation is nurse and critical care nurse.
Abstract
Purpose: Endotracheal suctioning is particularly important for patients that may not adequately cough out
secretions by themselves. The suction procedure is associated with complications and risks of
atelectasis. The purpose of this study was to make available the literature regarding endotracheal
suctioning for adult intubated patients and to provide evidence-based recommendations for endotracheal
suctioning and the prevention of atelectasis.
Methods: The process for this guideline consists of 4 stage was as follows: 1) The PICO format was
used to find questions; P (Populations) - endotracheal suction in adult ; I (Interventions) - interventions
endotracheal suction, suction, endotracheal suction, guideline, close suction, open suction, tracheal
suction ; O (Outcomes) - ventilator associated pneumonia (VAP), mucosa damage, hypoxia. ; 2) a
computer literature search was conducted for ascertaining the best evidence and syntheses for the
guideline. ; 3) the next strategies for an appropriate guideline were public hearings at the hospital.; 4)
Last, all processes of this guideline were proved by expert nurses.
Results: An electronic literature search for articles published between 2008 – 2012 was conducted using
the CINAHL, Cochrane, Proquest, and Pubmed databases. From the 18 citations found, 10 studies were
selected. The guideline came from the process of synthesizing 10 studies.
This guideline has three parts: 1) patient preparation, especially close suction, 2) the suction procedure
using the shallow suctioning technique, and 3) follow-up care.
Conclusion: This study revealed strong evidence to support endotracheal suctioning, which requires
further evaluation and needs to keep up with the changes in technology.
Contact
[email protected]

The Efficacy of Home-Based Walking Exercise on Sleep in Cancer Survivors: A
Meta-Analysis of Randomized Controlled Trials
Hsiao-Yean Chiu, RN, PhD, Taiwan
Pin-Yuan Chen, MD, PhD, Taiwan
Purpose
The purpose of this meta-analysis was to examine the efficacy of home-based walking exercise on sleep
in patients with cancer.
Target Audience
The target audience of this presentation is health care provider.
Abstract
Background Disturbed sleep is a common symptom experienced by cancer patients. The effects of
home-based walking exercise (HBWE) on sleep among cancer patients are conflicting.
Purposes To examine the efficacy of HBWE on sleep in patients with cancer.
Methods Electronic databases were searched thoroughly with keywords related to HBWE and sleep.
Methodological quality of included randomized controlled trials was assessed according to the Cochrane
Handbook for Systematic Review of Intervention 5.1.0, and the data were analyzed using the
Comprehensive Meta Analysis software 2.0.
Results Nine studies involving 606 subjects were included. The weighted mean effect size was -0.49
(95% CI, -0.61to -0.28, P< .001). The sensitivity analysis revealed a significant effect on sleep (g=-0.35,
P< .001). Number of treatment sessions was a significant moderator of the relationship between HBWE
and sleep (P=.03).
Conclusions This meta-analysis confirms that HBWE yielded a medium effect size on sleep and greater
number of treatment sessions had a higher effect on improving sleep. HBEW, which is a convenience and
low cost approach to the management of sleep quality, should be treated as adjuvant or complementary
and alternative therapy among cancer patients.
Contact
[email protected]

Effects of Advance Care Planning on Knowledge, Behavior and Well Being of
Older People: A Systematic Review Protocol
Mi Fun Ng, RN, BN, MN, Hong Kong
Doris Y. P. Leung, BSc, MPhil, PhD, Hong Kong
Helen Y. L. Chan, RN, PhD, Hong Kong
Purpose
The purpose of this presentation is to present a systematic review protocol on effects of advance care
planning on knowledge, behavior and wellbeing of older people
Target Audience
The target audience of this presentation is nurse and health care provider for thier reference on advance
care planning on older people
Abstract
Background: Advance Care Planning is a process of discussion about an individual’s preferences for
care in their anticipation of future deterioration. There are different formats and inconsistent approach in
implementing Advance Care Planning to older people. The effectiveness of Advance Care Planning
intervention will influence on the knowledge, behavior and well- being in older people.
Method of review: Inclusion Criteria
Types of participants:
• Older people who are age 60 or over
• With or without chronic illness, no restriction on any disease groups and health status of
participants
Types of interventions:
• Advance Care Planning (ACP) refers to a process of discussing on end of life care/ determining/
executing treatment directives/ appointing a proxy decision maker, or a combination of both
Formats: Self-administered computerized program, self- administered form, video, individual or group
interview, information sharing sessions, decision making meeting, counseling, single or multiple sessions
Types of studies: Studies designed in randomized control trial (RCT) to evaluate the outcomes of ACP
In absence of RCT, quasi-experimental studies will be included
Types of comparison:
• Comparison between usual care or practice (no ACP program) with the ACP intervention
• Comparison between two or more types of ACP-related interventions
• Comparison between different combinations of format of ACP-related interventions
Types of outcomes:
1. Knowledge: refer to the knowledge, understanding & awareness related to ACP & end of life care
Outcome measures client’s knowledge in:
• ACP
• advance directives
• appoint proxy
• knowledge of current & future health state
• associated management
2. Behavior: refers to client’s action taken after ACP
Outcome measures:
• identify preference of care or proxy
• documentation on their preferences for CPR, artificial nutrition, intravenous antibiotic etc.

• appointment of proxy
• health services utilization e.g. hospitalization, length of stay, clinic attendance, A & E
attendance

3. Well-being: Focus on client’s psychological state after the intervention
Outcome measures:
• client’s satisfaction
• level of stress/ anxiety
• quality of life
• communication or relationship with others (relatives & health care providers)
Studies published in English and Chinese will be searched by three steps approach.
Selected eligible articles will be managed by RevMan. The result will be pooled in statistical meta-
analysis. Subgroup analysis will be conduct when there are heterogeneity in terms of study design,
participants etc. For findings which are statistically analysis inappropriate, narrative summary will be
provided
Contact
[email protected]

Parent's Perception of Recommendation of HPV Vaccination for Adolescent
Children
Maria Jefferson-Walker, MSN, APN, USA
Purpose
The purpose of this presentation is to examine parents’ knowledge regarding HPV, vaccinations against
HPV, genital warts and related cancers. The researcher also explored whether parents that chose to
vaccinate their adolescent children gave informed consent or agreed to vaccination because their
perception is “Doctor knows best.”
Target Audience
The target audience of this presentation are parents or guardians of children ages 9-16 who live in areas
of health disparities and low HPV vaccination rates.
Abstract
According to the Centers for Disease Control and Prevention (CDC), there are approximately 40 types of
genital HPV. Some types are responsible for most cases of cervical cancer in woman and other forms of
cancer in men and women. Other types of HPV are responsible for genital warts in both men and women
(“HPV Vaccinations,” 2011). In a CDC report (2011), in the United States, 11,000 new cases of cervical
cancer occur each year and about 1 in 100 sexually active individuals contract genital warts at some
time.
The purpose of this study is to examine parents’ knowledge regarding HPV, vaccinations against HPV,
genital warts and related cancers. The researcher also explored whether parents that chose to vaccinate
their adolescent children gave informed consent or agreed to vaccination because their perception is
“Doctor knows best.” In this quantitative study, the researcher chose to utilize a descriptive correlational
design to describe the relationship between populations with health disparities and low HPV vaccination
rates.
A survey was administered in the form of a questionnaire from August 2012 to December 2012. The
Cronbach’s Alpha for this tool was .80. The data was analyzed with the SPSS program (SPSS Inc, Oak
Park, IL). The chosen populations for this study were parents of girls and boys, between the ages of 9-16,
attending a low income pediatric clinic on the south side of Chicago. A convenience sample of 25 parents
was selected from the physicians’ patient appointment schedule between August 2012 and December
2012.
The findings were as follows, people that heard of HPV tended to believe that vaccinations protect people
from disease. The one person that heard about HPV from their child’s school got their child
immunized. Four people mentioned that a barrier to receiving the vaccinations was that vaccinations
make their child sick but their children have received other vaccinations. People that answered yes to
wanting to get their child vaccinated also believed that the child is at increased risk for precarious sexual
behaviors. People that believed the child was at risk did get the child vaccinated. The response to the
intent to complete the vaccination series within 6 months of receiving the first dose was promising, 48%
answered yes and another 20% answered maybe.
In conclusion, I administered the survey prior to the participants entering the exam room. This method
provided education to parents about HPV vaccines and helped them come up with questions to ask the
physician during their visit. Had it not been for the education provided in the waiting room the topic may
not have been discussed during the visit or the physician might have recommended the vaccine and the
parent agreed because of their perception, “Doctor knows best.”
References
Ackerman, L. K. (2008). Update on Immunizations in Children and Adolescents. American Family Physician, 77(11),
1561-1568. Conner, M. R., & Collins, M. M. (2008). Human Papillomavirus Infection and the HPV Vaccine: What are

the facts? JAAPA, 21(10), 32-37. Dempsey, A. F., Singer, D., Clark, S. J., & Davis, M. M. (2009). Parents’ Views on 3
Shot- Related Visits: Implications for Use of Adolescent Vaccines Like Human Papillomavirus Vaccine. Academic
Pediatrics, 9(5), 348-352 de Visser, R., & McDonnell, E. (2008). Correlates of parents’ reports of acceptability of
human papillomavirus vaccination for their school-aged children. Sexual Health, 5, 331-338. doi: 10.1071/SH08042
Fain, J. A. (2009). Reading, Understanding, and Applying Nursing Research. North Dartmouth, MA: F. A. Davis
Company Gottlieb, S. L., Brewer, N. T., Sternberg, M. R., Smith, J. S., Zianarski, K., Liddon, N., & Markowitz, L. E.
(2009). Human Papillomavirus Vaccine Initiation in an Area with Elevated Rates of Cervical Cancer. Journal of
Adolescent Health, 45, 430-437. doi: 10.1016/j.jadohealth.2009.03.029 Center for Disease Control and Prevention.
(2011). HPV vaccinations. Retrieved from http://www.cdc.gov/vaccines/vpd-vac/hpv/default.htm Center for Disease
Control and Prevention. (2011). HPV vaccinations. Retrieved from http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-
faqs.htm Hughes, J., Cates, J. R., Liddon, N., Smith, J. S., Gottlieb, S. L., & Brewer, N. T. (2009). Disparities in How
Parents Are Learning about the Human Papillomavirus Vaccine. Cancer Epidemiol Biomarkers Prev 2009, 18(2),
363-372. doi: 10.1158/1055-9965.EPI. 08-0418 Kang, H. S. & Moneyham, L. (2011). Attitudes, Intentions, and
Perceived Barriers to Human Papillomavirus Vaccination Among Korean High School Girls and Their Mothers.
Cancer Nursing, 34(3), 202-208. doi: 10.1097/NCC.0b013e3181fa482b Kim, J. J. (2011). Weighing the Benefits and
Costs of HPV vaccinations of Young Men. The New England Journal of Medicine, 364(5), 393-395. doi:
10.1056/NEJMp1012246 Korfage, I. J., Essink-Bok, M. L., Daamen, R., Mols, F., & van Ballegooijen, M. (2008).
Women show mixed intentions regarding the uptake of HPV vaccinations in preadolescents: A questionnaire study.
European Journal of Cancer, 44(2008), 1186-1192. doi: 10.1016/j.ejca.2008.03.018 Michels, K. B., & zur Hausen, H.
(2009). HPV vaccine for all. The Lancet, 374, 268. doi: 10.1016/S0140-6736(09)61247-2 Patten, M. L. (2005).
Proposing Empirical Research. Glendale, CA: Pyrczak Publishing. Petaja, T., Keranen, H., Karppa, T., Kawa, A.,
Lantela, S., & Dubin, G. (2009). Immunogenicity and Safety of Human Papillomavirus (HPV)- 16/18 AS04-Adjuvanted
Vaccine in Healthy Boys Aged 10-18 Years. Journal of Adolescent Health, 44(2009), 33-40. doi:
10.1016/j.jadohealth.2008.10.002 Polit, D. F., & Beck, C. T. (2010). Essentials of Nursing Research. Philadelphia:
Lippincott Williams & Wilkins. Saca-Hazboun, H. (2008). HPV Vaccines: Are We Ready to Protect Our Children. ONS
Connect, 23(10), 27 Sperber, N. R., Brewer, N. T., & Smith, J. S. (2007). Influence of parent characteristics and
disease outcome framing on HPV vaccine acceptability among rural, Southern women. Cancer Causes Control,
19(2008), 115-118. doi: 10.1007/s10552-007-9074-9 Stanley, J. M. (2011). Selected Theories and Models for
Advanced Practice Nursing. In M. Walsh, & L. Bernhard (Eds.), Advanced Practice Nursing (pp. 89-113).
Philadelphia: F. A. Davis Company. Zimet, G. (2009). Potential Barriers to HPV Immunization: From Public Health to
Personal Choice. American Journal of Law & Medicine, 35(2009), 389-399
Contact
[email protected]

Preoperative Skin Traction in Adults with Hip Fracture: Evidence-Based Practice
Betul Tosun, MSc, Turkey
Ozlem Aslan, PhD, Turkey
Purpose
The purpose of this presentation that has the target audience as nurses who deliver care to adults with
hip fracture in the preoperative period, was to review and analyze the effects and complications of
different interventions in preoperative nursing care of adults with hip fracture.
Target Audience
The target audience of this presentation is nurses who deliver care to adults with hip fracture in the
preoperative period.
Abstract
Introduction: Mortality rate in the first year of hip fractures ranges from 12% to 37%. Moreover, many
patients are not to return to their homes and rather to stay in hospital or nursing homes due to morbidity
related to complications that occur in treatment and rehabilitation process of hip fracture. In order to
minimize the mortality and morbidity rates and to promote the treatment outcomes, patients should be
dealt with a multidisciplinary approach and should be given evidence based nursing care from admission
to discharge.
Aim: The aim of this study, that has the target audience as nurses who deliver care to adults with hip
fracture in the preoperative period, was to review and analyze the effects and complications of different
interventions in preoperative nursing care of adults with hip fracture.
Methods: We searched by using key words entitled ‘‘Hip Fracture Nursing Care, Preoperative Skin
Traction’’ through the The Cochrane Library, Pubmed (MEDLINE), CINAHL, EBSCOhost (from 1993 to 1
December 2013). Our selection criterias were all randomized or quasi-randomized trials comparing either
skin traction with no traction or patient care about acute hip fracture prior to surgery.
Results: Thirteen randomized or quasi-randomized trials were accessed during the search. Besides, nine
reviews on nursing care were found.
In the literature, traction was compared with no traction, where the patient is nursed ’free in bed’, often
with the injured limb being placed on a pillow. Outcomes of the studies that compare traction to no
traction can be classified as primary and secondary outcomes. Primary outcomes are pain (visual
analogue scale) or analgesia use prior to surgery and incidence of pressure ulcers while secondary
outcomes are ease of fracture reduction (subjective assessment by surgeon) or time taken to reduce
fracture, incidence of medical complications (thromboembolic complications and ’other’, as specified in
trial reports), incidence of adverse events related to treatment, including sciatic nerve palsy, incidence of
fracture healing complications (avascular necrosis and ’other’ as specified in trial reports) (long term: 6
months or more), mortality (long term: 6 months or more).
In the trials, among the primary outcomes such as pain and analgesics prior to surgery no significant
difference was found between traction and no traction groups while grade 1 pressure ulcers were more
common in traction groups and there was not enough evidence for grade 2 and deeper pressure ulcers.
As we look at the secondary outcomes such as reduction operation duration, medical complication
incidence, adverse event incidence, fracture healing and mortality, no significant difference was found
between traction and no traction groups, and considered not to have enough evidence for these
outcomes.
Nursing interventions that may minimize the possible complications held in nine reviews on preoperative
nursing practice can be categorized as;

• Quick preoperative preparation with detailed assessment of chronic diseases and medication to avoid
delayed surgery (within 24-36 hours),
• Assessment of pressure ulcer risk and if required, using supportive surfaces that avoid pressure
ulcers,
• Effective pain management,
• Stopping antiaggregant agents and utilizing low molecular weight heparin for thromboprophylaxis,
• Prophylactic antibiotics treatment,
• Close monitoring for complications including bleeding, fluid electrolyte imbalance, insufficient
nutrition, atelectasis, constipation, urinary tract infection, delirium, ischemia and nerve injury due to
tight strapping.
Conclusions and Recommendations: “Bedridden Patient Care” and “Activity and Exercise” are the
main fields of concepts, theories, principles and practices of nursing. Given this fact, learning evidence
based interventions, preparing and implementing nursing care plans, taking precautions to avoid
complications and assessing outcomes are responsibilities of nurses in care of patients with hip fracture.
From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip
fracture does not appear to have any benefit. Given the increasing lack of evidence for the use of pre-
operative traction, the responsibilty should now be on clinicians who persist in using pre-operative traction
to either stop using it or to use it only in the context of a well-designed randomized controlled trial.
References
1.Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, and Egol KA. Predictors of Mortality after
Hip Fracture A 10-Year Prospective Study, Bulletin of the NYU Hospital for Joint Diseases 2008:66(2):111-117.
2.Handoll HHG, Queally JM, Parker MJ. Pre-operative traction for hip fractures in adults (Review). The Cochrane
Library 2011;12:1-53. 3.Yip DK, Chan CF, Chiu PK, Wong JW, Kong JK. Why are we still using pre-operative skin
traction for hip fractures? International Orthopaedics 2002;26(6):361–364. 4.Rosen JE, Chen FS, Hiebert R, Koval
KJ. Efficacy of Preoperative Skin Traction in Hip Fracture Patients: A Prospective, Randomized Study Journal of
Orthopaedic Trauma 2001;5(2):81–85. 5.Saygi B, Ozkan K, Eceviz E, Tetik C, Sen C. Skin traction and placebo
effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures. Bulletin of the NYU
Hospital for Joint Diseases 2010;68(1):15–7. 6.Endo J, Yamaguchi S, Saito M, Itabashi T, Kita K, Koizumi W,
Kawaguchi Y, Asaka T, Saegusa O. Efficacy of preoperative skin traction for hip fractures: a single-institution
prospective randomized controlled trial of skin traction versus no traction. J Orthop Sci 2013;18:250–255. 7.Foster K.
A brief review of the effects of preoperative skin traction on hip fractures. Journal of Orthopaedic Nursing
2006;10:138–143. 8. Koval KJ. Preoperative skin traction was not useful for hip fractures. Journal of Bone and Joint
Surgery - American Volume 2001;83(2):303. 9. Resch S, Bjarnetoft B, Thorngren K-G. Preoperative skin traction or
pillow nursing in hip fractures: a prospective, randomized study in 123 patients. Disability and Rehabilitation
2005;27(18-19):1191–5. 10. Irajpour A, Kaji1 SJ, Nazari F, Azizkhani R, Zadeh AH. Comparison between the effects
of simple and traction splints on pain intensity in patients with femur fractures. Iranian Journal of Nursing and
Midwifery Research. 2012;17(7):530-533
Contact
[email protected]

Enhancing the Effectiveness of Chest Physical Therapy By Patients' Personal
Care Assistants in a Respiratory Care Ward
Li-Wei Hsieh, MS, RN, Taiwan
Miaofen Yen, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to illustrate a project which was designed to evaluate and enhance the
accuracy of chest physical therapy by patients’ PCAs in a respiratory care ward.
Target Audience
The target audience of this presentation is clinical nurses.
Abstract
Purpose: In the respiratory care ward, there are many patients with prolonged ventilator dependence. As
a consequent, nurses give health care education in chest respiratory care to patients’ personal-care
assistants (PCAs) and its correct execution to PCAs, and both influence the quality of respiratory care.
This project was designed to evaluate and enhance the accuracy of chest physical therapy by patients’
PCAs in a respiratory care ward.
Methods:Data collection and status analysis – A Table for Chest Physical Therapy was designed to
evaluate the status before and after chest physical therapy by patients’ PCAs in a respiratory care ward.
In a sample of 52 transactions, only 11.3% accuracy was achieved. Based on the questionnaire results
from 30 patients’ PCAs, 24 (80%) identified instructions from nursing staff, 10 (33.3%) recognized their
regular instructions, and another 10 (33.3%) neither realized the importance of chest physical therapy nor
that the lack of this therapy might cause complications. The data also showed that 85% of the patient’s
PCAs were foreigners who might have had communication problems.
Setting measurements and improvement – We established a Team for Standardizing Nursing
Instructions in order to conduct a documentary survey and to issue health education pamphlets like “
Chest Physical Therapy” and “Chest Physical Therapy Standards” to ensure the consistency of nursing
instructions to major PCAs. The CD-ROM “Multi-language Demonstrations of Chest Physical Therapy”
was produced to provide a learning model for foreign PCAs.
Results: An on-site survey of the execution of chest physical therapy conducted by patient’s PCAs in the
respiraoty care ward was carried out. Twenty-seven (86%) patients’ PCAs indicated the importance of
chest physical therapy and the possibility of ignorance causing complications. Use of the Table for Chest
Physical Therapy increased the accuracy from 11.3% to 77.1%. Based on a paired t-test analysis of the
two sets of scores, the recognition increase was statistically significant (p <0.001).
Conclusion: This project was designed to provide learning opportunities for patient’s personal-care
assistants by providing nursing instruction standards and learning aids. Multi-media learning aids are
highly recommended for the provision of complete nursing care through clinical demonstrations.
Contact
[email protected]

Physical Fitness Exercise vs. Cognitive Behavior Therapy on Reducing the
Depressive Symptoms Among Community-Dwelling Elderly Adults
Tzu-Ting Huang, PhD, RN, Taiwan
Yen-Fan Chin, PhD, Taiwan
Purpose
The purpose of this presentation is share the knowledge and clinical experiences with who interested in
this topic.
Target Audience
The target audience of this presentation is community health and mental health clinicians and scholars.
Abstract
Aim. To compare the effectiveness of three interventions (physical fitness exercise, cognitive behavior
therapy, and comparison) on primary outcomes (depressive symptoms), and secondary outcomes
(physical fitness, quality of life, cognitive function, and social support) of community-dwelling elderly
adults with depressive symptoms.
Background. Depressive inclination is a major problem among community-dwelling elderly adults. The
prevalence of depressive symptoms ranges from 10.4% to 39.3%. This indicates the importance of
developing effective strategies to reduce depressive symptoms among elderly adults.
Methods. Data was collected from May 2011 to April 2012. A randomized
controlled trial with three groups (N=57) was conducted in a suburban area of northern Taiwan.
Participants were assessed at baseline for demographic data, plus depressive symptoms, physical
fitness, cognitive function, quality of life, and social support were also collected at once, 3, and 6 months
after interventions.
Results. The baseline data of depressive symptoms in the three groups were higher than other post-tests
( time effect, F= 49.92, p= .000); at posttest 1, participants in the both experimental groups were
significantly less depression than those in the comparison group ( p= .012). Participants in PFE Group
were improved their physical fitness than those in the other groups. The baseline data of QOL in the three
groups were lower than other post-tests (time effect, F= 9.288, p< .001); at posttest 1, participants in the
exercise group were significantly higher QOL than those in the other two groups ( p= .005). The baseline
data of cognitive function among these three groups were lower than other post-tests (time effect, F=
8.334, p= .000). And, participants in the three groups differed significantly in social support (interaction
effect, F =4.73, p < .01) that indicate the increased perceived social support of elderly adults in the two
experiment groups was significantly higher at posttests (p=.000, .011 & .007, respectively) than those in
the control group.
Conclusion. Participants in both experimental groups were significant in improving the depressive
symptoms and perceived social support. In addition, physical fitness exercise can improve their physical
fitness, and quality of life, as well. However, if considering for improving physical fitness and quality of life
among elderly adults with depressive symptoms, exercise may be a better way to be chosen.
Contact
[email protected]

Impact of Different Types of Oral Care on Oral Mucositis and Quality of Life for
Head and Neck Cancer Patients during Radiotherapy
Yi-Ying Huang, MS, Taiwan
Sheng-Po Hao, MD, Taiwan
Pei Kwei Tsay, PhD, Taiwan
Kwan-Hwa Chi, MD, Taiwan
Purpose
The purpose of this longitudinal study is to examine the impact of different types of oral care on radiation-
induced oral mucositis and quality of life for head and neck cancer patients under ratiotherapy.
Target Audience
The target audience of this poster is RT nurse, ENT nurse or oral cancer.
Abstract
Aim: The purpose of this longitudinal study was to examine the impact of different types of oral care on
grades of radiation-induced oral mucositis, body weight, and quality of life for the head and neck cancer
patients during radiotherapy.
Introduction: Oral cavity is the major location that exhibits the toxic effects of radiotherapy and
chemotherapy for head and neck cancer patients. Oral mucositis is one of the most common
complications among these patients. Severe oral mucositis can lead to secondary complications (ie. loss
of body weight) and delay the planned treatment protocols.
Literature shows that oral care or used honey as agent can reduce the incidence of oral mucositis. What
will happen if we combine these two strategies as a protocol for oral care? Therefore, we conducted this
clinical trial to find the impact of combination.
Patients and methods: Patients were recruited from a medical center, Taiwan. During May 2012 and
August 2013, a total of 97 head and neck cancer patients undergoing radiotherapy were contacted and
94 subjects completed the whole study protocol. The reasons of drop out were: side-effect (1), too afraid
of treatment(1), and move to other hospital(1). Informed consent was obtained before the study started.
Inclusion and exclusion criteria
Those who diagnosed with head and neck cancer, plan to receive radiotherapy with least doses of
6000cGy as part of their treatment protocol, and older than 20 years were recruited. Those who have
been diagnosed as DM with HbA1C > 7% within 3 months, Karnofsky Performance Scale < 60, or
suffering from grade 4 oral mucositis were all excluded.
Study design: They were randomly stratified into three groups, where groupⅠreceived honey
mouthwash, instruction of oral care, and routine care; groupⅡreceived instruction of oral care and routine
care; and groupⅢas control group, received routine care only. The honey mouthwash was to swish 20 cc
nature and undiluted honey in mouth for 2 minutes and then swallowed it prior to RT, at 15 minutes and 6
hours after RT respectively.
Prior to radiotherapy, all patients completed Chinese version of EORTC QLQ-C30 and EORTC QLQ-
H&N35. An evaluation of their oral mucosa was conducted at the same time by a single researcher.
These questionnaires also need to be completed while the cumulative RT dose at 40Gy and at the end of
RT course. Their oral mucosa was evaluated when the RT doses were cumulated up to 10, 20, 30, 40,
50, 60 Gy and at the end of RT course respectively. Their body weight was measured at the beginning of
the study and weekly during the period of treatment.

Statistical analysis: Data were analyzed by the Statistical package for the Social Sciences 18 (SPSS)
program. Descriptive (mean, SD, %) and inferential statistics (chi-square, Survival Analysis, One way
ANOVA, Generalized Estimating Equation) were performed.
Results: The results showed that these three groups were homogeneous in their demographic variables
and disease-related variables prior to radiotherapy.
Mucositis (Primary Outcome)
The first onset of grade 1 mucositis was significantly different among these three groups by Log-Rank test
survival analysis (F= 8.29, p<.001) whereas the results of Post Hoc Bonferroni analysis showed that the
first onset of grade 1 mucositis in control group was significant quicker than groupⅠandⅡ. Mean value of
the first onset of these 3 groups were: 11th day (groupⅠ, SD= 4.20, range= 6~26 day); 10th day (groupⅡ
, SD= 4.47, range= 4~30 day); and 9th day (control group, SD= 2.63, range= 4~14 day) respectively.
In regard to the ratio for occurrence of oral mucositis at each point of assessment, groupⅠandⅡhad a
trend of lower ratio than the control group at the 3th, 4th, amd 6thassessment.
None of the patients developed grade 4 mucositis. However, when the dose of RT cumulated > 40 Gy,
the ratio of grade 3 mucositis was significant lower in groupⅠandⅡwhen compared with control group
(X2= 19.06~40.98, p<.001).
Body Weight(Secondary Outcome)
The comparisons of weekly changes in body weight showed that groupⅠandⅡhad less changes than the
control group (X2= 15.88~.9.00, p<.001). The range of changes in body weight were 0.95 to -2.52 kg
(groupⅠ), 0.75 ~ -1.81 kg (groupⅡ), and -0.81 ~ -4.77 kg (control group) respectively.
Quality of Life (Secondary Outcome)
The study found that, for all patients, the overall quality of life were significantly decreased along with the
cumulated doses of radiation (Wald X2= 44.99, p <.001).
After adjusting the group, time and interaction effects, the results of GEE for EORTC QOL-C30 and
EORTC QOL-H&N35 found that, at RT 40 Gy, the symptom scales of "appetite(Wald X2= 5.47, p=0.02)"
and "sociability eating(Wald X2= 4.74, p=0.03)" were significantly less problems in groupⅡwhen
compared with control group. At the end of RT, the functional scales of "physical functioning(Wald X2=
7.23, p=0.01; Wald X2= 4.43, p=0.04)" in groupⅠand groupⅡwere significantly better than the control
group. In addition, the functional scales of "role functioning(Wald X2= 4.28, p=0.04)" in groupⅡwas
significantly better and the symptom scales of "appetite(Wald X2= 6.38, p=0.01)", "speech problems(Wald
X2= 7.13, p=0.01)", "sociability eating(Wald X2= 4.28, p=0.04)", and "social contact(Wald X2= 5.68,
p=0.02)" were significantly less problems than the control group.
Conclusion: This study showed that, when compared with the control group, patients in both
experimental group reported less occurrence and late onset of first mucositis, less severe oral mucositis,
less weekly body changes, and even better quality of life during research period. Therefore, the
application of “honey mouthwash plus instruction of oral care” or “instruction of oral care alone” were
strongly suggested in clinical practice.
References
1.Biswal, M. B. , Zakaria, A. & Ahmad, N. M. (2003). Topical application of honey in the management of radiation
mucositis, a preliminary study. Support Care Cancer, 11, 242–248. 2.Motallebnejad, M., Akram, S., Moghadamnia,
A., Moulana, Z., & Omidi, S. J. (2008). The effect of topical application of pure honey on radiation-induced mucositis:
a randomized clinical trial. Contemp Dent Pract, 9(3), 40-47. 3.Rashad, U. M., Al-Gezawy, S.M., El-Gezawy, E., &
Azzaz, A. N. (2009). Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck
cancer. The journal of Laryngology Otology, 123(2), 223-228. 4.Khanal, B., Baliga, M., & Uppal, N. (2010). Effect of
topical honey on limitation of radiation-induced oral mucositis: an intervention study. International Journal of Oral and
Maxillofacial Surgery, 39(12), 1181-1185. 5.Jayachandran, S., & Balaji, N. (2012). Evaluating the effectiveness of
topical application of natural honey and benzydamine hydrochloride in the management of radiation mucositis. Indian
Journal of Palliat Care, 18(3), 190-195.

Contact
[email protected]

The Grounded Theory Research Study Group for Teaching Qualitative Research
Methodology to Postgraduate Psychiatric Nursing Students
Makiko Mori, PhD, RN, PHN, Japan
Purpose
A large number of postgraduate psychiatric nursing students have difficulties in applying and attaining
reliable and relevant qualitative research results. Hence , the purpose of this presentation is to provide
guidance in regards to teaching methods through a process of data analysis technique sharing at a
research study group.
Target Audience
Postgraduate psychiatric nursing students often choose to gather data through interviews, or by
participant-observation studies. However, a large number of students have difficulties in applying and
attaining reliable and relevant research results. Hence , the target audience are professors and students
who teach or study qualitative research methodology.
Abstract
Postgraduate psychiatric nursing students often choose to gather data through interviews, or by
participant-observation studies. However, a large number of students have difficulties in applying and
attaining reliable and relevant research results. Hence , we started the grounded theory research study
group from October , 2008.
The learner objectives:
1.The learner will be able to experience a process of data analysis technique sharing at the grounded
theory research study group.
2.The learner will be able to obtain high quality data by fundamental education to improve interview , and
participant-observation studies.
Method: The grounded theory research study group for postgraduate students majoring in psychiatric
nursing was conducted once a fortnight for a period of six months, at a university in Tokyo,
Japan. Statements and concerns raised by participants in regards to the qualitative research methods
was extracted, and analyzed by categorizing based on content.
Table1The research study group of grounded theory approach Schedule
(From October to March(once a fortnight 19:00-21:00))
Content to learn through a lecture / Contents of the practice

presentation
No.1 What is the GTA?

The meaning of learning the GTA
No.2 Fundamental education to improve Method of collecting data from interview

interview
No.3 Concepts The reading of data for understanding

extracting a property and a dimension
Properties and Dimensions
No.4 Labeling data Labeling data

Summarizing data within a category
No.5 Connecting categories Performing the comparison in data and

extracting a property and a dimension
Constructing the paradigm
No.6 Microanalysis Summarizing data within a category,

Labeling categories
No.7 Theoretical comparisons Theoretical comparisons

Theoretical sampling Theoretical sampling
No.8 Analytic tools Making a category association map
No.9 Fundamental education to improve Method of collecting data from participant-

participant-observation studies observation studies
-No.12
(Made this schedule based on “Shigeko Saiki-Craighil(2008).Qualitative Research Methodology Seminar FLearning
Grounded Theory Approach,Enlarged ed, p14,Table 1,Igaku-Shoin, Tokyo.” )
(Another reference in this research study group:Strauss , A.Corbin , J. (1998).Basics of Qualitative
Research:Techniques and Procedures for Developing Grounded Theory , 2nd ed , SAGE.)
The procedure of the analysis based on Grounded theory approach
1. The reading of data for understanding
↓ Extracting of properties and a dimensions every piece
2. Labeling data
↓ Comparison of dimensions and properties between labels
3. Labeling categories
↓ Comparison of dimensions and properties between categories
4. Grasping relations between categories
↓ Making a category association map based on a paradigm
5. Theoretical sampling
The comparison is performed through all processes of the analysis
Result: 245 statements were yielded, and were then placed in the following 5 categories, "question and
comment about interview technique", "question and comment about property and dimension", "question
and comment about theoretical comparisons", "question and comment about theoretical sampling", and
"question and comment about research process".
Question and comment about interview technique
- Methods on requesting interviews
- The grounded theory approach based on Symbolic Interactionism
- Necessity and the significance of theoretical sampling
- Necessity and the significance of using the comparison techniques during the interview
Question and comment about property and dimension
- Necessity and the significance of increasing property and dimension
- A stage to extract property and dimension

- Necessity and the significance of microanalysis
- How to extract property
- A stage which use property and dimension
Question and comment about theoretical comparisons
- Necessity and the significance of using the comparison
- Necessity and the significance of comparing it based on properties
- Necessity and the significance of the comparison of the data which have common labels
- How to practice theoretical comparisons
Question and comment about theoretical sampling
- Necessity and the significance of theoretical sampling
- Concerns regarding diffusion of data with theoretical sampling
- How to receive ethical review

Question and comment about research process
- Clear statement of research process demanded in article evaluation (a doctoral dissertation / a master's
thesis) and the description of the scientific grounds
- Necessity and the significance of microanalysis
- Positioning of paradigm and category association map
- Necessity and the significance of category association map
- Necessity and the significance of constructing the paradigm
- Necessity and the significance of experiencing a series of flows of the analysis
- How to write story lines
- How to select a core category
Conclusion: It is imperate to obtain high quality data, when conducting qualitative research.Hence,
fundamental education to improve interview, and participant-observation skills is necessary.
It is also necessary to provide guidance to ensure that each methodologies objective is at the fore front of
the students thoughts when analyzing data through "theoretical comparisons" and "theoretical sampling"
and when properties and dimensions of the research is being determined.
This will result in motivating students in continuing with the analysis, which often requires a steady
continuation of work.
Also it is worth noting that confirming the position of each analysis technique in the whole research
process, and linking this to the thesis writing process can reduce student concerns during the research
process.
References
1)Strauss , A.•Corbin , J.(1990). Basics of Qualitative Research: Techniques and Procedures for Developing
Grounded Theory , 1st ed , SAGE. 2) Strauss , A.•Corbin , J.(1998). Basics of Qualitative Research: Techniques and
Procedures for Developing Grounded Theory , 2nd ed , SAGE. 3) Strauss , A.•Corbin , J.(2007). Basics of Qualitative
Research: Techniques and Procedures for Developing Grounded Theory , 3rd ed , SAGE. 4)Shigeko Saiki-
Craighill(2005). Qualitative Research Methodology Seminar: Learning Grounded Theory Approach , 1st ed , Igaku-
Shoin , Tokyo. 5) Shigeko Saiki-Craighill(2008). Qualitative Research Methodology Seminar: Learning Grounded
Theory Approach , Enlarged ed , Igaku-Shoin , Tokyo. 6) Shigeko Saiki-Craighill(2013). Qualitative Research
Methodology Seminar: Learning Grounded Theory Approach , Revised ed , Igaku-Shoin , Tokyo. 7)Shigeko Saiki-
Craighill(2007). Grounded Theory Approach : A method of the theorization , Shinyo-Sha, Tokyo.
Contact
[email protected]

Factors Affecting Self-Management Behaviors of Patients with Chronic
Obstructive Pulmonary Disease: A Literature Review
Ching Ching Li, MPH, BSN, RN, Hong Kong
Doris Y. P. Leung, BSc, MPhil, PhD, China
Purpose
The purpose of this presentation is to review factors affecting self-management behaviors of patients with
chronic obstructive pulmonary disease
Target Audience
The target audiences of this presentation are healthcare professionals and social workers.
Abstract
Purpose:To review factors affecting self-management behaviors of patients with chronic obstructive
pulmonary disease (COPD).
Methods:Ten electronic databases AMED, BNI, CINAHL, EMBASE, MEDLINE, PsycINFO, Cochrane
Database of Systematic Review, China Journal Net, Taiwan Electronic Periodical Services and Google
Scholar were searched using keywords, including “chronic obstructive pulmonary disease” ; “chronic
obstructive airway disease”; “self-management” and “self-care” from inception to March 2013. Original
research exploring factors affecting self-management behaviors in COPD patients published English or
Chinese with full-text were selected. Studies which recruited subjects with asthma or major psychiatric
illnesses were excluded.
Results: Twenty-one studies were included in the final review. Seven of them were cross-sectional
studies and 14 were qualitative studies. Fourteen factors relating to self-management behaviors in COPD
patients were identified and categorized into four domains: 1) cognitive; 2) physical; 3) psychological; and
4) social. Cognitive domain contains one factor which is knowledge. Physical domain includes three
factors of dyspnea, fatigue and physical limitation. Psychological domain covers five factors and they are
self-efficacy, perceived usefulness, sense of coherence, perceived helplessness and depression. Social
domain encompasses three factors which are social support from family, peer and healthcare providers.
Conclusion: Upon reviewing the literature, a total number of 14 factors were identified. However, factors
found from empirical studies were discrete and isolated reflecting a lack of a comprehensive picture of
factors affecting self-management behaviors in COPD patients. Therefore, future study could consider
developing a comprehensive evidence-based COPD self-management model for guiding future
interventions in promoting self-management behaviors in COPD patients.
Contact
[email protected]

Physiological and Psychosocial Nursing Approaches to Orthopedic Oncology
Patients
Nursemin Unal, RN, Turkey
Mustafa Basbozkurt, Turkey
Betul Tosun, MSc, Turkey
Purpose
The purpose of this presentation is to learn physiological and psychosocial nursing approaches to
orthopedic oncology patients.
Target Audience
Nurses who take care of oncologic orthopedic patients will be able to identify the effects and symptoms of
bone cancer and discuss the nurse’s role in caring of patients with bone cancer.
Abstract
Introduction: The effects of bone cancer can be devastating for skeletal homeostasis, resulting in
sequelae such as bone pain, pathological fractures, hypercalcaemia, the need for palliative radiotherapy
or surgery to bone, spinal cord compression, anxiety, depression, awakening of self-esteem,
independence, social skills, and awareness. It is therefore important that nurses caring for patients with
advanced cancer are aware of the possible effects of bone cancers to ensure prompt and effective
management and help maintain patients’ quality of life.
Aim: The aim of this study is to identify the effects and symptoms of bone cancer and discuss the nurse’s
role in caring for patients with bone cancer in order to equip nurses caring patients with primary or
metastatic bone cancer.
Methods: We searched by using keywords entitled ‘‘orthopedic oncology, bone cancer, physiological and
psychosocial nursing care’’ through the The Cochrane Library, Pubmed (MEDLINE), CINAHL,
EBSCOhost (from 2003 to 1 December 2013). Selection criterion was full text articles in English on
nursing care of patients with primary or metastatic musculoskeletal cancer.
Results: In our search totally 13 papers were accessed including two case studies, five reviews and six
original researches. All studies we accessed were recommending physiological and psychosocial nursing
care for orthopedic oncology patients and their families in a holistic approach.
Nursing Care for Physiological Problems
Bone Pain: Bone pain deteriorates the life quality of orthopedic oncology patients and keeps patients
unable to perform daily life activities. In such patients effective pain management is crucial. Nurse should
be able to assess pain ( location, character, quality, intensity, associated other symptoms) and
a common validated pain scale should be used to assess pain. WHO Cancer Pain Relieve Programme
advices using opioids. Further, massage practice or nonpharmalogical pain alleviation methods may be
alternative treatment options. For documentation, pain score should be kept in a patient diary.
Pathological Fracture: In contrast to traumatic fractures, no external force is required to cause a
pathological fracture. The bone, which has been weakened substantially by bone metastases, fractures
spontaneously. Patients should be avoided from trauma and briefed on pathological fracture at the same
time with risk assessment for this possible complication.
Hypercalcaemia of malignancy: Hypercalcaemia of malignancy occurs in patients with cancer who have
tumors that secrete hormones and cytokines that cause calcium resorption from bone and
hypercalcaemia of malignancy. The secretion of parathyroid hormone-related protein by the tumour is
thought to have a major role. Hypercalcaemia symptoms include anorexia, nausea and vomiting, loss of
appetite, feeling very thirsty, dehydration, constipation, tiredness, muscle spasms or tremors, irregular
heartbeat, drowsiness, confusion, lethargy and agitation. Regulation of hypercalcaemia and symptomatic

treatment is vital. In severe hypercalcaemia (calcium >3.5mmol/L) initial management involves
intravenous (IV) fluid hydration and anti-emetics. Nurses should be aware that drugs promoting
hypercalcaemia such as thiazide diuretics, lithium, ranitidine, cimetidine, vitamins A and D, and
preparations containing calcium should be stopped. Hypercalcaemia usually develops as a late
complication of cancer. Providing psychological support for the patient and family is important. In addition,
the nurse has a key role in educating the patient and family members to report symptoms of
hypercalcaemia.
Malignant Spinal Cord Compression: Malignant spinal cord compression may be manifested with back
pain, motion limitation, motor weakness, paralysis, difficulty in daily life activities. Early diagnosis and
expert multidisciplinary care is essential to aid patient rehabilitation and optimize quality of life. Patients,
families and carers should be offered information that explains the symptoms of malignant spinal cord
compression, and advises on what to do if they develop these symptoms. A thorough patient history is
key to the evaluation of malignant spinal cord compression and nurses should consider the following
factors: characteristics of pain (location, radiation, duration, severity time of pain) and factors that
exacerbate or relieve pain and other symptoms, motor weakness, paresthesia. The nurse should question
the patient about the existence, location, and onset of numbness, tingling, or coolness in the arms, hands,
fingers, legs, feet, toes and trunk. Patients should also be asked about constipation, urinary retention or
continence issues with the bowel or bladder to identify possible signs of injury to the autonomic nerves.
Nursing Care for Psychosocial Problems: Quality of life assessment, including psychological, spiritual
and social care, is important because patients with distress also report higher levels of bone pain.
Ambiguity in diagnosis and prognosis of orthopedic cancer, symptoms of the disease and aggressive
treatment causes important psychological implications. Cancer diagnosis and treatment may lead
emotional problems in patients and families. It is known that despite the improvements in prognosis and
treatment, distress level of patients with cancer is elevated and problems such as anxiety and depression
are common. Nurses have an important role in providing emotional support to orthopedic oncology
patients. In clinical practice, emotional distress should be assessed for early detection of patient at high
risk. Such patients may benefit from support of appreciated individuals, positive and constructive thinking.
Nurses should be aware of characteristics of the period that the individual is trying to cope and how to
deal with it. Family caregivers should be included in the nursing care plans and families should be
assessed for depression and anxiety. Spirituality and prayer, calmness and peace are two main
strategies.
Main role of nurses is to assist the patient in understanding the principles of treatment approaches.
Positive factors that enable this main role are behaviors that promote the mood of patient, protection of
privacy, sufficient briefing, friendly approach, using humor, assistance in daily life activities, emotional
support, recognition of patient’s emotions, trust-based communication, time allocation for conversation,
relaxing attitudes of nurses. Negative behaviors that harm the interaction are not recognizing the patient’s
emotions, not listening to patient, being insensitive to patient, nurses being incompetent/hesitant,
inappropriate/unprofessional behaviors of nurses.
Conclusion and Recommendation: In our search, only a few studies on orthopedic oncology patients
were found. We suggest that nurses should get more involved in this area and deal in detail with
physiological and psychosocial needs of patients and consecutively develop evidence based practice that
promote quality of life.
References
1. Paredes T, Canavarro MC , Simões MR. Anxiety and Depression In Sarcoma Patients: Emotional Adjustment and
its Determinants in The Different Phases Of Disease. European Journal Of Oncology Nursing, 2011;15:73-79. 2.
Fitch M, Maxwell C, Ryan C, Löthman H, Drudge-Coates L, Costa L, Bone Metastases From Advanced
Cancers:Clinical Implications And Treatment Options. Clinical Journal of Oncology Nursing,2009;13(6):702-710.
3.Erin E. Callaghan.Achieving Balance: A Case Study Examination Of An Adolescent Coping With Life-Limiting
Cancer. Journal of Pediatric Oncology Nursing 2007;24(6):334-339. 4.Eiser C. Assessment Of Health-related Quality
Of Life After Bone Cancer In Young People: Easier Said Than Done.European Journal Of Cancer 2009; 1744–1747.
5. Kinnane N. Burden Of Bone Disease. European Journal Of Oncology Nursing 2007; 11:28–31. 6. Drudge-Coates
L, Turner B. Cancer-Induced Bone Disease.Nursing Standard 2013; 27 (19):48- 56. 7. Jane SW, Wilkie DJ, PhD,
RN,Gallucci BB, Beaton RD, Huang HY. Effects Of A Full-Body Massage On Pain Intensity, Anxiety,And

Physiological Relaxation In Taiwanese Patients With Metastatic Bone Pain: A Pilot Study.Journal of Pain And
Symptom Management 2009; 37(4):754- 763. 8. Spears J. Emotional Support Given By Ward-based Nurses To
Sarcoma Patients.European Journal of Oncology Nursing 2008;12: 334–341. 9.Heatley S. Metastacic Bone Disease
and Tumour- Induced Hypercalcaemia: Treatment Options.International JournL Of Palliative Nursing 2004;10(1):41-
46. 10.Demiralp M, Hatipoðlu S, Iyigun E,Demiralp B, Çiçek EI,Basbozkurt M. Living With a Malignant
Musculoskeletal Tumor: Experiences of Family Caregivers. Orthopaedic Nursing 2010; 29(2): 86- 91. 11. Yonemoto
T, Kamibeppu K,Ishii T,Iwata S, Tatezaki S. Posttraumatic Stress Symptom (PTSS) And Posttraumatic Growth (PTG)
In Parents Of Childhood, Adolescent And Young Adult Patients With High-Grade Osteosarcoma.Int J Clin Oncol
2012; 17:272–275. 12. Hendershot E. Treatment Approaches for Metastatic Ewing’s Sarcoma: A Review of the
Literatüre.Journal of Pediatric Oncology Nursing 2005; 22(6):339-352. 13.When Pregnancy Becomes Bittersweet:
Hearing ‘‘You Have Advanced Bone Cancer’’ at 34 Weeks.JOGNN 2011; 40: 120-134.
Contact
[email protected]

A Study on Improving Nursing Instruction for Post Total Knee Replacement
Patients in Orthopedic Ward in Taiwan
Fung-Yu Kang, RN, Taiwan
Pei-Jung Yu, RN, Taiwan
Purpose
The purpose of this presentation is designed to promote the nursing instruction rate for post total knee
replacement patients in orthopedic ward.
Target Audience
The target audience of this presentation is nurse.
Abstract
Preparation, education, continuity of care for patients are essential after a total knee replacement,
especially they are almost elderly. The patient and family members are most likely to be scared and
frustrated because it is difficult for them to get around with home care after a total knee replacement. The
purpose of this study was designed to promote the nursing instruction rate for post total knee replacement
patients in orthopedic ward. In our work place, we found unsatisfied poor outcomes with the home care
of post total knee replacement patients; therefore, we carry on root cause analysis and provide strategies
for solving the problem: reinforced education and training programs for nurses in ward; physicians, nurses
and therapists co-produced the education video for taking care of total knee replacement patients;
established protocols of post total knee replacement care and set up the knee replacement care
operational standards and check-up system for nurses. After the project was conducted, the testing score
of nurses with knowledge of post knee replacement care rose from 74.5 to 100, and the complete rate of
nursing instruction for post total knee replacement patients lifted from 62.5% to 95.7%. This study proved
that interdisciplinary teamwork enhances more the good quality care for patient. A complete health
education measure not only can improve the expertise of nurses but also let patients and their families
have high satisfaction and improvement in function and quality of life for patients and their families.
Contact
[email protected]

EBP PST 3 - Evidence-Based Practice Poster Session 3
Development of an Evidence-Based Guideline for Screening and Managing
Depression in Older Adults
Mann-Chian Wu, MSN, Taiwan
Huei-Chuan Sung, PhD, MSN, RN, Taiwan
Shin-Yann Tsai, MSN, RN, Taiwan
Graeme D. Smith, RN, BA, FEANS, PhD, United Kingdom
Purpose
The purpose of this presentation is to describe the development of an evidence-based guideline for
screening and managing depression in older adults.
Target Audience
The target audience of this presentation is to highlight the importance of screening and managing
depression of older adults and to share our experience for developing an evidence-based guideline for
screening and managing depression of older adults.
Abstract
Purpose: This study aimed to develop an evidence-based guideline for screening and managing
depression in older adults.
Background: Depression and dementia are common mental problems among aging population.
Depression in older adults is often ignored and inadequately diagnosed and managed. Literature
indicates that older patients with depression may also have cognitive impairment which has similar
symptoms with dementia. Therefore, this makes the assessment of depression more difficult among older
adults. There is a lack of guideline which can assist clinicians make better assessment and care plan for
older adults with depression in Taiwan. Therefore, a clear guideline for nursing professionals to screen
and manage older adults with depression is warranted.
Methods: A systematic review method was used and searched published guidelines and systematic
reviews from 2000-2012. Relevant guidelines and reviews were appraised by three certified reviewers
using appraisal tools and further analyzed. With the results from the systematic reviews and suggestions
from expert focus group, we developed the guideline protocol for screening and managing depression
suitable for older adults in Taiwan. This guideline protocol was evaluated by 12 psychiatric experts, and
further revision was made according to the experts’ recommendations. In addition, the guideline protocol
was assessed by 357 clinical health care professionals in psychiatric wards and long-term care facilities
using a questionnaire survey method for its feasibility and possible obstacles in implementing the
guideline in the clinical settings in Taiwan.
Results: The final version of guideline has 62 recommendations, including identifying high-risk factors for
older adults with depression, assessing cognitive function for older adults, assessing depression level of
older adults, screening results and referral requirements, and care interventions.
Conclusions: An evidence-based guideline for screening and managing depression of older adults was
developed through a systematic review method. This guideline provides nursing professionals a clear
guidance and tool to accurately assess depression in order to provide suitable care and interventions in
managing depression problems of older adults.
References
1. Brown, EL, Raue, PJ, & Halpert, KD. (2007). Detecting depression in older adults with dementia. Iowa City (IA):
University of Iowa Gerotological Nursing Intervention Research Center, Research 3.Dissemination Core, 39 p. 2.
Brown E, Raue P, Halpert KD. (2009). Detection of depression in older adults with dementia. Journal of
Gerontological Nursing, 35(2), 11-15. 3. Hollon SD, Jarrett RB, Nierenberg AA, Thase ME, Trivedi M, Rush AJ.
(2005). Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or
combined treatment. J Clin Psychiatry. 66(4), 455-68. 4. Kurlowicz L, Harvath TA. (2008). Depression. In: Capezuti E,
Zwicker D, Mezey M, Fulmer T. Editor(s). Evidence-based geriatric nursing protocols for best practice. 3rd ed. New

York (NY): Spinger Publishing Company; p.57-82. 5. Piven, MLS. (2005). Detection of depression in the cognitively
intact older adult. Iowa City (IA): University of Iowa Gerotological Nursing Intervention Research Center, Research
Dissemination Core, 33 p. 6. Watson, LC & Pignone, MP. (2003). Screening accuracy for late-life depression in
primary care: a systematic review. The Journal of Family Practice, 52(12), 956-964.
Contact
[email protected]

Hot Topics in Nurse Practitioner Clinical Education: An Evidenced-Based Review
Julie A. Stanik-Hutt, PhD, CRNP, CNS, FAAN, USA
Benita Walton-Moss, PhD, FNP-BC, USA
Purpose
The purpose of this presentation is to review the evidence for controversial and emerging topics related to
clinical preparation of nurse practitioner students in the United States.
Target Audience
The target audience of this presentation is nurses considering NP preparation, students enrolled in NP
programs and nurse educators.
Abstract
Clinical competence is the core of NP practice. High quality clinical education is crucial to the
development of NP competence. The purpose of this presentation is to discuss controversial issues
related to clinical preparation of NPs. Evidence on the four issues will be presented and discussed,
including: registered nurse (RN) experience prior to NP preparation, requirements for a minimum number
of hours of student clinical practicum, use of simulation to supplement or replace clinical practica, and
incorporation of interprofessional education (IPE) in order to produce graduates who are ready to create
interprofessional practice. It is time for NP educators to consider and apply available evidence to improve
student outcomes and change outdated requirements.
RN experience. The first NPs were experienced nurses who completed additional formal post graduate
education and supervised clinical practice before embarking on their advanced practice role. Initially,
admission to NP programs required at least 2 years of professional nursing experience. However several
years ago, NP programs began offering admission to highly qualified students immediately after
graduating from their initial nursing education or offered them admission to both the baccalaureate (BSN)
and the master’s (MSN) program simultaneously so that students could matriculate directly from the BSN
into the MSN. In some schools however, it has become the norm with up to ½ of NP students entering
the program directly from their BSN program without practicing a day as a RN. Acute care NP programs
are the notable exception to this trend. Advocates for so called ‘direct entry’ from the BSN to the MSN
argue that the requirement for RN experience is an outdated notion and that we need to encourage
students to enter graduate school early or they will never pursue same. They also assert that those
without RN experience are just as successful in graduate school and on certification examinations after
graduating, that they haven’t picked up bad habits from practice, and that their previous life experiences
also support their preparation for practice as an NP. Opponents argue that those without RN experience
are weak clinically, have difficulty internalizing advanced skills, and do not identify themselves as a nurse.
They also cite lack the clinical judgment and confidence that is forged in practice. What is the evidence
for or against requiring professional nursing experience before matriculation in an NP program?
Clinical hours. Accreditors require NP programs in the US to provide students with a specific minimum
number of hours of supervised direct patient care during which they can practice clinical skills. Students
preparing for practice with a single age group population (e.g. pediatric NPs who care only for children)
must complete at least 500 hours of supervised clinical practicum. The 500 hour ‘rule’ applies to
neonatal, pediatric primary care, adult primary care, adult acute care, and women’s health NP students.
Students preparing to provide care across age groups (e.g. Family NPs who care for adults, pregnant
women, and children) are expected to complete more than 500 hours of supervised clinical practicum.
The rational for requiring 500 hours, rather than some other number has been the focus of much
discussion at recent meetings of NP faculty. The number of clinical practice hours vary among schools,
and can range from 500 to close to 1000 for a single age group population. Some students meet
performance expectations at less than 500 hours and others are not able to perform as expected after
many more hours. What is the source of the 500 hour ‘rule’ and should mastery of clinical competencies
rather than completion of clock hours measure student readiness for practice.

Clinical simulation. Simulation is a commonly used educational strategy in nursing education and
practice. It provides learners an opportunity to apply critical thinking and clinical skills to complex
situations without exposing real patients to the risk associated with an inexperienced provider. In BSN
education, simulation is replacing as well as supplementing student clinical experiences. Medical students
spend many hours developing skills by working with highly trained standardized patients and using high
fidelity patient simulators in multimillion dollar simulation centers. Acute Care NP students often complete
skill and decision making in simulation labs. NP accreditation criteria do not allow simulation to replace
required practice time. However, there is growing interest in greater use of simulation to supplement NP
preparation. This strategy has been suggested during a time when it is increasingly difficult to secure
high quality precepted clinical placements for NP students. Some programs are considering the use of
objective structured clinical examinations (OSCE) to assess student competency. What is the evidence
regarding the use of educational as well as evaluative simulation in preparation of NPs? What can it
offer? And how should it be used and evaluated?
Interprofessional education. Interprofessional practice (IPP), characterized by mutual respect,
teamwork, communication and collaboration, is widely acknowledged as a key approach to produce
patient centered care, reduce medical errors and improve healthcare outcomes. But how can we create
IPP when students continue to study and learn in educational silos? Schools that prepare health care
professionals are being pushed to develop and increase the use of IPE. IPE requires that students from
at least two different health professions learn together during their pre-licensure professional education.
NP faculty struggle to form alliances with faculty from other health care professions and to create
meaningful opportunities to integrate IPE into sometimes rigid curricula. What can we learn from research
on IPE? What are the best practices and strategies for implementing IPE that can help NP faculty
successfully prepared graduates for IPP?
References
Bray, CO & Olson, KK. (2009). Family nurse practitioner clinical requirements.Is the best recommendation 500
hours? Journal of the American Academy of Nurse Practitioners,21, 135-139. Bridges, DR. et al. (2011).
Interprofessional collaboration: three best practice models of interprofessional collaboration.Medical Education
Online, 16, 6035. Hallas, D. et al. (2012). Evaluation of the clinical hour requirement and attainment of core clinical
competencies by nurse practitioners. Journal of the American Academy of Nurse Practitioners, 24, 544-553. Janson,
SL et al. (2009). Improving chronic care in type I diabetes using teams of interprofessional learners. Academic
Medicine, 84, 1540-8. Lapkin, S. et al. (2013). A systematic review of the effectiveness of interprofessional education
in health professional programs. Nurse Education Today, 33, 90-102. Reeves, S. et al. (2013). Interprofessional
education: effects on professional practice and healthcare outcomes.Cochrane Library, issue 3. Rich, ER et al.
(2001). Assessing successful entry in nurse practitioner practice: a literature review. Journal of the New York State
Association, 32(2), 00287684. Rich, ER. (2005). Does RN experience relate to NP clinical skills? The Nurse
Practitioner, 30(12), 51-56. Rich, ER & Rodriguez, L. (2002). A qualitative study of perceptions regarding the non-
nurse college graduate nurse practitioner. Journal of the New York State Association, 33(2), 31-5. Thistlewaite, J &
Moran, M. (2010). Learning outcomes for interprofessional education: literature review and synthesis. Journal of
Interprofessional Care, 24(5), 503-515.
Contact
[email protected]

Development of Multilingual Educational Materials for Postpartum Health of
Immigrant Women in South Korea
Kyungwon Kim, PhD, MS, RN, BS, South Korea
Purpose
This study was to develop educational materials for health care during postpartum periods in foreign
women who immigrated to South Korea. Then, educational materials were to translate into their native
languages.
Target Audience
The target audiences are foreign women who immigrated to South Korea through international marriage.
Married migrant women experienced a lack of knowledge, understanding, or self-care skills on
pregnancy, delivery, and postpartum. Because they got pregnant before they adjusted themselves to a
new family, environment, or Korean culture.
Abstract
Purpose: This study was to develop educational materials for health care during postpartum periods in
foreign women who immigrated to South Korea. Then, educational materials were to translate into their
native languages. Method: This study was composed of three procedures. First, the contents of materials
were made up of result from the survey on health care needs of immigrant women and health staffs of the
community health centers and group discussion by experts in women’s health. Detailed items of contents
were based on Roy’s adaptation modes. Second, content validity in educational materials was conducted
by experts in women’s health and immigrant women. Educational materials, which were composed of
procedure one and two, have been translated into 4 languages in consultation with relevant foreign
language. Third, evaluation of educational materials was accomplished through satisfaction survey.
Result: Educational materials on postpartum health were developed for immigrant women and translated
with multilingual. The title was healthy mother, happy family; “8-step guide to a healthcare after childbirth".
These materials were composed of 8-step guides to healthcare after childbirth, self-examination check
list, websites for childbirth education and information, and guidelines on educational material in the form
of a brochure. The 8-step guides were: “understand changes in your body and manage them after birth”,
“the mother’s nutrition is important”, “rest and exercise appropriately”, “keep your body clean and warm”,
“become a good parent”, “manage any depression after childbirth”, “plan your birth control”, “do postnatal
exercise” In evaluation of educational materials, the satisfaction scores ranged from 3.53 to3.73 and the
overall level of satisfaction was high(3.61 score). Conclusion: Multilingual educational materials will help
manage postpartum health and will be utilized in childbirth health education for immigrant women with
various nationalities. Evaluation after using educational materials also will be needed to develop more
suitable materials for immigrant women in South Korea.
References
[1]The Ministry of Health and Welfare of Korea, The 2009 Survey on National Multi-Cultural Families in Korea, 2010.
[2]Korea Institute for Health and Social Affairs, Reproductive Health Status of Married Migrant Women and Policy
Tasks, 2008. [3]The Minister of Agriculture and Forestry of Korea, The Political Measures to Support Married Migrant
Women in Rural Korea, 2006. [4]Y. O. Youn, I. O. Moon, “Associated factors on reproductive health of Vietnamese
female immigrants: Application of PRECEDE Model”, Korean Journal of Health Education and Promotion. vol. 27, no.
4, pp. 61-72, 2010. [5]Korea National Statistical Office, Marriage rate for Korean men and foreign women,
http://kosis.nso.go.kr, 2011. [6]The Ministry of Gender Equality and Family of Korea, The training manual for
childrearing care providers for married migrant families in Korea, 2007. [7]H.J. Kim. “A study of spousal support, the
demand for health education, and quality of life for married female immigrants”, Korean Journal of Women Health
Nursing, vol.14, no.1. pp.5-11. 2008. [8]E. Y. Choi, E. H. Lee, J. S. Choi, & S. H. Choi, “Comparative study on
postpartum depression of Vietnamese married immigrant women and Korean women”, Korean Journal of Women
Health Nursing, vol. 17, no. 1, pp 39-51, 2011. [9]G. H. Jeong, H. J. Koh, “A survey on health management during
pregnancy, childbirth, and the postpartum period of immigrant women in a multi-cultural family”, Korean Journal of

Women Health Nursing, vol. 15, no. 4, pp. 261-269. 2009. [10]H. R. Kim, “Maternal health and nutritional status of
marriage-based women immigrants in Korea and policy directions”, Health Welfare Forum. pp. 50-64. 2009.
Contact
[email protected]

The Effectiveness of Music Interventions on Reducing Anxiety, Sedative
Requirements, Pain, and Improving Physiological Outcomes and Satisfaction
Among Adult Patients Undergoing Colonoscopy: A Systematic Review Protocol
Shuk Yee Ko, RN, RM, Hong Kong
Purpose
The learner will be able to identify the rationale and significance of conducting a systematic review on
effectiveness of music interventions on patients undergoing colonoscopy, and review the methods for
conducting a systematic review of evidence generated by quantitative research.
Target Audience
The target audience of this presentation includes nurses, health care providers and academia.
Abstract
Background: Anxiety and pain are common problems in patients undergoing a colonoscopy procedure.
High levels of anxiety may result in more difficult and painful procedures, incomplete procedures, greater
medication uses, increased likelihood of sedative-related complications, and prevent the patients from
undertaking the examination (Stirling et al., 2007). High anxiety levels may also lead to negative
physiological outcomes including elevated blood cortisol levels, increased blood pressure, heart rates,
and respiratory rates.
Music is well recognized as an important and safe intervention to aid the healing processes (Johnson et
al., 2012). Music intervention has been used in different medical fields including cardiology and radiology
because music has been found to promote relaxation, induce positive associations, and divert attention
from negative experiences (Nilsson, 2008). Music has been hypothesized to act as an anxiolytic and
analgesic to alleviate anxiety and pain for patients undergoing stressful and painful endoscopic
procedures. Nevertheless, no conclusion has yet been reached about its effectiveness in patients
undergoing colonoscopy.
Objective: This systematic review will summarize the evidence regarding the effectiveness of music
interventions on patient outcomes including levels of anxiety, the needs for sedation, pain, physiological
variables, and satisfaction.
Methods: The review will include all studies with adult patients ≥18 years old who underwent
colonoscopy procedures in endoscopy suites. Foreseen comparisons include: (1) comparison between
music interventions vs. no music intervention; and (2). Comparison between different formats and types
of music interventions. All randomised controlled trials comparing the effectiveness of music interventions
on patients undergoing colonoscopy will be considered for inclusion in this review. In the absence of
randomised controlled trials, other research designs including quasi-experimental, non-randomised
controlled trials, and before and after studies will be included. The search strategy is aimed to find all
published and unpublished studies in English and Chinese in order to generate a comprehensive list of
primary studies that can answer the question posed in this review. Two reviewers will independently
assess all identified studies against the inclusion and exclusion criteria, appraise the methodological
quality, and perform the data extraction. Quantitative results of comparable studies will be pooled in
statistical meta-analysis. If statistical pooling of results of the included studies is not appropriate or
possible, the findings will be summarized in narrative form.
Conclusion: This systematic review protocol describes in detail the process of conducting a systematic
review of evidence generated by quantitative research. The significance of this review is to identify the
effectiveness of music interventions on reducing anxiety and sedative medication requirements,
improving physiological parameters, relieving pain, and promoting satisfaction among adult patients
undergoing colonoscopy. The findings will provide useful information for health care professionals to
promote well-being of patients undergoing colonoscopy.

References
Stirling L, Raab G, Alder EM, Robertson F. Randomized trial of essential oils to reduce perioperative patient anxiety:
Feasibility study. J Adv Nurs 2007; 60(5): 494-501. Johnson B, Raymond S, Goss J. Perioperative music or headsets
to decrease anxiety. J PeriAnesth Nurs 2012; 27(3):146-154. Nilsson U. The anxiety and pain reducing effects of
music interventions: A systematic review. AORN 2008; 87(4):780-807.
Contact
[email protected]

The Experience of Evidence-Based Nursing Implementation at a North Medical
Center in Taiwan
Yueh-E. Lin, RN, MSN, Taiwan
Purpose
The purpose of this presentation is to understand learning clinical EBN skills satisfaction and needs in
nurse staffs. From the Evidence-Based Nursing (EBN) Implementation to solve and improving the care
skills knowledge, attitudes and motivation of the nurses who attended the training program.
Target Audience
The target audience of this presentation is interesting in learning Evidence-Based Nursing (EBN) staffs.
Besides, these results are expected to provide a reference and shares the experiences of evidence-
based nursing implementation to develop a training program of EBN.
Abstract
Objective: Evidence-based nursing (EBN) is an essential issue for improving quality of care. Enhancing
the competence of EBN is the foundation of implementing evidence-based practice. This project aimed to
understand learning clinical EBN skills satisfaction and needs in nurse staffs. From the Evidence-Based
Nursing (EBN) Implementation to solve and improving the care skills knowledge, attitudes and motivation
of the nurses who attended the training program.
Methods: Analysis of the needs in EBN skills and abilities for nurse staffs. Adopt an actual observation
method, questionnaire for staff's before working. We collected totally 84 staffs from based on the survey
results and literature review on December 2012, Statistical analysis of surveys on nurses’ skills that staffs
felt the needs in an urgent needs assistance showed 67.47% of accuracy on knowledge of clinical EBN
skills. Analysis of the survey that EBN of skills included 5 dimensions: Asking
Acquire. Appraisal. Apply. Audit.(5A). Knowledge of clinical practice experience, and lack of in-service
educations and trainings. Therefore, we used the following methods to improve the project. We arranged
the clinical EBN training programs for nurse staffs and compared with none any arrangement EBN
training.
Results: After all the above interventions, nurses had higher accuracy on stress scores in the range of
"slightly" to "servere" . Appraisal, Acquire , asking, PICO and apply. The staffs who were "having apply
experience", " or " high level of interesting in EBN " were at a higher needs in the EBN training. The
completeness of before EBN training in the abilities been promoted from 68.7% to
88.2%(promote28.38%). However, the posttest score of EBN knowledge in nurses at the age of 36-40
years, 10-15years of work experience, bachelor degree, and administrator were significantly higher than
the score of pretest.
Conclusion: The EBN workshop with adequate scenario practice which included "Formulating a PICO
question", "Data searching", "Level of evidence rating" might improve the knowledge, attitudes and skills
of EBN attendants. The satisfaction of nurses in the workshop was high. It’s not only promotion of quality
care, but also prevention of incident. Hope the results benefit the policy making in organizations in the
future. In addition, to be a health educator will be the most important responsibility for us, we hope to
continue develop this project and follow the effect advanced. In addition, These results are expected to
provide a reference and shares the experiences of evidence-based nursing implementation to develop a
training program of EBN.
Contact
[email protected]

Nurses' Knowledge, Attitude, and Implement Confidence Regarding Evidence-
Based Nursing in Taiwan
Chou-Ping Chiou, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to report the findings which describe nurses’ knowledge, attitude, and
implement confidence regarding evidence-based nursing (EBP) and major barriers to EBP in Taiwan.
Target Audience
The target audience of this presentation is nurses from clinical practice and nursing researchers.
Abstract
Purpose: The objectives of this study were to describe nurses’ knowledge, attitude, and implement
confidence regarding evidence-based nursing (EBP) and major barriers to EBP.
Methods: The study was approved by the appropriate ethics committees. A descriptive survey was
conducted with a random sample of 300 nurses from a regional teaching hospital in Southern Taiwan.
Results: The results showed that nursing staffs had insufficient knowledge about EBP and they
moderately believed that research evidence has been used to guide nursing practice and to improve
patient outcome. Only 13% indicated their confidence to implement EBP. Significant relationships were
found between EBP knowledge, attitude and implement confidence. The identified barriers included: lack
of time, lack of financial support, lack of knowledge, and lack of support.
Conclusions: Since this study was conducted with a sample of nurses from a regional teaching hospital,
it will be important to gather this type of data of nurses who are active in other hospitals, so that findings
can be generalized to the greater population of nurses in practice. Nurses in clinical settings need to be
able to use research findings and incorporate EBP into their clinical practice to enhance patient
outcomes. Nurses must be provided with information that strengthens their attitudes about EBP improving
care and patient outcome to accelerate evidence-based nursing practice. Therefore, intervention studies
that determine what specifically is accountable for a change to EBP in nurses are urgently needed.
Contact
[email protected]

The Knowledge and Expectation about the Content of Pediatric Nursing Course in
a Two-Year Nursing College Program and Related Factors in Taiwan
I-Chen Lu, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to show audience an evidence-based course design research to
develop pediatric nursing course in a two-year nursing college program in Taiwan. The audience will learn
Taiwanese students’ knowledge and expectation about pediatric nursing course and related factors.
Target Audience
The target audience of this presentation is nursing teachers or educators who are interested in evidence-
based course design, especially for pediatric nursing course. The audience will learn Taiwanese students’
knowledge and expectation about pediatric nursing course in a two-year nursing college program and
related factors.
Abstract
Purpose: The two-year nursing college program was developed in Taiwan, which helps the students
graduated from a five-year junior nursing college to get a bachelor degree in nursing in two-year. To avoid
repeating learning content, and to learn useful nursing knowledge for clinical pediatric nursing practice,
the course design of pediatric nursing is very important. However, there is little evidence-based research
about this course design in previous study. The purposes of this study were: 1) to examine the students’
knowledge and expectation about the content of pediatric nursing course in a two-year nursing college
program in Taiwan; and 2) to explore the factors which influence the students’ knowledge and expectation
about the content of pediatric nursing course.
Methods: A correlational study was conducted. A nonprobability sample of 102 two- year nursing college
students was recruited from a technology university located in southern Taiwan. All participants
completed the consent forms and the questionnaires. A demographic questionnaire and the
Questionnaire of the Knowledge and Expectation about the Content of Pediatric Nursing Course were
used to collect data. Data were analyzed by descriptive statistical techniques, ANOVA and Pearson’s
correlations.
Results: The findings showed that student participants got higher scores in the knowledge about body
system (mean score = 3.26) than the knowledge about nursing process (mean score = 2.76), and the
knowledge about nursing concepts (mean score = 1.81). Moreover, student participants showed higher
expectation to learn the knowledge about nursing process (mean score = 3.86) than the knowledge about
nursing concepts (mean score = 3.11), and the knowledge about body system (mean score = 2.32). The
years after graduation from five-year junior college were negatively and significantly related to the score
of knowledge about body system, nursing process, and nursing concepts. The years of students’ working
experience were positively and significantly related to the score of expectation to learn the knowledge
about nursing process.
Conclusion: The results showed the students’ knowledge level and expectation about the content of
pediatric nursing course. The findings can be used in the future to make a better design of pediatric
nursing course in a two-year nursing college program to meet students‘ expectation and to enhance the
knowledge of pediatric nursing for clinical practice. The evidence- based research method for course
design can be utilized in other countries to develop appropriate course content for a new course.
References
Gagne, R.M., Briggs, L.J. & Wager, W.W. (1992). Principles of instructional Design. Philadelphia: Harcourt Brace
Jovanovich. Namnabati, M., Azar, E. F., Valizadeh, S., & Tazakori, Z. (2011) Lecturing or Problem-based Learning:
Comparing Effects of the Two Teaching Methods in Academic Achievement and Knowledge Retention in Pediatrics
Course for Nursing Students. Iranian Journal of Medical Education, 10 (4): 1-10. Samawi, Z., Haras, M. S., & Miller,
T. L. (2012). Age-Appropriate Health Promotion Education: Roots Firmly Established in Baccalaureate Nursing

Pediatric Rotation. Journal of Pediatric Nursing, 27 (1): 44-9. Torres, C.,& Stanton, M. (1985). Curriculum process in
nursing. NY:Viking Press. Torres, C. & Stanton, M.(1985). Curriculum process in nursing: a guide to curriculum
development. New Jersey: Prentice Hall Inc.
Contact
[email protected]

A Diabetes Self-Management Education Program Based on the Information-
Motivation-Behavioral Skills Model: Effects on Older Adults with Type 2 Diabetes
in Korea
Suyoung Choi, PhD, GNP, RN, South Korea
Misoon Song, RN, PhD, South Korea
Se-an Kim, RN, MSN, South Korea
Kyoungsan Seo, RN, MSN, South Korea
Soo Jin Lee, RN, MSN, South Korea
Purpose
The purpose of this presentation is to describe the effect of the theory-based and behavioral outcome-
focused diabetes self-management program for older adults in Korea.
Target Audience
The target audiences of this presentation are nurses, diabetes educators, and health professionals who
are interested in evidence-based health practice.
Abstract
Purpose: The purpose of this study was to evaluate the effect of the Diabetes Self-Management
Education for Older Koreans (DSME-OK) program based on the Information-Motivation-Behavioral skills
(IMB) model. The unique characteristics of the DSME-OK program are the application of the IMB model
and utilization of the intervention mapping (IM) protocol. The IMB model includes three important
behavioral change resources: information, motivation, and behavioral skills. The IM protocol includes
needs assessment, defining goals and objectives, identifying theory and determinants, developing a
matrix to form change objectives, selecting strategies and methods, structuring the program, and planning
for evaluation.
Methods: A two-group, quasi-experimental study design was used to test the DSME-OK program with
community-dwelling older adults in Korea. The DSME-OK program has 14 weekly 90-minute sessions. It
has adopted seven behavior objectives developed by the American Association of Diabetes Educators as
behavioral outcomes. Thirty older adults between 66 and 90 years old (mean 76.8 ± 5.4) completed the
entire research protocol and assessments at four time points. Changes in scores (from baseline to 14
weeks and 3- and 6-month follow-up) of outcome variables were compared between the intervention
group (n = 15) and the control group (n = 15).
Results: At 14 weeks, diabetes self-management motivation (p = 0.042) was higher in the DSME-OK
program participants than usual care control subjects. At 3- and 6-month follow ups, diabetes self-
management motivation (p = 0.022), self-efficacy (p = 0.004), and self-management knowledge (p =
0.039) were higher in the DSME-OK program participants than the controls. However, the groups did not
significantly differ in A1C, lipids (triglycerides, total cholesterol, high-density lipoprotein cholesterol, and
low-density lipoprotein cholesterol), and self-management behavior change scores. These variables were
relatively similar between groups at baseline.
Conclusion: This theory-based self-management program that focused on behavioral outcomes was
effective for improving diabetes self-management information, motivation, and behavioral skills for older
adults with diabetes. These results provide further evidence of the effectiveness of theory-based
interventions for changing self-management behaviors. Further studies should attempt to replicate the
current findings by using larger samples and longer time frames.
References
American Association of Diabetes educators (2008). AADE7 self-care behaviors. The Diabetes Educators, 34(3),
445-449. Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: A process for developing theory-
and evidence-based health education programs. Health Education & Behavior, 25(5), 545–563. Fisher, J. D., Fisher,
W. A., & Shuper, P. A. (2009). The information-motivation-behavioral skills model of HIV preventive behavior. In R.

DiClemente, R. A. Crosby, & M. Kegler (Eds.), Emerging theories in health promotion practice and research (2 ed.,
pp. 22–63).: San Francisco, CA: Jossey-Bass.
Contact
[email protected]

Allergen Screening and Telephone Coaching Interventions to Prevent School-Age
Children at Risk of Developing Asthma
Bih-Shya Gau, PhD, Taiwan
Yuan-Ju Liao, MSN, Taiwan
Yu-Fen Tzeng, MSN, Taiwan
Pei-Ching Liu, MSN, RN, Taiwan
Purpose
Asthma is the most common chronic health condition for children globally, and the prevalence is
increasing in Taiwan. This project was aimed to have evidence-based asthma intervention program for
children at risk of asthma.
Target Audience
The target audience of this presentation is nursing scholars and clinical nurrse experts in the child health
care.
Abstract
Purpose: Asthma is the most common chronic health condition for children globally, and the prevalence
is increasing in Taiwan. According to surveys by the Department of Health, Taipei City Government, the
prevalence of asthma among first graders was 20.34% and 20.74% in 2007 and 2009 respectively. This
project was aimed to have evidence-based intervention program for children at risk of asthma.
Methods: During 2010 to 2012, an action research was conducted to deliver an overall allergen
screening for the enrolled first-grade pupils and to provide telephone coaching interventions for the high-
risk group in Taipei city, Taiwan. Dimensions of the interventions consisted of providing telephone
coaching and parenting group, establishing the document of the coaching process and feedback,
disseminating the asthma education materials and website resources. Before the research project, a
standard telephone coaching protocol was developed and achieved to consensuses. Ten telephone
coachers were recruited then trained by a series of asthma in-service education; they had clinical nurse
practices at least 5 years and had approval as qualified asthma educators by Taiwan Association of
Asthma Education. The high risk first graders were screened by using the asthma symptoms screening
questionnaire and confirmed by blood allergen test. Parents of blood test positive children were given
telephone coaching asthma education first and then received follow-up care. In addition, they were invited
to parenting group for further dynamic asthma care consultation and supports. Outcome evaluation
included narrative feedback and structural questionnaire of asthma knowledge, asthma symptom control,
adherence to asthma care, level of satisfaction to the interventions.
Results: A total of 5,463 were screened out of the 62,497 first-grade schoolchildren as high risk group for
asthma. As receiving allergen blood test, 4267 schoolchildren were confirmed to have positive findings;
positive rate was 78.11% (4267/5263). Ninety percent positive cases (3878/426=90.8%) were
successfully recruited to have the interventions. Among them, house dust mites (dermatophagoides
pteronyssinus & dermatophagoides farine), blomia tropicalis and hair of dogs/cats were reported to be the
first three leading allergens for children. Mothers are the key recipients having the telephone coaching
(68.5%). The major contents of the coaching included allergen prevention (70.8%), facets of allergy and
asthma (60.4%), use of controller and rescue medicine (62.7%). Use of peak expiratory flow meter,
prevention of exercise induced asthma and skills of using inhaler were insufficient for their self-
management. Among the children, 5.3% experienced the ER visit in the past one year and 3.7% had
school absences. Prevention of asthma exacerbation during sandstorm and cold wave were also
discussed. In addition to adherence to asthma medicine, prevention of triggers, healthy eating and regular
exercise were fully shared and reinforced during the process. The final follow-up evaluation showed a
high degree of satisfaction of telephone coaching and parenting group among parents, statistical
significant reductions in ER rate and days of absence among schoolchildren.

Conclusions: The interventions in the research support the “asthma control-oriented asthma care”
advocated by the Global Initiative for Asthma (GINA). The findings indicate that developing partnership
between parents/children with asthma, identifying the triggers and reducing exposure to risk factors,
empowering the asthma self-monitor and self-management efficacy can enhance health outcomes and
quality of life for children and their families.
References
Bartholomew, L. K., Sockrider, M. M., Abramson, S. L., Swank, P. R., Czyzewski, D. I., Tortolero, S. R., Markham, C.
M., Fernandez, M. E., Shegog, R., & Tyrrell, S. (2006). Partners in school asthma management: Evaluation of a self-
management program for children with asthma. Journal of School Health, 76(6), 283-290. Bruzzese, J. M., Evans, D.,
Wiesemann, S., Pinkett-Heller, M., Levison, M. J., Du, Y., Fitzpatrick, C., Krigsman, G., Ramos-Bonoan, G., Turner,
L., Mellins, R. B. (2006). Using school staff to establish a preventive network of care to improve elementary school
student’s control of asthma. Journal of School Health, 76(6), 307-312. Buford, T. A. (2004). Transfer of asthma
management responsibility from parents to their school-age children. Journal of Pediatric Nursing, 19(1), 3-12. C., &
ISAAC Phase Three Study Group. (2007). worldwide trends in the prevalence of asthma symptoms: Phase Ⅲ of the
international study of asthma and allergies in childhood (ISAAC). Thorax, 62, 758-766. Global Initiative For Asthma.
(2013). Pocket guide for asthma management and prevention.
http://www.ginasthma.org/local/uploads/files/GINA_Pocket2013_May15.pdf Murdock, K. K., Robinson, E. M., Adams,
S. K., Berz, J., & Rollock, M. J. D. (2009). Family-school connections and internalizing problems among children
living with asthma in urban, low-income neighborhoods. Journal of Child Health Care, 13(3), 275-294. Pearce, N., Ait-
Khaled, N., Beasley, R., Mallol, J., Keil, U., Mitchell, Ed., Robertson, Pender, N.J., Murdaugh, C., & Parsons, M.A.
(2010). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson/Prentice-Hall. Swerczek, L.
M., Banister, C., Bloomberg, G. R., Bruns, J. M., Epstein, J., Highstein, G.R., ...Garbutt, J. M. (2013). A telephone
coaching intervention to improve asthma self-management behaviors. Pediatric Nursing, 39(3), 125-30, 45.
Contact
[email protected]

Meta-Analyses of Epigenetics Risk Factors for Prevention of Hypertension:
Angiotensinogen Human Gene Variations Across Different Race-Ethnicity Groups
Guey-Shiun Huang, PhD, RN., Taiwan
Kidest Babi, MSN, NP, USA
S. Pamela Shiao, PhD, RN, FAAN., USA
Purpose
The purpose of this presentation is to disseminate current evidence on population genome health,
through meta-analyses of epigenetic risk factors, for hypertension.
Target Audience
The target audiences can include nursing and inter-professional colleagues who are interested in learning
about population genome health and epigenetics risk factors for prevention of hypertension.
Abstract
Background: Hypertension is a major risk factor for heart diseases, stroke, and kidney diseases.
Previous research suggests an association between Angiotensinogen (AGT) single nucleotide
polymorphisms M235T variations and hypertension. Life style risk factors were associated with increased
risk for hypertension. No meta-analysis concluded the association for AGT M235T with hypertension for
different population groups.
Purpose: The purpose of this study was to identify the association of AGT M235T gene variations and
hypertension for various race-ethnicity groups and the associated risk factors for the prevention of
hypertension.
Method/Results: Preliminary analyses included 7607 cases and 9673 controls associating AGT M235T
with hypertension from 30 case-control studies published within the last 18 years. The gene mutation
variations (MT and TT subtypes) in Asians (70.8-100%) were higher than Caucasians (62.0-79.0%) in the
world, for control and case groups. For validation, pollution indicators were checked and shown worse in
Asia than other countries in recent years. For lifestyle related meta-analyses, smoking (11 studies, 2155
cases, 3518 controls, RR=1.14, 95% Confidence Interval =0.93-1.40), alcohol intake (5 studies, 1076
cases, 2280 controls, RR=0.82, 95% CI=0.60-1.13), and physical inactivity (3 studies, 470 cases, 2021
controls, RR=0.97, 95% CI=0.86-1.09) were pooled for meta-analyses. For association of AGT235 gene
variations, genotype MM (16.9% cases, 19.1% controls) was protective against hypertension for all
populations combined (RR=0.83, 95% CI=0.73-0.94, p=0.0026).
Conclusion: Future research is needed to investigate the interactions between epigenetic risk factors
and AGT gene variations for the population heath across the world in the prevention of hypertension.
References
1.Charita B, Padma G, Sushma P, Deepak P, Padma T. Estimation of risk and interaction of single nucleotide
polymorphisms at angiotensinogen locus causing susceptibility to essential hypertension: a case control study. J
Renin Angiotensin Aldosterone Syst. 2012 Dec;13(4):461-71. 2.Cheng, J.-L., A.-L. Wang, et al. (2012). "Association
between the M235T polymorphism of the AGT gene and cytokines in patients with hypertension." Experimental and
Therapeutic Medicine3(3): 509-512.
Contact
[email protected]

The Adoption and Implementation of the Columbia-Suicide Severity Rating Scale
(C-SSRS) in a Psychiatric Emergency Service: Utilizing Roger's Diffusion of
Innovations Model
Cheranne Morse, DNP, RN, PMHNP-BC, CASAC, CD, USA
Purpose
The purpose of this presentation is to increase awareness to the scope of suicide and the need for better
suicide risk assessments in acute clinical settings through the implementation of the Columbia-Suicide
Severity Rating Scale (C-SSRS).
Target Audience
The target audience of this presentation are Psychiatric & Emergency Department staff such as Nurses,
Nurse Practitioners, Physicians, Social Workers.
Abstract
Suicide is a major public health problem and the most dreaded patient outcome. Patient suicides are one
of the top five most common sentinel events in health care. Within two months of discharge from an
emergency department, one in ten patients will commit suicide. However, the exact number for completed
patient suicides following an evaluation in a psychiatric emergency service is unknown. Patients present
to the psychiatric emergency department in an acute crisis state often due to suicidal ideation and
behaviors. Psychiatric emergency service clinicians are faced with performing a suicide risk assessment
in a highly complex environment. Assessment practices vary across institutions and currently there is no
universally accepted instrument. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a brief, valid,
reliable instrument which makes its application well-suited for psychiatric emergency services. The
objective of this quality improvement project is to evaluate the adoption and implementation of the
Columbia-Suicide Severity Rating Scale (C-SSRS) to assess suicidal ideation and behaviors of acute
psychiatric patients, in a suburban, tertiary care, psychiatric emergency service using Roger’s Diffusion of
Innovations model as a framework. Results support a 90% uptake of the intervention for at least 6
months following the implementation. Results from this project have the potential to improve
comprehensive evaluations of suicide risk which augment clinical judgment and may lead to an increase
in effective interventions and decreased suicidal behaviors.
References
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., . . . Mann, J. J. (2011). The
columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with
adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. Ronquillo, L., Minassian, A., Vilke, G.
M., & Wilson, M. P. (2012). Literature-based Recommendations for Suicide Assessment in the Emergency
Department: A Review. The Journal of Emergency Medicine, 43(5), 836-842. doi: 10.1016/j.jemermed.2012.08.015
Simon, R. I. (2009). Enhancing suicide risk assessment through evidence-based psychiatry. Psychiatric Times, 26(1),
42-45. Zun, L. S. (2012). Pitfalls in the Care of the Psychiatric Patient in the Emergency Department. The Journal of
Emergency Medicine, 43(5), 829-835. doi: http://dx.doi.org/10.1016/j.jemermed.2012.01.064
Contact
[email protected]

Spotlight on Practice: Achieving Excellence in Service, Accountability, and
Professional Leadership
Rani Hajela Srivastava, RN, MScN, PhD, Canada
Jane Paterson, MSW, RSW, Canada
Gabriella Golea, RN, BScN, MN, CPMHN (C), Canada
Margaret Gehrs, RN, BSc (HK), BScN, MScN, CPMHN (C), Canada
Purpose
to describe how the best practice guideline implementation can be used for strategic practice
transformation
Target Audience
Senior Administrators, Clinicians, Advanced practice nurses, Educators,
Abstract
While much has been written about the implementation of Nursing best practice guidelines within
hospitals, there is a dearth of evidence on how to support such implementation within a mental health and
addictions environment, and in an integrated interprofessional manner. This presentation will describe
how one large mental health and addictions academic teaching hospital endeavored to promote best
practice guidelines (BPG’s) as part of a new strategic direction and practice plan. It will highlight how the
unique aspects of organizational culture were considered during the selection, development,
implementation, and evaluation of BPG’s in a mental health and addictions health care environment. The
implementation was broadly guided by an organizational change framework that consists of six core
strategies that the organization had initially used in an organizational initiative focused on the reduction of
restraints and seclusion (National Executive Training Institute, 2003). The six core strategies are: (1)
leadership, (2) using data to inform practice, (3) workforce development, (4) tools and resources, (5)
debriefs and learning from experience, and (6) full inclusion of clients and families . This overarching
framework was used an overall guiding strategy and augmented by additional supporting frameworks
from the literature including the PARIHS Framework (see Rycroft-Malone, 2004), Complex Systems
Perspective (see Suter et al, 2011), and the Organizational Memory Framework (see Virani et al, 2009).
Change management processes addressed the unique skills mix of interprofessional care providers and
integration with other initiatives and the strategic priorities of the organization.
Although designed and led by professional practice leadership, the formal initiative was designed as a 3
year journey that focused at all levels the organization with respect to leadership, engagement, and
accountability. The engagement included the quality committee of the hospital board, senior
management, advanced practice nurses and clinicians, educators, and an inteprofessional group of
champions in direct care. Six clinical and two healthy work environment best practice guidelines were
chosen for implementation. We are two years into the three year journey and have experienced many
expected and unexpected challenges and successes. The presentation will highlight the phases of the
the journey and critical success factors at each stage. A key factor to the overall success has been the
adoption of a continuous learning stance and intentional integration of the BPG implementation to other
organizational initiatives and goals.
References
National Executive Training Institute (2003). National Association of State Mental Health Program Directors: Training
curriculum for the reduction of seclusion and restraint. Curriculum Guide (Trainee Handout). Rycroft-Malone, J.
(2004). The PARIHS Framework – A framework for guiding the implementation of evidence-based practice. Journal
of Nursing Care Quality, 19(4), 297-304. Suter, E. and Deutschlander, S. (2011). Using a complex systems
perspective to achieve sustainable healthcare practice change. Journal of Research in Interprofessional Practice and
Education, 2.1, 83-99. Virani, T., Lemieux-Charles, L., Davis, D.A., and Berta, W. (2009). Sustaining change: Once
evidence-based practices are transferred, what then? Longwoods Review, 6(4), 89-96.
Contact

[email protected]

Integrating Genomics into Nursing Education
Ann H. Maradiegue, PhD, MSN, BSN, USA
Quannetta T. Edwards, PhD, RN, FNP, WHNP, FAANP, USA
Purpose
the purpose of this presentation is to provide a framework, along with resources for nurse educators to be
able to integrate genomics into their nursing undergraduate and graduate programs.
Target Audience
The target audience is nurse educators who wish to integrate genomics into their curriculum.
Abstract
Purpose: To provide nursing faculty with strategies and resources to be able to integrate genomic
information into their existing curriculum.
Evidence: Nurses must be knowledgeable in the current scientific discoveries related to health care in
order to practice effectively. Recent genomic advances include novel drug therapies, more nuanced
reproductive counselling and reproductive options, enhanced risk assessment, and expanded clinical
laboratory testing. Genomic discoveries are expected to transform future health care and nurses are ‘key’
to this transformation. As the largest healthcare discipline, nurses are in the position to educate, care for
and manage individuals and families with genetic/genomic disorders in primary and acute care settings,
as well as in the community. Preparing nurses for this future transformation is in the hands of educators.
Nurse leaders from around the globe have developed genetic/genomic competencies to enhance the
education of nurses. Although many countries require nursing programs to include genetic/genomic
content in nursing education, studies have revealed that the level of content in this subject are low or
absent in nursing curriculum, even though nurses are open to genetics/genomic education that applies
the scientific principles to practice.
Nursing faculty continue to have low comfort and knowledge levels with teaching genetics/genomics
content. More training is warranted for nursing faculty so they are knowledgeable and comfortable with
genetic/genomic topics to prepare future generations of nurses to address the public’s health, and to be
comfortable with advanced technologies. The shift to precision health care makes it clear that genomics
must be fully integrated into nursing curricula.
Methods: Strategies for integration of content into undergraduate and graduate programs will be
presented, with examples and case studies. A list of tools, web sites, books and articles will be made
available.
References
Calzone, K., Jenkins, J., Yates, J., Cusack, G., Wallen, G., Liewehr, D.,… McBride, C. (2012). Survey of nursing
integration of genomics into nursing practice. Journal of Nursing Scholarship, 44(4), 428–436. Dodson, C., &
Lewallen, L. (2011). Nursing students’ perceived knowledge and attitude towards genetics. Nurse Education Today,
31(4), 333–339. Guttmacher, A., Porteous, M., & McInerney, J. (2007). Educating health professionals about genetics
and genomics. Nature Reviews Genetics, 8(2), 151–157. Williams, J. K., Prows, C. A., Conley, Y. P., Eggert, J., Kirk,
M., & Nichols, F. (2011). Strategies to Prepare Faculty to Integrate Genomics Into Nursing Education Programs.
Journal of Nursing Scholarship, 43(3) 1547-5069. Kirk, M., Tonkin, E., & Burke, S. (2008). Engaging nurses in
genetics: The strategic approach of the NHS National Genetics Education and Development Centre. Journal of
Genetics Counseling, 17, 180–188. Kirk M, Calzone K, Arimori N, Tonkin E. (2011). Genetics-genomics
competencies and nursing regulation. Journal of Nursing Scholarship, 43(2), 107-116. Maradiegue, A. (2008). A
resource guide for learning about genetics. Online Journal of Issues in Nursing (OJIN), 13(1) Manuscript 6.
Maradiegue, A., Edwards, Q., Seibert, D. (2013). 5 years later-Have faculty integrated medical genetics into nurse
practitioner curriculum? International Journal of Nursing Education and Scholarship, 10(1), 1-10. doi 10.1515/ijnes-
2012-0007
Contact

[email protected]

Effects of Instructor Immediacy and Online Course Design in Student Satisfaction
and Successful Course Completion
Nancy J. Slizewski, DNP, RN, USA
Purpose
The purpose of this presentation is to discuss the results of a nursing doctoral capstone project
investigating the effects of course design and instructor feedback on student success and satisfaction in
an online medical terminology course.
Target Audience
The target audience is nursing or health care instructors teaching online courses.
Abstract
Background: The withdrawal and failure rates for online classes and student satisfaction of online
courses are identified as problems.
Aim and Objectives: The aim was to investigate the effects of course design and instructor feedback on
student success and satisfaction in online courses.
Method: The literature review supported further investigation of student satisfaction and course
completion in online courses and the college approved the project. Student satisfaction with the course
and instructor were evaluated utilizing the college’s current survey tool. Student course completion was
evaluated. Results of the project were compared to the 2010 online Medical Terminology course and all
2011 online courses at the technical college in Wisconsin.
Analysis and Results: The data analysis showed no significant differences in the survey results
between groups. Differences were noted in the rates of successful course completion in the Medical
Terminology courses and all online courses at the college. The course design differed in the two Medical
Terminology online courses therefore the increased rates cannot be solely attributed to the capstone
interventions.
Recommendations: Course design and instructor feedback may have a significant impact on student
success and satisfaction in online courses warranting further studies. The results of further studies may
improve student outcomes benefitting not only the students but the college as well.
References
Altmann, T. (2007). An evaluation of the seminal work of Patricia Benner: Theory or philosophy? Contemporary
Nurse: A Journal for the Australian Nursing Profession, 25(1-2), 114-123. Retrieved from
http://search.ebscohost.com.dml.regis.edu/login.aspx?direct=true&db=c8h&AN=2009644791&site=ehost-live
American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for Advanced Nursing
Practice. Retrieved from http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf Bangert, A. (2005). Identifying factors
underlying the quality of online teaching effectiveness: An exploratory study. Journal of Computing in Higher
Education. 17(2), 79-99. Retrieved from Regis University Interlibrary Loan. Benner, P. (2001). From novice to expert:
excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley Pub. Co., Nursing Division.
Bennett-Woods, D. (2011). Ethics at a glance. Retrieved from http://rhchp.regis.edu/HCE/EthicsAtAGlance/index.html
Berthelot, J.M., Le Goff, B., Maugars, Y. (2011). The Hawthorne effect: Stronger than the placebo effect? Joint, Bone,
Spine. 78(4), 335-336. Retrieved from http://www.sciencedirect.com/science/article/pii/S1297319X11001515
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Contact
[email protected]

A Faith-Based Concept Analysis for Nursing Education
Charlene Niemi, MSN, PHN, BSN, RN, USA
Robin Covey, MSN, FNP-C, BSN, RN, USA
Carolyn Hanohano, MSN, BSN, PHN, RN, USA
Veletta Ogaz, MSN, FNP,BSN, USA
Patricia Frohock Hanes, PhD, MSN, MAEd, RN, CNE, USA
Purpose
The purpose of this presentation is to share how faith-based concepts can provide a specific focus or an
overarching unity to specific nursing content areas and to assist nursing educators wishing to apply
spiritual concepts from a scholarly perspective into their teaching without resorting to the practice of
bookending.
Target Audience
The target audience for this presentation is nursing educators at secular and faith-based institutions.
Abstract
Background/Purpose: Doctoral students who are also teaching at secular and faith-based institutions
conducted a teaching/research project to integrate faith-based concepts related to specific nursing topics
into their teaching plans. The purpose of this presentation is to share how faith-based concepts can
provide a specific focus or an overarching unity to specific nursing content areas and to assist nursing
educators wishing to apply spiritual concepts from a scholarly perspective into their teaching without
resorting to the practice of bookending.
Conceptual Framework: This project was based on multiple learning theories including adult learning
theories, Walker and Avant’s concept analysis, and transformative learning theory as a core value.
Methods/Results: Doctoral students used a concept analysis approach where they first chose concepts
related to specific teaching topics, and then conducted a concept analysis using dictionaries, scriptural
resources such as the Bible, scriptural concordances, Bible commentaries, and scholarly Internet
sources. The process involved the eight steps of concept analysis as discussed by Walker and Avant.
Ultimately, the doctoral students integrated their findings into specific lesson plans to enhance the depth
of their teaching. Students planned how the integration of concepts would be used in secular schools
versus faith-based institutions, e.g. incorporating content while teaching about spirituality in relation to the
Neuman’s systems model. Concept analysis using faith-based concepts can provide educators with a
teaching strategy to holistically integrate faith integration and spirituality into their teaching plans.
Implications/Significance/Recommendations: This process can be used in both secular and faith-
based institutions, both inside and outside of the nursing discipline. The process presents spiritual
concepts from a scholarly perspective. It seamlessly integrates a faith-based and spiritual approach into
the nursing classroom. Concepts drive nursing practice; therefore, it is important to discover how specific
faith related concepts affect how nurses visualize and provide care in a variety of situations.
References
Neuman, B., & Fawcett, J. (Eds.). (2011). The Neuman systems model (5th ed.). Upper Saddle River, NJ: Pearson.
Walker, L.O. & Avant, K.C. (2005). Strategies for theory construction in nursing. Upper Saddle River, NJ: Pearson.
Contact
[email protected]

Implementation of a Nurse-Driven Foley Catheter Removal Protocol: A Patient
Safety and Quality Improvement Project
Aimee L. Burch, MS, APRN-CNS, CMSRN, USA
Purpose
The purpose of this presentation is to present knowledge and data obtained from the implementation of a
Nurse-Driven Foley Catheter Removal Protocol that was put into practice to decrease device utilization
rates (DUR) and catheter-associated urinary tract infections (CAUTIs).
Target Audience
The target audience of this presentation is clinical nurses and nurse managers hoping to decrease or
discontinue Foley catheter use in an acute care setting.
Abstract
Urinary tract infections (UTIs) are the most prevalent healthcare associated infections (HAIs) with
incidence rates topping 30%, and can lead to increased hospital cost, length of stay, morbidity and
mortality (1,2). Inserting urinary catheters causes most UTIs (2), suggesting that preventing catheter use or
removing the catheters as soon as possible would decrease UTI rates. Urinary catheter removal may be
overlooked by the medical team when considering all other patient issues. Placing nursing in control of
noting inappropriate or unnecessary catheters and then empowering nursing staff to remove those
catheters has been recommended to decrease catheter dwell time, leading to reductions in catheter-
associated UTIs (CAUTIs).
Noting an increase in CAUTIs, the infection prevention department nurses formed a team to look at
CAUTIs and devise a plan of action. As noted in the literature, keeping catheters out or removing them
quickly has been proven to decrease catheter-associated problems. A physician champion from the
urology service line (utilizing Centers for Disease Control guidelines) assisted the team with an approved
list of indications for catheter placement and maintenance. A literature review completed by team
members showed several other catheter removal protocols; however, none had all of the components
that the team deemed necessary for a complete protocol.
The team utilized part of a protocol designed by Tufts Medical Center (shared via slide) to form a protocol
that would meet all of the patient’s needs. This included the indications for placing or maintaining a
catheter, the removal protocol, and guidelines for bladder ultrasound combined with intermittent
catheterization after catheter removal. The protocol was taken to several medical and administrative
committees for approval prior to trial initiation.
Baseline data for CAUTI and device utilization rates was obtained from infection prevention prior to
initiation of this patient safety and quality improvement trial. The nurse-driven catheter removal protocol
was then conducted for 6 months on 2 medical-surgical units with a combined average census of 32
patients. Utilizing the criteria in the protocol, unnecessary catheters were removed by nursing staff per the
protocol (without a call to the provider). Protocol instructions include a bladder ultrasound every 6 hours if
the patient had not voided, with intermittent catheterization if post-void residuals exceeded 400 milliliters.
Perineal care post-removal was also an essential part of the infection prevention process.
Education of nursing staff and practitioners was essential to the success of the trial. Topics included
general CAUTI information, proper catheter and perineal care, criteria for catheter insertion and
maintenance, as well as protocol use. Education was completed utilizing many methods including on-line
computer modules, presentations at staff meetings, hands-on practice at skills fairs and one-on-one
coaching with staff and providers alike. Initially there was some pushback from the surgical group, but
that was alleviated utilizing more one-on-one sessions with each surgeon to address their concerns.
Overall the protocol appears to be a physician satisfier, with fewer calls regarding patients with retention,
and issues with catheter care and removal.

Data was collected via daily rounding by infection prevention, nurse managers and clinical nurse
specialists to assess catheters present on each unit for necessity and duration. This time was also utilized
for coaching and answering questions that may arise regarding the process. A log was kept on the floor
and was updated daily as possible. Data collected during the trial included device utilization rate (DUR),
catheter reinsertion rate, number of CAUTIs, the CAUTI rate and device days.
Data collected showed that fewer catheters were being placed inappropriately and kept unnecessarily,
while the reinsertion rate on both units remained steady throughout the trial, with many patients requiring
catheter reinsertion being referred to urology for follow-up. DUR, CAUTIs and device days (approximate)
for both units decreased (unit 1 DUR decreased from 35.48 to 34.48, CAUTIs fell from 3 to 2 and device
days declined from 2400 to 2200; unit 2 DUR was reduced from 25 to 18.82, the number of CAUTIs
decreased from 2 to 1, with the device days being cut from 4050 to 3300). The actual CAUTI rates of both
units increased (unit 1 from 1.57 to 1.76 and unit 2 from 0.57 to 0.92). This was primarily attributed to low
catheter numbers during the trial period.
The protocol was initiated hospital-wide in September of 2013, with preliminary data from the recently
surveyed areas (notably the intensive care and progressive care units) indicating a continued successful
process. The DUR for all inpatient units has declined noticeably since hospital-wide protocol initiation, as
have the number of CAUTIS and reinsertion rates. There will be considerably more data by the
conference, with the hope being that other hospitals and nursing areas can adopt and utilize the protocol
to decrease urinary infection rates and device days while increasing patient safety.
References
1. American Association of Critical Care Nurses. Practice Alert (2011).
http://www.aacn.org/WD/practice/docs/practicealerts/catheter-associated-uti- practice-alert.pdf 2. Gotelli, J.M., et.al.
2008. A quality improvement project to reduce the complications associated with indwelling urinary catheters. Urology
Nursing, 28(6):465-7, 473. 3. Tufts Medical Center’s Nurse Driven Protocol for Removing Indwelling Urinary
Catheters, slide shared.
Contact
[email protected]

Best Practice Guidelines for Uncomplicated Urinary Tract Infections Reduce the
Rates of Antibiotic Resistance: A CE Module for Clinicians
Romina Lo-Montano, MSN, USA
Purpose
The purpose of this presentation is to provide the most current information about the proper treatment
and management of uncomplicated UTI’s in women, which will result in a decrease in the incidence and
prevalence of antibiotic resistance, through the dissemination of information via a CE module.
Target Audience
The target audience of this presentation is all health care providers such as nurse practitioners,
physicians, and physician assistants.
Abstract
For the past two decades antibiotic resistance has become a global issue stemming from the overuse of
antibiotics. The lack of appropriate management of the client with uncomplicated urinary tract infections
(UTI’s) contributes to antibiotic overuse and an increase in antibiotic resistance. Uncomplicated UTI ranks
as one of the most frequently treated diagnosis in primary care settings and urgent care clinics. In fact,
approximately one in six women will experience an uncomplicated UTI in her lifetime.
More than eleven percent of women are diagnosed with uncomplicated UTI’s annually and many of these
women are needlessly treated with antibiotics. The costs associated with the evaluation and treatment of
uncomplicated UTI’s in women was estimated to be $3.5 million in 2000. The total cost associated with
treatment of UTI’s in the emergency department has amounted to $4 billion dollars (Gregg, 2013). The
expense of treating patients with uncomplicated UTI’s has continued to rise contributing to the
astronomical cost of healthcare affecting insurance companies, individuals, and providers. A vast number
of studies have shown that almost 50% of women presenting with symptoms of uncomplicated UTI will
recover spontaneously within one week without antibiotics (Knottnerus et al., 2013; Leydon, Turner,
Smith, & Little, 2009). However, providers continue to treat patients with uncomplicated UTI’s by
prescribing antibiotics in spite of the recommendations from the current best practice guidelines.
Statement of purpose: A continuing education (CE) module targeting health care providers will provide
the most current information about the proper treatment and management of uncomplicated UTI’s in
women, which will result in a decrease in the incidence and prevalence of antibiotic resistance.
Literature review. Research studies have shown an alarming increase in the rates of resistance against
antibiotics that are commonly used to treat uncomplicated UTI’s in women. Empiric treatment of
uncomplicated UTI’s has resulted in an increase in antibiotic resistance from 20% to 40% within the past
decade in various regions of the United States (Ansbach, Dybus, and Bergeson, 2005). However,
healthcare providers continue to prescribe a long-term course of antibiotic therapy for treatment of
uncomplicated UTI’s instead of adhering to EBP guidelines. A comprehensive literature review has shown
that short-term course antibiotic therapy is just as effective as the traditional long-course therapy for
treatment of uUTI’s, and patients are more likely to complete the short-term course of treatment (Barclay,
2008; Kahan, Chinitz, & Kahan, 2004).
Theory. The development of this CE module will be based on concepts from Malcolm Knowles’ Adult
Learning Theory. Knowles believed that adults are responsible for their own learning and are motivated
by their need to know and internal drive (Norrie & Dalby, 2007). The CE module will be a self-directed
learning experience at a time and place that is convenient for the participant.
Education module. The goal of this CE module is to increase provider awareness regarding the
appropriate use of antibiotics and length of therapy for the treatment of uUTI’s in women in accordance
with the latest EBP guidelines while reducing the risk of antibiotic resistance. The latest guidelines as set
forth by the Infectious Disease Society of America (IDSA) in 2011 as well as the earlier 2008 guidelines

developed by the American College of Obstetrics and Gynecologists (Gupta, Hooton, Naber, Wullt,
Colgan, Miller, Soper, 2010). A pre-test, post-test method will be used. A multiple choice questionnaire
consisting of 10-questions will be used to assess and to evaluate current knowledge, awareness, and
practice behaviors regarding the use of antibiotics for the treatment of uUTI’s.
Summary. It is imperative the providers adhere closely to EBP guidelines for the proper management of
uUTI’s in women and they have a goal to minimize further development of antibiotic resistance.
Increased adherence to EBP guidelines will reduce healthcare costs, decrease adverse reactions,
minimize antibiotic use and ultimately impact the global issue of increasing antibiotic resistance.
References
Ansbach, R. K., Dybus, K., & Bergeson, R. (2005). Uncomplicated E. coli urinary tract infection in college women: a
follow-up study of E. coli sensitivities to commonly prescribed antibiotics. Journal of American College Health, 54, 81-
84. Barclay, L. (2008). New guidelines for management of urinary tract infection in nonpregnant women. Retrieved
from www.medscape.org/viewarticle/571545 Bjorkman, I., Berg, J., Viberg, N., & Lunborg, C. S. (2013). Awareness of
antibiotic resistance and antibiotic prescribing in UTI treatment: A qualitative study among primary care physicians in
Sweden. Scandinavian Journal of Primary Health Care, 31, 50-55. Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B.,
Colgan, R., Miller, L. G., Soper, D. E. (2010, March 1). International Clinical Practice Guidelines for the Treatment of
Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of
America and the European Society for Microbiology and Infectious Diseases. Clinical Practice Guidelines, 201, e103-
120. Retrieved from http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-
Patient_Care/PDF_Library/Uncomp%20UTI.pdf Gregg, H. (2013, May). ER visits for UTIs add $4B in unnecessary
healthcare costs annually. Retrieved from http://www.beckershospitalreview.com/quality/er-visits-for-utis-add-4b-in-
unnecessary-healthcare-costs-annually.html Kahan, N. R., Chinitz, D. P., & Kahan, E. (2004). Longer than
recommended empiric antibiotic treatment of urinary tract infection in women: an avoidable waste of money. Journal
of Clinical Pharmacy and Therapeutics, 29, 59-63. Knottnerus, B. J., Geerlings, S. E., Moll van Charante, E. P., & ter
Riet, G. (2013, May 31st). Women with symptoms of uncomplicated urinary tract infection are often willing to delay
antibiotic treatment: A prospective cohort study. BMC Family Practice. Leydon, G. M., Turner,. S., Smith, H., & Little,
P. (2010). Women’s views about management and cause of urinary tract infection: Qualitative interview study.
Mangin, D., Murdoch, D., Wells, J. E., Coughlan, E., Bagshaw, S., Corwin, P., Toop, L. (2012). Chlamydia
trachomatis Testing sensitivity in midstream compared with first-void urine specimens. Annals of Family Medicine, 10,
50-53. Norrie, P., & Dalby, D. (2007). How adult are our learners? Journal of Research in Nursing, 12, 319-329.
http://dx.doi.org/10.1177/1744987107075254
Contact
[email protected]

Multi-Faceted Approach to Increase Type 2 Diabetes Mellitus Screening in
Children
Grace Carla Bacani, RN, BS, USA
Shelley Hawkins, PhD, DSN, MSN, USA
Kathleen Helgesen, MSN, USA
Purpose
To disseminate effective strategies to increase type 2 diabetes screening in children.
Target Audience
Nurse practitioners and other health care providers.
Abstract
Purpose/Aim: The purpose of this evidence-based practice project is to increase type 2 diabetes mellitus
(T2DM) screening in a pediatric primary care clinic.
Background/Rationale: The prevalence of pediatric T2DM continues to escalate, increasing from 9% in
1999 to 23% in 2008. Minimal, or absence of, screening leads to insufficient detection of the disease,
increased diabetes exposure, and increased risks for long-term complications. Poor screening can be
attributed to the lack of provider adherence to clinical practice guidelines (CPG), including diabetes
screening guidelines. Computerized protocol sets, provider reminders, and patient cues have been shown
to increase provider adherence to CPG. According to the American Diabetes Association (ADA), as many
as 62% of children eligible are not screened. In the project facility, there was no screening protocol in
use.
Best Practice: The purpose of this evidence-based practice project is to increase provider screening for
T2DM by 10% at a pediatric primary care clinic in southern California. A multi-faceted approach was
implemented, including the incorporation of a computerized T2DM screening protocol based on ADA
guidelines into the electronic medical record system. Paper-based provider reminders on ADA screening
criteria were also displayed in provider workspaces, while visual patient cues regarding screening
eligibility were displayed in the waiting and patient rooms. The screening rates for T2DM based on ADA
criteria were determined three months before and after implementation.
Outcomes: In progress. Upon completion of the project, it is anticipated there will be at least a 10%
increase in provider screening for T2DM patients at the pediatric primary care clinic.
Conclusions: A multi-faceted approach should increase provider adherence to ADA guidelines for
screening T2DM in children. Increased T2DM screening in children should increase detection of the
disease, yielding greater opportunities for early interventions, and decreased morbidity and mortality in
this increasingly susceptible population.
References
Flanagan, M., Ramanujam, R., & Doebbling, B. (2009). The effect of provider- and workflow-focused strategies for
guideline implementation on provider acceptance. Implementation Science, 4(71). doi: 10.1186/1748-5908-4-71 Prior,
M., Guerin, M., & Grimmer-Somers, K. (2008). The effectiveness of clinical guideline implementation strategies: A
synthesis of systematic review findings. Journal of Evaluation in Clinical Practice, 14, 888-897.
Contact
[email protected]

Part VI: Research Poster Presentations
RSC PST 1 - Research Posters Session 1
Using the Job Demands-Resource Model to Decrease Burnout of Perioperative
Nurse Managers
Theresa M. Criscitelli, RN, CNOR, USA
Purpose
The purpose of this presentation is to improve the human and social conditions of the Perioperative Nurse
Managers. Perioperative Nurse Managers lack the available resources to effectively cope with role
demands on a daily basis. Lack of resources has led to decreased work engagement, job dissatisfaction,
frustration, and ultimately attrition.
Target Audience
The target audience of this presentation is registered nurses, nurse managers, and nursing
administration.
Abstract
Purpose: Perioperative Nurse Managers are an integral part of the administration of quality health care,
performing an array of clinical, financial, and leadership roles. The focus of this research is to improve the
human and social conditions of the Perioperative Nurse Managers. Perioperative Nurse Managers lack
the available resources to effectively cope with role demands on a daily basis. Lack of resources has led
to decreased work engagement, job dissatisfaction, frustration, and ultimately attrition. The Job
Demands-Resource Model provides a conceptual framework to increase work engagement, motivation,
and organizational outcomes.
Methods: A qualitative case study design was employed to investigate, from the perspective of
Perioperative Nurse Managers, how to manage job demands and identify viable resources to increase
motivation and prevent burnout. The sample consisted of ten Perioperative Nurse Managers who were
interviewed utilizing a pre-established Nurse Manager Engagement Questionnaire (NMEQ) to better
understand the experiences of this group of individuals. Data was transcribed and coded, using elements
of the conceptual framework and research questions, to determine common themes to help implement
new work and social strategies.
Results: Eight out of ten of the participants indicated a lack of formal leadership training, which was
never provided in either their educational curricula or was limited within the institution. Other themes
emerged including a lack of role clarity, being overtasked on a daily basis, and the desire for motivation
through positive verbal feedback.
Conclusion: In order to prevent burnout of Perioperative Nurse Managers, roles need to clearly
be delineated and appropriately delegated to decrease overtasking. Positive feedback from providers,
patients, and staff members must be encouraged and embraced by upper administration to assist in
motivating the Perioperative Nurse Managers. Formal and informal leadership training is an imperative
aspect of professional development that must be fostered to increase motivation and work engagement,
and prevent burnout.
Contact
[email protected]

The Effectiveness of the Over 24 Hours Physical Restraint Indicators
YiChun Chen, RN, BS, Taiwan
Purpose
To explore physical restraint rates in a hospital and to investigate the effectiveness of the intervention.
Target Audience
That different care should be taken to prevent interventions in physical restraints so as to improve quality
of patient care.
Abstract
Purpose: A physical restraint is frequent initiatives in the hospital patients. However, there are a few
studies on the indicators of physical restraint. The aim of this retrospective study was to explore physical
restraint rates in a hospital and to investigate the effectiveness of the intervention. It is hoped that the
over-24-hour physical restraints of patient can be reduced in long term.
Methods: We analyze the Physical Restraint Reporting System between January 2013 and July 2013
and extracted data of the prevalence of the over-24-hour physical restraint among inpatients to collect the
over-24-hour physical restraint events. Physical restraint rates before and after the interventions were
compared. The reasons for the over-24-hour physical restraints were summarized as follows. 1. Systemic
problems: After the discharge, the constraint records were not deleted. 2. The clarification defined based
on Taiwan Clinical Performance Indicator. 3. Utilization of Team Resource Management to discuss
alternative restraint programs. 4. Continuous analysis of data and comparison with restraint rates and
compared with the restraint time.
Results: The results revealed that the over-24-hour physical restraints rates were reduced from 41.29
percent to 13.73 percent.
Conclusion: The over-24-hour physical restraints is an important issue in a hospital setting. The results
show that different care should be taken to prevent interventions in physical restraints so as to improve
quality of patient care.
Contact
[email protected]

The Correlations Between Meridian Energy and Nausea/Vomiting in Lung Cancer
Patients Receiving Chemotherapy
Chi-Hsiang Shen, MSN, Taiwan
Li-Yu Yang, PhD, Taiwan
Purpose
The purpose of this presentation is to explore the correlations between meridian energy and
nausea/vomiting in lung cancer patients receiving chemotherapy.
Target Audience
The target audience of this presentation is the lung cancer patients who had received at least one dose of
Cisplatin (50-75mg/m2) and had experienced nausea/vomiting during chemotherapy.
Abstract
Purpose: This study is to explore the correlations between meridian energy and nausea/vomiting in lung
cancer patients receiving chemotherapy.
Methods: A cross-sectional and correlational design was used. This study was reviewed and approved
by the Institutional Review Boards (KMUH-IRB-20120114). The participants were a total of 70 lung
cancer patients who had received at least one dose of Cisplatin (50-75mg/m2) and had experienced
nausea/vomiting during chemotherapy from the chest medicine ward of a medical center located in
Southern Taiwan. The research instruments, including a demographic data sheet, the Morrow
Assessment of Nausea and Emesis, and the Meridian Energy Analysis Device, were used to collect and
monitor participants’ level of nausea/vomiting and changes in meridian energy.
Results: The Pericardium Meridian of Hand-Jueyin, Spleen Meridian of Foot-Taiyin, and Mean Meridian
Energy values in lung cancer patients receiving chemotherapy ranged from 21.1 to 27.5 microamperes,
which were relatively low as compared with the normal meridian energy values (20-60 microamperes). As
for demographic characteristics, past history was negatively correlated with the energy of Pericardium
Meridian of Hand-Jueyin on the left and right sides (r = -.28, p = .020; r = -.27, p = .023, respectively), the
energy of Spleen Meridian of Foot-Taiyin on the left and right sides (r = -.38, p = .001; r = -.29, p = .013,
respectively), and the Mean Meridian Energy (r = -.29, p = .012). Chemotherapy course was negatively
correlated with the energy of Pericardium Meridian of Hand-Jueyin on the right side (r = -.25, p = .038) but
positively correlated with the level of vomiting (r = .25, p = .036). Experience of car-sickness or sea-
sickness was negatively correlated with the level of nausea (r = -.25, p = .036). However, no correlations
were found between the level of nausea/vomiting and all meridian energy variables.
Conclusion: The results of this study found that, despite being within the normal range, the Pericardium
Meridian of Hand-Jueyin, Spleen Meridian of Foot-Taiyin, and Mean Meridian Energy values in patients
receiving chemotherapy were only slightly higher than the lower limit of normal range and were far lower
than the median value of meridian energy. The low energy indicated that the Qi and blood status of lung
cancer patients who received chemotherapy was weaker than that of healthy people. However, this study
did not find direct correlations between the level of nausea/vomiting and the Pericardium Meridian of
Hand-Jueyin, Spleen Meridian of Foot-Taiyin, and Mean Meridian Energy. The reason might be that these
lung cancer patients have not yet experienced nausea/vomiting while having a low Mean Meridian
Energy, so the correlations between nausea/vomiting and meridian energy could not be established.
Therefore, this study could not directly infer whether chemotherapy-induced nausea/vomiting would affect
the changes in the Pericardium Meridian of Hand-Jueyin, Spleen Meridian of Foot-Taiyin, and Mean
Meridian Energy. Research on this aspect is scarce, so future research might be needed to address
these issues.
References
1. Deng, T. T. (2003). Diagnostics of traditional Chinese medicine. Taipei City, Taiwan, ROC: Jyin. 2. Huang, X. Z.
(2007). Using Ryodoraku to explain the effects of physical activity on physical and mental health of the human body--

using middle to old aged people as an example. Journal of Physical Education and Sports, 18(4), 39-60. 3. National
Comprehensive Cancer Network (NCCN) (2012). NCCN clinical practice guidelines in oncology: Non-small cell lung
cancer. Retrieved March 1, 2011, from http://www.nccn.com/images/ patient-guidelines /pdf /nsclc.pdf. 4. Wang, D.
R., Yin, G. Y., Wang, T., She, Y. C., Ji, Z. P., Chen, J. W., & He, S. L. (2007). Introduction to modern Chinese
medical physiology. Taipei City, Taiwan, ROC: Jyin. 5. Yang, D. W. (2009). Diagrams and illustrations of human body
meridians. Taipei City, Taiwan, ROC: Theway.
Contact
[email protected]

The Survey for Nursing Management Behavior of Diabetes Liaison Nurses in
Guangdong Province
Peiru Zhou, RN, China
Xueyan Liu, RN, China
Purpose
The purpose of this presentation is nursing management behavior in guangdong province through the
questionnaire investigation of diabetes liaison nurses .
Target Audience
The target audience of this presentation is nursing managers and clinical nurses
Abstract
Purpose: To investigate work status quo related to diabetes care management of diabetes liaison
nurses; Probe into effects of the related factors for diabetes liaison nurses management.
Methods: 426 cases of diabetes link nurses were cross-sectional surveyed by application of the
management behavior scale.
Results: On average each item score of diabetes link nurse management behavior scales was
3.63±0.54,the average item score of domain 2 “blood glucose monitoring and insulin injection
management”ranked the first(3.98±0.76)during all the dimensions.The item5 “check the period of validity
of blood glucose monitoring test paper in ward” scored the highget(4.10±0.90) ,the item4 “calculate
hypoglycemic events of patients in ward”scored the lowest(3.05±1.16).
Conclusion: the management work status quo of diabetes liaison nurse was not optimistic, fails to reach
the management level “frequently”as a whole，the link nurse did blood glucose monitoring and insulin
injection management better,they didn’t pay much attention to hypoglycemic events of patients in ward
relatively.
References
[1]Yang WJ,Lu JM, Weng JP,et al.Prevalence of diabetes among men and women in China[J].The new england
journalof medicine,2010,362(12):1090-1101. [2]Burden Felix AC.Diabetes nursing for inpatients[J].Nursing
times,2002,98 (19):51. [3]Ding biao,Zhang nina,Kan kai. 662 clinical nurses cognitive situation of blood sugar
monitoring knowledge and training countermeasures [J]. Journal of nursing, 2012, 19(12B): 13-16. [4]Xie xiaoqing,
Yao meihua. Quality management of insulin injections in ward [J]. Nursing and Rehabilitation
Journal,2012,11(04):376- 377. [5]Liu xueyan,Zhou peiru. clinical nurse insulin injections of knowledge, attitude and
behavior survey in Guangdong province [J]. Nursing research, 2012,26(10):2614-2616. [6]Phillips A.Starting patients
on insulin therapy:diabetes nurse specialist views[J].Nursing Standard (Royal College Of Nursing (Great
Britain):1987),2007, 21(30):35-40. [7]Sigurdardottir AK.Nurse specialists' perceptions of their role and function in
relation to starting an adult diabetic on insulin[J].Journal Of Clinical Nursing,1999,8(5):512-518. [8]Hermanns N.The
effect of an education programme(MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2
diabetes[J].Patient Education and Counseling,2012,86(2):226-232. [9]Una.McErlean.Improving inpatient care with the
help of a diabetes link nurse [J].Journal of Diabetes Nursing,2005,(9):259-262. [10]Mary Beth Modic, Rebecca
Sauvey, Christina Canfield,et al. Building a Novel Inpatient Diabetes Management Mentor Program:A Blueprint for
Success[J]. The Diabetes Educator,2013,39(3):293-303.
Contact
[email protected]

The Change of Meridian Energy and Symptoms Among the Breast Cancer
Patients with Chemotherapy
Ping-Ho Chen, MD, MS, Taiwan
Chen-Jei Tai, MD, PhD, Taiwan
Sheng-Miauh Huang, PhD, Taiwan
Purpose
The primary purpose of the study was to describe the change of the meridian energy, symptom severity
and interference among the patients with breast carcinoma receiving the chemotherapy. Also, the study
explored the factors to predict the meridian energy.
Target Audience
The target audience of this presentation is the nurse who is interested in integrated and complementary
medicine. Oncologic nurses are welcome to join the presentation.
Abstract
Purpose: There was rare study to evaluate the change of the meridian energy among breast cancer
patients during chemotherapy. Therefore, the primary purpose of the study was to describe the change of
the meridian energy, symptom severity and interference among the patients with breast carcinoma
receiving the chemotherapy. Also, the study explored the factors to predict the meridian energy.
Methods: A longitudinal study was carried out with 121 patients at four teaching hospitals in the north of
Taiwan. The researcher recruited the subjects from July 1st, 2009 to February 28th, 2011. The researcher
collected data at the pre-treatment, and the 1st and 3rd month after the treatment. The meridian energy
was examined by using the Meridian Energy Analysis Device Me-Pro. The symptom severity and
interference was assessed by the M. D. Anderson Symptom Inventory-Taiwan version.
Results: As time went by, the patients had the worse overall meridian energy and symptom severity.
Older women had lower overall meridian energy. The symptom severity is the strong factors to predict the
deteriorated overall meridian energy. The patients who used traditional Chinese medicine had higher
overall meridian energy and who used mind-body medicine had lower overall meridian energy.
Conclusion: The overall meridian energy and symptom severity among the patients still deteriorated
during chemotherapy. TCM doctors should observe the change of the symptoms and give some
treatments to alleviate the symptoms and even to ameliorate the meridian energy. Whether using
traditional Chinese medicine could improve overall health or not is worth doing further studies.
Contact
[email protected]

Factors Involved in Coping with the Dilemma of Using Physical Restraints on
Elderly People with Dementia: Perspectives from Nurses Who Live with Elderly
Relatives
Miwa Yamamoto, RN, PhD, Japan
Noriko Adachi, RN, PhD, Japan
Naoko Nishimura, RN, PhD, Japan
Yasuko Maekawa, RN, PhD, Japan
Yoshimi Noguchi, RN, MS, Japan
Tomoharu Nakashima, PhD, Japan
Purpose
The present study aimed to clarify factors surrounding the dilemma of using physical restraints on elderly
patients with dementia. In particular, we surveyed how nurses who live with elderly relatives coped with
this issue.
Target Audience
Abstract
Purpose: In Japan, physical restraint of patients has been used in nursing care to ensure patient safety1-
2). However, in 2000, when public care insurance was implemented, a ministerial decree, entitled
“Regulations prohibiting physical restraint” was enforced. This was passed by the Ministry of Health,
Labour and Welfare, and legally prohibits the physical restraint of elderly patients in target institutions.
Harmful effects due to physical restraint of patients have been verified by several studies 3-5), and the
discontinuation of this practice has become a social trend (Ministry of Health, Labour and Welfare 2001).
However, alternative measures or systems which might replace the use of physical restraint in nursing
care for senile patients with dementia have not been established. As such, physical restraint is still used
at institutions that are not covered by the decree, and nurses are left with mixed feelings regarding this
dilemma6-8). Specifically, nurses worry about how to provide the best care for their patients without
compromising nursing conditions. One major component of this ethical dilemma concerns the often
necessary use of physical restraint, and coping with this can be difficult9-10). One study reported that
coping with the dilemma of whether or not to use physical restraints on elderly individuals with dementia
is influenced by one’s experience of living with an elderly person11).Reflection on and clarification of the
root causes of this ethical dilemma are not only important for developing ways to cope with this issue11),
but also represent an opportunity to examine how job satisfaction among nurses and quality of care might
be improved. The present study aimed to clarify factors surrounding the dilemma of using physical
restraints on elderly patients with dementia. In particular, we surveyed how nurses who live with elderly
relatives coped with this issue.
Subjects: Perspectives on this dilemma differ by individual, and are affected by educational background,
experiences both in nursing and in one’s own life, and by each individual’s value system 11). Subjects were
selected using the purposive selection method12)at community hospitals in mid-western Japan. Selection
criteria for hospitals required that they 1) contained an independent nursing division or department in the
hospital under nursing management, 2) offered a postgraduate study or educational program for nurses,
3) provided similar employment conditions for all nurses who served as subjects for our study, and 4)
served as a general hospital. Study objectives and methods were explained to individuals in charge of
nursing at the 3 selected hospitals. We enrolled 269 nurses who worked in general wards of the 3
hospitals and who agreed to participate in the present study.
Data collection and ethical considerations: The study was performed using an independently prepared
questionnaire. Study participants were informed of the study objectives, methods of questionnaire
distribution and recovery, and addresses of the investigators in one of the following ways: 1) we
distributed request sheets disclosing this information, or 2) investigators explained this information to the

individuals in charge of nursing at the hospital/ward at the time of the interview. Request sheets sent to
individuals disclosed the definition of “physical restraint” and “elderly patients,” instructions on completing
the questionnaire and the period of response, and the present study objectives. Investigator addresses
were enclosed to help nurses better understand the study.
The questionnaire was designed to ensure subject privacy. Specifically, interviewees were allowed to
complete the form themselves and remain anonymous. The questionnaire was constructed so that, when
completed, it could be inserted in an envelope distributed in advance to the subjects who could seal it
themselves. Subjects were asked to return the completed questionnaire in the sealed envelope to a
designated place, roughly two weeks after distribution. Head nurses for the wards were asked to collect
completed questionnaires in the sealed envelopes and return all of them together to those in charge of
the study. This study was approved by the Ethics Committee of the Nursing Department of the Meiji
University of Integrative Medicine.
Extraction of dilemma coping items: We developed a 16-item survey to assess dilemma coping items
(Table 1). Coping with ethical dilemmas can be divided into the following three content areas: (i) positive
cognition and actions (Items 1-9); (ii) negative cognition and actions (Items 12-16); and (iii) choosing not
to act, or maintaining the status quo (Items 10-11). Each of the survey questions was based on a four-
point Likert scale, with higher scores indicating good coping strategies. When faced with the dilemma of
physically restraining an older person with dementia, we assumed that nurses used one of the three
coping methods. “Positive cognition and actions” would involve a nurse solving a dilemma in a positive
manner, with the intent to resolve the problem (e.g., some nurses held conferences to consult with
experienced senior nurses about the issue of restraining patients). “Negative cognition and actions” would
involve nurses avoiding the dilemma (e.g., some nurses either refused to work with patients with
dementia, or reminded themselves that the patient would leave soon and therefore did not give careful
thought to the situation). “Choosing not to act, or maintaining the status quo” involved nurses accepting
the present situation and doing nothing to resolve the problem (e.g., some nurses who felt inexperienced
with regard to dementia care thought it to best to follow the doctor’s instructions without questioning the
situation). A preliminary test was conducted among 10 nurses working in orthopedic surgery wards at
community hospitals, and the results from this test were used to improve the questionnaire. Data obtained
from the modified questionnaire were analyzed in the present study.
Validity and reliability of dilemma factors: Reliability of the constructed items within the dilemma was
examined using a Cronbach’s α coefficient of 0.6 or greater to test for internal consistency. Factor
structure was confirmed following factor analysis (maximum likelihood method: promax rotation) for
construct validity. Criteria for sample validity for the factor analysis targeted a KMO value of 0.6 or greater
and a cumulative contribution ratio of 60% or more. Item exclusion was applied to a factor loading of 0.4
or greater without difficulty in interpretation.
Adequacy of item selection and dilemma coping factors: The 16 dilemma coping items were
subjected to a factor analysis (maximum likelihood method: promax rotation) to clarify dilemma coping
factors among nurses who live with elderly relatives. Items with either a factor loading of 0.4 or less or
difficulty in interpretation were deleted, and the final remaining 14 items were used for analysis. We
extracted four items with a characteristic value of one or greater, which yielded a significant KMO value of
0.79 and a cumulative contribution ratio of 66.8%. Cronbach’s α coefficients for composing items of each
factor were 0.87, 0.83, 0.60, and 0.68 for factors 1, 2, 3, and 4, respectively.
The same procedure as described above was performed for the 16 dilemma coping items among nurses
who did not live with elderly relatives, which resulted in a total of 16 final items used in the analysis. Three
items with a characteristic value of one or greater were extracted, revealing a significant KMO value of
0.78 and a cumulative contribution ratio of 56.8%. Cronbach’s α coefficients for composing items of each
factor were 0.84, 0.85 and 0.79 for factors 1, 2, and 3, respectively.
Conclusion: We extracted deferent factors with regard to the dilemma faced by nurses concerning the
physical restraint of elderly patients. We found that exposure or living with elderly relatives influenced
nurses’ coping with this dilemma.
References

1. Akihiro Ogura; A method of restraint, Medical Friend¡¯s Nursing Science Dictionary, 4th Ed. Medical Friend Co.,
Ltd., Tokyo, 2059£¬1997 2. Ujiie S., Aso Y. Shitaitekiyokusei [Physical restraints], Kango gijytu[Nursing skills] 6th
edtion., IgakuShoin , Tokyo,2005;147¨C151. (in Japanese). 3. Evans LK., Strumpf NE. Myths about elderly restraint.
Image: Journal of Nursing Scholarship, 1989; 22:124¨C128. 4. Hajime Hashimoto: Restraint of the Elderly, Clinical
Nursing (Rinsho-Kango), 22£º1381-1385£¬1996£® 5. Abe T., Chiba Y. Kan-go generalba no jyoushiki wo minaosu
sintaiyokusei [Re-examination of physical restraint customarily carried out in nursing practice]. Evidenced Based
Nursing 2001; 1:49¨C55 (in Japanese). 6. Scherer YK., Janelli LM., Kanski GW., Neary MA., North NE. The nursing
ethical dilemma of restraints. Journal of Gerontological Nursing 1991; 17:14¨C17. 7. Kihata Mitsuko: ¡°Restraint¡± is a
dilemma of nurse, Consciousness of nurse to ¡°restraint¡± not so as to feel guilty and my proposal to physical
restraint, Expert Nurse, 13:24-27, 1997. 8. Yamamoto M., Isumi K., Usui K. Ethical dilemmas facing Japanese nurses
regarding the physical restraint of elderly patients, Japan Journal of Nursing Science, 2006;3: 43-50. 9. Nili Tabk,
Tamar Ben-Or. The nurse¡¯s challenge in coping with ethical dilemmas in occupational health. Nursing ethics, 1994;
1-4. 10. Ham K., Principled thinking: a comparison of nursing students and experienced nurses. Journal of Continuing
Education in Nursing, 2004; 35:66¨C73. 11. Crisham P. MORAL: how can I do what¡¯s right. Critical Care
Management Edition/Nursing U.S.A., 1993; 16: 42A¨C42N. 12. Takagi H. Nasu no tameno toukeigaku deta no
torikata ikashikata [Statistics for nurses ¨C A method for data collection and effective use of statistical data for
nurses], Tokyo, Igaku-Shoin, 1984. (in Japanese). 13. Barbara L. Tate, International Council of Nurses, Geneva,
Switzerland £ºThe Nurses dilemma¨DEthical considerations in nursing practice, USA, 1977. ICN Ed. by Katsuko
Kodama, translated by Yoko Oda; Japanese Nursing Association, Div. of Publishing, Tokyo, 1977. 14. Michiyo
Kojima, Conference of general and sub-general managers of National University Hospitals in the Western and
Shikoku district of Japan: Mapping for management of dilemma of nurses¡ªCommunication with doctors for nursing
focused on patients, Igaku-Shoin Ltd., Tokyo, 9, 1997.
Contact
[email protected]

Experiences of Nurses Working Night Shift in Regional Australian Hospitals: A
Qualitative Case Study
Idona N. Powell, RN, RM, MHlthSc (Man), PGDipClinN (Psychiatry), Australia
Purpose
To provide genuine recognition of the critical role of night nurses; to promote understanding by managers
and non-nightshift nursing staff of the challenges and burdens endured by night staff nurses; and to
identify strategies that have the potential to create positive change, improve worker satisfaction and
patient care delivery.
Target Audience
nurse managers, non nightshift nurses and nightshift nurses working in acute 24hour care facilities.
Abstract
Purpose: The study aimed to explore experiences of nightshift nurses working in Australian regional
hospitals focusing on their relationships with other nightshift nurses, non-nightshift staff and general work
satisfaction issues. Study intention was to act as a catalyst to the development and implementation of
strategies to create positive change for the nightshift nurses.
Methods: The study was conducted at three Australian regional hospitals. Data were derived from semi-
structured interviews and participant diaries over a six month period in 2010. The participants were 14
nurses working nights half or more of their total shifts in medical or surgical wards. Thematic analysis of
the data was undertaken.
Results: The major findings centered on four themes. Work Relationships demonstrated that positive
relationships were more common with nurses on the same shift then on opposing shifts. Work
Environment revealed nightshift nurses endured poorer working conditions in terms of physical and
interpersonal interactions than their daytime counterparts. Work Practices showed nightshift provided
opportunity for professional growth for some nurses but produced a slippage in skills for others. Impact
on lifestyle and perceptions of others demonstrated nightshift provided nurses with flexibility for family
and social activities yet impeded these same activities. The themes were influenced by perceived value
and level of control held by the nurses.
Conclusion: Nightshift nurses had strong positive relationships with co-workers, but experienced
disconnectedness with staff from other shifts and the facility in which they worked. They consider their
role was highly critical yet believed they were poorly regarded. While the study took place in regional
Australia it has implications for OEC and development member countries. The important areas of
interpersonal relationships, effective leadership, work environment, clinical competencies and recognition
of the critical role of night nurses must be used to inform future decisions that impact night shift nursing
staff.
Contact
[email protected]

Electronic Monitoring of Hand Hygiene: Challenges and Methods
Elaine Larson, RN, BSN, MA, PhD, USA
Bevin Cohen, BA, MPH, USA
Meghan Murray, BA, MPH, USA
Paul Alper, BA, USA
Lisa Saiman, BA, MPH, MD, USA
Laurie Conway, BSN, MSN, USA
Purpose
The purpose of this presentation is to discuss implementation of an electronic hand hygiene monitoring
system, including challenges and strategies.
Target Audience
The target audience for this presentation is clinicians, infection prevention and quality assurance staff,
and clinical managers.
Abstract
Purpose: Because hand hygiene (HH) is one of the primary strategies to prevent infection transmission,
many facilities are now monitoring staff HH behavior using direct observation. Observation, however, is
costly and subject to multiple biases. Therefore, electronic monitoring of HH has been proposed as a
feasible and potentially more accurate solution for tracking trends in HH practices and for providing staff
with performance feedback. The purpose of this presentation is to discuss implementation of an
electronic HH monitoring system, including challenges and strategies.
Methods: An electronic group monitoring system which counted number of HH events, but had no
individual identifiers, was installed in all soap and alcohol dispensers in patient care areas of three
pediatric long term care facilities (284 beds) and one acute care community hospital (140 beds) located in
the United States. The system generates graphs and reports using various formats (locations,
times). Researchers worked with administrative staff in each facility to develop implementation plans,
determine how feedback would be provided to patient care staff, and track changes in HH rates. Reports
were generated and sent to individuals selected by each facility. Report formats could also be changed
by these individuals at each facility.
Results: Challenges during implementation of the system included addressing staff/administrator
concerns about the validity and use of data, ensuring that feedback on HH reached patient care staff, and
dealing with wide variations in implementation across sites. Administrators were inconsistent in
disseminating the information; several months after installation, many staff members in some facilities
were still unaware of the monitoring strategy and had received no feedback.
In the community hospital, when compared to HH frequency before staff feedback, frequency of HH for
medical-surgical units, coronary care unit, and emergency department was slightly, but statistically
significantly higher, after providing staff feedback (mean difference=4.9% compliance, SD 4.3, p=0.02). In
the pediatric long term care facilities, however, HH frequency 3 month prior to and 3 months following
staff receipt of electronic HH feedback was not significantly changed (21,730 and 20,910 HH episodes,
respectively).
Conclusion: Monitoring HH is performed in many facilities, but feedback alone is not sufficient to improve
practice. Even with automated monitoring systems, well planned implementation strategies are essential
to improve HH practice.
Contact
[email protected]

A Comparative Study to Assess the Effectiveness of Structured Teaching
Programme on Addiction Among Adolescents in Selected Schools of Salem
District, Tamil Nadu State
Umapathi Mariappan, PhD, Malaysia
Purpose
The purpose of this presentation is to highlight the adolescents addiction problem and importanc eof
school based health education programmes to enhance the adolescents knowldeg on addiction (tobacco)
and inturn reduces the incidence of addiction among adolescents.
Target Audience
The target audience of this presentation is nurse educator, community health nurses, child health nurses,
nurse researchers , nurse leaders and school health nurses.
Abstract
Purpose: This study aimed to assess the effectiveness of Structured Teaching Programme (STP) on
Tobacco abuse among adolescents in selected schools of Salem District, Tamil Nadu State
Methods: Quantitative approach with one group pre test, post test quasi experimental design was
adopted for this study. Multi stage cluster random sampling technique was used to select the study area
and purposive sampling technique was used to select the sample (Rural n =200, Urban n=200).
Adolescents between the age group of 15-17 years and who were studying 10th class in selected schools
in rural and urban area of Salem district, Tamilnadu was selected. Tool used for this study was self
administered structured questionnaire on tobacco abuse. On the first day, pre test was administered and
the second day STP was intervened to the selected sample. After 10 working days, post test was
conducted by using the same structured questionnaire. A formal permission was obtained from school
authority and from the sample. Finally, the data obtained was analyzed by the SPSS 17 software using
Descriptive & Inferential Statistics like Percentages, Mean, S.D. Mean Percentage, t-test, paired t-test and
Chi-square test at a significant level of P≤0.05
Results: Overall post test knowledge score on Tobacco abuse showed that, the majority of the sample
had good knowledge (Urban 90.5% and Rural 88.5%).Results revealed that the urban school adolescents
gained more knowledge than rural school adolescents. The STP implementation was effective and
enriched the knowledge of adolescents on Tobacco abuse (Paired ‘t’ value = Rural 70.591 and Urban
86.391; P<0.000).
Conclusion: Significant difference was identified between rural and urban school of adolescents on their
knowledge level on Tobacco abuse. The results indicated the STP intervention was very effective in
enhancing the knowledge level of adolescents on Tobacco abuse
References
1. Centre on Addiction and Substance Abuse. (2000) Substance Abuse Treatment for Persons with Child Abuse and
Neglect Issues. Treatment Improvement Protocol (TIP) Series 36. Rockville, MD: DHHS Publication 2. WHO Report.
(2011) the global tobacco epidemic: warning about the dangers of tobacco and Tobacco Free Initiative (TFI). 3. Salim
Surani, et al.(2011) Ill Effects of Smoking: Baseline Knowledge among School Children and Implementation of the
“AntE Tobacco” Project. International Journal of Pediatrics .Volume7 . 4. United Nation. (2010) Centers for Disease
Control and Prevention. Current Intelligence Bulletin 54: Environmental Tobacco Smoke in the Workplace -- Lung
Cancer and Other Health Effects. 5. World Health Organization.(2010)Tobacco Cessation :A Manual for Nurses,
Health Workers and other Health Professionals. Regional Office for South-East Asia. 6. Global Youth Tobacco
Survey.(2011) Gender Differences in Worldwide Tobacco Use by Gender. Journal of School Health ;( 6): 207-215. 7.
Sama L. (2006) Strategic Directions for Nursing research in Tobacco dependence. Nursing Research .Jul - Aug;55
(45):51-9. 8. Johnson, D. E. (1980). The behavioral system model for nursing. In J. P. Riehl & C. Roy, Conceptual
models for nursing practice (2nd ed., pp. 207–216). New York: Appleton-Century-Crofts. 9. Haddad L, et al.(2010)
Knowledge of substance abuse among high school students in Jordan. J Transcult Nurs. Apr;21(2):143-50.

Contact
[email protected]

Validity and Reliability of Thai Version of Self-Efficacy for Appropriate Medication
Use Scale Among Thai with Post-Myocardial Infarction
Rapin Polsook, PhD, Thailand
Yupin Aungsuroch, PhD, Thailand
Sureeporn Thanasilp, PhD, RN, Thailand
Joanne R. Duffy, PhD, USA
Purpose
The purpose of this study was to perform psychometric testing of an instrument for assessing self-efficacy
for medication adherence among Thai post-myocardial infarction (MI) patients.
Target Audience
The Self-Efficacy for Appropriate Medication Use Scale (SEAMS) were collected from 100 Thai post-MI
patients.The SEAMS may be used in the clinic to measure self-efficacy for medication adherence among
Thai post-MI patients.
Abstract
Purpose: The purpose of this study was to translate the self-efficacy for appropriate medication use into
Thai and then examine the validity and reliability of this version of questionnaire.
Methods: Responses to the 13-item Thai version of the Self-Efficacy for Appropriate Medication Use
Scale (SEAMS) were collected from 100 Thai post-MI patients. None of the 13 items violated any
assumption for factor analysis. Hypothetical exampling and factor analysis were performed.
Results: Factor analysis revealed three components for determining the self-efficacy for medication
adherence: the patient’s self-confidence (six items), complexity of medication (four items), and daily life
change (three items). The instrument showed acceptable validity and reliability.
Conclusion: The SEAMS may be used in the clinic to measure self-efficacy for medication adherence
among Thai post-MI patients.
References
Albert, N. M. 2008. Improving medication adherence in chronic cardiovascular disease. Critical Care Nurse. 28, 54-
64. Armstrong, K. A. 2010. The relationship of personal characteristics, behavioral capability, environmental factors,
and hypertension medication adherence in African American adults with metabolic syndrome. Unpublished Ph.D
dissertation, school of nursing in the college of health and science, Georgia State University. Bosworth, H. B.,
Oddone, E. Z., and Weinberger, M. 2006. Patient treatment adherence concept, intervention, and measurement.
Lawrence Erlbaum Associates, New Jersey. Boulet, L. 1998. Perception of the roe and potential side effects of
inhaled corticosteroids among asthmatic patients. Chest. 113, 587-592. Chiou, A-F., Wang, H-L., Chan, P., Ding Y-
A., Hsu, K-L., and Kao, H-L. 2009. Factors associated with behavior modification for cardiovascular risk factor in
patients with coronary artery disease in Northern Taiwan. Journal of Nursing Research. 17(3), 221- 229. Choudhry,
N. K., Patrick, A. R., Antman, E. M., Avorn, J., and Shrank, W. H. 2008. Cost-effectiveness of providing full drug
coverage to increase medication adherence in post-myocardial infarction Medicare beneficiaries. Circulation. 117,
1261- 1268. Corrao, G., Conti, V., Merlino, L., Catapano, A. L., and Mancia, G. 2010. Result of a retrospective
database analysis of adherence to statins therapy and risk of nonfatal ischemic heart disease in daily clinical practice
in Italy. Clinical Therapeutics. 32 (2), 300- 310. Dragomir, A., Cote, R., White, M., Lalonde, L., Blais, L., and Berard,
A. et al. 2010. Relationship between adherence level to statins, clinical issues, and health-care costs in real-life
clinical setting. Value in Health. 13, 87- 94. Gehi, A. K., Ali, S., Na, B., and Whooley, M. A. 2007. Self-report
medication adherence and cardiovascular events in patients with stable coronary heart disease. Achieve International
Medicine. 167(16), 1798- 1803. Hair, J. F., Black, W. C., Babin, B. J., and Anderson, R. E. 2010. Multivariate data
analysis (7th ed). Pearson Education, Inc. Upper Saddle River, New Jersy Ho, P. M., Magid, D. J., Shetterly, S. M.,
Olson, K. L., Maddox, T. M., and Peterson, P. N. et al. 2008. Medication nonadherence is associated with a broad
range of adverse outcomes in patients with coronary artery disease. American Heart Journal. 155, 772-779.
Jackevicius, C. A., Li, P., and Tu, J. V. 2008. Prevalence, predictors, and outcomes of primary nonadherence after
acute myocardial infarction. Circulation. 117, 1028- 1036. Kang, Y., Yang, I., and Kim, N. 2010. Correlates of health
behaviors in patients with coronary artery disease. Asain Nursig Research. 4, 45- 55. Kusuma, KH. 2006. Adherence

to self-care requirements model; an empirical test among patients with coronary artery disease. Unpublished Ph.D
dissertation, Graduate Studies, Phylosophy (Nursing), Graduate Studies, Mahidol University. Maddox, T. M., and Ho,
P. M. 2009. Medication adherence and the patient with coronary artery disease: challenges for the practitioner.
Current Opinion in Cardiology. 24, 468- 472. Ngamvitroj, A., and Kang, D. 2007. Effect of self-efficacy, social support,
and knowledge on adherence PEFR self-monitoring among adults with asthma: A prospective repeated measures
study. International Journal of Nursing Studies. 44, 882-892. Perreault, S., Dragomir, A., Roy, L., White, M., Blais, L.,
and Lalonde, L. et al. 2009. Adherence level of antihypertensive agents in coronary artery disease. British Journal of
Clinical Pharmacology. 69, 74- 84. Polack, J., Jorgenson, D., and Robertson, P. 2008. Evaluation of different
methods of providing medication-related education to patients following myocardial infarction. Canadian
pharmacology Journal. 141( 4), 241-247. Public Health Statistic. 2009. Health Information Division, Bureau of Health
Policy and Plan. Number of deaths and death rates per 100,000 population by leading causes of death, 2009 [online].
Available at: http:// epid.moph.go.th (November 7, 2011) Risser, J., Jacobson, T. A., and Kripalani, S. 2007.
Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in
Low-Literacy patients with chronic disease. Journal of Nursing Measurement. 15(3), 203- 219. Schoenthaler, A.,
Ogedegbe, G., and Allegrante, J, P. 2009. Self-efficacy mediates the relationship between depressive symptoms and
medication adherence among hypertensive African Americans. Health Education & Behavior. 36, 127-137. Shah, N.
D., Dunlay, S. M., Ting, H. H., Montori, V. M., Thomas, R. J., and Wagie, A. E. et al. 2009. Long-term medication
adherence after myocardial infarction: experience of a community. The American Journal of Medicine. 122, 961.e7-
961.e12. Smith, D. H., Kramer, J. M., Perrin, N., Platt, R., Roblin, D. W., and Lane, et al. 2008. A randomized trial of
direct-to-patient communication to enhance adherence to β-Blocker Therapy Following Myocardial Infarction. Achieve
International Medicine. 168(5):477- 483. Timmin, F. 2005. A review of the information needs of patient with acute
coronary syndromes. Nursing in Critical Care. 10(4), 174-181. Van der Elst, M. E., Bouvy, M., Blaey, C. J., and de
Boer, A. 2007. Effect of drug combinations on admission for recurrent myocardial infarction. Heart. 93, 1226–1230.
Vlasnik, J. J., Aliotta, S. L., and DeLor, B. 2005. Medication adherence: Factors influencing compliance with
prescribed medication plans. Traditional Chinese Medicine (TCM). 47-51. Willich, S. N., Muller-Nordhorn, J., Kulig,
M., Binting, S., Gohlke, H., and Hahmann, H. et al. 2001. Cardiac risk factors, medication, and recureent clinical
events after coronary artery disease. European Heart Journal. 22, 307- 313. Wolf, M. S., Davis, T. C., Osborn, C. Y.,
Skripkauskas, S., Bennett, C. L., and Makoul, G. 2007. Literacy, self-efficacy, and HIV medication adherence. Patient
Education and Counseling. 65, 253-260. World Health Organization (WHO). 2003. Adherence to long term therapies:
evidence for Action. [online] Available at: http:// www. WHO. Com / WHO Library Cataloguing in-Publication Data.
(April 7, 2011) World Health Organization (WHO). 2011. Global status report on noncommunicable diseases 2010:
Burden: mortality, morbidity and risk factors. [online] Available at: http:// www. WHO. Com/ data and statistic. (April 7,
2011) Wu, JR., Moser, D. K., Lennie, T. A., and Burkhart, P. V. 2008. Medication adherence in patients who have
heart failure: a review of the literature. Clinics of North America. 43, 133- 153. Wu, JR., Moser, D. K., Lennie, T. A.,
Peden, A. R., Chen, Yu-C., and Heo, S. 2008. Factors influencing medication adherence in patients with heart failure.
Heart Lung. 37, 8- 16. Zhao, D. (2000). Self- efficacy and compliance with medical regimen among hypertensive
patients. Unpublished master’s thesis, Nursing Science (Adult Nursing), Graduate Studies, Chiang Mai University.
Contact
[email protected]

Outcomes and Medical Utilization for Lung Cancer Patients Undergoing Surgery
Shu-Ling Phom, NP, Taiwan
Yao Fong, MD, Taiwan
Purpose
The purpose of the study to Investigate the efficacy of lung cancer patients undergoing surgery and
medical impact factor.
Target Audience
clinicians,pharmacists, nurses, physician assistants, and other allied health professionals, health policy
makers, researchers, health educators, and public and community health leaders.
Abstract
Purpose: Lung cancer belongs to the top ten death causes, ranking the second position. There were few
systemic studies focus on the operation and medical resources for the patients. The purpose of the study
was to evaluate the impact factors such as in-hospital days and the using of the medical facilities after 6-
month discharge from the hospital for the lung cancer patient who underwent the surgical intervention.
We also examined the factors which influence the mid-term and long-term follow up for the patients.
Methods: This was a retrospective study involving a single medical center in southern Taiwan. Between
Jan 2008 to Dec 2012, we collected the primary lung cancer patients receiving the first surgical
intervention. Data analysis was divided to two parts, chart review and the data base from our ministry of
health. Dichotomous variables were evaluated
with 2 analysis to define various patient groups contributing significantly to in-hospital mortality. Risk
factors were determined using univariate analysis. Only those variables that reached p < 0.05 were
considered for the model. Once we identified these potential risk factors, a multivariate stepwise logistic
regression analysis was done to identify independent predictors. Statistical significance was set at p <
0.05. SPSS 19.0 (SPSS Inc., Chicago, IL, USA) was used for all statistical analysis Only those variables
that reached p < 0.05 were considered for the model.
Results: There were 207 patients enrolled in our study with an average of 63.1 years old, male dominant
(58.1%), adenocarcinoma dominant (57%), complication rate of 45.4%. Operation methods were
thoracoscopy dominant (79.1%) and lung lobectomy dominant (47.8%). Average operation time and in-
hospital days were 322 mins and 15.5 days, respectively. Recurrence rate was 26.6%. Different operation
methods were highly influenced to different results. The complication rate had statistically significance to
operation time, in-hospital days and chest tube time. Different operation methods were related to in-
hospital days, blood loss amount, ICU days and chest tube time. Gender, severity of the diseases, lung
function, different operation had relationship to in-hospital days. Mortality was influenced by the degree of
lung obstruction, recurrence, ICU days, chest tube time, in-hospital days and operation methods.
Conclusion: Different operations lead to different results. Gender, the severity of diseases, lung function,
operation methods have effects on using the medical resources. We recommended precise evaluation of
age, physical status, operation methods for patients in order to reducing the operative complications and
the wasting the medical resources. With the developments of medical technology, we believe the results
may provide some suggestions to the policy maker and medical service provider.
References
Bernard, A., Deschamps, C., Allen, M. S., Miller, D. L., Trastek, V. F., Jenkins, G. D., & Pairolero, P. C. (2001).
Pneumonectomy for malignant disease: Factors affecting early morbidity and mortality. Journal of Thoracic and
Cardiovascular Surgery, 121(6), 1076-1082. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical
comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619.
Fedor, D., Johnson, W. R., & Singhal, S. (2013). Local recurrence following lung cancer surgery: Incidence, risk
factors, and outcomes. Surgical oncology, 56(3), 23-31. Giulianotti, P. C., Buchs, N. C., Caravaglios, G., & Bianco, F.
M. (2010). Robot-assisted lung resection: outcomes and technical details. Interactive Cardiovascular and Thoracic

Surgery, 11, 387-392. Hung, J. J.,Wu,Y. C., Huang, M. H., Huang, B. S.,Wang, L. S., & Hsu,W. H. (2009). Distant
Failure Patterns of Resected StageⅠNon-small Cell Lung Cancer: A Long-term Follow-up. Division of Thoracic
Surgery, 39(5), 227-235. Hyun-Sung, Lee., Jang, H. J., & Park,S. Y. (2012). Cost-effectiveness of robot-assisted
lobectomy compared with VATS lobectomy for early-stage lung cancer in the National Health Insurance Program of
Korea. Jouranal of Clincal Oncology, 30(15), 2318. Jemal, A., Silgel, R., Ward, E., Hao,Y., Jiaquan, X. U., & Michael,
J. (2009). Cancer statistics, 2009. Joural for Clinicians, 59(4), 225-249. Kameyama, K., Takahashi, M., Ohata, K.,
Igai, H., Yamashina, A., Matsuoka, T.,…et al Okumura, N. (2008). Evaluation of the new TNM staging system
proposed by the International Association for the Study of Lung Cancer at a single institution. Journal of Thoracic and
Cardiovascular Surgery, 37(5), 1180-1184. Kawaguchi, T., Tojo, T., Kushibe, K., Kimura, M., Nagata,Y.,& Taniguchi,
S. (2008). Short-and long-term outcomes after pneumonectomy for primary lung cancer. Cardiovascular Surgeons of
Asia,14(5),289-293. Kozower, B. D., Sheng, S., & MJ Liptay, SM. (2010). STS Database Risk Models: Predictors of
Mortality and Major Morbidity for Lung Cancer Resection. The Society of Thoracic Surgeons, 90 (3),875-883. Ludwig,
C., Stoelben, E., Olschewski, M., & Hasse, J. (2005). Comparison of Morbidity, 30-Day Mortality and Long-Term
Survival after Pneumonectomy and Sleeve Lobectomy for Non–Small Cell Lung Carcinoma. The Annals of Thoracic
surgery, 79(3), 968-973. McKenna, R. J., Houck, W., & Fuller, C. K. (2006). Video-Assisted Thoracic Surgery
Lobectomy : Experience With 1,100 Cases. The Society of Thoracic Surgeons, 81(2), 421-426. Melloula, E., Eggerb,
B., Kruegera, T., Chenga, C., Mithieuxa, F., Ruffieuxc, C.,…et al Risa, H. B. (2008). Mortality, complications and loss
of pulmonary function after pneumonectomy vs.sleeve lobectomy in patients younger and older than 70 years.
Interactive CardioVasc Thoracic Surgery, 7(6), 986-989. Park, B. J., Flores, R. M., & Rusch,V. W. (2006). Robotic
assistance for video-assisted thoracic surgical lobectomy: technique and initial results. Journal of Thoracic and
Cardiovascular Surgery, 131(1), 54-59. Ramos, R., Masuet, C., & Gossot, D. (2012). Lobectomy for early-stage lung
carcinoma: a cost analysis of full thoracoscopy versus posterolateral thoracotomy. Surgical endoscopy , 26(2), 431-
417. Satherley, L. K., Luckraz, H., Rammohana, K. S., Phillipsa, M., Kulatilakea, N. EP., Peter, A. (2009). Routine
placement of an intercostal chest drain during video-assisted thoracoscopic surgical lung biopsy unnecessarily
prolongs in-hospital length of stay in selected patients. European Journal of Cardio-thoracic Surgery, 36(2), 737-740.
Takeda, S. I., Maeda, H., Koma, M., Matsubara,Y., Sawabata, N., Inoue, M.,…et al Ohta, M. (2006). Comparison of
surgical results after pneumonectomy and sleeve lobectomy for non-small cell lung cancer.Trends over time and 20-
year institutional experience. European Journal Cardio-Thoracic Surgery, 29(3), 276-280. Watanabe, A., Toshiaki,
W., Ohsawa, H., Mawatari, T., Ichimiya,Y., Takahashi, N.,…et al Tomio, A. (2004). Avoiding chest tube placement
after video-assisted thoracoscopic wedge resection of the lung. European Journal Cardio-Thoracic Surgery, 25(5),
872-876. Wright1, G., Manser, R. L., Byrnes, G., Hart, D., & Campbell, D. A. (2005). Surgery for non-small cell lung
cancer: systematic review and meta-analysis of randomised controlled trials. An International Joural of Respiratory
Medicine, 61(7), 597-603. Yildizeli, B., Fadel, E., Mussot, S., Fabre, D., Chataigner, O., & Dartevelle, P. G. (2007).
Morbidity,mortality,and long-term survival after sleeve lobectomy for non-small cell lung cancer. European Journal
Cardio-Thoracic Surgery, 31(1), 95-102 .
Contact
[email protected]

Application of Propensity Scores to Estimate the Association Between
Cardiovascular Disease and Meridian Energy
Ping-Ho Chen, MD, MS, Taiwan
Chen-Jei Tai, MD, PhD, Taiwan
Sheng-Miauh Huang, PhD, Taiwan
Purpose
This paper reports a study to describe the physiological indicators and the meridian energy among adult
people. Also, the study explored the net impact of cardiovascular disease on yin, yang, and overall
meridian energy.
Target Audience
The target audience of this presentation is the nurse who is interested in traditional Chinese medicine.
Nurses at cardiovascular department are welcome to join the presentation.
Abstract
Background: According to the theories of Traditional Chinese Medicine (TCM), the physiological and
pathological changes of the internal organs are presented on the external manifestation through meridian
energy. But no documentation is available which shows the actual impact of cardiovascular disease
(CVD) on meridian energy.
Purpose: This paper reports a study to describe the physiological indicators and the meridian energy
among adult people. Also, the study explored the net impact of CVD on yin, yang, and overall meridian
energy.
Methods: A health examination data at a university hospital in Taipei from 1st August 2005 through
31stDecember 2011 was used for the present study. Adult participants who accepted physiological and
meridian energy examination at the same day were enrolled. The physiological examination was the
blood-test and diagnosis data from the medical charts. Meridian energy was examined using a meridian
energy analysis device. Linear regression was calculated to compare the differences of meridian energy
between with and without CVD group, giving adjusted the propensity score.
Results: The mean meridian energy of 2,875adult participants was 24.5 (SD =18.1). Eighty six
participants (2.99%) had actual cardiovascular disease. The regression model showed current
cardiovascular disease was negatively associated yin, yang, and overall meridian energy (overall:
adjusted β = -6.03, 95% CI:-9.95 to -0.21; yin: adjusted β = -6.16, 95% CI:-10.35 to -1.97; yang: adjusted
β = -5.89, 95% CI:-9.67 to -2.12).
Conclusion: The results of this study demonstrated that the cardiovascular disease was related to lower
meridian energy. Whether enhancing meridian energy could improve cardiovascular function merits
further studies.
Contact
[email protected]

The Discrimination of Screen Pre-Frailty for Community-Dwelling Elderly People
Shu-Fang Chang, PhD, Taiwan
Purpose
The purpose of this presentation is to analyze the risk factors and cut-off point of a short battery of
physical performance tests for identifying community-dwelling elderly people with pre-frailty.
Target Audience
The target audience of this presentation is suit for all participates.
Abstract
Purpose: The purpose of this presentation is to analyze the risk factors and cut-off point of a short
battery of physical performance tests for identifying community-dwelling elderly people with pre-frailty.
Methods: A short battery of physical performance tests was employed at community activity center to
assess the following characteristics among elderly people: balance, mobility, and flexibility. Instructions
were provided to participants by demonstration.
Results: Logistic regression analysis indicated that four indicators were significantly correlated to pre-
frailty, that is, pre-frailty included falls in the previous year (OR = 3.05, 95% CI of OR = 1.46 – 6.38),
smoking (OR = 3.22, 95% CI of OR = 1.40 – 7.38), hypertension (OR = 2.21, 95% CI of OR = 1.16 –
4.21) and bone and joint disease (OR = 8.96, 95% CI of OR = 3.05 – 26.30) (Tables 3). Furthermore,
according to the logistic regression analysis results, three of the mentioned tests could significantly
predict pre-frailty, namely, right-hand grip (OR = 0.96, 95% CI of OR = 1.92 – 1.99), left-hand grip (OR =
0.92, 95% CI of OR = 1.87 – 1.97), and the 8-foot up-and-go test (OR = 1.15, 95% CI of OR = 1.04 –
1.27). The results indicate that grip and 8-foot up-and-go are effective independent predictors for
Conclusion: To the best of our knowledge, this study is the first academic examination of the cut-off
points for objective physiological indicators assessing pre-frailty among elderly Asian people. Although
this study focuses on community-dwelling elderly people in East Asian countries, research investigating
the diagnosis methods, sensitivity, specificity, NPV, and PPV of screening methods for pre-frailty are
scarce. Furthermore, in this study, pre-frailty is determined according to an established and validated
index
References
[1] WHO (2013). What WHO is doing Guidance on pre-frailty:
http://www.who.int/ageing/about/who_activities/en/index1.html [2] Department of Health, Executive Yuan, R.O.C.
(TAIWAN) (2013). Healthy people 2020: http://www.doh.gov.tw/CHT2006/index_populace.aspx [3] Ávila-Funes, J. A.,
Helmer, C., Amieva, H., Barberger-Gateau, P., Le Goff, M., Ritchie, K., ... & Dartigues, J. F. (2008). Pre-frailty among
community-dwelling elderly people in France: the three-city study. The Journals of Gerontology Series A: Biological
Sciences and Medical Sciences, 63(10), 1089-1096. [4] Bartali, B., Frongillo, E. A., Bandinelli, S., Lauretani, F.,
Semba, R. D., Fried, L. P., & Ferrucci, L. (2006). Low nutrient intake is an essential component of pre-frailty in older
persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(6), 589-593. [5]
Bergman, H. (2008). Pre-frailty: Searching for a relevant clinical and research. In paradigm 28th Canadian geriatrics
society annual meeting: Academic Career Day, 11(3), 9-11. [6] Bilotta, C., Nicolini, P., Casè, A., Pina, G., Rossi, S.,
＆ Vergani, C. (2012). Pre-frailty syndrome diagnosed according to the Study of Osteoporotic Fractures (SOF) criteria
and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort
study. Archives of Gerontology and Geriatrics, 54 (2), 23-28.
Contact
[email protected]

The Effects of Psychological Nursing Intervention Program on Psychological
Distress and Quality of Life in Women with Breast Cancer Undergoing
Chemotherapy
Yeon Hee Kim, PhD, RN, South Korea
Kyung Sook Choi, PhD, RN, South Korea
Purpose
The purpose of this study was to develop a psychological nursing intervention program and evaluate the
effect on psychological distress and quality of life for women breast cancer patients undergoing
chemotherapy.
Target Audience
The target audience of this presentation is clinical nurses and academic nursing professor
Abstract
Purpose: The purpose of this study was to develop a psychological nursing intervention program and
evaluate the effect on psychological distress and quality of life for women breast cancer patients
undergoing chemotherapy.
Methods: The research design was pre and post randomized controlled trials. Development of the
psychological nursing intervention program proceeded as follows:
(1) The program was based on the guideline of psychological intervention proposed by Fawzy(1996),
focusing on chemotherapy symptom management education, coping skill for negative emotion while
treatment process, and emotional support: body image, self concept, stress coping, expressing fear of
cancer recurrence, how to overcome difficulty in personal relation, utilization of social resource, sharing
experience related to sexual life, and self acceptance etc.
This program was structured to express their feelings and provide emotional support.
The program consisted eight 30~60 minute sessions over the weekly counseling with face to face counsel
combined with telephone counsel.
(2) The psychological nursing intervention program was finalized after expert group validation of structure,
formation, and content.
To evaluate the effect of the intervention, the high risk group for depression was sampled among women
breast cancer patients scheduled chemotherapy at outpatient clinic, a tertiary hospital. A total of 44
participants were recruited and allocated to an experimental group and a control group.
The effect of the program was evaluated by measuring psychological distress such as mood, anxiety, and
depression and quality of life.
The data were analyzed using SPSS program for descriptive statistics, independent t-test, x2-test,
Fisher’s exact test, and RM-ANOVA.
Results: The results of this study are as follows:
1. Hypothesis 1: “The experimental group which participated in the program will show lower psychological
distress than the control group.”
1) Hypothesis 1-1: “The experimental group which participated in the program will show more improved
mood than the control group.” was supported (F=7.290, p=0.003).
2) Hypothesis 1-2: “The experimental group which participated in the program will show lower anxiety
level than the control group.” was supported (F=7.770, p=0.002).

3) Hypothesis 1-3: “The experimental group which participated in the program will show lower depression
level than the control group.” was supported (F=11.921, p=0.000).
2. Hypothesis 2: “The experimental group which participated in the program will show higher quality of life
than the control group.” was not supported (F=1.144, p=0.313).
Conclusion: this psychological nursing intervention program for women breast cancer undergoing
chemotherapy was effective for reducing psychological distress and improving quality of life in some
domain. The program will reduce psychological distress for breast cancer patients undergoing one more
therapy and enable them to improve long term survival rate as well as to improve their quality of life. More
psychological intervention programs will be needed.
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Contact
[email protected]

A Comparative Analysis of Nursing Students' Knowledge, Attitude, Perception
and Self-Efficacy of Child Abuse and Neglect Cases in the Cross-National
Research
Pei-Yu Lee, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to survey and investigate the knowledge, attitude, perception and self-
efficacy for nursing students of universities in different countries and cultures.
Target Audience
The target audience of this presentation is university nursing students.
Abstract
Purpose: To conduct a cross-national research on the current situation of the nursing students’
knowledge, attitude, perception and self-efficacy on child abuse and neglect through structured
questionnaires and to analyze the similarities and differences in the findings in different countries.
Methods: A cross-sectional and convenient sampling was used and recruited 200 participants
fromTaiwan & Australia's nursing schools. The participants must conform to the following criteria: (1)
should be undergraduate nursing students; (2) with clinical practice experiences; (3) understand the
purpose and methods of this research and are willing to participate in this research.
Expected Results: Tsai & Wang (2009) pointed out that health care professionals should expose
themselves to ethnic groups with different cultural backgrounds in order to respect and use a non-
judgmental attitude in understanding different culture’s ethnic values, beliefs and behaviors to propose
cultural appropriate care services. The author hopes to understand the education on child abuse issues
for nursing students in Eastern and Western countries through the results of this study to promote
different cultural self-awareness of nursing students and to cultivate cultural sensitivity to develop
international and global perspectives for nursing education in child abuse issues.
Conclusion: ongoing work study.
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Contact
[email protected]

The Effect of the Burnout on the Negative and Positive Automatic Thought in a
Japanese Nurse
Takashi Ohue, RN, PhD, Japan
Michiko Moriyama, RN, PhD, Japan
Takashi Nakaya, PhD, Japan
Purpose
The purpose of this study is to examine the effect on a burnout of the negative automatic thought and
positive automatic thought in a nurse, and to consider effective cognitive approach.
Target Audience
The purpose of this study is to examine the effect on a burnout of the negative automatic thought and
positive automatic thought in a nurse, and to consider effective cognitive approach.
Abstract
Purpose: The purpose of this study is to examine the effect on a burnout of the negative automatic
thought and positive automatic thought in a nurse, and to consider effective cognitive approach.
Methods: A total of 336 nurses (27 males and 309 females) who worked at 5 acute-care hospitals were
asked to complete a questionnaire that was designed to determine the status of burnout (Maslach
Burnout Inventory:MBI) and automatic thoughts (Automatic Thoughts Questionnare-Revised).
Ethical considerations: The protocol of this study was approved by the Hiroshima University Ethics
Committee, Japan. The objectives and procedures were explained in writing to the participants.
Results: First, in order to examine the effect by the combination of negative automatic thought and
positive automatic thought, We considered "negative evaluation of the future" and "self-blame" as
negative automatic thought and positive automatic thought, classified into the low group high group using
the median about each of subscale, and conducted two-way ANOVA which make these groups a factor
every three subscale of a burnout. The results revealed a significant interaction for “emotional exhaustion”
(p < 0.05). Namely, it was confirmed that the higher the score for negative automatic thoughts, and the
lower the score for positive automatic thoughts, the higher the score for emotional exhaustion. In relation
to "depersonalization" and "personal accomplishment", although there was no significant interaction, a
significant difference was found for the main effect. In order to examine a concrete factor affecting, We
conducted multiple regression analysis. As a result, in "emotional exhaustion", and "depersonalization",
"negative evaluation of the future" showed positive relationship and showed negative relationship by
"positive automatic thought." Moreover, in the "personal accomplishment", "positive automatic thought"
showed positive relationship.
Conclusion: That is, in decrease in a burnout, while putting power into decreasing "negative automatic
thought", it is necessary to increase "positive automatic thought." It was suggested especially that
decrease of "negative evaluation of the future" and the intervention in ""positive automatic thought" are
important. This was mostly in agreement also with the result of Kendall (1992), and a possibility that this
method could reduce "emotional exhaustion" used as the key point of a burnout was suggested.
Contact
[email protected]

Too Anxious to Learn?: Should the Ongoing Debriefing Technique be Amongst
the Best Practices in Simulation?
Marc E. Code, CRNA, BS, MSN, USA
Purpose
The purpose of this poster presentation is to demonstrate benefit of the Ongoing Simulation Debriefing
Technique on lowering anxiety levels amongst those participating in simulation activities.
Target Audience
The target audience of this presentation is educators who integrate simulation based learning into
courses.
Abstract
Purpose: The aim of this paper is to demonstrate benefit of the Ongoing Simulation Debriefing
Technique on lowering anxiety levels amongst those participating in simulation activities.
Methods: After IRB approval, the pre-simulation/post-simulation anxiety levels were evaluated in first
year nurse anesthesia students (n=26) in three different scenarios using State Trait Anxiety Inventory
(STAI). Students were divided into two groups - Control group (End Debriefing) and Experimental group
(Ongoing Simulation Debriefing Technique). Both groups were exposed to identical simulations of
increasing scenario complexity with the last scenario being the most difficult and complex (pediatric
induction). Students were asked to complete a questionnaire both pre/post simulation. The data were
collected from 2012 to 2013.
Results: A quasi-experimental design was used to collect research data and analyzed for validity and
significance utilizing SPSS and T–test analysis. The anxiety levels were reduced in both control and
experimental groups post simulation as compared to their pre simulation values as evident by STAI
scores. The overall mean STAI scores were reduced by 15.21 and 21.81 percentage points, respectively,
in control and experimental groups. The difference between means was statistically significant (P <
0.001). Students’ perception of confidence and satisfaction was measured on a 5-point Likert scale.
Students demonstrated more confidence and satisfaction in the control group than the experimental
group in cardiovascular emergencies while in respiratory and pediatric simulations the experimental group
demonstrated more confidence and satisfaction. In the most difficult and complex of the three scenarios,
the pediatric emergencies, the experimental group showed the most dramatic increase in confidence and
satisfaction while the control group showed a decline.
Conclusion: Ongoing Simulation Debriefing Technique reduces stress and anxiety levels generated by
simulation more than when using the End-Debriefing Technique. The Ongoing Simulation Debriefing
Technique creates a safer learning environment in which students can maximize their learning potential.
This technique should be considered as a best practice for Simulation Based Learning with adults. This
method has shown to exhibit more confidence in students but more research is needed to determine its
implications on performance in the clinical setting.
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A. E., & Lushington, K. (2002). The effect of percieved stress on student performance. Journal of Dental Education,
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nurse anesthesia students. Ann Arbor: ProQuest LLC. Yeager, K. H. (2004). High-fidelity fimulation based training in
neonatal nursing. Advanced Neonatal Care,, 326-331.
Contact
[email protected]

A Correlational Study in Older Adults with Metabolic Syndrome
Yi-Lin Su, RN, Taiwan
Purpose
The purpose of this presentation is to investigate the correlated factors of elderly people with metabolic
syndrome.
Target Audience
The target audience of this presentation is Clinical team.
Abstract
Purpose: To investigate the correlated factors of elderly people with metabolic syndrome.
Methods: The method was based on cross-sectional survey and convenient sampling. Data were
collected through a structured questionnaire assessing personal information, disease related information,
health promotion lifestyle and perceived health status of each respondent. The respondents were
selected from elderly people who took a health exam in a regional hospital in Taipei City in 2010 and
elderly people who needed to visit the hospital for follow-up assessment or treatment of metabolic
syndrome.
Results: Two hundred and twenty questionnaires were distributed, and 184 valid responses were
returned, resulting in a response rate of 83.6%. In health promotion lifestyle, the group of respondents
without metabolic syndrome scored significantly higher than the group of respondents with metabolic
syndrome (t=-2.06, p=.04). Respondents who were married, on a job, with a senior high or higher
education level, and without hospitalization in recent one year scored significantly higher on health
promotion lifestyle. Health promotion lifestyle was significantly and negatively correlated with age, total
number of metabolic syndrome risk factors, total number of chronic disease, and was significantly and
positively correlated with perceived health status. The univariate logistic regression analysis showed
education level (OR=2.21, 95% CI=1.24~4.30, p=.00) and health promotion lifestyle (OR=.99, 95%
CI=.95~1.02, p=.04) were significant predictors of metabolic syndrome.
Conclusion: For elderly people, especially for those who were less educated, more effort should be
made to enhance their abilities to maintain their own health and well-being through health promotional
lifestyles
References
Wang, R. H., Hsu, H. Y. (1997). Health promotion behaviors and related factors among the elderly in the San-Min
District of Kaohsiung City. Nursing Research, 5(4), 321-329. Wang, B. (2005). The study on learning needs of elders
of Chiayi County senior centers. Unpublished master ffs thesis.
Elder Graduate
Education, Institute o
National
Chung Cheng University, Chiayi. Lee, Y. S., Chi, Y. C., Chanh, W. P., & Wu, C. L. (2010). The Relationship between
Occupation and Metabolic Syndrome in Taiwan. Taipei City Medical Journal, 7(3), 49-59. Lin, S. S., & Lee, S. C.
(2008). A study on the leisure participation, leisure benefits and leisure satisfaction of the older adult in Nantou
County. Journal of Sport and Recreation Management, 5(1), 35-36. Chen, M. Y., Chou, C. C.,Huang, H. S., Wang, E.
K., Chiou, H. J., & Liao, J. C. (1997). The development of chinese version health promoting lifestyle profile. Chang
Gung Nursing, 8(1), 14-24. Hsu, C. C., Hsu, H. M., Shu, C. C., Shin, Y. T., & Tai, T. Y. (2003). Factors contributing to
health behaviors among the elderly in Taiwan. Taiwan Journal of Public Health, 22(6), 441-452. Huang, W. Y.,& Wu,
Y. T. (2013). Effects of Exercise or Physical Activity Intervention in the Elders with Metabolic Syndrome. Formosan
Journal of Physical Therapy, 38(2), 163-171. Huang, Y. H.,& Chiou, C. J. (1997). Predictors contributing to health-
promoting lifestyles among college students in Kaohsiung area. Chinese Journal of Public Health, 16(1), 24-36. Kuo,
Y. C.,& Kao, S. K. (2003). A study on the effect between lifestyle and learning needs of older adults in elder college of
Kaohsiung City. Review of Agricultural Extension Science, 20 C57
-80. Kuo, C. F., Yu, K. H., Chen, Y. M., Huang, J.
S., Li, H. Y., Shen, Y. M. & See, L. C. (2010). Gender differences in the prevalence of metabolic syndrome.
Formosan Journal of Medicine, 14(4), 384-391. Yang, R. S. (2011). Against the metabolic syndrome, to start to start
eating. Health World, 301, 7. Yang, C. L., & Wang, Y. W. (2009). Nutrition and health of the metabolic syndrome.
Taipei, Taiwan: Farreaching Huacheng. Chung, F. L. (2011). Waist-to-thigh ratio and its association with diabetes and
metabolic syndrome components. Unpublished master -fs thesis.
Shan School of Public Health, Ch
Medical

University, Taichung. Chang, T. H., & Huang, C. C. (2002). The relationship between health promotion lifestyle and
perceived health status among adults. Journal of Health Education, 17, 15-30. Chang, C. Y., Kao, Y. Y., Chen, Y. N.,
Hung, C. T., Chen, J. S., & Liao, C. T. (2009). The prevalence of metabolic syndrome within aged people in Nantou,
Taiwan. Journal of Biomedical & Laboratory Sciences, 20(3-4), 40-46. Liao, C. C., Liao, M. Y., Lee, M. C., Li, H. W.,
Chen, S. T., Chen, L. M c. & Jong, G. P. (201
a
Taichung community . Taiwan Geriatrics & Gerontology, 6(4), 221-231. Liao, W. C., Chiu, L. A., & Yueh, H. P. (2012).
A study of rural elderly's health information needs and seeking behavior. Journal of Library and Information Studies,
10(1), 155-204. Chao, A. N., Gau, M. L., & Lin, S. H. (2004). The relationships between health status and quality of
life among rural community elderly dwellers. The Journal of Longterm Care, 8(1), 41-55. Liu, C. N. (2009). The
Association of depressive symptoms with socioeconomic status, general health conditions, and health behaviors in
community-dwelling adults. Taiwan Journal of Public Health, 28(4), 300-311. Lai, H. Y., Huang, K. C., & Chen, C. Y.
(2006). The elderly with metabolic syndrome. Primary Medical Care & Family Medicine, 21(9), 239-243. Anderson, S.
A., Carroll, S., & Vrdal, P. (2007). Combined diet and exercise intervention reverses the metabolic syndrome in
middle-age males: Results from the Oslo Diet and Exercise Study. Scandinavian Journal of Medicine & Science in
Sports, 17, 687-695. Caserta, M. S. (1995). Health promotion and the older population: Expanding our theoretical
horizons. Journal of Community Health, 20(3), 283-292. Chang, C. F., Lin, M. H., Wang, J., Fan, J. Y., Chou, L. N., &
Chen, M. Y. (2013). The relationship between geriatric depression and health-promoting behaviors among
community-dwelling seniors. The Journal of Nursing Research, 21(2), 75-82. Ding, E. L., Song, Y., Malik, V. S., & Liu,
S. (2006). Sex difference of endogenous sex hormones and risk of type 2 diabetes: A systematic review and meta-
analysis. The Journal of the American Medical Association , 295, 1288-1299. Donna, C. (2005). Healthy behaviors,
self-efficacy, self-care, and basic conditioning factors in older adults. Journal of Community Health Nursing, 22(3),
169-178. Kang, S. W., Yoo, J. S. (2012). Health-promoting lifestyle and depression in metabolic syndrome patients in
Korea. International Journal of Nursing Practice, 18, 268-274. Khan, S. S., Kazmi, W. H., Abichandani, R., Tighiouart,
H., Pereira, B. J., & Kausz, A. T. (2002).Health care utilization among patients with chronic kidney disease. Kidney
International, 62(1), 229-236. Morton, K. (2013). Implenting evidence-based health promotion strategies. Nursing
Standard, 27(33), 35-42. Pitsavos, C., Panagiotakos, D., & Weinem, M. (2006). Diet, exercise and the metabolic
syndrome. The Review of Diabetic Study, 3, 118-126. Polit, D., & Beck, C. T. (2008). Nursing research: Generating
and assessing evidence for nursing practice (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Sohng, K. Y.,
Sohng, S., & Yeom, H. A. (2002). Health promotion behaviors of elderly Korean immigrants in the United States.
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lifestyle profile: Development and psychometric characteristic. Nursing Research, 36(2), 77-81.
Contact
[email protected]

Mental Health Nurses' Attitudes Toward Self-Harm: Curricular Implications of a
Qualitative Study
Purpose
The purpose of this presentation is to: 1) illustrate attitudes of nurses toward service users who self-harm
in secure environments. 2) discuss a conceptual model that will inform curriculum innovation at both
under- and post-graduate levels
Target Audience
The target audience of this presentation inlcudes all mental health practitioners, including mental health
nurses and academics of health related subjects
Abstract
Purpose: The purpose of the study was to examine the attitudes of nurses toward service users who self-
harm in secure environments. The educational implications arising from this study form the focus of this
paper.
Methods: A qualitative multi-method approach was adopted, underpinned by interpretive
phenomenology. The setting was a large secure mental health unit to the west of London in the United
Kingdom. Data were obtained from mental health nurses using individual interviews and focus groups.
Results: Nurses vary in their attitudes towards self-harm but mainly hold negative ones, usually related to
limited knowledge and skills in this area. The results of the study, informed by the Theory of Planned
Behaviour, led to the development of a model entitled Factors Affecting Self-Harming Behaviours (FASH).
Conclusion: The FASH Model, which captures the results of this study, is intended to inform future
curriculum innovation at both under- and post-graduate levels. It is argued that only by adopting a holistic
approach to education about self-harm can attitudes and skills be developed to make care provision more
effective in secure mental health settings.
References
Ajzen, I. and Fishbein, M. (2005) The influence of attitude on behaviour. In, D. Albarracin, B. T. Johnson and M. P.
Zanna (eds). Handbook of attitude and attitude change: basic principles. Mahwah: Erlbaum. 173-221 Anderson, M.
and Standen, P. (2007) Attitudes towards suicide among nurses and doctors working with children and young people
who self-harm. Journal of Psychiatric and Mental Health Nursing. 14 (5): 470-477 Sandy, P.T. & Shaw, D. (2012)
Attitudes of mental health nurses to self-harm in secure forensic settings: a multi-method phenomenological
investigation. Journal of Medicine and Medical Science Research.1 (4),63–75.
Contact
[email protected]

Exploration of the Role of Gastroesophageal Reflux Disease in Chronic
Obstructive Pulmonary Disease Patients: A Nationwide Population-Based Cohort
Study
Yu-Huei Lin, MS, Taiwan
Chii Jeng, PhD, Taiwan
Purpose
This study aimed to investigate whether GERD is associated with an increased risk of severe acute
exacerbation of COPD (AECOPD) by analyzing a nationwide health care database.
Target Audience
The target audience of this presentation are clinical practitioners and academic researchers.
Abstract
Purpose: To investigate whether GERD is associated with an increased risk of severe acute
exacerbation of COPD (AECOPD) by analyzing a nationwide health care database.
Methods: This study employed a population-based retrospective cohort design. We conducted
propensity score method with 1:2 matching. In this study we analyzed 1,976 COPD subjects with GERD
and 3,943 COPD subjects as a comparison group. We individually tracked each subject in this study for
12 months and identified those subjects who experienced episodes of severe AECOPD required
hospitalization or emergency department visit. The cumulative incidence of AECOPD was estimated
using the Kaplan-Meier method to analyze the difference between two groups. Hazard ratios (HR) were
calculated using Cox proportional hazards regression analysis.
Results: The incidence of severe AECOPD was 3.40 and 2.34 per 1,000 person-months in individuals
with and without GERD, respectively (P=0.0137). Following adjustment for sex, age, ischemic heart
disease, heart failure, atrial fibrillation, hypertension, osteoporosis, anxiety, diabetes mellitus, angina,
stroke, anemia, dementia, occupational category, monthly insurance premium, Cox regression analysis
revealed that GERD was associated with severe AECOPD (HR=1.45, 95% CI=1.07 ~ 1.95).
Conclusion: This study demonstrated that GERD is an independent risk factor for severe AECOPD.
Caution should be exercised in COPD patients when assessing GERD symptoms in clinical practice.
Contact
[email protected]

The Influence of Clinical Placements on Final Grades in an Undergraduate
Nursing Course: A Comparative Study
Kath Peters, RN, BN (Hons), PhD, Australia
Judy Mannix, RN, BEd (Nsg), MN (Hons), Australia
Purpose
The purpose of this presentation is to report the effects on nursing student academic performance of
deferred clinical placements, outside scheduled teaching sessions. Increasing nursing student enrolments
in undergraduate pre-registration courses, clinical workforce pressures, and changes to health service
structures have resulted in more students attending clinical placements.
Target Audience
The target audience of this presentation is nursing faculty involved in the planning and delivery of
undergraduate nursing curricula, clinicians involved in clinical teaching, and health administrators
responsible for determining the allocation of clinical placements for nursing students in undergraduate
programs.
Abstract
Purpose: The purpose of this presentation is to report the effects on nursing student academic
performance of deferred clinical placements, outside scheduled teaching sessions. Increasing nursing
student enrolments in undergraduate pre-registration courses, clinical workforce pressures, and changes
to health service structures have resulted in more students attending clinical placements.
Methods: Within a Bachelor of Nursing (BN) degree six subjects involving a graded clinical placement
component were identified and included in the study. In all subjects, a proportion of enrolled students
were routinely allocated a deferred clinical placement. Following ethics approval all student results from
the six identified subjects offered in one calendar year were extracted from existing university data bases.
These results included overall final grades and associated components, including theoretical grades,
Objective Simulated Clinical Assessment (OSCA) results and clinical practicum evaluations. Once
collected, all data were de-identified. In all, over 5500 individual student results from across the 3 years of
the BN course were included in the data-set. Comparative analysis was undertaken to compare individual
academic performance against the timing of clinical practicum.
Results: Within the overall data-set more than 40% of all students were allocated a deferred clinical in at
least one subject. The overwhelming majority of deferred clinical placements occurred immediately after
finalisation of all theoretical and OSCA results. Overall, students who completed their clinical practicum as
scheduled during teaching sessions achieved higher academic results than those who were allocated a
deferred clinical placement. For those students who experienced a deferred clinical placement for one of
their two clinical subjects during a single teaching session, academic performance was indicative of the
timing of clinical placement.
Conclusion: The results from this study reinforce the importance of clinical placement for undergraduate
nursing students. Being able to integrate theoretical knowledge and an actual clinical practice context,
within a nursing course, has been reflected in the academic performance of nursing students across a 3
year pre-registration course. Results from this study support the importance of praxis in the practice
based discipline of nursing. It is imperative for providers of undergraduate pre-registration nurse
education to ensure students undertake clinical placements when planned in a program of study.
Contact
[email protected]

The Experiences of Stigma As Described by Taiwanese People Living with
Schizophrenia
Yu-Hui Ku, RN, BSN, Taiwan
Ji-An Su, MD, MS, Taiwan
Purpose
The purpose of this presentation is to investigate the experience of stigma as described by Taiwanese
people living with schizophrenia and understand the interaction between patient and sociality.
Target Audience
The target audience of this presentation is for psychiatric nurses, health professional and public health
nurses.
Abstract
Purpose: People with schizophrenia have chronic and regressive features which make patients remain
partial residual symptoms even if patients have received regularly medication treatment. These symptoms
not only cause discrimination and stigma but also influence patients’ psychology, marriage, interpersonal
relationship, and occupation. For Chinese people, stigma may be much more serious and particularly
significant than Western people because of social culture and family structure. The purpose of this study
is to investigate the experience of stigma as described by Taiwanese people living with schizophrenia and
understand the interaction between patient and sociality.
Methods: 12 people with schizophrenia at psychiatric day care in south Taiwan were recruited. Each
participant investigated with 25-item Psychiatric Stigma Scale and twice in-depth 40-minute interviews.
Results: The average score of Psychiatric Stigma Scale was lower in people with schizophrenia. This
meant that people with schizophrenia felt they seldomly had experiences of stigma. A narrative qualitative
approach to inquiry formed the theoretical framework. Four core categories were explicated from the
analysis of data: feeling isolation, caught in a dilemma, seeking religion, family desire.
Conclusion: The findings could not only help psychiatric professional understood the experiences of
stigma, but also provide timely interventions to reduce the phenomenon of stigma in our society.
References
1. Han, D. Y., & Chen, S. H. (2008). Psychometric Properties of the Perceived Psychiatric Stigma Scale and Its Short
Version. Formosa Journal of Mental Health, 21(3), 273-290. 2. Corrigan, P. W., & Kleinlein, P. (2005). The impact of
mental illness stigma. 3. Gerlinger, G., Hauser, M., Hert, M., Lacluyse, K., Wampers, M., & Correll, C. U. (2013).
Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and
interventions. World Psychiatry, 12(2), 155-164.
Contact
[email protected]

The Development of Cultural-Specific Caregiver Telephone Coaching Program to
Improve Heart Failure (HF) Home Care
Ubolrat Piamjariyakul, PhD, RN, USA
Carol E. Smith, PhD, FAAN, RN, USA
Purpose
to use qualitative data from patients, family caregivers, and professionals experienced in HF care and
national clinical guidelines to guide the development of cultural-specific caregiver telephone coaching
program (FamHFcare). Coaching and teach-back strategies were used throughout.
Target Audience
clinical nurses, nurse researchers who involved in heart failure home care management.
Abstract
Background: The significance of this study is related to the prevalence of HF in African Americans at
younger ages, with earlier severe complications and mortality. In addition, the economic burden of HF
affects these populations greatly. Ethnic-specific needs must be identified to help patients and family
caregivers. Thus, a program to provide African American caregivers with skills to improve HF home care,
reduce patient rehospitalization costs, and prevent caregiver burden is critically needed.
Purpose: Qualitative data from patients, family caregivers, and professionals experienced in HF care and
national clinical guidelines were used to guide the development of cultural-specific caregiver telephone
coaching program (FamHFcare). Coaching and teach-back strategies were used throughout.
Methods: The University Medical Center Institutional Review Board approved the study. FamHFcare
program was developed from qualitative data, feasibility study, and using national clinical guidelines HF
home care management contents as a guide. The project was completed in two interrelated phases: (1)
conducted qualitative community based participatory study (n=30) to identify cultural-specific preferences
of African American families managing HF at home; and (2) current African American feasibility study
funded by Blue Cross Blue Shield (n=10 caregivers).
Results: The program was nurse-led and conducted in 5 telephone coaching sessions. Each coaching
session includes information about HF management related to specific cultural strengths and challenges.
Since African Americans have multiple family caregivers who want to help (but may not know how to), the
nurse coach helps the family coordinate arrangement for transportation, chores, and support telephone
contacts and easy-to-follow daily home care routines. The materials on dietary sodium management have
been modified for cultural preferences in common African American diets. Applications for reduced-cost
drug programs are completed. Coaching is given on comorbid symptom recognition, and dietary and
physical activity instructions per physicians and national core HF measures guides. Visuals for assessing
cyanosis and edema in darker skinned individuals are used. The nurse helps patients and caregivers
practice monitoring and timely reporting of HF symptoms to professionals. As a reinforcement for
cementing the FamFHcare information each caregiver is asked to "teach back" to the nurse what was
learned in each session. The results from the current comparison study (n=10) indicates that there was a
24.5% improvement in the caregivers’ HF knowledge, symptom monitoring and reporting in week two
following the coaching session. Further, following the second session there was only one caregiver
requiring educational reinforcement in week two.
Conclusion: This project described critical steps in developing cultural-specific caregiver telephone
coaching program. The coaching program was evaluated as helpful in problem-solving HF related home
care challenges.
References
Piamjariyakul, U., Smith, C.E., Werkowitch, M., & Elyachar, A. (2012, a). Part I: Heart failure home management:
Patients, multidisciplinary healthcare professionals and family caregivers perspectives. Applied Nursing Research,

25(4), 239-245. Piamjariyakul, U., Smith, C.E., Werkowitch, M., & Elyachar, A. (2012, b). Part II: Heart failure home
management: integrating patients’, professionals’, and caregivers recommendations. Applied Nursing Research,
25(4), 246-250. Piamjariyakul U, Russell, C., Smith CE, Werkowitch M, Elyachar A. (2013). The feasibility of a
telephone coaching program on heart failure home management for family caregivers. Heart & Lung, 42(1): 32-9.
Wongpiriyayothar, A., Piamjariyakul, U., & Williams, P.D. (2011). Effects of Coaching Using Telephone on Dyspnea
and Physical Functioning Among Persons with Chronic Heart Failure. Applied Nursing Research, 24(4), e59-e66.
Piamjariyakul, U. (2013-2014). Telephone coaching program and HF symptom recognition for African American
family members of patients with heart failure. Research Study funded by Kansas City Area Life Science Institute, Blue
Cross Blue Shield. Yancy, C.W., Jessup, M., Bozkurt, B., et al. (2013). 2013 ACCF/AHA Guideline for the
Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines. J Am Coll Cardiol [June 5, Epub ahead of print]. Clark, A.M.,
Freydberg, C.N., McAlister, F.A., Tsuyuki, R.T., Armstrong, P.W., & Strain, L.A. (2009). Patient and informal
caregivers’ knowledge of heart failure: Necessary but insufficient for effective self-care. European Journal of Heart
Failure, 11(6), 617-621. Pressler, S.J., Gradua-Pizlo, I., Chubinski, S.D. et al. (2009). Family caregiver outcomes in
heart failure. Am J Crit Care, 18(2), 149-159. Wilkins, V.M., Bruce, M.L., & Sirey, J.L. (2009). Caregiving tasks and
training interest of family caregivers of medically ill homebound older adults. Journal of Aging and Health, 21(3), 528-
542. Molloy, G.J., Johnston, D.W., & Witham, M.D. (2005). Family caregiving and congestive heart failure. Review
and analysis. Eur J Heart Fail, 7(4), 592-603. Smith, C.E. (2012-2013). Advanced HF Illness Burden
Trajectories/Ethno-Cultural Needs of African Americans. Research Study funded by Research Institute Inc (RI Grant
#858550).
Contact
[email protected]

Pilot Study to Describe the Substance Use Experiences of HIV-Positive Young
Black Men Who Have Sex with Men (MSM) Between the Ages of 18-29 in San
Francisco
Austin Nation, RN, PHN, MSN, USA
Purpose
The purpose of this presentation is to offer insight about the range of factors and enhance our
understanding about the role that substance use plays in the lives of HIV-positive young Black MSM.
Target Audience
The target audience of this presentation is clinicians and researchers in all academic and practice
settings who will encounter HIV-positive young Black men with substance use issues.
Abstract
Purpose: The prevalence of HIV among young Black men who have sex with men (MSM) is three to four
times higher than white MSM. Young black MSM are run-aways and homeless, forcing them to survive on
the streets by becoming sex workers, engaging in unprotected anal intercourse because either they or
their partner is under the influence of drugs or alcohol. Previous studies cite crack cocaine use, sex while
high on crack cocaine, marijuana and alcohol, or sharing needles for injection drugs as strongly
associated with HIV infection among young black MSM. The purpose of this presentation is to identify
contributing risk factors for acquiring HIV/AIDS among young Black MSM as well as describe and explain
the significance of substance use among this population
Methods: This qualitative study is to offer insight about the range of factors and enhance our
understanding about the role that substance use plays in the lives of HIV-positive young Black MSM.
Surprisingly, the results of this study do not draw the same conclusions as previously cited studies with
HIV-positive young Black MSM in other cities.
Results: The themes that emerged from the coding of this qualitative narrative study describe an across-
case experiential trajectory with a summary of the significant experiences of this population, contributing
to the limited body of knowledge currently available about family, relocation, relationships,
methamphetamine prevalence and access, testing positive for HIV and willpower, coping and the sense
of hope.
This information will contribute to the development of prevention education strategies specifically tailored
to this population that address issues surrounding substance abuse in HIV transmission.
a. family and includes issues with being stigmatized due to their sexual orientation along with rejection,
judgment, discrimination, and lack of acceptance and early exposure to drugs and sex in the family.
b. relocation to San Francisco, they talk about HIV, being homeless and the theme of survival, needing
money for meet their basic needs including food and housing so they can have a place to sleep and
shower.
c. relationships, which include feelings of abandonment, alone, lonely, and the need to find a community
and have a sense of belonging.
d. methamphetamine exposure, prevalence, and access happening among their newfound community
and peer pressure to do the drug, using it for emotional numbing so that they can deal with
their circumstances. They discover the sexual enhancement benefit and this leads them to engage in
high risk behaviors such as URAI.
e. testing positive for HIV, describing as a sense of relief and something they are not surprised about;
there is a resignation about eventually being HIV infected.
f. willpower, coping, and a sense of hope for their future

Conclusion: Clinicians and researchers in all academic and practice settings will encounter HIV-positive
young Black men and need to understand the prevalence of HIV/AIDS among this population as well as
the importance of making a thorough sexual health and risk behavior assessment. It appears that the high
exposure, prevalence, and access of methamphetamine in San Francisco among the predominantly
White MSM population has had an impact on these young Black men.
References
Bauermeister, J., Elkington, K. Brackis-Cott, E. Dolezal, C. & Mellins, C. (2009). Sexual behavior and perceived peer
norms: Comparing perinatally HIV-infected and HIV-affected youth. Journal of Youth and Adolescence, 38, 1110-
1122. doi: 10.1007/s10964-008-9315-6. Caros, J. Binghan, T. Stueve, A, Lauby, J. Ayala, G. Millett, G. & Wheeler, D.
(2010). The role Of peer support on condom use among Black and Latino MSM in three urban areas. AIDS Education
and Prevention, 22(5), 430-444. Center for Disease Control and Prevention. (2011). Health Disparities in HIV/AIDS,
Viral Hepatitis, STDs, and TB: African Americans/Blacks HIV/AIDS. Cohall, A., Dini, S., Nye, A., Dye, B., Neu, N. &
Hyden, C. (2010). HIV testing preferences among young men of color who have sex with men. American Journal of
Public Health, 100(10), 1961-1968. Denning, P.H., Jones, J.L., and Ward, J. W. (1997). Recent trends in the HIV
epidemic in adolescent and young adult gay and bisexual men. Journal of Acquired Immune Deficiency Syndromes
and Human Retrovirology, 16, 374-379. Dodge, B., Jeffries IV, W. & Sandfort, T. (2008). Beyond the down low:
Sexual risk, protection, and disclosure among at-risk Black men who have sex with both men and women (MSMW).
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Malebranche, D., Ellen, J. & Schuster, M. (2011). HIV risk perceptions of masculinity among young Black men who
have sex with men. Journal of Adolescent Health. Griffin, J. (2005). The Building Resiliency and Vocational
Excellence (BRAVE) Program: A violence-prevention and role model program for young African American males.
Journal of Health Care for the Poor and Underserved, 16(4), 78-88. Godfrey-Smith, P. (2003). Theory and reality: an
introduction to the philosophy of science. Chicago: University of Chicago Press. Harawa, N., Greenland, S., Bingham,
T., Johnson, D., Cochran, S., Cunningham, W. . . Valleroy, L. (2004). Associations of race/ethnicity with HIV
prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United
States. Journal of Acquired Immune Deficiency Syndrome, 35(5), 526-536. Harawa, N., Williams, J., Ramamurthi, H.,
Manago, M., Avinia, S. & Jones, M. (2008). Sexual behavior, sexual identity, and substance use among low-income
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Kauffman, K. (1994). The insider/outsider dilemma:field experience of a white researcher “getting in” a poor Black
community. Nursing Research, 43(3), 179-183. Kesselring, A., Chesla, C. & Leonard, V. (2010). Why study caring
practices? In Interpretive Phenomenology in Health Care Research. G. Chan, K. Brykczynski, R. Malone & P.
Benner, Eds. Sigma Theta Tau International Press, 3-22. Leonard, V. (1989). A Heideggerian phenomenologic
perspective on the concept of the person. Advances in Nursing Science, 11(4), 40-55. Natale, A. (2008). HIV
transmission factors: Denver MSM culture and contexts. Journal of HIV/AIDS and Social Services, 7(3), 241-264.
National Institution on Drug Abuse. (2011). Research report series: Which populations are most affected? Magnus,
M., Kuo, I., Phillips II, G., Shelly, K., Rawls, A., Montanex, L. . . . Greenberg, A. (2010). Elevated HIV prevalence
despite lower rates of sexual risk behaviors among Black men in the District of Columbia who have sex with men.
AIDS Patient Care, 24(10). 615-622. Malebranche, D., Gvetadze, R., Millett, G. & Sutton, M. (2011). The relationship
between gender role conflict and condom use among Black MSM. AIDS Behavior. McKirnan, D., Vanable, P.,
Ostrow, D. & Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay
and bisexual men. Journal of Substance Abuse, 13, 137-154. Miller, M., Serner, M. & Wagner, M. (2005). Sexual
diversity among Black men who have sex with men in an inner-city community. Journal of Urban Health: Bulleting of
the New York Academy of Medicine. Mimiaga, M., Reisner, S. Cranston, K., Isenberg, D., Bright, D., Dafflin, G.,
Bland, S., Driscoll, M., VanDerwarker, R., Vega, B.& Mayer, K. (2009). Sexual mixing patterns and partner
characteristics of Black MSM in Massachusetts at increased risk for HIV infection and transmission. Journal of Urban
Health: Bulletin of the New York Academy of Medicine, doi: 10.1007/s11524-009-9363-6. Mimiaga, M., Reisner, S.,
Fontaine, Y., Bland, S. Driscoll, M., Isenberg, D., Cranston, K., Skeer, M. & Mayer, K. (2010). Walking the line:
Stimulant use during sex and HIV risk behavior among Black urban MSM. Drug and Alcohol Dependence. National
Institution on Drug Abuse. (2011). Research report series: Which populations are most affected? Peterson, J. &
Jones, K. (2009). HIV prevention for Black men who have sex with men in the United States. American Journal of
Public Health, 99(6), 976-980. Purcell, D., Parsons, J., Halkitis, P., Mizuno, Y. & Woods, W. (2001). Substance use
and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse, 13,
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Lippincott, Williams, and Wilkins. Sandfort, T. & Dodge, B. (2008). “…And then there was the down low”: Introduction
to Black and Latino Male Bisexualities. Archives of Sexual Behavior,37. 675-682. Sutton, M. & Parks, C. (2011).
HIV/AIDS prevention, faith, and spirituality among Black/African American and Latino communities in the United
States: Strengthening scientific faith-based efforts to shift the course of the epidemic and reduce HIV-related health
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Piggott, T., Bleakley, A., Birnbaum, J., Siegal, K., Lekas, H., Schrimshaw, E., Cohall, A. & Ramjohn, D. (2011). The

influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk
behavior among young Black and Latino men who have sex with men living with HIV: A qualitative study. AIDS
Patient Care and STDs, 25(2). doi: 10.1089/apc.2010.0100. Warren, J., Fernandez, M., Harper, G., Hidalgo, M.,
Jamil, O., and Torres, R. (2007). Predictors of unprotected sex among young sexually active African American,
Hispanic, and White MSM: The importance of ethnicity and culture. AIDS and Behavior, 12(3), 459-468, doi:
10.1007/s10461-007-9291-y Weidman-Hightow, L., Smith, J., Valera, E., Matthews, D. & Lyons, P. (2011). Keeping
them in “STYLE”: Finding, linking, and retaining young HIV-positive Black and Latino men who have sex with men in
care. AIDS Patient Care and STDs, 25(1), doi: 10.1089/apc.2010.0192. Whittemore, R., Chase, S. & Mandle, C.
(2001). Validity in qualitative research. Qualitative Health Research, 11(4), 522-537. Williams, J., Wyatt, G., Rivkin, I.,
Ramamurthi, H. & Liu, H. (2008). Risk reduction for HIV- positive African-American and Latino men with histories of
childhood sexual abuse. Archives of Sexual Behavior,37. 763-772. Wilton, L., Halkitis, P., English, G. & Roberson, M.
(2005). An exploratory study of barebacking, club drug use, and meanings of sex in Black and Latino gay and
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Contact
[email protected]

The Impact of Parent Reaction to Sexual Orientation on Depressive Symptoms
and Sex Risk Among Hispanic Men Who Have Sex with Men
Joseph P. De Santis, PhD, ARNP, ACRN, USA
Natalie LeBlanc, BA, MPH, BSN, USA
Diego Deleon, MD, USA
Purpose
The purpose of this presentation is to share findings from a study examining how Latino men who have
sex with men perceived their parent's acceptance of their sexual orientation, and the impact of parental
acceptance on depressive symptoms and sexual risk. We also examined acculturation as a moderator.
Target Audience
The target audience for this presentation is researchers and clinicians who have an interest in cross-
cultural health and health disparities.
Abstract
Purpose: The study aimed to examine the impact of parents’ reaction to their sons’ sexual orientation on
the son’s depressive symptoms and sexual risk behaviors among Hispanic adult men who have sex with
men (MSM). We also sought to examine whether the son’s level of acculturation would moderate the
relationship between parental reaction and the outcome variables. The study tested the following
hypotheses:
1. Lower parental acceptance will be related to depressive symptoms
2. Lower parental acceptance will be related to sexual risk behavior behaviors
3. The relationship between lower parental acceptance and depressive symptoms will be stronger
for men who are less acculturated
4. The relationship between lower parental acceptance and sexual behaviors will be stronger for
men who are less acculturated
Methods: This is a secondary analysis from a larger mixed methods study that assessed cultural
influences on risk behaviors and mental health among Hispanic MSM. The segment of the study being
reported in this presentation used a quantitative cross-sectional design. Participants for the study were
recruited from a community-based organization that provides HIV testing and counseling to MSM. After
participation in the study, men were provided business cards with study information and were encouraged
to refer other potential participants. The study was approved by the University of Miami Institutional
Review Board and participants were compensated for their time.
The sample consisted of 125 community-dwelling Hispanic MSM. Most (53%) of the men were born in
Cuba, 14% born in the U.S., 10% born in Puerto Rico, and the remainder in other Latin American nations.
Participants had a mean of 14.26 (SD = 3.20) years of education, and 58% were currently employed.
Most men identified themselves as homosexual (87%). The mean age of the participants was 43.02
years (range 21-65, SD = 10.34). Of 125, 78 (62%) said their mother (or mother-figure) and 55 (44%)
said their father (or father-figure) knew about their sexual orientation. Only those men with at least one
parent who knew about their sexual orientation contributed data for this analysis, and mother and father
reactions were analyzed separately. GZLM in SPSS 19 was used for all analyses.
Parental reaction to their son’s sexual orientation was assessed using the Perceived Parent Reaction
Scale (Willoughby, Malik, & Lindahl, 2006). This measure includes 32 items that assess an individual’s
perception of their parent’s level of general homophobia, shock, denial, anger, bargaining, depression,
and acceptance of their child’s sexual orientation. Scores range from 32 to 160 and higher scores indicate
more negative perceptions (i.e., lower acceptance), The study asked participants to report separately on

their mother and father’s current attitudes. Cronbach’s alpha for this sample were .96 for mother, and .96
for father; reactions were standardized when testing interactions.
Acculturation was assessed using the Bidimensional Acculturation Scale (Marin & Gamba, 1996). This
measure includes 24 items regarding the respondent’s English and Spanish language behaviors in the
domains of language use, language proficiency, and language use in media. Two subscales of 12 items
each assess Hispanicism and Americanism. Cronbach’s alpha for this sample were .94 for Americanism
and .83 for Hispanicism. Only acculturation to the U.S., i.e., Americanism, was used in this study;
acculturation was standardized when testing interactions.
Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale
(CES-D; Radloff, 1977). The CES-D includes 20 items that measure the frequency of depressive
symptoms. Cronbach’s alpha for this sample was .90.
Sexual risk was assessed using the Safer Sex Behavior Questionnaire (DiIorio, Parsons, Lehr, Adame, &
Carlone, 1992). The measure includes 27-items addressing condom usage, high risk sexual behaviors,
and sexual communication and negotiation. Lower scores indicate higher sexual risk. Cronbach’s alpha
for this sample was .82.
Results: Lower acceptance from mother, B = 3.61, SE = 1.68, p = .032, and from father, B = 5.35, SE =
1.88, p = .004, were related to higher depressive symptoms. Mother and father reaction were not directly
related to sexual risk. There was no significant interaction between mother or father reaction and
acculturation to the U.S. with respect to depression. There was a significant interaction between mother
reaction and acculturation to the U.S. with safer sex behaviors, B = -2.64, SE = 1.27, p= .037.
Acculturation to the U.S. was directly linked to lower sexual risk behavior, but lower acceptance from the
mother tempered the protective effects of acculturation. There was no significant father reaction x
acculturation interaction with safer sex behaviors.
Conclusion: This study demonstrates the importance of parental acceptance for the mental health of
Latino MSM. Men who perceived that their mother or father currently held a negative attitude towards
their sexual orientation experienced more depressive symptoms. Men who were less acculturated and
who perceived their mothers as non-accepting of their sexual orientation were also more likely to engage
in riskier sexual behaviors. This study suggests the need for family-based interventions to improve
relationships among Latino MSM and their parents. It is noteworthy that parental reactions were influential
in this sample of grown men, whose average age was in their 40’s, suggesting that family acceptance is
important well into adulthood.
References
Dilorio, C., Parsons, M., Lehr, S., Adame, D., & Carlone, J. (1992). Measurement of safe sex behavior in adolescents
and young adults. Nursing Research. 41(4), 203-208. Marin, G., & Gamba, R. J. (1996). A new measurement of
acculturation for Hispanics: The bideimensional acculturation scale for hispanics (BAS). Hispanic Journal of
Behavioral Sciences, 18(297), 297-316. doi:10.1177/07399863960183002 Raldoff, L. S. (1977). The CES-D Scale: A
self-report depression scale for Research in the General Population. Applied Psychological Measurement, 1(385),
386-401. doi:10.1177/014662167700100306 Willoughby, B. L. B., Malik, N. M., & Lindahl, K. M. (2006). Parental
reactions to their sons’ sexual orientation disclosures: The roles of family cohesion, adaptability, and parenting style.
Psychology of Men and Masculinity, 7(1), 14–26. doi: 10.1037/1524-9220.7.1.14
Contact
[email protected]

The Identification of Stimulant Misuse
Wanda L. Hilliard, MBA, MSN, APRN, PMHNP-BC, USA
Jayne Perkins, MSN, APRN, CNS, GNP, USA
Purpose
to educate healthcare professionals on the prevalence of stimulant misuse. Stimulants play an important
role in the treatment of attention deficit hyperactivity disorders, but they are a highly misused class of
medications. It is imperative to understand the misuse potential of stimulants, and risk reduction
techniques and clinical implications.
Target Audience
Healthcare professionals working in a clinical setting, as well as administrators and educators responsible
for oversight.
Abstract
Purpose: Stimulants play an important role in the treatment of attention deficit hyperactivity disorders, as
well as other psychiatric conditions. It is well known that stimulants are highly misused due to their
mechanism of action in today's society. The pharmacokinetics, biochemical structure and physiological
effects all contribute to the misuse of stimulants. It is imperative for prescribers and clinicians to
understand the misuse potential of this class of medications.
Methods: A literature search and case studies are presented demonstrating the misuse potential, along
with a review of the clinical implications and strategies for risk reduction.
Results: We conclude stimulants are one of the most abused class of prescription medications worldwide
due to the mechanism of action.
Conclusion: Healthcare professionals and clinicals must implement strategies to identify and reduce
stimulant misuse, as well as understanding the clinical implementatons in these patients.
References
Burgess, S.G., P, Harris M, Malhi GS, Whiteford H, Hall W. (2012). Stimulant use disorders: characteristics and
comorbidity in an Australian population sample, Aust N Z J Psychiatry, 46(12):1173-81. doi:
10.1177/0004867412461057 Hartzler, B., Donovan, D., & Huang, Z. (2011). Rates and Influences of Alcohol Use
Disorder Comorbidity among Primary Stimulant Misusing Treatment-Seekers: Meta-analytic Findings Across Eight
NIDA CTN Trials. American Journal Of Drug & Alcohol Abuse, 37(5), 460-471. McCarthy M. (2007). Prescription drug
use up sharply in the USA. Lancet, 369: 1505–6 Michael G. McDonell, Ph.D.; Debra Srebnik, Ph.D.; Frank Angelo,
M.A.; Sterling McPherson, Ph.D.; Jessica M. Lowe, B.A.; Andrea Sugar, B.A.; Robert A. Short, Ph.D.; John M. Roll,
Ph.D.; Richard K. Ries, M.D. (2013). Randomized Controlled Trial of Contingency Management for Stimulant Use in
Community Mental Health Patients With Serious Mental Illness, Am J Psychiatry, 170:94-101.
doi:10.1176/appi.ajp.2012.11121831 Smout, M., Longo, M., Harrison, S., Minniti, R., Cahill, S., Wickes, W., & White,
J. (2010). The Psychostimulant Check-Up: A pilot study of a brief intervention to reduce illicit stimulant use. Drug &
Alcohol Review, 29(2), 169-176. doi:10.1111/j.1465-3362.2009.00133.x Wilens, T., Faraone, S., Biederman, J., &
Gunawardene, S. (2003). Does stimulant therapy for attention-deficit/hyperactivity disorder beget later substance
abuse? A meta-analytic review of the literature. Pediatrics, 111(1), 179-185. Wu, L., Blazer, D., Patkar, A., Stitzer, M.,
Wakim, P., & Brooner, R. (2009). Heterogeneity of stimulant dependence: a national drug abuse treatment clinical
trials network study. American Journal on Addictions, 18(3), 206-218. doi:10.1080/10550490902787031
Contact
[email protected]

A Study of Service Quality Perception for Blood Donors
Shu-Chen Yang, MSN, RN, Taiwan
Shu-Wen Chen, PhD, RN, Taiwan
Chin-Ching Yu, PhD,RN, Taiwan
Purpose
The purpose of this study was to evaluate blood donors’ satisfaction of service quality in a blood donation
center.
Target Audience
Abstract
Purpose: The purpose of this study was to evaluate blood donors’ satisfaction of service quality in a
blood donation center.
Methods: A total of 423 blood donors were randomly selected from the database of a blood center in
Taichung, Taiwan, with a final sample of 407 participated in this cross-sectional study. Data was collected
by a 31-item Blood Donor Satisfaction Scale (BDSS), measuring five dimensions: tangible, reliability,
convenience, responsiveness and benefit, on a 5-point Likert scale ranging from very dissatisfactory
(score= 1) to very satisfactory (score= 5). Participants were aged between 17-61 years old (35±12), and
55% of them were male.Descriptive statistics, independent t tests and one-way ANOVA were done to
analyse the influence of age groups and gender on satisfaction of service quality.
Results: The mean score of BDSS was 127±14 (ranged155-86). Blood donors scored high in the
dimensions of tangible, reliability and responsiveness. The dimensions of convenience and benefit gained
lower scores compared to other dimensions. Age and gender of blood donors were not related to the
satisfaction of service quality.
Conclusion: Related policies should be enacted in response to catch up on what blood donors have
expected.
Contact
[email protected]

The Incidence and Severity of Musculoskeletal Disorders Among Nurses Working
in Taiwan Medical Center
Shu-Hung Lee, RN, MSN, Taiwan
Shu-Yuan Lin, RN, PhD, Taiwan
Purpose
The purpose of this study is to investigate the incidence and severity of musculoskeletal disorders (MSDs)
among medical center nurses.
Target Audience
Nurses whom are interesting to understand about musculoskeletal disorders and nurses' work
environment.
Abstract
Purpose: The purpose of this study is to investigate the incidence and severity of musculoskeletal
disorders (MSDs) among medical center nurses.
Methods: This study used a cross-sectional descriptive design with the purposive sampling method.
Between April 2013 and May 2013, structure questionnaires were used to survey nurses employed in the
medical centers of southern Taiwan. A total of 992 questionnaires were distributed to all of the medical
center nurses, and 906 questionnaires were returned. A response rate was 91.3.0%. Excluding the
incomplete questionnaires, data of 741 valid questionnaires was analyzed. Descriptive and inferential
statistics such as t tests, ANOVA and Post hoc Scheffe tests were performed by using SPSS version 17.
Results: The incidence of MSDs was 86.5% in the medical centers nurses, and 65.8% reported
moderate to severe degree of MSDs. The most frequently reported injuries in body were low back
(52.0%), shoulder (41.8%), and neck (38.1%). Significant differences were found between age, years of
nursing practice, years of employment, past disease history, designation, department and the severity of
MSDs. The most frequently reported protective materials is compression
socks(73.9%),backrest(45.6%)and corset belt(36.8%)
Conclusion: The MSDs is highly prevalent and the severity has an impact on nurses’ work and daily life.
The MSDs become more severe as a result of an increase of age, years of nursing practice, and years of
employment. We suggest nursing managers to schedule appropriate breaks during the work hours, buy
protective devices, arrange continue education about the prevention of MSDs
References
1.Hayes M, Cockrell D, Smith DR: A systematic review of musculoskeletal disorders among dental professionals. Int
J Dent Hyg 2009; 7:159-65. 2.Adegoke BO, Akodu AK, Oyeyemi AL: Work-related musculoskeletal disorders among
Nigerian physiotherapists. BMC Musculoskeletal Disorders 2008; 9:1-9. 3.West DJ, Gardner D: Occupational injuries
of physiotherapists in north and central Queensland. Aust J Physiother 2001; 47:179-86. 4.Harcombe H, McBride D,
Derrett S, et al: Prevalence and impact of musculoskeletal disorders in New Zealand nurses, postal workers and
office workers. Aust N Z J Public Health 2009; 33:437-41. 5.Choobineh A, Movahed M, Tabatabaie S H., et al:
Perceived demands and musculoskeletal disorders in operating room nurses of shiraz city hospitals. Ind Health 2010;
48:74-84. 6.Timmons L: Creating a no-lift, no-transfer environment in the OR. AORN J 2009; 89:733-76. 7.Meijsen P,
Knibbe H J J: Work-related musculoskeletal disorders of perioperative personnel in the Netherlands. AORN J 2007;
86:193-208. 8.Ogg M J: Introduction to the safe patient handling and movement series. AORN J 2011; 93:331-3.
9.Hou JY, Shiao SC: Risk factors for musculoskeletal discomfort in nurses. J Nurs Res 2006; 14:228-36.
10.Sheikhzadeh A, Gore C, Zuckerman JD, et al: Perioperating nurses and technicians' perceptions of ergonomic risk
factors in the surgical environment. Appl Ergon 2009; 40:833-9. 11.Tinubu BM, Mbada CE, Oyeyemi AL, et al: Work-
related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: A cross-sectional survey. BMC
Musculoskelet Disord 2010; 11:12. 12.Buerhaus PI, DesRoches C, Donelan K,et al: Still making progress to improve
the hospital workplace environment? Results from the 2008 National Survey of Registered Nurses. Nurs Econ 2009;
27:289-301. 13.McLean SM, May S, Klaber-Moffett J, et al: Risk factors for the onset of non-specific neck pain: A
systematic review. J Epidemiol Community Health 2010; 64:565-72. 14.Caruso CC, Waters TR: A review of work

schedule issues and musculoskeletal disorders with an emphasis on the healthcare sector. Ind health 2008; 46:524-
34. 15.Trinkoff A, Le R, Geiger-Brown J, et al: Longitudinal relationship of work hours, mandatory overtime, and on-
call to musculoskeletal problems in nurses. Am J Ind Med 2006; 49: 964-71.
Contact
[email protected]

Development and Evaluation of the Simulation Learning Effectiveness Inventory
Shiah-Lian Chen, PhD, RN, Taiwan
Tsai-Wei Huang, PhD, RN, Taiwan
I-Chen Liao, MSN, RN, Taiwan
Purpose
The purpose of this presentation is to present a reliable and valid instrument to measure simulation
learning effectiveness.
Target Audience
The target audience of this presentation is those educators or researchers who are interesting in using
patient simulation in their practice.
Abstract
Purpose: High fidelity simulators help nursing students learn complex patient care. Yet, reliable
instruments measuring learning outcomes are scant. The purpose of the study was to develop and
evaluate psychometric properties of the Simulation Learning Effectiveness Inventory.
Methods: A cross-sectional survey was conducted. A purposive sample of 505 nursing students who had
taken a simulation course was recruited from department of nursing of a university in central Taiwan. The
study was conducted in two phases. In Phase I, question items were developed and the preliminary
psychometric properties of the inventory were evaluated using exploratory factor analysis. Phase II was
conducted to evaluate the reliability and validity of the finalized inventory using confirmatory factor
analysis.
Results: The results of both exploratory factor analysis and confirmatory factor analysis showed that the
instrument contained seven factors, named course content, resource, clinical ability, debriefing, deep
approach, confidence, and collaboration. In the exploratory factor analysis, the seven-factor solution with
34 items explained 71.25% of the total variance. However, two items were deleted because of fitting
poorly to the data in confirmatory factor analysis. A further second-order analysis showed comparable fits
(preparation, process, and outcome) between a three second-order factor and the seven first-order
factors. Internal consistency was adequate with a Cronbach alpha ranging 0.82-0.91 and composite
reliability ranging 0.80-0.91. Convergent and discriminant validities were also supported by confirmatory
factor analysis.
Conclusion: Simulation teaching is more helpful than traditional teaching methods in developing higher
level practicing skills. The Simulation Learning Effectiveness Inventory is a reliable and valid instrument.
The instrument is helpful in building the evidence-based knowledge of the effect of simulation teaching on
students’ learning outcomes.
References
Issenberg, S. Barry, McGaghie, William C., Petrusa, Emil R., Gordon, David Lee, & Scalese, Ross J. (2005).
Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.
Medical Teacher, 27(1), 10 - 28. Jeffries, P. R. . (2005). A framework for designing, implementing, and evaluating
simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96.
Contact
[email protected]

Relation of Perception of Career Ladder System, Job Satisfaction, Intention to
Leave Among Perioperative Nurses
Sena Chae, BA, South Korea
Purpose
This study is the descriptive correlation study to provide the useful data for establishing strategies to
improve career ladder system.
Target Audience
perioperative nurses, nurse administrator and clinical nurses.
Abstract
Purpose: This study is the descriptive correlation study to provide the useful data for establishing
strategies to improve career ladder system.
Methods: The subjects of the study are 154 of perioperative nurses of a general hospital in Seoul. The
data were collected from April 16th to April 22th, 2013. The structured questionnaire used for this study
included, ‘the perception measurement tool of the career ladder system’ developed by Park Gwangok and
Lee Yoonyoung (2010) ‘the job satisfaction measurement tool for perioperative nurses’ developed by
Yoon Gyesook and Park Seongae (2009) and ‘the intention to leave scale developed by Lawler(1983),
and modified by Park Hyunsook (2002). The data were analyzed using frequency, average, t-test, one-
way ANOVA, Scheffé test , Pearson's correlation Coefficient and stepwise regression analysis with the
SPSS WIN 15.0 program.
Results: 1. The average mean score for perception of career ladder system is mid-line at 2.69 point out
of 4 points. The subject with higher more age (r=0.164, p<.01), higher personal growth need (r=0.164,
p<.01) had higher scores for perception of career ladder system. And specialist 2 nurse has higher scores
for perception of career ladder system than new nurse, general nurse and specialist 1 nurse (F=5.04, p=
０.002).
2. The average mean score for is slightly high at 3.40 point out of 5 points. The subject with higher more
age(r=.288, p<.001) and the longer total employment history of operation room(r=.230, p<.001) has
higher scores for job satisfaction. Also, The subject with the longer total employment history of current
surgery department(r=.220, p<.001) has higher scores for job satisfaction. had higher scores for stronger
personal growth need has higher scores for job satisfaction(r=.318, p<0.001). The married subject has
more job satisfaction than the single subject(F=4.169, p<.05). Furthermore, charge nurse has more job
satisfaction than general nurse(F=5.569, p<0.05). And fixed-worker has more job satisfaction than shift
worker (F=5.656, p<0.05). Specialist 2 nurse has higher job satisfaction than new nurse, general nurse
and specialist 1 nurse (F=3.443,p=０.018).
3. The average mean score for intention to leave is slightly high at 3.78 point out of 5 points has. The
subject with higher age(r=.194, p<.01), the longer total employment history of operation room(r=.336,
p<.001), and the longer total employment history of current surgery department(r=.343, p<.001) has
higher scores for intention to leave. However, the subject with stronger personal growth need has lower
scores for intention to leave(r=-.308, p<.001). The nurses who have no experience of job transfer
between different surgical fields in the operating room (F=15.26, p<.001) has less intention to leave. Also,
type 1 that one nurse is in charge of one operating room has lower scores for intention to leave. Specialist
2 nurse has higher scores for intention to leave than the others. On the other hand, new nurse has lower
scores for intention to leave than the others (F=8.513, p=０.000).
4. The subject with higher scores for perception of career ladder system has higher scores for job
satisfaction (r=0.384, p<.01), and lower scores for intention to leave(r=-0.875, p<.01). Finally, the subject
with higher scores for job satisfaction has lower scores for intention to leave (r=-0.251, p<.01).

5. The factors affecting the job satisfaction of the subjects are the perception of career ladder
system, total employment history of operation room and personal growth need, the move-up experience
to a higher level which is the subcategory of perception of career ladder system which explained 30.9 %
of the variance in job satisfaction. The factors affecting the intention to leave of the subjects are, the
expected effect which is also subcategory of perception of career ladder system, the number of overtime
work for the last six months, personal growth need and total employment history of operation room which
explained 26.1% of the variance in intention to leave.
Conclusion: In conclusion, the perception of career ladder system of perioperative nurses is mid-line.
The higher perception of career ladder system is related to the higher job satisfactions, the higher
expected effect on career ladder system of the subjects is related to the lower intention to
leave. Specialist 2 nurse has higher scores for perception of career ladder system than new nurse,
general nurse and specialist 1 nurse's perception of career ladder system. Specialist 2 nurse also has
higher scores for job satisfaction than the others, however, the intention to leave of specialist 2 nurse is
the highest than the others.
Therefore, it is needed to enhance the perception of career ladder system and to establish a plan how to
fulfill the expected effect of career ladder system for improving a perioperative nurse's job satisfaction and
reducing an intention to leave. Moreover, it is needad to establishing continuous strategies to reduce
specialist 2 nurse's intention to leave.
References
Allen. S. R. & Fiorini. P., Dickey. M. (2010). A streamlined clinical advancement program improves RN participation
and retention. JONA, 40(7-8), 316-322 Bjork, I. T., Hansen, B. S., Samdal, G. B., Torstad, S. & Hamiton, G. A.
(2007). Evaluation of clinical ladder participation in Norway. Journal of Nursing Scholarsh, 39(1), 88-94. and so on.
Contact
[email protected]

A Concept Analysis of Self-Management Behavior and its Implications in
Research and Policy
Amanda Constance Green, MSN, RN, PHCNS-BC, USA
Purpose
The purpose of the poster presentation is to disseminate innovative insights from this analysis of self-
management behaviors in acute or chronic disease. Self-management behaviors have specific attributes
from the literature that are necessary for improved management of disease, yet are not commonly
incorporated into measurement tools or interventions.
Target Audience
researchers, clinicians, politicians and leaders in the nursing profession. Disseminating the research gap
related to self-management behaviors will assist researchers, clinicians and leaders create policies and
interventions that are inclusive of all the essential aspects of self-management that stem from this
analysis.
Abstract
Purpose: The concept of self-management behavior (SMB) has been used extensively by professionals
from multiple disciplines. Nursing scholars often use the concept with chronic illness and international
health organizations, such as the World Health Organization, use the concept for disease
management. The purpose of this concept analysis was to create a clarifying theoretical definition of self-
management behavior.
Methods: The analysis was conducted conceptually in the context of Orem’s Self-care Framework.
Walker and Avant’s eight-step concept analysis approach guided the analysis. A systematic review of the
literature was conducted using seven relevant academic databases, including the Cumulative Index to
Nursing and Allied Health Literature (CIHAHL), Cochrane Database of Systematic Reviews, Cochrane
Central Register of Controlled Trials, the U.S. National Library of Medicine’s MEDLINE, American
Psychological Association’s PsycARTICLES and PsycINFO, and the Sociology Research Database
SocINDEX. The search term used was “self-management behavior” and articles were limited to those
published between April 2001 and 2013. Inclusion and exclusion criteria were stated. Attributes,
antecedents and consequences were extracted to support the creation of theoretical and operational
definitions.
Results: Eight dictionary definitions and 174 scholarly articles were reviewed. Sixteen percent of studies
(n= 28) had a theoretical context and only seven (4.0%) included a definition of SMBs. Attributes,
antecedents and consequences were identified. The newly constructed theoretical definition of self-
management behaviors is: these behaviors are proactive actions related to lifestyle, a problem, planning,
collaborating, and mental support, as well as reactive actions related to a circumstantial change, to
achieve a goal. Physical, psychological, socioeconomic and cultural characteristics, specifically
responsibility, as well as collaborative and received support, predict the type of SMBs. The results of
SMBs are control over a problem and progress toward a goal, as well as individual and societal benefits.
A model case will be presented to illustrate the constructed definition.
Conclusion: This theoretical definition of self-management behavior has potential to facilitate
interprofessional and global collaboration in future research and clinical and public health practice.
Contact
[email protected]

Preoperative Education and Its Associated Factors Among the Patients with Total
Knee Arthroplasty
Yun-Yi Huang, NP, Taiwan
Purpose
The purpose of this study for discussion about preoperative education and its associated factors among
the patients with total knee arthroplasty.
Target Audience
The patients who accept the total knee arthroplasty and lets them understanding that the effect well
besides the surgical technique. A suitable preoperative education that can shorten hospital days,
increased post-operative physiological functions, reducing patient anxiety, reduce postoperative pain and
increase patient satisfaction
Abstract
Purpose: The purpose of this study for discussion about preoperative education and its associated
factors among the patients with total knee arthroplasty.
Methods: A descriptive and comparative study, purposive sampling, the sample source from a medical
center in the middle area of Taiwan was prepared to accept total knee arthroplasty(N=60) which divided
into two groups :the control group(n=30) and experimental group(n=30). The research data collection
processes is that in the case of out-patient admission and 24-48 hours before surgery to an interview that
to explain the purpose of study and research process and later to obtain the consent of the subjects filled
out consent under the case agreed to join the study and at the same time, filled out the basic information
on the activities of the functional assessment form, SF - 36 health survey scale. The experimental group
receive health education at the same time. Experimental group and control group complete the functional
activities of scale on the seventh and the thirtieth day after the operation.
Results: Pre-operative education associated with the case get out of bed on the first time, seventh and
thirtieth day following the function of functional assessment scales which the average total score on the
seventh day and the thirtieth day following knee activity, the experimental and control groups showed
significant differences ( t = .00, .022, .012, .042, .00, p <.05). Get out of bed on the first time was that
experimental group was shorter than the control group is 1.17. The physical features of the activities of
the experimental group than the control group scored was high. The total score of SF-36 and functional
scale and self-efficacy was that seventh and thirtieth day following the activity of the knee, showing a
positive correlation (γ =. 635, .041, .0514, p < .05)
Conclusion: The results of this study for pre-operative education and the days in the hospital was no
significant difference but the experimental group shorter than control group was 0.2 days. Pre-operative
education and functional activity was a positive correlation, which is pre-operative education will help
patients in the post-operative function of promotion activities. Self-efficacy and SF-36 showed a positive
correlation function.
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L.(1998). The effect of pre-operative information, and post-operative anxiety, satisfaction with information, and
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Contact
[email protected]

Factors Contributing to Malnutrition in Patients with Gynecologic Cancer Patients
JuHee Nho, PhD, South Korea
Sung Reul Kim, PhD, South Korea
Purpose
The purpose of this study was to evaluate the nutritional status and to identify clinical, psychosocial, and
nutritional factors contributing to malnutrition in Korean gynecologic cancer patients.
Target Audience
The target audience of this presentation is nurses of oncology, gynecology.
Abstract
Purpose: 40-80% of cancer patients had nutritional disorder. Patients with gynecological cancer who is
recognized as a major health problem, but the incidence of malnutrition and related factors about the
results are reported to be varied. Malnutrition appears differently depending on the treatment period,
psychological factors such as depression affect malnutrition. It is important nursing actions that nurses
understand the nutritional status of the subjects and identify the relevant factors. The purpose of this
study was to evaluate the nutritional status and to identify clinical, psychosocial, and nutritional factors
contributing to malnutrition in Korean gynecologic cancer patients.
Methods: There were 129 gynecologic cancer patients in Ulsan in Korea between June and October
2013. These patients completed a PG-SGA (Patient-Generated Subjective Global Assessment), SNAQ
(Simplified Nutritional Appetite Questionnaire), BDI (Beck Depression Inventory).
Results: 69 (53.5%) of 129 patients were reported malnutrition. Depression of malnutrition patients was
higher in non-malnutrition patients (t=-3.893, p<.001). Nutritional status was correlated depression(r=.353,
p<.01), appetite(r=-.530, p<.01), BMI(r=-.231, p<.01). In multiple logistic regression analysis, depression
(OR=1.111, 95% CI: 1.047-1.179, p=.001), appetite (OR=0.714, 95% CI: 0.600-0.850, p<.001) were
significant factors predicting malnutrition in patients with gynecologic cancer.
Conclusion: Nurses can improve nutritional status of gynecologic cancer patients through reformation of
depression, appetite. This allows the subject’s quality of life may be improved.
References
Green SM & Watson R. (2005) Nutritional screening and assessment tools for use by nurse: literature review. Journal
of Advanced Nursing ,50, 69–83. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G & Obermair A. (2007). Malnutrition
among gynaecological cancer patients. European Journal of Clinical Nutrition , 61, 642–646. Mendonsa RD, Appaya
P. (2010). Psychiatric morbidity in outpatients of gynecological oncology clinic in a tertiary care hospital. Indian J
Psychiatry. 52(4):327-32. Suzuki N, Ninomiya M, Maruta S, Hosonuma S, Nishigaya Y, Kobayashi Y, Kiguchi K,
Ishizuka B. Psychological characteristics of Japanese gynecologic cancer patients after learning the diagnosis
according to the hospital anxiety and depression scale. J Obstet Gynaecol Res. 37(7), 800-8.
Contact
[email protected]

Diet, Encoded Memory, Visual Cues, Obesity, and Neuroimaging: The Role of
JoAnn D. Long, RN, PhD, NEA-BC, USA
Sara L. Dodd, PhD, USA
Martin Binks, PhD, USA
Ngozi Anyanwu, RN, USA
Toby Rogers, PhD, MPT, USA
Carol Boswell, EdD, RN, CNE, ANEF, USA
Purpose
The purpose of this presentation is for nurse educators/researchers to discuss the use of neuroimaging in
understanding the role of diet, encoded memory, visual cues and obesity.
Target Audience
The target audience for this presentation is for nurse educators/researchers to discuss the use of
neuroimaging in understanding the role of diet, encoded memory, visual cues and obesity.
Abstract
Purpose: According to the World Health Organization, 35.8 million people are obese Worldwide. The
obesogenic factors contributing to this global problem are thought to reflect a complex interrelationship
between social, physiological, and environmental factors. Behaviorally focused interventions focused on
healthy eating, portion size, and public health strategies to increase fruit and vegetable intake have
reported modest success in addressing the obesity epidemic. Appreciating how individuals differ in
response to environmental eating conditions remains enigmatic. Recent advances in neuroimaging have
opened the possibility of a new frontier by understanding the neural responses to food intake, visual cues,
and affective response to encoded memory of diet. The purpose of this study is to provide a review of the
emerging scientific literature on the use of neuroimaging to shed light on diet, encoded memory, visual
cues, and obesity through fMRI studies and the application of these emerging applications to nursing
science.
Methods: A comprehensive literature search using peer-reviewed research articles. PubMed and
CINHAL databases were searched using two sets of search terms “diet,” and “memory,” and “fMRI” and
“diet” and “memory,” and “visual cues.” Inclusion criteria include studies using human subjects. Studies
focused solely on disease processes were eliminated. The research questions were: 1) what is the state
of the science reporting fMRI to illuminate understanding on the role of diet, memory, and visual cues on
food choices? 2) How does the neuroimaging literature inform nursing research concerning obesity
prevention?
Results: Twenty-two articles were located. Eleven met the inclusion criteria and ranged in publication
date from 1994 – 2013. Each of the articles were published in a different journal and no articles were
published in the nursing research. Only one article referenced obesity in the title; however,
neuroimaging use is increasing in obesity research.
Conclusion: The body of knowledge being generated through use of fMRI to understand diet, memory,
and visual cues on food choices is growing. Advances in fMRI holds promise for greater understanding of
how individuals differ in neural response to complex eating behaviors. Nursing scientists working in
obesity prevention should consider the emerging findings from neuroimaging studies and further study is
merited.
Contact
[email protected]

Intention of Regular Exercise Among Pregnant Women: Theory of Planned
Behavior
Ching-Fang Lee, EdD, Taiwan
I-Chyun Chiang, PhD, Taiwan
Fan-Hao Chou, RN, PhD, Taiwan
Purpose
The purpose of this presentation was to explore the regular exercise behavioral intention on Theory of
Planned Behavior (TPB) among pregnancy women.
Target Audience
The target audience of this presentation is all nurses in attendance.
Abstract
Purpose: The purpose of this study was to explore the regular exercise behavioral intention on Theory of
Planned Behavior (TPB) among pregnancy women and evaluated the model goodness of fit.
Methods: Using purposive sampling, the researchers invited pregnant women from the obstetrics
outpatient clinics of three medical centers in northern Taiwan to participate. The 621 participants had an
average age of 31.76, were in at least their 12thweek of gestation and were not experiencing any
problems with their pregnancy. The self- administered questionnaire asked about participants’ age,
education, job, family, knowledge pertaining to exercise during pregnancy, and attitude toward regular
exercise during their own pregnancy. The data was analyzed using SPSS 14.0 software and LISREL 8.72
software.
Results:
1. The model of intention to regularly exercise (AB) which we derived from our data was found to fit
the Theory of Planned Intention (TBI) (GFI=0.90, AGFI=0.88, RMSEA=0.062, SRMR=0.074,
NFI=0.96, NNFI=0.97, CFI=0.98, PNFI=0.84,(χ2/df)=3.4).
2. Participants’ perceived behavioral control (PBC) significantly influenced AB and explained 57% of
the variance in regular exercise intention among pregnant women. The major influencing factor
was PBC (β=0.68, p<0.01).
3. AB had a significant influence on participants’ behavioral beliefs multiplied by evaluations of
outcomes (γ=0.58, p<0.01). PBC had a significant influence on participants’ behavioral beliefs
multiplied by their own perceived power (γ=0.35, p<0.01).
4. There was a significantly positive relationship between and among participants’ AB and PBC.
Conclusion: It was also concluded that doctors and nurses should encourage pregnant women to
exercise regularly.
Contact
[email protected]

Forewarned is Forearmed: Preparing Nursing Students for Workplace Adversity
Julie Hanson, RN, BN, GradCertAdvPrac, Australia
Purpose
The purpose of this presentation is to show how stories of adversity, originating in the life-world of nursing
students, can be used to teach future generations of nurses not to dwell on ritualistic and exclusionary
workplace practices but be empowered by critical thinking skills to forge connections with professional
colleagues.
Target Audience
The target audience of this presentation is educators and clinical stakeholders worldwide who are
concerned with reports of increasing violence within the profession and related attrition rates, particularly
of nursing students, which are contributing to ongoing workforce shortages
Abstract
Purpose: The poster presentation reports on an education-focused research project that is underway to
explore contradictions in the way in which adversity is understood and responded to and the contribution
the curriculum is (and is not) making in one university in Australia. The project is divided into 3 stages:
exploratory interviews with nursing students identifying critical events that have occurred in the
workplace; the generation of learning materials that will assist educators, clinicians and students to
explore these critical incidents in new ways, so that new insights may emerge, and then designing
strategies to advance the prerequisite knowledge and skills that will prepare nursing students to think
critically about their practice and remain resilient in the face of adversity. Whilst the academics designing
curricula understand the mandate to provide the healthcare industry with ‘work-ready’ graduates to meet
the increasingly complex care needs of clients (Wolff, Pesut, & Regan, 2010), they experience the
common challenges of sequencing courses for delivery in nursing programs and of ever having the right
level of prerequisite knowledge in the curriculum to develop students’ hands-on skills in addition to
leadership and team work qualities. The purpose of the research is to address the pressing concern of
how nursing students can to be prepared for workplace hardships of staff shortages and the emotional
exhaustion related to bullying because in the international literature, experiences such as these are
reported as having a significant impact on nursing retention and workforce stability worldwide
(Laschinger, Wong, & Grau, 2012). For over a decade dissatisfaction, oppression and violence have been
prominent themes within the nursing literature affecting nurses and are attributed to a variety of reasons.
Dissonance between ‘learned’ professional values and ‘experienced’ bureaucratic workplace values has
been offered as one explanation (Kramer, 1970), along with marginalisation and lack of professional
autonomy (Roberts, 1983), and increasing nurse-nurse workplace bullying (Croft & Cash, 2012), hostility
(Hutchinson & Jackson, 2013) and incivility (Leiter, Price, & Laschinger 2010). One argument is that
these phenomena are culturally derived because the cycle of interpersonal conflict that occurs within
healthcare bureaucracies all over the world is accepted or at least not resisted in part because
hegemonic forces convince nurses that working under these conditions is normal in health services
(Austin, 2007). It is troubling that nursing students are entering a health care culture characterised by top-
down leadership, cliques and increasing violence that is often unquestioned and are in danger of
succumbing to the deleterious effects of these cultural norms and this research has been undertaken to
search for solutions to a critical workforce issue.
Methods: Critical Social Theory underpins the exploration of adversity and the contribution of the
curriculum to preparedness. Critical Incident Technique is used in individual guided interviews to elicit
descriptions of meaningful events, progressing to individual interviews using original student narratives of
adversity to uncover the educative potential of the stories from the student’s perspective, and concluding
with validation of the findings in a final focus group interview. The value of critical analysis lies in its ability
to interrogate critical moments, tensions and turning points in the discourses of the nursing students’ life-
world. The narratives of the nursing students make their ordeals accessible and memorable to others
revealing the subjective realities of the nursing world to learn from and prepare for.

Results: Early findings from this project identify discursive practices that support the status quo of
hostility, isolation and alienation as part of nursing culture and so it is proposed that, although the stories
that nursing students tell are painful to hear, such critically meaningful events that individuals and groups
experience can become a trigger for deep learning. A practice framework for the 21st Century nurse is
offered that extends from the ‘doing’ and ‘being’ of nursing to incorporate high level critical thinking in
‘realising’ what happens in the real-world of nursing, to ‘critiquing’ the foundations of routinised practices.
Thus, it is not the objective for educators to protect students from these experiences, but rather to foster
skills in realising the existence of hostile cultural practices in nursing, and critically analysing them to
arrive at new understandings of themselves and their discipline. Such an understanding would better
equip students to become agents for change in their chosen profession.
Conclusion: It is interesting is that nursing students have been identified as particularly vulnerable
targets of hostile practices (Jackson, Hutchinson, Everett, Mannix, Peters, & Weaver, 2011), but in the
emergent literature internationally there is evidence that they are resisting and challenging the status quo
(Curtis, Bowen, & Reid 2007; Pearcey & Draper, 2008; Jackson et al., 2011). Subverting cultural norms in
this way is significant because students are potential agents of change, having yet to be socialised to
accept the practices and internalise them. This poster discusses early research findings, presenting one
story of adversity as an example of the potential benefits of using narrative pedagogy for educators,
clinicians and students to critique the culture of nursing. The educative potential of stories originating in
the lived experiences of nursing students is to raise awareness of how nurses can unconsciously become
a part of a hegemonic force and empower them with skills to notice, resist or negotiate culturally derived
injustice and inequality.
References
Austin, W. (2007). The McDonaldization of nursing? Health: An Interdisciplinary Journal for the Social Study of
Health, Illness and Medicine. Los Angeles: SAGE Publishing. Croft, R.K., & Cash, P.A. (2012). Deconstructing
contributing factors to bullying and lateral violence in nursing using a postcolonial feminist lens. Contemporary Nurse,
42(2), 226-242. Curtis, J., Bowen, I., & Reid, A. (2007). You have no credibility: Nursing students’ experiences of
horizontal violence. Nurse Education in Practice, 7(3),156-163. Hutchinson, M., & Jackson, D. (2013). Hostile
clinician behaviours in the nursing work environment and implications for patient care: a mixed-methods systematic
review. BMC Nursing, 12 (25), 1-12. Retrieved October 8, 2013 from http://www.biomedcentral.com/1472-
6955/12/25. Jackson, D., Hutchinson, M., Everett, B., Mannix, J., Peters, K., Weaver, R., & Salamonson, Y. (2011).
Struggling for legitimacy: nursing students’ stories of organisational aggression, resilience and resistance. Nursing
Inquiry, 18 (2), 102-110. Kramer, M. (1970). Role Conceptions of Baccalaureate Nurses and success in hospital
nursing. Nursing Research, 19 (5), 428-439. Laschinger, H.K.S., Wong, C.A., & Grau, A.L. (2012). The influence of
authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes:
A cross-sectional study. International Journal of Nursing Studies, 49(10), 1266-1276. Pearcey, P., & Draper, P.
(2008). Exploring clinical nursing experiences: Listening to student nurses. Nurse Education Today, 28 (5), 595-601.
Roberts, S.J. (1983). Oppressed group behaviour: implications for nursing. Advances in Nursing Science, 5 (4), 21-
30. Wolff, A.C., Pesut, B., & Regan, S. (2010). New graduate nurse practice readiness: Perspectives on the context
shaping our understanding and expectations. Nurse Education Today, 30 (2), 187-191.
Contact
[email protected]

Development of a New Growth and Development Sectors for the Family System
Unit
Junko Honda, PhD, RN, PHN, Japan
Naohiro Hohashi, PhD, RN, PHN, LSN, Japan
Purpose
The purpose of this presentation is to test the effectiveness of the "Growth and Development Sectors for
the Family System Unit" in families in a particular environment.
Target Audience
The target audiences of this presentation are the nurse theorists and researchers in the area of family
health nursing.
Abstract
Purpose: "Family Development Theory" is a theory utilized when performing family assessment in the
area of family nursing. However in modern families diversity has become pronounced, and it has become
difficult to apply family development theories that are based on the traditional family model. The authors,
based on family members' perception of changes in the structure and function of families, have developed
and repeatedly revised the "Growth and Development Sectors for the Family System Unit" which they are
proposing as a replacement for family development theory. In this study, in order to further advance the
"Growth and Development Sectors for the Family System Unit," surveys of Japanese families residing
overseas were conducted, and the effectiveness of the "Growth and Development Sectors for the Family
System Unit" was tested in families in a particular environment. After additions and modifications, more
diverse families were categorized and comprehended, with the objective of revising a portion of these
sectors to enable resolution of family problem phenomena.
Methods: We obtained approval from the university’s Institutional Review Board (IRB). We searched
articles utilizing Ichushi-Web (Japanese database), by key words, e.g., family growth, family development,
families assigned overseas, and obtained 60 articles in Japanese matched the purpose of this study.
Three experts in family nursing performed content analysis on the articles, and identified categories, that
is, growth and development sectors for the family system unit. Hong Kong has two Japanese primary
schools, and most Japanese families on overseas work assignments send their school-age children to
these schools. The authors visited each of these schools, explained the study particulars verbally and in
writing to the directors or principals, and requested their participation. These schools agreed to
participate, and cooperation was requested in writing to 718 Japanese families on family-accompanied
assignments with children enrolled at the schools. Consequently semi-structured interviews of about two
hours in length were conducted with nine families. Interviews were recorded on an IC recorder and a
verbatim transcript was prepared later, and categories were identified by using content analysis. Analysis
was carried out in the following order: (a) identification of the recording unit (the smallest body of content
to be analyzed); (b) identification of the context unit (the largest body of content that may be examined in
characterizing a recording unit); and (c) coding and conferring of names for categories, that is, growth and
development sectors for the family system unit.
Results: First, 60 papers concerning families posted on overseas assignments were reviewed and from
this we added three new sectors: "period of plunging into confusion," "period of confusion, and "period of
getting out of confusion." Then, as a result of a semi-structured interviews with nine Japanese families
posted to Hong Kong, the number of growth and development sectors for the family system unit was
modified to the following 14 items: 1) family formation period; 2) family expansion period; 3) family
reduction period; 4) family completion period; 5) child nursing period; 6) child education period; 7) child
independence period; 8) nursing care period; 9) period of embodiment of hope; 10) initial application
process period; 11) stability and fulfillment period; 12) period of plunging into trouble/confusion; 13) period
of trouble/confusion; and 14) period of getting out of trouble/confusion. In addition, during interviews we

received opinions concerning the definitions of the various sectors, revising and refining the text
accordingly.
Conclusion: This resulted in a more refined "Growth and Development Sectors for the Family System
Unit" with greater applicability, and we suppose these sectors will make a contribution to family nursing
support and address the gaps in the science of family nursing.
References
Hohashi, N., & Honda, J. (2011). Development of the Concentric Sphere Family Environment Model and companion
tools for culturally congruent family assessment. Journal of Transcultural Nursing, 22(4), 350-361.
doi:10.1177/1043659611414200
Contact
[email protected]

Re-Warming Baby after First Bath: A Non-Randomized Clinical Trial
Sino S. George, MSN, APRN, RNC-OB, WHNP-BC, USA
Purpose
The purpose of this presentation is to increase knowledge by evaluating two methods of re-warming
newborns, radiant warming (RW) and skin to skin (S2S). The research question is, “In healthy, full-term
newborns, is S2S contact with mother as effective as RW in restoring the newborn’s temperature after the
first bath?”
Target Audience
The target audience of this presentation is clinical nursing staff who provide nursing care at the bedside
as well as those in academia. The new evidence obtained by doing research will enable the staff to apply
in their practices.
Abstract
Purpose: To evaluate two methods of re-warming newborns, radiant warming (RW) and skin to skin
(S2S). The research question is, “In a population of healthy, full-term newborns, is S2S contact with
mother as effective as RW in restoring the newborn’s temperature after the first bath?”
Methods: Newborn temperatures were taken immediately prior to the bath (T1), and 30 minutes (T2) and
60 minutes (T3) after the bath. Descriptive statistics and t-tests were used to determine differences
between groups and between time points.
Results: Because 96 of the first 100 mothers chose S2S re-warming, we concluded the study early and
analyzed the data. Of the 96 mothers who chose S2S, 92 successfully re-warmed and 4 required rescue
re-warming under the RW. Careful review of newborns requiring rescuing showed inadequate skin to skin
contact or removal of protective covering. Incidental findings: a) African American mothers were
significantly younger, had smaller babies and had lower temperature than non-African American babies.
Conclusion: Given a choice mothers overwhelmingly preferred S2S re-warming. Newborns can safely
re-warm S2S if staff pay special attention to how they are positioning the baby and re-check mother and
baby frequently. This study has profound clinical significance for nursing practice. First, we’re failing to
provide an option for re-warming that many of our mothers would choose. Second, S2S re-warming adds
opportunities for mothers to nurse their newborns. Promoting breastfeeding is also in line with the Healthy
People 2020 goals for increasing breastfeeding rates. Unexpected finding of racial differences in maternal
and newborn characteristics will require further investigation.
References
1.Blackburn, S. T. Thermoregulation. In Maternal, fetal, and neonatal physiology: A clinical perspective (2nd ed.).
Philadelphia, 2003, W.B. Saunders, pp. 707-730 2. Bramson, L., Lee, J., Moore, E., Montegomery, S., Neish, C.,
Bahjri,K., et al. (2010). Effect of early skin-to-skin mother-infant contact during the first 3 hours following birth on
exclusive breastfeeding during the hospital stay. Journal of Human Lactation, 26, 130–137. 3. Ferber, S. G., &
Makhoul, I. R. (2004). The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral
responses of the term newborn: A randomized, controlled trial :Pediatrics, 113, 858–865. 4. Galligan, M. (2006). Skin-
to Skin treatment of neonatal hypothermia. Maternal Child Nursing, 31, 298-304. 5. Gangal, P., Bhagat, K., Prabhu,
S., & Nair, R. (2007). Breast crawl: Initiation of breastfeeding by the breast crawl. Retrieved from
http://www.breastcrawl.org/ 6. Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., Di Giulio, P., (2010)
Skin-to skin contact after cesarean delivery: An experimental study; Nursing research, Vol 59. No.2, 78-84 7.
Hackman, P.S. (2001). Recognizing and understanding the cold –stressed term infant. Neonatal Network, 20(8), 35-
41. 8. Haxton, D., Doering, J., Gingras, L., Kelly, L. (2012) Implementing skin-to-skin contact at birth using the Iowa
Model: Nursing for Women’s Health, Volume 16, Issue 3 220-230 9. Kimura, C. & Matsuoka, M. (2007) Changes in
Breast Skin Temperature during the Course of breastfeeding; J Hum Lactation 23:60: DOI:
10.1177/0890334406297255. 10. Knobel, R. & Holdtich-Davis,D. (2007). Thermoregulation and heat loss prevention
after birth and during neonatal intensive care unit stabilization of extremely low birth weight infants. Journal of OB-
GYN and Neonatal Nursing, 10,S 7-S14 11. Maramkhah,F. (2006) Don’t let radiant warmers overheat infants.
Nursing Times,36(3), 28 12. Moore, E. R., Anderson, G. C., & Bergman, N. (2007) Early skin -to-skin contact for
mothers and their healthy newborn infants [review] . Cochrane Database of Systemic Reviews. Issue 3. doi:

10.1002/14651858.CD003519.pub2. 13. Moore, E., & Anderson, G. (2007). Randomized control trial of very early
mother-infant skin-to-skin contact and breastfeeding status. Journal of Midwifery and Women’s Health, 52, 116–125.
doi:10.1016/j.jmwh.2006.12002 14. U.S. Breastfeeding Committee. (2010). Implementing the Joint Commission
Perinatal Core Measure on exclusive breast milk feeding. Washington, DC: Author. Retrieved from http://www.
usbreastfeeding.org/Portals/0/Coalitions/2010-NCSBC/BTTHandouts/BTT-29-Handout.pdf 15. University of
California, San Diego, Women and Infant Services. (2008). Skin to skin care in the ISCC. Retrieved from
http://spinprogram.ucsd.edu/nicu-staff-resources/Documents/SPIN_ SkintoskinpoS208final.doc 16. Velandia, M.,
Matthisen, A., Uvnas-Moberg, K., & Nissan, E.(2010). Onset of early vocal interaction between parents and newborns
in skin-to-skin contact immediately after elective cesarean section. Birth, 37(3), 192–201. 17. Verklan, M.T. and
Walden, M. Thermoregulation. In Core Curriculum for Neonatal Intensive care Nursing (3rd ed.) St Louis, 2004,
Saunders, pp. 125-134. 18. Walters, M., Boggs, K., Ludington-Hoe, S., Price, K., & Morrison,B. (2007). Kangaroo
care at birth for full term infants: A pilot study. MCN The American Journal of Maternal Child Nursing, 32(6), 375–381.
Contact
[email protected]

Using Evidence Integrated e-Learning to Enhance the Case Management
Continuing Education for Taiwanese Psychiatric Nurses
Wen-I Liu, PhD, RN, Taiwan
Jiin-Ru Rong, PhD, Taiwan
Purpose
The purpose of this presentation is to describe the development and effectiveness of an evidence-
integrated e-learning to enhance the case management continuing education for Taiwanese psychiatric
nurses.
Target Audience
The target audience of this presentation is those clinical, academic and administrative staff interested in
the methods to develop and evaluate an evidence-based continuing education program using a more
flexible and cost effective e learning.
Abstract
Purpose: The purpose of this paper is to describe the development and effectiveness of an evidence-
integrated e-learning to enhance the continuing education of case management for Taiwanese psychiatric
nurses
Methods: The development of the e-learning program was divided into four stages: 1. Identifying current
evidence for e learning and case management education through systematic review articles; 2.conducting
a national survey and a focus group to confirm the educational needs; 3.developing teaching materials;
and 4.performing a preliminary evaluation of the program with 40 nurses to improve the program quality.
The e-learning program was integrated current evidence and built through the collaboration of a nurse
educator and an informatics professor.
After the completion of the programme development, a randomized controlled trial with 3 times
measurement design was employed to evaluate the effectiveness of the e-learning programme .This case
management e-learning programme used CDs as the primary teaching material. The digital program
consisted of 5 learning modules, self-assessment questions, learning cases, sharing experiences, and
learning resources. In-service psychiatric registered nurses were recruited through the website of the
Psychiatric Mental Health Nurses Association and randomised allocation into either experiemntal or
comparison group. The psychiatric nurses in the experimental group participated in an interactive case
management e-learning programme, whereas those in the comparison group were provided no
intervention. The case management knowledge index with sufficient reliability and validity and a
satisfaction survey were used to determine the learning outcomes. A generalized estimating equation was

used to assess the difference between the 2 groups regarding the case management knowledge before,
after, and 3 months following the psychiatric nurses’ participation in 2012.
Results: A total of 200 participants completed the 3 measurements. The participants in the experimental
group exhibited positive learning perceptions. The knowledge scores of the participants in the
experimental group significantly exceeded those of the participants in the comparison group both after the
e-learning programme and at the 3-month follow-up.
Conclusion: The case management e-learning programme could be an evidence-based educational
resource for nursing continuing education. The results supported the use of e learning to provide a more
flexible and effective presentation method for continuing education programs.
Contact
[email protected]

Aggression in South Korean Middle School Students
Jihea Choi, RN, CPNP, PhD, South Korea
Purpose
The study was undertaken to assess the levels of aggressiveness among South Korean middle school
students, and determine how strongly negative factors (e.g., academic stress and depression) and
positive factors (e.g., self-esteem, decision-making competency, and happiness) influence to
aggressiveness.
Target Audience
The target audience of this presentation is health care providers or health educators who are interested in
young adolescent’s mental health problem including aggression, depression, self esteem, and decision
making competency.
Abstract
Purpose: Aggressiveness is a behavioral and emotional response made on purpose for the sake of
destroying or damaging other persons or things (Kim & Kim, 2007). Currently South Korean society
suffers from violent and inhuman juvenile crimes like collective bullying and school violence that are due
to aggressiveness (Hwang, 2010). Juvenile violence due to aggressiveness in South Korean society is
not just a current issue. Seven out of 10 cases of juvenile violence occurring between 2008 and 2010
were committed by middle school students, and 69% of school violence cases occurred in middle schools
(Bae, Kim, Chung, Kang, & Park, 2010). Considering these data, more attention should be dedicated to
studying aggressiveness in middle school students who are in early adolescence. Previous studies have
attempted to clarify various factors that influence juvenile aggressiveness. Otherwise, concentrated re-
investigation is necessary to reveal factors influencing Korean middle school students’ aggression. In this
study depression and academic stress as negative emotional aspects, and self-esteem, decision-making
competency, happiness as positive emotional aspect of middle school students were investigated
specifically. In conclusion, the purpose of this study was to assess levels of aggressiveness, and to
determine factors affecting aggressiveness among South Korean middle school students.
Methods: A descriptive study was conducted using self-report questionnaires. The participants were 340
girls and boys from two middle schools and 302 questionnaires were used for the final data analysis.
Aggressiveness was measured with the ‘Aggression Questionnaire’ developed by Buss & Perry (1992)
and used in Shin’s study (2000). It consists with 24 questions (5-point Likert scale) including physical
aggression, verbal aggression, anger and hostility. Higher average scores correspond to higher levels of
aggressiveness. Academic stress was measured with the ‘Academic Stress Questionnaire’ developed by
Lee (2007), and it was developed to assess of middle school students’ academic stress reflecting the
educational environment of Korea. The measurement consisted with 25 items (5-point Likert scale)
assessing perceived pressure from examinations, conflicts between family and friends related to
academic performance and burden in relation to scores and class. Higher average scores correspond to
higher levels of academic stress. Depression was measured with a 13-question checklist (5-point Likert
scale) to evaluate depression, taken from the ‘Symptom Checklist-90-Revision’ revised by Kim, Kim, &
Won (1984). Higher average scores indicate higher levels of depression. Scores above 70 percent of the
measured score (above 3.5 out of 5.0) indicate that the person is depressed. Self-esteem was measured
with the ‘Self-esteem Scale’ developed by Rogenberg (1965) and translated to Korean by Jeon (1974). It
includes a 4-point Likert scale with a total of 10 questions to measure the levels of self-esteem and
emotional aspects of self-approval. Higher average scores indicate higher levels of self-esteem. Decision-
making competency was measured with the ‘Decision-Making-Competency Inventory’ developed by Miller
and Byrnes (2001) and translated to Korean by Park et al. (2012). It includes a 5-point Likert scale with a
total 18 questions to measure informed decisions, self-appraisal, autonomy, self-confidence. Higher
average scores correspond with better decision-making abilities. Happiness was measured by the
question “do you think you are living happily now?” with a 5-point Likert scale. Higher scores indicated

higher levels of happiness. Data were analyzed using descriptive statistics including t-test, one-way
ANOVA, Pearson correlation coefficient and multiple regressions.
Results: Mean score for participants’ aggressiveness was 2.49 out of 5. Academic stress was 3.38 out of
5, for self-esteem, 2.86 out of 4, for decision-making competency, 3.2 out of 5, and for happiness, 3.82
out of 5. Depression was 2.56 out of 5 that it was lower than 3.5 indicating depression. Significant
explanatory variables for aggressiveness were grade, second grader (t = 4.39, p < .001), academic stress
(t = 2.78, p = .006), and depression (t = 5.03, p < .001). The explanatory power of these factors was
26.9%, and it was statistically significant (F = 16.06, p < .001).
Conclusion: Findings indicate that depression, academic stress, and grade (second graders) influence
aggressiveness. To decrease aggressive behavior, it is necessary to provide systematic and political
programs in schools and local communities that can ameliorate negative emotional factors like
depression and academic stress, especially for second grade middle school students. Additionally,
development of positive factors such as self-esteem, decision-making skills, and happiness in middle
school students is important to reduce aggressiveness.
References
Bae, J. M., Kim, D. M., Chung, S. K., Kang, T. H., & Park, H. J. (2010). 2010 a national survey of youth risk behaviors
(KDC 189). Seoul: Korea Youth Counseling Institute. Buss, A. H., & Perry, M. P. (1992). The Aggression
Questionnaire. Journal of Personality and Social Psychology, 63, 452-459. Hwang, P. (2010). The effect of media
education emphasizing the harm on the teenagers' aggression. Unpublished master's thesis, Dong-A University,
Busan. Jeon, B. J. (1974). Self-esteem: a test of its measurability. Yonsei Nonchong, 11, 107-129. Kim, J. W., & Kim,
H. J. (2007). Relationships among children’s aggression, temperament, home environment, and school adjustment.
The Journal of Child Education, 16(2), 85-93. Kim, K. I., Kim, J. W., & Won, H. T. (1984). SCL-90-R (Symptom
Checklist-90-Revision). Seoul: Jungang Aptitude Publisher. Lee, B. Y. (2007). A study on academic stress and stress
with high school admission among middle schoolers. Unpublished master's thesis, Kangwon National University,
Chuncheon. Park, M. J., Oh, D. N., Ham, Y. L., Lim , S. J. & Lim, Y. M. (2012). Reliability and validity of the decision-
making-competency inventory (DMCI) in Korean adolescents. Journal of Korean Academy of Child Health Nursing,
18(2), 53-59. Rosenberg, M. (1965). Society and adolescent self-image. Princeton. NJ: Princeton University Press.
Shin, J. H. (2009). The moderating effects of self-efficacy and self-control on the relation between aggression and
school adjustment in the middle school students. Unpublished master dissertation, Keimyung University, Daegu.
Contact
[email protected]

Exploration of Dutch Intensive Care Nurses' Experience of Planned or Emergent
Change Implementation of an Innovation
Marie-Louise Luiking, RGN, MA, Netherlands
Purpose
The purpose of this presentation is to present the experiences of nurses of emergent change
implementation and planned change implementation of a nursing innovation, the experienced influence
on workplace empowerment and job satisfaction.
Target Audience
The target audience of this presentation are nurse leaders and nursing managers who want to implement
nursing innovations and also want to retain or improve nurses’ workplace empowerment and job
satisfaction, both important characteristics of magnet hospitals.
Abstract
Purpose: Workplace empowerment is considered an important magnet hospital characteristic, which is
also related to patient outcomes and job satisfaction (Upenieks 2003 , Laschinger & Havens 1997).
Armstrong (2006) described workplace empowerment as workplace structural factors related to nurses’
ability to function with autonomy and make decisions about their practice, i.e. how to implement their
practice.
In implementation science, Burnes (1996), Bamford and Forrester (2003) divide implementation
approaches for innovations into two types. They distinguish planned change implementation and
emergent change implementation. The crucial difference between these types is staff members’
participation in the implementation process and in the construction of the final innovation. In planned
change implementation approach, there is no such participation, it is “a pre-planned and centrally-directed
process”(Burnes 1996). In emergent change implementation approach, the goal to aim for is put forward
by management to the staff members. The staff members are invited to participate in finding ways to
achieve the goal. Magnet hospital research seems to indicate that an emergent change implementation
would provide more workplace empowerment than planned change implementation and therefore be
more attractive for nurses as a working method.
The aim of this study was to describe the intensive care nurses’ experience of the introduction of an
innovation using either implementation approach and to identify what aspects were positively or
negatively valued.
Methods: An innovation was implemented in two groups (teams) of nurses using planned change
implementation in one team and emergent change implementation in the other team. The two teams were
part of one intensive care unit with two spatially separated wings. The patients were admitted to either
wing at random. The innovation was an intensive insulin therapy (IIT) for the treatment of high blood
glucose values in intensive care unit (ICU) patients. This IIT described how ICU-nurses’ treatment can
bring about the desired effect for the patient. The IIT was self directing, which entailed that the ICU-
nurses made their own decisions to initiate, change and stop the intravenous insulin administration and
check the blood glucose values with the help of a treatment protocol. This self directing was a new
feature in this ICU.
In one team (planned change team) a planned change implementation approach was used, in the other
(emergent change team) an emergent change implementation approach. The members of the emergent
change team were invited to propose changes to the protocol while the members of the planned change
team were not given the opportunity to change the protocol. The effectiveness of the IIT in both teams on
patient blood glucose control and nurse compliance are described elsewhere and show a slightly better
patient blood glucose control and better nurse compliance in the ECteam. (Luiking et al 2013) The
resulting differences of both implementation approaches in the nurses’ professional clinical autonomy and
personal values and norms are also described elsewhere, and show an increase in the nurses’

professional clinical autonomy in the emergent change team and a decrease in the planned change
team. The personal values and norms in the teams showed changes in line with the implementation
approach applied in the team (Article submitted).
Thereafter 8 nurses from either group were interviewed. A qualitative content analysis was done of these
semi-structured interviews. The found positive and negative appreciation subcategories were further
quantitative analysed using quantitizing. Quantitizing involves the transformation of qualitative date
esp. qualitative themes to numerical form . This quantitizing was done using frequency manifest effect
sizes. Frequency manifest effect sizes represent the prevalence rates of themes or observations in a
qualitative study. They can be used to compare prevalence rates of themes or observations in
(sub)groups of participants.
Results: The 5 inductive categories emerging from the interviews were: perception of the innovation, of
the implementation, of the implementation and innovation as a responsibility for the nurses, of the
influence on the profession and of the influence on the team.
The experiences of the innovation and implementation was in line with the character of the
implementation approach. A striking example of this is the way the nurses worded the nurses’ role in this
innovation. In the emergent change team the nurses’ role was described as achieving better patient
results. It was described that the protocol had to be followed: “The innovation is nice, because you know
exactly what is to come and you know what you have to focus upon”. But it was also described that
getting better patient results was more important than exactly adhering to the written down protocol: “you
have to adapt the treatment but not according to the exact protocol”, because: “ I know that if I adhere to
the protocol in that way, the patient will develop hypoglycaemias or hyperglycaemias [complications]”. In
the planned change team the adherence to the exact wording of the protocol was emphasized: “Look on
the list [protocol], this is the glucose value, so that’s what you have to do.”
Both groups had similar views upon what they considered important in their work, e.g. the feeling of being
supported by management was important to the nurses. The quantitizing showed a higher ratio
of positive than negative appreciation statements in the emergent change group for the subcategories
perception of the innovation (Chi square=5.156, p= 0.023), of the implementation (Chi square=26.381,
p<0.0001)and of the implementation and innovation as a responsibility of the nurses (Chi square=52.846,
p< 0.0001).
Conclusion: In the planned change group innovations and their implementation were seen as the
responsibility of the management. In the emergent change group it was seen as a shared responsibility.
In the emergent change group it was in line with how Burnes (1996) described the goal for using
emergent change: “developing a workforce that will take responsibility for identifying the need for change
and implementing it”. Thus emergent change implementation provided increased workplace
empowerment to the nurses.
The quantitizing of the statements in the interviews indicated that the emergent change implementation
was more attractive for the nurses.
This seems to corroborate the magnet hospital research which indicated that an emergent change
implementation would provide more workplace empowerment than planned change implementation and
therefore would be more attractive for the nurses as a working method.
Although support by management in the two implementation approaches was very different. It was
considered important irrespective of the specific type of support provided.
References
Armstrong KJ & Laschinger H (2006) Structural empowerment, Magnet hospital characteristics, and patient safety
culture: making the link. J Nurs Care Qual 21(2):124-32 Bamford D & Forrester P (2003) Managing planned and
emergent change within an operations management environment. International Journal of Operations & Production
Management 23(5): 546-564 Burnes B (1996) No such thing as … a “one best way” to manage organizational
change. Management Decision, 34(10): 11-18 Laschinger HK & Havens DS (1997) The effect of workplace
empowerment on staff nurses' occupational mental health and work effectiveness. J Nurs Adm. 27(6):42-50. Luiking
ML, van Linge L, Bras L, Grypdonck M, Aarts L. (2013) Intensive insulin therapy implementation by means of planned
versus emergent change approach.Nursing in Critical Care, In press Upenieks VV. (2003)The interrelationship of

organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction. Health Care
Manag 22(2):83-98.
Contact
[email protected]

Effectiveness of Kagayashiki Music Intervention on Depression, Cognition and
Basic Activity Daily Living in the Institutionalized Elderly
Hsueh-Jen Ho, MSN, RN, Taiwan
Shu-Chuan Chen, MSN, RN, Taiwan
An-Na Chao, MSN, RN, Taiwan
Li-Na Chou, PhD, RN, Taiwan
Purpose
The learners will be able to understand (1) the current state of depression, cognition, and basic activities
of daily living in the institutionalized elderly in southern Taiwan and (2) to display the effects of
Kagayashiki music intervention measures on depression, cognition, and basic activities of daily living.
Target Audience
The target audience of this presentation is to understand the effects of Kagayashiki music intervention
measures on depression, cognition, and basic activities of daily living and to the music intervention
program aimed to lower the percentage of the institutionalized elderly with depression in southern
Taiwan.
Abstract
Purpose: Kagayashiki music intervention has been gradually applied in long term care in Taiwan.
Compared to other music therapy, evidence-based researches of Kagayashiki music intervention are
fewer. The research objective of this study was to examine the effects of Kagayashiki music intervention
measures on depression, cognition, and basic activity daily living in the institutionalized elderly.
Methods: With one-group pretest-posttest quasi-experimental design, this study adopted the purposive
sampling of selecting the subjects from two elder care institutions in Southern Taiwan, and then random
assignment was carried out in the Kagayashiki music intervention group. A total of 36 subjects enrolled in
this experimental group. The music intervention group was required to perform 40 minutes once a week
for twelve weeks. Demographic sheet, Geriatric Depression Scale, Mini-Mental Status Examination Scale,
Basic Activities of Daily Living Scale were evaluated before and after the intervention. The analysis was
conducted using SPSS version 18.0, and the significance level α was set at 0.05.
Results: 31(86.1%) participants came to complete the study, most of whom were female (n=25; 80.6%).
Average age was 82.3 years. The mean score of depression decreased from 7.16 in the pretest to 6.19 in
the posttest and cognitive function improved from 17.52 to 19.55. The mean score of BADL in the pretest
and posttest was 56.33 and 66.67, separately. The pair t test results indicated that GDS (t=-2.36, p<.05),
MMSE (t=2.13, p<.05), and BADL (t=2.42, p<.05) exhibited significant changes.
Conclusion: The results indicate that Kagayashiki music intervention can improve the depression,
cognitive function, and basic activities of daily living in the institutionalized elderly. Therefore, Kagayashiki
music intervention can be widely implemented among the institutionalized elders. This intervention can be
incorporated into day activity program in order to lower the rate of depression, and thus enhance
cognitive function and activities of daily living. It is suggested that randomized researches with larger
sample sizes be used for appropriate calculation, measurement after multiple sessions, and physiological
and psychological measurement.
Contact
[email protected]

Hypertension, Acculturation, Work-Related Stress, and Psychological Distress
Among Filipino-American Registered Nurses (RNs) and Domestic and Home Care
Workers (DHCWs)
Emerson Eresmas Ea, DNP, APRN, CNE, USA
Purpose
to present the results of a study which aimed to: (a) identify and determine the relationships among the
levels of acculturation, work-related stress, psychological distress and hypertension, and (b) identify and
explore the perceived personal and cultural factors associated with hypertension among FA RNs and
DHCWs in New York.
Target Audience
The target audience of this presentation include clinical nurses, nurse educators, nurse administrators,
and nurse researchers and scientists.
Abstract
Background: Filipino Americans (FAs) have one of the highest rates of hypertension (HTN) among Asian
Americans. As one of the largest and fastest growing groups of immigrants in the United States (US), very
little is known about them in the literature especially about their cardiovascular health. A significant
number of FA professionals are licensed Registered Nurses (RNs) and Domestic and Home Care
Workers (DHCWs). Owing to the nature of their work, anecdotal evidence indicates that many of Filipino
RNs and DHCWs suffer from hypertension (HTN). Despite the population growth and documentation of
HTN among FAs, very little is known about their health status and needs, specifically those that explore
FA RNs’ and DHCWs’ cardiovascular health in the Northeast.
Purpose: The purposes of this study are to (a) identify and determine the relationships among the levels
of acculturation, work-related stress, psychological distress and prevalence of hypertension, and (b)
identify and explore the perceived personal and cultural factors associated with the diagnosis and
management of hypertension among FA RNs and DHCWs in New York (NY).
Methods: A survey using a demographic questionnaire and A Short Acculturation Scale for Filipino
Americans (ASASFA), a modified Daily Hassles Scale, and Mental Health Inventory instruments was
conducted including a blood pressure screening among a convenience sample of Filipino RNs and
DHCWs in NY. In addition, focus group interviews were conducted to those who have HTN. IRB approval
was obtained prior to this study and statistical analyses were conducted using SPSS. Qualitative data
were analyzed using the Consensual Qualitative Research (CQR) method.
Results: Results revealed that majority of the FA RNs and DHCWS surveyed (N=228) are women,
married, work full-time and 50% of those screened were found to be hypertensive. Logistic regression
analysis did not reveal significant relationships among acculturation, work-related stress, psychological
distress and hypertension. The four domains identified by the participants to be associated with the
diagnosis and management of hypertension include: Awareness of the Intrinsic and Extrinsic Factors that
Affect HTN, Managing HTN and Coping Mechanisms, Barriers and Challenges to Managing HTN, and
Experiences with Hypertension.
Conclusion: The results of the study provide valuable information about the cardiovascular health of
Filipino RNs and DHCWs. Although there was no relationship found between hypertension and the
variables measured in the study, the high number of participants found to have hypertensive is a cause
for concern. This has significant implications to nursing science and practice. There is a need to further
explore hypertension among this understudied group of FA immigrants especially the factors that could
contribute to hypertension. The qualitative data results could be used to design culturally tailored nursing
interventions that could lead to positive health outcomes among FAs who have HTN.
Contact

[email protected]

Faculty and Organizational Characteristics Associated with Informatics/Health
Information Technology Adoption in DNP Programs
Cathy R. Fulton, DNP, RN, ANP-BC, FNP-BC, USA
Julie Meek, PhD, RN, CNS, USA
Purpose
The purpose of this presentation is to relate the results of a descriptive study, eliciting perceptions of DNP
program directors relative to whether and how the AACN’s Essential IV standard has been met in their
programs and the faculty and organizational characteristics associated with the adoption of AACN’s
Essential IV.
Target Audience
The target audience of this presentation is graduate nursing faculty and nursing students.
Abstract
Purpose: Nursing informatics/Health information technology are key components of graduate nursing
education and an accreditation requirement, yet little is known about the extent to which Doctor of
Nursing Practice (DNP) curricula include these content domains. The purpose of this descriptive study
was to elicit perceptions of DNP program directors relative to: 1) whether and how the American
Association of Colleges of Nursing’s (AACN’s) Essential IV standard has been met in their DNP
programs; 2) whether the Technology Informatics Guiding Educational Reform Initiative Foundation’s
Phase II competencies have been integrated in their programs; and 3) the faculty and organizational
characteristics associated with the adoption of the AACN’s Essential IV.
Methods: In 2011 an electronic survey was sent to all 138 DNP program directors identified on the AACN
website with an 81.2% response rate.
Results: Findings include variation in whether and how programs have integrated informatics/health
information technology content, a lack of informatics-certified and/or master’s prepared faculty, and a
perceived lack of faculty awareness of informatics curricular guidelines.
Conclusion: DNP program director and dean awareness and support of faculty informatics education,
use of informatics competency guidelines, and national policy and stimulus funding support are
recommended to promote curricular inclusion and the engagement of nurses in strong informatics
practices.
Contact
[email protected]

Quality of Life and Associated Factors in Pregnant Women during the Third
Trimester
Fan-Hao Chou, RN, PhD, Taiwan
Hsiang Han Chang, MSN, Taiwan
Purpose
The purpose of this presentation is to share the research findings, especially for prenatal health care.
Target Audience
The target audience of this presentation is for all the healthcar professional.
Abstract
Purpose: The purpose of this study was to explore quality of life and associated factors in pregnant
women during the third trimester.
Methods: A cross-sectional and correlational research design was conducted using the Demographic
Inventory, the Discomfort Symptom Questionnaire of the Third Trimester, and the World Health
Organization Quality of Life Assessment (WHOQOL)-Brief Taiwan version. A convenience sample of 207
pregnant women aged 20 years old or above were recruited from a medical center in southern Taiwan
after consent forms were obtained. Data were analyzed using SPSS 19.0 software, including descriptive
statistics, Pearson’s correlation coefficient, and multiple regression.
Results: Results found (1) pregnant women an average QOL index score of 70.58 (moderate and
above); (2) significant differences in QOL scores for the variables of occupation (yes/no), education level,
religion, monthly personal and family income; (3) discomfort symptoms of the third trimester and prenatal
stress were significantly associated with QOL; (4) 49.9% of QOL variance was explained by discomfort
symptoms of the third trimester, monthly personal income, prenatal stress and planned pregnancy.
Conclusion: The results of this study may help healthcare professionals to understand relationships
among symptoms of the third trimester, prenatal stress and QOL in pregnant women during the third
trimester. It could also be an evidence-based data for assessment and caring of those pregnant women.
Contact
[email protected]

Adults with Type 1 Diabetes: Lifetime Support and Management
Donna Freeborn, PhD, FNP, CNM, USA
Jordan Scanlon, RN, USA
Tina Dyches, PhD, USA
Susanne Olsen Roper, PhD, USA
Barbara Mandleco, RN, PhD, USA
Purpose
The purpose of this presentation is to share the perception of adults with type 1 diabetes about family
support and how it influenced their compliance with diabetes management.
Target Audience
The target audience of this presentation is nurses, advanced practice nurses, and others who work with
children, adolescents, and adults with type 1 diabetes in order to improve family support and patient self-
management of type 1 diabetes.
Abstract
Purpose: To explore family support and it effects on diabetes management of adults with type 1 diabetes
Methods: This study consisted of two in-depth interviews of 23 adult females and 12 adult males ranging
in age from 19 to 70 years (M=36.54, SD=16.65). Participants’ ages at diagnosis with type 1 diabetes
ranged from two to 35 years (M=15.06, SD=9.84) with one to 54 years since diagnosis (M=21.46,
SD=12.87). This qualitative study, using the biographical method, consisted of two in-depth interviews.
The first interview allowed the participant to answer the prompt “tell me about growing up and living with
type 1 diabetes.” The interviewers used additional prompts such as “tell me more about” or “can you
explain that further” but the participant directed the interview. The second interview took place
approximately one week later. This interview began by the interviewers soliciting clarification, if needed,
from the first interview. Then interviewers asked questions including: a) Tell us about when you were
diagnosed with type 1 diabetes; b) How were your family and friends supportive/non-supportive? c) How
compliant have you been throughout your lifetime to your health care regime? d) What were the biggest
factors in helping you stay compliant?
Results: Factors that increased compliance included: positive family involvement both with siblings and
parents; increased early independence in managing their diabetes; education about type 1 diabetes for
both children and families; involvement of other influential adults in teaching the importance of diabetes
management; motivation to live up to their dreams; and, increased knowledge that compliance was
possible. Factors that decreased compliance included: children viewing diabetes as a chore; feeling
different from other children and family members; over protective parents who did not encourage
independent self-management of diabetes; changing routines such as going on vacation or transitioning
to college; and, being stressed due to the emphasis on diabetes management and health.
Conclusion: Participants described that at the time of their diagnosis with type 1 diabetes they believed
that their life was over and they would never be able to do the things they wanted to do. Children with
type 1 diabetes need clear education about their disease, how they can still participate in favorite
activities and their role in assuming independent self-management skills. Children and their families all
need to be taught that they can lead healthy and normal lives and that they should be optimistic about the
future. Type 1 diabetes is a life-time condition and those living with the disease, whether they be children
or adults, need support to manage the condition and live healthy, active lives.
References
Balfe, M. (2009). The body projects of university students with type 1 diabetes. Qualitative Health Research, 19(2),
128-139. Busse, F. P., Hiermann, P., Galler, A., Stumvoll, M., Wiessner, T., Kiess, W., et al. (2007). Evaluation of
patients' opinion and metabolic control after transfer of young adults with type 1 diabetes from a a pediatric diabetes
clinic to adult care. Hormone Research, 67(3), 132-138 Insabella, G., Grey, M., Knafl, G., & Taborlane, W. (2007).

The transition to young adulthood in youth with type 1 diabetes on intensive treatment. Pediatric Diabetes, 8(4), 228-
234. Luyckx, K., Vanhalst, J., Seiffge-Krenke, I., & Weets, I. (2010). A typology of coping with type 1 diabetes in
emerging adulthood: Associations with demographic, psychological and clinical parameters. Journal of Behavioral
Medicine, 33(3), 228-238. Pereira, M. G., Berg-Cross, L., Almeida, P., & Machado, J. C. (2008). Impact of family
environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes.
International Journal of Behavioral Medicine, 15, 187-193. Tahbaz, F., Kreis, I., & Calvert, D. (2006). An audit of
diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus and a comparison with
nondiabetic subjects. Journal of Human Nutrition & Dietetics, 19(1), 3-11.
Contact
[email protected]

Diabetes Self-Management Practice of Older Koreans Based on AADE-7
(American Association of Diabetes Educatiors 7 Behaviors) Domains
Misoon Song, RN, PhD, South Korea
Suyoung Choi, PhD, GNP, RN, South Korea
Sun Ju Chang, PhD, RN, South Korea
Soo Jin Lee, RN, MSN, South Korea
Kyoungsan Seo, RN, MSN, South Korea
Se-an Kim, RN, MSN, South Korea
Purpose
The purpose of this presentation is to describe diabetes self-management practice of older Koreans
based on AADE-7 criteria.
Target Audience
The target audience of this presentation are nurses, diabetes educators,nursing educators, and health
professionals who are interested in cultural difference of health practice.
Abstract
Purpose: American Association of Diabetes Educators identified 7 domains of self-care behaviors
essential for effective diabetes-self-management from the extensive review of evidences and expert
consensus. But measurement tool for self-management behaviors based on this framework has not been
developed in Korea. The purposes of this study were to develop the diabetes self-management behavior
scale for older Koreans (DSMS-OK) based on AADE-7 domains and to describe current status of
diabetes self-management behaviors of Korean older adults in the community measured by the scale.
Methods: The AADE-7 domains were utilized in developing the DSMS-OK items: healthy eating, being
active, monitoring, taking medication, problem solving, reducing risks, and healthy coping. The scale was
developed with consideration of feasibility and readability for targeting older adults with type 2 diabetes.
The preliminary 10 items of 4-point (0-3) Likert type DSMS-OK were evaluated by ten diabetes education
experts. The content validity index evaluated by the experts was 1.0 for all items in the scale, and all
items were retained. Then the DSMS-OK was applied to 150 older adults (mean age 76.5 ±5.8 years)
with diabetes in a senior center. Criterion related validity was evaluated by correlation with alternate form
of Diabetes self-care behavior scale (Korean version of Summary of Diabetes Self-care Activities
Questionnaire, K-SDSCA) which includes only 5 domains of AADE-7 domains.
Results: There was a significant relationship between totla scores of the DSMS-OK and the K-SDSCA
(r=.502, p<.001), thus the criterion validity was supported. The most practicing self-management behavior
was domain of taking medication (2.85/3, ±0.51), and the least practicing self-management behavior was
domain of healthy coping (1.59/3, ±1.59).
Conclusion: The DSMS-OK is a useful tool for measuring diabetes self-management behaviors based
on AADE-7 framework for older Koreans. The scale is short and easy to use for older adults, but further
validation is required for psychometric properties. It is recommended that behaviors related to healthy
coping domain need attention when designing diabetes self-management education program for older
Koreans.
References
American Association of Diabetes educators (2009). AADE guidelines for the practice of diabetes self-management
education and training, The Diabetes Educators, Suppl 85s-107s.
Contact
[email protected]

Effects of Balneotherapy on Pulmonary Function and Quality of Life in Chronic
Obstructive Pulmonary Disease Patients
Feng Lien Lin, RN, MS, Taiwan
Purpose
The purpose of this presentation is sharing the effect of Complementary care in chronic obstructive
pulmonary disease patients
Target Audience
The target audience of this presentation is interested in Complementary care.
Abstract
Purpose: The purpose of this study was to evaluate the effect of balneotherapy on pulmonary function
and quality of life in patients with chronic obstructive pulmonary disease (COPD).
Methods: Subjects managed at a chest medical clinic of a medical center in Taipei city were included
voluntarily after signing informed consents. The inclusion criteria were age>40, the mild and moderate
COPD by GOLD criteria. The 10 subjects in the experimental group received balneotherapy twice per
week for 6weeks with regular medical treatment. The balneotherapy included the diaphragmatic
breathing(DB), pursed lips breathing(PLB), and walking in the pool of the hot spring. Subjects in the
experimental group had a
one-hour instruction by a professional instructor. The 14 subjects in control group received medical
treatment without balneotherapy. All subjects received pulmonary function tests and WHOQOL-Bref
(Taiwan) questionnaire prior to the operation (pre-test) and 6weeks later (post-test). The experimental
group received third measurement at the end of operation for 4weeks (post post-test).The statistical
analysis applied in data analysis included percentage, mean, standard deviation, chi-square, Mann-
Whitney U test, Wilcoxon signed-rank test, and Friedman analysis of variance by ranks.
Results: The results indicated that subjects in the experimental group had improvement in mean of
FEV1% predicted and QOL (p<.05) after balneotherapy, while subjects in the control group did not.
Differences of pulmonary function and quality of life of COPD patients of experimental and control group
Pre-test post-test Wilcoxon signed- P value

rank test
(n=10) (n=10)
mean±SD mean±SD
PFT
FEV1(%predicted) 63.66±11.29 73.00±20.04 -1.479 .139
WHOQOL-Bref
(Taiwan)
Physical domain 13.09±1.28 15.66±1.35 -2.703 .007**
Psychological domain 12.47±2.74 15.26±1.67 -2.191 .028*
Social domain 13.60±3.41 15.40±1.58 -2.047 .041*

Environmental domain 13.64±2.34 16.04±1.21 -2.429 .015*
Conclusion: The present study implies that balneotherapy were effective in improving pulmonary
function and quality of life of patients with mild and moderate COPD. The results of this study could be
used as a reference for health professionals in COPD management.
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Contact
[email protected]

Experiences of Preceptors in Dedicated Education Units in the Public Hospital
Environment
Jennifer L. Kitchens, MSN, RN, ACNS-BC, CVRN, USA
Joe Burrage, PhD, RN, FAAN, USA
Purpose
The purpose of this presentation is to describe experiences of nurse preceptors working with students in
Dedicated Education Units (DEU) or Traditional Nursing Units (TNU). The long term objective is to
develop a systematic method to evaluate preceptor experiences in order to develop interventions which
enhance preceptor satisfaction and retention.
Target Audience
The target audience of this presentation is academic and clinical faculty, nursing preceptors, hospital staff
and administration, Clinical Nurse Specialists, and nursing students.
Abstract
Purpose: To provide data on which to develop a method to evaluate experiences of preceptors of nursing
students on a Dedicated Education Unit (DEU)/Traditional Nursing Unit (TNU). The specific aim was to
describe experiences of nurse preceptors who have worked with at least two rotations of nursing students
over the last 12 month in a DEU/TNU setting. Current faculty shortages, increased patient care acuity,
advanced technology, greater system complexity, and sophisticated computer systems have resulted in
the increased need to use staff nurses preceptors to provide students with clinical instruction and
experience. More information is needed about the experiences of preceptors of nursing students. Studies
specifically addressing preceptor experiences on DEUs are rare.
Methods: Orling's Meaning of Preceptorship Theory guided this cross-sectional qualitative study. A total
of eleven full time registered nurses (convenience sample) with experience as preceptors on a DEU or
traditional medical-surgical nursing units at a complex county acute care hospital were recruited to
participate in digitally recorded individual interviews. Thematic content analysis was conducted to identify
patterns and meanings. An iterative process of comparison was used to further analyze the data, moving
between individual elements of the text.
Results: Ten of the 11 participants were female. Four were between the ages of 31-40 years and 7 were
between the ages of 41-60 years. Six held an ASN degree and 5 held a BSN. Seven participants reported
employment at the agency for 18 months to 3 years, and 4 reported 10 or more years. Nine of the nurses
were assigned to the DEU and 2 were not, with 5 of the 11 receiving formal training to be a preceptor.
Three distinct themes emerged: Preceptor Role, Student Role, and Infrastructure (Agency) Role.
Subthemes of barriers and facilitators emerged.
Conclusion: Findings indicate concepts of preceptor, student, and infrastructure role and related barriers
and facilitators should be considered in the development of instruments to assess nurse preceptor
satisfaction. Further barriers and facilitators to these roles should be carefully examined when
implementing programs to increase nurse preceptor satisfaction and retention.
References
Bourbonnais, F. F., & Kerr, E. (2007). Preceptoring a student in the final clinical placement: Reflections from nurses
in a Canadian hospital. Journal of Clinical Nursing, 16(8), 1543-1549. Brammer, J. (2006). A phenomenographic
study of registered nurses' understanding of their role in student learning: An Australian perspective. International
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(2008). Kai Tiaki. Nursing New Zeland(11). Gonda, J., Wotton, K., & Mason, P. (1999). Dedicated Education Units: 2
An evaluation Contemporary Nurse, 8, 172-176. Kaviani, N., & Stillwell, Y. (2000). An evaluative study of clinical
preceptorship. Nurse Education Today, 20(3), 218-226. Lillibridge, J. (2007). Using clinical nurses as preceptors to
teach leadership and management to senior nursing students: A qualitative descriptive study. Nurse Education in
Practice, 7(1), 44-52. Miller, T. (2005). The Dedicated Education Unit. Nursing Leadership Forum, 9(4), 169-173.

Ohrling, K., & Hallberg, I. (2001). The meaning of preceptorship: Nurses' lived experience of being a preceptor.
Journal of Advanced Nursing, 33(4), 530-540. Pappas, S. (2007). Improving patient safety and nurse engagement
with a Dedicated Education Unit. Nurse Leader(6), 40-43. Ranse, K., & Grealish, L. (2007). Nursing students'
perceptions of learning in the clinical setting of the Dedicated Education Unit. Journal of Advanced Nursing, 58(2),
171-179. Stevenson, B., Doorley J., Moddeman, G., & Benson-Landau, M. (1995). The preceptor experience: A
qualitative study of perceptions of nurse preceptors regarding the preceptor role. Journal of Nursing Staff
Development, 11(3), 160-165. Wotton, K., & Gonda, J. (2004). Clinician and student evaluation of a collaborative
clinical teaching model. Nurse Education in Practice, 4, 120-127.
Contact
[email protected]

Learning Needs of Hospitalized Heart Failure Patients in Singapore
Shu Fen Ong, RN, Singapore
Purpose
The purpose of this presentation is to share our research findings on the learning needs of HF patients in
Singapore and to provide practical suggestions about how educational materials can be developed to
meet the needs of HF patients.
Target Audience
The target audience of this presentation are nurses and clinicians who are involved in the care of Heart
Failure patients
Abstract
Purpose: The purpose of the study is to investigate the learning needs of hospitalized HF patients for the
purpose of informing the design of educational material which is tailored for HF patients in Singapore.
The specific objectives of the study are as follows:
(1) To investigate the learning needs of patient with HF in Singapore;
(2) To identify the relationship between patients’ leaning needs and their social-demographic
and clinical characteristics.
Methods: Study Design: A descriptive correlational study with questionnaire survey is used in this project.
Settings and sample: A convenience sample is recruited from an acute tertiary hospital in Singapore. The
inclusion criteria are patients who are as follows: (1) clinically diagnosed with HF, NYHA (New York Heart
Association) classification I to IV; (2) are 21 years of age or older; and (3) are able to communicate in
English and Chinese. The exclusion criteria covers patients with a known history of major psychiatric
illness, terminal illness other than HF and impaired bilateral hearing or vision.
The sample size is determined by the number of participants that are required to maintain the statistical
power for the statistical tests involved, including correlation analysis. To achieve a power of 0.80 at the
5% significance level, the minimum of 85 participants is required (Cohen, 1992).
Data collection: A well-developed instrument, named “Heart Failure Patient Learning Needs Inventory”
(HFLNI), as well as a Chinese version of it (C-HFLNI) is used to investigate the learning needs of patients
with HF. A socio-demographic and clinical data sheet in both English and Chinese was developed to
collect information on the socio-demographic profile and clinical data of study subjects.
The HFPLNI is an instrument modified from the Cardiac Patient Learning Needs Inventory by Wehby and
Brenner (1999). The HFPLNI is a comprehensive instrument for assessing the learning needs of patients
with HF, as recommended by the Agency for Health Care Policy and Research (AHCPR) in the United
States (Yu et al., 2010). The reliability and validity of the scale has been established with Cronbach alpha
0.96 for the total scale and greater than 0.87 for all subscales (Wehby & Brenner, 1999). The C-HFLNI
has established validity, test-retest reliability and internal consistency with a Cronbach’s α of 0.96 for the
total scale and 0.77 and 0.89 for the subscales (Yu et al., 2010).
Data collection procedure: The researchers first identify eligible subjects from the study settings. The
purpose of the study is explained and a Participant Information Sheet, in either English or Chinese is
provided for written reference. The potential subject are given time to consider his/her participation.
Depending on their preferred spoken language, the HFPLNI / C-HFLNI questionnaire are handed to the
participant to collect data on their learning needs. No identifiable information is asked or recorded in the
questionnaire. The demographic information and clinical data are collected by interviewing patients and
reviewing their medical charts upon agreement to participate in the research.

Data analysis: SPSS 20.0 is used for data entry and analysis. Descriptive statistics, including frequency
distribution and central tendency, are used to summarize and describe the learning needs of the subjects.
Bivariate correlation or association between learning needs and the socio-demographic and clinical
variables are estimated by using independent t-test or analysis of variance for nominal variables,
Spearman's rho for ordinal variables and Pearson's correlation for continuous variables.
Results: Data collection is in progress.
Conclusion: The research is in progress. However, the results of this study will provide practical
suggestions about how educational material can be developed to meet the needs of HF patients. The
development of effective educational resources will further enhance Heart Failure Management
Programmes service delivery and contribute to improved health outcomes for HF patients in Singapore.
References
Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98-101. Wehby, D., &
Brenner, P. S. (1999). Perceived learning needs of patients with heart failure. Heart & Lung, 28(1), 31-40. Yu, M.,
Chair, S.Y., Chan, C.W.H., & Liu, M. (2010). Testing the psychometric properties of the Chinese version of the Heart
Failure Learning Needs Inventory. Heart & Lung, 2010, 39(4), 262-274.
Contact
[email protected]

Caring Behaviors, Self-Efficacy, and Their Associations with Job Involvement
Among Nurses
Hsiang Yen, MA, Taiwan
Li-Na Chou, PhD, Taiwan
Miao-Fung Shih, MA, Taiwan
Purpose
The purpose of this presentation is to: 1. Explore caring behaviors and self-efficacy from clinical nurse. 2.
Assess nurse attitudes toward involvement in the job to the employing organization. 3. Examine nurses’
caring behaviors, self-efficacy and their association with job involvement.
Target Audience
The target audience of this presentation is that people in field of specialization and people in fields closely
related to clinical nurse, nurse manager /administrator are worth capturing, because they can have
interesting insights and perspectives about this work.
Abstract
Purpose: Caring behaviors and self-efficacy among nurses may affect the quality of the nursing care they
provide and their intention to quit. The job involvement level of nurses in Taiwan has been reported as
lower than other countries, with over half of nurses self-identified as having contemplated leaving the
nursing profession. Job involvement has great importance and significance in organizational
development. Few studies have collected data regarding the relations among nurse caring behaviors,
self-efficacy, and job involvement. The model was tested using structural equation modeling (SEM) to
evaluate the fit. Four hypotheses were formulated as follows:
H1: The job involvement model has an acceptable goodness-of-fit, confirmed by SEM.
H2: Caring behaviors positively influence self-efficacy.
H3: Caring behaviors positively influence job involvement.
H4: Self-efficacy positively influences job involvement.
Methods: A cross-sectional and correlative research design was used in this study.A total of 405 clinical
nurses at a hospital in Southern Taiwan were recruited, and 338 participants completed the
questionnaire. The response rate was 83.4%.
Results: The ages of the participants ranged from 21 to 55 years. Most of them were single (56.8%).
They had worked for their organization an average of 4.75 years.205 (60.9%) participants completed
university; 298 (88.4%) participants had N2-level positions; and 218 (64.5%) participants had received
continuing education. In their working environments, 36% perceived extremely high work pressure, and
103 (30.5%) perceived high work pressure. The results revealed that the postulated model fit the data
collected in this study. Self-efficacy was no significantly correlated with job involvement. Caring behaviors
were a significant factor predicting job involvement.
Conclusion: Nurses who felt their caring behaviors were recognized and rewarded were likely to be
involved in their workplaces. The results of this study are particularly salient for hospital managers, who
can foster attractive workplaces by deriving gratification from caring for patients and providing support to
nurses, thereby enhancing their involvement in job. It also can play an important role in alleviating the
impending nurse shortage by increasing the job involvement currently in Taiwan healthcare system and
attracting newcomers to the nursing profession.
Contact
[email protected]

First-Time Fathers' Experiences during Childbirth in Taiwan
Wan-Lin Pan, RN, Taiwan
Purpose
The purpose of this presentation is to explore first-time fathers’ experiences during childbirth in Taiwan.
Grounded theory method were used. Six fathers were interviewed after the birth.” Willing to participate in
the birth and support their partner” was the core category for describing and guiding the process of
childbirth.
Target Audience
The target audience of this presentation is midwives, nurses and health care professionals. It is important
for fathers to be prepared and to feel needed, which relevance for professional support. Fathers need to
be knowed, seen and encouraged by healthcare professionals, who have to acknowledge and support
their significant position.
Abstract
Purpose: The purpose of this presentation is to explore first-time fathers’ experiences during their wives'
childbirth in Taiwan.
Methods: This qualitative study was undertaken using a grounded theory approach. We developed a
semi-structured questionnaire for in-depth interviews conducted with 6 participants from hospital.
Constant comparison, theoretical sampling, literature review, member checking and an expert panel were
used to ensure research trust worthiness. A purposive sample of the fathers aged above 21 years who
accompanied their wives throughout childbirth were recruited from the postnatal wards between one to
seven days after the birth of their children.
Results: The theme "Willing to participate in the birth and support their partner” was the core category for
describing and guiding the process of childbirth. During this process, "Mixed feelings",
"healthcare professional needed", "want to guard and support the couple", " the decision to
se epidural analgesia during labor or not " and "long wait times and feeling helpless." was found to affect
the first-time fathers’ significantly. This study discovered that a prevalent lack of a stnadardized protocol
to prepare and support first-time fathers.
Conclusion: Childbirth was experienced as a mutually shared process for the couple. Overall, the fathers
were faced their weak but mixed feelings while striving to participate in the childbirth. Fathers also worry
about the woman and the baby so they need explanations about normal changes as well as possible
complications. It is important for fathers to be prepared and to feel needed, which relevance for
professional support. Fathers need to be knowed, seen and encouraged by healthcare professionals, who
have to acknowledge and support their significant position.
References
1.Alio, A. P., Kornosky, J. L., Mbah, A. K., Marty, P. J., & Salihu, H. M. (2010). The impact of paternal involvement on
feto-infant morbidity among whites, blacks and hispanics. Maternal And Child Health Journal, 14 (5),735–741. 2.Alio,
A. P., Lewis, C. A., Scarborough, K., Harris, K., & Fiscella, K. (2013). A community perspective on the role of fathers
during pregnancy: a qualitative study. BMC Pregnancy & Childbirth,13 (1),1-11. 3. Bäckström, C., & Wahn, E. H. (
2009). Support during labour: First-time fathers’ descriptions of requested and received support during the birth of
their child. Midwifery, 27, 67–73. 4.Barclay, L., & Lupton, D. (1999). The experiences of new fatherhood: a socio-
cultural analysis. Journal of Advanced Nursing, 29, 1013–1020. 5.Bondas-Salonen, T. (1998). How women
experience the presence of their partners at the birth of their babies. Qualitative Health Research, 8 (6), 784-800.
6.Capogna, G., Camorcia, M.,& Stirparo, S.(2007). Expectant fathers’experience during labor with or without epidural
analgesia. International Journal of Obstetric Anesthesia,16, 110-5 7.Chalmers,B., Porter,R., Sheratt,D., Tucker,C., &
Peat,A.(2002). Essential Antenatal, Perinatal and Post-Partum care. Copenhagen: World Health Organization.
8.Chapman,L.L. (1992). Expectant father’s roles during labor and birth. Journal of Obstetric and Gynecologic and
Neonatal Nursing, 21 (2), 114-120. 9.Chin, R., Hall, P., & Daiches, A. (2011). Fathers’experiences of their transition
to fatherhood: A metasynthesis. Journal of Reproductive and Infant Psychology, 29, 4-18. 10.Deave,T., & Johnson,D.

(2008). The transition to parenthood: what does it mean for fathers? Journal of Advanced Nursing, 63, 626–633.
11.Draper,J. (2002). It’s the first scientific evidence: men’s experience of pregnancy confirmation. Journal of
Advanced Nursing, 39, 563–570. 12.Eriksson,C., Westman,G., & Hamberg,K. (2006). Content of childbirth-related
fear in Swedish women and men—analysis of an open-ended question. Journal of Midwifery & Women’s Health, 51,
112–118. 13.Genesoni,L., & Tallandini,M.A. (2009). Men’s psychological transition to fatherhood: An analysis of the
literature, 1989-2008. Birth, 36, 305-318. 14.Ghosh,J.,Wilhelm,M.,Dunkel-Schetter,C.,Lombardi,C., & Ritz, B.(2010).
Paternal support and preterm birth, and the moderation of effects of chronic stress: a study in Los Angeles County
mothers. Archives Of Women's Mental Health,13 (4), 327–338. 15.Hallgren,A.,Kihlgren,M.,Forslin,L., & Norberg,A.
(1999). Swedish fathers’ involvement in and experiences of childbirth preparation and childbirth. Midwifery, 15, 6-15.
16.Hodnett,E.D.(1996). Nursing support of the labor women.Journal of Obstertric and Gynecology, and Neonatal
Nursing, 25, 257-264. 17.Hodnett, E.D. (2002). Pain and women's satisfaction with the experience of childbirth: a
systematic review. American Journal of Obstetrics and Gynecology Gynecol,186 (Suppl),S160-S172. 18.Li, H-T., Lin,
K-C., Chang, S-C., Kao, C-H., Liu, C-Y., & Kuo, S-C. (2009). A Birth Education Program for Expectant Fathers in
Taiwan: Effects on Their Anxiety. Birth, 36 (4), 289-296. 19.Lincoln,Y.S., & Guba,E.G.(1985). Naturalistic inquiry.
Newbury Park, CA: Sage. 20.Liukkonen,A., & Vehvilainen-Julkunen, K.(1997). Fathers’Childbirth Experience and
Nursing Interventions. Hoitotiede,9, 118-126. 21.Ip,W.Y.,Tang,C.S.K.,& Goggins,W.B.(2009). An educational
intervention to improve the women’s ability to cope with childbirth. Journal of Clinical Nursing,18 (15), 2125-2135.
22.Kao,B.C.,Gau,M.L.,Wu,S.F.,Kuo,B.J.,& Lee,T.Y. (2004). A comparative study of expectant parents 'childbirth
expectations. Journal of Nursing Research, 12 (3), 191-202. 23.Keirse,M.,Enkin,M.,& Lumley,J.(1989). Social and
professional support during childbirth. In: Chalmers I, Enkin M, Keirse M (Eds.) Effective Care in Pregnancy and
Childbirth, Oxford: Oxford University Press. 24.McBride, B.A., Brown, G.L., Bost, K.K., Shin, N., Vaughn, B., & Korth,
B. (2005). Paternal identity, maternal gatekeeping, and father involvement. Family Relations, 54, 360-372.
25.Niven,C.,& Gijsbers,K.(1984).Obstetric and non-obstetric factors related to labour pain. Journal of Reproductive
and Infant Psychology, 2, 61-78. 26.Pestvenidze,E., & Bohrer,M.(2007). Finally, daddies in the delivery
rooms:Parent's education in Georgia, Global Public Health, 2(2),169-83. 27.Plantin,L, Olykoya,A.A.,& Ny,P.
(2011).Positive Health Outcomes of Fathers’ Involvment in Pregnancy and Childbirth Paternal Support: A Scope
Study Literature Review. Fathering,9 (1), 87-102. 28.Raynes-Greenow,C.,Roberts,C.,McCaffery,K.,& Clarke,J.(2007),
Knowledge and decision-making for labour analgesia of Australian primiparous women. Midwifery. 23 (2), 139-145.
29.Segal,S.(2010). Labor epidural analgesia and maternal fever. Anesthesia & Analgesia, 111 (6),1467-1475.
30.Strauss,A.C., & Corbin,J.M.(1990). Basic of qualitative research: Grounded theory procedures & techniques.
Thousand Oaks, CA: Sage. 31.Strauss,A.C., & Corbin,J.M. (1998). Grounded theory methodology. In strategies of
qualitative inquiry. London, UK: Sage. 32.Taylor,S.E.,Sherman,D.K.,Kim,H.S.,Jarcho,J.,Takagi,K.,& Dunagan,M.S.
(2004). Culture and social support: Who seeks it and why? Journal of Personality and Social Psychology, 87 (3),
354Y362. 33.Walker,D.S.,Visger,J.M., & Rossie,D. (2009). Contemporary Childbirth Education Models. Journal of
Midwifery & Women’s Health, 54, 469–476.
Contact
[email protected]

Educating Nursing Students to Recognize and Report Negative Behavior in the
Clinical Setting: A Feasibility Study
Florence Schaefer, MS, RN, ACNS-BC, USA
Purpose
The purpose of this study is to determine if senior nursing students who witness negative behavior in a
video simulating a clinical experience setting are able to recognize the behaviors as negative and to
determine if the student would report or ignore the episode of negative behavior.
Target Audience
The target audience of this presentation is all nursing faculty, educators and hospital staff who work with
nursing students in the clinical setting.
Abstract
Purpose: While the clinical rotation provides an essential venue for socialization into the role of the
professional nurse, socialization into a culture of abuse also begins at this time. The term “eating our
young” has terrible connotations. Between 72-100% of students reported witnessing or experiencing
negative behavior (NB). Clinical nurses are frequently identified as a major perpetrator of the NB
experienced by students. Episodes of NB, verbal and physical, are under reported. Reasons for this is
that being a recipient of violence was viewed as being part of the job and the student has a need to fit in.
The research question is: Are senior baccalaureate nursing students who participate in a training program
for recognizing and reporting negative behavior better able to identify and more likely to report incidents
of negative behavior in a clinical simulation exercise than comparable senior baccalaureate nursing
students who participate in a training program that addresses strategies for sleep and shift work? The aim
of the study is to determine if senior nursing students who witness NB in a video that simulates a clinical
experience are able to recognize the NB and to determine if they would report or ignore the NB.
Methods: A mixed method, two groups, randomly assigned, intervention trial will be utilized. The
intervention group which will attend a one-hour training program on recognition and reporting of NB while
the control group will attend a one-hour session on sleep and shift work. Both groups will then view a
simulated NB video and complete the study survey at the conclusion of the video. The independent
variable is the NB training program. The dependent variable is the student’s identification of NB in the
video.
Results: Demographics: No difference found between groups. Nominal and Interval data: Slight statistical
difference found between groups in physical abuse. Both groups were able to recognize the verbal and
physical negative behaviors however neither group identified the subtle/overt negative behaviors.
Emerging themes were developed from the qualitative responses.
Conclusion: Education focusing on the subtle forms of negative behavior and continued need to report
should be incorporated into nursing education curriculum to help break the cycle of violence identified as
“eating our young”.
References
Bradbury-Jones, C., Sambrook, S., & Irvine, F. (2007). The meaning of empowerment for nursing students: A critical
incident study. Journal of Advanced Nursing, 59(4), 342-353. Brothers, D., Condon, E., Cross, B. A., Ganske, K. M.,
& Lewis, E. (2011). Taming the beast of lateral violence among nurses. Virginia Nurses Today. Retrieved from
www.VirginiaNurses.com Brunt. B. (2011). Breaking the cycle of horizontal violence. ISNA Bulletin, Feb, March,
April,2011. Chapman, R., Styles, I, Perry, L, & Combs, S. (2010). Examining the characteristics of workplace violence
in one non-tertiary hospital. Journal of Clinical Nursing, 19, 479-488. Clark, C. M. (2008). The dance of incivility in
nursing education as described by nursing faculty and students. Advances in Nursing Science, 31(4), E47-E54. Clark,
C. M., Farnsworth, J., & Landrum, R. E. (2009). Development and description of the incivility in nursing education
survey. The Journal of Theory Construction and Testing, 13(1), 7-15. Clark, C. M., Olender, L., Cardoni, C, & Kenski,
D. (2011). Fostering incivility in nursing education and practice: nurse leaders’ perspectives. Journal of Nursing

Administration, 41(7), 324-330. Cleary, M., Hunt, G. E., & Horsfall, J. (2010). Identifying and addressing bullying in
nursing. Issues in Mental Health Nursing, 31, 331-335. Crabbs, N.A., & Smith, C. K. (2011). From oppression to
opportunity: eliminating lateral violence and bullying in the workplace. Med-Surg Matters. Retrieved from
www.amsn.org Curtis, J., Bowen, I., & Reid, A. (2007). You have no credibility: nursing students’ experiences of
horizontal violence. Nurse Education in Practice, 7, 156-163. Dellasaga, C. (2009). Bullying among nurses. American
Journal of Nursing, 109(1), 52-58. Einarsen, S. (1999). The nature and causes of bullying at work. International
Journal of Manpower, 20, 16-27. Ferns, T., & Meerabeau, E. (2009). Reporting behaviours of nursing students who
have experienced verbal abuse. Journal of Advanced Nursing, 65(12), 2678-2688. Hertzog, M. A. (2008).
Considerations in determining sample size for pilot studies. Research in Nursing and Health, 31(2), 180-191. Hewett,
D. (2010). Workplace Violence Targeting Student Nurses in the Clinical Areas. (Master’s thesis) Retrieved from
http://scholar.sun.ac.za/handle/10019.1/5183 Hinchberger, P. A. (2009). Violence against female nursing students in
the workplace. Nursing Forum, 44(1), 37-46. Iennaco, J, D., Dixon, J., Whittemore, R., and Bowers, L. (2013).
Measurement and monitoring of health care worker aggression exposure. The Online Journal of Issues in Nursing,
18(1). Johnston, M., Phanhtarath, P., & Jackson, B. S. (2010). The bullying aspect of workplace violence in nursing.
Critical Care Nursing Quarterly, 12(2), 36-42. Lammers, W. J., & Badia, P. (2005). Fundamentals of Behavioral
Research. Belmont, California: Thomson Wadsworth. Lindsey, P. L., & Jenkins, S. (2013). Nursing students’ clinical
judgment regarding rapid response: the influence of a clinical simulation education intervention. Nursing Forum,
48(1), 61-70. Longo, J. (2007). Horizontal violence among nursing students. Archives of Psychiatric Nursing, 21(3),
177-178. Longo, J. (2010). Combating disruptive behaviors: strategies to promote a healthy work environment. The
Online Journal of Issues in Nursing, 15(1), manuscript 5. Lovell, A., Skellern, J., and Mason, T. (2011). Violence and
under-reporting: learning disability nursing and the impact on the environment, experience and banding. Journal of
Clinical Nursing, 20, 3304-3312. Magnavita, N. & Heponiemi, T. (2011). Workplace violence against nursing students
and nurses: an Italian experience. Journal of Nursing Scholarship, 43(2), 203-210. Namie, G. (2010). The WBI U.S.
workplace bullying survey, Retrieved March 10, 2012 from http://bullyinginstitute.org/res/WBIsurvey2010.pdf Pallant,
J. (2007). SPSS Survival Manual. (3rd ed.). New York, New York: McGraw-Hill Peabody, J. W., Luck, J. Glassman,
Dresselhaus, T. R., & Lee, M. (2000). Comparison of vignettes, standardized patients, and chart abstraction. JAMA,
283(13), 1715-1722. Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for
nursing practice (9th ed.). Philadelphia: Lippincott, Williams & Wilkins. Rowell, P. (2005). Being a "target" at work: Or
William Tell and how the apple felt. Journal of Advanced Nursing, 35, 377-379. Sauer, P. (2012). Do nurses eat their
young? Truth or consequences. Journal of Emergency Nursing, 38(1), 43-46. Thomas, C. M. (2010). Teaching
nursing students and newly registered nurses strategies to deal with violent behaviors in the professional practice
environment. The Journal of Continuing Education in Nursing, 41(7), 299-308. Thomas, S. P., & Burk, R. (2009).
Junior nursing students’ experiences of vertical violence during clinical rotations. Nursing Outlook, 57(4), 226-231.
Urbaniak, G. C. and Plous, S. (2013). Research Randomizer, Social Psychology Network. Retrieved from
http://www.randomizer.org/ Vallant, S., & Neville, S. (2006). The relationship between student nurse and nurse
clinician: Impact on student learning. Nursing Praxis in New Zealand, 22(3), 23-33. Waltz, C. F., Strickland, O. L., &
Lenz, E. R. (2010). Measurement in Nursing and Health Research. (4th ed.). New York, NY: Springer. Yamada, D. C.
(2008). Workplace bullying and ethical leadership. The Journal of Values Based Leadership, 1(2), 48-59.
Contact
[email protected]

Removal of Mechanical Ventilator on a Patient of ALS
Ying-Chin Lu, RN, Taiwan
Kuan-Ting Chen, RN, Taiwan
Purpose
The removal of ventilation and the palliative hospice care during the final stages of ALS are discussed
thoroughly in laws, ethics and emotions in this case report.
Target Audience
Physician.Nurse.Medical staff
Abstract
Purpose: In this case, the patient with ALS in the final stages had a respiratory problem in our hospital. A
tracheal intubation is performed for applying ventilation in the intensive care unit to avoid his respiratory
failure. Knowing that although mechanical ventilators can prolong survival, it does not provide life quality
and dignity, the patient decided to not have a tracheostomy. He requested for removing ventilation and
moved into palliative care unit for ventilation removal the next day. The removal of ventilation and the
palliative hospice care during the final stages of ALS are discussed thoroughly in laws, ethics and
emotions in this case report.
To the principle of medical ethics and hospice care, be discussed in Helping a Patient with Amyotrophic
Lateral Sclerosis (ALS) in the Final Stages to Remove Mechanical Ventilation.
Methods: This research adopts purposive sampling and qualitative research, including deep interview
method, observation method, and literature survey method . In this study, the medical ethical principle
of "The Principle of Autonomy," The Principle of Nonmaleficence "," The Principle of Beneficence", " The
principle of justice", be discussed in Helping a Patient with Amyotrophic Lateral Sclerosis (ALS) in the
Final Stages to Remove Mechanical Ventilation.
Results: Under the principle of the pursuit of patients with active hospice care, the health care workers,
chaplains, social workers, family members, etc., according to law, management, emotional level to a
comprehensive discussion, also sought order to many related hospice expert advice, and finally based
hospice Ordinance removal the patient's respirator, respecting the wishes of the case, so the case can
have the dignity of life and fulfill my wish, and Enron's gone, this is the ultimate goal of hospice care.
Conclusion: It is getting before a final withdrawal in patients with ventilator. After the end of the process
of hospice care in the legal, ethical on all levels have reached emotional finest successful draw the
sentence points, hospice medical team also learn from this case to care for a lot of valuable experience.
References
1. Lisa Schwartz FMedical
-109. 2. ethics F a case ba
Raanan Gillon F Philosophical
-73. 3. Tony medical ethics .Docters
Hope FMedical ethics and l
aw FThe
-51 4. core curriculum .Eth
Gregory E. Pence -FClassic cases in m
57.
Contact
[email protected]

The Factors Influencing the Self-Care and Quality of Life of Patients with
Coronary Artery Disease
Suthanithi Kangchanakul, RN, BNS, Thailand
Aem-orn Saengsiri, RN, APN, PhD, Thailand
Duangkamol Wattradul, RN, DNS, Thailand
Purpose
The purpose of this presentation is sharing the selected factors influencing self-care and quality of life of
patients with coronary artery disease.
Target Audience
The target audience of this presentation is cardiovascular nurses.
Abstract
Purpose: Coronary artery disease (CAD) is the most common cause of death in Thailand. The patients
with CAD need long-term care to enhance their quality of life. This study was aimed at exploring the
selected factors influencing self-care and quality of life (QOL) of patients with coronary artery disease.
Methods: Purposive sampling of 100 patients with CAD receiving care at King Chulalongkorn Memorial
Hospital was enrolled in this study. Data were collected by using the self-care agency questionnaire of
cardiovascular disease, and Powers’ Quality of Life Index Cardiac Version-IV. Data were analyzed by
using descriptive statistics and multiple regression.
Results: On hundred patients (30 females, 70 males; Mean age 65.13 years) participated in this project.
The self-care agency of patients with CAD was at a moderate level at 70.43% (Mean = 76.07, SD. =
9.84). The QOL of patients with CAD was also at a moderate level at 76.86% (Mean =23.06, SD. = 4.89).
The independent variables influencing the QOL of patients with CAD were educational level, exercise,
and self-care agency, with a statistically significant predictor at 46 percent (p< .05).
Conclusion: Education level, exercise, and self-care agency were more useful predictors in increasing
the QOL of patients with CAD. The evidence from this study supports healthcare providers in terms of
their ability to improve the self-care capacity of patients with CAD by developing health promotion
programs for improving the quality of life of patients with CAD.
Contact
[email protected]

Effects of Cinenurducation Based on Kolb's Experiential Learning Theory Model
for Understanding Child Growth and Development
Jina Oh, RN, PhD, South Korea
Mihae Im, BSN, RN, South Korea
Hyerin Roh, PhD, MD, South Korea
Purpose
to develop and to evaluate effects of a cinenurducation (i.e. nursing education using cinema) based on
Kolb’s ELT Model for first-year nursing students in a private research university located in Busan, South
Korea.
Target Audience
nurse educator and nursing students
Abstract
Purpose: Kolb (1984)’s Experiential Learning Theory Model [Kolb’s ELT Model] sets out four distinct
learning styles since it offers both a way to understand individual people’s different learning styles
including diverging, assimilating, converging, and accommodating, and also an explanation of a cycle of
experiential learning including concrete experience [CO], reflective observation [RO], abstract
conceptualization [AC], and active experiment [AE] that applies to us all. The purpose of this presentation
is to develop and to evaluate effects of a cinenurducation (i.e. nursing education using cinema) based on
Kolb’s ELT Model for first-year nursing students in a private research university located in Busan, South
Korea.
Methods: Using case study eight-two nursing freshmen participated in human growth and development
course in the 2013 spring semester. In each class, participants watched film (CE), participated in think
pair share (RO), synthesized from educator’s lecture (AC), and wrote a composition (AE) based on Kolb’s
four learning stages. After class 74 participants (90.2%) filled out a questionnaire to analyze satisfaction
of cinenurducation according to students’ learning style and learning content, and open-ended survey to
find merits and demerits of cinenurducation.
Results: This study showed high satisfaction of cinenurducation regardless of learning type (F=0.17,
p=.913) including Diverger, Accomodator, Converger, and Assimilator, and content concerning child
growth and development (F=1.24, p=.302) including Infant, Toddler, Preschooler, Schooler, and
Adolescent stage. Advantages of cinenurducation included it being “fun and interesting,” “helpful to
understand the characteristics of children,” and “develop critical thinking through discussions.”
Disadvantages included “long time needed,” and “burdensome.”
Conclusion: Films are advantageous in that they provide indirect experience for nursing students.
Selection of appropriate films and evaluation of learning goal achievements are important to maximize the
effectiveness of cinenurducation.
References
Kolb, D. A. (1984). Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs,
NJ: Prentice-Hall.
Contact
[email protected]

Self Governance Increases Staff Morale
Ron Billano Ordona, RN, MSN, FNP, USA
Purpose
The purpose of this presentation is to highlight how float staff self governance council promoted
framework for unit identity and improvement of staff competency resulted in higher than benchmark staff
morale and commitment in 2012 Morehead Survey. Peer Advocacy Leadership Support (Pals) program
enhanced assimilation of new hires.
Target Audience
The target audience of this presentation are clinical and administrative groups; both on the nursing
personnel and hospital administration roles.
Abstract
Purpose: The University of California, Davis Medical Center (UCDMC) Patient Care Resources (PCR)
staff is in a unique position because they float into different specialty units and assume care of patients in
diverse settings.
Through a survey, staff identified need for consistent peer support and training to improve competency
and proficiency in delivery of patient care.
The goals of the unit based practice council (UBPC), a professional governance unit of the department,
included (1) promotion of a framework for unit identity; and (2) improvement of staff level of competency
and proficiency in the delivery of patient care.
Methods: To promote a framework for unit identity:
• Implement and maintain the Peer Advocacy Leadership Support (Pals) program, promoting peer
support of new hires.
o Match new hires each month with volunteer peers of the department.
o Manage the Pals program by making personal contact with participants.
o Provide pre and post surveys to measure effectiveness of the program.
o Collect, review, and disseminate data findings.
o Highlight staff accomplishments and achievements on the department website
o Promote department bonding through:
 Annual celebration for staff that graduates (i.e., Bachelor's, Master's; NPs, and the
like).
 Annual summer get-together.
 Annual holiday
• To promote competency and proficiency in the delivery of patient care:
o Support skills day (in conjunction with unit administration)
o Promote and expand use of PCR department website as a means of communication among
staff
o Improve communication between leadership and staff by creating a centralized department
email
o Improve divisional information dissemination through unit council participation
Results: Staff morale and commitment in the department is high as shown by the 2012 Morehead Survey
results. PCR staff excels above benchmark (as compared to the medical center-wide score) in all of the
domains measured.
PCR staff demonstrated excellence in three different domains: (from a scale of 1 as lowest to 5 as
highest): organizational 4.25 vs. 3.9 benchmark; manager 4.37 vs. 3.98 benchmark; employee 4.33 vs.
4.03 benchmark; and commitment 4.59 vs. benchmark 4.24 indicators.

New hires expressed that peer support enhanced their assimilation into the department. More than 50%
of new hires completed the 12-month Pals program. Staff reported an increased sense of unit identity via
survey data collected from the PCR Pals program post-survey.
Conclusion: Self-governance results in high morale and fosters a stronger commitment among staff of a
float pool department. Peer support and communication are effective avenues to achieve a strong sense
of unit identity despite the challenges of a unique department such as the float pool.
References
2012 Morehead Survey results, UC Davis Medical Center, Sacramento, CA © 2013 Press Ganey Associates, Inc.
Contact
[email protected]

The Risk Factors of Unplanned Endotracheal Extubation in Adult Intensive Care
Unit
Pei-Chen Huang, RN, Taiwan
Hui-Ting Kuo, RN, Taiwan
Yu-Ching Yang, RN, Taiwan
Purpose
To investigate the risk factors of unplanned endotracheal extubation in the intensive care Unit.
Target Audience
clinicians,pharmacists,nurses,physician assistants,and other allied health
professionals,researchers,health educators
Abstract
Purpose: Unplanned extubation (UEE)is a frequent problem in the intensive care unit and represents an
adverse event. It increases morbidity in the intensive care unit (ICU) resulting in prolonged hospital stays
and increased costs.To investigate the risk factors of unplanned endotracheal extubation in the intensive
care Unit.
Methods: We collected 106 unplanned self-extubation cases for this study from January 2011 to
December 2012. in a medical center at southern Taiwan . The contents included patients’ characteristics,
unplanned tubing removal situation.
Results: The results show: (1) 106 patients occurred of unplanned endotracheal extubation in the year of
2011 and 2012. (2) The rate in man was higher than in woman, which mostly was distributed in the
patients with the age over 70. The frequency (41.5%) in the nursing of day shift was highest than others..
Unplanned extubation was happend during on duty before and after work one hour(21.6%). Over half of
them were been restrained inappropriately .29.4% UEE patients during mouth care . After unplanned
endotracheal extubation, 50.9% self-extubation patients needed to be re-intubated..
Conclusion: The concluded factors in unplanned endotracheal extubation could be used in improving
quality control of medical administration, clinical practice, and nursing education.
References
Leape LL. Institute of Medicine medical error figures are not exaggerated. JAMA 2000;284(l):95-97. Donchin Y,
Seagull FJ. The hostile environment of the intensive care unit. Curr Opin Crit Care 2002;8(4):316-320. Hendrikse KA,
Gratama JW, Hove W, Rommes JH, Schultz MJ, Spronk PE. Low value of routine chest radiographs in a mixed
medical- surgical ICU. Chest 2007;132(3):823-828.
Contact
[email protected]

The Effects of E-Health Management for Weight Control and Metabolic Syndrome
Abnormalities in Adolescent Girls
Mei-Chen Su, PhD, Taiwan
Lee-Ing Tsao, DNSc, Taiwan
Purpose
The purpose of this study investigated the effects of a 6-month health management platform with Internet-
based intervention in overweight adolescent girls in Taiwan.
Target Audience
The target audience of this presentation is interested about E-health management and adolescent girls
health promotion.
Abstract
Purpose: Obesity is increasing at an alarming rate among adolescents. Previous studies have shown
that lifestyle modification and weight control can improve all of the metabolic risk factors associated with
obesity. Adolescent girls are more likely than boys to have sedentary lifestyles, low levels of physical
activity, unhealthy weight-control behaviours, and disordered eating behaviours. The purpose of this
study investigated the effects of a 6-month health management platform with Internet-based intervention
in overweight adolescent girls in Taiwan.
Methods: After IRB approval, a longitudinal approach and repeated testing using a quasi-experimental
design to evaluate the follow-up outcomes of the e-heath management platform intervention for 137
overweight adolescent girls at two nursing colleges with 5 years associated program. The intervention
group (n=62) which were completed 6-month health management platform with Internet-based
intervention, consisting of 150+ minutes of regular exercise per week; increasing fruit and vegetable
intake to 5+ servings per day; decreasing total fat to <30% of total calorie consumption, tailored graphical
feedback was provided; one-on-one psychobehavioral counseling based on constructs from the
Transtheoretical Model, and peer-group support, reminder system also included. Participants in the
control group (n=75) received the typical health education provided in schools. All participants completed
anthropometric and metabolic measures including BMI, waist circumference, BP, HDL, triglyceride and
fasting glucose at both the baseline, 3-month and 6-month stages. SPSS version 18.0 software was used
to compile and analyze the research data. Descriptive statistics, the chi-squared test, Student t test, and
generalized estimating equations were used during analysis.
Results: The results showed that 3 months after the intervention began, the experimental group
demonstrated significant improvements (β = -0.436, p = .004) compared with the results of the control
group. Improvements were exhibited in the following risk factors for metabolic syndrome: the body mass
index (BMI), waist circumference measurements, HDL levels, and systolic and diastolic blood pressure
results. In addition, these outcomes remained statically significant 6 months after the intervention began.
Six months after the intervention began, the following intervention outcomes were observed: a decline in
fasting blood glucose levels (β = -7.174, p < .001). On average, the body weight of the experimental
group than the control group in the 3-month decreased 2.146 Kilogram, in the 6-month decreased 2.460
Kilogram, the results were statistically significant (p <.05). The frequency of using the food and exercise
diaries was negatively correlated to changes in the risk factors for metabolic syndrome (i.e., BMI and
waist circumference measurements and triglyceride levels), but was positively correlated to changes in
HDL levels. The frequency of using the website was negatively correlated to changes in the risk factors
for metabolic syndrome (i.e., waist circumference measurements and systolic blood pressure and
triglyceride levels).
Conclusion: The 6-month health management platform with Internet-based intervention had positive
effects on reserve the markers of metabolic syndrome in overweight adolescent girls. By using the
Internet, which is not bound by time and space, this model is the most effective self-health management

method for young people. Continued follow up may be required for long-term maintenance in lifestyle
behavior change.
References
Hobbs, R., Broder, S., Pope, H., & Rowe, J. (2006). How adolescent girls interpret weight-loss advertising. Health
Education Research, 21(5), 719-730. doi: 10.1093/her/cyl077 Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M.,
& Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. The Journal
of American Medical Association, 303(3), 242-249. doi:10.1001/jama.2009.2012 Shaw, K. A., Gennat, H. C.,
O'Rourke, P., & Del Mar, C. (2006). Exercise for overweight or obesity. Cochrane Database Systematic Review, 4,
CD003817. doi:10.1002/14651858.CD003817.pub3
Contact
[email protected]

Home Visit Nurse's Thoughts for Complementary and Alternative Medicine (CAM)
in Japan
Atsuko Tokushige, RN, PHN, PhD, Japan
Sayuri Tanaka, RN, PHN, MSN, Japan
Purpose
The purpose of this presentation is to verify home visit nurse’s thoughts for complementary therapy to get
a suggestion for the CAM spread in Japan.
Target Audience
The target audience of this presentation is home visit nurses and practitioners of complementary
therapies.
Abstract
Purpose: In Japan, complementary and alternative medicine (CAM) of knowledge and skills of the visiting
nurses is required with the spread of palliative care due to an increase in cancer sufferers and
complication of the disease structure in aging.
In the report of the group "Research on Complementary and Alternative therapy of cancer in our country"
in the Ministry of Health, Labour and Welfare grant-in-aid for cancer research, for the use in the medical
field, that 44.6% of cancer patients are using one or more types of CAM has been reported 1). This study
is a thing of health care facilities, it would likewise be utilized from the hospital is considered to be people
who were using the CAM in the medical facility needs of CAM in cancer patients to medical treatment at
home is to be higher is presumed.
For CAM use of home care's, it has been reported per 1,000 medical users, 49 people and are using
CAM 2). Also, in the survey of the general public, utilization of CAM has been reported 65% in 1999, 68%
in 2005 3).
From these facts, it is considered that the need for CAM implementation of the visiting nurse is high, but
the fact-finding of the CAM practice of the home visit nurse has not been carried out until now. Therefore
we randomly selected approximately 30% of stations in Japan (1,700 facilities) and performed the mail
investigation into questionnaire. As a result, it was revealed that only approximately 30% of temporary
nursing at home stations practiced CAM 4).
Therefore, using our findings, it was intended to get a suggestion for the CAM spread in Japan in this
study and analyzed it using technique of the text mining about the reason that did not carry out CAM.
Methods: 1. The subject and data collection method
1) Study1
We randomly selected approximately 30% of stations in Japan (1,700 facilities) and performed the mail
investigation into questionnaire. Among 1,687 facilities which excluded the place where there was the
communication such as the facilities closedown, it was collected from 381 facilities (22.6% of recoveries).
About 247 facilities that answered them, that it has not been performed CAM, it was the object of
analyzing the reason for not implementing the CAM portion of the free described.
2) Study2
We carried out semi-structured interviews for the veteran nurse practitioners about thoughts for CAM. She
has 30 years nurse career and nine years experience of visiting nurse.
2.Data analyses
1) Study1

About a free mention about reason which did not practice CAM, we analyzed it using technique of the text
mining. We assumed the lower limit of the appearance frequency ten times. The software which we used
is SPSS Analytics for Surveys 4.0.
2) Study2
“How did you incorporate CAM in nursing care" "How can we do to go spread the CAM" and "CAM needs
of the patient and family", we carried out semi-structured interviews. The transcript verbatim record by
recording, for talking of nurses, they were analyzed using the technique of text mining interview. We
assumed the lower limit of the appearance frequency twenty times. The software which we used is SPSS
Analytics for Surveys 4.0.
3) Ethical considerations
This research got the approval of the Ethical Review Board of the university where a researcher belonged
to. For the interview, we explain in writing and verbally that research aims, methods, research
cooperation are arbitrary, that there is no disadvantage of participation refusal, that the withdrawal of
study participants is also possible, to protect the privacy. It was performed on with the consent.
Results: 1) Study1
The extracted category were [Knowledge], [Time], [Skill], [Staff], [CAM], [Understanding], [Patients-
, [Practice],[Need].
The <lack of knowledge> and the <there is no way to learn> were included in the [Knowledge]. The < do
not have time to study> and the <there is no time to perform the CAM to visit nursing time> were included
in the [Time]. The < skill shortages> was includes in the [Skill]. The <lack of staff> and the <knowledge
and skill shortage of staff> were included in the [Staff]. The < I do not know the CAM> and the <I first
heard the term CAM> were included in the CAM]. The <difficult to obtain an understanding of the staff>,
the <difficult to obtain an understanding of the attending physician> and the <it is difficult to obtain an
understanding of the family> were included in the [Understanding]. The <it is difficult to obtain an
understanding of the patient > and the < It is necessary to have a patient purchase aroma oil > were
included in the [Patients-. The <It is difficult to do > was included in the - [Practice]. The <r
skill > and the < need for permission from a boss> were included in the [Need].
2) Study2
The extracted category were [I-Myself], [Doctors], [Patients],[Nursing Care].
The < I also healed> and the <I think that it boost the immune system> were included in the [I-Myself].
The <doctors believe that they can not do anything to the patient> and the <patient rejoice doctor just to
home visit > were included in the [Doctors]. The <patient's happiness> and the <be taught from patients>
were included in the [Patients]. The < care to make use of natural healing power in to the maximum> and
the <our care> were included in the [Nursing Care].
Conclusion: In this research, reasons of the home visit nursing station which did not practice CAM
included lack of [Knowledge] , [Time], [SKill], were able to extr
getting understanding of the staff of the station and the understanding of the governing body of the
station. In addition, from the narrative of visiting nurse veteran, it has been found and that it has
implemented care while being healed, that the joy of the patient is in the motivation of practice.
In Japan, we cannot get the knowledge about CAM in the school education. Because knowledge and the
technical acquisition are left to nurse oneself, it is thought that the difference of a person with knowledge
and a technique and the person who do not have is very large. What is adopted in a curriculum of the
school education is desirable to diffuse CAM in a visit nurse, but it is difficult under the present
conditions. We thought that it is important to make an opportunity of the learning to the managers of the
home visit nursing station at first. But, there is a big issue that who performs it and how to make a
opportunity to learning. We think that it is necessary to cooperate with the College of Nursing which can
teach CAM and professional organizations such as the Japanese Nursing Association.
References

1) Hyodo I, et al. FNationwide Surve
Clin Oncol, 2005,23(12) ,2645
-2654 2) Fikui T, et al. FThe
Care inEcology of Medical
Japan. JMAJ,
2005 ,48(4),163
-167 3) Imanishi J et al. FC
omplementary and alternative medicine for health care workers
current situation and problems at home and abroad of complementary and alternative therapies, Jiro Imanishi eds,
KimuKaoru- do, Kyoto,2009,9-22 4) Tokushige A and Tanaka S:The current situation of practice of Complementary
and Alternative Medicine (CAM) in home-visit nursing. JJIM, 2013,6(1),83-92
Contact
[email protected]

Successful Strategies for Recruiting Low-Income Minority Group Women in a
Community-Based Health Promotion Program
Adejoke B. Ayoola, PhD, RN, USA
Gail Landheer Zandee, MSN, RN, USA
Laura Schipper, BSN, RN, USA
Kendra Pennings, USA
Purpose
to describe the strategies that were successful in recruiting low-income minority women into a community-
based health promotion program.
Target Audience
Nurses and other health professionals who are interested in learning about successful strategies that
were successful in recruiting low-income minority women into a community-based health promotion
program.
Abstract
Purpose: Low-income and minority groups need to be well represented in health promotion studies so as
to identify and address the existing health disparities in the U.S. However, studies have shown that it is
challenging to successfully recruit low-income and minority groups into a study. The purpose of this study
is to describe the strategies that were successful in recruiting low-income minority women into a
community-based health promotion program.
Methods: This is a simple descriptive study where women were asked during a pre-intervention
screening survey about how they learned about the study. Univariate and bivariate analyses were
conducted using STATA 10.
Results: Sixty-one (43%) of the 141 women were African American, 38% were Hispanic, and 15% were
White. The women were 18 to 55 years of age (mean =31 years), 73% had household income less than
$20,000.00. Most of the recruitment was done through community health workers (28.4%) and flyers
distributed from house to house in the neighborhoods (27.7%). Fifteen percent of the women heard about
the study through community-based agencies. The most successful means of recruitment among African
American was through the community health workers, and through flyers distributed in the neighborhoods
for Hispanic and White women
Conclusions: Partnership within the neighborhoods through active involvement of resident community
health workers and local agencies are successful means of recruiting low-income women from ethnic
minority group into a community-based health promotion program.
References
Yancey, A. K., Ortega, A. N., & Kumanyika, S. K. (2006). Effective recruitment and retention of minority research
participants. Annual Review of Public Health, 27, 1–28. doi:10.1146/annurev.publhealth.27.021405.102113
Contact
[email protected]

The Effects of an Oral Care Program on Oral Health of Institutionalized Elderly
Chia-Chi Chang, PhD, RN, Taiwan
Jih-Hsuan Wu, RN, MS, Taiwan
Purpose
The purpose of this study was to develop an oral care program and to examine the effects of this program
among institutionalized elderly
Target Audience
The targe audience of this presentation is anyone who are intested in oral and nutrition issues.
Abstract
Purpose: Institutionalized elderly overlooked the oral care because of multiple chronic diseases and
decline self-care skills, impact the oral health quality of life, oral health status and nutritional status,
resulting in oral-related diseases. There are few oral care program interventions. The purpose of this
study was to develop an oral care program and to examine the effects of this program among
institutionalized elderly.
Methods: This was a quasi-experimental study. Fifty-five convenience subjects were recruited from two
northern long-term care facilities, randomly assigned to the experimental group (n = 24) and the control
group(n = 30). The experimental group received four weeks of oral health programs, the control group
received routine oral care. Data were collected pre- and post-tests including demographic variables,
general health status, subjective oral health status, and objective oral health status. Subjective oral health
status was measured by Oral Health Impact Scale -14 (OHIP-14) and objective oral health status were
measured by plaque status and oral health assessment tool (OHAT). The data were analyzed by SPSS
19.0 for Windows.
Results: The study results showed that the experimental group had improve significantly with OHAT
results (F = 21.094, p <.01), plaque status (F = 4.438, p <.05),and reduce the feeding time (F = 5.372, p
<.05).
Conclusion: Therefore the oral care program should be recommended in the future in long-term care
facilities in order to promote the oral health and improve the quality of life.
Contact
[email protected]

Exploration of Factors Influencing Sleeping Quality Among College Nursing
Students in Taiwan
Tz-Ling Fu, BS, Taiwan
Wei-Yu Chen, BS, Taiwa
Tsai-Tzu Yi, BS, Taiwan
Yang-Jing Ru, BS, Taiwan
Chi-Yun Cheng, BS, Taiwan
Zhang-Ya ‚Gan, BS, Taiwan
Purpose
The purpose of this presentation is to explore the factors of leading to poor sleep quality among nursing
college students in Taiwan.
Target Audience
nursing students, nursing teachers, clinical nurses
Abstract
Purpose: Sleep is one of the human physiological needs. Sleep can promote personal health and
provide the best physical and mental functions for human bodies. Recently we discovered that nursing
college students in Taiwan are often lethargic and dozing in the classroom. Therefore, the study explored
the factors of leading to poor sleep quality among nursing college students in Taiwan.
Methods: In this study, the Pittsburgh Sleep Scale (Pittsburgh Sleep Quality Index, PSQI) was used to
investigate the sleep quality among third year nursing students in Taiwan.
Results: total of 100 questionnaires were issued. There are 94 valid questionnaires.
There were 86 % of female, and 14% of male participants in this study. The average age was 20 years
old.
The studies showed that the main factors of causing poor sleep quality among nursing college were
Internet use. Nursing college students used social networking all night in talking to friends which leaded
to emotional dependent and stay up late.
In terms of quality of sleep, there were 67 nursing students (71.3%) indicating poor sleep quality (PSQI
score>= 5), and results showed that their sleeping time was between 12am to 2am. There were no
significantly between male and female.
Conclusion: In order to improve the quality of sleep, we hoped to enhance good lifestyle and good sleep
habits among nursing college students. We recommended for proper time arrangements at homework
and lifestyle; and taking regular exercise each day.
References
The Pittsburgh Sleep Quality Index. (1989). Psychiatry Research, 28(2),193-213.
Contact
[email protected]

Asian-American Midlife Women's Physical Activity and Their Relationships to
Sleep-Related Symptoms
Youjeong Kang, MPH, CCRN, USA
Ok Kyung Ham, PhD, RN, South Korea
Yaelim Lee, MSN,RN, USA
Wonshik Chee, PhD, USA
Helen Teng, MSN,CRNP, USA
Purpose
The purpose of this presentation is to explain sleep-related symptoms that Asian American midlife women
experience during their menopausal transition and the relationships between their physical activity and
sleep disturbances.
Target Audience
The target audience of this presentation is researchers who are interested in cultural diversity health
behaviors.
Abstract
Purpose: Midlife women are reportedly experiencing a set of symptoms during their menopausal
transition as their estrogen declines (Avis et al., 2001). The symptoms include both physical and
psychological symptoms, and sleep difficulties are one of the physical symptoms that midlife women are
frequently experiencing (Avis et al., 2001). Indeed, the National Library of Medicine (2013) reported that
about 16% to 42% of premenopausal women and 35% to 60% of postmenopausal women experience
sleep-related symptoms during their menopausal transition. Physical activities reportedly improve the
sleep disturbances experienced by midlife women in the menopausal transition (Mansikkamäki et al.,
2012). However, the findings on the association between physical activity and sleep disturbances
reported in the literature are inconsistent. Some reported that sleep problems were positively correlated
with high exercise or leisure time physical activity (Tu et al., 2012). Others reported that physical activity
negatively influences sleep problems, subsequently improving sleep quality of midlife women (Tworoger
et al., 2003). Occupational physical activity was positively related to increased rates of moderately poor
sleep quality, but women with moderate physical activity were less likely to experience sleep problems
(Soltani et al., 2012). However, no statistically significant association of physical activity and sleep
disturbances was also reported (Casas, Pettee Gabriel, Kriska, Kuller, & Conroy, 2012).
When race/ethnicity is considered in determining the relationship between physical activity and sleep, the
relationship gets more complicated. A large number of studies reported racial/ethnic differences in
physical activity (Centers for Disease Control and Prevention, 2008; Whitt, DuBose, Ainsworth, & Tudor-
Locke, 2004), but few studies reported racial/ethnic differences in sleep-related symptoms that midlife
women experience during their menopausal transition (Ramos et al., 2011). Subsequently, very little is
still known about the relationships between physical activity and sleep-related problems in ethnic minority
midlife women including Asian American midlife women. Thus, the purpose of this study is to explore
sleep-related symptoms that Asian American midlife women experience during their menopausal
transition and determine the relationships between their physical activity and sleep disturbances while
considering other influencing factors.
Methods: This was a secondary analysis of the data from a larger study on midlife women’s attitudes
toward physical activity. Only the data on 123 Asian American midlife women were included for this
secondary analysis. The instruments included questions on background characteristics and health and
menopausal status, the Sleep Index for Midlife Women (SIMW), and the Kaiser Physical Activity Survey.
The SIMW was derived from the Midlife Women’s Symptom Index (MSI) (Im, 2006). The SIMW is a 24
item sub-scale of the MSI to measure sleep-related symptoms, and the individual item of the SIMW
includes two parts: (a) symptom prevalence part using dichotomous scale (1 = yes; 0 = no) and (b)

symptom severity part using 6-point Likert scale (0 = no symptom; 5 = extremely). The Cronbach's alpha
for the SIMW was .89 in this study. The KPAS (Ainsworth, Sternfeld, Richardson, & Jackson, 2000)
includes four subscales on household/caring index, occupational index, active living index, and
sports/exercise index, and each item is a 5-point Likert scale. The Cronbach's alpha for the KPAS was
.84 in this study. The data were analyzed using descriptive statistics and inferential statistics including
correlation and hierarchical multiple regression analyses.
Results: There were significant correlations between the three subscale scores of physical activity
(household activity [r=.24, p<.01], occupational activity [r=.24, p<.01], and active living activity [r=-.18,
p<.05]) and the total number and total severity of sleep-related symptoms. When controlling other
influencing factors, only household activity (β=1.94, p<.05) and active living activity (β=-2.3, p<.01)
significantly contributed to the total variances in total number of sleep-related symptoms (R2=.09, p<.01).
The only other significant predictor of the total number of sleep-related symptoms among Asian American
midlife women was perceived general health (β=-1.99, p<.01).
While household activity and occupational activity are positively related to the sleep-related symptoms,
only active living activity is negatively related to sleep-related symptoms. In other words, some physical
activity such as household activity and occupational activity could increase sleep-related symptoms
during menopausal transition. This finding agrees with some previous studies that reported negative
influences of occupational physical activity on the quality of sleep (Soltani et al., 2012). Health care
providers need to consider in their research and practice that increasing active living activity (leisure-time
physical activity) would improve Asian American midlife women’s sleep-related symptoms, but increased
household activity and occupational activity could be detrimental to sleep-related symptoms.
Conclusion: Considering the inconsistent findings on the relationships between physical activity and
sleep problems in the literature, further studies on sleep problems experienced by midlife women need to
be conducted while considering different types and amount of physical activity.
Acknowledgement: This analysis was conducted as a part of a larger study funded by NIH/NINR
(1R01NR010568-01) entitled "Ethnic-Specific Midlife Women's Attitudes Toward Physical Activity.”
References
Ainsworth, B. E., Sternfeld, B., Richardson, M. T., & Jackson, K. (2000). Evaluation of the kaiser physical activity
survey in women. Medicine and Science in Sports and Exercise, 32(7), 1327–1338. Avis, N. E., Stellato, R.,
Crawford, S., Bromberger, J., Ganz, P., Cain, V., & Kagawa-Singer, M. (2001). Is there a menopausal syndrome?
Menopausal status and symptoms across racial/ethnic groups. Social science & medicine (1982), 52(3), 345–356.
Casas, R. S., Pettee Gabriel, K. K., Kriska, A. M., Kuller, L. H., & Conroy, M. B. (2012). Association of leisure physical
activity and sleep with cardiovascular risk factors in postmenopausal women. Menopause (New York, N.Y.), 19(4),
413–419. doi:10.1097/gme.0b013e318230f531 Centers for Disease Control and Prevention. (n.d.). Physical activity
among Asians and Native Hawaiian or Other Pacific Islanders—50 States and the District of Columbia, 2001-2003.
MMWR Morbidity and Mortality Weekly Report, 53(33), 756–760. Im, E.-O. (2006). The Midlife Women’s Symptom
Index (MSI). Health care for women international, 27(3), 268–287. doi:10.1080/07399330500506600 Mansikkamäki,
K., Raitanen, J., Nygård, C.-H., Heinonen, R., Mikkola, T., EijaTomás, & Luoto, R. (2012). Sleep quality and aerobic
training among menopausal women--a randomized controlled trial. Maturitas, 72(4), 339–345.
doi:10.1016/j.maturitas.2012.05.003 Ramos, A. R., Wohlgemuth, W. K., Dong, C., Gardener, H., Wright, C. B.,
Boden-Albala, B., … Rundek, T. (2011). Race-ethnic differences of sleep symptoms in an elderly multi-ethnic cohort:
the Northern Manhattan Study. Neuroepidemiology, 37(3-4), 210–215. doi:10.1159/000334315 Soltani, M.,
Haytabakhsh, M. R., Najman, J. M., Williams, G. M., O’Callaghan, M. J., Bor, W., … Clavarino, A. (2012). Sleepless
nights: the effect of socioeconomic status, physical activity, and lifestyle factors on sleep quality in a large cohort of
Australian women. Archives of women’s mental health, 15(4), 237–247. doi:10.1007/s00737-012-0281-3 Tu, X., Cai,
H., Gao, Y.-T., Wu, X., Ji, B.-T., Yang, G., … Shu, X. O. (2012). Sleep duration and its correlates in middle-aged and
elderly Chinese women: The Shanghai Women’s Health Study. Sleep Medicine, 13(9), 1138–1145.
doi:10.1016/j.sleep.2012.06.014 Tworoger, S. S., Yasui, Y., Vitiello, M. V., Schwartz, R. S., Ulrich, C. M., Aiello, E. J.,
… McTiernan, A. (2003). Effects of a yearlong moderate-intensity exercise and a stretching intervention on sleep
quality in postmenopausal women. Sleep, 26(7), 830–836. U.S. National Library of Medicine. (2013). Sleep disorders
- overview. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001803/ Whitt, M. C., DuBose, K. D.,
Ainsworth, B. E., & Tudor-Locke, C. (2004). Walking patterns in a sample of African American, Native American, and
Caucasian women: the cross-cultural activity participation study. Health Education & Behavior: The Official
Publication of the Society for Public Health Education, 31(4 Suppl), 45S–56S. doi:10.1177/1090198104266034
Contact

[email protected]

Utilization of Fall Preventive Sensors and Moral Sensitivity
Miho Matsui, RN, PhD, Japan
Purpose
The purpose of this presentation is to examine relationships between use of fall preventive sensors and
staff’s moral sensitivity in hospital settings.
Target Audience
The target audience of this presentation is staff's among hospital settings.
Abstract
Purpose: Using fall preventive sensors among hospitalized older adults is a kind of restraint and remains
an important issue. Alarm sensors are effective to prevent patient’s falls, however, a report revealed that
patients felt they are under watch by using these devices. The purpose of this study is to examine
relationships between use of fall preventive sensors and staff’s moral sensitivity in hospital settings.
Methods: A cross-sectional study was conducted using questionnaire. Two Japanese hospital staffs
including nurses and care workers received the questionnaire. Survey items included demographics,
utilization and perception of using fall preventive sensors, and staff’s moral sensitivity. Moral sensitivity
was assessed by Japanese version of the revised Moral Sensitivity Questionnaire (J-MSQ). J-MSQ is 9
item questionnaire measures consisting of three sub-categories of Moral Strength (MS), Sense of Moral
Burden (SMB), and Moral Responsibility (MR). Each item is ranked on a 6-point Likerttype scale.
Results: The questionnaire was distributed to 241 staffs and was returned by 208 (response rate 86.3%),
206 were valid response (85.5%). The sample had a mean age of 34.7 years (SD 9.8, range 20–63
years) and had been nursing for an average of 11.2 years (SD 9.3, range 0.3–35years). The majority of
respondents were women (92.6%). Most all subjects (98.1%) used fall preventive sensors in their current
ward. Perception of using fall preventive sensors, 69.7% thought patient could be under stress using
sensors, 41.5% would respect patient’s self-esteem, 19.5% did not want to use sensors because of
considering restraint, and 15.9% thought utilization of sensors is an invasion of human rights. These
responses were significantly associated with moral sensitivity assessed by SMB and MR of the J-MSQ.
Conclusion: Although most staffs used sensors in the current ward, perception of using fall preventive
sensors and staff’s moral sensitivity were significantly related. These results suggest that staff’s moral
sensitivity is an important factor to reduce utilization of these devices in clinical settings.
Contact
[email protected]

Effect of the " SHISEI" Meta
-Cognition Educational Program Aiming at the Low
Back Pain Improvement of the Female New Face Nurses in Japan
Keiko Takeda, PhD, RN, Japan
Yoriko Watanabe, PhD, RN, Japan
Purpose
We examine an effect of the improvement of low back pain of the female nurse by the -"SHISEI" Meta
Cognition educational program that we developed.
Target Audience
Nurses with the low back pain and nursing teachers.
Abstract
Purpose: We examine an effect of the improvement of low back pain of the female nurse by the "SHISEI"
Meta-Cognition educational program that we developed.
Methods: The subjects included were 31 female new face nurses with the low back pain in Japan. The
purpose of this education program is to enhance awareness of physical and psychosocial factors
affecting posture. The educational program is comprised of two elements. In Part 1, we explained it so
that nurses could recognize low back pain as biopsychosocial sharp pain syndrome. Then, in Part 2, we
introduced a practical method for improving the symptoms of low back pain and preventing their
occurrence. An enforcement period of the programs is two weeks. We examined an effect based on
results of the inventory survey about low back pain (VAS: Visual analogue scale) and physical posture,
psychological attitude, social attitude before and after enforcement. Ethical Review Board approval No.
12002. The Meta-Cognition is to grasp thought and action itself objectively, and to recognize it. In this
program, we assume "SHISEI" Meta-Cognition as the Meta-Cognition for physical posture, psychological
attitude and social attitude. We define as the "SHISEI" Meta-Cognition that nurses recognize the low back
pain and relations with each one's physical posture, psychological attitude , social attitude and do self-
evaluation and adjust it.
Results: It was eight nurses (25.8%) who recognized low back pain as biopsychosocial sharp pain
syndrome before intervention, but increased to 16 nurses (51.6%) after intervention. Low back pain
significantly improved nurses who recognized low back pain as biopsychosocial sharp pain syndrome
than nurses who did not recognize it (t=-2.2, p=.040). After program practice, Use of the body mechanics
of nurses significantly increased (t=2.4, p=.030). And muscular workout (t=2.2, p=.045), relax the
backbone (t=4.4, p=.000) , keep the backbone correctly aligned (t=5.4, p=.000). In addition, as for nurses,
reflected one's opinion in a policy of the work (t=2.4, p=.029), control of the work (t=2.5, p=.027), check a
cause and solve a problem (t=2.2, p=.041), talk and solve a problem (t=2.5, p=.023), to talk about (t=2.4,
p=.029) significantly increased. Furthermore, nurses significantly increased to change (t=2.2, p=.048).
Conclusion: As a result of having intervened in female new face nurses with the low back pain by the
"SHISEI" meta-cognition educational program, the low back pain was improved if they were recognizable
when low back pain was biopsychosocial sharp pain syndrome.
Contact
[email protected]

Job Demand, Work-Family Conflict and Nurses' Intention to Leave
Li-Chung Pien, RN, MSN, Taiwan
Purpose
The purpose of this presentation is to understand the distribution of ward nurses's job demand and work-
family conflict. Investigating the factors which affect nurses's intention to leave.
Target Audience
The target audience of this presentation is the clinical managers and policy makers.
Abstract
Purpose: The purpose of this presentation is to understand the distribution of ward nurses's job demand
and work-family conflict. And examined their association with intention to leave among ward nurses.
Methods: This study used cross-sectional study design. The study used convenience sampling in a
teaching hospital, total interviewed 154 subjects. Research instruments including basic demographic
questionnaire, Chinese Version of the Job Content Questionnaire (C-JCQ) (Cronbach’s alpha=.61-.91),
Work-Family Conflict Questionnaire (Cronbach’s alpha=.909) and intention to leave Questionnaire
(Cronbach’s alpha=.93).
Results: The results showed that first, subjects mean age was 29.3 years old (SD = 6.1), working years
6.9 years (SD = 5.7). Second, job demand and intention to leave were positive correlation and had
statistically significant (r = .395, P <.001). Third, work-family conflict and intention to leave were positive
correlation and had statistically significant (r = .347, P <.001). Fourth, in the multiple linear regression
models, after adjusting for age, working years , workplace characteristics, when job demand and work-
family conflict increases, intention to leave was significantly increased. Multiple regression model can
explain intention to leave .302variance. Job demand and work-family conflict are the best predictors of
intention to leave.
Conclusion: High job demand and work-family conflict that may make it easier nurses have intention to
leave their work. Job demand and work-family conflict were associated with nurses's intention to
leave. The results helped hospital managers to understand the underlying factors about nurses's
intention to leave. Hospital management class may provide a good working environment and family-
friendly policies in the workplace, reduce nurses's turnover intention and the manpower drain.
References
Nurses Early Exit Study (NEXT): Working Conditions and Intent to Leave the Profession among Nursing Staff in
Europe, 2003 (www.next-study.net) Anderson, S. E., Coffey, B. S., & Byerly, R. T. (2002). Formal organizational
initiatives and informal workplace practices: Links to work-family conflict and job-related outcomes. Journal of
Management, 28(6), 787-810. Batt, R., & Valcour, P. M. (2003). Human resources practices as predictors of work-
family outcomes and employee turnover. Industrial Relations, 42(2),189-220. Cortese, C. G., Colombo, L., & Ghislieri,
C. (2010). Determinants of nurses’ job satisfaction: the role of work–family conflict, job demand, emotional charge
and social support. Journal of Nursing Management, 18(1), 35-43. Fu, C. K., & Shaffer, M. A. (2001). The tug of work
and family - Direct and indirect domain-specific determinants of work-family conflict. Personnel Review, 30(5-6), 502-
522. Greenberger, E., Goldberg, W. A., Hamill, S., Oneil, R., & Payne, C. K. (1989). Contributions of a supportive
work environment to parents' well-being and orientation to work. American Journal of Community Psychology, 17(6),
755-783.
Contact
[email protected]

An Effect of Hands-On Training for Female University Students Using the Model
of Breast on the Knowledge and Techniques of Breast Self Examination
Kwang Ok Lee, PhD, RN, South Korea
Ji Young Hwang, BS, South Korea
Purpose
The purpose of this study was to determine the effectiveness of hand-on training using the model of
breast on the knowledge and skills of breast self examination and to utilize the nursing interventions for
the prevention of breast cancer.
Target Audience
To determine the effectiveness of hand-on training using the model of breast on the knowledge and skills
of breast self examination and to utilize the nursing interventions for the prevention of breast cancer.
Abstract
Purpose: According to the National Statistical Office (NSO), there are the number of women breast
cancer in 2009 for 177 people in their 20s and 6,848 people in their 30s~40s per 100,000 population in
Korea. The purpose of this study was to determine the effectiveness of hand-on training using the model
of breast on the knowledge and skills of breast self examination and to utilize the nursing interventions for
the prevention of breast cancer.
Methods: This study was the non equivalent quasi-experiment, and a total of 75 people participated with
38 for experimental group and 37 for control group. The training of breast self examination using the
model of breast was provided for the experimental group and the training of breast self examination with
the brochure was provided for the control group. The data collection was carried out from Oct 27 to Dec
12, 2012
Results: Checking the change of knowledge about breast self examination after the intervention, the
experimental group using the model of breast increased to 1.92±1.83, the control group using brochure
increased to 0.97±2.70, and there was no significant difference between the two groups (p=.079). As a
result of the analysis of technical aspects' change about breast self examination after the intervention, the
experimental group using the model of breast increased to 3.65±2.71, the control group providing
brochure only increased to 1.78±3.32, and there was a significant difference between the two groups
(p=.009).
Conclusion: The hand-on training using the model of breast increases the techniques of breast self
examination significantly than the training with only a simple brochure, thus, the training of self
examination for prevention of breast cancer needs to go hand in hand with the hand-on training using the
model.
References
Awareness and Impact of Education on Breast Self Examination Among College Going Girls / Shalini, Divya
Varghese, and Malathi Nayak / Indian J Palliat Care. 2011 May-Aug; 17(2): 150–154.
Contact
[email protected]

Child Rearing Support of Nurses who are Mothers of Pre-School Age Children
Akiko Maruyama, PhD, Japan
Eiko Suzuki, PhD, Japan
Tomomi Azuma, PhD, RN, Japan
Miyuki Saito, PhD, RN, PHN, Japan
Purpose
The purpose of this presentation is to get the knowledge to manage both job and child rearing in nurses
who are mothers of pre-school-age children.
Target Audience
The target audience of this presentation is nurses who have pre-school-age children and want to continue
work as nurses.In addition, nurse managers and nursing researchers could be target of this presentation
to get the knowledge of prevention of turnover.
Abstract
Purpose: Managing both job and child rearing is a big challenge for women, and it is specifically difficult
for nurses to manage both and that many nurses are susceptible to stress. This study aimed to clarify the
relationship between burnout and child rearing support of nurses who have pre-school age children.
Methods: The subjects were 2,151 nurses who have pre-school age children, working in 70 hospitals
with at least 200 beds, established by cities and towns across Japan. The questionnaires were completed
by 1,644 nurses (92.3%) in October 2010, and they were divided into two cohorts to observe the
incidence of burnout, which was investigated in October 2011. To assess child rearing support, nurses
were asked whether there were any persons (parents, sibling, frend, relative, neighbor, babysitter) who
support them and with whom (parents, sibling, frend, relative, neighbor, babysitter) they can consult in
child rearing, and how often they have occasion to talk with their spouse about their children (Anme
1987). We assessed burnout using the total Maslach Burnout Inventory (MBI) score. In many other
studies (Bourbonnais, Comeau, Vezina & Dion, 1998; Inaoka, 1988), the definition of burnout was applied
to the subjects with MBI scores in the highest tertile. Therefore, the subjects with total MBI scores in the
highest tertile were defined as being burnout.
Results: By excluding nurses whose total MBI was in the top one-third or higher (12.14 point or higher), a
cohort was set up (n=1,096). In the survey conducted in October 2011, the number of valid responses
after excluding the ones that were incomplete or duplicated was 1,008 (82.4%). After matching the
responses obtained in the baseline survey with the survey in October 2011, the number of nurses that
were eligible for a follow-up survey was 523 (47.3%), and the burnout incidence group had 117 nurses
(22.4%). As a result of the chi-square test, child rearing support related to burnout was existence of
consulters about child rearing, especially neighbors (0.01<P<0.05).
Conclusion: According to the factors affecting burnout of nurses, ‘service years at the present
workplace’, ‘will to continue the work’, ‘assertiveness’ and ‘overtime work’ were already reported in the
previous studies. However, there are a few researches for nurses who have pre-school age children.
Since ‘Child rearing support’ is unique to this study, it can be regarded as a newly found factor. In Japan,
nuclear family has been increasing. Mother during child care tends to be lonely. Neighbor seems to be a
big help than kinsman. We have found that the presence of consulters contributes significantly to the
elimination of stress in nurses who have pre-school children.
References
Anme, T. & Ueda, R. (1987). Changes and continuity of the development during preschool years and related factors:
From longitudinal study: Proceedings of international society for the study of behavioral development. Tokyo, Japan.
Bourbonnais, R., Comeau, M., Vezina, M. & Dion, G. (1998). Job strain, psychological distress, and burnout in
nurses. American Journal of Industrial Medicine, 34, 20-28. Inaoka, F. (1988). Burnout genshou to burnout shakudo
[Burnout phenomenon and burnout scale]. Offical Journal of the Japanese Nursing Association, 21 (2), 27-35.

Contact
[email protected]

The Carers of People with Dementia in the Sub-Acute Facility: A Qualitative Study
Robin Digby, Australia
Melissa Bloomer, PhD, RN, Australia
Kimberley Crawford, PhD, BSc (Hons), Australia
Allison Fiona Williams, PhD, RN, Australia
Purpose
to increase allied health and nursing staff’s knowledge of the issues faced by family caregivers of people
with dementia, who transitioned through the hospital setting and were waiting for a position in a
residential care facility
Target Audience
allied health and nursing staff involved in aged care who will come into contact with caregivers of people
with dementia
Abstract
Purpose: When a person with dementia is receiving in-hospital treatment, transitioning through the
hospital system and subsequently assessed as requiring residential care, family caregivers may feel
overwhelmed and disempowered by the healthcare system (Haesler et al. 2010). There is a danger that
the caregiver will feel excluded from decision-making and uncertain about their role as key provider of
care for their relative (Efraimsson et al.2006). Although there is a growing body of literature exploring
family involvement in the care of persons with dementia in Australia and internationally, minimal research
has been conducted on the impact that transition from the sub-acute inpatient facility to a residential
facility has on family caregivers. The aims of this study were to explore the experiences of caregivers of
people with dementia, who transitioned through the sub-acute inpatient facility and were waiting for
residential care placement.
Methods: Potential participants were identified from patient hospital admission data at The Mornington
Centre, an Aged Rehabilitation and Geriatric Evaluation and Management sub-acute inpatient facility on
the Mornington Peninsula, Victoria, Australia. The treating clinical team were consulted regarding the
suitability of caregivers, for example, in terms of their own health, language spoken and emotional state
before being invited to participate. Participants were aged over 18 years old, spoke English, and had
been caring for a person with dementia at home prior to that person being admitted to the sub-acute
inpatient facility. This study utilized a descriptive qualitative design (Sandelowski 2000); each caregiver
was interviewed using a conversational approach through which they were encouraged to speak about
their experiences during this transition phase. This approach allowed for the subjectivity of the individual’s
experience to be captured; the personal experiences and stories unique for that person (Taylor 2006)
unlikely to be evident in quantitative surveys. Following consent, the interviews were conducted in a quiet
location, at The Mornington Centre; all interviews were taped and then professionally transcribed. The
interviews were conducted between April and November 2013. Thematic analysis using Sandelowski’s
(2000) method of qualitative description was conducted to explore the experience of the caregiver during
the transition of a relative with dementia through the sub-acute inpatient facility moving into a residential
aged care facility.
Results: Participants were aged between 34 and 92 years with equal gender distribution. The majority of
the caregivers were in their late 70s or early 80s. Every person that was asked to be interviewed agreed
to participate. The caregiver participants consisted of six husbands, seven wives, two daughters, two
sons, one daughter-in-law and two friends (both males). The interviews ranged in length from 13.5 mins
to 43 mins (average 25.01 mins + 7.39 (SD)). In total, 502 minutes of interview data was collected. Many
of the caregivers appreciated the opportunity to talk about their experience, likening it to ‘getting things off
their chest’. One woman said that no one had asked her how she felt about the experience with her
husband’s dementia before. The findings of this study emphasise the wave of emotions the caregiver will
experience during this transition phase. Caregivers found it difficult to adjust to their new role as the

visitor. Caregivers were relieved that they were no longer solely responsible for their relative or friend but
they felt they were losing control and guilty that they could no longer care for them. Spousal caregivers
spoke about the support they received from other family members; however, despite having family around
them, they spoke of loneliness.
Conclusion: During a hospital stay, the focus is on the patient and not the caregiver; rarely does
someone ask how the caregiver is feeling and how they are coping. These interviews gave the caregiver
the opportunity to speak to someone about themselves. The results from this study were used to produce
a brochure that will be given to caregivers, assuring them that they are not alone and the emotions they
are experiencing are natural responses during this transition phase. The brochure will include contact
details for support services identified in the interviews to help caregivers overcome their difficulties. The
distribution of the brochure is intended to improve the family caregiver’s experience within the healthcare
system and make this transition phase easier. The findings of this study have also been presented to
allied health and nursing staff that have daily contact with the caregivers; increasing the clinicians’
understanding of the issues faced by family caregivers.
References
Efraimsson, E., Sandman, P., Hyden, L. & Rasmussen, B. (2006). How to get one’s voice heard: The problem of the
discharge planning conference. Journal of Advanced Nursing. 53(6), 646-655. Haesler, E., Bauer, M. & Nay, R.
(2007). Constructive staff-family relationships in the care of older people: A report on a systematic review. Research
in Nursing and Health. 30, 385-398. Sandelowski, M. (2000). Whatever happened to qualitative description?
Research in Nursing & Health, 23, 334- 340. Taylor, B. (2006) ‘Qualitative data collection and management’, in
Taylor, B., Kermode, S. & Roberts, K. Research in Nursing and Health Care: Evidence for Practice, Cengage
Learning Australia, Melbourne.
Contact
[email protected]

Effectiveness of Motivational Enhancement Therapy Plus Cognitive Behavior
Therapy on Glycerol Control, Depressive Symptoms, and Health Related Quality
of Life in Diabetic Patients: A Randomized Controlled Trial
Chiung-Yu Huang, PhD, Taiwan
Hui-Ling Lai, PhD, RN, Taiwan
Wen-Kuei Chen, PhD, Taiwan
Purpose
The purpose of this presentation is sharing the evidence outcomes of Effectiveness of motivational
enhancement therapy plus cognitive behavior therapy on glycerol control, depressive symptoms, and
health related quality of life in diabetic patients.
Target Audience
The target audience of this presentation is adults with type II diabetes mellitus.
Abstract
Purpose: When patients with diabetes have proper glycerol control, negative emotional responses
usually occur and their health related quality of life is consequently under threats. The objective of this
study was to determine the effectiveness of motivational enhancement therapy (MET) plus cognitive
behavioral therapy (CBT) on depressive symptoms, HbA1C, fasting sugar, BMI, and health related quality
of life in type II diabetic patients.
Methods: There was an experimental design, a repeated measurement analysis. Data were collected in
diabetic outpatient department. In the outpatients department of a general hospital, 241 diabetes patients
had been approached in a managed diabetes care system, and 61 of them were recruited for the
intervention clinical trial, who were screened by using Radloff CESD for depressive symptoms with score
above 16. The MET plus CBT intervention consisted of twelve weekly 80 minute-sessions. At this
purpose, six scales were repeated measured before and after the intervention, and there month follow-up.
Results: Sixty-one patients completed the study. There were statistically significant improvements for
outcome variables in the MET plus CBT experimental group (n = 31) (p < 0.01). In comparison the
outcomes to experiment and control group (n = 30), there were statistically significant decreasing in
HbA1C and fasting sugar three months after intervention (p = 0.0009, p = 0.0144), and significant
decreasing in depressive symptoms after and three month later of intervention (p = 0.0000).
Conclusion: Cognitive behavioral therapy improves self control skills and thus strengthens diabetes
control skills, which results into the changes in fasting sugar, HbA1C, and depressive symptoms, and
enhance health related quality of life. The intervention results 1-month improvement in HbA1C, fasting
sugar and post and 3-month decreasing depressive symptoms compared with usual medical care. Nurse
and psychiatrist delivered MET plus CBT as feasible for adults with depressive symptoms of type II
diabetes. Nursing professional can consider using MET plus CBT besides usual care for improving
psychological adjustment to their situation and thus lower the complications and cost of diabetic
consequences.
References
Motivational enhancement therapy, cognitive behavioral therapy, fasting sugar, depressive symptoms, health related
quality of life
Contact
[email protected]

Development of the Japanese Version of the Teaching Style Assessment Scale
Fumiko Yoshida, MSN, RN, Japan
Toyoaki Yamauchi, MD, ND, PhD, FNP, RN, Japan
Purpose
To develop the Teaching Style Assessment Scale for Japanese nursing educators. To enable nursing
educators to analyze their own teaching style. To identify student-centered and/or teacher-centered
elements in their individual practice.
Target Audience
1. The learner will be able to list and define all the elements of learner-centered teaching 2. The learner
will be able to identify cross cultural issues in Japanese education.
Abstract
Purpose: To develop the Teaching Style Assessment Scale for Japanese nursing educators.
To enable nursing educators to analyze their own teaching style.
To identify student-centered and/or teacher-centered elements in their individual practice.
Methods: The original scale on which this research is based was developed as the Principles of Adult
Learning Scale (PALS) by Gary J. Conti, EdD, and was itself based on an Adult Learning Model.
There was no scale with which to measure a teacher’s teaching style in Japan. Therefore, a Japanese
version of PALS was necessary, and Dr. Conti granted permission for the development of such a scale.
A Provisional Japanese Version of the Teaching Style Assessment Scale (P-JVTSAS) was created by the
researchers. The translation was accomplished in three steps.
After approval by the Nagoya University Graduate School of Medicine IRB, copies of the P-JVTSAS were
sent to a national sample of 2,256 Japanese nursing educators.
Based on a survey of 1,111 participants, using the P-JVTSAS which had been submitted to Japanese
nursing teachers throughout Japan, the researchers developed the Japanese Version of the Teaching
Style Assessment Scale.
Analyses: compared the scores of nursing teachers from the USA and Japan. Verification: Criterion-
related validity, Construct validity, Content validity and Reliability.
Results: SPSS software was used for analysis.
The Japanese teachers’ average for P-JVTSAS was 121.03 with a standard deviation of 15, which is
lower than the scores of the American teachers (146 with SD 20). These scores indicate that Japanese
nursing teachers lean toward a teacher-centered rather than student-centered teaching style.
Critertion-related validity and Construct validity were examined using 44 items; 7 factors were found by
confirmatory factor analysis. 3 factors were found by exploratory factor analysis except 8 items, which
were low loading (< 0.30). Content validity was examined with the testimony of the English experts.
Internal consistency: Cronbach’s confident alpha was 0.854.
Conclusion: The Japanese Version of the Teaching Assessment Scale consists of 3 factors:
individualization, student-centered actions by the teacher, and teacher-centered actions.
The validity and reliability of the JVTSAS were examined.
Contact
[email protected]

Efficacy of Mantram Repetition Program on Insomnia in Veterans with
Posttraumatic Stress Disorder
Lindsay Cosco Holt, RN, USA
Jill Bormann, PhD, RN, FAAN, USA
Taylor Andrews, BA, USA
Lin Liu, RN, USA
Joseph F. Burkard, DNSc, CRNA, USA
Purpose
The purpose of this presentation is to disseminate the effects of the Mantram Repetition Program (MRP)
on sleep in the veteran population. The results of this research will aim to encourage subsequent studies
on the Mantram Repetition Program in various populations.
Target Audience
The target audience for this presentation includes those interested in learning more about complementary
therapies and those who currently practice mantra-focused and other meditative methods, and clinicians
who have not yet integrated these types of therapies into their practice.
Abstract
Purpose: Posttraumatic Stress Disorder (PTSD) affects over seven million (3.5%) of the US adult
population, 36% categorized as a severe diagnosis. In 2011, 476,515 veterans were currently seeking
treatment for PTSD (http://www.va.gov/opa/issues/ptsd.asp). Statistics show that 87% of veterans with
PTSD report sleep disturbances and 52% experience frequent nightmares, making sleep the second
most common reason why veterans seek mental health care upon return from deployment (Germain et
al., 2006). Poor sleep is related to daytime impairment including greater reaction to stimuli, decreased
ability to focus and concentrate, impaired goal achievement, and greater risk of suicide (Nappi et al.,
2011). Studies have sought to find a link between PTSD and sleep, and the importance of sleep in the
recovery process, but there is a gap in the research on sleep disturbances and interventions for
improvement in veterans with PTSD. The Mantram Repetition Program (MRP) teaches a portable method
of meditation that has been shown to improve symptoms of PTSD in the Veteran population (Bormann et
al., 2012). Qualitative studies have shown that veterans report improvements in sleep by using skills
learned in the MRP. However, no quantitative study has been conducted to assess veteran sleep patterns
before and after MRP.
This study’s aims were to: (1) Evaluate the efficacy of the MRP on sleep habits; (2) Identify the aspects of
sleep that are positively influenced by the MRP; and (3) Assess the demographic variables and their
relationships to MRP and sleep outcomes.
Methods: The study design is a within group pre-post test design. Four primary screening tools were
used to evaluate PTSD symptom burden and sleep habits including the Clinical Administered PTSD
Scale (CAPS) interview, Insomnia Severity Index (ISI), Glasgow Sleep Effort Scale (GSES), and Pre
Sleep Arousal Scale (PSAS).
Results: Results for this study are pending.
Conclusion: With new cases of PTSD being diagnosed every day, more research is needed for best
practices to improve outcomes for current and future veterans. With the present gaps in sleep knowledge
and its effect on daytime symptoms, this research will help further identify interventions that are evidence-
based with data-grounded results on intervention progression as well as symptom improvement. These
studies address the global issues of PTSD, hoping to further expand treatment availability to those
coming home from combat, and also looking to discover the best ways to prevent PTSD in the future.
Results from this study will lend to the foundation of sleep intervention research on veterans with PTSD,
in hopes to aid in symptom relief of veterans who have suffered with the adverse effects of the
disorder. Research results will further explore the value of the MRP, aiding in its dissemination for others
to learn and practice as a part of their daily routine.

References
Bormann, J.E., Thorp, S.R., Wetherell, J.L., Goshan, S., Lang, A. (2012). Meditation-based mantram intervention for
veterans with posttraumatic stress disorder: a randomized trial. Phsychological trauma: theory, research, practice,
and policy. Germain, A., Shear, M.K., Hall, M., Buysse. (2006). Effects of a brief behavioral treatment for PTSD-
related sleep disturbances: A pilot study. Behavior Research and Therapy, 45, 627-632. Nappi, C.M., Drummond,
S.P.A., Hall, J.M.H. (2011). Treating nightmares and insomnia in posttraumatic stress disorder: a review of current
evidence. Neuropharmacology, 62, 576-585. U.S. Department of Veteran Affairs. (2013, November 11). Veterans
Posttraumatic Stress Disorder. Retrieved Novermber 25, 2013, from http://www.va.gov/opa/issues/ptsd.asp.
Contact
[email protected]

The Historical Research of Japanese Administrative Policy and Outcome of
Maternal and Child Health Education
Yukari Kawahara, PhD, RN, Japan
Atsuko Yumoto, MA, CNM, Japan
Kazuko Yarimizo, BS, Japan
Sachiko Tanaka, PhD, RN, Japan
Keiko Ogawa, MA, CNM, Japan
Purpose
The purpose of this presentation is to examine the administrative policies and outcome to change
maternal and infant health in Japan by historical research.
Target Audience
The target audience of this presentation is academic professional and administrative personnel who
intend to improve maternal and child health in cultural diverse situations.
Abstract
Purpose: The purpose of this study is to examine the history of maternal and infant health in Japan by
clarifying the administrative policies of the Japanese government from 1917 to present and the effect of
these policies on the health of mothers and children education.
Methods: The historical research was conducted between August 1, 2012 and March 31, 2013. Sixteen
semi-structured interviews were conducted with the past government officials responsible for health
policies, related organizations, researchers, and specialists and relevant materials from respective
institutions and libraries were examined. The research was approved by the ethics committees of the
affiliated organizations.
Results: The modernization of Japan’s maternal and child health administration began from 1917, when
the government cemented a policy based on scientific evidence and statistical research conducted by the
Health Hygiene Investigation Committee. The Japanese maternal and child health system, which involved
issuing maternity record books, providing health guidance through mass examination and home visits,
and forging links with welfare systems, was produced by modeling after those of Germany and later
enhanced by administrations in the period of U.S. occupation with the exception of the eugenic thought.
Although in 1955 the Japanese government presented a policy that maternal and child health services by
prefectural government will be provided by municipal in future, it failed to materialize due to issues related
to human resources and technology; therefore, projects continued to be supported by non-government
and community organizations. In mid 1970s, Japan was one of the nation which achieved the lowest rate
of infant and maternal mortality in the world and were starting to aware of the limitations of a public
hygiene approach based on improving these indicators. Then, from 1994, as national focus shifted to the
aging population, and power became decentralized, and most of maternal and child health
service were provided by municipal governments. Today, the maternal and child health

service requires higher level ability which must also consider psychosocial dimensions of mothers and
children. It faces challenges such as enhancing the ability of municipal public health nurses, establishing
effective collaboration between prefectural and municipal public health nurses, promoting collaboration
between national, local and municipal governments, local residents, and non-government organizations,
and cultivating citizenship.
Conclusion: The administrative policies, outcomes and factors related to change maternal and child
health in Japan are discussed. It contributed to achieve the lowest infant and maternal mortality in the
past and is needed to tackle current challenges aging society with child birthrate falling and
decentralization.
Contact
[email protected]

Understanding Self-Care Coping Styles in Patients with Chronic Heart Failure
Chia-Chien Li, MSN, RN, Taiwan
Shiow-Ching Shun, PhD, Taiwan
Purpose
1) To understand the coping of self-care in physical and psychological aspect in chronic HF patients; and
2) To understand the associated factors with the coping of self-care.
Target Audience
Nursing researchers and clinical health professionals in cardiovascular field, especially in heart failure
Abstract
Background: Heat failure (HF) is a serious disease with poor prognosis and large numbers of people
suffer from heart failure around the world. The physical and psychological self-care coping styles affect
the quality of life (QoL) among patients with chronic HF. The decreasing of physical and psychological
functioning often contributes to poor QoL. Therefore, it is important to understand the coping styles and
the related factors in physical and psychosocial self-care.
Purpose: 1) To understand the coping of self-care in physical and psychological aspects in chronic HF
patients; and 2) To understand the associated factors with the coping of self-care.
Methods: A literature review with the database PubMed (1984-2013), CINHAL (1988-2013) and
PsycINFO (1967-2013), and Airti Library (1984-2013) were searched. The Strengthening the Reporting of
Observational Studies in Epidemiology and the Critical Appraisal Skills Program were used to assess the
quality of studies.
Results: In total, 26 studies were included. Seven studies investigated the impact of coping of physical
self-care, eleven studies investigated the association of coping of psychological self-care and eight
studies were explored both coping of physical and psychological self-care. Emotion-focused coping (i.e.,
acceptance and disavowal) and problem-focused coping are positively associated better physical and
psychological self-care; whereas, emotional approach with escape-avoidance was negatively related to
adaptive self-care. To enhance the use of emotion-focused coping with acceptance could facilitate the
use of problem-focused coping to cope with the physical self-care such as medication and dietary
adherence and reducing adverse drug effects. The influencing factors in coping styles of physical and
psychological self-care included the demographic (age, gender, ethnic, marital status), underlying
disease, personality, disease management knowledge level, self-care confidence and social support.
Conclusion: This paper presents an integrative review of the literature on understanding self-care coping
styles in patients with chronic heart failure. Emotion-focused coping with acceptance and disavowal, and
problem-focused coping may positively influence physical and psychological self-care. Health
professionals could educate acceptance and disavowal skills, and then it may facilitate the using problem-
focused coping skills among HF patients. The influencing factors have important roles on individual’s
coping styles, but lacking of the study to explore how the influencing factors affect the coping of self-care.
Contact
[email protected]

Relationship Between the Risk Factor of Latex Allergies and Rubber Products in
Daily Use By the Japanese Nursing Students
Emi Kajiwara, MSN, RN, Japan
Hidechika Iino, MEco, RN, Japan
Teruko Honda, RN, Japan
Satoko Ono, MSN, RN, Japan
Junko Suemitsu, RN, Japan
Teruyo Iwamoto, PhD, RN, Japan
Hideko Oda, ML, RN, Japan
Yoshinobu Asano, MD, PhD, Japan
Purpose
The purpose of this presentation is to discuss the relationship of such allergies to daily use of rubber
products, and the risk factor of LA from results of a survey of nursing students.
Target Audience
The target audience of this presentation is nursing educators, The nurse who is interested in medical
security.
Abstract
Purpose: We are researching prevention of latex allergies (LA) in a Japanese undergraduate nursing
program. From previous research, we found some nursing students have allergies to rubber products. We
discuss the relationship of such allergies to daily use of rubber products, and the risk factor of LA from
results of a survey of nursing students.
The purpose is to clarify the relationship of such allergies to everyday rubber products (gloves, rubber
bands, headbands, balloons) and risk factor of LA to other allergies, LA-associated foods (e.g., kiwi,
banana, celery) ,experience of operation, medical history of allergies in family, and self-prediction when
donning latex gloves.
Methods: We performed a survey of 572 Japanese nursing university students. The data were analysed
by Chi-square test or Fisher’s exact test using the statistical software package Stat Flex ver.6.0 for
Windows. Ethical approval for this study was obtained from the Ethical Review Committee of Seinan Jo
Gakuin University.
Results: The response rate was 95.5% (N=546) and all response data was complete for analysis. All
respondents were female students (average of age 19.1±1.5). Of these, 4.9% (27/546) had allergic
reactions to rubber products (gloves, rubber bands, headbands, balloons). The prevalence of some
allergy were 56.0%. Those with atopic disease and contact dermatitis were 14.5% (79/546) and 14.7% (
80/546), respectively. This data showed allergic symptoms to rubber products were related to atopic
disease (p<0.001), contact dermatitis (p<0.05), and self-prediction when donning latex gloves (p<0.001).
Conclusion: In the Japanese guidelines, one of the risk groups of LA had atopic dermatitis. A similar
result was shown in these findings. This result suggested we should add atopic dermatitis as one criteria
for screening LA.
Contact
[email protected]

Application of Andersen Model to Verify Utilization of Maternal and Child's
Preventive Care Among South-East Asian Immigrant Women in Taiwan: Influence
of Acculturation and Associated Factors
Ching-Min Chen, DNS, Taiwan
Wen-Yin Chang, RN, PhD, Taiwan
Shu-Fen Kuo, PhD, Taiwan
Purpose
The purpose of this presentation is to examine the predisposing, enabling, need factors among immigrant
women in Taiwan, and further to explore acculturation and other predictors of both utilizations.
Target Audience
The target audience of this presentation is community nurses and researchers.
Abstract
Purpose: This is a report of utilization of maternal and child’s preventive care based on Andersen health
seeking behavior model. The purpose of this study was to examine the predisposing, enabling, need
factors among immigrant women in Taiwan, and further to explore acculturation and other predictors of
both utilizations.
Methods: A cross-sectional survey was conducted. Immigrant women who were living in Taiwan with
their Taiwanese husbands and with children under 7 years old were included. Andersen behavior model
(1995) was used to identify influencing factors with acculturation and medical access barrier be added in
the enabling factors, and health status in need factor. The Structural Equation Modeling (SEM) method
was used by SPSS 17.0 and AMOS 18.0 for data analysis.
Results: The completed sample included 284 women lived in 2 counties of Taiwan who were in 28.6
years old (SD=4.33) averaged. Results showed that the Chi-square test for the model produced a
statistically significant finding (χ2 =568.74, df =206, p=0.001; χ2 =539.86, df =206, p=0.001) of maternal
and child’s preventive care use. Based on the χ2/ df ratio (2.76; 2.62), the second-order factor baseline
model fits the data quite well (CFI =0.826, RMSEA =0.079; CFI =0.837, RMSEA =0.076). There were four
factors significantly predicted utilization of maternal preventive care: length of stay in Taiwan, educational
level in original country, perceived support and integration. And three factors significantly predicted
utilization of child’s preventive care: family income, perceived support and integration.
Conclusion: Our findings indicated a significant relationship of predisposing and enabling factors with
utilization of maternal and child’s preventive care. This study demonstrated that acculturation was a vivid
factor to influence the utilization of maternal and child’s preventive care use. Clinical interventions based
on these results should be developed and further to examine its effects in order to improve health
behavior of immigrant women who might be in different acculturation and need more health support.
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Contact
[email protected]

The Centers for Medicare and Medicaid Services' Nonpayment Policy and Nursing
Sensitive Patient Outcomes in the U.S. Hospitals
Sung-Heui Bae, PhD, MPH, RN, USA
Purpose
The purpose of this presentation is to examine the impact of the Centers for Medicare & Medicaid
Services nonpayment policy on nursing sensitive patient outcomes.
Target Audience
The target audience of this presentation will be registered nurses, nurse managers, regulatory body
(CMS) and health policy makers who are interested in the impact of the CMS nonpayment policy on
nursing sensitive patient outcome.
Abstract
Purpose: The Centers for Medicare & Medicaid Services (CMS) implemented a new policy for Medicare
in 2008 to reduce preventable adverse outcomes in hospitals. The new CMS reimbursement policy
incentivizes the prevention of avoidable adverse patient outcomes by eliminating reimbursement for
treatment of those outcomes in hospitals (Department of Health and Human Services, 2009). Intended
consequences of the new CMS policy include appropriate changes in care processes to foster better
quality of care so that hospitals can prevent adverse outcomes. However, there are also concerns about
possible unintended consequences of such a financial program, including avoiding admissions of patients
with higher acuity levels and resource shifting to focus only on the targeted adverse outcomes (Hart-
Hester et al., 2008; Hartley, 2004). However, researchers have not yet examined the implementation of
such policy focusing on nursing sensitive outcomes and factors related to better implementation.
Therefore, the current study examined the impact of the new CMS nonpayment policy on nursing
sensitive patient outcomes.
Methods: The current study used data from the 2010 American Hospital Association Annual Survey data,
Hospital Compare data from CMS, and the Rural-Urban Commuting Area code (RUCA) data based on
Census commuting data and zip codes. This study focused on 4 nursing sensitive patient outcomes: (1)
stages III and IV pressure ulcers, (2) falls and trauma, (3) catheter-associated urinary tract infections
(CAUTI), and (4) vascular catheter-associated infections (VCAI). The variation of the implementation of
the CMS policy was measured by the proportion of hospital discharges paid by Medicare as a proxy. We
also examined factors contributing to better implementation, including region, size, ownership, teaching
status, length of stay, RN staffing, and case mix. The final analytic sample consisted of 3,260 U.S.
hospitals.
Results: In 2010, pressure ulcer stages III and IV occurred 0.106 per 1,000 discharges paid by Medicare.
Falls and trauma and CAUTI occurred 0.556 and 0.304 per 1,000 discharges. On average, 0.282 VCAI
per 1,000 Medicare discharges were reported. In further analyses, we will test what extent all of these
nursing sensitive patient outcomes are related to the implementation of the CMS nonpayment policy and
factors related to better implementation.
Conclusion: The study finding will provide critical information regarding the implementation of the new
CMS nonpayment policy and nursing sensitive adverse outcomes. Especially, it will provide which
hospitals are at risk to prevent those adverse outcome and to adjust themselves to this new budget
constraint. As the policy of nonpayment for preventable adverse patient outcomes to Medicare will be
expanded through the Affordable Care Act, the study findings will provide critical information regarding
the effect of this program on nursing sensitive patient outcomes.
References
Department of Health and Human Services. (2009). HHS Action Plan to Prevent Healthcare-Associated Infections.
http://www.hhs.gov/ash/initiatives/hai/actionplan/ Hart-Hester, S., Jones, W., Watzlaf, V. J., Fenton, S. H., Nielsen,
C., Madison, M., . . . Rudman, W. (2008). Impact of creating a pay for quality improvement (P4QI) incentive program

on healthcare disparity: leveraging HIT in rural hospitals and small physician offices. Perspect Health Inf Manag, 5,
14. Hartley, D. (2004). Rural health disparities, population health, and rural culture. Am J Public Health, 94(10), 1675-
1678.
Contact
[email protected]

Impact of Marital Coping on Body Image and Sexual Relationship Among Breast
Cancer Survivors
Tzu-Chun Chen, RN, BS, Taiwan
Wan-Chun Tung, RN, BS, Taiwan
Hsiu-Mei Huang, RN, BS, Taiwan
Yi-Chen Lin, RN, MSN, Taiwan
Su-Ying Fang, RN, PhD, Taiwan
Purpose
The purpose of this presentation is to help audiences to understand breast cancer women’s marital
coping efforts and their association with body image as well as sexual relationship.
Target Audience
The target audience of this presentation is the researchers who interested in studying body image and
sexual health issue of women with cancer.
Abstract
Purpose: Changes in body image and sexual relationships can be problematic for women after breast
cancer treatments. Breast cancer is a challenge that may change women’s usual roles and that can be
stressful for women’s relationship with their partners. The use of ineffective coping efforts to deal with
marital conflicts could result in a lack of support from the partner, which could have a negative impact on
a woman’s body image and sexual relationships. Understanding women’s particular marital coping efforts
to deal with their marital conflict and their association with body image as well as sexual relationship can
help healthcare providers develop effective interventions to ameliorate these problems. The purpose of
the study were:1) understand the relationship between women’s marital coping efforts and body image
and 2) understand the relationship between women’s marital coping efforts and the sexual relationship
and 3) identify variables that might be used to predict a breast cancer survivor’s body image and sexual
relationship.
Methods: A cross-sectional, correlational design was used. Permission to carry out the study was
received from the hospital ethics committee. Women who met the inclusion criteria, which included 1)
having been married and 2) completion of required adjuvant therapy, were recruited from the hospital
cancer registry. After agreeing to participate and signing the informed consent, women were given
questionnaires that measured marital coping, body image, and relationship and sexuality scales.
Results: One hundred and twenty-six women were recruited for this study. The results indicated the
following: 1) body image and sexual relationship were moderately correlated (p<.001); 2) women who
used avoidance or introspective self-blame marital coping to deal with marital conflict reported more body
image and sexual relationship problems (p< .001); women who used avoidance marital coping to deal
with marital conflict were vulnerable to sexual problems including a decrease in sexual-esteem and
sexual performance; However, if women tended to use positive-approach coping to deal with marital
conflict, their sexual performance and sexual intimacy would be enhanced (p< .001); 3) marital coping
efforts, including avoidance, positive-approach effort and body image, were predictors of women’s sexual
relationships and explained 36% of the variance in this variable; and 4) self-blame and avoidance marital
coping as well as fear of recurrence were predictors of women’s body image problems and explained
35% of the variance in this variable.
Conclusion: Marital coping efforts could significantly influence women’s body image and sexual
relationships. Future interventions that address the body image and sexual health of breast cancer
survivors should be considered to encourage female breast cancer survivors to use positive-approach
marital coping effort and prevent them from using disengaged avoidance or self-blame coping efforts to
deal with their marital strain.
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T. M., Wiesenthal, N. & Keefe, F. J. et al. (2009). A couple based intervention for female breast cancer. Psycho-
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adjustment to early stage breast cancer. Psychosom Med, 60(2), 168-174. Chen, X., Zheng, Y., Zheng, W., Gu, K.,
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(2010). A study of body image in long-term breast cancer survivors. Cancer, 116(15), 3549-3557. Figueiredo, M. I.,
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Giese-Davis, J. Hermanson, K., Koopman, C., Weibel, D., & Spiegel, D. (2000). Quality of couples’ relationship and
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(2008). Body image issues in women with breast cancer. Psychol Health Med, 13(3), 313-325. Hopwood, P.,
Haviland, J., Mills, J., Sumo, G., & Bliss, J. M. (2007). The impact of age and clinical factors on quality of life in early
breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy
Trial). Breast, 16(3), 241-251. Janz, N. K., Mujahid, M., Lantz, P. M., Fagerlin, A., Salem, B., Morrow, M., et al.
(2005). Population-based study of the relationship of treatment and sociodemographics on quality of life for early
stage breast cancer. Qual Life Res, 14(6), 1467-1479. Kalaitzi, C., Papadopoulos, V. P., Michas, K., Vlasis, K.,
Skandalakis, P., & Filippou, D. (2007). Combined brief psychosexual intervention after mastectomy: effects on
sexuality, body image, and psychological well-being. J Surg Oncol, 96(3), 235-240. Kudel, I., Edwards, R., Raja, S.,
Haythornthwaite, J., & Heinberg, L. J. (2008). The association of perceived partner-related social support with self-
reported outcomes in women post-mastectomy. J Health Psychol, 13(8), 1030-1039. Nano, M.T., Gill, P. G., Kollias,
J., Bochner, M.A., Malycha, P., & Winefield, H.R. (2005). Psychological impact and cosmetic outcome of surgical
breast cancer strategies. AZN Journal of Surgery, 75, 940-947. Rowland, J. H., Desmond, K. A., Meyerowitz, B. E.,
Belin, T. R., Wyatt, G. E., & Ganz, P. A. (2000). Role of breast reconstructive surgery in physical and emotional
outcomes among breast cancer survivors. J Natl Cancer Inst, 92(17), 1422-1429. Schover, L.R. (1991). The impact of
breast cancer on sexuality, body image, and intimate relationships. Ca: a Cancer Journal for Clinicians. 41(2):112-20.
Schumm, W. R., Paff-bergen, L. A., Hatch, R. C., Obiorah, F. C., Copeland, J. M., Meens, L. D. & Bugaighis, M. A.
(1986). Concurrent and discriminant validity of the Kansas marital satisfaction scale. Journal of Marriage and the
Family, 48, 381-387. Scott, J. L., Halford, W. K., & Ward, B. (2004). United we stand? The effects of a couple-coping
intervention on adjustment to breast or gynaecological cancer. Journal of Consulting and Clinical Psychology, 72,
1122-1135. Scott, J. L., Halford, W. K., & Ward, B. G. (2004). United we stand? The effects of a couple-coping
intervention on adjustment to early stage breast or gynecological cancer. J Consult Clin Psychol, 72(6), 1122-1135.
Wimberly, S. R., Carver, C. S., Laurenceau, J. P., Harris, S. D., & Antoni, M. H. (2005). Perceived partner reactions
to diagnosis and treatment of breast cancer: impact on psychosocial and psychosexual adjustment. J Consult Clin
Psychol, 73(2), 300-311. Wolberg, W. H., Romsaas, E. P., Tanner, M. A., & Malec, J. F. (1989). Psychosexual
adaptation to breast cancer surgery. Cancer, 63(8), 1645-1655. Yurek, D. Farrar, W. Andersen, B. L. (2000). Breast
cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body
change stress. Journal of Consulting & Clinical Psychology. 68(4):697-709. Zimmermann, T., Scott, J. L., & Heinrichs,
N. (2010). Individual and dyadic predictors of body image in women with breast cancer. Psychooncology, 19(10),
1061-1068.
Contact
[email protected]

Experiences of Vietnamese Marriage Immigrant Women with Pregnancy, Birthing,
and Postpartum Care in Korea
Sun-Hee Kim, RN, PhD, South Korea
Yu-Jin Lee, RN, MSN, South Korea
Purpose
The purpose of this presentation is to describe the birthing experiences of Vietnamese marriage
immigrant women in Korea. This presentation will help the audience fully understand Vietnamese
immigrant women's experiences during pregnancy and childbirth.
Target Audience
The target audience of this presentation is mainly nurses who work in the childbirth centers, postpartum
care centers, and community health centers.
Abstract
Purpose: Korea used to be a nation with homogeneous racial composition has become a multicultural
country with foreigners making up 2.8% of total population due to influx of foreigners. Among the
foreigners in Korea, marriage immigrants are about 28,000, making up 8.7% of the marriage with the
mostly Korean male with foreign national female. Out of all marriages with foreign nationals, marriage with
Chinese women (34.1%) and Vietnamese women (31.9%) takes up the majority.
Most marriage immigrant women become pregnant within a year from marriage, making them yet another
challenge aside from the new language, culture, and environment. Also, they get prenatal care, birthing,
and postpartum care with the language barrier. There has not been a study for the experiences and
difficulties of such marriage immigrants who live in a foreign (Korean) culture and foreign (Korean)
husband and this study aims to point out the pregnancy, birthing, and postpartum care experience of
marriage immigrants in Korea. The objective of this study is to describe a meaning and reality of
pregnancy, birthing, and postpartum care for Vietnamese marriage immigrants by questioning “What it
means to have a pregnancy and birthing for Vietnamese marriage immigrants in Korea”
Methods: A qualitative research design Colaizzi's phenomenological method was chosen in order to
obtain rich, in-depth information needed to understand and interpret experiences of Vietnamese marriage
immigrants with pregnancy, birthing, and postpartum care. Data were collected through in-depth
interviews at the participants' homes.
Participants : The study participants were selected among the Vietnamese marriage immigrants who are
now pregnant or those who have given a birth within 5 years in order to provide enough study size and
relevancy to the study.
Data Generation and Analysis: After seeking approval from the university hospital institutional review
board, recruitment of participants began in one local hospital and through introductions by an
acquaintance followed by snowball technique. The description and consent form about the study was
prepared in Vietnamese language and a Vietnamese female fluent in Korean language served as a
research assistant during the data collection process. Research assistant presented the study
description, consent form, and explained questions about social background and partial translation during
the personal interview. In total, fifteen women participated in the study and all of them were in their 20’s
with the mean age of 23.4 and the length of stay in Korea 2.5 years. Ten participants were with birthing
experiences (6 participants with one child, 4 participants with 2 children) and five participants were
pregnant at the time of study. The study questions were as follows: (a)What are the experiences during
pregnancy, birthing, and postpartum care in Korea? (b)What are the differences in healthcare during
pregnancy, birthing, and postpartum care that were different between Korea and Vietnam and how did
you deal with those?

Personal in depth-interviews were given during April 5th, 2012 thru November 20th, 2013. For partial
translation, Vietnamese translator (research assistant) accompanied the interviewer. Interviews were
audio recorded and each participant was interviewed once or twice, approximately 50-120 minutes per
interview. The interview tapes were transcribed. Field notes from the interview, discussion between the
researcher and research assistant after an interview, expectation, discrepancy from expectation, and
questionnaire were recorded in debriefing note. The transcripts, field note, and debriefing note were
analyzed. Data collected has been analyzed in 7 steps given by Colaizzi (1978) currently past 5thstep out
of 7. The research has consciously tried not to from a bias during the interview, analysis and drawing
conclusion in order to maintain neutrality.
Results: According to the data analysis of this study, nine themes were derived from the data were as
following: “Worsening homesick due to being lonely in a foreign environment,” “Not-so-wanted pregnancy
but received help from the family in Korea for prenatal care”, “Suffering hardship due to a lack of
information for pregnancy and birthing”, “Accepting different healthcare system from Vietnam without fully
understanding”, “Going through trouble and hurting one’s feeling due to Indifferent and careless
treatment from the healthcare practitioners”, “Being indecisive over different traditional healthcare practice
between Korea and Vietnam existed and then negotiating and conforming”, “Relying solely on husband
as the only passage of communication”, “Being disappointed in family owing to lack of proper postpartum
care”, and “Desiring to do my best for the most precious baby”.
Twenty one sub-theme were as following: “Homesick in a place everything is foreign after marriage”,
“Pregnancy right after marriage and morning sickness worsened for no availability of the food from
home”, “Unwanted pregnancy welcomed by the Korean family”, “Went to the hospital with family”,
“Learned about pregnancy and birthing from the family in Vietnam before marriage but asked again for
lack of detailed information”, “Couldn’t ask about the sexual life during and after pregnancy and used self-
judgment”, “Both husband and I were confused and scared because we didn’t know the birthing
procedure”, “Would like to get explanation for different ways of prenatal and postpartum care”,
“Reluctantly accepted the care without complaining for it was thought to be a way of Korean hospital
system works”, “Lack of proper explanations with different medical care system caused compliance
without full understanding”, “Indifferent and careless treatment from the healthcare practitioners cause
physical or mental discomfort”, “More advanced postpartum care method was foreign at first and learned
more about it later”, “Husband is the passage of communication with other family members”, “Husband
supports the birthing and child upbringing”, “Difference in prenatal and postpartum care between the self
and the family caused second opinion from the others”, “Tried to mediate two traditional prenatal and
postpartum care method”, “Learned and followed the way from the mother-in-law at first even though it
was foreign and strange, but gradually switched back to ones own method”, “Lack of support for
postpartum care from husband and his family was disappointing”, “Raising the baby without support from
the family”, “Would like to do my best for the most precious baby”, and “Taking on the challenges to
breastfeed the baby like women in home country do”.
Conclusion: This study provided cultural perception of pregnancy, child birthing, and postpartum care
and the adaptation experiences of the immigrants in Korean culture. In order to reduce the hardship that
Vietnamese marriage immigrants experience, planned pregnancy should be encouraged so that the
pregnancy and birthing can be prepared during the time period preparing the international marriage.
Secondly, communications with healthcare practitioners need to incorporate effective means of
translation as well as sensitivity training to respect the difference in culture while attending to Vietnamese
patients. Lastly, prenatal and postpartum care education and care plan that reflects Vietnamese culture
should be established in clinical setting and have the family participate in education, counseling, and plan
about pregnancy, birthing, and postpartum care.
References
Colaizzi, P. E. (1978). Psychological research as the phenomenological views.In R. Valle, & M. King (Eds), Existential
phenomenological alternative for psychology. (pp.48-71). New York, NY: Oxford University Press. Migrant Health
Association in Korea. (2009, September). Migrants' right to health through the eyes of human rights "Era of 1,000,000
immigrants, integrated health care policies were disputed". September Discussion Report. Retrieved May 20, 2011,
from http://www.mumk.org/html/05library/ngoLibrary_view.php?number=627&start=20&key=&keyfield= Lim, H. S.
(2011). The experience of transition in pregnancy and childbirth among the married immigrant women in Korea.
Korean Journal of Women Health Nursing, 17(3), 243-255. Ministry of Public Administration and Security. (2011,

September). Survey results on foreign residents of local governments in 2011. Retrieved January 29, 2012, from
http://www.mopas.go.kr/gpms/ns/mogaha/user/userlayout/bulletin/userBtView.action?userBtBean.bbsSeq=1021046&
userBtBean.ctxCd=1291&userBtBean.ctxType=21010002¤tPage=1 Statistics Korea (2013, April). 2012 Marriage
statistics. Retrieved June 25, 2013, from
http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&bSeq=&aSeq=286676&pageNo=1&rowNum=1
0&navCount=10&currPg=&sTarget=title&sTxt=2012
Contact
[email protected]

The Historical Research of Legislative Process of the Eugenic Protection Act and
Maternal and Child Health Administration in Japan
Sachiko Tanaka, RN, PhD, Japan
Purpose
The purpose of this presentation is to clarify the legislative process from the pre-war National Eugenic Act
to the post-war Eugenic Protection Act, and to the present Maternal Protection Act @in Japan.
Target Audience
The target audience of this presentation is nurses,researcher of history
Abstract
Purpose: Selections by individuals concerning pregnancy and childbirth fundamentally depend not only
on the individual’s will, but also on the country’s paradigm and policy of the time. In Japan, after more
than 60 years from the Second World War, the broadest ever range of selections has become available
concerning pregnancy and childbirth, with the effect of developing medical science. It is considered
essential to look back on Japan’s historical systems related to pregnancy and childbirth, for the purpose
of examining future maternal and child health administration and nursing. This study is aimed at clarifying
the legislative process from the pre-war National Eugenic Act to the post-war Eugenic Protection Act, and
to the present Maternal Protection Act in Japan.
Methods: A historical study based on interviews and literature search was conducted. The study period
extended from August 2012 to March 2013. Interviews with Japanese civil organizations concerning
maternal and child health were conducted in a semi-structured manner, where questions were asked
relating to maternal and child health conditions and challenges in each period, influence on administrative
measures in terms of relationship with today’s maternal and child health and hygiene. The responses
were analyzed in time series, in combination with literature search results. The interviews were recorded
with agreement of the respondents. The scope of literature search was set at materials concerning
material and child health administration, and the search was conducted at the Library of the Ministry of
Health, Labour and Welfare, Japan Family Planning Association, and other institutions. Approval was
obtained from the Ethics Committee of the researcher’s organization, and adequate considerations were
taken for the protection of privacy and copyright.
Results: The eugenic philosophy as the basis of Japan’s National Eugenic Act was imported from
Europe into Japan. “An Essay on the Principle of Population”, written by T. R. Malthus, was focused on
population control measures, and affected the concepts of eugenics and birth control toward a “better
race”. Since 1900, eugenics was gradually linked to a desirable status of the country. Following the visit
to Japan by M. Sanger, birth control activities also emerged in Japan. However, because the English term
“birth control” was translated into a Japanese phrase “sanji seigen (birth limitation)”, it was misunderstood
as including abortion, in contrast to Sanger’s true concept for birth control to “protect mothers and
children”, which was not actually based on the population theory by Malthus. It is possible that Japanese
people in those days incorrectly understood the birth control concept proposed by Sanger. As eugenics
became increasingly closely tied to nationalism, the National Eugenic Act was enacted in 1940, aimed at
improvement of the people’s nature. Following Japan’s defeat in war, there was a remarkable increase in
artificial abortions, because substantial expansion of population was expected. This resulted in a rise in
illegal abortions, causing concerns about possible injuries to mother’s health. The Eugenic Protection Act
was enforced in June 1948, with a very short time period from its promulgation, suggesting the
seriousness of maternal and child health problems caused by illegal artificial abortions. In the midst of
pros and cons, this act made possible artificial abortions for economic reasons in 1949, triggering intense

arguments concerning abortions and birth control. The Maternal Protection Act was established in 1996,
as new problems arose, such as post-divorce abortions, artificial abortions by teenagers, and multiple
pregnancies. Concepts for abortions and birth control have become more and more complicated, as
science and technology develop while no clear answer to human life has been identified in the historical
acts.
Conclusion: 1. “An Essay on the Principle of Population”, written by T. R. Malthus, was focused on
population control measures, and affected the concepts of eugenics and birth control toward a “better
race”. 2. Sanger’s true concept for birth control to “protect mothers and children”, which was not actually
based on the population theory by Malthus. It is possible that Japanese people in those days incorrectly
understood the birth control concept proposed by Sanger. 3.The Eugenic Protection Act was enforced in
June 1948, with a very short time period. This act made possible artificial abortions for economic reasons
in 1949 without protection of mother’s health.
Contact
[email protected]

Relationship Between Social Desirability and Preception of Physical Restraint
Use Among Japanese Nurses
Kyoko Shida, MS, RN, Japan
Makiko Muya, PhD, RN, Japan
Purpose
The purpose of this presentation is to explore the relationship between social desirability and the
perception of physical restraint use among nurses work in acute hospitals in Japan.
Target Audience
The target audience of this prerentaion is clinical nurses, nurse manageres, and educators.
Abstract
Purpose: In Japan, the aging society has been growing rapidly. In 2055, it is estimated the aging ratio
would be 40.5%. The issues of aging society are proposed from several domains of quality of life. The
increase of elderly patients and the shortage of care providers are also big issues. Additionally, ethical
consideration for patients has been more and more paid attention under the precarious balance. Many
nurses experience ethical dilemma toward elderly care, especially, the use of physical restraint for
cognitive impairment. Ethical decision to use of physical restraint is entrusted to nurses owned their
profession although the final decision and order is authorized by physicians. It is important to explore the
perception of the use and the characteristics. In this study, our purpose is to explore the relationship
between perception of physical restraint use and social desirability among Japanese nurses.
Methods: By referring PRUQ developed by Evans and Strumpf (1988), a measurement of perception of
physical restraint use was developed as Japanese language version for the dependent variable. This
scale is constructed of 19 items and each item is ranked on terms of importance on a 5-point Likert scale,
with 1 denoting not at all important and 5 signifying most important. As the independent variable, Crowne
& Marlow`s social desirability scale (MC-SDS) was selected. This scale contains 33 items divided into 2
dimensions: impression management and self-deception. Each item was chosen with applicable or not in
terms of self-tendency. As the demographic data, sex, age, tenure, year of experience, work status,
license status, academic status were collected.
Results: The convenience sample (N=310) of nursing care staff working in two acute hospitals located in
Kanto district, Japan. The demographic characteristics of the study population were 31 male and 279
female. The distribution of age was 33.7±10.4. 10% of total nurses were graduated from bachelor
schools. As the result of factor analysis, PRUQ was divided into 6 categories by the reasons such as (1)
falling, (2) elderly, (3) incidents, (4) severe incidents, (5) shortage of staffs, (6) general interests for ethical
issues. The consequences of Pearson correlation analysis, 1) there were negatively significant relations
between SD-self-deception and PRUQ-falling, incidents and severe incidents (p<0.05), 2) there was
negatively significant relation between SD-impression management and general interest for ethical issues
(p<0.05), 3)academic status was significantly related to PRUQ-severe incidents(p<0.05), although there
was no significant relation between academic status and SD scores. Subsequently, respondents were
divided into 3 groups, such as high-scored SD, medium-scored SD and low-scored SD. The result of
Pearson correction analysis of each group had different features. At the low-SD group, there were
negatively correlated between age and PRUQ-elderly and severe incidents (p<0.05). At the mid-SD
group, there were negatively correlated between age and all PRUQ items (p<0.05 or p<0.01). At the high-
SD group, there was negatively correlated between age and PRUQ-severe incidents (p<0.05).
Conclusion: It is important to assess the bias of social desirability of participants in the case of that their
ethical decision making is studied. This result implies the use of physical restraint is affected by their
social culture and age. To establish ethical climate applied to professional code should be
demonstrated.
References

1.Strumpf N. and Evans L.(1988) Physical restraint of the hospitalized elderly: Perception of patients and nurses.
Nursing Res. 37:132-137. 2.Crowne, D. P. and Marlowe, D. (1960) A new scale of social desirability independent of
psycho-pathology. Journal of Consulting Psychology, 24: 349-354.
Contact
[email protected]

The Knowledge of Blood Pressure Measurement Affecting Medication Adherence
in Patients with Hypertension
Yu Fang Lin, BSN, Taiwan
Chia-Chi Chang, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to determine whether a relationship existed between the knowledge of
blood pressure measurement and adherence to medications among patients with hypertention.
Target Audience
The target audience of this presentation is participants who are interested in hypertension and
gerontology.
Abstract
Purpose: To determine whether a relationship existed between the knowledge of blood pressure
measurement and adherence to medications among hypertensive patients.
Methods:
• Data from a longitudinal study investigating the effect of 16-week self-blood-pressure monitoring
intervention program among hypertensive patients.
• Subjects were recruited from outpatient clinics of a medical center and a community health service
center.
• All participants completed the Knowledge of Blood Pressure Measurement Scale (KBPM scale) and
the Health Behaviors Scale which consists of four subscales (i.e., diet control behavior, exercise
behavior, scheduled appointments, and medication adherence) .
• Descriptive statistics and multivariate linear regression were used for data analyses.
Results: Two hundred and sixty respondents with mean age of 63.7 were enrolled. The average score of
KBPM and medication adherence were 9.1 and 17.6, respectively. After adjusting for living area, female
gender, age, educational level, and health behaviors, higher knowledge of blood pressure
measurement was associated with better medication adherence (p< .01).
Conclusion: The result of the current study suggests that the knowledge of blood pressure
measurement is an independent predictor of adherence to medications in hypertensive patients. Further
investigation into this relation is warranted.
References
Chiang, C. E., Wang, T. D., Li, Y. H., Lin, T. H., Chien, K. L., Yeh, H. I.,... Hypertension Committee of the Taiwan
Society of Cardiology. (2010). 2010 guidelines of the Taiwan Society of Cardiology for the management of
hypertension. Journal of the Formosan Medical Association, 109(10), 740-73. doi: 10.1016/S0929-6646(10)60120-9.
Hung, F. L. (2003). The effectiveness of applying case management for patients with hypertension at an outpatient
department (Master's thesis). Retrieved from http://ndltd.ncl.edu.tw/ Ma, C., Chen, S., You, L., Luo, Z., & Xing, C.
(2012). Development and psychometric evaluation of the Treatment Adherence Questionnaire for Patients with
Hypertension. Journal of Advanced Nursing, 68(6), 1402-1413. doi: 10.1111/j.1365-2648.2011.05835.x. Patel, R. P.,
& Taylor, S. D. (2002). Factors affecting medication adherence in hypertensive patients. Ann Pharmacother, 36(1),
40-45. Whitworth, J. A., & World Health Organization, International Society of Hypertension Writing Group. (2003).
2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of
hypertension. Journal of Hypertension, 21, 1983-1992.
Contact
[email protected]

Lifestyle Characteristics Correlated with Daily Life Functions of Patients with
Mental Disorders
Mariko Kato, RN, PHN, Japan
Yukiko Sato, PhD, Japan
Purpose
The purpose of this presentation is this study aims at investigating the lifestyle characteristics of
ambulatory patients that correlate with such functions.
Target Audience
Abstract
Purpose: It is important for patients with mental disorders to have stable daily life functions. In order to
achieve this, institutions, such as psychiatric daycares and small-scale working places for patients with
mental disorders, provide daily life support to ambulatory patients. Ambulatory patients receive training for
cooking and cleaning in these institutions. However, despite having received such training, ambulatory
patients sometimes face difficulties in their actual daily life. The lifestyle characteristics of ambulatory
patients are one of the factors that influence their daily life functions. Thus, this study aims at investigating
the lifestyle characteristics of ambulatory patients that correlate with such functions.
Methods: The subjects were 2,190 individuals with schizophrenia who regularly visited day-care centers
or workshops in Japan. We administered a self-assessment questionnaire survey sent via mail. The
contents of the questionnaire included background information such as age, and purposes for making
regular visits (multiple answers allowed), and the Rating Scale for Functioning in Individuals with Mental
Disorders (from 0 to 126 points). The study was conducted between September and November 2008. We
analyzed their answers statistically using a t-test and multiple regression analysis.
Ethical considerations: We conducted the study according to the ethical guidelines for clinical studies by
the Ministry of Health, Labor and Welfare. We notified the subjects in writing of information such as the
purpose and method of the study, privacy protection, and that participation was voluntary; we deemed
their consent given if we received their answer to the questionnaire. In addition, we obtained approval
from the ethical review board of the institution the researchers belonged to.
Results: There were 78.9 ± 16.2 points of life functions of ambulatory patients. A total of 681 patients
(69.4%) had a housemate, 588 patients (59.9%) did their own washing, 341 patients (56.4%) did their
own cleaning, and 352 patients (35.9%) cooked for themselves. Moreover, 294 patients (30.0%) did their
own housework (including washing, cleaning, and cooking). It was understood that the patients had very
few opportunities to do their own washing, cleaning, and cooking in their actual daily lives. The reason for
such is that schizophrenic patients find it difficult to grasp the overall situation, and their unpredictable
behavioral characteristics also affect their lifestyle.
Patients who self-performed washing, cleaning, and cooking had higher daily life functions compared with
those who did not self-perform the housework (t = 2.11–2.40, p = 0.018–0.035). There was no significant
statistical difference in daily life functions based on the presence or absence of a housemate. Significant
correlation of life function points with washing, cleaning, and cooking was only found in “cleaning on their
own” (β = .15, p = .001).
From the above, it has been recognized that patients who self-perform washing, cleaning, and cooking
have a high daily life functions, and that that doing self-cleaning can improve such functions.

Furthermore, life functions can be improved by increasing practice opportunities not only during training in
the institution but also in their daily life.
Conclusion: It has been recognized that patients who self-perform washing, cleaning, and cooking have
a high daily life functions, and that that doing self-cleaning can improve such functions.
Contact
[email protected]

"Try Not to Judge:" Mothers of Infants with Neonatal Abstinence Syndrome
Lisa M. Cleveland, PhD, RN, PNP-BC, IBCLC, USA
Rebecca Bonugli, PhD, APRN, PMHCNS, USA
Purpose
The purpose of this presentation is to describe the experiences of mothers of infants with neonatal
abstinence syndrome (NAS)?
Target Audience
The target audience for this presentation includes: maternal-child, public health, and psychiatric/mental
health nurses.
Abstract
Purpose: To explore the experiences of mothers of infants with neonatal abstinence syndrome (NAS).
Methods: Qualitative description
Results: Participants were recruited from community-based, out-patient, addiction treatment facilities in a
large urban city in the southwestern region of the United States. A convenience sample of 15 Latina,
substance addicted mothers of infants with NAS participated although enrollment was open to women of
all ethnicities. Semi-structured, individual, interviews were conducted and the data were analyzed using
qualitative content analysis. Data were first anlayzied independently followed by a discussion of the
themes until a consensus was reached. Four themes were identified: a) understanding addiction, b)
watching the infant withdraw, c) judging, and d) trusting the nurses. To provide further explanation, the
mothers felt there was a lack of understanding concerning addiction which was particularly noted when
interacting with the nurses. They shared their feelings of guilt and shame while observing their infant's
withdrawal symptoms. Further, the mothers felt judged by the nurses for having used illicit drugs during
pregnancy. Feeling judged interfered with the mothers’ ability to trust the nurses.
Conclusion: These findings provide nurses with a better understanding of the experiences of addicted
mothers and may lead to more customized nursing care for this high-risk population of mothers and their
infants.
Contact
[email protected]

Dyspnea Management Experiences Among Patients with Chronic Obstructive
Pulmonary Disease: A Qualitative Study
Wei-Chun Lin, RN, MS, Taiwan
Purpose
The purpose of this presentation is share of research results.
Target Audience
The target audience of this presentation is all the clinical nurses or chronic health care providers.
Abstract
Purpose: Dyspnea is the primary chief complains for patients with chronic obstructive pulmonary disease
(COPD). Dyspnea refers to the subjective perception of illness used to describe “a subjective experience
of breathing discomfort that consists of qualitatively distinct sensations of varying intensity”. This
experience is derived from the influences of physiological, psychological, social, and environmental
factors and results in physiological and behavioral reactions. For patients with COPD, dyspnea is a
subjective body feeling that often creates enormous distress for patients. However, most of dyspnea
health examination and measurement are from objective data. There were few studies conducted from
the subjective experiences of dyspnea from patients. The aim of this study was to explore the dyspnea
management experiences among COPD patients.
Methods: A qualitative descriptive study examining 7 purposively sampled outpatients with COPD from
the Respiratory Medicine Department of a medical center in Central Taiwan. One-on-one in-depth
interviews about life experiences for COPD patients with dyspnea were conducted.
Results: Through content analysis of the interview data, six themes regarding the dyspnea experiences
are found in this study.
1. An internal emergency signal result from the inability to breathe on the verge of death
Dyspnea is a subjective perception that often starts with constriction, tightness, and pain in the chest.
During an episode of dyspnea, the patient experiences uncomfortable feelings including constriction in
the chest and throttled, the inability to inhale that is similar to the stop of breathing, and indescribable
pain.
“When gasping, I felt tightness in my chest. It was like being pressed by something and like someone was
strangling me. I could not breathe…” (1)
2. Triggering and straining
After suffering and experiencing acute exacerbation, the patients realized that dyspnea is easily triggered
in certain contexts that are likely or inevitable in daily life. These contexts include a rapid or intense
physical movement, excessive emotional responses, poor weather or environmental conditions, and
respiratory tract infections.
“…Of course when I carry heavy things! I have to use my arm strength, and immediately start gasping.”
(3)
“...When I am nervous, I start gasping. If I am irritated, or angered by a conversation, I gasp when I am
mad.” (1)
“If I catch a small cold and cough, it is really uncomfortable to cough and gasp with phlegm in my mouth.”
(2)
“…Cold weather often triggers my illness.” (4)
“The dust caused by sweeping and the smoke and poor-quality air make me gasp.” (7)

3. Constraints in daily life due to dyspnea
Dyspnea causes numerous inconveniences in daily life, altering the lifestyle of its sufferers and often
resulting in the inability to work or manage daily-life activities, a reduction or loss of social and
recreational activities, and an inability to sleep on the back which results in insufficient sleep.
“I gasped even though I just made a few movements, and I could not continue if I gasped. In the end, I did
not go anymore. My work was laborious, and I had to carry heavy things! I use my arm strength, but I
gasped when I did this. I just could not work.” (3)
“To sum up, it is very tough! I need my family to take care of my life, even when I want to go to the toilet. I
cannot put on clothes and trousers or take a shower by myself! I gasp as soon as I start walking. I need
someone to bring my meals. I need someone to be with me all day long.” (2)
“Difficulty in breathing requires me to sit up. I cannot fall asleep because I cannot lie down. I sleep for less
than three hours every night.” (1)
4. Immediate Self-Rescue Strategies
Having suffered from dyspnea over time, patients with COPD accumulate experience and health
knowledge in their illness, developing a set of coping strategies for themselves. In other words, they know
the first-line treatments to alleviate the discomfort caused by dyspnea. When dyspnea occurs, the coping
strategies that patients can adopt include halting the ongoing activity, changing poses or sitting down in a
comfortable pose, then taking a bronchodilator or inhaling oxygen, adjusting breathing, and easing the
emotion. If these first-line strategies cannot alleviate the discomfort, most patients seek medical
assistance at a hospital or clinic.
“I use the sprayer first. I bear the discomfort and tell myself to breathe lightly. Inhale lightly and exhale
lightly. Oxygen helps a little, and it makes me gasp less. But, when I gasp really heavily, it does not work;
even if I switch it to the highest level 5 and use the sprayer, the symptoms are not eased. In this situation,
I have to go to the hospital.” (2)
5. Self-Care Awareness in Daily Life
Patients with COPD understand that their lung function can never recover, so they adopt daily-life
protection measures, such as altering their lifestyle to reduce the frequency of dyspnea episodes.
Regularly visiting a doctor and following medical advice is fundamental for decelerating the speed of
exacerbation and reducing the frequency of episodes. Regarding food, COPD patients are aware that
irritating and strong tonic foods can harm them and they must avoid eating cold-nature foods. Patients
must also change their dietary habits and quit smoking and drinking alcohol. In addition, some patients
consider their lungs to be dirty and clean them by using herbal medicines. After facing COPD, the
patients identify the causes that make breathing difficult and adopt countermeasures. They know that
variable weather is an inevitable trigger, so they focus keeping themselves warm, especially their necks.
“Do not eat spicy, hot, and irritating foods. If you breathe in dirty air, you have to clean your lungs. Lungs
are too dirty. You should eat some detoxification matters from time to time. In the mountains where I live,
there are detox herbs.” (1)
“Do not eat icy or cold-nature foods, such as Chinese radish, Chinese cabbage, and watermelons. These
foods should be avoided.” (5)
6. Coexist with the Disease and Self-Repositioning -- accepting fate and being optimistic
Because of physical constraints, COPD patients cannot accomplish numerous daily activities; thus, they
possess an altered self-concepts. Some patients consider themselves disabled and incompetent or even
dead because of loss of physical function. Now, they can only sit like a fool, unable to execute their own
will. Having an irreversible pulmonary disease is like heading toward death; the patient can only wait for
the end to come. However, some patients believe that the time of death cannot be predicted and attempt
to remain optimistic, taking care of their bodies.
“I cannot do what I want to do. I am as useless as a dead person. I can only complain that I am ill-fated
and unlucky.” (1)

“I am not a person who does not feel upset, I have that feeling, but I still go out and visit my friends. We
can spend the day chatting, or feel upset and keep thinking about the annoying things, which makes us
feel unhappy and wear a sad face. We can spend a day in either way. To sum up, do not think too much.
Be optimistic and do whatever you want to do.” (3)
Conclusion: When COPD presents, patients experience discomfort, identify the risk factors of
deterioration, and devise methods to address their symptoms. Most patients experience a loss of mobility
that inconveniences their daily life. These patients begin repositioning themselves. The goal of the
medical staff and patients is to maintain existing functions and health of patients. The findings in this
study can serve as references for medical teams in developing self-management plans.
Contact
[email protected]

How to Improve the Case Report Writing and Review Pass Rates Among Nurses
at One Surgical Ward
Wan Yu Chi, RN, Taiwan
Hui-Ju Chugn, RN, Taiwan
Purpose
The goal was to improve their writing skills as well as the review pass rate of their case reports, thereby
driving their development in clinical expertise and enhance the integration of clinical practices so that
patients can receive high quality nursing and care.
Target Audience
Nursing administrators, researchers and clinical educators
Abstract
Purpose: The “Expertise Advancement System for Primary Care Nurses” is implemented to improve
nurses’ clinical expertise and encourage staff development. Studies confirm that the clinical skill rating
system can determine nurses’ skills and create a learning climate that increases professional values and
capabilities. For years, the percentage of nurses at this unit who won promotion remained unsatisfactory.
The main reason for lack of promotion was low case report writing and review pass rates. Clinical nurses
often complained about writing difficulties, which led to their reluctance towards advancement. The
intention of improving the situation and seeking viable solutions motivated this unit to organize a project
team responsible for coaching our nurses in case report writing. The goal was to improve their writing
skills as well as the review pass rate of their case reports, thereby driving their development in clinical
expertise and enhance the integration of clinical practices so that patients can receive high quality nursing
and care.
Methods: This study was conducted in three stages, namely, planning, execution and appraisal. In the
first stage: the project team was created. Through interviews and literature review, the team members
uncovered the following reasons for the low case report writing rates among nurses at this unit: 1)
inadequate writing composition skills, 2) lack of mentor guidance, 3) lack of educational programs for
case report writing at the unit, 4) low motivation for writing reports, and 5) absence of a report writing
climate at the unit. In the second stage: the project team was engaged in discussions and outlined
viable solutions by using a decision matrix and examining their viability, convenience, required manpower
and costs, and effectiveness. Based on the results of their analysis, the team decided on and
implemented the following solutions: 1) boosting awareness of the significance of the advancement
system to promote the climate that encourages case report writing, 2) providing seeded mentors and
creating a faculty database, 3) planning case report writing programs, 4) meeting with staff willing to write
and setting deadlines for the completion of case reports, and 5) arranging experience sharing by staff
whose case reports have passed reviews. In the third stage: the team compared the results before and
after the project implementation and conducted appraisals based on the list of accepted case reports for
November 2013 published by Taiwan Nurses Association.
Results: During the project implementation by the unit, 11 case reports were completed and submitted
for review in June, 2013. Appraisal results show that 8 of the reports passed the review by Taiwan Nurses
Association at the end of November, 2013. Our staff became more aware of the importance of nursing
expertise through case mentors provided and programs related to case reports planned and launched by
the project team, experience sharing, awareness raising activities regarding the significance of the
expertise advancement system, and the creation of a culture that encourages report writing. As a result,
staff followed the arrangements by the project team and actively participated in related programs and
case report writing Staff’s case report writing rate increased from 18% to 64% and their review pass rate
from 33% to 72.73%, both surpassing the 50% project target. The results proved the significant
effectiveness of the project implementation.

Conclusion: As the project progressed, it was noted that staff writing case reports were three times more
than mentors. To maintain individual coaching and coaching quality, it was sometimes necessary to
request mentoring support from external entities. This was in fact one limit of this project. Therefore,
training mentors and creating a mentoring faculty database is the next target of the unit. In addition,
education and training for nurses, their clinical experiences and a climate that encourages advancement
all have an impact on the development of personal capabilities. In this sense, the review pass rate of case
reports is directly linked to the improvement of the ability to assess clinical professional nursing. The
project implementation successfully reduced the difficulty of writing case reports, boosted confidence in
writing reports, and created a culture that encourages report writing at the unit. All of these incorporated
into patient-centered holistic nursing in clinical practices can achieve effective nursing and enhance the
ability to analyze and deal with patient problems, thereby improving quality of care provided by nursing
staff.
References
Bjork,I.T., Hansen, B. S., Sanmal, G.T.,Torstad, S.,& Hamilton, G.A.(2007).Evaluation of clinical ladder participation
in Norway. Journal of Nursing Scholarship,39(1),88-39. Ming-Chen Lin &Ching-Huey Chen.(2004).An Investigation on
the Nursing Competence of Southern Taiwan Nurses Who Have Passed N3 Case Report Accreditstion. Journal of
Nursing Research,12(3),203-212. Riley, J. K., & Rolband, D. H. (2009). Clinical ladder :Nursea´ perceptions and
satisfiers. Journal of Nursing Administration,39(4),182-188.
Contact
[email protected]

Prevalence of Obesity in a National Representative Sample of Taiwan
Adolescents
Chen-Mei Chen, MSN, Taiwan
Purpose
To determine the prevalence of obesity in Taiwanese adolescents and important related variables.
Target Audience
The target audience of this presentation is health care staffs and policy markers.
Abstract
Purpose: To determine the prevalence of obesity in Taiwanese adolescents and important related
variables.
Methods: This analysis was based on the Nutrition and Health Survey in Taiwan (NAHSIT) data during
2010 and 2011. The original study was a cross-sectional and national representative survey. A total of
1842 subjects (920 males and 922 females) aged 11–20 years participated. Research tools consisted of
questionnaires and anthropometry parameters, and Taiwanese criteria were used to classify adolescents’
weights. The acquired data were analyzed using descriptive and inferential statistics.
Results: The prevalence of obesity in Taiwanese adolescents was 16.7%. Logistic regression analysis
showed that, obesity in adolescents was significantly associated with male gender, parental obesity,
mother’s overweight, eating habits, and perceived dietary benefits.
Conclusion: Obesity among adolescents in Taiwan is a health concern that requires attention. The
prevalence may be reduced by adjusting lifestyles. Prevention strategies should focus on adolescents,
particularly adolescents of obese parents. Furthermore, employing integrative, education-based methods
can reduce the health risks caused by obesity.
References
Andegiorgish AK, Wang J, Zhang X, Liu X, Zhu H. Prevalence of overweight, obesity, and associated risk factors
among school children and adolescents in Tianjin, China. Eur J Pediatr 2012; 171: 697-703. Boumtje PI, Huang CL,
Lee JY, Lin BH. Dietary habits, demographics, and the development of overweight and obesity among children in the
United States. Food Policy 2005; 30: 15-128. Chen SC, Li MC, Sun KT, Lai CL, Shen KT. Relevance of early
teenager obesity and physical activity, lifestyle, and sex hormones in central Taiwan. Cheng Ching Med J 2009; 5:
21-27. Chen W, Chang MH. New growth charts for Taiwanese children and adolescents based on World Health
Organization standards and health-related physical fitness. Pediatr Neonatol 2010; 51: 69-79. Chen W. Screening
obesity children and adolescents with a four-stage. Taiwan Med J 2013; 56: 18-22. Cole TJ, Bellizzi MC, Flegal KM,
Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ
2000; 320: 1240-1245. Pan WH, Flegal KM, Chang HY, Yeh WT, Yeh CJ, Lee WC. Body mass index and obesity-
related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and
obesity for Asians. Am J Clin Nutr 2004; 79: 31-39. Park J, Park J, Hilmers DC, Mendoza JA, Stuff JE, Liu Y, Nicklas
TA. Prevalence of metabolic syndrome and obesity in adolescents aged 12 to 19 years: comparison between the
United States and Korea. J Korean Med Sci 2010; 25: 75-82. Peng JK, Huang KC, Chen CY. Obesity and Metabolic
Syndrome. Primary Med care 2006; 21: 367-371. Reilly JJ. Descriptive epidemiology and health consequences of
childhood obesity. Best Pract Res Clin Endocrinol Metab 2005; 19: 327-341. Temple J, Wrotniak B, Paluch R,
Roemmich J, Epstein L. Relationship between sex of parent and child on weight loss and maintenance in a family-
based obesity treatment program. Int J Obesity 2006; 30: 1260-1264. Tsai YJ, Jeng HM. Vegetable intake behaviors
among employees at work-a transtheoretical study of the business associates of a business and management
consulting. Health Promot Health Educ J 2006; 26: 17-30. Weiss R, Weiss R, Dziura J, Burgert TS, Tamborlane WV,
Taksali SE et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 2362-
2374.
Contact
[email protected]

The Effect of Characteristics of Medical Market and Institutions on Staff-Mixing
Level of Long-Term Care Hospitals
Hee Sun Kang, PhD, South Korea
D. H. Kim, PhD, South Korea
Hanju Lee, PhD, South Korea
Purpose
The purpose of this presentation is to clarify the influences that competition of health care market and the
institutional characteristics on the staff-mixing level of elderly hospitals.
Target Audience
The target audience of this presentation is nurse administrator, policy maker, scholars.
Abstract
Purpose: As the number of long-term care hospitals has quickly increased in Korea with a rapidly aging
population, it is time to provide appropriate services for patients not only quantitative but also qualitative
perspective. Professional nursing services which are provided in long-term care hospitals that performs
as an intermediary care-given institution between acute care facilities and nursing homes, is very
important to ensure patients safety. It is considered that the level of staff-mixing reflects the quality of
nursing service. However, the current system that allows nursing aides to serve as part of registered
nurses and the competitive characteristics of medical service market as a whole have influence on the
long-term care hospitals' intent to recruit nurses and their actual recruiting practice. This study aims to
clarify the influences that competition of health care market and the institutional characteristics on the
staff-mixing level of elderly hospitals.
Methods: Data were obtained from the health insurance reimbursement records of 377 long-term care
hospitals for claims made to the Health Insurance Review and Assessment Service between January 1,
2008, and December 31, 2010. Data were analyzed using one-way fixed panel regression. The
dependent variable was the ratio of nurses to nursing resource(including nursing aides). The independent
variables were the regional availability of acute and long-term care beds, the annual increase rate of
beds. The characteristics of each long-term care hospitals (number of doctors, number of beds and
number of inpatients, increase rate of beds, and owner type) and patients(severity, age) were included.
Results: The results of the study are as follows. 1) The ratio of nurses showed low in regions with high
level of availability of beds of long-term care hospitals. 2) Ratio of nurses showed lower with increasing
number of beds for acute care hospitals, while it showed higher with increasing number of beds of long-
term care hospital. 3) As for patient’s characteristics, the ratio of nurses decreased with increasing
number of patients per beds and the ratio of number of aged patients, which increased with increasing
severity of patients. 4) As for the characteristics of long-term care hospitals, ratio of nurses increased with
increasing numbers of doctors and hospitals, while nurse recruiting rate stayed lower for long-term care
hospitals established by individuals or incorporations, as compared to those established by public
organizations.
Conclusion: In conclusion, as the level of staff-mixing which is essential to ensure adequate nursing
service, varies with the type of patients, regions, and long-term care hospitals, a monitoring system and
policy-making that assures quality of long-term care hospitals by government are needed.
Contact
[email protected]

Situations Among Novice Nurses and Preceptor: They Cannot be Assertive
Akiko Maruyama, PhD, Japan
Atsuko Kobiyama, RN, Japan
Yuko Takayama, RN, Japan
Purpose
The purpose of this presentation is to clarify the situations among novice nurses and preceptor, they
cannot be assertive. Previous studies have indicated that the novice nurses f assertiveness is
significantly related to burnout.
Target Audience
The target audience of this presentation is nurse managers.
Abstract
Purpose: This study describes “the situations where novice nurses and preceptor nurses felt “I wanted to
decline, but I could not do so” on the job relatively.
Methods: A self-administered questionnaire was distributed to 102 novice nurses and 52 preceptor in
each workshop. Having been explained the definition of assertiveness in the questionnaire, participants
were asked about the situations and reasons where they have felt: “I wanted to decline but could not do
so” as “using an example at the workplace from the past year of when they felt they wanted to be
assertive and could not be”. Three situations labeled, “what happened”, ”what I wanted to do”, and “what I
could not do” and their reasons were extracted from the scenarios described in the questionnaire’. A
content analysis based on Krippendorff's method was carried out on their described messages by
focusing on the context. The situations were classified for each participant, and categorized based on the
similarity of the situations.
Results: Novice nurse’s number of valid responses was 81, and the average age was 23.7 years old.
Preceptor’s number valid responses was 42, and the mean age was 33.3 years old. The situations where
the participant novice nurses felt “I could not be assertive toward my seniors” yielded the following nine
categories: (1) I cannot decline tasks assigned to me; (2) I cannot say anything about my senior’s
unfavorable behavior; (3) I cannot say I’m confused by the unstructured instructions; (4) I cannot argue
against my senior’s scolding or pointing out grievances regarding my work; (5) I cannot argue about my
senior’s behavior toward me and novice nurses; (6) I cannot declare my uneasiness about the work; (7) I
cannot argue about a false accusation of errors made by my senior; (8) I cannot decline private requests;
and (9) Others.The situations where the preceptor felt the following seven categories: “Nursing practice”,
“Dependent behavior”, “Lack of feeling strain”, “Inappropriate language”, “Presentation of the homework”,
“Appearance”, “Character of novice nurse”.
Conclusion: Novice nurses were in situations where they could not decline to do something or were
made to feel uneasiness about fulfilling their duties, or declining overtime work, and not being able to
communicate or report necessary messages, all of which were potential situations that could contribute to
medical accidents. The preceptors considered relationships with novice nurses to be important. This
study made us realize the importance of assertiveness education for novice nurses. As well, it suggested
the necessity to ensure the assertiveness of the whole ward by improving the assertiveness of preceptors
or bosses.
References
1.Suzuki E CItomine
anoya Y, etICK
al. FFactors Affecting Rapid Turnover
University @HospitalDJo

T et al.: Assertiveness affecting burnout of novice nurses at university hospitals. Japan Journal of nursing Science.
2006. 3.93-105 3.Suzuki E., Kanoya Y., Katsuki T. & Sato C. (2007). Verification of the reliability and validity a
Japanese version of the Rathus Assertiveness Schedule.. Journal of Nursing Management.15, 530-537 4.Suzuki
E. CItomine, I., Saito, M
longitudinal study. Japan Journal of nursing Science C2008G5.9
-21 5.Suzuki E., Saito M., Tagaya A., Mihara
R.,etal.2009): Relationship between assertiveness and burnout among nurse managers. Japan Journal of Nursing
Science.2009. 6, 71-81 6.Suzuki Eiko, Tagaya Akira, Ota Katuya, et al. Factors affecting turnover of Japanese novice
nurses in university hospitals in early and later periods of employment, Journal of Nursing Management,
2010,18,194-204
Contact
[email protected]

Patients' Lived Experience of Chemotherapy after Mastectomy: A
Phenomenological Study
Yu Chen Liao, RN, Taiwan
Li-Fen Wu, PhD, Taiwan
Purpose
The study discovers the chemotherapy patient’s life experiences that are breast cancer after mastectomy,
and understood patient's demand and the symptom distress, as well as the factor affect their life journey.
Target Audience
This study provide understanding of the experience of living in the process of breast cancer
chemotherapy. It can be used as the application with reference to provide clinical nursing care .
Abstract
Purpose: The study discovers the chemotherapy patient’s life experiences that are breast cancer after
mastectomy, and understood patient's demand and the symptom distress, as well as the factor affect their
life journey.
Methods: This research used phenomenology research technique and semi-structural interview. The
subjects confirmed to participate the study and signed the letter of consent. After the conversation, the
record of the material copied out the writing. The case experience was faithful also the integrity presents
by the writing, and accept any change or the fluctuation, Study cases were from a medical center in
central Taiwan, outpatient chemotherapy room, patient processed the end of chemotherapy. It was 40
cases, the actual size of the sample size data analysis was no new case presented as the standard. The
selection criteria were as follows: breast cancer after surgery, chemotherapy, conscious clear, can talk in
Mandarin or Taiwanese language, willing to participate in study and share life experience of adult women
. The reliability of the data was carefully selected cases, pre-interview skills training, control interview
context, to establish interactive data analysis. Validity established by the recording interview and audio
transcription quality control, interviews and analysis of information considered “deposit regardless of”
principle, in order to reduce errors and to be objective . This study used Giorgi & Giorgi (2003) proposed
research procedures for data analysis.
Results: Four main concepts through the case described in the context of the experience, they are as
follows: Embrace hope, Struggle for life, Reflect on life, and Meet in regret. The added bonus is that
patients appreciate the opportunity to express the feeling of suffering. Through the one-on-one talks
between nursing staff and patients, the patients re-examine their past life, and re-establish the meaning of
life.
Conclusion: The results of the study provide an important basis for the nursing staff who take care of this
type of patients.
Contact
[email protected]

Factors Influencing Emotional Labor of Clinical Nursing Staff in Taiwan
Kai Ching Lin, MSc, Taiwan
Hui-Yu Liang, RN, Taiwan
Chiung Yu Lin, BS, Taiwan
Chi Shiu Lai, BS, Taiwan
Purpose
The purpose of this presentation is to identify the factors influencing emotional labor for nursing staff in
Taiwan.
Target Audience
The target audience of this presentation is a administrator, and policy makers in hospitals.
Abstract
Purpose: Emotional management and regulation of displays as part of work. However, emotional labor
becoming more and more important in nursing workplace. The purpose of the study was to identify the
associations between emotional labor and various factors.
Methods: A cross-sectional study design was conducted in this study. Subjects were selected by using a
purposive sampling method. Emotional labor Questionnaire was used to collect data and completed by
202 subjects. Questionnaire consisted of three dimensions and 26 items: Controlling negative emotions
(10 items), expressing positive emotions (5items), handling others negative emotions (11 items), and
overall Cronbach α was 0.97.
Results: The finding indicated that nurses perceived the level of emotional labor was moderate (the
mean score was 3.49 out of a possible score of 6; SD = 0.95) and 45.2% nurses staff express higher
degree of emotional labor, and 55.34% nurses staff experiences higher degree of controlling negative
emotions in clinical practice. Independent t test analysis indicated that different position emotional labor
significant different (t= -2.42, p=0.02), head nurse perceived of handling others negative emotions (t= -
2.143, p=0.03) and controlling negative emotions (t= -2.60, p=0.01) significant higher than nurses. Hours
worked per week was significant different emotional labor, 30-35 hours worked per week significant
higher than 36-40hours (t=2.30, p<0.01). The finding of liner regression analysis indicated that nurses
position (β= 0.17, t= 2.42, p=0.02, 95% CI= 3.41 to 33.48), hours worked per week (β= -0.16, t= -2.30,
p=0.02, 95% CI= -26.63 to -2.02) were significant predictors of emotional labor and explained 5.4% of the
total variance.
Conclusion: Nurses’ administrator perceived higher degree of emotional labor of recognized in this
study, which developing health promotion program not only for nurse but also nurses administrator,
decrease job related emotional stress skills should be established in nursing workforce.
Contact
[email protected]

Effects of a Cultural Competence Education Program for Nursing Students in
Taiwan
Chia-Jung Lin, MSN, Taiwan
Mei-Chih Huang, PhD, Taiwan
Purpose
The purpose of this study was to investigate the effectiveness of a selective course on enhancing nursing
student’s knowledge, attitude, skill and behavior of cultural competence.
Target Audience
The target audience of this presentation is faculty, nursing students, and registered Nurse.
Abstract
Background: Cultural competent care is an essential ability for nursing students in current Taiwanese
global context. However, little is known about nursing students’ knowledge, attitude, skill and behavior of
cultural competence. Moreover, the creative cultural competence courses were designed and aimed to
build up the nursing students’ abilities on cultural competence care in clinical setting. The effects of
educational intervention are eagerly concerned and require to be evaluated.
Purpose: The purpose of this study was to investigate the effectiveness of a selective course on
enhancing nursing student’s knowledge, attitude, skill and behavior of cultural competence.
Methods: A quasi-experimental study was conducted using the mixed method for data collection and
analysis. A total of 105 nursing students were recruited from 2-year programs offered by two medical
technology universities in Southern Taiwan. The students were assigned to the experimental group (n =
51) and control group (n = 54) according to university. This study was conducted from August 2012 to
July 2013. The educational intervention consisted of a 36-hour course entitled Cultural Competence Care
that was expected to achieve the five course objectives: 1. Prioritize the social and cultural factors that
affect health in designing and delivering care across multiple contexts; 2. Use relevant data sources and
best evidence in providing culturally competent care; 3. Promote achievement of safe and quality
outcomes of care for diverse populations; 4. Transform systems to address social justice and health
disparities; and 5. Participate in continuous cultural competence development. Data were simultaneously
collected from both groups pre- and post- the education intervention using structured questionnaires. The
questionnaire consists of a demographic profile, the Cultural Competence Assessment Instrument-
Chinese version (CCA-CV), the dilemma associated with cultural care, and a self-assessment after
complete the course. The CCA-CV included two sub-dimensions which are cultural awareness and
sensitivity, and cultural competence behavior.
Results: The experimental group was composed of 2 males and 49 females and the control group
comprised 54 females, all of whom were grade 2 students. In the experimental and control groups, 96.1%
and 94.3% of the students, respectively, had never taken a cultural competence course; 92.2% and
30.2% of the students in experimental group and control group, respectively, believed that offering
cultural competence courses is necessary. The percentages of students who were unfamiliar with the
word “cultural competence” were 62.5% in the experimental group and 96.2% in the control group; 39.2%
and 51.9% of the students in the experimental group and control group, respectively, had experience in
caring for people in culturally diverse populations, such as the aborigines or new immigrants. The three
major problems encountered when caring for culturally diverse populations are communication difficulties,
unfamiliarity with patients’ needs, and a lack of health education brochures with their native language. For
both groups used in this study, identifying patient requirements is the task that requires the most
assistance when caring for people in culturally diverse populations. In comparison of the pre-test scores
between the two groups, there are no significant differences in the scores of CCA-CV and the scores of
self-assessment of the course. Regarding cultural competence, the students in experimental group
produced significantly higher posttest scores on cultural awareness and sensitivity (p = .02), and cultural

competence behavior (p = .03) than the students in control group. The post-test scores of self-
assessment of the course on ‘’basic knowledge’’ (p <.001), ‘’important theme’’ (p <.01), ‘’stereotype of the
medical decision-making’’ (p <.01), and ‘’clinical practice skills’’ (p <.01) for experimental group were
significantly higher than the post-test results for the same items in the control group. All scores of cultural
competence behavior and a self-assessment of the course in the pre- and post- test results for the
experimental and control group demonstrated statistical significance (see table1). Qualitative analysis of
collected data is done in terms of cultural knowledge, affection, skill and behavior, all benefiting from
course-related activities.
Table 1. The pre- and post scores of cultural competence and a self-assessment for the course
Within group
Experimental Group Control Group Between
Item pretest - posttest
Mean ± SD Mean ± SD groups Pb
Experimental Pa Control Pa
Pre-test (n =51 in Experimental; n = 54 in Control)
Cultural Competence(CCA-CV)
Cultural awareness and

58.35±5.81 57.57±5.05 .46
sensitivity
Cultural competence
65.25±17.67 68.33±14.61 .33
behavior
Self-assessment of the course
Basic knowledge 54.37±10.13 55.48±11.61 .60
Important theme 48.16±10.16 48.17±9.64 1.00
Stereotype of medical
44.76±10.35 46.49±10.92 .41
decision
Clinical practices skills 42.86±12.14 54.38±8.59 .41
Post-test (n =44 in Experimental; n = 47 in Control)
Cultural Competence
Cultural awareness and

59.48±4.85 57.12±4.68 .41 .30 .02*
sensitivity
Cultural competence
78.96±9.50 74.10±11.10 .00** .001** .03*
behavior
Self-assessment of the course
Basic knowledge 67.04±8.21 61.07±9.80 .00** .001** .00*
Important theme 56.21±6.99 52.16±8.10 .00** .01* .01*

Stereotype of medical
54.51±8.26 50.05±8.17 .00** .02* .01*
decision
Clinical practices skills 54.38±8.59 49.16±9.16 .00** .008** .01*
*p<.0.05, **p<0.01; pa Paired-T test, pb Independent-T test
Conclusions: Applying this cultural competence course in nursing students can improve the cultural
knowledge, attitude, skill and behavior of cultural competence. This study suggests that nursing students
need to be educated regarding the cultural competence with diversity population. The researchers
recommended the results could be used as a reference in incorporating the cultural competence concept
into nursing education.
Contact
[email protected]

Three Japanese Expert Nurses' Professional Narrative: Reflections on Their
Accumulated Clinical Nursing Experiences Refining Nursing Identity
Hiromi Kuroda, RN, MN, Japan
Satomi Yamaguchi, RN, MN, Japan
Sayaka Higajima, RN, BA, Japan
Tomoko Miyashita, RN, BA, Japan
Hideko Urata, RN, PhD, Japan
Purpose
Reflecting on own practices and experiences is a significant key for the expert nurses as it constructs
intellectual and practical ability of nurse and would refining their professional identity. The purpose of this
study is to describe 3 Japanese expert nurses’ perceptions for nursing as the lifework profession.
Target Audience
The target audience of this presentation is expert clinical nurses, educators, researchers and young
nurses who are interested in understanding how professional nurses’ perceive their professional
experiences and refining and accumulating their professional identity, cross culturally.
Abstract
Purpose: Reflection on one’s own practices and experiences is a significant key for the expert nurses as
it constructs intellectual and clinical competencies of nurse and it would refine their professional identity.
The purpose of this study is to describe 3 Japanese expert nurses’ perceptions for nursing as their
lifework profession.
Methods: Three active expert nurses, who have over 30 years of work experiences, working for a
University Medical Hospital with 800 beds in Japan, were the informants of the study. The main role of the
informants was day to day patient care rather than the administrative aspect of their work. The interview
guide with some key questions such as 1)What do you give attention to the most when you interact with
the patients? 2) What does nursing mean for you? 3) What do you wish to tell about nursing and for this
to be adopted by the next generation of nurses? was distributed to the informants a few days before the
semi-structured interview. The IC recorder was used and the interview was taken in each interview, and
the transcripts were made after the interviews. Some categorie! s and sub-categories were extracted in
inductive manner, and careful analysis was maintained by discussions and triangulation of the research
team members.
Results: The three female nurses in their 50’s agreed with the study. The mean interview hour was 56
minutes, and 12 categories with 45 sub-categories and 118 codes were extracted from the transcripts.
Unique categories [ ] were found as [Ideal nursing] [Importance of communication and social skills]
[Nursing as the interpersonal relations with the patients] [Caring includes family of the patients]
[Supporting patient with team] [Realizing a true attraction of nursing by the accumulated experiences]
[Increasing the choices/options of appropriate care for the patients by considering their individuality] [not
only quietly cuddling close to the patients but also providing appropriate care] [Determining to carry out
care for patents’ true bene! fit] [Accumulations of both personal life and professional life fosters nurses
growth] [Recognition of what is a key to maintain nursing career] [Considering own role to educate and
guide the next generation nurses into nursing]
Conclusion: Professional roles and identity of expert nurses were cultivated within their everyday
practices and repetitive reflections of those actions.[Ideal nursing and] [Nursing as the interpersonal
relations with the patients] were the principle ideas beyond the age and career of nurses. However, these
Japanese expert nurses perceived that their professional growth was underpinned by [Accumulations of
both personal life and professional life fosters nurses' professional growth]. With over 30 years of nursing
experiences and tuning into in their 50s, these experts refined what and how the nursing professional is
like. That was also influenced by their interactions with patients and others. In addition, [Increasi! ng the

choices/options of appropriate care for the patients by considering their individuality] was perceived. The
more expert nurses reflect their own practices the more they would have choices of care to be provided,
and to be flexible and creative to provide care of which patients individuality is well considered.
[Determining to carry out the care for patents’ true benefit] and [not only quietly cuddling close to the
patients but also provide appropriate care] showed Japanese expert nurses’ specific approaches as they
believe it fulfilled patients' needs. They accept their patients as they are, but at the same time they
provide necessary and beneficial care for their patients with their strong faith as it fosters patients growth.
They also perceived themselves as the leaders to lead the next generations as [Considering their own
role to educate and guide the next generation nurses into nursing] was shown. !
Acknowledgement: A part of this study was supported by the Research founding of the Alumni
Association of Nagasaki University Department of Nursing 2012
References
1.May Solveig Fagermoen (1997).Professional identity: values embedded in meaningful nursing practice,Journal of
Advanced Nursing,Volume 25, Issue 3, pages 434–441 2.Joakim Öhlén,Kerstin Segesten(1998).The professional
identity of the nurse: concept analysis and development.Journal of Advanced Nursing,Volume 28, Issue 4, pages
720–727. 3.Johns C (2011). Guided reflection: a narrative approach to advancing professional practice(2nd ed).
Wiley-Blackwell
Contact
[email protected]

Factors That Influence the Amount of Time Spent on Child Care and Housework
by Fathers until One Month after Child Birth
Sanae Yamaguchi, MSN, Japan
Shiho Sato, MS, Japan
Purpose
the purpose of this presentation is to promote fathers' childcare participation.
Target Audience
The target audience of this presentation is clinical nurses and family nursing researchers.
Abstract
Purpose: This study aimed to identify the factors that influence the amount of spent on child care
and housework by fathers.
Methods: The subjects were 24 men who were to be first-time fathers. The subjects participated in the
fathers’ class developed by the researcher. After the class, the questionnaire was sent to the subjects.
Multiple regression and path analyses were conducted. This survey was approved by the Ethics Review
Committee of the organization with which the researchers belongs.
Results: The mean age of the subjects was 33.4 years old. The lecture of ‘The response way when a
child cries’ in the fathers’ class correlated with the amount of time spent on child care through
development as a father. The lecture of ‘the image of feeding schedule’ in the fathers’ class correlated
with the amount of time spent on child care through development as a father and the sense of burden
related to child care. In addition, The lecture of ‘the image of feeding schedule’ in the fathers’ class
correlated with the amount of time spent on housework through equalitarian sex role attitudes and
acceptance of a role in housework. The lecture of ‘the importance of the father’s participation in
housework’ in the fathers’ class correlated with the amount of time spent on housework through the
acceptance of a role in housework.
Conclusion: The fathers’ class was found to influence the amount of time spent on child care by fathers
through the development as a father and the sense of burden related to child care. The fathers’ class was
found to influence the amount of time spent on housework by fathers through equalitarian sex role
attitudes and acceptance of a role in housework.
Contact
[email protected]

Health Status, Healthy Lifestyle, Activity, Perception of Health, and Health
Services: Differences Between Baby Boomer Women and Elderly Women in
Korea
Narae Heo, RN, BSN, MS, South Korea
Jiyoung Kim, RN, BSN, MS, South Korea
Purpose
The purpose of this was to investigate the health status, healthy lifestyle, activity, perception of health,
and health services between Baby Boomer Women and Elder Women in Korea.
Target Audience
The target audience of this presentation is conference participants who are involved in nursing related to
“Culturally Diverse Health Behaviors”
Abstract
Purpose: The purpose of this was to investigate the health status, healthy lifestyle, activity, perception of
health, and health services between Baby Boomer Women and Elder Women in Korea.
Methods: The data were derived from the 2011 Korea Health Panel annual survey database (β-version
2.0) by National Health Insurance Services [NHIS] and Korea Institute for Health and Social Affairs
[KIHSA]. Based on the database on the 170,350 Korean who had ever used Health Services in 2011,
data of the number of women aged 50 or older were used for this study (N=3559). They were divided into
the 1058 baby boomer women group (50-64) and 2051 elderly women group (65+). The data were
statistically analyzed by descriptive statistics with module of the SPSS Statistics V 21.0 program.
Results: 1: Health status: 77 percent of the baby boomer women group and 93 percent of Elder Women
groups are diagnosed with chronic disease. Nearly 24 percent of the baby boomer group and 37.5
percent of Elder Women groups have eye problems. A fourth of the baby boomer group and less than half
of the Elder Women group complained “difficulty chewing due to teeth and mouth” for one year.
Almost 20 percent of the participants presented “little bit feeling of anxiety and depression”. Past history
of medication related feeling of depression and suicidal thought accounted for 10 percent of the
participants. About 30 percent of the baby boomer women group and nearly 20 percent of Elder Women
groups reported stress to their task.
2: Healthy lifestyle: Over 80 percent of the two groups reported that they have three meals a day
regularly. Only 3 percent of both groups were reported to have toothbrushes between meals. More than
88 percent of the two groups reported that they can dress and bath without help. Just 5 percent of both
groups were reported to have history of smoking.
3: Activity: Less than 10 percent of Baby Boomer Women group and roughly 30 percent of Elder women
group reported “walking problems and daily activities of the day”. Regarding physical activity, roughly 70
percent of the both groups stated “not engaging in vigorous physical activity and moderating physical
activity for the seven days”. On the contrary, around 30 percent of the two groups reported walking for
seven days.
4: Perception of health and health services: About 28 percent of Baby Boomer Women group and 14
percent of Elder Women group reported poor self-perceived health status. Nearly 24 percent of two
groups surveyed stated that they could not avoid cancer in their life. Unlike the perception of cancer risk,
more than half of the two groups thought that they are less like to have cancer within 10 years. Roughly
50 percent of the both groups visited clinics when they had negative feeling to their health for one year. In
addition, more than 80 percent of the groups thought that “routine exams are helpful for overall state of
health”. However, less than half of the two groups visited dental clinics for three years.

Conclusion: These results could be fundamental information to understanding of comprehensive health
conditions for baby boomer women and elder women in Korea. Therefore, all of the information will allow
the women and nurses to take these strategies into consideration so that the women maintain health.
References
National Health Insurance Services [NHIS] and Korea Institute for Health and Social Affairs [KIHSA]. 2011. 2011
Korea Health Panel annual survey database (â-version 2.0).
Contact
[email protected]

Mediating Effect on the Relationship Between Professional Commitment and
Intent-to-Leave Among Hospital Nurses in Taiwan
Yuan-Ping Chang, PhD, Taiwan
Purpose
This study was conducted to determine the mediating effect of work frustration on the relationship
between professional commitment and intent-to-leave.
Target Audience
The target audience of this presentation is all nurses and managers in the clinical setting.
Abstract
Purpose: This study was conducted to determine the mediating effect of work frustration on the
relationship between professional commitment and intent-to-leave.
Methods: A cross-sectional study with a questionnaire survey was performed. The participants in this
study were hospital nurses in Taiwan. Three questionnaires covering work frustration, professional
commitment and intent-to-leave were used as measuring tools. Data were verified by SEM with AMOS.
Results: There was a significant direct and inverse correlation between professional commitment and
intent-to-leave as well as a significant and indirect effect of professional commitment on intent to leave
through work frustration (p < .05).
Conclusion: Work frustration may cause turnover among nurses and reduce the quality of nursing care.
Managers should thus strive to enhance interpersonal relationships in the workplace, schedule adequate
numbers of staff and provide sufficient equipment and supplies to engender a safe and positive work
environment and to improve the retention of nurses.
References
Chang, Y. P., Tsai, L. Y., Liao, R. Y., Wang, H. I., & Wang, H. H., 2012. Testing the reliability and validity of Chinese-
version work excitement and work frustration questionnaires. Journal of Nursing and Healthcare Research 8 (3), 232-
241. Cho, D. H., & Son, J. M., 2012. Job embeddedness and turnover intentions: An empirical investigation of
construction IT industries. International Journal of Advanced Science and Technology 40, 101-110. Hayes, L. J.,
O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., …Stone, P. W., 2006. Nurse turnover: A
literature review. International Journal of Nursing Studies 43 (2), 237-263. Kirschenbaum, A., & Weisberg, J., 2002.
Employee's turnover intentions and job destination choices. Journal of Organizational Behavior 23 (1), 109-125.
Kutney-Lee, A., Wu, E. S., Sloane, D. M., & Aiken, L. H., 2012. Changes in hospital nurse work environments and
nurse job outcomes: An analysis of panel data. International Journal of Nursing Studies 50 (2), 195-201. Lu, K. Y.,
Chang, L. C., & Wu, H. L., 2007. Relationships between professional commitment, job satisfaction, and work stress in
public health nurses in Taiwan. Journal of Professional Nursing, 23 (2), 110-116. Lu, M. S., 2011. 2010 Medical
manpower demand estimate forum: Nurses workforce. . McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D.
M., & Aiken, L. H., 2011. Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal
problems for patient care. Health Affairs 30 (2), 202-210. Milisen, K., Abraham, I., Siebens, K., Darras, E., & de
Casterlé, B. D., 2006. Work environment and workforce problems: A cross-sectional questionnaire survey of hospital
nurses in Belgium. International Journal of Nursing Studies 43 (6), 745-754. Teng, C. I., Shyu, Y. I., & Chang, H. Y.,
2007. Moderating effects of professional commitment on hospital nurses in Taiwan. Journal of Professional Nursing
23 (1), 47-54. Wang, L., Tao, H., Ellenbecker, C. H., & Liu, X., 2012. Job satisfaction, occupational commitment and
intent to stay among Chinese nurses: a cross-sectional questionnaire survey. Journal of Advanced Nursing 68 (3),
539-549. Zangaro, G. A., & Soeken, K. L., 2007. A meta-analysis of studies of nurses' job satisfaction. Research in
Nursing & Health 30 (4), 445-458.
Contact
[email protected]

Pilot Survey of Nurses' Attitudes and Practice of Developmentally Supportive
Care in NICUs inTaiwan
Chia-Ling Wu, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to examine neonatal nurses' attitudes in applying developmentally
supportive care (DSC) knowledge and their perceptions of practice of DSC in NICUs in Taiwan.
Target Audience
The target audience of this presentation is neonatal care professionals.
Abstract
Purpose: to examine both neonatal nurses' attitudes in applying developmentally supportive care (DSC)
and their perceptions of practice of DSC in NICUs in Taiwan.
Methods: The Chinese version of Neonatal Nursing Care Survey (NNCS) was a self-administered paper
survey and distributed to NICU nurses from six regional medical institutions (two each located in the
northern, central, and southern Taiwan). This tool designed on a five-Likert scale ranging from 1 to 5
assesses nurses' attitudes (including 38 items) toward and perceptions of their practice (including 61
items) of DSC for preterm infants in NICU. The context of NNCS reflects overall DSC strategies classified
into five components: individualized care, appropriate sensory input, promote comfort, appropriate
positioning, and parental involvement. Higher scores indicate that the nurse has a more positive attitude
about applying DSC knowledge, and/or that she provides DSC to preterm infants more frequently.
Results: Of 267 questionnaires, 221 were returned, gathering an 82.8 % response rate that varied
between 62.5 and 96.8% among hospitals. Neonatal nurses generally showed a positive attitude about
applying DSC knowledge (M=3.50, SD=.38). Their highest attitude score was "promote comfort
component", while as the lowest one was "individualized care". The top 5 of 16 practice strategies of
DSC provided by nurses in order to frequency were: "nesting", "supportive positioning aids", "covering the
incubator", "holding in tucked position", and "midline positioning". The average practice scores (ranging
from 3.44-4.08, SD= .54-.74) were higher than the score in attitudes. In this study, the correlations of five
DSC components between attitudes and practice were weak. "Individual care" attitudes and practice had
no significant correlation with any component of other DSC attitudes or practices. Nurses' attitudes
towards "appropriate sensory inputs" and "promote comfort" consistently correlated with their practice of
these two components, whereas "appropriate positioning" and "parent involvement" show no such
consistency.
Conclusion: Findings of this study may help nursing educators and administrators at both unit and
hospital levels to provide educational programs and supports in order to promote nurses' knowledge and
attitudes, and consequently facilitate nurses' DSC practice. Further studies to understand nurses'
attitudes and practice experience are recommended, especially for those items with low values.
References
Als, H. (1986) A synactive model of neonatal behavioral organization: Framework for the assessment of
neurobehavior in the preterm infant for support of infants and parents in the neonatal intensive care environment.
Physical and Occupational Therapy in Pediatrics, 6, 3-35.
Contact
[email protected]

Reliability and Validity of the Chinese Version of the Suicide Caring Competence
Scale (SCCS) for Family Caregivers: Scale Development
Fan-Ko Sun, PhD, Taiwan
Wang Ruey-Hsia, PhD, Taiwan
Chun-Ying Chiang, RN, PhD, Taiwan
Wei-Jen Chen, MS, Taiwan
Purpose
The purpose of this presentation is to inform an audience of nurses on the findings of a study that
developed a Chinese version of the Suicide Caring Competence Scale (SCCS) for family Caregivers and
prove its reliability and validity.
Target Audience
The target audience of this presentation is nurses who evaluate family caregivers caring ability for their
suicidal relatives.
Abstract
Purpose: To develop a Chinese version of the Suicide Caring Competence Scale (SCCS) for family
Caregivers and to examine its reliability and validity.
Methods: The study was a cross-sectional questionnaire survey. Participants came from a Suicide
Prevention Center and two acute psychiatric hospitals in Taiwan. A convenience sample of 165
caregivers of people who attempted suicide. To be eligible to participate participants had to be a primary
caregiver of people who had attempted suicide and be over 18 years of age. The questionnaire consisted
of the Chinese version of the 20-item SCCS, developed by the authors and was based on a previous
qualitative study. Item analysis was used to delete redundant items. Exploratory factor analysis (EFA) and
confirmatory factor analysis (CFA) were used to examine the construct validity. The association between
educational level and SCCS was used to examine the concurrent validity of SCCS. Cronbach’s α and
test-retest reliability were examined to understand the reliability of SCCS. The study was conducted in
2008 and 2009.
Results: EFA and CFA indicated that a second-order factorial model with five subscales and 19 items
best fit the data. The five subscales were proactive prevention, daily living care, seeking assistance from
professional resources, seeking assistance from laypersons, and seeking assistance from religious
resources. The higher the educational level, the higher the SCCS was. Cronbach’s α and test-retest
reliability of total and subscales ranged from 0.67 to 0.90 and from 0.62 to 0.82, respectively. The SCCS
had acceptable validity and reliability.
Conclusion: The Chinese version of SCCS has satisfactory reliability and validity. Nurses could use the
SCCS to assess the family caregivers’ competence and provide proper education to improve their caring
competence for their suicidal relatives.
Contact
[email protected]

Current Status and Issues about Nursing Practice Ability of Nursing Faculty in
BSN Programs in Japan
Wakako Sadahiro, RN, DNSc, Japan
Sachiko Kiguchi, RN, MNSc, Japan
Akiko Hiyama, RN, RPHN, MSc, Japan
Purpose
The purpose of this presentation is to discuss the nursing faculties’ ability necessary for nursing practice
instructions with faculties in various countries and to identify the international prospect for the realization
of the effective practice instructions.
Target Audience
The target audiences are the nursing faculties in charge of clinical nursing practicum instructions, the
planning directors of the Faculty Development program, and researchers of the transcultural nursing
education program.
Abstract
Purpose: The number of the Japanese BSN programs exceeds 200 today, having increased by 20-fold
over the last 20 years. This sudden increase resulted in the qualitative and quantitative deficiency of
nursing faculties in universities. As a result, deterioration in the quality of nursing practice ability of nurses
graduated from BSN programs is of particular concern and the improvement of their practical ability has
become a social problem. It is effective to conduct a high quality nursing practice to improve the students’
nursing practice ability, and therefore the nursing practice ability of nursing faculties is being called into
question. In addition, the result of our study clearly demonstrates that the instruction ability of nursing
faculties is significantly subject to the nursing practice ability (KIGUCHI: 2013). Therefore, this study was
conducted under the following purpose. The purpose of this study is to clarify the current status and
issues about the nursing practice ability of nursing faculties who belong to Japanese nursing universities
and instruction clinical nursing practicum.
Methods: A questionnaire survey by mail was conducted for 869 nursing teachers in Japan who belong
to nursing university and in charge of clinical nursing practicum. “The Self Evaluation Scale of Oriented
Problem Solving Behavior in Nursing Practice (OPSN)”, a 5-point Likert-type scale comprising of 25 items
with 5 sub-scales, was used as a measuring instrument. SPSS Statistics 20 was used for the data
analysis to calculate the descriptive statistics, which was compared with the result of a preceding nation-
wide study conducted for nurses in Japan (Funashima ; Sadahiro, 2009).
Results: A total of 325 questionnaires were returned (response rate: 37.4%) and 312 of which were valid
responses. The characteristics of the target nursing faculties showed that the mean age was 47.3 year
old, the mean educational experience was 9.2 years (SD: 7.5), and the mean clinical experience was 10.0
years (SD: 6.9). Cronbach's coefficient alpha of OPSN for the entire scale was 0.781. In addition, the
coefficient alpha for the sub-scale ranged from 0.685 to 0.697, which showed that the reliability was
secured. As a result of factor analysis, 23 out of 25 items converged to the original sub-scale, which
showed that OPSN almost secured the construct validity. OPSN score ranged from 25 points to 125
points, with the mean score being 110.2 points (SD: 13.7). This score exceeded the mean score, 95.9
points, of the preceding study that was conducted for nurses by 14.3 points. Furthermore, as a result of
matching with the scoring section of the preceding study, 171 (54.8%), 131 (42.0%), and 10 teachers
(3.2%) were identified in the high-, middle-, and low-scoring areas, respectively. These results show that
the nursing practice ability of the nursing faculties belonging to the Japanese nursing universities is higher
than the average practical ability of nurses. In addition, the score in each sub-scale were as follows: “IV.
Providing emotional support for patients toward overcoming problems” was highest at 22.8 points on
average (SD: 3.0), followed by “III. Making smooth interaction toward problem solving” with 22.6 points on
average (SD: 2.9), “I. Search and discovery of problems by organizing and utilizing information” with 22.1
points on average (SD: 2.9), “II. Giving assistance to patients' activities in their daily life and medical

doctors’ treatment, alleviating symptoms, and maintaining and promoting life function and their
individualization toward solving and avoiding problems” with 21.7 points on average (SD: 3.1), and “V.
Self-evaluation toward problem solving” with lowest at 20.9 points on average (SD: 3.9). All these scores
of the sub scale were also higher than the result of the nation-wide study for nurses, which confirmed that
the practical ability of nursing faculties were high in several aspects. The scores of nurses, on the other
hand, were higher in II than in I, whereas those of nursing faculties were found to be higher in I than in II.
This fact suggested that nursing faculties would tend to be higher in the assessment ability than in
technical ability in the nursing practice. Furthermore, the scores of nurses was also low in V, suggesting a
possibility that nursing professions in Japan including nursing faculties were generally poor in conducting
self-assessment activity in an appropriate manner. From now on, improvement of nursing practice ability
of nursing faculties can be expected by implementing the Faculty Development program with a concept to
promote technical skills and self-assessment.
Conclusion: It was revealed that the nursing faculty of the Japanese BSN programs has high nursing
practice ability. It would become possible to further enhance the practical ability in the future by continuing
education for the assessment activity or technical skills. Moreover, a possibility was suggested that
enhancing several aspects of teaching activities could provide high quality nursing practice instructions to
students based on these high practical abilities.
References
Naomi Funashima ; Wakako Sadahiro :Files of measurement for Nursing Practice and Nursing Education
2nd.ed.,Igaku-shoin,Japan,2009. Sachiko KIguchi:The Quality of Teaching Behaviors at Clinical Nursing Practicum
on Nursing Faculties in Japanese Universities,master thesis of Sapporo City University,2013.
Contact
[email protected]

Healthcare Needs Among New Immigrate Spouses in Taiwan
Tzu-Chun Chen, MS, Taiwan
Purpose
The purpose of this presentation is to present the health care needs of new immigrant spouses in Taiwan.
Target Audience
Abstract
Purpose: To examine health care needs among new immigrate in Taiwan. This is a descriptive research
design.
Methods: This study used a purposive sampling method to recruit foreign and mainland Chinese
spouses in Taiwan. SPSS 16.0 for Windows was used to analyze the data. An alpha of 0.05 was set as
the level of significance. The data were analyzed by using descriptive statistics, independent t test, and
Pearson correlation.
Results: Three hundred and forty-seven new immigrate spouses were recruited in southern Taiwan. The
age of subjects ranged from 21-35 years old (58.5%). The majority subjects’ educational level was junior
high school (33.1%) and high received (31.4%). The majority of subjects came from southeast countries
(62.5%). Results showed that majority of subject perceived good health (71.1%). Subjects also reported
that they do not have other health insurance rather than national health insurance (72.3%). When
subjects felt un-comfortable, only 47% of them went to visit a doctor. Thirty-three percent of them did was
forbearance, and 18.2% used medicine without prescription. The major reason they did not go to visit a
doctor immediate when they were sick was lack of time.
Conclusion: This study is important for health care workers in Taiwan to understand health care needs
among new immigrate spouses in Taiwan. Hence, health care worker in Taiwan should used these
information to assist new immigrate spouses to maintain and improve their health.
Contact
[email protected]

Regional Maternal and Child Health Efforts By Nurses, Local Residents, and Civic
Organizations from 1936 in Japan
Sachiko Tanaka, RN, PhD, Japan
Purpose
The purpose of this presentation is to describe the efforts of regional organizations and civic
organizations as well as collaborations with local nursing professionals that have implemented national
policies for improving maternal and child health from 1936 in Japan.
Target Audience
The target audience of this presentation is academic professional and administrative personnel who
intend to improve maternal and child health in cultural diverse situations.
Abstract
Purpose: The purpose of this study is to describe the efforts of regional organizations and civic
organizations as well as collaborations with local nursing professionals that have implemented national
policies for improving maternal and child health from 1936 to present in Japan.
Methods: Historical study based on interviews and reference materials. Semi-structured interviews with
16 individuals including OB/OG from the Maternal and Child Health Division of the Japanese Ministry of
Health, Labor and Welfare, related groups, researchers, and specialists. Review of relevant materials
from related institutions and libraries.The research was approved by the ethics committees of the
affiliated organizations.
Results: Notable regional sources of non-specialist workers in maternal and child health in Japan include
“aiiku-han” from 1936 onward, “health helpers” (hoken hodouin) from about 1945 onward, and “Maternal
and Child Health Promoters” after the Maternal and Child Health Law was enacted in 1965. The activities
of these groups focus on local women and include comprehending the health condition of mothers and
children by making home visits, promoting doctor visits, and helping with health classes and checkups.
Various civic organizations related to maternal and child health were established in the 1950s. They
became responsible for some non-specialist efforts in maternal and child health such as issuing bulletins
and statistical data about regional governing bodies and related agencies, spreading knowledge about
and advocating for maternal and child health, releasing various educational materials and guides to the
general population, and supporting local residents. The number of local public health nurses began to
grow rapidly when “Local Health Centers” were established in 1978. Local public health nurses and
midwives were responsible for guiding these regional maternal and child health organizations and their
staff as professionals and expanded efforts in maternal and child health through collaborations and
partnerships.
Conclusion: The nurses and medical professionals that directly provide services needed to work
together with local residents and civic groups to ensure that the maternal and child health policy of the
Japanese government would be utilized by all mothers and children, that it would take root, and that it
would work effectively to improve maternal and child health.
Contact
[email protected]

Healthcare Needs during Pregnancy, Childbirth, and Childrearing of Chinese
Immigrant Women in Korea
Geum-Hee Jeong, PhD, RN, South Korea
Kyungwon Kim, PhD, MS, RN, BS, South Korea
Sunghee Baik, PhD, RN, BS, South Korea
Purpose
It aims to identify health care needs for the entire process of reproduction, including pregnancy, delivery,
postpartum care, and childrearing, among Chinese women who immigrated to Korea through international
marriage, for the purpose of providing the baseline data for developing reproductive health promotion
programs for married migrant women in Korea.
Target Audience
Target audience is health care workers or educators who work for health care of immigrant women.
Abstract
Purpose: With the increase in international marriage, the number of immigrant women who were married
to Korean men has been on the rise to 120,146 in 2010. Major portion of those who immigrated to Korea
through interracial marriage was Chinese. Married immigrant women are usually lack of appropriate
health intervention and educational services. They were more likely to have problems before and after
giving birth than the native Korean women. Therefore, this study was conducted to identify health care
needs for the entire process of reproduction, including pregnancy, delivery, postpartum care, and
childrearing, among Chinese women who immigrated to Korea through international marriage, for the
purpose of providing the baseline data for developing reproductive health promotion programs for married
migrant women in Korea.
Methods: Subjects in this study included 148 Chinese immigrant women visiting 25 health centers in
Korea. Based on Roy's four modes of adaptation, this study used a preliminary tool for childbearing and
childrearing process, which included the total of 53 question items. Cronbach's α of the internal reliability
of the data was .96. The data were collected in 2012. Translators working at health centers visited and
had an interview with subjects. Data analyzed by SPSS 18.0 Window Program. For the characteristics of
subjects' demographic and the entire process of childbearing and childrearing, descriptive statistics were
calculated. For the subjects' health care needs for the entire process of pregnancy, childbirth, postpartum
care, and childrearing, descriptive statistics were calculated.
Results: The average age of the subjects was 32.0. Educational background showed that high school
graduates are the largest portion, 48.67%. Average length of time living in Korea after immigration is 3.3
years. Portion of jobless subjects is 85.2%. As much as 66.2% of the subjects reported the past
experience of pregnancy prior to this study, 20.3% was pregnant at the time of collecting the data. The
majority of the subjects (96.6%) had an experience of getting prenatal care during pregnancy at a hospital
(87.1%), and at health center (10.8%). Almost everyone in this study gave birth at a hospital (87.8%). As
much as 52.0% of the subjects reported that husband was the most helpful person in taking care of them
during pregnancy and childbirth, hospital personnel to 31.1%, health center workers to 25.7%, and
husband's family members to 13.5%. As far as the information and educational methods were concerned,
attending lectures or educational programs (52.0%) was the most common form of getting information,
followed by educational booklets (20.9%), internet data (16.2%) and individual interview (14.2%). The
score for general health care was 3.42, after that, postpartum health care (3.39), health care for delivery
(3.38), and health care during pregnancy (3.35) in order.
Conclusion: When the effect of fertility power of Chinese immigrant women on the future paradigm in
fertility rates of Korea is taken into consideration, it would be urgent to develop a more effective health
care services and educational programs that lead those ethnic group of women to be adjusted to fit the
mainstream of the Korean society in order to give birth to healthy children and successful outcomes of

pregnancy. It is necessary to develop cross-cultural educational programs focused on educating Korean
men to have friendly attitude toward gender role exchange.
Contact
[email protected]

Relationship of Job Satisfaction and Quality of Life Among Taiwanese Nurses: A
Pilot Study
Chia-Hsin Cheng, MS, RN, Taiwan
Chia-Ju Huang, MS, RN, Taiwan
Purpose
The purpose of this presentation is to allow audiences to know whether there is a relation between job
satisfaction and quality of life of nurses in Taiwan. Also, the findings of relationships between
demographic characteristics and job satisfaction, and quality of life will be informed.
Target Audience
The target audience of this presentation is clinical nurses, nursing administrators, and policy makers.
Abstract
Purpose: The purpose of this pilot study was to explore the relation between job satisfaction and quality
of life of nurses in Taiwan. Another objective was to examine the relationship between the demographic
characteristics of nurses and their job satisfaction and quality of life.
Methods: The pilot study used a cross-sectional survey design. The purposive sampling method was
used to administer questionnaires to informed participants. Thirty-one professional nurses working in
medical centers in central and northern Taiwan returned completed questionnaires. Items on the
questionnaire fall into three major categories: demographic characteristics, the Chinese version of the
Nurses' Job Satisfaction Scale (Chinese version of MMSS) (Tsai, 2001), and World Health Organization
Quality Of Life-BREF Taiwan Version (Taiwan version of WHOQOL-BREF) (Yao, 2005). Chinese version
of MMSS is a 34-item, with a Likert scale ranging from 5 (very satisfied) to 1 (very dissatisfied). The range
is 34-170, with higher scores indicating nurses feel more satisfied with their current job. Five domains
were included: satisfaction with interaction, professional participation, extrinsic rewards, control over work
environment, and schedule arrangement. Cronbach’s alpha for the 34-item has been reported previously
as .94. World Health Organization Quality Of Life-BREF comprises 26 items, with the following four
domains: physical health, psychological health, social relationships, and environment. Additional two
items were added to Taiwanese version of WHOQOL-BREF: “been respected and accepted” under social
relationships domain, and “food” under environment domain. Five-point Likert scale ranges from 5 (very
satisfied) to 1 (very dissatisfied). Domain-specific items scores were added first, then been averaged, and
then been multiplied four to get the scores for each domain. The scores range is 4-20. The total scores of
four domains were then been added together with overall quality of life and general health to represent
overall quality of life scores. Total scores range from 24-120, with higher scores meaning better quality of
life. Cronbach’s alpha for the 28-item has been demonstrated previously as .95. In the current pilot study,
data analysis was carried out on SPSS 18.0 Chinese version. Besides descriptive analysis, t tests, One-
Way ANOVA, and Pearson correlation coefficients were also calculated to examine associations between
each of the five job satisfaction domains and each of the six quality of life domains. Furthermore, Pearson
product-moment correlation coefficients were used to test demographic variables and quality of life
variables. Finally, the significant correlation found between demographic variables and quality of life
variables was tested with job satisfaction variables through regression analysis. A significance level of .05
was accepted.
Results: The mean age of the participants was 27.6±4.25 years. All were female, with baccalaureate
degree. Most were single (87.1%), working in the internal medicine wards (93.5%). Of the five job
satisfaction domains, extrinsic rewards (mean score=2.43 /5) and professional participation (mean
score=2.45 /5) were found to have the lowest scores. Number of working hours per week and self-
perceived health status were shown to be significantly correlated with job satisfaction and quality of life.
Self-perceived health status was reported to have a positive relationship with quality of life. Also, working
less than forty-hour per week and having a positive self-perceived health status were demonstrated to

have significant positive relationships with job satisfaction and quality of life. However, the study identified
no significant relationship between job satisfaction and quality of life.
Conclusion: Nurses who work over forty-hour per week tend to feel more dissatisfied with their jobs and
have negative perceptions of their health statuses. This in turn affects the quality of life of nurses. It is
quite likely that these factors lead to greater nurse turnover. The pilot study has implications for nursing
administrators regarding the nursing overtime issue in Taiwan; Taiwanese nurses should continue to
push policy makers to introduce nursing overtime regulations. One limitation of the current study is the
small sample size. Evaluating whether there is a relation between job satisfaction and quality of life of
nurses in Taiwan will necessitate the use of larger sample sizes in future studies.
References
Tsai, S. L., & Lin, S. L.(2001). The Reliability and Validity of the Nurses' Job Satisfaction Scale. VGH Nursing, 18(3),
270-280. Yao, K. P. (2005). Development and Instructional Manual of Taiwan version World Health Organization
quality of life measure - abbreviated version. Taipei: The Whoqol-Taiwan Group.
Contact
[email protected]

Clinical Experiences of Standard Precautions Among Nursing Students: Based
on the Theory of Planned Behaviour
Hyunjin Oh, PhD, South Korea
Kyung-mi KIM, RN, PhD, ICAPN, South Korea
Purpose
The purpose of study is to explore clinical experiences of Standard Precaution compliance, using the
Theory of Planned Behaviour among nursing students in clinical practice settings in South Korea.
Target Audience
The target audience of this presentation is clinical nurses, educators, and faculty.
Abstract
Purpose: Healthcare associated infections (HAIs) are a concern for healthcare workers (HCWs) as well
as their patients. In addition, nursing students in long-term clinical placements may find themselves in
close contact with patients and providing nursing interventions, which may lead to exposure to harmful
pathogens. Even though nursing students should also practice SP compliance to limit infection exposure,
they are thought to experience other barriers to this practice. Several studies focused on increasing the
compliance rates of infection control practice by applying behavioral science theory have been
conducted.1,2,3 The Theory of Planned Behavior (TPB), developed by Icek Ajzen is widely used as a
theoretical framework in behavioral studies and has successfully explained a variety of human behaviors
and their determinants.4 Few studies have used TPB to explore SP compliance as a major concept of
infection control for nursing students. The purpose of study is to explore clinical experiences of Standard
Precaution compliance, using the Theory of Planned Behaviour among nursing students in clinical
practice settings in South Korea.
Methods: We conducted interviews with 6 focus groups of nursing students from two South Korean
universities. A total of 38 senior nursing students were broken into 6 different focus groups and
interviewed. All students had finished one year of clinical experience in tertiary hospitals in South Korea.
The focus groups were all homogenous with respect to grade and clinical settings experience. The
research team created a structured interview guide for this study and utilized the theoretical frameworks
of TPB to guide the focus group interviews. Thematic content analysis was used to code and analyze the
data from the focus group interviews.
Results: Attitudes Knowledge deficit Most of the students in the study did not know the exact concept of
SP or had confused SP with general infection control practice. Students had heard the term but did not
know the specific definition and measures of SP. Sensitivity Although participants had a vague
understanding about SP concepts, they were aware of the risk of being exposed to specific pathogens
during clinical practices. Their experience was limited to a cognitive understanding as opposed to
practical demonstration.
Subjective norm Negative role models Most students shared negative SP experiences from their clinical
placements. Participants discussed various situations and events related to noncompliance, including
poor hand hygiene, the non-use of personal protective equipment (PPE), and needle recapping
situations. Gap between classrooms and fields Participants reported that practices they experienced in
clinical settings were quite different from what they had learned in classrooms. Students shared the
difficulties of SP compliance in daily basic nursing care activities. Blind spots Some clinical organizations
monitored the nursing students’ nursing care activities and gave close attention to the SP compliance.
However, most settings did not monitor SP compliance or educate nursing students in SP compliance.
Perceived behavioural control Psychological barriers Study participants experienced a variety of
psychological barriers such as worry about patient discomfort, their own immaturity and fear, being
emotionally uncomfortable, and feeling overwhelmed by tasks. Most participants shared that their SP
compliance training while in clinical rotation was limited to following the lead of their nursing supervisors.
Nursing students complained about the difficulties of SP compliance when they were with nurses with

poor compliance behaviours. Busyness was also another barrier that interfered with SP compliance for
students. Physiological barriers Study participants experienced various physical limitations as well as
psychological barriers to SP compliance during their clinical training. They complained of difficulties due
to limited availability of PPE and accessibility to the equipment. Lack of information Nursing students
expressed that a lack of patient information and accessibility to it was another barrier in SP compliance.
They had limited information and understanding of patient situations. Participants reported the lack of
systematic education and management for students about SP compliance and guidelines in hospitals.
Some students shared their experiences with blood and body fluid exposure in practice, but the post-
exposure procedures were not performed properly.
Intention Changes in compliance awareness Most participants learned and recognized the importance
of SP compliance in schools, but they discussed a cognitive change to an understanding of ’do not need
to keep’ when they observed noncompliance of guidelines by HCWs.
Conclusion: This study explored nursing students’ experiences with SP compliance as a method to avoid
occupational exposure to microorganisms within clinical settings. Using the TPB as its theoretical
framework, this study has closely focused on the students’ explanations of SP compliance in their clinical
rotations. To our knowledge, this is the first study exploring the issues surrounding SP compliance for
nursing students at their clinical sites. Interestingly enough, this study found that the general vulnerability
of nursing students at their clinical sites and their reliance on mentors for information and guidance led to
strikingly different compliance experiences than those reported by HCWs.
Participants reported confusion about the concept of SP and general infection control. Aware that they
are at risk for pathogen exposure in clinical practice, students did not have a strong understanding of
protection as a core concept of SP. The fact that students are aware of the risk of exposure to pathogens
but less familiar with the SP guidelines means that students do not know what to do to protect themselves
from the risk of exposure. Nursing students’ experiences of SP compliance are quite different from those
of nurses due to their relatively lowly status within the information hierarchy. Students are not able to
control resources and barriers during their clinical rotations. In particular, they experienced the absence of
subjective norms and the presence of various barriers that need to be removed.
Interestingly, most participants witnessed nurses’ noncompliance in the general ward. Participants said
that some nurses admitted their noncompliance and then explained what they should follow as guidelines
to the students. Others were not even aware of their noncompliance behaviours. These situations imply
that students are in inappropriate or negative educational situations. Nurses’ SP noncompliance models
poor practices to students and seriously and directly affects changes in compliance awareness and
noncompliance behaviours.
The important cultural characteristic that emerged is that nursing students are aware of ’cues’ from their
clinical preceptors regarding SP compliance. The students discussed the ambiguous position of a student
nurse within the clinical practice hierarchies and how this led to limited access to patient information and
standardized nursing practices. This lowly position also discouraged the students from proactively
seeking information around SP compliance; instead, they were expected to simply do as their work
superiors did, without question. Disturbingly, following supervisors' non-compliance behaviours was given
as the main reason students did not comply with SP. Above all, students perceived their positions as
socially indefinite, being not nurse nor student, making it difficult to independently comply with SP during
their clinical training.
Furthermore, students experienced limited PPE accessibility. For SP compliance, students should have
free access to protective devices and no limitation on their usage. While nurses have limited access
because of a supply deficiency, 1 nursing students’ PPE accessibility is related to a lack of knowledge
about PPE location and the perceived indifference nurses have to their charges’ education. Participating
students were left in the nursing staff’s blind spot and did not receive proper care and education during
clinical training. Therefore, in order to increase the SP compliance of students, detailed and direct
education about SP guidelines should be preceded.
Nursing students are the nurses of the future, so compliance education and an intention to follow
compliance in a student are directly related to a nurse’s commitment to compliance. This cognitive
change could influence their future SP compliance once they become nurses. Therefore, exploring the
factors affecting SP compliance for nurses in charge of student education is needed. In addition, faculty

should develop continuing education programs in schools that include discussion on SP compliance,
infection control guidelines, and noncompliance cases, then reinforce SP compliance education before
clinical placements begin. These focus groups revealed that many nursing student were in vulnerable
environments and risked exposure to pathogens. By removing the barriers presented in this study,
nursing students would be able to do clinical practice in a safe environment.
References
1. G. Efstathiou, E. Papastavrou, V. Raftopoulos, A. Merkouris. Factors influencing nurses' compliance with standard
precautions in order to avoid occupational exposure to microorganisms: a focus group study. BMC Nurs 2011; 10: 1-
12. 2. E.P. Trunnell, G.L. White Jr. Using behavior change theories to enhance hand hygiene behavior. Educ Health
2005; 18: 80-84. 3. M. Whitby, M.L. McLaws, M.W. Ross. Why healthcare workers don't wash their hands: a
behavioral explanation. Infect Control Hosp Epidemiol 2006; 27: 484-492. 4. K. Glanz, B.K. Rimer, K. Viswanath.
Health behavior and health education. In: Montaño DE, Kasprzyk D, editors. Theory of reasoned action, theory of
planned behavior, and the integrated behavioral model. SanFrancisco: Jossey-Bass; 2008. 68-96.
Contact
[email protected]

Gender Differences in Depression, Life Satisfaction, and Health in Middle-Aged
Koreans
Oksoo Kim, PhD, RN, MSN, BA, South Korea
Purpose
The purpose of this study was to investigate gender differences in health, depression, and life satisfaction
among the middle aged in Korea. Also the predictors of depression by gender were identified.
Target Audience
Nursing scholars, nursing educators, graduate students
Abstract
Purpose: The purpose of this study was to investigate gender differences in health, depression, and life
satisfaction among the middle aged in Korea. Also the predictors of depression by gender were identified.
Methods: The data in this cross-sectional descriptive study were derived from the “2010 Survey for
Health, Life condition, and Welfare Needs of Middle Aged Koreans” conducted by the Korea Institute for
Health and Social Affairs. The health related characteristics included perceived health, alcohol drinking,
nutrition, exercise, chronic disease, and climacteric syndrome. The participants were asked “Have you
ever experienced sadness or helplessness affecting your life for 2 weeks or longer during the past 12
months?” to identify depression. Those who answered “yes” to the question were designated to the
depressed group. Life satisfaction was measured using the 12 item Korean version (Rhee, Suh, Gho &
Park, 1994) of Life Satisfaction Index A (Neugarten, Harvighurst, & Tobin, 1961). Statistical analyses
were performed using SPSS 21.0 (SPSS, Chicago IL, USA). Chi-square tests were used to identify the
differences in health related characteristics, depression, and life satisfaction by gender. T-test was used
to compare life satisfaction by gender. The multiple logistic regression model was used to identify the
significant predictors for depression in each gender.
Results: The proportion of male alcohol drinkers (75.1%) was higher than that of females (46.5%) (X2 =
345.479, p= .000). 11.6% of males reported that they had experienced discomfort due to the climacteric
syndrome whereas 34.5% of females reported discomfort (X2 = 294.651, p= .000). The proportion of
females with chronic disease (32.4%) was higher than that of males (28%) (X2 = 9.186, p= .002). 9.1% of
males reported their health as poor and 14.1% of females reported their health as poor (X2 = 60.559, p=
.000). 6.8% of males revealed that they experienced depressed mood whereas 13% of females reported
depressed mood (X2 = 44.303, p= .000). The level of life satisfaction (t=1.968, p=0.049) of males were
higher than that of females. There were no significant differences in having a spouse, nutrition, and
exercise by gender. Males who had a spouse (OR: 0.510, 95% CI = 0.313-0.830), perceived their health
as good (OR: 0.376, 95% CI = 0.200-0.710), or who had higher life satisfaction (OR: 0.922, 95% CI =
0.893-0.952) were less likely to experience depression. Males who had climacteric syndrome (OR: 4.264,
95% CI = 2.779-6.542) were more likely to experience depression. Females who had higher life
satisfaction (OR: 0.900, 95% CI = 0.880-0.921), perceived their health as good (OR: 0.429, 95% CI =
0.288-0.641) or fair (OR: 0.469, 95% CI = 0.326-0.675) were less likely to experience depression.
Females who had chronic disease (OR: 1.660, 95% CI = 1.218-2.261) and climacteric syndrome (OR:
1.793 95%, CI = 1.349-2.383) were more likely to experience depression.
Conclusion: There were gender differences in depression, life satisfaction, and health in middle aged
Koreans. Females had lower levels of life satisfaction than that of males. The proportions of females with
depression and poor health was higher than that of males. There were differences in predictors of
depression according to gender.
References
Birkhaeuser M (2013) Depression, anxiety and somatic symptoms in peri-and postmenopausal women, Climacteric,
16(4), 502. Bromberger JT, Kravitz HM, Matthews K,Youk A, Brown C. Feng W. (2009) Predictors of first lifetime
episodes of major depression in midlife women. Psychological Medicine, 39(1), 55-64. Burns RA, Anstey KJ, Windsor

TD (2011) Subjective well-being mediates the effects of resilience and mastery on depression and anxiety in a large
community sample of young and middle-aged adults. Australian and New Zealand Journal of Psychiatry, 45(3) 240-
248. Choi MK, Lee YH. (2010) Depression, powerlessness, social support, and socioeconomic status in middle aged
community residents, The Journal of Korean Psychiatric and Mental Health Nursing Academic Society, 19(2), 196-
204. Choi WH (2012) The relationship of depression, fatigue and quality of life in middle-aged adults The Korean
Journal of Health Service Management, 6(2), 91-99. Gureje O, Oladeji B, Abiona T (2011) Incidence and risk factors
for late-life depression in the Ibadan Study of Ageing. Psychological Medicine, 41(9), 1897-1906. Jonusiene G,
Zilaitiene B, Adomaitiene V (2012) Sexual function, mood and menopause symptoms in Lithuanian postmenopausal
women, Climacteric, 16(1), 185-193. Lin HW, Hsu HC, Chang MC (2011) Gender differences in the association
between stress trajectories and depressive symptoms among middle aged and older adults in Taiwan. Journal of
Women & Aging, 2011 23(3) 233-245. Lue BH, Chen LJ, Wu SC (2010) Health, financial stresses, and life
satisfaction affecting late-life depression among older adults: a nationwide, longitudinal survey in Taiwan. Archives of
Gerontology and Geriatrics, 50(1), 34-38. Neugarten BL, Havighurst RJ, & Tobin SS (1961) The Measurement of Life
Satisfaction. Journal of Gerontology, 16(2), 134-143. Park, JH (2012) The influence of depression on the life
satisfaction of the middle aged males: a moderating effect of problem drinking. Korean Journal of Social Welfare
Research, 33, 1-20 Rhee KO, Suh MK, Gho KH, Park JD. (1994) Life condition analysis of elderly people and policy
issues. Retrieved October 10, 2012, from http://repository.kihasa.re.kr:8080/handle/201002/753 Weyerer S,
Eifflaender-Gorfer S, Wiese B, Luppa M, Pentzek M, Bickel H., Bachmann C, Scherer M, Maier W, Rieel-Heller SG
(2013) Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older:
results from a 3-year follow-up study. Age and Ageing, 42(2), 173-180.
Contact
[email protected]

The Association Between Laryngectomized Patients' Quality of Life and Their
Medical Treatment
Kazuyo Iwanaga, RN, MSN, Japan
Kumiko Kotake, PhD, RN, Japan
Yoshimi Suzukamo, PhD, Japan
Ichiro Kai, MD, MPH, Japan
Kaori Haba, RN, PHN, MSN, Japan
Yuki Nagamatsu, RN, MSN, Japan
Aya Takahashi, RN, PHN, MSN, Japan
Rieko Kawamoto, Japan
Purpose
The purpose of this study is to clarify the association between the QOL and treatment by comparing the
QOL of patients who underwent laryngectomy with that of patients who underwent both laryngectomy and
radiation therapy from the period of time before discharge from a hospital to 12 months after it.
Target Audience
The target audience of this presentation is the nurse who practices a cancer nursing.
Abstract
Purpose: The purpose of this study is to clarify the association between the quality of life (QOL) and
medical treatment by comparing the QOL of patients who underwent total laryngectomy with that of
patients who underwent both total laryngectomy and radiation therapy from the period of time before
discharge from a hospital to 12 months after it.
Methods: Subjects were 58 patients who underwent total laryngectomy in three hospitals located in
Prefecture A, Japan, agreed to participate in the research, and returned questionnaires before discharge
from hospitals and 3, 6, 12 months after discharge from hospitals. Main study subjects were age, sex,
and the QOL, and the data of diagnosis, staging, and medical treatment were collected from medical
records. SF-36v2 and mail survey were used in the analysis of the QOL data. SF-36v2 is a
comprehensive QOL scale composed of 8 domains: physical function (PF), role physical (RP), body pain
(BP), general health perception (GH), vitality (VT), social functioning (SF), role emotional (RE), and
mental health (MH). As an analytical method we calculated descriptive statistics of basic attributes and
QOL scale scores. Norm-based scoring (NBS) was used in the calculation of the latter.
We confirmed that there is no statistical difference on QOL scale scores in age and staging. Then
subjects were classified into two groups: patients who underwent only total laryngectomy and patients
who underwent both total laryngectomy and radiation therapy for conducting t-tests to examine their
associations with the QOL (p < 0.05). This study was approved by ethical review committees of an
affiliated university and medical facilities.
Results: Subjects' basic attributes were as follows:
average age: 67.4 years old (ranging from 48 to 83) at the time of total laryngectomy
sex: 52 males (89.7%) and 6 females (10.3%)
diagnosis: cancers of larynx 19 (32.8%), of hypopharynx 29 (50.0%), of oropharynx 1 (1.7%), of thyroid 1
(1.7%), of tongue 1 (1.7%) and of cervical esophagus 7 (12.3%).
staging: stage I – 2 (3.5%), stage II – 6 (10.3%), stage III – 13 (22.4%), and stage IV – 37 (63.8%).
treatment: only total laryngectomy 23 (39.6%), and both total laryngectomy and radiation therapy 35
(60.4%).
The basic attributes of patients who underwent only total laryngectomy were as follows:

average age: 68.8 years old (ranging from 49 to 83)
diagnosis: larynx cancer 9 (39.1%), hypopharynx cancer 9 (39.1%), and other types of cancers such as
neck cancer and esophagus cancer 5 (21.8%).
staging: stage II – 5 (21.7%), stage III – 8 (34.8%), and stage IV – 10 (43.5%).
The basic attributes of patients who underwent both total laryngectomy and radiation therapy were as
follows:
average age: 66.3 years old (ranging from 48 to 82)
diagnosis: larynx cancer 10 (28.6%), hypopharynx cancer 20 (57.1%), other types of cancers such as
neck cancer and esophagus cancer 5 (14.3%).
staging: stage I – 2 (5.7%), stage II – 1 (2.9%), stage III – 5 (14.3%), and stage IV – 27 (77.1%).
types of radiotherapy: preoperative 18 (31.0%), postoperative 11 (19.0%), and preoperative and
postoperative 6 (10.3%).
There were 43 responses from those who took treatment before discharge from hospital. Among them
PF_N of those who underwent only total laryngectomy was 25.0±3.8 (mean and standard deviation) and
PF_N of those who underwent both total laryngectomy and radiation therapy was 39.5 ± 3.6, showing that
there was statistical difference between them (p=.009). Yet, there was no statistical difference between
them on BP_N, GH_N, VT_N, and MH_N. (There was no investigation on RP_N, SF_N, and RE_N).
There were 38 responses from those who took treatment 3 month after discharge from hospital. GH_N of
patients who underwent only total laryngectomy and of patients who underwent both total laryngectomy
and radiation therapy were 38.2 ± 2.3 and 45.6 ± 2.3, respectively, showing statistical difference between
them (p = .03). Yet, there was no statistical difference between them on PF_N, RP_N, BP_N, VT_N,
SF_N, RE_N, and MH_N. There were 34 responses from those who took treatment 6 month after
discharge from hospital. Yet, there was no statistical difference in every item. There were 33 responses
from those who took treatment 12 month after discharge from hospital. PF_N of patients who underwent
only total laryngectomy and of patients who underwent both total laryngectomy and radiation therapy
were 35.0 ± 3.4 and 44.5 ± 3.1, respectively, showing statistical difference between them (p =.047). Yet,
there was no statistical difference between them on PF_N, RP_N, BP_N, VT_N, SF_N, RE_N, and
MH_N.
Conclusion: Laryngectomy is done for advanced cancers of the head and neck and of cervical
esophageal. Radiation therapy is also used as adjuvant therapy before and after surgery. Total
laryngectomy causes several physical problems such as a loss of voice functions, the change of
breathing route, the increase of cough and phlegm, and the change of swallowing function and
appearance (Armstrong et al., 2001). These physical problems bring about socio-economic problems
such as a loss of jobs and fall in income (Kotake, et al. 2005) and other problems such as the loss of
human relationship and of social contribution and negative effects on family members. There is also a
research which shows that the disruption of social life brings about social trauma and other mental
disorders (Bussian et al. 2010). Such physical, psychological, and social problems impair the QOL of
laryngectomees severely. This research also revealed that the QOL of patients who underwent total
laryngectomy was consistently below the national standard value. Previous studies gained the results that
the QOL of patients who underwent only total laryngectomy had no significant difference with the QOL of
patients who underwent only chemoradiation therapy (Hanna et al., 2004). Yet, there is no study which
compares between the QOL of patients who underwent only total laryngectomy and the QOL of patients
who underwent both total laryngectomy and radiation therapy. This research showed that the QOL of
patients who underwent total laryngectomy 12 month after discharge from a hospital was lower than the
QOL of patients who underwent both total laryngectomy and radiation therapy. This shows that the latter
improved their physical functions, compared with the former. PF_N of those who underwent only total
laryngectomy was 25.0±3.8 before discharge from a hospital and 35.0 ± 3.4 twelve month after discharge
from a hospital. PF_N of those who underwent both total laryngectomy and radiation therapy was 39.5 ±

3.6 before discharge from a hospital and 44.5 ± 3.1 twelve month after discharge from a hospital. These
results show that in both treatment patients' physical functions improved with time. In this study we
examined patients who underwent preoperative, postoperative, and preoperative and postoperative
radiotherapy but we could not examine irradiation period due to the size of sample number. This is a
future subject. We also need to examine the reasons why physical functions of patients who underwent
only total laryngectomy are more likely to improve than those of patients who underwent both total
laryngectomy and radiation therapy by focusing on patients' awareness of functional disorder.
References
Armstrong E., Isman K., Dooley P., et al.(2001): An investigation into the quality of life of individuals after
laryngectomy, Head&Neck, 23(1), 16-24. Bussian C., Wollbrück D., Danker H., et al.(2010): Mental health after
laryngectomy and partial laryngectomy: a comparative study, Eur Arch Otorhinolaryngol, 267(2), 261-266. Kumiko
Kotake, Mitsuko Sato.(2005): The relationships between communication methods for the patients after laryngectomy,
Jurnal of Japanese Society of Nursing Research,28(1), 109-113.
Contact
[email protected]

The Effect of Multimedia Education of PCA on Patients' Cognition, Interference of
Life, and Satisfaction
Chiu-Hua Li, BS, Taiwan
Purpose
The purpose of this presentation is to report the finding which examined the effect of interactive
multimedia education program of patient-controlled analgesia on cognition, interference of life, and
satisfaction of patients who was going to receive osteological surgery
Target Audience
Abstract
Purpose: To examine the effect of interactive multimedia education program (MEP) of patient-controlled
analgesia (PCA) on cognition, interference of life, and satisfaction of patients who was going to receive
osteological surgery.
Methods: A quasi-experimental design was used with intervention and control groups. Eligible subjects
recruited from one teaching hospital in Kaohsiung. Inclusion criteria were the patients aged 20 and above
who was going to receive osteological surgery and agreed to use PCA. Totally, 60 subjects were non-
randomly assigned into either the intervention group（n=30）or the control group（n=30）. Before
surgery the intervention group received MEP, and the control group only received regular routine care
(pamphlet education). The research instruments included pain cognition questionnaire, life interference
scale, and satisfaction scale. SPSS 18.0 version software was used for coding and data analysis.
Statistical methods included t-test and pair t-test.
Results:
1. Participants in the MEP group have higher cognition (p< .001) and satisfaction (p<.001) with PCA
than the pamphlet group.
2. There is significant difference (p<.001) in life interference before and after surgery for each group,
but there is no significant difference between these two group.
Conclusion: This research shows that using MEP in per-operative education for patients who was going
to receive osteological surgery can increase their cognition, and satisfaction for PCA. Results
demonstrate the potential benefits of using MEP for surgery patients with PCA.
Contact
[email protected]

The Impact of Personality Traits on Early Job Resignation of Newly Graduated
Nurses
Sachiko Teraoka, RN, MN, PhD, Japan
Miyuki Takase, RN, BN, MN, MBiostat, PhD, Japan
Purpose
The purpose of this presentation is to examine a quitting a intention to resign of the newly graduated
nurses.
Target Audience
The target audiences of this presentation is clinical nurses and nurse managers.
Abstract
Purpose: Psychological anxiety has been identified as a factor in early job resignation of newly
graduated nurses. Despite support for skill acquisition and workplace adaptation, the lack of which is
known source of psychological anxiety, the issue of early job resignation has not been resolved. The
influence of personality traits relating to how people react to events is suspected to be a potential factor in
job resignation. Based on personality traits, it may be possible to develop advanced measures to prevent
job resignation by interfering with the chain of events leading to intention to resign. The present study
clarifies a relation of personality traits, nursing skill competence, and psychological anxiety to intention to
resign.
Methods: A total of 199 newly graduated nurses were surveyed 6 months after obtaining employment.
Questionnaires elicited the following: their intention to resign, the self-rated nursing skill competence,
state and trait anxiety (i.e., the degree of anxiety experienced at present, and the stability of anxious
state, which were assessed by State-Trait Anxiety Inventory [STAI]), and personality profile using Tokyo
University Egogram-II [TEG-II]. The TEG-II identifies the following personality traits: Critical Parent (CP),
Nurturing Parent (NP), Rational Adult (A), Free Child (FC), and Adapted Child (AC). Subjects were
classified as AC-dominant or non-AC-dominant based on the TEG-II results. The relationships between
the above variables were assessed by regression analysis. Prior to data collection, ethical approval was
obtained from the participating hospital.
Results: A total of 126 newly graduated nurses returned the usable questionnaires (a response rate of
63.1%). The average age of the participants was 22.1±2.1. The participants consisted of 11 males (8.7%)
and 115 females (91.3%). The major personality traits of the graduates were as follows: AC-dominant
(42.1%), FC-dominant (7.9%), and NP-dominant (7.2%). These traits were further classified into the
following AC pattern: AC-dominant (42.3% of the graduate falling in this category) and non-AC-dominant
(57.7% of the graduates were identified as fitting in this category). The results of regression analysis
investigating the relationship between the self-rated nursing skill competence and state anxiety according
to the AC pattern were as follows. Nursing skill competence and state anxiety were negatively correlated
in AC-dominant subjects (B=-0.236, p=0.034), while no correlation was observed for non-AC-dominant
subjects (B=0.001, p=0.987). Similar results were also obtained for trait anxiety. In the AC-dominant
group, the high self-rated nursing skill competence was associated with low trait anxiety (B=0.269,
p=0.013). However, non-significant correlation was observed in non-AC-dominant graduates (B=0.014,
p=0.859). While the negative correlation observed between nursing skill competence and intention to
resign was not statistically significant, a stronger tendency was present in AC-dominant subjects (B=-
4.817, p=0.117) compared with non-AC-dominant subjects (B=2.442, p=0.180). The present findings
demonstrated that the relationship between nursing skill competence and intention to resign differed
slightly based on novice nurses’ personality traits.
Conclusion: An AC-dominant personality trait moderated the relationship between nursing skill
competence and psychological anxiety of newly graduated nurses, while a non-AC-dominant personality
did not exhibit such an effect. Minor moderation was also observed in the relationship between nursing

skill competence and intention to resign in the AC-dominant graduates. An AC-dominant person tends to
possess such characteristics as prioritizing others, being reserved, and caring for the evaluation by
others. These types of the characteristics allow the graduates to maintain a good relationship with others
despite the fact that they experience anxiety due to a lack of competence. Because of the good
relationship with others, their intention to resign was considered low. On the other hand, non-AC-
dominant graduates might not experience anxiety due to their lack of competence. However, their
difficulty establishing a good relationship with others might have led to a greater intention to leave their
jobs. Considering that AC-dominant graduate nurses comprised 42.1% of our study population, helping
them to establish a good collegial relationship is an effective way to reduce their early exit from nursing.
Contact
[email protected]

Risk Factors of Thromboembolic Events and the Impact on Survival in Newly
Diagnosed Breast Cancer Patients: An Experience from Taiwan
Pi-Ching Hsieh, PhD, RN, Taiwan
Hui-Fang Su, RN, PhD, Taiwan
Kuan-Chia Lin, PhD, Taiwan
Purpose
The purposes of this study are to evaluate the incidence and risk factors for developing a new TEEs in a
large population-based study of breast cancer patients and also to examine the effect of TEEs on 2-year
survival.
Target Audience
The target audiences of this presentation are the registered nurses who are working on the Oncology
care area and the researchers who are interesting in the quality of care for cancer patients.
Abstract
Purpose: Thromboembolic events (TEEs) are one of the major complications of breast cancer patients
and associate with increased mortality. These events have been included as the Core Measure Set by
Joint Commission International for the international hospital evaluation in 2013. However, few evidence-
based data are available on the development of TEEs in breast cancer patients in Taiwan.
Methods: Using the National Health Insurance Research Database between 1997- 2010 in Taiwan, we
conducted a retrospective cohort study to evaluate 2-year incidence of TEEs and risk factors on 2000-
2008 breast cancer cohorts. Matching based on the propensity of age and co-morbidity was used to
identify the patients with and without TEEs groups. An accelerated failure time model was applied to
analyze the effect of TEEs on death within 2 years after breast cancer diagnosis.
Results: A total of 80598 patients with breast cancer between 2000 and 2008, the 2-year cumulative
TEEs incidence was 1.78% (95% CI = 1.74-1.82), with a rate of 1.38 and 0.43 events/100 patient-years
during the first and second half year, respectively. In multivariate model, significant predictors of
developing TEEs within 2 years were: age (adjusted incidence rate ratio [adj. IRR] = 3.87 if ≧65 year v＜
45; 95% CI = 3.80-3.93), co-morbidity (adj. IRR = 1.96 if ≧3 v 0, 95% CI = 1.93-2.00), hypertension
history (adj. IRR = 1.43 if yes v no, 95% CI = 1.41-1.45), breast surgery (adj. IRR = 1.47 if yes v no, 95%
CI = 1.45-1.49), radiotherapy (adj. IRR = 1.29 if yes v no, 95% CI = 1.28-1.31), chemotherapy (adj. IRR =
1.40 if yes v no, 95% CI = 1.38-1.42), hormone therapy (adj. IRR = 0.92 if yes v no, 95% CI = 0.91-0.94),
and type of hospital (adj. IRR = 1.13 if district v medical center 95% CI = 1.11-1.15). In AFT model
analysis, after controlling the characteristics of patient, treatment, hospital, TEE was a significant predictor
of decrease 2-year survival (adjusted rate ratio [adj. RR = 2.55, 95 % CI = 2.24-2.91).
Conclusion: Approximate 1.78% of breast cancer patients developed TEEs within 2 years, with the
highest incidence in the first 6 months after diagnosis. Age, co-morbidity, hypertension history, breast
surgery, radiotherapy, chemotherapy, and type of hospital level were the significant predictors. Breast
cancer patients with TEEs were associated with a higher risk of death within 2 years.
Contact
[email protected]

Using Failure Mode and Effects Analysis (FMEA) to Improve Patient Safety in
u-Health Nursing Service
Hanna Choi, MA, South Korea
Purpose
The aim of this study is to identify and assess the management of risk in relation to the use of a tele-
nursing service to promote service quality and assure patient safety. This study utilizes failure mode and
effect analysis, a proactive technique.
Target Audience
The target audience of this presentation is care givers who deliver care with information technology.
Abstract
Purpose: The aim of this study is to identify and assess the management of risk in relation to the use of a
tele-nursing service to promote service quality and assure patient safety. This study utilizes failure mode
and effect analysis, a proactive technique. Low-income older adults generally have higher requirements
for a u-health service as they suffer from more diseases and thus have more of a need for health
management than the general adult population. However, there are difficulties and possible risk factors
given their low health literacy rates and inability to use new u-Health devices. The FMEA method is
utilized to implement the new service in an effort to prevent avoid errors before they occur.
Methods: First, the context was established, after which four multidisciplinary teams of four persons
each, including a tele-nurse, an internet company staff member, a representative from the equipment
manufacturer, and a person serving as a manager of the participant resident, were assembled to analyze
the possible causes of issues that can arise during the tele-nursing service process. Second, analyses of
identification risk areas were conducted to examine the risk factors associated with the process, looking
forward at component failure rather than backward. Failure modes were scored with a risk priority number
(RPN) for each step and change, by multiplying the Occurrence, Severity, and Detection scores
according to the JCAHO classification.
Results: Twenty three clinical error and failure modes were analyzed in relation to the u-Health nursing
service. As a result, accidents could be sorted into two types: care service (43.5%) and system (56.5%)
accidents. A flow diagram indicating the four points of preparation for bio-signal measurements,
measurement followed by device instructions, the checking of the result by the participant and tele-nurse,
and an assessment outcome, was devised . A hazard analysis according to the RPN risk priority number
was conducted to analyze elements leading to the following areas: a lack of preparation for bio-signal
check-ups(24 score), forgetting the measurement method(15 score), emergencies which could arise(15
score), situations related to the internet connection network(12 score) and power(12 score), not following
the instructions of the u-Health measurement device(12 score), and assessments of older people by
telephone(12 score).
Conclusion: We understood where and when risk tasks are undertaken during a participants check their
bio-signal. FMEA to Tele-nursing services for patient safety enhance and reduce from significant risks.
Identified many clinical risk assessment management can be preventable usage in service using aged
population.
References
Chiozza, M. L., & Ponzetti, C. (2009). FMEA: a model for reducing medical errors. Clinica Chimica Acta, 404(1), 75-
78.
Contact
[email protected]

Development of Assessment Sheet of Older Adults Who Relocate to a Recovery
Phase Rehabilitation Ward
Misa Komatsu, PhD, Japan
Akiko Hamahata, PhD, Japan
Megumi Nakamura, MSN, Japan
Shizuka Otsuka, MSN, Japan
Purpose
The purpose of this presentation is to develop an assessment sheet for use during relocation to a
recovery phase rehabilitation ward in Japan, based on a conceptual model that views relocation from the
perspective of older adults.
Target Audience
The target audience of this presentation is nurses working in a recovery phase rehabilitation ward.
Abstract
Purpose: In current healthcare in Japan, hospitalized patients have more serious conditions and hospital
stays are becoming shorter. Older adults with health problems who cannot live independently at home
usually decide to relocate to a recovery phase rehabilitation ward. For older adults relocation to a
recovery phase rehabilitation ward is a life event that requires adaptation to new living circumstances.
The purpose of this study was to develop an assessment sheet for use during relocation to a recovery
phase rehabilitation ward in Japan, based on a conceptual model that views relocation from the
perspective of older adults (Komatsu, Hamahata, & Magilvy, 2007).
Methods: A Relocation Assessment Sheet (Assessment Sheet) was developed with reference to this
model and included questions on constipation and insomnia, which readily appear after relocation,
especially among Japanese older patients. Five of the 43 questions on the Assessment Sheet were on
background and personal factors. The other 38 questions were set up as a scale to understand whether
or not an older adult had adapted during relocation. This scale consisted of 10 subscales. The subscales
and number of questions were Relocation-Related Factors, such as intention to relocate, three questions;
Physical Environmental Factors, such as constipation, four questions; Social Environmental Factors, such
as conversations with others, five questions; Cognitive Appraisal, such as statements on life in the
hospital, three questions; Adaptive Tasks such as worsening of disease state, five questions; Coping
Skills, such as asking for help from others, five questions; Tasks for Life Integration, such as anxiety
toward the future, three questions; Resolution of Unrecognized Problems, such as loss of appetite or
troubles with others, three questions; Support of staff and other persons depended on, four questions;
and Outcome of Relocation, such as becoming accustomed to the hospital, three questions. Nurses
responded to the questions in about the second week from the date of relocation of the older adult.
The subjects for analysis were 336 people for whom there was no missing data among the 371
Assessment Sheets. In the analysis, Cronbach’s alpha coefficient was calculated for the 38 questions that
affect adaptation. In addition, using descriptive statistics, the characteristics of the older adults who had
relocated to the recovery phase rehabilitation wards were clarified.
This study was approved by the research ethics committee of the participating university. For the consent
of study participants, first approval was obtained from the manager of each hospital and then the study
was explained to the nurses, and their consent was obtained. Finally, the study was explained in writing
to the older adults, their families, and nurses, and their consent was obtained. No direct burden was
placed on the older adults from this study. Personal information was protected in the implementation of
the study, and privacy was ensured.
Results: Thirty-eight questions on the Assessment Sheet used in this study constituted a scale to
understand whether or not the older adult had adapted at the time of relocation. This scale consists of 10

subscales corresponding to items in the conceptual model. With regard to the reliability of the scale, the
overall Cronbach’s alpha coefficient was 0.87. The coefficients for the 10 subscales were 0.42, 0.58,
0.72, 0.70, 0.62, 0.65, 0.79, 0.80, 0.50 and 0.82, respectively.
The mean age of the older adults who had relocated was 81.2±6.4 years, and many were women
(67.3%). About half of the subjects had dementia (46.5%), which was mild (27.4%), moderate (14.6%), or
severe (4.5%). Among Relocation-Related Factors, A large number were the first relocation to a recovery
phase rehabilitation ward (85.1%). Nurses made referrals and explained the hospital before relocation
(64.3%), and guided subjects around the hospital after relocation (92.8%).
Physical Environmental Factors included that some of the older adults were independent at the time of
relocation (32.7%), and some of them also had language impairments (23.5%). After relocation,
constipation (48.2%) and depression (18.8%) appeared in some patients.
Social Environmental Factors included that a little under half of the older adults brought personal items,
placing familiar items in their rooms (36.0%) and bringing treasured items with them when they relocated
to the hospital (13.7%). However, the rate of participation in recreation and other events held in the
hospital was high (46.2%), and many of the older adults communicated with others, having conversations
with nurses (65.2%) and other patients (50.0%).
With regard to the older adults’ Cognitive Appraisal of the recovery phase rehabilitation ward , some had
not accepted to be hospitalized, saying “I have nowhere else to go,” (2.7%), and “I don’t like it here”
(6.0%). Nurses felt that some of the elderly were just “putting up with life in the hospital” (25.9%).On the
Adaptive Tasks subscale, complaints of “I want to go home” (22.6%) and “I don't feel well” (14.3%), and
worsening disease state (4.8%) were seen in some of the older adults. Older adults who caused trouble
with other patients were also seen (5.1%). Nurses also responded that providing care for some of the
older adults was difficult (25.0%). These things show that older adults present different kinds of
adaptation issues immediately after relocating to a recovery phase rehabilitation ward .In Coping Skills,
the older adults often used problem-focused coping for adaptation issues, such as “seeking help from the
nurse” (60.4%), “expressing one’s wishes” (58.0%), and “seeking help from other patients” (14.2%).
Emotion-focused coping of “getting angry, crying, becoming agitated” was also used (10.7%).
Under Tasks for Life Integration there were older adults who expressed worries or anxiety (12.5%) and
made negative statements about themselves (9.2%). Under Support, the persons providing support for
the older adults were nurses (38.1%) and family members (48.8%). Resolution of Unrecognized Problems
included nurses resolving physical issues such as constipation and loss of appetite that were not
recognized by the older adults themselves (35.4%). Similarly, nurses resolved mental issues such as a
gloomy countenance or not smiling (21.5%) and social issues such as trouble with other patients and
dissatisfaction with the hospital (14.3%).
Conclusion: The older adults who were the subjects of this study had a high mean age, and many had
dementia. For many it was also their first time to relocate to a recovery phase rehabilitation ward and thus
for these older adults relocation was a large environmental change. In addition, the level of independence
in daily life was low. Older adults with speech disorders were also seen, and it was probably difficult for
them to control their environment themselves after the relocation. For many of these older adults the
nurse had made a referral and explained the ward before relocation and guided them around the ward at
the time of relocation. This is thought to have had an effect in terms of adaptation to the recovery phase
rehabilitation ward by the older adults.
Constipation and depressive symptoms appeared in some subjects after the relocation, and attention
should be paid to these symptoms as signs of maladaptation in older adults. In the responses to
questions in the Cognitive Appraisal subsection, language and behavior indicating resignation with regard
to relocation and non-acceptance of life in the hospital were seen. Focusing on words showing such
cognition in older adults and understanding the feelings of the individual is thought to be important. Under
Adaptive Tasks in hospital life, worsening of disease or worsening of physical symptoms, such as
complaining “I don't feel well,” was seen. Nurses need to focus on these physical symptoms and deal with
them through early interventions.
The Coping Skills of the older adults were not limited to emotion-focused coping only. Many of the older
adults used problem-focused coping. In cases when coping skills were not seen, resolution of mental

issues by the nurse on behalf of the individual was related to the individual’s adaptation. Nurses need to
recognize anew that they are persons these older adults rely on, and fulfill the role of resolving issues on
behalf of these older adults.
The Assessment Sheet used in this study has reliability as a tool that shows adaptation in older adults. It
also showed the characteristics of relocating older adults, suggesting that it can be a useful tool in
understanding relocating older adults.
This study was supported by 2012 Grant-in-Aid for Scientific Research(24593542) from the Ministry of
Education, Science ,and Culture, Japan.
References
Komatsu, M., Hamahata, A. C& Magilvy, J.K. (2
persons who relocate to a health-care facility in Japan. Japan Journal of Nursing Science, 4, 27-38.
Contact
[email protected]

Promotion of End-of-Life Care at Home for the Elderly in a Community Setting in
Japan: Results of Qualitative Research
Yae Takeshita, RN, BSN, MSN, Japan
Purpose
The purpose of this study was to extract the obstacles from the healthcare staff and caretakers in terms of
actualizing and supporting the elderly's wishes regarding end-of-life stage.
Target Audience
The target audience of this presentation is the medical professionals,the health caretakers and the
researchers.
Abstract
Background: In Japan, according to the national statistics, only 33.1% of the elderly people died at
home, even though 89.1%of them wish to die at home. This discrepancy indicates obstacles existing in
many areas in this society. One major reason is that advance directive is not legislated, and only a few
people write their end-of-life wishes as a legal document in Japan. Without legal protection, healthcare
professionals want to escape from legal trouble even if the elderly show their wishes at the end stage.
In order to protect the elderly wishes of dying without any life-prolong medical actions in this country, it is
necessary to educate the elderly to write a advance directive documentation and make it legally active.
On the other hand, environment should be prepared to make the documentation active. First, we need to
educate the elderly how they spend their end stage, and to support them to make their
decisions. Secondly, we need to enhance discussion with the elderly and the families regarding the end-
of-life wishes and advance directives. Thirdly, we need to support medical professionals to accept and
follow the document that the elderly make. To achieve our goal, we conducted the action research.
Moreover, during taking this action research, we found that healthcare professionals working in
community including medical doctors and professional caretakers were insecure and less confidence in
providing end-of-life care which allows the elderly dying at home.
In this presentation, therefore, we will report the qualitative research results of obstacles recognized by
medical professionals in community settings regarding actualizing the elderly dying at home.
Action research goal: The final goal of this action research is to actualize the elderly people's wishes.
Action research procedure to actualize the goal: 1st step: Developed a committee to achieve this
goal. Recruited committee members from the community and from medical facilities and healthcare
agencies of the town.
2nd step: Conducted an attitude survey to the elderly living in the town regarding end-of-life wishes and
the obstacles achieving them.
3rd step: Provided educational lectures by lawyers to the elderly how to spend their end-of-life stage and
to make decisions and advance directives.
4th step: Conducted a qualitative research study to healthcare and caretaker agencies about their
recognition and attitude to end-of-life care and advance directives.
5th step: Developed the system actualizing the elderly dying at home. Conducted meetings and
conferences to promote the action with personnel of the clinics, home-visiting nursing agencies, care
manager offices, and home help agencies regularly. All of them support the elderly's daily life.

Purpose of this study: The purpose of this study was to extract the obstacles from the healthcare staff
and caretakers in terms of actualizing and supporting the elderly's wishes regarding end-of-life stage. This
is a report of 4th step result.
Methods: Participants of the 4th step research study Participants were personnel from clinics, home-
visiting nursing agencies, care management offices, and home help agencies in K town in Hiroshima city,
Japan. Primary physicians, nurses, care managers, home helpers and home-visiting nurses were
participated. K town is a highly aged community. Method of this research The semi-structured
questionnaire was administered to the participants. The participants were asked to write and describe
obstacles to actualize the elderly's wishes dying at home. The data were analyzed qualitatively and
categorized. To assure the validity of the analysis, categorized data were returned to the participants and
checked by them (member's checking). The ethical consideration was taken.
Results: Five categories were extracted from the qualitative analysis. Those are shown in below.
1. Difficulty in cooperating multidisciplinary between agencies (home-visiting nursing agencies, care
management offices, and home help agencies) and clinics (physicians).
2. Lack of knowledge and skills about the end-of-life home medical care due to the little experience of the
home medical care at the end stage.
3. An underdeveloped system of care at the end stage such as shortage of manpower or difficulty of
treatment in emergencies
4. Preoccupied recognition by medical professionals, health caretaker, the elderly and their family that it is
natural to die at a hospital, and they believe it is impossible to die at home without enough social
background (family living with them, enough budget to ask enough social resources).
5. Patients' and families' lack of knowledge on the end-of-life care.
Discussion: These findings show that there is a shortage of health care workers in a community, and
collaboration system between multidisciplinary is underdeveloped in practice of the home medical care at
the end period. While the promotion of the home medical care needs to be is hurried because of
the rapid aging progress and increase in hospital death in Japan, community supporters feel that it is
difficult to care at home at the end stage. It is necessary to take it from feasible measures. Furthermore, it
is supposed that a cultural background is related about the problems. Japanese sometimes entrust
decision to their families even if it is personal decision and they leave medical care to an expert.
However, we can help to make it possible to support a patient at the end period if we make their hope
clear. Actually, supporters feel that it is difficult to care at-home without declaration of their hope. Itis
required education and support that Japanese people are enabled to make an advance directive.
Discussion: Recognized obstacles by healthcare professionals occur in two areas; One is healthcare
professionals' factor and the other is elderly's factor. In the healthcare professionals area, communication
gaps existed between medical professionals and caretakers, care managers, who mostly do not have
medical knowledge. This lack of medical knowledge makes caretakers and care managers withdraw
taking necessary communication with medical professionals. Most of caretakers often feel fear of
communicating with physicians, which, as a result, make a multidisciplinary team discussion regarding
end-of-life care difficult. The fact that most of the elderly dying in hospitals make healthcare professionals
and caretakers lack of experience in taking care of the elderly dying at home. Therefore, they are
insecure and anxiety taking care of the elderly. So when elderly's conditions get worsen, healthcare
workers and caretakers feels anxiety and send them to hospitals. Lack of manpower of home-health
professionals is crucial. Taking care of end stage takes a lot of time from the professionals. This situation
makes the professionals reluctant to take care of the elderly dying at home. Therefore, Japanese
government seriously need to take an action to increase healthcare professional in community settings.
Without manpower, it is impossible to actualize at-home-death. Patients and families also need to be
educated more about end-of-life care and decision-making. It is obvious that they are not provided
understandable information about healthcare resources which actualize dying at home. The most
important thing is that we need to accumulate successful cases one by one. When we have a case who
want to die at home, it is important to have a case conference with a patient, the family, medical

professionals, a care manager, and caretakers together, which will actualize at-home-death. To resolve
these obstacles, we will continue this action research project.
Summary: This study showed that health care workers who provide end-of-life care at home feel difficulty
in various dimensions. It seems to be related to the underdeveloped system of the end-of-life care and
lack of community education. In order to promote at-home death, we need to accumulate successful
cases one by one with multidisciplinary discussion.
References
White Paper on Health and Welfare (1997) Retrieved December 12, 2013, from Ministry of Health, Labour and
Welfare Web site: http://www1.mhlw.go.jp/wp/4-2-6.html Survey on Attitude toward the medical care in end-of-life
(2013) Retrieved December 12, 2013, from Ministry of Health, Labour and Welfare Web site:
http://www.mhlw.go.jp/stf/shingi/2r98520000035sag-att/2r98520000035sf3.pdf
Contact
[email protected]

Readmission and Risk Factors Among Community Rehabilitation Users with
Psychiatric Disease in Taiwan
Hui-Fang Su, RN, PhD, Taiwan
Pi-Ching Hsieh, PhD, RN, Taiwan
Purpose
The aims of this study were first to investigate the characteristics of community rehabilitation care users
and then to analyze the frequency of readmission and its risk factors within one year after discharge from
a hospital for the treatment of mental illness.
Target Audience
The target audiences of this presentation are the registered nurses who are working in community for
psychiatruc disease care and the researchers who are interesting in the quality of care for patients with
psychiatric disease.
Abstract
Purpose: With reference to phase I and phase II of Andersen’s behavioral model of health service
utilization, the aims of this study were first to investigate the characteristics of community rehabilitation
care users and then to analyze the frequency of readmission and its risk factors within one year after
discharge from a hospital for the treatment of mental illness.
Methods: A retrospective cohort study design was used. Data analyzed in this study were retrieved from
the ‘home care specific files’ of the National Health Insurance Research Database issued by the National
Institutes of Health between 1999 and 2009. A total of 25,218 people were new cases of community
rehabilitation care between 2000 and 2007. In order to forecast these community rehabilitation care
users’ risk of readmission within one year after discharge, the Cox proportional hazard model was
utilized.
Results: We found that the adjusted hazard ratio was significantly lower for groups of 8-14 times users
and 15 or more-times users of community rehabilitation care than for 1-7 times users (0.73 & 0.72
respectively) in the Cox regression model. Furthermore, the risk of readmission was lower for females,
clients who were insured by sub-bureau in the middle part of Taiwan, a diagnosis of schizophrenia, and a
length of hospital stay less than 55 days.
Conclusion: The lower the frequency of psychiatric patients’ using community rehabilitation care, the
higher the risk of readmission.
Contact
[email protected]

Variables Affecting the Reporting of the Patient Safety Events
Shu-Chen Chang, MSN, RN, Taiwan
Mei-Yu Kang, RN, Taiwan
Ya-Hui Hsieh, PhD, Taiwan
Tsui-Fen Chung, MS, Taiwan
Purpose
to share nurses' reporting intention of medical incidents on the basis of Theory of Planned Behaviour
(TPB)
Target Audience
the nursing leaders of hospitals.
Abstract
Purpose: This study aims to investigate nurses' reporting intention of medical incidents on the basis of
Theory of Planned Behaviour (TPB).
Methods: The design of questionnaire was based on TPB and the literature of patient safety. The
researchers adopt the purposeful sampling approach. Three hospital systems in Taiwan were selected.
Totally, 2,565 questionnaires were distributed and 2,151 were collected. The response rate was 81.2%.
Results: 53.8% participants had incidents reporting experiences. The average time of completing
reporting by entering data was 21.67 minutes. Then, learning how to use the reporting system averagely
took 17.9 minutes. There was no significance among three hospital systems in terms of incidents
reporting intention by using ANOVA test. However, there were significantly different between
variables(p<.01). The study found that the nurses' reporting intention of medical incidents was affected by
the attitude and behaviour beliefs, self control, and the main reference groups.
Conclusions: The internalization of value of medical incidents reporting and the formulation of its culture
would contribute to the reporting of medical incidents. The willpower control of reporters played a pivotal
role of reporting incidents. Especially, the unit supervisor, colleagues in the same unit, colleagues having
reporting experiences, and the same event another party were important reference groups of reporting
behaviour norm.
Contact
[email protected]

Mental Health Trajectories and Related Factors Among Perinatal Taiwanese
Women
Pei-Chao Lin, RN, Taiwan
Chich-Hsiu Hung, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to present mental health trajectories from the third trimester of
pregnancy through four weeks postpartum in Taiwanese women and the correlations of these trajectories
with perceived social support and demographic characteristics.
Target Audience
The target audience of this presentation is health care providers who concern women’s perinatal health.
Abstract
Purpose: To investigate mental health trajectories from the third trimester of pregnancy through four
weeks postpartum in Taiwanese women and the correlations of these trajectories with perceived social
support and demographic characteristics.
Methods: This study is a repeated measures design. 194 Taiwanese women completed the Chinese
Health Questionnaire and Social Support Scale at the 36th gestational week and 1st and 4th weeks
postpartum. Latent class growth analysis was used to identify the change tendency and major classes of
mental health status among perinatal women. Multinomial logistic regression was then used to determine
if demographic characteristics and social support were associated with the classes of mental health
trajectories among perinatal women.
Results: Three linear mental health trajectories for perinatal women were identified. The three classes of
mental health trajectories among perinatal women were identified as Class 1 (“consistently good perinatal
mental health,” 12.4%); Class 2 (“improved perinatal mental health after childbirth,” 71.6%); and Class 3
(“consistently poor perinatal mental health,” 16.0%). Multinomial logistic regression was used to examine
correlations of the three classes of mental health trajectories with demographic characteristics and social
support. Class 1 served as the control group. Social support was significantly related to the three classes
of perinatal mental health trajectories. Less social support was associated with lower prenatal mental
health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was
associated with improved mental health after childbirth.
Conclusion: Mental health was worse in the third trimester of pregnancy than postpartum. Less social
support was associated with lower prenatal mental health scores, and similarly distributed between
women with consistently poor and improved mental health after birth. Health care providers should
assess women’s mental health status and provide timely interventions during the perinatal period. Social
support intervention should be carried out for pregnant women, especially for those with younger age or
lower perceived social support.
References
Andruff H, Carraro N, Thompson A & Gaudreau P (2009) Latent class growth modeling: A tutorial. Tutorials in
Quantitative Methods for Psychology 5, 11-24. Austin MP, Reilly N & Sullivan E (2012) The need to evaluate public
health reforms: Australian perinatal mental health initiatives. Australian and New Zealand Journal of Public Health 36,
208-211. Faisal-Cury A & Menezes PR (2012) Antenatal depression strongly predicts postnatal depression in primary
health care. Revista Brasileira de Psiquiatria 34, 446-450. Fisher J, Tran T, Tran TD, Dwyer T, Nguyen T, Casey GJ
… Biggs BA (2013) Prevalence and risk factors for symptoms of common mental disorders in early and late
pregnancy in Vietnamese women: A prospective population-based study. Journal of Affective Disorders 146, 213-
219. Lau Y (2011) A longitudinal study of family conflicts, social support, and antenatal depressive symptoms among
Chinese women. Archives of Psychiatric Nursing 25, 206-219. Sawyer A, Ayers S & Smith H (2010) Pre- and
postnatal psychological wellbeing in Africa: A systematic review. Journal of Affective Disorders 123, 17–29. Zelkowitz
P, Saucier JF, Wang T, Katofsky L, Valenzuela M & Westreich R (2008) Stability and change in depressive

symptoms from pregnancy to two months postpartum in childbearing immigrant women. Archives of Women’s Mental
Health 11, 1-11.
Contact
[email protected]

Narrative Study in Young Adult Offspring of Parents with Bipolar Disorder
Sara Hsin-Yi Liu, RN, Taiwan
Fei-Hsiu Hsiao, PhD, RN, Taiwan
Shing-Chia, Chen, PhD, RN, Taiwan
Shu-jen Shiau, PhD, MPH, RN, Taiwan
Ming-Hsien Hsieh, PhD, Taiwan
Purpose
It will explore young adult offspring of parents with bipolar disorder about how ill patient impact their
offspring, including their feeling, growing experience, difficulties and challenge to care the ill parent, and
their adjustment strategy to cope the suffering in different stage.
Target Audience
It will provide a fresh view to care the offspring of parental mental illness for practitioner of mental health
and family nursing.
Abstract
Background: Bipolar disorder is a chronic mental illness which often results in family’s burden. More
attentions have been paid to the psychosocial adjustment of patients’ offspring because symptoms often
deteriorate the family function and patients’ parenting practice. However, we know little about the
offspring’s experiences of how they perceived and adjust with their parent’s illness.
Purpose: This study aimed to explore young adult offspring of parents with bipolar disorder about how
their lives are influenced by their parents’ mental illness, how they perceived their parent’s illness, how
they healed their suffering, how they learnt about the positive experiences of living with their parent’s
illness.
Methods: This study adopted qualitative method with interviewing 20 young adult (20-40 years old)
offspring of bipolar patient. Through the narrative analysis method, the interviewed verbatim text are
organized by the themes of offspring’s experience.
Results: It is an ongoing study. This preliminary result has shown some themes including: I should keep
quiet when father or mother got mad, no one tell me the reason why father or mother get hospitalized ,
suffering from the childhood, struggle to leave parent’s home, having more perseverance to face stressed
situation in adulthood.
Conclusion: This preliminary result helps us to develop the nursing intervention program for offspring of
patients with bipolar disorder based on understanding their experience of suffering and healing among
young adult offspring of bipolar patient.
Contact
[email protected]

The Experiences of Families to Care the Children with Asthma during the
Developmental Transition: A Mixed Method
Li-Chi Chiang, RN, PhD, Taiwan
Purpose
1. To realize the phenomena that the over-protection, interdependent of parent/child dyad in managing
the children's asthma. 2. To understand the context of the family management style influence on the
change of asthma sign and symptom.
Target Audience
All of the nurses interesting on the family life transition and wish to understanding the process of
developing and tailoring an appropriate developmental care for children with chronic illness.
Abstract
Purpose: To explore the experience of families having children with asthma to transfer the
responsibilities of asthma self-management during the development transition period.
Design:A mixed method study was used to explore the experiences of families to care the children with
asthma during the developmental transition stage.
Methods: Twenty parents and children with asthma dyad were interviewed and followed by structure
questionnaire from preschool to school-age transition stage. The qualitative data was transcribed and
analyzed by the content analysis. The structure questionnaires including the self-management of children
and parents, family function and children’s ARQOL, asthma signs/symptoms, lung function were repeat
measured for six months after the child entering the elementary school accordingly. The quantitative data
was analyzed by the General Lineal Model (GLM).
Results: The qualitative data revealed that parents perceived hesitate let go or not, indecision to shift
responsibilities and coexist of Happy and Hazard to unclear school situation .The quantitative results
revealed that assessing behavior of self-management and mastery of stress of parents were significantly
improved through the transition respectively. The ARQOL and Family function without significantly
change. The family management style was significantly impact on the changes of parents’ self-
management and children’s asthma sign and symptoms.
Conclusion: Most of the parents without preparedness for their child transition independent for the
asthma management into school. The developing care for children with asthma was recommended,
including three components: 1) Reinforcing the illness perception of parents and children about asthma;
2) Encouraging shifting the responsibilities; 3) Commence the self-management behaviors for children.
Empowering the parents to rear the child with asthma gradually relief the responsibilities to children in
each transitional condition. Further examination of the comprehensive and applicability of developing care
model is necessary.
Contact
[email protected]

Health and Social Service Utilization and Postpartum Depression Among
Childbearing Chinese New Immigrants in Canada
Tsorng-Yeh Lee, PhD, Canada
Purpose
The purpose of this presentation is to explore how Chinese women who immigrated to Canada in the last
5 years access and use maternity care services, their support system and postpartum emotional
wellbeing.
Target Audience
The target audience of this presentation is healthcare providers who work in Maternity field and health
care policy makers.
Abstract
Purpose: To explore how Chinese women who immigrated to Canada in the last 5 years access and use
maternity care services, their support system and postpartum emotional wellbeing.
Background: Culturally and linguistically appropriate health care is suggested by many researchers as a
necessity for all immigrants in Canada. Relatively little research examines the access and use of
maternity care services by immigrant women in Canada, especially Chinese immigrants. Chinese women
practice special culture-based behaviours and eat a special diet during pregnancy and postpartum.
Exploring these cultural practices and preferences will contribute to the body of knowledge related to
immigrant women’s maternity care and will help inform culturally sensitive care for Chinese women who
live in Canada.
Methods: A cross-sectional survey was used. Thirty participants were recruited from the Chinese
community in Toronto, Canada after obtaining ethical approval. Eligible participants were Chinese new
immigrant women (< five years) who resided in Toronto, fluent in English or Mandarin, within two to six
months after delivering their baby. The Edinburgh Postnatal Depression Scale (Cox, Holden, & Sagovsky,
1987) and the Ontario Mother and Infant Survey II: Part H-Satisfaction with services were used to assess
risk of postpartum depression, health and social service needs and utilization patterns. A demographic
data questionnaire was also filled out by the participants. Data analysis was conducted by SPSS 21.0.
Results : Chinese immigrant women preferred to receive care from Chinese healthcare providers, with an
obstetrician over a midwife. They received appropriate pregnant information, such as physical changes,
nutrition, and exercise, through oral or written form. The information was provided in both English and
Chinese, while preferred Chinese. Half of the Chinese immigrant women manifested possible postpartum
depression. Women with own mother as a key helper had lower depression than women with husband as
a key helper. Women demonstrated lower postpartum depression when they were more satisfied with the
health service in the community.
Conclusion: Although the sample size was small, the result of this preliminary study enhanced our
knowledge and understanding of Chinese women’s utilization of maternity health services. Improving
access to postpartum health service in the community was emphasized and recommended. Health care
professionals should acknowledge that a linguistically and culturally sensitive maternity service played an
important role in Chinese women’s searching information and emotional wellbeing during pregnant and
postpartum period.
References
References: Browne, G., Gafni, A., Roberts, C. L., Goldsmith, A., & Jamieson, E. (1995). Approach to the
measurement of costs when evaluating health and social programmes. Hamilton, ON: The System Linked Research
Unit McMaster University. Cox, J., Holden, J., & Sagovsky, R. (1987). Detection of postnatal depression:
development of the10-item Edinburgh postpartum depression scale. British Journal of Psychiatry, 150, 782-786.
Wang, L., Rosenberg, M., & Lo, L. (2008). Ethnicity and utilization of family physicians: A case study of Mainland

Chinese immigrants in Toronto, Canada. Social Science &Medicine, 67, 1410-1422. doi:
10.1016/j.socscimed.2008.06.012.
Contact
[email protected]

The Effectiveness of Analytical Music Videos Appreciation in Elderly People with
Depressive Mood
Hui-Ling Lai, PhD, RN, Taiwan
Chiung-Yu Huang, PhD, Taiwan
Purpose
The purpose of this presentation is to compare the effects of meaningful fast music videos (MV) and
soothing music MV on HRV (heart rate variability), SC (skin conductance), and EMG (electromyography)
and depression in elderly people with depressive mood.
Target Audience
Abstract
Purpose: To compare the effects of meaningful fast music videos (MV) and soothing music MV on HRV
(heart rate variability), SC (skin conductance), and EMG (electromyography) and depression in elderly
people with depressive mood.
Methods: Thirty participants were randomly assigned to a meaningful fast music/soothing music MV
sequence or soothing music/ fast music MV sequence. The MV music was played on an iPad. Each
intervention lasted 30 minutes, and was held at the participant’s home. Continuous measurements of
HRV, SC and EMG were taken throughout the procedure. Depression was measured before and after
each intervention.
Results: Both interventions had beneficial effects on HRV, SC and EMG and depression. Significant
differences between the two interventions were also observed for depression, and HRV. Fast music was
more effective in lessening depression (p < 0.05). All participants rated that both MV were meaningful to
them.
Conclusion: Both MV interventions were beneficial, as measured on psycho-physiological indices. The
beneficial effects of fast MV were more powerful than those of soothing MV in reducing depression and
improving the low/high frequency (LF/HF) ratio component of heart rate variability.
Contact
[email protected]

The Effectiveness of an Educational Intervention of Evidence-Based Nursing on
Nurses' Knowledge, Attitude, and Implement Confidence
Purpose
The purpose of this presentation is to report the findings which develop EBP curricular components and
explore the effectiveness of the EBP course on RN-BSN students.
Target Audience
Abstract
Purpose: Although Evidence-based practice (EBP) has been recognized by the healthcare community as
the gold standard for the provision of safe healthcare, its implementation can be challenging. Dealing with
innumerable crucial clinical decisions, nurses require to grasp the ways to locate, critically appraise, and
apply the best evidence to assure optimal care for patients. One way nurse educators can assist students
encounter these challenges is to educate them in evidence-based practice. The objectives of this study
were to develop EBP curricular components and explore the effectiveness of the EBP course on RN-BSN
students.
Methods: The study was approved by the appropriate ethics committees. A quasi-experimental, repeated
measures design, with intervention and control groups was used. The EBN knowledge, attitude, and
implement confidence were measured with a questionnaire before and after implementing the EBP
course. The repeated measure ANOVA was used for analyzing the effectiveness of the EBP course.
Results: Participants in the intervention group had higher scores on knowledge (p< .01), attitude (p< .01),
and implement confidence (p< .05) of EBP than those in the control group.
Conclusion: The course effectively enhanced EBP knowledge, attitude and implement confidence of RN-
BSN students. This illustrates the positive effects of this EBP course. The results can be used by nursing
leaders in health care organizations to educate and engage nurses in EBP initiatives and research
utilization.
Contact
[email protected]

Health Status of Postpartum Women: Bladder Symptoms, Postpartum
Depression, and Physical Activity
Jeung-Im Kim, PhD, South Korea
Young-Mi Yang, MSN, South Korea
Purpose
To report postpartum health outcomes and to know the professional members those who are interested in
health status after woman delivery babies.
Target Audience
People who are interested in changes of women's health status before and after delivery babies.
Abstract
Purpose: The overall purpose of this study was to determine the levels and the associations among
postpartum health outcomes. The specific research objectives were as follows; first, to describe general
and obstetric characteristics, secondly to describe the levels of the bladder syndrome, postpartum
depression, physical activities and postpartum fatigue, thirdly to explain the differences of health
outcomes at time-points. Lastly it was aimed to show the associations of the health outcomes.
Methods: Study design was a cross-sectional research at time-points of 4-, 8-, and 12 weeks to know the
changes over the time. Ethical approval was obtained from IRB of SoonChunHyang University Chonan
Hosptial. Recruitment of subjects was done by two ways. Main approach was done by using professional
online survey organization, and another approach was one to one contact at the waiting area of the
hospital and health center. After subjects answered, we gave the small first-aid kit to them. Total subject
was 303 women, but we excluded twin mother and preterm labor, and finally we analyzed 290 subjects.
Measurements we used in this research were the Interstitial Cystitis Symptom Index/ Interstitial Cystitis
Problem Index (ICSI/ICPI), International Physical Activity Questionnaire (IPAQ) short form, and Piper’s
revised Fatigue Scale, etc. Cronbach’s alphas were .825 for ICSI/ICPI, .613 for IBS, .86 for the Edinbergh
Postnatal Depression Scale, .778 for women’s health problem and .954 for postpartum fatigue.
Results: The mean age of subjects was 32.9 (SD 3.53) and the mean BMI (body mass index) was 20.97
(SD 3.23). They got the prenatal care with the mean of 8.37 times. As shown table 1, health outcomes
were all significantly different by the inter-subjects as shown table 1. the better physical health status, the
lower the EPDS score. The higher physical health symptom scores, the higher bladder symptom scores
(r=.317, p<.001). Also health outcomes had positively / negatively associated among themselves.
Conclusion: After women had a baby, their physical health symptom was decreased over the
time, and postpartum depression and fatigue were increased. So we have to aware of physical and
psychological problems.
Table1. Subject’s Health outcomes
Item Mean SD F p
Health problems 20.74 5.89 59.92 .000
Postpartum Fatigue 87.89 18.21 82.21 .000
ICSI/ICPI 13.07 4.76 46.79 .000
ICSI 6.87 2.45 47.79 .000
ICPI 6.20 2.86 36.98 .000

Irritable Bowel Syndrome 17.82 4.38 69.36 .000
Postpartum depression 9.34 5.78 27.53 .000
References
Jeung-Im, Kim RN., PhD, Professor in SoonChunHyang University Young-Mi, Yang RN., MSN, Chief of Nursing
Department in Saerona Hospital
Contact
[email protected]

Changing Southern African Nurses' Roles in Antibiotic Stewardship: An
Innovative Pedagogical Approach
Christine Amalia Varga, RN, MSN, MA, PhD, South Africa
Purpose
The purpose of this presentation is to describe the roles nurses can play in antimicrobial stewardship,
lessons learned in the creation of health-related e-learning efforts in a developing country context. It will
also illustrate means of encouraging inter-disciplinary strategies to antimicrobial steward through
innovative pedagical approaches.
Target Audience
The target audience of this presentation is those interested in international health issues, strengthening
nursing's role in interdisciplinary approaches to healthcare, and cross-cultural and innovative approaches
to nursing research and education. It will appeal to nursing researchers, educators and practitioners.
Abstract
Purpose: The purpose of this presentation is to describe the roles nurses can play in antimicrobial
stewardship, lessons learned in the creation of health-related e-learning efforts in a developing country
context. It will also illustrate means of encouraging inter-disciplinary strategies to antimicrobial steward
through innovative pedagical approaches. Antimicrobial resistance (AMR) is an international health
concern and major threat to global stability (Laxminarayan et al., 2007). While drug resistance is
increasing worldwide, evidence suggests that AMR is disproportionately high in developing countries
(Nweneka et al., 2009). This is certainly true for (southern) African countries, where factors such as high
rates of HIV/AIDS and tuberculosis exacerbate complex political, health systems, economic and socio-
cultural elements that influence antimicrobial access, use, surveillance, and ultimately rates of resistance
(Gelband & Duse, 2011; Kimanga 2012). Antibiotic/antimicrobial stewardship (AS) efforts, defined here as
a suite of interventions aimed at measurement, conservation, and optimal use of antimicrobials for
favorable patient outcomes and reduction of resistance, are one response in attempting to reduce AMR.
There is a small but growing literature on nurses’ role in antibiotic stewardship in developed country
settings (Edwards et al. 2010, Ladenheim et al. 2013), especially in in-patient settings (Edwards et al.
2011). However, in the developing world the relationship between nursing and AS seems to have been
largely overlooked. Such a gap stands in stark contrast to the fact that in many such environments
including South Africa, Malawi and Mozambique, where this work is situated, nurses play a frontline role
in antimicrobial management. This is especially true in primary health care settings, where the majority of
health care provision - including medication prescription and education - takes place. Further, nurses’
ability to effect change within healthcare is often curtailed by cultural, institutional, and systems-level
factors. Against this background, we present an update on the formative stages of a multi-country inter-
disciplinary pilot project aimed at strengthening AS efforts among nurses and other allied health care
professionals through the use of e-learning approaches. The project described aims to develop a 2-year
e-learning Masters-level curriculum in Malawi and Mozambique that will provide learners with appropriate
critical analytical, research, communication and practical skills relevant to antibiotic stewardship, infection
prevention and control. The curriculum is based on an existing e-learning program in South Africa housed
within the University of KwaZulu-Natal School of Health Sciences. One portion of the formative research
stage of the project addresses the role of nursing in antibiotic stewardship efforts and infection prevention
and control. In each of the three country settings (Mozambique, Malawi, and South Africa) the research
describes 1) nurses’ current roles in antibiotic prescription, administration, management, and patient
education; 2) socio-cultural, educational, institutional and systems-level factors that affect nurses’ ability
to meaningfully engage in antibiotic stewardship efforts; 3) nurses’ knowledge related to antimicrobials in
general and AS in particular; and 4) factors involved in developing an inter-disciplinary approach to
antibiotic stewardship that includes nursing professionals and nursing approaches.

Methods: Data collection takes place through qualitative (focus groups, in-depth interviews, narrative
research and role mapping activities) and quantitative (questionnaires) data collection among potential
learners (i.e. nurse applicants), policymakers and government officials, individuals involved in healthcare
management on institutional and community levels, actively practicing nurses in a variety of healthcare
environments, individuals involved in (undergraduate and post-graduate) nursing education, and nursing
students.
Results: The presentation will: 1) illustrate the role nurses in South Africa, Malawi and Mozambique
currently play in antimicrobial prescription, management, administration, monitoring and patient
education; 2) discuss existing barriers in nurses’ ability to engage in antibiotic stewardship efforts; 3)
describe nurses’ knowledge of antimicrobials and AS, highlighting strengths and gaps; 4) suggest means
to more meaningfully and actively involve nurses in stewardship efforts in developing country contexts; 5)
discuss means of encouraging inter-disciplinary strategies to AS via innovative pedagical approaches;
and 6) highlight lessons learned concerning health-related e-learning and the curriculum development
process in developing country contexts.
Conclusion: The target audience of this presentation is those interested in international health issues,
strengthening nursing's role in interdisciplinary approaches to healthcare, and cross-cultural and
innovative approaches to nursing research and education. It will appeal to nursing researchers, educators
and practitioners.
References
Edwards, R., Drumright, L., Kiernan, M, and Holmes, A. (2010). Covering more territory to fight resistance:
considering nurses’ role in antimicrobial stewardship. Journal of Infection Prevention, 12: 6-10 Edwards, R., Loveday,
H, Drumright, L., and Holmes, A. (2011). Should nurses be more involved in antimicrobial management? Journal of
Infection Prevention, 13: 4-6 Gelband, H. and Duse, A. (2011) Executive Summary: Special Issue of South African
Medical Journal on Antimicrobial Resistance, SAMJ, 101(8), 552-555. Kimanga, A. N. (2012) A situational analysis of
antimicrobial drug resistance in Africa: are we losing the battle? Ethiopian Journal of Health Sciences, 22(2), 135-
143. Ladenheim, D., Rosembert, D., Hallam, C. and Micallef, C. (2013). Antimicrobial Stewardship: the role of the
nurse. Nursing Standard, 28, 6, 46-49 Laxminarayan, R, Malani, A, Howard, D, and Smith, D (2007) Extending the
Cure: Policy Responses to the Growing Threat of Antibiotic Resistance. Resources for the Future: Washington DC.
Nweneka , C., Tapha-Sosseh, N, and Sosa, A. (2009)Curbing the menace of antimicrobial resistance in developing
countries. Harm Reduction Journal, 6(31), 1-4
Contact
[email protected]

A Study of the Relationship Between Compassion Fatigue, Somatization, and
Silencing Response Among Hospital Nurses: Focusing on the Mediating Effects
of Silencing Response
Sunhwa Kim, RN, South Korea
Purpose
The purpose of this study was to identify compassion fatigue(CF), somatization, and silencing
response(SR) among nurses and understand intermediate effects between variables.
Target Audience
clinical nurse, head nurse, team manager
Abstract
Purpose: The purpose of this study was to identify compassion fatigue(CF), somatization, and silencing
response(SR) among nurses and understand intermediate effects between variables.
Methods: The sample of 240 nurses who were working in medical, surgical wards and emergency room
had shift-work in 3 hospitals with over 700 beds. A structured questionnaire was used and included CF,
Somatization and SR scale. The data were analyzed using descriptive statistics, ANOVA, Pearson's
correlation coefficients and stepwise multiple regression.
Results: There were statistically significant differences in CF, somatization and SR depending on
perceived personal health condition, experience of turnover, co-worker support. There were significant
correlations among those study variables. The result also indicated that burnout (ß= .810, p<.001) which
is a part of secondary traumatic stress and somatization (ß= .786, p<.001) have the role of partial
mediator in the relationship between secondary traumatic stress and silencing response
Conclusion: The result of study that intermediary role by burnout and somatization in silencing response
of nurses is important for effective human resource management in hospital nursing. Effective human
resource management which includes mentoring and social support system can enhance the professional
quality of life of nurses, which will eventually contribute quality of care as a care provider and counselor.
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Korean journal of fundamentals of nursing, 13(1),96-106. Oh, H. J. (2008). The Impact of Job Stress and Alexithymia
on Somatization. Unpublished master’s thesis, Daegu University, Kyeongbuk. Park, B. Y. (2012). The Relationship of
Emotional Labor with Professional Quality of Life in General Hospital Personnel. Unpublished doctoral dissertation,
Chosun University, Kwangju. Park, H. J. (2009). Emotional Labour, Emotional Expression and Burnout of Clinical
Nurses. The Journal of Korean Nursing Administration Academic Society, 15(2), 225-232. Pfifferling, J. H., Gilley, K.
(2000). Overcoming compassion fatigue. Family Practice Management, 7(4),39-46. Radziewicz, R. M. (2001). Self-
care for the caregiver. Nursing Clinics of North America, 36(4),855-869. Shin, M. K., Kang, H. L. (2011). Effects of
Emotional Labor and Occupational Stress on Somatization in Nurses. The Journal of Korean Nursing Administration
Academic Society, 17(2), 158-167. Stamm, B. H. (2010). The Concise ProQOL Manua.l 2nd Ed. Pocatello, ID:
ProQOL.org. Stamm, B. H. (2002). Measuring compassion satisfaction as well as fatigue; Developmental history of
the Compassion Satisfaction and Fatigue Test. Psychosocial stress series. NY, US; Brunner-Routledge. Vitello-
Cicciu, J. M. (2003). Innovative leadership through emotional intelligence. Nursing Management, 34(10),28-33. Yom,
Y. H., Kim, H. J. (2012). Effects of Compassion Satisfaction and Social Support in the Relationship between
Compassion Fatigue and Burnout in Hospital Nurses. Journal of Korean Academy of Nursing, 42(6), 870-878. Yoon,
K. S., Kim, S. Y. (2010). Influences of Job Stress and Burnout on Turnover Intention of Nurses. The Journal of
Korean Nursing Administration Academic Society, 16(4), 507-516.
Contact
[email protected]

Mentoring and the Early Career Nurse: A Critical Relationship
Tracey L. Moroney, PhD, BN (Hons), Australia
Levina Saad, BN, Australia
Purpose
The purpose of this presentation is to inform clinicians and educators about the important of as assisting
early career nurses in identifying mentors that can support their personal and professional growth.
Target Audience
The target audience of this presentation is clinicians, academics, educators and early career nurses.
Abstract
Purpose: There has been significant attention to the role of mentoring in nursing with discussion focusing
on defining the concept, the nature of the mentoring role and the characteristics of the mentor. There is
however some tension in the literature around the role and functions of a mentor (Andrews and Wallis
1999) with conflicting opinions. This is compounded by the use of interchangeable terms, including
preceptor and supervisor and a variety of definitions, which has created misinterpretation and confusion
on the nature of mentoring.
Despite the variety of definitions to describe mentoring, mentoring in essence is the relationship between
two individuals designed to achieve personal and professional growth. In the early career stage for new
graduate nurses, this supportive relationship can be critical to assisting new graduates to consolidate
knowledge and practice required of a registered nurse. It is evident however that many early career
nurses struggle with the beginning years of practice and it is this difficult adjustment that may be linked to
increasing numbers of early career nurses who leave the profession.
Methods: This research study, using a Grounded Theory methodology, explored the concept of
mentoring in early career nurses. In particular the research explored the way in which early career nurses
identified potential mentors and used these mentors to support their practice. This project has global
significance, as the support of early career nurses is important to the development of a knowledgeable
and effective nursing workforce (Ferguson 2011).
Results: Mentoring was seen by early career nurses as important to surviving the new graduate
transition however formal mentoring was found to be less successful than the informal mentoring
structures that early career nurses adopted.
Conclusion: This poster presentation will explore the role of mentoring and in particular the way in which
early career nurses identified and used mentors. Finally this poster presentation will recommend
strategies for improving mentoring programs for early career nurses.
References
Andrews, M., & Wallis, M. (1999). Mentorship in nursing: A literature review. Journal of Advanced Nursing. 29 (1),
201-207 Ferguson, L.M. (2011). From the perspective of new nurses: What do effective mentors look like in practice?
Nurse Education in Practice. 11, 119-123
Contact
[email protected]

Nurses' Needs to Competently Care for Transitioning Pediatric-Sized Adult
Patients
Lauren Hyatt, MSN, RN, USA
Purpose
The purpose of this presentation is to present an education plan for nurses caring for transitioning
pediatric-sized adult patients. Due to advanced healthcare practices, children with chronic illnesses are
beginning to survive into adulthood. As a result, nurses in the adult setting must be prepared to
competently care for them.
Target Audience
The target audience of this presentation is nurses caring for patients in the adult healthcare setting.
Abstract
Purpose: The purpose of this presentation is to present an education plan for nurses caring for
transitioning pediatric-sized adult patients in the adult health care setting. In today’s world of advanced
healthcare practices, children with chronic childhood illnesses are beginning to survive into adulthood
(McDonnell, Kocolas, Roosevelt, & Yetman, 2010). As a result, nurses, physicians, and other members of
the healthcare team are faced with the challenge of how to properly care for them. In placing them in the
adult hospital setting, the nurse must encompass the knowledge and skill set to safely care for them. The
nurse must also understand how to retrieve the resources that are available to him or her. This
presentation will identify the common needs expressed by nurses’ in the adult ICU setting of a large
teaching hospital in the Southeast.
Methods: A mixed methods study will be conducted to identify nurses’ needs to competently care for
pediatric-sized adult patients in the adult ICU setting of a large teaching hospital in the
Southeast. Approximately 80 nurses from the medical ICU, 80 nurses from the surgical-trauma ICU, and
80 nurses from the neurosurgical ICU will be asked to participate in a survey composed of 14 closed-
ended and open-ended questions. To achieve more statistically accurate data, the student investigator
hopes to incorporate at least 100 participants in the study. All nurses in the adult ICU setting, regardless
of employment status (full time, part time, prn), will be given a survey via their work email to complete
within a two-week time period from the date of sending the original email. The survey will be accessible
to the participant during this entire two-week time period. To avoid duplication of results, only the
participants work email will be used. Prior to the administration of the survey, a discussion between the
nurse manager and the staff of each nursing unit involved will take place to encourage nurses to
participate. Nurses will be informed that the feedback they provide through the survey can better assist
the hospital in developing an education plan that will better equip them to care for transitioning pediatric-
sized adult patients.
The literature has yet to define “pediatric-size,” therefore, the definitions of chronic illness with the
inclusion of common chronic childhood diseases will be used for the purpose of this study. Mosby’s
Dictionary of Medicine, Nursing, and Health Professions (2006), defines chronic illness as “any disorder
that persists over a long period and affects physical, emotional, intellectual, vocational, social, or spiritual
functioning” (p.383). Common chronic childhood diseases may include, but are not limited to, cystic
fibrosis, diabetes, asthma, obesity, malnutrition, developmental disabilities, cerebral palsy, hemophilia,
spina bifida, congenital heart disorders, juvenile rheumatoid arthritis, and mental illness (Staa, Jedeloo,
Meeteren, & Latour, 2011; Torpy, Campbell, & Glass, 2010).
Results: Results will be retrieved and analyzed in February, 2014.
Conclusion: The lack of research on caring for pediatric-sized adult patients represents the need for this
nursing research. It is already concluded that there is a need for an education plan on how to provide
competent, safe care to a transitioning pediatric-sized adult patient. The conclusion will be drawn from the
results of the research study in February, 2014.

References
Baines, J.M. (2009). Promoting better care: Transition from child to adult services. Nursing Standard, 23(19), 35-40.
Benner, P., Tanner, C., & Chelsa, C. (2009). Expertise in nursing practice: Caring, clinical judgment, and ethics. New
York, NY: Springer Publishing. Dinapoli, P., Nelson, J., Turkel, M., & Watson, J. (2010). Measuring the caritas
processes: Caring factor survey. International Journal of Human Caring, 14 (3), 15-20. Flemming, E., Carter, B., &
Gillibrand, W. (2002). The transition ofadolescents with diabetes from the children’s health care service into the adult
health care service: A review of the literature. Journal of Clinical Nursing. 11(5), 560-567. Gentile, D.L. (2012).
Applying the novice-to-expert model to infusion nursing. Infusion Nurses Society, 35 (2), 101-107. doi:
0.1097/NAN.0b013e3182424336. Hankins, J.S., Osarogiagbon, R., Adams-Graves, P., McHugh, L., Steele, V.,
Smeltzer, M.P., & Anderson, S.M. (2012). A transition pilot program for adolescents with sickle cell disease. Journal
of Pediatric Health Care, 26 (6), 45-49. doi: 10.1016/j.pedhc.2012.06.004. McDonnell, W.M., Kocolas, I., Roosevelt,
G.E., & Yetman, A.T. (2010). Pediatric emergency department use by adults with chronic pediatric disorders.
American Medical Association, 164(6), 572-576. Chronic Illness. Mosby’s dictionary of medicine, nursing, & health
professions (7th ed.). (2006). St. Louis, MO: Elsevier. Rutishauser, C., Akre, C., & Suris, J. C. (2011). Transition from
pediatric to adult health care: Expectations of adolescents with chronic disorders and their parents. European Journal
of Pediatrics, 170, 865-871. doi:10.1007/s00431-010-1364-7. Staa, A.L., Jedeloo, S., Meeteren, J.V. & Latour, J.M.
(2011). Crossing the transition chasm: Experiences and recommendations for improving transitional care of young
adults, parents, and providers. Child: Care, Health and Development, 37 (6), 821-832. doi: 10.1111/j.1365-
2214.2011.01261.x. Torpy, J.M., Campbell, A., & Glass, R.M. (2010). Chronic diseases of children. The Journal of
the American Medical Association, 303(7), 682. doi: 10.1001/jama.303.7.682.
Contact
[email protected]

Exploration of Undocumented Antenatal Domestic Violence
Kaye I. Bultemeier, PhD, MSN, APRN/BC, USA
Amy Jelley, MSN, BS, USA
Robin Wilson, EdD, USA
Rebecca Raymond, MSN, BS, USA
Purpose
to explore the incidence and type of undocumented domestic violence among pregnant women in rural
Tennessee
Target Audience
Health care providers and educators
Abstract
Studies indicate that 22% of women in the US admit partner abuse during pregnancy. An additional 6.5%
indicate they have never informed their health care provider of the abuse. Abuse is noted to increase
with psychosocial stress. Whitley County Kentucky is noted for the fact that 26% of the residents live
below the poverty level and unemployment rates are above 10%. Infant death rates are 11.4/1000 live
births versus the state average of 7.8/1000. This study therefore will explore undocumented domestic
violence against women during pregnancy among pregnant women in rural Kentucky.
Purpose: To explore the incidence and types of undocumented domestic violence in rural Kentucky in
the United States.
Methods: Setting: Corbin, Kentucky postnatal wards at the hospitals. Letter requesting permission to
collect data at postnatal ward attached. This is a cohort study and replication of study completed
Chazweka (2012).Letter of permission to use questionnaire is attached.
Data Collection: The pilot study will be completed in 2013
• The researcher or co researcher will visit the postnatal wards daily and ask staff to identify postnatal
women who have delivered within the previous 48 hours and meet the criteria for the study. The
postnatal nurse will ask the patient if they are willing to talk to the research nurse.
• If they agree the researcher will distribute to the potential participant the information sheet and an
envelope which contains a blank questionnaire.
• No identifying information will be on the questionnaires but only a subject number.
• Participants are asked to complete the questionnaire, place it inside the envelope and deposit it in the
locked box. The locked box will be located in the postnatal ward.
• Consent is assumed by the participant completing the questionnaire and placing it in the locked box.
Inclusion criteria:
1. Women who have delivered a live infant within the past two days and are patients on the
postnatal ward
2. Women who can read and comprehend English
3. Women who delivered healthy infants
Exclusion Criteria:
1. Women who cannot read or speak English
2. Women who are not postnatal within the past three days
3. Women who are seriously ill or have a seriously ill infant
4. Women who delivered a stillbirth
Data Collection Instrument: A self-administered questionnaire-copy attached. There are four parts to the
questionnaire.

• Part 1-Biographical data
• Part 2-Women’s safety
Psychological maltreatment of Women Inventory (PMWI)-short form-Tolman 1999. Internal
consistency Dominance/isolation .88, emotional/verbal .92. Evidence of construct, convergent
and discriminant validity noted. None copywrite material but request for online registration.
Permission given by registering at site-completed 2/5/2013
• Part 3-Severity of Violence Against Women Scale
Results: Data is entered in SPSS version 19. Descriptive Statistics are run on all variable. Initial results of
the first 62 participants reveal >10% with undocumented domestic violence during their recent
pregnancy. The majority was psychological with threats of harm.
Conclusion: Preliminary results indicate violence is occurring during pregnancy that is primarily
psychological in nature. Further research is needed to determine if this is occurring worldwide or is an
isolated finding.
Contact
[email protected]

Depression, Balance, and Cognitive Function in the Elderly That Practice and Do
Not Practice Yoga: A Comparative Study
Hermes González, BSN, Mexico
Wendy Molina, BSN, Mexico
Ana María Arredondo, BSN, Mexico
María de los Ángeles Villarreal Reyna, PhD, Mexico
Purpose
The purpose of this presentation is to show the progress of a research project to identify the relationship
between the levels of depression, balance problems, and cognitive impairment in elderly Mexican
population that practice and do not practice yoga.
Target Audience
Nurses interested in the use of alternative interventions based on the scientific evidence.
Abstract
Purpose: To identify the relationship between the levels of depression, balance problems, and cognitive
impairment in Mexican elderly that practice and do not practice yoga
Methods: This study will be evaluated using a descriptive comparative correlational design with two
different groups: the yoga group (n1=65) and the non-yoga group (n2=65). The sample size will
be estimated using the nQuery Advisor 7.0 software; level of confidence 90%, margin of error 5%, and a
correlation of .35. The following variables will be observed using standardized assessments: depression,
balance, and cognitive impairment. The outcomes will be processed on the SPSS 21.0 database. The
study will be conducted in the elderly population of Saltillo Coahuila city, between the months of January
and December 2014.
Results: The results of the two groups will be compared. Descriptive statistics, comparison of means and
correlation analysis will be used.
Conclusion: We will discuss the use of standardized assessments based on the scientific evidence
available in the advanced nursing practice and their implications in positive health outcomes in Mexican
older adults.
References
Barrantes-Monge, M., García-Mayo, E. J., Gutiérrez-Robledo, L. M. & Miguel-Jaimes, A. (2007). Dependencia
funcional y enfermedades crónicas en ancianos mexicanos. Salud Publica de México, 49 (4). S459-S466. Chen KM,
Tseng WS, Ting LF, Huang GF. (2007). Development and evaluation of a yoga exercise programme for older adults.
Journal of Advanced Nursing, 57:432-441 Mahlknecht P, Kiechl S, Bloem BR, Willeit J, Scherfler C, et al. (2013)
Prevalence and Burden of Gait Disorders in Elderly Men and Women Aged 60–97 Years: A Population-Based Study.
PLoS ONE 8(7): e69627. doi:10.1371. Marchetti, G.F., Whitney, S.L., Blatt, P.J., Morris, L.O. & Vance, J.M. (2008).
Temporal and spatial characteristics of gait during performance of the dynamic gait index in people with and people
without balance or vestibular disorders. Physical Therapy, 88(5), 641-651. Ostrosky-Solís, F. López-Arango, G. &
Ardila, A. (2000). Sensitivity and specificity of the Mini-Mental State Examination in a spanish speaking population.
Applied Neuropsychology, 7, (1), 25-31. Peek, M. Howrey, B. Samper, R. Ray, L. y Ottenbacher, K. (2012). Social
Support, Stressors, and Frailty Among Older Mexican American Adults. The Journals of Gerontology: Series B, 67.
755-764. Steffens DC, Otey E, Alexopoulos GS, Butters MA, Cuthbert B, Ganguli M, et al. (2006). Perspectives on
depression, mild cognitive impairment, and cognitive decline. Archives of General Psychiatry 63:130-138. Tinetti, M.
(1990). Falls. Hazzard, W. Reubin, A. Edwin, L. Bierman, J. (Eds.) Principles of Geriatric Medicine and Gerontology.
(pp 1192-1199) Mc Graw Hill. Zettergren KK, Lubeski JM, Viverito JM. (2011). Effects of a yoga program on postural
control, mobility, and gait speed in community-living older adults: A pilot study. Journal of Geriatric Physical Therapy,
34:88-94. Ikai S, Uchida H, Suzuki T, Tsunoda K, Mimura M, Fujii Y. (2013). Effects of yoga therapy on postural
stability in patients with schizophrenia-spectrum disorders:A single-blind randomized controlled trial. Journal of
Psychiatric Research, 47:1744-1750. Hariprasad V.R, Koparde V, Sivakumar P.T, Varambally S, Thirthalli J,
Varghese M, et al.(2013). Randomized clinical trial of yoga-based intervention in residents from elderly homes:

Effects on cognitive function. Indian Journal of Psychiatry, 55:S357-S363 Chen KM, Chen MH, Chao HC, Hung HM,
Lin HS, Li CH.(2009). Sleep quality, depression state, and health status of older adults after silver yoga
exercises:Cluster randomized trial. International Journal of Nursing Studies, 46:154-163 Perez Zepeda M.(2010).
Deterioro Cognoscitivo. Instituto De Geriatria, 220-228
Contact
[email protected]

Perception of Healthy Aging Among Elderly with Chronic Disease in Taiwan: A
Qualitative Study
Yu-Rung Wang, MSN, RN, Taiwan
Ching-Min Chen, DNS, Taiwan
Purpose
This study investigated the living experience of health aging from the perspectives of the elderly with
chronic disease, including physical, psychological and social aging experience of life.
Target Audience
The target audience of this presentation is understand living experience of health aging from the
perspectives of the elderly with chronic disease.
Abstract
Purpose: The aging population in Taiwan is gradually increasing. The elderly population reached 11.2%
in 2012, and it is estimated that by 2060, the percentage will reach 39.4%. There are up to 88% of
Taiwan's elderly reporting with at least one kind of chronic diseases. How to enhance the belief of healthy
ageing for elderly with chronic conditions has become an important concern for the elders, policymakers
and researchers worldwide. Taiwan's government has adopted and implemented healthy aging policy
since 2008. The policy includes improved integration in the economic security and social participation,
better lifestyles, adapting health systems to the needs of the elderly, attacking underlying social and
environmental factors affecting healthy ageing. However, very little research evidence is given for the
perspectives on healthy aging among the elderly with chronic disease after the policy implementation.
This study investigated the living experience of health aging from the perspectives of the elderly with
chronic disease, including physical, psychological and social aging experience of life.
Methods: Qualitative approach was conducted. Participants were recruited from outpatient department of
a medical center in southern Taiwan. Subjects were chronic disease patients 65 years old and above with
clear conscious, being able to communicate in Mandarin or Taiwanese. Ten in-depth interviews were
conducted through purposeful sampling. Following these interviews, verbatim transcription of the
recorded data was used for content analysis. Lincoln and Guba's trustworthiness criteria was applied to
evaluate rigor of this study. Participants were asked to share their living experience regarding aging
process and aging perspectives, definition of healthy aging, as well as factors that influence healthy
aging.
Results: Pilot analysis of two verbatim transcriptions indicated that healthy aging can be viewed from
physical, psychological and social contexts. Elderly adapt their aging process from referential and clinical
situations. Recommendations for approaching healthy aging were collected. Further eight transcriptions
will be analyzed using content analysis in the near future.
Conclusion: From this pilot result, exploration of life experience of the elderly with chronic disease is
made possible for better understanding of their health aging perspectives and aging process, which can
serve as a reference for planning of community health promotion activities and related health policy
making and promotion.
References
Cyarto, E. V., Dow, B., Vrantsidis, F., Meyer, C. (2013). Promoting healthy ageing: development of the Healthy
Ageing Quiz. Australasian Journal on Ageing, 32(1), 15-20. Hansen-Kyle, L. (2005). A concept analysis of healthy
aging. Nursing Forum, 40(2), 45-57. Howse, K, (2012). Healthy ageing: the role of health care services. Perspectives
in Public Health, 132(4), 171-177. Khaw, K. (2012). Prospective population studies such as EPIC and pathways to
healthy ageing: how relevant to Asia? Symposium on Healthy Aging in Taiwan. Symposium conducted at the meeting
of the National Health Research Institutes, Taipei City, Taiwan, ROC. Khaw, K. (1997). Healthy aging. British Medical
Journal, 315, 1090-1096. Kuo, K. N. (2012). Development of Healthy Ageing Policy: A Reflection of Healthy People
2020. Symposium on Healthy Aging in Taiwan. Symposium conducted at the meeting of the National Health

Research Institutes, Taipei City, Taiwan, ROC. Hsiung, C. A. (2012). Healthy Aging Longitudinal Study in Taiwan
(HALST). Symposium on Healthy Aging in Taiwan. Symposium conducted at the meeting of the National Health
Research Institutes, Taipei City, Taiwan, ROC. Thiamwong, L., Maneesriwongul,W., Malathum, P., Jitapunkul, S.,
Vorapongsathorn, T., Stewart, A. L. (2008). Development and psychometric testing of the Healthy Aging Instrument.
Thai Journal of Nursing Research, 12(4), 285 – 296.
Contact
[email protected]

Exploring Nurses' Barriers, Attitudes and Related Factors in Reporting
Medication Administration Errors
Fu-In Tang, PhD, Taiwan
Yung Hai-Peng, RN. MSN, Taiwan
Purpose
The purpose of this presentation is to explore nurses' perceptions of reporting barriers and attitudes in
reporting medication administration errors and to examine the relationship between the barriers and
attitudes in medication administration errors reporting.
Target Audience
The target audience of this presentation is nursing clinical staffs, nursing school teachers and academic
researchers.
Abstract
Purpose: Medication safety is a major concern worldwide that directly relates to patient care quality and
patient safety. Reducing medication administration error incidents is a critical medication safety issue.
Research indicated that most of medication errors happened during the administration stage. However,
nurses estimated that only 25% to 63% of medication administration errors (MAEs) were actually
reported. Understanding of nurses’ barriers in reporting MAEs, their attitudes and related factors is the
initial step to strengthen medication safety. The purposes of this study were to explore nurses'
perceptions of reporting barriers and attitudes in reporting MAEs and to examine the relationship between
the barriers and attitudes in MAEs reporting.
Methods: A cross-sectional, descriptive correlational design with self-administered questionnaire filled
out by the nurses of a medical center hospital in northern Taiwan was conducted. The measurement tools
included the Barriers to MAEs Reporting Questionnaire and Attitudes to MAEs reporting Questionnaire.
These questionnaires were developed from literature and expert input and validated by subject experts
(content validity) and a pilot study. 340 nurses responded to the survey, with 306 valid questionnaires
used in the data analysis of this study.
Results: The major perceived barrier was fear of the consequences of reporting (3.18 ± 0.48), followed
by lack of perceptions in reporting (2.72 ± 0.75) and the negtive impact by the administrator’s attitudes
(2.36 ± 0.54). The staff nurses’ perceptions of reporting barriers was higher than nurse administrators with
a significant difference (2.75 ± 0.34 vs. 2.61 ± 0.35; t=2.71; p=.007). Nurses’ perceptions of reporting
attitudes was neutral yet slightly positive (2.47 ± 0.40); but the nurse administrators had a more positive
attitudes than staff nurses (2.91 ± 0.42 vs. 2.38 ± 0.33; t=-8.43; p=.001). The study also reveals that the
more barriers nurses perceived, the more negative attitudes to MAEs reporting. The barriers to MAEs
reporting and attitudes to MAEs reporting were negative association (r =-.41; p=.001). Among a total of
306 administration errors were collected, most errors had occurred during the day shift (45.8%; 140/306).
The most common errors involved wrong dose (50.7%; 155/306) and wrong drug (35.9%; 110/306).
Among 306 actual errors, 85.6% (262/306) of patients showed no adverse effects. Oral reporting rates to
the nursing department 93.8% (255/272), nurses most common reported to head nurse 76.1% (207/272)
and coworkers 62.5% (170/272); only 28.0% (58/207) of the errors had been reported through the
hospital internet reporting system.
Conclusion: This study shows that the nurses still have fear and feel insecure even when the
administration encourages reporting without blaming; the attitudes of reporting MAEs is also not very
positive. Thus, it is advisable to strengthen the perceptions of reporting and improve the nurses’ attitudes
in reporting MAEs for the overall improvement in MAEs reporting culture.
Contact
[email protected]

Life Experiences of Donors in Living Donor Liver Transplantation
Mei-Yun Wu, RN, Taiwan
Purpose
The purpose of this presentation is the results of this study could provide insight of caring for donors'
physical safety and their psychological comforts. Furthermore, this study could improve the quality of
nursing care and provide holistic care of liver transplantation donor.
Target Audience
The target audience of this presentation is nursing care and provide holistic care of liver transplantation
donor.
Abstract
Purpose: This study aimed to investigate the lived experiences of living liver transplant donors (LLTD). A
total of 8 donors, who had been in an intensive care unit post-op from donating partial livers and
transferred to a step down unit, participated in this study in a medical center located in Southern Taiwan.
Methods: This study was conducted with the phenomenological method. Data were collected through
observations and interviews. The in-depth interview was used to collect data, with recording, was
performed with purposive sampling and using. The researcher then transcribed the recorded contents
verbatim and utilized the Colaizzi (1978) phenomenological analytical method.
Results: The information collected was then inducted and systematically sorted of the life experiences of
LLTD. Which is manifested in five themes: self constructed meanings of liver transplant behaviors,
conflicts of their beliefs and choices, the adaptive processes of the operation, physical sensations after
surgery, and the gains and losses of the physical donor body.
Conclusion: Through this study, the researchers discovered the lived experiences and the process of the
LLTDs. Not only does this study show the donors' personal in-depth and close experiences towards the
processes of liver transplantation, the results of this study could provide insight of caring for donors'
physical safety and their psychological comforts. Furthermore, this study could improve the quality of
nursing care and provide holistic care of liver transplantation donor
References
Aragon, R. J., & Solomon, N. L. (2012). Review article techniques of hepatic resection. Journal of Gastrointestinal
Oncology, 3(1), 28-40. Beavers, K. L., Sandler, R. S., & Shrestha, R. (2002). Donor morbidity associated with right
lobectomy for living donor liver transplantation to adult recipients: A systematic review. Liver Transplantation, 8(2),
110-117. Biller-Andorno, N. (2011). Voluntariness in living-related organ donation. Transplantation, 92(6), 617-619.
Bismuth, H. (2013) Revisiting Liver Anatomy and Terminology of Hepatectomies. Annals of Surgery, 257(3), 383-386.
Brown, R. S. (2003). Evaluation of the potential living donor. Transplantation Proceedings, 35, 915–916. Castedal,
M., Andersson, M., Polanska-Tamborek, D., Friman, S., Olausson, M., & Fehrman-Ekholm, I. (2010). Long-term
follow-up of living liver donors. Transplantation Proceedings, 42, 4449-4454. Catalano, O. A., Singh, A. H., Uppot, R.
N., Hahn, P.F., Ferrone, C. R., Sahani, D. V. (2008). Vascular and Biliary Variants in the Liver: Implications for Liver
Surgery. RadioGraphics 28, 359-378. Cohen, D. J., & Crabtree, B. F. (2008). Evaluative criteria for qualitative
research in health care: controversies and recommendations. Annals of family medicine, 6(4), 1-9. Concejero, A. M.
& C., C. L. (2009). Ethical perspectives on living donor organ transplantation in Asia. Liver Transplantation, 15, 1658-
1661. Cronin, D. C., & Siegler, M. (2003). Ethical issues in living donor transplantation. Transplantation Proceedings,
35, 904-905. Crowell, S. G. (1990). Husserl, Heidegger, and transcendental Philosophy: Another look at
Encyclopaedia britannica article. Philosophy and phenomenological research, 1(3), 501-518. de Oliveira-Cardoso, É.
A. d., dos Santos, M. A., Mastropietro, A. P., & Voltarelli, J. C. (2010). Bone marrow donation from the perspective of
sibling donors. Rev. Latino-Am. Enfermagem, 18(5), 911-918. De Villa, V. H., Lo, C. M., & Chen, C. L. (2003). Etiics
and rationale of living-donor liver transplantation in Asia. Transplantation, 75(3), S2-S5. Demirbas, T., Bulutcu, F.,
Dayangac, M., Yaprak, O., Guler, N., Oklu, L., Akyildiz, M., Altaca, G., Tokat, Y., & Yuzer, Y. (2013). Which incision is
better for living-donor Right Hepatectomy? Midline, J-Shaped, or Mercedes. Transplantation Proceedings, 45, 218–
221. Doherty, G. M., Lowney, J. K., Mason, J. E., Reznik, S. I., & Smith, M. A. (2005)‧華盛頓外科學手冊 The
washington manual of surgery（于大雄譯）‧台北：合記。（原著出版於2000） Erim, Y., Malag'o, M., Valentin-

Gamazo, C., Senf, W., & Broelsch, C. E. (2003). Guidelines for the psychosomatic evaluation of living liver donors:
analysis of donor exclusion. Transplantation Proceedings, 35, 909–910. Erim, Y., Senf, W., & Heitfeld, M. (2003).
Psychosocial impact of living donation. Transplantation Proceedings, 35, 911-912. Erim, Y., Beckmann, M., Valentin-
Gamazo, C., Malago, M., Frilling, A., Schlaak, J. F., Gerken, G., Broelsch, C. E., & Senf, W. (2006). Quality of life and
psychiatric complications after adult living donor liver transplantation. Liver Transplantation, 12, 1782-1790. Erim, Y.,
Beckmann, M., Kroencke, S., Valentin-Gamazo, C., Malago, M., Broering, D., Rogiers, X., Frilling, A., Broelsch, C. E.,
& Schulz, K. H. (2007). Psychological strain in urgent indications for living donor liver transplantation. Liver
Transplantation, 13, 886-895. Fan, S. T. (2006). Live donor liver transplantation in adults. Transplantation, 82(6), 723-
732. Fan, S. T. (2007). Living donor liver transplantation. Hong Kong: The university of Hong Kong. Fan, S. T. (2011)
Living donor liver transplantation. Hong Kong: The university of Hong Kong. Fujita, M., A. A., Slingsby, B. T., Kosugi,
S., Fujimoto,Y., & Tanaka K. (2006). A model of donor's decision-making in adult-to-adult living donot liver
transplantation in Japan: Having no choice. Liver transplantaion, 12, 768-774. Gill, P., & Lowes, L. (2008). Gift
exchange and organ donation: Donor and recipient experiences of live related kidney transplantation. International
Journal of Nursing Studies, 45, 1607-1617. Gordon, E. J., Daud, A., Caicedo, J. C., Cameron, K. A., Jay, C., Fryer,
J., Beauvais, N., Skaro, A., & Baker, T. (2011). Informed consent and decision-making about adult-to-adult living
donor liver transplantation: A systematic review of empirical research. Transplantation, 92(12), 1285-1296. Henry, M.
M., & Thompson, J. N. (2003)‧彩色圖解臨床外科學 Clinical surgery（林恩源、田炯璽、黃明東、曾元生、李協興譯）
‧台北：合記。（原著出版於2000） Hsu, H. T., Hwang, S. L., Lee, P. H., & Chen, S. C. (2006). Impact of liver
donation on quality of life and physical and psychological distress. Transplantation Proceedings, 38, 2102-2105.
Inagaki, M., Yagi, T., Sadamori, H., Urushihara, N., Matsukawa, H., Nakao, A., Matsuno, T., Takakura, N., Tanaka,
S., Tanaka, N. (2001). Analysis of donor complications in living donor liver transplantation. Transplantation
Proceedings, 33, 1386-1387. Kiuchi, T., & Tanaka, K. (2003). Living donor liver transplantation: personal experience.
Transplantation Proceedings, 35, 950–951. Koffron, A. S., J. A. (2008). Liver Transplantation: Indications,
Pretransplant Evaluation, surgery, and posttransplant Complications. Med Clin N Am, 92, 861-888. Kusakabe, T., Irie,
S., Ito, N., & Kazuma, K. (2008). Feelings of living donors about adult-to-adult living donor liver transplantation.
Gastroenterology Nursing, 31(4), 263-272. Lee, S. H., Jeong, J. S., Ha, H. S., No, M. J., Hong, J. J., Kwon, J. S., Lee,
K. H., Han, D. J., & Lee, S. G. (2005). Decision-related factors and attitudes toward donation in living related liver
transplantation: Ten-year experience. Transplantation Proceedings, 37, 1081-1084. Lo, C. M. (2003). Complications
and long-term outcome of living liver donors: A survery of 1,508 cases in five Asian centers. Transplantation, 75(3),
12-15. McGrath, P. Holewa, H. (2012). 'It's a regional thing': financial impact of renal transplantation on live donors.
Rural and Remote Health, 12, 2144. Merion, R. M., & F. A. C. S. (2010). Current status and future of liver
transplantation. Seminars in liver disease, 30(4), 411-421. Moran, D. (2005)‧現象學導論 Introduction to
phenomenology（蔡錚雲譯）‧台北：桂冠。（原著出版於1999） Papachristou, C., Walter, M., Dietrich, K., Danzer,
G., Klupp, J., Klapp, B. F., & Frommer, J. (2004). Motivation for living-donor liver transplantation from the donor's
perspective: An in-depth qualitative research study. Transplantation, 78(10), 1506-1514. Papachristou, C., Walter, M.,
Schmid, G., Frommer, J., & Klapp, B. F. (2009). Living donor liver transplantation and its effect on the donor-recipient
relationship-a qualitative interview study with donors, Clinical Transplantation, 23, 382-391. Parikh, N. D., Ladner, D.,
Abecassis, M., & Butt, Z. (2010). Quality of life for donors after living donor liver transplantation: A review of the
literature. liver Transplantation, 16(12), 1352-1358. Preester, H. D. (2002). Naturalizing Husserlian Phenomenology:
An introduction. Psychoanalytische perspectieven, 20(4), 633-647. Reiners, G. M. (2012). Understanding the
differences between Husserl's (Descriptive) and Heidegger's (Interpretive) phenomenological research. Journal of
Nursing & Care, 1(5), 1-3. Schulz, K. H., Kroencke, S., Beckmann, M., Nadalin, S., Paul, A., Fischer, L., Nashan, B.,
Senf, W., & Erim, Y. (2009). Mental and physical quality of life in actual living liver donors versus potential living liver
donors: A prospective, controlled, multicenter Study. Liver Transplantation 15, 1676-1687. Shah, S. A., Levy, G. A.,
Adcock, L. D., Gallagher, G., Grant, D. R. (2006). Adult-to-adult living donor liver transplantation. Can J Gastroenterol
20(5), 339-343. Simpson, M. A., & Pomfret, E. A. (2012). Checking the Harness: Safety for living liver donors. Liver
Transplantation, 18(11), Suppl 2 (November). S15-S19. Sokolowski, R. (2004)‧現象學十四講 Introduction to
phenomenology（李維倫譯）‧台北：心靈工坊。（原著出版於2000） Tanaka, K., Inomata, Y., & Kaihera, S. (2003).
Living-donor liver transplantation. Surgical techniques and innovations Kyoto: Kyoto University Hospital, Japan.
Trotter, J. F., Talamantes, M., McClure, M., Wachs, M., Bak, T. Trouillot, T., Kugelmas, M., Everson, G. T., & Kam, I.
(2001). Right hepatic lobe donation for living donor liver transplantation: Impact on donor quality of life. Liver
Transplantation, 7(6), 485-493. Ummel, D., Achille, M., & Mekkelholt, J. (2011). Review Article donors and recipients
of living kidney donation: A qualitative Metasummary of their experiences. Journal of Transplantation, 2011, 1-11.
Valapour, M. (2008) The live organ donor's consent: is it informed and voluntary? Transplantation Reviews, 22, 196-
199. Verbesey, J. E., Simpson, M. A., Pomposelli, J. J., Richman, E., Bracken, A. M., Garrigan, K., Chang, H.,
Jenkins, R. L., & Pomfreta, E. A. (2005). Living donor adult liver transplantation: A longitudinal study of the donor's
quality of life. American Journal of Transplantation, 5, 2770-2777. Walter, M., Dammann, G., Papachristou, C.,
Pascher, A., Neuhaus, P., Danzer, G., & Klapp, B. F. (2003). Quality of life of living donors before and after living
donor liver transplantation. Transplantation Proceedings, 35, 2961-2963. Walter, M., Papachristou, C., Pascher, A.,
Danzer, G., Neuhaus, P., Klapp, B. F., & Frommer, J.( 2006). Impaired psychosocial outcome of donors after living
donor liver transplantation: a qualitative case study. Clinical Transplantation, 20, 410-415. Weng, L. C., Huang, H. L.,

Wang, Y. W., Chang, C. L., Tsai, C. H., Lee, W. C. (2012). The coping experience of Taiwanese male donors in living
donor liver transplantation. Nursing Research, 61(2), 133-139.
Contact
[email protected]

The Challenge of Caring for Incontinence: The Experience of Family Caregivers of
Stroke Survivors
Meei-Fang Lou, RN, PhD, Taiwan
Chien-Ning Tseng, RN, Taiwan
Purpose
to describe the experience of caring for incontinence of family caregivers of stroke survivors.
Target Audience
clinical nurses who work with stroke patients and those who are interested in continence care.
Abstract
Purpose: Family caregivers’ experiences of caring for the older stroke relatives with urinary/fecal
incontinence were explored.
Methods: A qualitative study was designed to elicit a rich understanding of the experience of family
caregivers of older stroke survivors with incontinence. Grounded theory method was used to collect and
analysis data from deep interviews with ten family caregivers of older stroke relatives with incontinence,
aged 21-78 years, during 2011.
Results: Four major themes that emerged from these data were “being in chaos”, “being in vigilance”,
“being in exhaustion” and “being in creating a new life on track”. Subthemes that arose within “the chaos”
included “fluster” and “fuss” and “dirtiness”; in terms of “vigilance” shared subthemes “urgency” as well as
“health-hazard”; the “exhaustion” were extracted “physical-consuming labor”, “mental-consuming labor”
and “money/time-consuming labor” subthemes; the “creating a new life on track” constructed two
subthemes “learning from professionals and accumulating experience by doing” and “attitude adjustment
and forward looking”.
Conclusion: The research highlighted unique caring experiences of family caregivers of older stroke
relatives focused on the ‘incontinence issue’ alone. To recognizing the progress of mental reactions of
family caregivers in caring for older stroke relatives with incontinence may help nurses provide better
supports and resources to meet their needs.
Contact
[email protected]

Postpartum Depression in Women in a Postpartum Nursing Center
Mei-Ling Chen, RN, Taiwan
Purpose
The purpose of this presentation is to quantify the status and change in postpartum depression (PPD) of
women in a postpartum nursing center.
Target Audience
The target audience of this presentation is healthcare workers. It can be seen that this study results could
provide healthcare workers to realize the needs of postpartum care and the changes of postpartum
emotion.
Abstract
Purpose: The study aims to quantify the status and change in postpartum depression (PPD) of women in
a postpartum nursing center.
Methods: The Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and semi-
structured interviews with purposive sampling were utilized in data collection. The total sample size was
50 women, consistent with the selection criteria in the postpartum nursing center from eastern Taiwan.
Quantitative data was collected at day 3-5 (EPDS-1) and week 3 (EPDS-2) postpartum and qualitative
data was collected at week 2 and week 4 postpartum. Paired-sample t test was used to identify the
differences in mean scores between EPDS-1 and EPDS-2. To compare the difference in rates of PPD
between EPDS-1 and EPDS-2, a McNemar test was conducted. All p values were two-sided. The level of
significance was p < .05.
Results: The difference in mean scores of EPDS-1 and EPDS-2 showed statistical significance (mean
7.36 vs. 5.84; t = 4.42; p = .00). It was found that 28.0% of women experienced depressive symptoms at
day 3-5 (scores of EPDS above 9). At week 3, the rate fell to 12.0% and had a statistical significance (χ2 =
4.42; p = .02). Women staying in the postpartum nursing center, received professional care, learned
parenting skills, and were able to get adequate rest. These factors strongly affected women's levels of
postpartum depression.
Conclusion: The effect of appropriate professional postpartum care cannot be underestimated. Effective
postpartum nursing center care, suggests alleviation of the symptoms of PPD. This has significant impact
on family life and potential early return to work. The psychological implications of PPD are well
documented in the literature. Therefore, the management of PPD via carefully designed postpartum
programs offers the potential for minimizing the damaging effects of PPD.
References
1.Buist, A. E., Austin, M-P. V., Hayes, B. A., Speelman, C., Bilszta, C. L., & Gemmill, A. W. (2008). Postnatal mental
health of women giving birth in Australia 2002-2004: findings from the beyondblue National Postnatal Depression
Program. Australian and New Zealand Journal of Psychiatry, 42(1), 66-73. 2.Cox, J. L., Holden, J. M., & Sagovsky, R.
(1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale.
3.American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed.Text
Revision. Washington, DC: American Psychiatric Association.ritish Journal of Psychiatry, 150(6), 782-786.
4.Edhborg, M. (2008). Comparisons of different instruments to measure blues and to predict depressive symptoms 2
months potpartum: A study of new mothers and fathers. Scandinavina Journal of Caring Science, 22, 186-195.
5.Gjerdingen, D., Fontaine, P., Crow, S., McGovern, P., Center, B., & Miner, M. (2009). Predictors of mothers’
postpartum body dissatisfaction. Women Health, 49(6-7), 491-504. 6.Hanusa, B. H., Scholle, S. H., Haskett, R. F.,
Spadaro, K., & Wisner, K. (2008). Screening for depression in the postpartum period: A comparison of three
instruments. Journal of Women’s Health, 17(4), 585-596. 7.Howell, E. A., Mora, P. A., DiBonaventura, M. D., &
Leventhal, H. (2009). Modifiable factors associated with changes in postpartum depressive symptoms. Arch Ment
Health, 12(2), 113-120. 8.Seehusen, D. A., Baldwin, L. M., Runkle, G. P., & Clark, G. (2005). Are family physicians
appropriately screening for postpartum depression? Journal of the American Board of Family Practice, 18(2), 104-
112. 9.World Health Organization. (2008). Maternal mental health & child health and development in low and middle

income countries. Retrieved from http://www.who.int /mental_ health/prevention /suicide/mmh_jan08_meeting
_report.pdf 10.World Health Organization. (2012). Women and mental health: Situation and trends. Retrieved from
http://www.who.int/gho/ women_and _health/diseases_risk_factors/mental_health_text/en/index.html
Contact
[email protected]

Beyond the Braden Scale: Effectiveness of a Small Group Educational Program
on Neuro-Nurses' Braden Risk Assessment Scores and Number of Preventative
Nursing Interventions
Shakira Henderson, MS, MPH, RNC-NIC, IBCLC, USA
Purpose
to present a descriptive, quasi-experimental study that attempts to bridge the gap between pressure ulcer
risk assessment and application of nursing interventions.
Target Audience
nurses, physicians, nursing students, nurse hospital administrators, nurse educators, nurse clinicians
Abstract
Purpose: Hospital-acquired pressure ulcers remain an utmost healthcare concern because of the
significant emotional and physical toll on the patient and the large financial impact on hospitals. With an
incidence rate of 38% and a total annual cost of approximately $11 billion dollars in the United States, the
Center for Medicare and Medicaid Service will not reimburse for these injuries. Neurological patients are
even more susceptible to pressure ulcer formation than most patients. Consequently, neuro- nurses are
charged with being implementation experts of preventative nursing interventions in response to their risk
assessments. Yet research shows that there is a gap between risk assessment and application of nursing
interventions. Nurses tend to either not apply preventative measures or are inconsistent despite having
an “at risk” patient. Research is needed to address this problem. The proposed study attempts to assist in
bridging that gap by assessing the neuro-nurse’s understanding of “at risk” and evaluating the impact of
an educational intervention on improving the neuro-nurse’s knowledge of pressure ulcer risk assessment
and subsequent preventative nursing interventions.
Methods: A descriptive, quasi-experimental design with a one-group, pre-intervention survey,
educational intervention, and post-intervention survey method will be used.
Results: A paired t-test was conducted to evaluate the impact of the educational intervention on both
Braden score choices and number of nursing interventions chosen by the nurse participants. There was
no statistically significant difference in Braden scores post-education (M = 13.41, SD =5.38) vs. pre-
education (M = 13.67, SD = 4.49), t(23) =, p <.465 (two-tailed). However, there was a statistically
significant increase in number of nursing interventions post-education (M = 10.69, SD =2.38) vs. pre-
education (M= 10.11, SD= 4.83), t(23) =, p<. 001 (two-tailed).
Conclusion: Neuro-nurses are competent on assessing "risk" of pressure ulcers for nuero patients using
the Braden Scale. However, there is variation on how to manage risk based on the Braden score
assessed. Further research is needed to bridge the gap between risk assessment and nursing application
of interventions. This gap may be a contributing factor to the incidence of pressure ulcers in the clinical
setting.
References
Bandura, A. (2000). Self-efficacy: The foundation of agency. In W. J. Perrig & A. Grob (Eds.), Control of human
behaviour, mental processes and consciousness (pp. 17-33). Mahwak, NJ: Erlbaum. Erdfelder, E., Faul, F., &
Buchner, A. (1996). GPOWER: A general power analysis program. Behavior Research Methods, Instruments, &
Computers, 28, 1-11. Retrieved from http://www.researchgate.net/journal/0743-
3808_Behavior_research_methods_instruments_computers_a_journal_of_the_Psychonomic_Society_Inc Fife, C.,
Otto, G., Capsuto, E.G., Brandt, K., Lyssy, K., Murphy, K., & Short, C. (2001). Incidence of pressure ulcers in a
neurologic intensive care unit. Critical Care Medicine, 29(2), 283-290. Retrieved from
http://journals.lww.com/ccmjournal/pages/default.aspx Hart, P., Buckner, M., Morrow, B.N., Barrett, D.T., Fraser,
D.D., Hooks, D., & Sharrer, R. L. (2008). Effectiveness of a computer-based educational program on nurses’
knowledge, attitude, and skill related to evidence-based practice. Worldviews on Evidence-based Nursing, 5(2), 75-
84. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/ (ISSN)1741-6787 Healthcare cost and utilization

project[HCUP]. (2008, December). Hospitalizations Related to Pressure Ulcers among Adults 18 Years and Older,
2006 (Statistical Brief No. 64). Rockville, MD: Agency for Healthcare Research and Quality. Kottner, J., Hauss, A.,
Schluer, A.B., & Dassen, T. (2011). Validation and clinical impact of paediatric pressure ulcer risk assessment scales:
A systematic review. International Journal of Nursing Studies, 1-12. doi:10.1016/j.ijnurstu.2011.04.014 Jankowski,
I.M., & Nadzman, D.M. (2011). Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention
programs. The Joint Commission Journal on Quality and Patient Safety, 37(6), 253-264. Retrieved from
http://www.jcrinc.com/Periodicals/THE-JOINT-COMMISSION-JOURNAL-ON-QUALITY-AND-PATIENT-SAFETY/903/
Ozdemir, H., & Karadag, A. (2008). Prevention of pressure ulcers: A descriptive study in 3 intensive care units in
Turkey. Journal of Wound, Ostomy, & Continence Nursing, 35(3), 293-300. Retrieved from
http://journals.lww.com/jwocnonline/pages/default.aspx Pancorbo-Hidalgo, P.L., Garcia-Fernandez, F.P., Lopez-
Medina, I.M., & Alvarez-Nieto, C. (2006). Risk assessment for pressure ulcer prevention: a systematic review. Journal
of Advanced Nursing, 54(1), 94-110. Retrieved from http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2648
Contact
[email protected]

The Effects on Caring Behavior of Nursing Students with Different Phases of
Clinical Practice in a 5-Year Junior College in Southern Taiwan
Purpose
The purpose of this presentation is to understand the caring behavior of nursing students in the first and
the final phase during clinical practice and to compare the caring behaviors and related factors among
nursing students with the initial and final phase of clinical practice in a 5-year Junior College.
Target Audience
The target audience of this presentation is clinical instructor and nurse and every audience who are
interesting in the -caring behavior of nursing students.
Abstract
Purpose: The aim of this study was to compare the caring behaviors and related factors among nursing
students with the initial and final phase of clinical practice in a 5-year Junior College.
Methods: Methodologically, a cross-sectional survey with a self-administered structured questionnaire in
the first and the final phase of clinical practice during practicum was implemented for this purpose.
Subjects of this survey were recruited from students of one 5-year Junior College located in Southern
Taiwan. A total of 194 subjects were recruited. Cronbach’s Alpha and content validity were conducted to
assess the reliability and validity of scales. Collecting questionnaire data was anonymous. The data was
analyzed by descriptive and inferential statistics.
Results: Results of the study showed that the mean score of caring behavior in the first and final phase
was 51.56 and 54.72 separately. Results also sowed that there were differences between both phases of
clinical practicum were found in caring behavior, support from the clinical workplace, and clinical teaching
strategies. Hence, the significant predictors of the caring behavior score among subjects in the final
phase included interest in nursing practicum, clinical teaching strategies, students’ characteristics, and
hospital class. The total amount of variance could be explained 21.6%.
Conclusion: However, the findings demonstrate that the caring behavior of nursing students has been
promoted through continuous clinical practicum program. Nursing faculty should inspire the students to
learn the caring behaviors with diverse teaching strategies and be set up as an example of a role model.
Contact

[email protected]

Biobehavioral Consequences of Chronic Social Defeat: A Model of Extreme
Stress in Male and Female Rats
Gayle G. Page, RN, DNSc, USA
Sharon Kozachik, RN, MSN, PhD, USA
Purpose
The purpose of this presentation is to provide findings from an investigation of the impact of chronic social
defeat on sleep architecture and on neuroimmune function in rats; and to examine the etiological
consistency of this model with human responses to extreme stress.
Target Audience
The target audience for this presentation is individuals interested in the biobehavioral impact of stress on
the organism, the importance of animal models in symptom science.
Abstract
Purpose: Thirty-three million individuals in the United States are projected to suffer from major
depressive disorder (MDD) in their lifetime (Kessler et al. 2007). Genetic antecedents and environmental
influences are well acknowledged contributors to the precipitation and perpetuation of major depression,
and stress is a unifying concept such that the first depressive episode is more likely to be preceded by a
severe stressful life event than are recurrent episodes (Foster and MacQueen 2008; Miller et al. 2009;
Stroud et al. 2008). Biological markers associated with MDD are largely related to the assessment of HPA
axis function (Vreeburg et al. 2009) and inflammatory immune indicators, two interdependent pathways
also prominently affected by severe psychological stress (Irwin and Miller 2007; Miller et al. 2009; Miller et
al. 2005), as well as glucocorticoid receptor sensitivity (Miller et al. 2005).
A social defeat paradigm, repeated exposures to a dominant resident distributed over 4 weeks, induces
depression in the rat in order to causally evaluate the impact of depression on sleep. There is etiological
consistency regarding the prominence of extreme stress, particularly of a social nature, as a depression
triggering event in humans (Huhman 2006; Stroud et al. 2008). The effects of social defeat that
correspond to criteria for MDD in humans including, anhedonia and reduced food consumption and
activity, are improved with antidepressant administration (Becker et al. 2008; Rygula et al. 2006a; Rygula
et al. 2006b), supporting our contention that chronic social defeat in the rat can be a useful model of first
onset depression. To our knowledge, sleep and neuroimmune function have been minimally studied (e.g.,
Kieran et al. 2010; Razzoli et al. 2007), and immune function has not been studied in this promising
preclinical model.
This study is intended to causally evaluate the impact of repeated exposures to social defeat on sleep
architecture using electroencephalogram (EEG) / electromyogram (EMG) recordings, as well as
neuroendocrine and immune function in Fischer 344 female and male rats. A simple 2´2 experimental
design was used: female versus male by repeated exposures to either social defeat or remaining in the
home cage. Our goal is to determine the impact of repeated exposures to social defeat on sleep
architecture and on neuroimmune function.
Methods: Mature female and male Fischer 344 and Long Evans rats were maintained on a 12:12 hour
dark/light cycle and ambient temperature at 22±1 ºC. Given that the active period for rats is during the
dark phase and evidence of greater sleep disruption with light phase manipulations (Chang and Opp
2002), all perturbations were undertaken during the dark phase.
Fischer 344 rats either underwent 12 exposures to social defeat or remained in their home cage. The
social defeat paradigm consists of 12 60-minute intrusions over a 4-week period into a resident cage
populated by a Long Evans male ex-breeder and a long-term cohabiting ligatured female who continues
to cycle, but cannot become pregnant. Female F344 rats are introduced into the resident cage
immediately following the removal of the Long Evans male; male F344 rats are introduced into the
resident cage with both the female and male Long Evans rats (Becker et al. 2008; Rygula et al. 2005).

Immediately following defeat of the intruder, 5 submissive postures or the intruder is pinned for 5
seconds; a protective mesh barrier is placed over the intruder within the resident cage for the remainder
of the intrusion period. This barrier allows the stressful nature of the encounter to continue without the
threat of physical defeat (Becker et al. 2008; Rygula et al. 2005; Sloman et al. 2003), reflective of
entrapment (Gilbert et al. 2002; Sloman et al. 2003). A rotation of residents was used such that intruders
were exposed to a minimum of six different residents over the 4 week course.
Telemetric transmitters for EEG/EMG recording were implanted under isoflurane anesthesia and animals
were allowed 4 weeks recovery. EEG/EMG recordings were continuous, allowing us to preserve all data,
and selectively sample. Arousal state was classified as wakefulness, non-rapid eye movement sleep
(NREMS), or REMS as detailed in (Opp 1998). Determination of arousal state was undertaken for a 24-
hour period prior to the first social defeat exposure, baseline, and following the final social defeat. Arousal
state determination is in progress for the midpoint of the defeat paradigm.
Four biobehavioral outcomes comprise parallels to human MDD criteria. (1) Anhedonia was assessed as
sucrose preference, a choice between plain water and a 0.5% sucrose-water solution, reported as %
sucrose intake; (2) Changes in body weight reflect decreased food consumption; (3) plasma levels of pro-
inflammatory cytokines parallel a pro-inflammatory immune balance evident in humans with MDD; and (4)
reduced glucocorticoid receptor sensitivity is reflected by in vitro dexamethasone (DEX) suppression of
pro-inflammatory cytokine production. Briefly, diluted whole blood is co-incubated with lipopolysaccharide
(LPS) to stimulate pro-inflammatory cytokine production, plus varying concentrations of DEX (0, 1, 10, 50,
100 and 1000 nM) for 48 hours at 37o C. The harvested supernate is then assayed for TNF-alpha levels to
determine the 50% inhibition concentration (IC50) of DEX for each individual animal based upon the
individual dose response curve generated (Miller et al. 2005).
Results: Data collection has been completed and analyses are in progress. First, there are changes in
light phase sleep architecture from baseline to the final social defeat. Specifically, both %REMS per hour
and the total number of REMS bouts in the light phase decreased from baseline to the final social defeat
[t(12)=2.350 and 2.522, respectively, p<0.05]. The average duration of wakefulness also decreased from
baseline to the final social defeat [t(12)=2.541, p<0.05]. The total light phase NREMS bouts increased
from baseline to the final social defeat [t(12)=2.390, p<0.05]. T-tests yielded trends for increasing sleep
state transitions, p=0.052. Given that the dark phase is the more active phase of the rat, that we detected
no sleep architecture changes from baseline to the final social defeat is not a surprise. Second, over the
4-week paradigm, the social defeat animals exhibited a marked reduction in sucrose intake compared to
home animals [F(1,28)=104.783, p<0.001], and among the social defeat animals, females exhibited
significantly less sucrose intake compared to the males [F(1,13)=9.807, p<0.01]. Changes in body weight
over the 4-week period of social defeat, and terminal plasma pro-inflammatory cytokine levels and DEX
suppression are currently under analysis.
Conclusion: The problems of insufficient sleep and depression are substantial in the U.S. (Kessler et al.
2007; Krueger and Friedman 2009); both are associated with substantial consequences to health (Roth
2009; Rush 2007); and the comorbidity of sleep problems and depression are well known (e.g., Lam
2006; Staner 2010). Sleep disturbance is a common symptom of MDD, affecting 80% or more of
individuals with MDD. 15-35% endorse hypersomnia and difficulty with morning arising. Others endorse
difficulty falling asleep, staying asleep, and early morning awakenings (Armitage 2007; Germain and
Kupfer 2008), consistent with findings of studies using EEG for arousal state determination (Armitage
2007). This study in rats offers a means by which to examine the relevance of this preclinical model with
which to study the biobehavioral consequences of an etiologically consistent and profoundly stressful
phenomenon, chronic social defeat.
To our knowledge, females have not been included in previous studies of chronic social defeat. (Becker
et al. 2008; Razzoli et al. 2007; Rygula et al. 2005; Rygula et al. 2006a; Rygula et al. 2006b; Sgoifo et al.
2002), and although there are a number of reports of sex and estrous phase related sleep differences in
rats (e.g., Del Río-Portilla et al. 1997; Fang and Fishbein 1996; Schwierin et al. 1998), the literature
focusing on sex differences in stress-induced changes in sleep is scarce; and no reports of sleep in
female rats exposed to social defeat are evident.
References

Reference List Armitage R (2007) Sleep and circadian rhythms in mood disorders. Acta Psychiatr Scand 115:104-115
Becker C, Zeau B, Rivat C, Blugeot A, Hamon M, Benoliel JJ (2008) Repeated social defeat-induced depression-like
behavioral and biological alterations in rats: involvement of cholecystokinin. Mol Psychiatry 13:1079-1092 Chang FC,
Opp MR (2002) Role of corticotropin-releasing hormone in stressor-induced alterations of sleep in rat. Am J Physiol
Regul Integr Comp Physiol 283:R400-R407 Del Río-Portilla I, Ugalde E, Juárez J, Roldán A, Corsi-Cabrera M (1997)
Sex differences in EEG in adult gonadectomized rats before and after hormonal treatment.
Psychoneuroendocrinology 22:627-642 Fang J, Fishbein W (1996) Sex differences in paradoxical sleep: influences of
estrus cycle and ovariectomy. Brain Res 734:275-285 Foster JA, MacQueen G (2008) Neurobiological factors linking
personality traits and major depression. Can J Psychiatry 53:6-13 Germain A, Kupfer DJ (2008) Circadian rhythm
disturbances in depression. Hum Psychopharmacol 23:571-585 Gilbert P, Brough AS, Melley S, Miles JNV (2002)
Relationship of anhedonia and anxiety to social rank, defeat and entrapment. J Affect Disord 71:141-151 Huhman KL
(2006) Social conflict models: can they inform us about human psychopathology? Horm Behav 50:640-646 Irwin MR,
Miller AH (2007) Depressive disorders and immunity: 20 years of progress and discovery. Brain Behav Immun
21:374-383 Kessler RC, Merikangas KR, Wang PS (2007) Prevalence, comorbidity, and service utilization for mood
disorders inthe United States at the beginning of the twenty-first century. Annu Rev Clin Psychol 3:137-158 Kieran N,
Ou XM, Iyo AH (2010) Chronic social defeat downregulates the 5-HT1A receptor but not Freud-1 or NUDR in the rat
prefrontal cortex. Neurosci Lett 469:380-384 Krueger PM, Friedman EM (2009) Sleep duration in the United States: a
cross-sectional population-based study. Am J Epidemiol 169:1052-1063 Lam RW (2006) Sleep disturbances and
depression: a challenge for antidepressants. Int Clin Psychopharmacol 21:S25-S29 Miller AH, Maletic V, Raison CL
(2009) Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol
Psychiatry 65:732-741 Miller GE, Rohleder N, Stetler C, Kirschbaum C (2005) Clinical depression and regulation of
the inflammatory response during acute stress. Psychosom Med 67:679-687 Opp MR (1998) Rat strain differences
suggest a role for corticotropin-releasing hormone in modulating sleep. Physiol Behav 63:67-74 Razzoli M, Carboni L,
Guidi A, Gerrard P, Arban R (2007) Social defeat-induced contextual conditioning differentially imprints behavioral
and adrenal activity: a time-course study in the rat. Physiol Behav 92:734-740 Roth T (2009) Comorbid insomnia:
current directions and future challenges. Am J Manag Care 15:S6-S13 Rush AJ (2007) The varied clinical
presentations of major depressive disorder. J Clin Psychiatry 68[suppl8]:4-10 Rygula R, Abumaria N, Domenici E,
Hiemke C, Fuchs E (2006a) Effects of fluoxetine on behavioral deficits evoked by chronic social stress in rats. Behav
Brain Res 174:188-192 Rygula R, Abumaria N, Flügge G, Fuchs E, Rüther E, Havemann-Reinecke U (2005)
Anhedonia and motivational deficits in rats: impact of chronic social stress. Behav Brain Res 162:127-134 Rygula R,
Abumaria N, Flügge G, Hiemke C, Fuchs E, Rüther E, Havemann-Reinecke U (2006b) Citalopram counteracts
depressive-like symptoms evoked by chornic social stress in rats. Behav Pharmacol 17:19-29 Schwierin B, Borbély
AA, Tobler I (1998) Sleep homeostasis in the female rat during the estrous cycle. Brain Res 811:96-104 Sgoifo A,
Pozzato C, Meerlo P, Costoli T, Manghi M, Stilli D, Olivetti G, Musso E (2002) Intermittent exposure to social defeat
and open-field test in rats: acute and long-term effects on ECG, body temperature and physical activity. Stress 5:23-
35 Sloman L, Gilbert P, Hasey G (2003) Evolved mechanisms in depression: the role and interaction of attachment
and social rank in depression. J Affect Disord 74:107-121 Staner L (2010) Comorbidity of insomnia and depression.
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van Pelt J, DeRijk R, Verhagen JCM, van Dyck R, Smit JH, Zitman FG, Penninx B (2009) Major depressive disorder
and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Arch Gen Psychiatry 66:617-626
Contact
[email protected]

Factors Related Obesity Among Korean Workers By Occupational Type
Eun Joo Ji, PhD, South Korea
Eunkyoung Lee, PhD, South Korea
Purpose
OECD report that Korean’s working hours are the longest among OECD countries. So, heavy work
related stress, frequent drinking, dining together could be increased the risk of being exposed to obesity.
It is needed to be explored factor related obesity amonng korean workers by occupational type.
Target Audience
Nurse and nursing educator, the person who work with goverment institution
Abstract
Purpose: Korean government has established a comprehensive national health plan , known as Health
2020, for nation-wide health promotion and, under the plan, set up goals to deal with smoking, drinking,
exercise, nutrition issues and acted upon them. However, the rate of prevalence of obesity among adults,
31.9% in 2011, haven’t declined significantly. Obesity is caused by chronic energy imbalance and it gives
rise to changes in the physiological level of insulin resistance, blood sugar, triglycerides, and blood
pressure. And it is classified as cardiovascular risk factors. Therefore, obesity becomes a cause of
premature death and also various diseases not fatal but affecting on the quality of life. Factors affecting
on obesity have been reported to be associated with life style, such as smoking, drinking alcohol, sleep,
exercise, physical activity level. Smoking and drinking alcohol are strongly related to job stress and,
therfore, these are health risk factors among Korean workers. OECD reports, in 2013, that Koreans’
working hours are the longest among OECD countries. Therefore, there is a high risk of having obesity,
among Korean workers, due to excess level of work related stress, which frequently results in workers
drinking heavily with fellow workers, after long-hours of work. But, there may be differences in working
style between blue-collar and white collar workers, so factors related obesity by the occupational type
needed to be examined. So, the aim of the present study was to investigate the factors related to obesity
risks between blue collar and white collar workers.
Methods: This study was based on data obtained in the Fifth Korea National Health and Nutrition
Examination survey (KNHANES V). These surveys have been conducted periodically since 1998 to
assess the health and nutritional status of the non-institutionalized civilian population of Korea, a cross-
sectional and nationally representative survey by the Korea Centers for Disease Control and Prevention.
Total 10,589 individuals (3,289 families) were included in KNHANES V; among them, 76.1% subjects
participated in health surveillance and blood sampling and 82.4% subjects participated in nutrition survey.
Among the subjects aged ≥20 years, 1,292 employees over the BMI of 18.5 blue or white collars were
finally included in this study. All subject measurements were performed by trained examiners. The blood
pressure and serum glucose and cholesterol were taken by skilled nurses in mobile vehicle. Nutrition
surveys were conducted by nutritionists in a home visit.
Predictor variables: Predictor variables included age, gender, education, marital status, individual income,
physical activity level, exercise, amount of drinking, body weight control, sleeping time, BP, serum
glucose, serum cholesterol and dietary factors. Hypertension was defined as an average SBP≥140mmHg
or DBP≥90mmHg (The Korean Society of Hypertension, 2007). According to such standards, estimated
energy requirement (EER) for man is 2,600 kcal for man (2,100 kcal for woman) aged 19-29 years, 2,400
kcal for man (1,900 kcal for woman) aged 30-49 years, and 2,200 kcal for man (1,800 kcal for woman)
aged 50-64 years. The standards suggest that appropriate ratio of carbohydrate intake is 55-70% of the
total calories and that appropriate ratio of fat intake is 15-25% of the total calories. It is suggested that
target intake of sodium is 2,000mg. Based on the suggested standards, the adequate group was defined
when calorie intake was 100% or less of the EER, carbohydrate intake was 70% or less of the calorie, fat
intake was 25% or less of the calorie, and sodium intake was 2,000 mg.

Outcome variables: BMI was calculated as the subject’s weight in kilograms divided by the square of the
subject’s height in meters. As per current recommendations, obesity was defined as BMI 25.0 or higher
and normal as a BMI of less than 18.5.
All data were analyzed, using IBM SPSS 19.0, to generate population weighted estimate accounting for
the complex sample design of the KNHANES. A multiple logistic regression analysis was used to assess
the factors related to obesity among blue collars and white collars. A P-value <0.05 was considered
statistically significant
Results: There were differences in sex, age, individual income, marital status, body weight control, stress
level. smoking status, physical activity, hypertension, obesity, diabetic mellitus, carbohydrate, and fat
intake between blue collar and white collar workers. Blue collar workers, subjective health status, body
weight control, sleep duration, hypertension, diabetic mellitus, and sodium intake. White collar workers,
sex, age, body weight control, hypertension, hypertriglycemia, and sodium intake (Table 2).
Conclusion: Depending on the occupational type, there were differences in the factors related to obesity.
References
Korean society for the study of obesity (2009). Fact sheet. Huh, K. H., Won, y. l., Ko, K.S.,& Kim, K. W. (2009).
Effects of Obesity on the Physiological Levels of Adiponectin, Leptin and Diagnostic Indices of Metabolic Syndrome in
Male Workers . Korean Journal of Occupational Health Nursing, 18(1), 44-54. Ministry of Health and Welfare (2011).
2005 Korea National Health and Nutrition Examination Survey. Seoul, 2012. The Korean Nutrition Society, Korean
Dietary Reference Intakes for 2010, Seoul, 2010. The Korean Society of Hypertension, Blood pressure monitoring
guidelines, Seoul, 2007. Owen, N., Sparling, P. B., Healy, G. N., Dunstan, D. W., & Matthews, C. E. (2010).
Sedentary behavior: Emerging evidence for a new health risk. Mayo Clinic Proceedings, 85(12), 1138-1141. Rhu, J.
S., Kang, K. H.,& Lee, J. H. (2011). Factors of Problem Drinking among Korean Adults. Journal of The Korean
Alcohol Science, 12(1), 29-42. Shin, E. S., Kwon, I. S., Cho, Y. C. (2013). Investigation of Blood Pressure, Serum
Lipids, and Obesity Indices according to Smoking Status in Middle-Aged Males. The Korea Academia -Industrial
cooperation Society, 14(3), 1359-1366. Theodore A. K. (2010). Obesity-Related Hypertension: Epidemiology,
pathophysiology, and Clinical Management. American Journal of Hypertension, 23(11),1170-1178. Van Gaal L. F,
Mertens I. L, De Block C.E.(2006). Mechanisms linking obesity with cardiovascular disease. Nature, 444(7121),875-
80.
Contact
[email protected]

Implementation of the Prevention of Mother to Child Transmission (PMTCT) of
HIV Program: An Integrative Literature Review
Chifundo Colleta Zimba, BSCHN, RN, RM, USA
Purpose
Disseminate the findings from an integrative literature review (ILR) of studies that either described or
evaluated the implementation of the Prevention-of- mother-child-transmission (PMTCT) of HIV programs
across the globe
Target Audience
The target audience of this presentation is the nurse scientist and implementers in the field of health
promotion and prevention programs. Program mangers and nurses working at policy level are highly
targeted.
Abstract
Purpose: The burden of HIV/AIDS on women and children is very high. Worldwide, 60% of HIV infections
occurred in women and children in 2007. In 2009, 370,000 children were born with HIV. With effective
interventions, the rate of mother to child transmission of HIV can be reduced from 45% to 5%. Evidence
on effectiveness is not sufficient, however, evidence on implementation also is needed to ensure that
programs reach and retain women over time.The pupose of this review was to provide an integrative
information on how PMTCT is being implemented across different heath care settings globally.
Methods: We searched the following databases: PubMed, CINAHL and Family & Society Studies
Worldwide. The search was limited to studies published in English between 2007 and 2012. Studies that
evaluated PMTCT programs were included in the review. A standardized template was applied to extract
data on study design, study quality, sample, setting, and validity and reliability of the data collection
measures. To identify factors associated with PMTCT program implementation, we extracted data on the
profession of PMTCT service providers, program components, program congruence with World Health
Organization guidelines for PMTCT, fidelity of implementation, and program reach to and retention of
women at labor and delivery, 6 weeks, 6 months and ≥15months post-delivery periods.
Results: Twenty studies were included: 18 in Africa and 2 in Asia. Nurses were the major PMTCT service
providers. The primary interventions they provided were HIV testing and counseling and providing
Antiretroviral Therapy to pregnant women. Most programs were congruent with the WHO’s PMTCT
guidelines. Retention of women was low across all settings (Range: 23.5%- 99% at delivery, 9.6%-68% at
6 weeks, and 44% at 6 months [one study] and 10.5%-85% at ≥15 months ). Active involvement of
community members in intervention design and implementation was the program component most
strongly associated with higher retention rates.
Conclusion: The best approach to implementing PMTCT programs is still unknown. Exploring factors
responsible for high attrition rates is an urgent need because women, who are retained in the program,
will have access to HIV-related care and support which could help improve their health and reduce
pediatric HIV infection
References
References Beltman, J. J., Fitzgerald, M., Buhendwa, L., Moens, M., Massaquoi, M., Kazima, J., . . . van Roosmalen,
J. (2010). Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical
point in the programme at district level in Malawi. AIDS Care, 22(11), 1367-1372. doi:10.1080/09540121003758473
Byamugisha, R., Tylleskar, T., Kagawa, M. N., Onyango, S., Karamagi, C. A., & Tumwine, J. K. (2010). Dramatic and
sustained increase in HIV-testing rates among antenatal attendees in eastern Uganda after a policy change from
voluntary counseling and testing to routine counseling and testing for HIV: A retrospective analysis of hospital
records, 2002-2009. BMC Health Services Research, 10, 290. doi:10.1186/1472-6963-10-290 Centers for Disease
Control and Prevention. (2011a). HIV/AIDS. Retrieved from http://www.cdc.gov /hiv Centers for Disease Control and
Prevention. (2011b). HIV surveillance-United States, 1981–2008. Morbidity and Mortality Weekly Reports, 60, 689–

93. Retrieved from http://www.cdc.gov /mmwr/preview/mmwrhtml/mm6021a2.htm CDC Revised recommendations
for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR 2006; 55 (NO.RR-14).
Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm Centers for Disease Control and Prevention
(CDC). (2004). Introduction of routine HIV testing in prenatal care--Botswana, 2004. MMWR.Morbidity and Mortality
Weekly Report, 53(46), Chandisarewa, W., Stranix-Chibanda, L., Chirapa, E., Miller, A., Simoyi, M., Mahomva, A., . .
. Shetty, A. K. (2007). Routine offer of antenatal HIV testing ("opt-out" approach) to prevent mother-to-child
transmission of HIV in urban Zimbabwe. Bulletin of the World Health Organization, 85(11), 843-850. Ciaranello, A. L.,
Perez, F., Keatinge, J., Park, J. E., Engelsmann, B., Maruva, M., . . . Freedberg, K. A. (2012). What will it take to
eliminate pediatric HIV? Reaching WHO target rates of mother-to-child HIV transmission in Zimbabwe: A model-
based analysis. PLoS Medicine, 9(1), e1001156. doi:10.1371/journal.pmed.1001156 Creek, T., Tanuri, A., Smith, M.,
Seipone, K., Smit, M., Legwaila, K., . . . Shaffer, N. (2008). Early diagnosis of human immunodeficiency virus in
infants using polymerase chain reaction on dried blood spots in botswana's national program for prevention of
mother-to-child transmission. The Pediatric Infectious Disease Journal, 27(1), 22-26.
doi:10.1097/INF.0b013e3181469050 Creek, T. L., Ntumy, R., Seipone, K., Smith, M., Mogodi, M., Smit, M., . . .
Kilmarx, P. H. (2007). Successful introduction of routine opt-out HIV testing in antenatal care in botswana. Journal of
Acquired Immune Deficiency Syndromes (1999), 45(1), 102-107. doi:10.1097/QAI.0b013e318047df88 Doherty, T.,
Chopra, M., Nsibande, D., & Mngoma, D. (2009). Improving the coverage of the PMTCT programme through a
participatory quality improvement intervention in South Africa. BMC Public Health, 9, 406. doi:10.1186/1471-2458-9-
406 Doherty, T. M., McCoy, D., & Donohue, S. (2005). Health system constraints to optimal coverage of the
prevention of mother-to-child HIV transmission programme in south africa: Lessons from the implementation of the
national pilot programme. African Health Sciences, 5(3), 213-218. doi:10.5555/afhs.2005.5.3.213 Futterman, D.,
Shea, J., Besser, M., Stafford, S., Desmond, K., Comulada, W. S., & Greco, E. (2010). Mamekhaya: A pilot study
combining a cognitive-behavioral intervention and mentor mothers with PMTCT services in south africa. AIDS Care,
22(9), 1093-1100. doi:10.1080/09540121003600352 Geddes, R., Giddy, J., Butler, L. M., Van Wyk, E., Crankshaw,
T., Esterhuizen, T. M., & Knight, S. (2011). Dual and triple therapy to prevent mother-to-child transmission of HIV in a
resource-limited setting - lessons from a South African programme. South African Medical Journal = Suid-Afrikaanse
Tydskrif Vir Geneeskunde, 101(9), 651-654. Hardon, A. P., Oosterhoff, P., Imelda, J. D., Anh, N. T., & Hidayana, I.
(2009). Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: Diverging care dynamics. Social
Science & Medicine (1982), 69(6), 838-845. doi:10.1016/j.socscimed.2009.05.043 Joint United Nations Programme
on HIV/AIDS. (2011). HIV/AIDS numbers from around the world: Marking the 30th anniversary of the first reports of
HIV/AIDS. Reuter (06.01.11) Kasenga, F., Byass, P., Emmelin, M., & Hurtig, A. K. (2009). The implications of policy
changes on the uptake of a PMTCT programme in rural Malawi: First three years of experience. Global Health Action,
2, 10.3402/gha.v2i0.1883. doi:10.3402/gha.v2i0.1883; 10.3402/gha.v2i0.1883 Malema, , RN, Malaka, , DW, &
Mothiba, , TM. (2010). Experiences of lay counselors who provide VCT for PMTCT of HIV and AIDS in the Capricorn
district, Limpopo province. Curationis, 33(3), 15-23. Retrieved from
https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2010
957070&site=ehost-live&scope=site Mate, K. S., Bennett, B., Mphatswe, W., Barker, P., & Rollins, N. (2009).
Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV
transmission in South Africa. PloS One, 4(5), e5483. doi:10.1371/journal.pone.0005483 Manzi, M., Zachariah, R.,
Teck, R., Buhendwa, L., Kazima, J., Bakali, E., . . . Humblet, P. (2005). High acceptability of voluntary counselling
and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in
rural malawi: Scaling-up requires a different way of acting. Tropical Medicine & International Health : TM & IH, 10(12),
1242-1250. doi:10.1111/j.1365-3156.2005.01526.x Moses, A., Zimba, C., Kamanga, E., Nkhoma, J., Maida, A.,
Martinson, F., ….Van der Horst, C. M. (2008). Prevention of mother-to-child transmission: Program changes and the
effect on uptake of the HIVNET 012 regimen in Malawi. AIDS, 22, 83–87. Mirkuzie, A. H., Hinderaker, S. G., &
Morkve, O. (2010). Promising outcomes of a national programme for the prevention of mother-to-child HIV
transmission in addis ababa: A retrospective study. BMC Health Services Research, 10, 267. doi:10.1186/1472-6963-
10-267 Mugore, L., Engelsmann, B., Ndoro, T., Dabis, F., & Perez, F. (2008). An assessment of the understanding of
the offer of routine HIV testing among pregnant women in rural zimbabwe. AIDS Care, 20(6), 660-666.
doi:10.1080/09540120701687034 Nyuzaghl, J., Ohene, S., & Odoi-Agyarko, K. (2011). Acceptability of routine offer
of HIV testing (opt-out approach) among pregnant women in the Wa Municipality. Ghana Medical Journal, 45(1), 10-
15. Oosterhoff, P., Hardon, A. P., Nguyen, T. A., Pham, N. Y., & Wright, P. (2008). Dealing with a positive result:
Routine HIV testing of pregnant women in Vietnam. AIDS Care, 20(6), 654-659. doi:10.1080/09540120701687026
Perez, F., Zvandaziva, C., Engelsmann, B., & Dabis, F. (2006). Acceptability of routine HIV testing ("opt-out") in
antenatal services in two rural districts of zimbabwe. Journal of Acquired Immune Deficiency Syndromes (1999),
41(4), 514-520. doi:10.1097/01.qai.0000191285.70331.a0 Shetty, A. K., Marangwanda, C., Stranix-Chibanda, L.,
Chandisarewa, W., Chirapa, E., Mahomva, A., . . . Maldonado, Y. (2008). The feasibility of preventing mother-to-child
transmission of HIV using peer counselors in Zimbabwe. AIDS Research and Therapy, 5, 17. doi:10.1186/1742-6405-
5-17 UNAIDS (2011). HIV/AIDS Numbers from Around the World: Marking the 30th Anniversary of the first reports of
HIV/AIDS. Reuter (06.01.11) United Nations. (2009). End poverty: Millennium Development Goals 2015-Make it
happen. New York, NY. World Health Organization (2004). Antiretroviral drugs for treating pregnant women and
prevention HIV infection in infants: guidelines on care, treatment and support for women living with HIV/AIDS and

their children in resource-constrained settings. Retrieved from
http://www.who.int/hiv/pub/mtct/en/arvdrugswomenguidelinesfinal.pdf World Health Organization (2004). Treat 3
million by 2005. Rapid HIV Tests: Guidelines for use in HIV testing and counseling services in resource-constrained
settings. World Health Organization. (2006). Antiretroviral drugs for treating pregnant women and preventing HIV
infection in infants: Towards universal access: Recommendations for public health approach. Retrieved from
http://www.who.int/hiv/pub/guidelines /pmtctguidelines3.pdf World Health Organization. (2007). Prevention of mother-
to-child transmission (PMTCT) briefing note. Retrieved from http://www.who.int/hiv/topics/mtct/en/ World Health
Organization. (2010). Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants:
Recommendations for public health approach. Retrieved from
http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf World Health Organization. (2012). Mother-to-
child transmission of HIV. Retrieved from http://www.who.int/hiv/topics/mtct/en/
Contact
[email protected]

Nursing Model for Japanese Oriental Medicine in Japan
Toshie Yamamoto, PhD, RN, PHN, Japan
Fusako Kawabe, PhD, RN, PHN, Japan
Shu Chun Chien, RN, PhD, Japan
Akiko Nagata, MN, RN, Japan
Shinobu Saito, PhD, RN, Japan
Yoshiko Wazumi, PhD, RN, Japan
Purpose
The purpose of this presentation is to create a nursing model for Japanese Oriental "Kampo" Medicine
Outpatient of University Hospital.
Target Audience
The target audience of this presentation is nursing researchers who interest the nursing in Oriental and
Asian Traditional Medicine.
Abstract
Purpose: Purpose of this study was to create a nursing model for nursing of Japanese Oriental Medicine.
Methods: Method of this study took Literature Review and Qualitative Research.
1. Search papers about nursing and outpatient nursing of Oriental medicine from the Japan Medical
Abstracts Society which is the web reference site for medical science
2. Clarify characters of nursing articles of Oriental medicine
3. Focus group interview participants were nurses and doctors who practice at the Japanese
Oriental “Kampo” Medicine of university hospital
4. Analyze and abduct interview data to create categories
5. Create a nursing model l for nursing of Japanese Oriental Medicine
Results: Results were as follows,

1. 142 papers from the Japan Medical Abstracts Society which is web reference site for medical and
nursing were searched. From article titles and content summaries, these papers were classified
into four types.
2. Characters of articles that were nursing of Oriental medicine were as follows.
1) According to symptomatic treatments such as medication, finger pressure therapy and
acupuncture, and its effect.
2) Introduction of nursing education in Oriental medicine.
3) Introduced as a paradigm of health based on Oriental medicine.
4) The flow of various Asian traditional medicine. That were Kampo medicine, Chinese
medicine, Korea style medicine, Indian traditional medicine, Tibetan traditional medicine
and Comprehensive medicine.
3. These papers showed there was no model of nursing for nursing of Oriental medicine.
Although the new trend of nursing science was introduced as a paradigm of health based on
Oriental medicine. Nurses are used to holistic nursing, who are easy to accept the paradigm
change from Western medicine.
4. Participants were 3 nurses and 2 physicians who practice at the Japanese Oriental “Kampo”
Medicine of university hospital. In the group focus interview they were asked about the nursing,
instructions and communications remains in the impression in their practices, difficulties in
practice and suggestions to nursing in Oriental medicine.
The patient type remains in the impression were as follows. Patients undergoing chemotherapy or
radiation therapy for cancer treatment, symptom control becomes difficult, take in Oriental
medicine. Gynecological diseases with complaints unidentified. Physical symptoms control is
difficult in psychiatric disorders. Difficult experiences were as follows.

Physicians had spent hours roughly doubled than doctors of Western medicine. Such patients
had not at ease all instead visiting time is prolonged. Reasons are physical problems over the
self-affirmation of family support or financial hardship, their self-esteem are low. Devise
countermeasures were as follows. Against such difficulties, physicians of Oriental medicine,
Western medicine treatment approximately twice as much practice time to listen, were
addressed. While nurses and information exchange and other clinic nurses had to respond to
patient needs.
5. The purpose of this study is to create a nursing model. Therefore, when analyzing data, we had
the premise to clarify the mean for patients and implications for nursing process.
1 ） Categories are extracted from the viewpoint of meaning for the patient.
• Patients are divided to 2 types. Patients of are to receive treatments depend on
Oriental medicine in Oriental medicine. Patients of another type who undergoing
treatment depend on Western medicine are to receive treatment because of symptoms
controls in Oriental medicine.
• Patients receive Oriental medicine treatment secondary while undergoing treatment. It
means that is often confusing to medicine because by paradigm of Western medicine
and Oriental medicine. These paradigms are different from each other.
• Effectiveness of symptom controls are different from each other that paradigms of
Western medicine and Oriental medicine. Oriental medical treatment often takes a lot
of time to effect to symptom controls.
• There are drugs and acupuncture treatments other than the needed changes in
lifestyle, such as diet and continue to control symptoms in Oriental medicine. Patients
expects that could not be controlled by Western medicine medical symptoms improve
in Oriental medicine. However, to take time to symptom improvement in Oriental
medicine, does not go as expected.
• It is easy for patients to accept symptom control of secondary treatment instead of
Western medicine treatment, although difficult to accept Oriental medicine as a new
paradigm, and avert that.
• Patients often accept Oriental medicine as physician was told. They are difficult to
make a decision of whether or not accept the understanding of Oriental medicine and
Oriental medicine treatment with Oriental medicine paradigm. They are uncertain to
their conditions and future.
2 ）Categories are extracted from the viewpoint that mean for patients and implications for
nursing process
• The role of nurses in Oriental medicine nursing implement kampo treatment as
physician told.
• Although nurses sympathize with the treatment and idea of Oriental medicine, they
don’t think about concepts relevancies between Oriental medicine and nursing
concepts.
• Nurses are busy to implement instructions of their physicians. Nurses don’t think to
implement nursing method utilizing Oriental medicine.
• Nurses think patients who don't listen to descriptions and ignore orders from their
physicians have problems.
• Nurses trust physicians with settlements of patients’ problems that symptom control
takes time and patients’ acceptance paradigm of Oriental medicine.
• However nurses gather informations for sharing that with nurses, do not think the
nursing process utilizing that informations.
6. Create a nursing model for Nursing of Japanese Oriental Medicine
In the beginning, we made to identify obviously necessary and sufficient condition of nursing
models. A necessary and sufficient condition, is configured in the necessary condition and
sufficient condition. Therefore, we considered separately for each of the conditions. That are the
necessary conditions for requirements should be met through a qualitative analysis and literature
review of nursing in Oriental medicine discovered. Then consider sufficient conditions of nursing
models.Fundamentally, the nurse provide nursing process through patient nursing. Oriental
medicine nursing is no exception. Therefore, sufficient conditions of nursing model is in Oriental

Medicine patients in nursing nurses can be. We made the nursing model for Nursing of Japanese
Oriental Medicine.
Conclusion: In Japan, it already started nursing of Oriental Medicine as symptomatic treatments. Now a
day, the new trend of nursing science is the introduction as a paradigm of health based on Oriental
medicine. Nurses are used to holistic nursing, who are easy to accept the paradigm change from Western
medicine. Nursing education may have some nursing classes about nursing of Oriental medicine.
Contact
[email protected]

Experiences of Patients and Nurses Regarding the Use of Electronic Informed
Consent
Sun Hee Kim, MS, South Korea
Hee Sun Kang, PhD, South Korea
Purpose
The purpose of this presentation is to explore the experiences of patients and nurses regarding their use
of electronic informed consent.
Target Audience
The target audience of this presentation is nurses or educators who are interested in using electronic
informed consent.
Abstract
Purpose: The purpose of this study was to explore the experiences of patients and nurses regarding
their use of electronic informed consent.
Methods: Participants were 30 Korean nurses and 27 patients. Data were collected from October to
November 2013 in one university hospital. After obtaining permission from the participants, each focus
group and in-depth interview was audio-taped and transcribed. The responses were analyzed using
qualitative content analysis.
Results: Most participants perceived the use of electronic informed consent as simple and convenient to
use, saving space and time, and associated with a quality, high-tech hospital. However, participants
stated that the system was not satisfactory in part because of the occasional unexpected machinery error
or malfunction, and because they were at first unaccustomed to its use. Some patients wished for
function improvements related to the e-signature, making it more similar to a handwritten signature; to
improve the system’s adjustability to allow a larger font size when needed; and for the use of multimedia
to assist in better understanding the informed consent material. In contrast, nurses wanted a wider
implementation of electronic informed consent because it was not being used for all informed consent
cases, resulting in confusion and an additional workload.
Conclusion: User satisfaction could be increased by improving the functions of the electronic informed
consent system. This includes offering education regarding how to use it, incorporating multimedia, and
expanding the use of electronic informed consent in more cases.
Contact
[email protected]

Characteristics and Quality of Gait in Older Adults living in Saltillo, Coahuila,
Mexico and Lima, Peru
María de los Angeles Villarreal-Reyna, PhD, Mexico
Ana Laura Carrillo-Cervantes, RN, Mexico
Maria Magdalena Delabra-Salinas, RN, Mexico
Wendy Garcia-Meza, BS, Mexico
Mistral Carhuapoma-Acosta, RN, Peru
Elena Zuñiga-Chura, RN, Peru
Jack Roberto Silva-Fhon, RN, Brazil
Purpose
The purpose of this presentation is to compare the characteristics and quality of gait in older adults living
in the metropolitan area of Saltillo, Coahuila. Mexico and Lima, Peru.
Target Audience
The target audience of this presentation are nurse researchers and clinical nursing interested in the
functionality of the older adult and the global attention in nursing.
Abstract
Purpose: To compare the characteristics and quality of gait in older adults living in the metropolitan area
of Saltillo, Coahuila. Mexico and Lima, Peru.
Methods: Descriptive-comparative design. Population integrated by older adults with 60 or more years,
users of Daycare Centers for Older Adults. The calculated sample was of 210 older adults from Saltillo,
Mexico (n1=105) and Lima, Peru (n2=105) selected by convenience. Spatial-temporal characteristics and
quality of gait were evaluated.
Results: The averages of the spatial-time parameters of gait show that it was characterized for being
regular (speed (n1) = 1.42 m/s; speed (n2) = 1.55 m/s ; U = 5233; p = .526 and rhythm (n1) = 1.52 steps/s;
rhythm (n2) = 1.55; U = 4888; p = .156); of short steps (length (n1) = 49.5 cm; length (n2) = 50.3 cm; t(208) = -
.589; p=.073) and large (width (n1) = 7.70 cm, width (n2) = 10.20 cm; t(208) = -5.47; p=.467). When
classifying the scores for quality of gait by risk of falling, the 23.8% of the older adults from Saltillo, Mexico
and the 20.0% from Lima, Peru resulted in the high risk category (χ2= 2.09; p = .350). It was found that
older adults with the highest age, and that reported a longer time diagnosed with Diabetes, reached the
gait with the highest speed and number of steps, but with steps and a shorter cycle and with a lower
quality when walking (p < .01).
Conclusion: It is necessary to continue exploring the characteristics and the quality of gait through the
use of a more advanced and precise technology, and also to consider variables such as gender, age
segments, chronicity and polypharmacy; and with that, to continue generating relevant knowledge about
the phenomenon of functionality in the Latin-American context and for the attention of global gerontology.
References
Azidah, A.K., Hasnia, H. & Zunauna, E. (2012). Prevalence of Falls and Its Associated Factors among Elderly
Diabetes in a Tertiary Center, Malaysia. Current Gerontology and Geriatrics Research, 1-5. Ceballos Alatorre, B.
(2010). Capacidad sensorial y de marcha en adultos mayores residentes del área metropolitana de Monterrey. Tesis
de Maestría. Facultad de Enfermería, Universidad Autónoma de Nuevo León, México. Baezner, H. Blanhak, C.,
Poggesi, A., Pantoni, L. Izitari, D., Chabriat, H. et al. (2008). Association of gait and balance disorders with age-
related white matter changes: the LADIS study. Neurology, 70 (129, 935-942. Calandre, L., Conde, I. & Bermejo, F.
(2005). Trastornos del equilibrio y de la marcha en el anciano: análisis clínico de una serie de 259 casos mayores de
70 años. Neurología, (20), 232-239. Ferreira, P. C.; Tavares, D. M.,& Rodrigues, R A P (2011). Características
sociodemográficas, capacidade funcional e morbidades entre idosos com e sem declínio cognitivo. Acta Paulista de
Enfermagem, 24(1), 29-35. Gallegos-Carrillo, K., García-Peña, C., Durán-Muñoz, C., Mudgal, J., Durán-Arenas, L. &
Salmerón-Castro, J. (2008). Health care utilization and health-related quality of life perception older adults: a study of
the Mexican social security institute. Salud Pública de México, (50), 207-217. Ham Chande, R. (2011). Diagnóstico
sociodemográfico del envejecimiento en México. En La situación demográfica en México 2011. México: Concejo

Nacional de Población, 141-155. Marchetti, G.F., Whitney, S.L., Blatt, P.J., Morris, L.O. & Vance, J.M. (2008).
Temporal and spatial characteristics of gait during performance of the dynamic gait index in people with and people
without balance or vestibular disorders. Physical Therapy, 88(5), 641-651. Pedrazzi, E. C.; Rodrigues, R. A. P.;
Schiavetto, F. V. (2007). Morbidade referida e capacidade funcional de idosos. Ciência, Cuidado e Saúde,. 6, (4),
407-413. Plan Nacional para las Personas Adultas Mayores 2006-2010. Lima: Dirección de personas adultas
mayores. Ministerio de la Mujer y Desarrollo Social. Untiveros Mayorga Ch., Nuñez Chavez O., Tapia Zegarra L. &
Tapia Zegarra, G. (2004). Diabetes mellitus tipo 2 en el Hospital II Essalud – Cañete: Aspectos demográficos y
clínicos. Revista Medica Herediana 15 (1), 19-23. Villagómez Ornelas, P. (2010).El Envejecimiento Demográfico En
México: niveles, tendencias y reflexiones en torno a la población de adultos mayores. Instituto de Geriatría, 306-313.
Contact
[email protected]

Factors Related to Social Support and Communication Methods for Psychological
and Social Adjustment in Japanese Laryngectomized Individuals: A Study of a
Self-Help Group
Purpose
The purpose of this study is to clarify factors related to social support and communication methods that
are associated with psychological and social adjustment and to evaluate the nursing support plan for the
promotion of social adjustment in laryngectomized patients.
Target Audience
The target audience of this presentation is oncology and home nursing.
Abstract
Purpose: The purpose of this study is to clarify factors related to social support and communication
methods that are associated with psychological and social adjustment and to evaluate the nursing
support plan for the promotion of social adjustment in laryngectomized patients.
Methods: We contacted, through a mail survey, perilaryngeal cancer patients who were enrolled in a
patient association. This group included 893 of the 1828 patients who agreed to participate in the study.
They were registered members of a laryngectomized patient association, “A,” which is a public interest
incorporated self-help group. Its objective is to provide training on enunciation techniques and support the
rehabilitation of those who have lost their vocal function due to a total laryngectomy. They achieve this by
publishing and selling relevant books and wellness equipment nationwide. The survey items included
age, gender, occupation, length of time post-surgery, communication methods, psychological adjustment
(the Nottingham Adjustment Scale Japanese Laryngectomy version [NAS-J-L], translated by Yaguchi et
al. [2004]), the Health-Related Quality of Life ([HRQOL]; the SF-36v2 Japanese version), informal support
(the Medical Outcomes Study Social Support Questionnaire [MOS-SS]) and formal support (the Hospital
Patient Satisfaction Questionnaire-25 [HPSQ-25]). Social support, communication methods, and HRQOL
were added to the three-tier structural model of psychological adjustment for laryngectomized patients as
shown in the previous study, and covariance structure analysis was conducted. These variables were
measured by administering the NAS-J-L, which consists of the following seven subscales and 26 items: (i)
six items that assessed the anxiety-depression of patients who had lost their voices (e.g., “have you

recently been finding everything getting on top of you?”), hereafter abridged as “anxiety-depression”; (ii)
two items that measured the self-esteem of patients (e.g., “I feel totally useless from time to time”),
hereafter abridged as “self-esteem”; (iii) three items that measured their self-knowledge regarding the
acceptance of their disability (e.g., “I do not need to be anxious about losing my voice”), hereafter
abridged as “self-knowledge”; (iv) six items that assessed their positive affirmation regarding the
acceptance of their disability (e.g., “I feel that my life is very significant even after losing my voice”),
hereafter abridged as “positive affirmation”; (v) four items that measured the attitude toward
laryngectomized patients (e.g., “many people with vocal impairments generally consider losing their
voices as the worst incident to have happened”), hereafter abridged as “attitude”; (vi) three items that
measured patients’ self-efficacy (e.g., “I tend to give up easily”), hereafter abridged as “self-efficacy”; and
(vii) two items that measured patients’ locus of control (e.g., “I will make only very little progress in
rehabilitation”), hereafter abridged as “locus of control.” The higher the points in each subscale were, the
higher the psychological adjustment was. This scale has established reliability (α= .69
-.91), validity of
the structural concept, and criterion-related validity (Yaguchi et al., 2004). Self-knowledge regarding the
acceptance of their disability, which was part of the original scale, had a poor relationship with the
structure of psychological adjustment (Yaguchi et al., 2004). Consequently, this was excluded from the
NAS-J-L for this study. In the Social Adjustment Scale, we used three subscales from the SF-36v2
(Japanese version), which uses norm-based scoring: Role-Physical (RP), Role-Emotional (RE), and
Social Functioning (SF). We defined the three subscales as “social unification” in this study. In the Social
Support Scale, for informal social support, 20 items from the MOS-SS were used for measurement (four
subscales: emotional/informational, tangible, affectionate, and positive social interaction) (Cathy et al.,
1991). For formal social support, 10 items from the Hospital Patient Satisfaction Questionnaire-25
(HPSQ-25) were used (two subscales: technical evaluation and human aspects) (Bito et al., 2005). Age,
gender, and the duration of the post-surgery period were surveyed. Communication methods (esophageal
speech, electrolarynx, tracheoesophageal speech, writing, and gesturing) and the number of syllables
they were able to produce were also investigated. The communication methods were classified into two
groups (“esophageal/tracheoesophageal group” and “others group”) for analyzing. In order to understand
the characteristics of the study population, descriptive data were calculated. We then used a
psychological adjustment model for laryngectomized patients (Kotake et al., 2008). The model had a
three-tier structure: the "Recognition of oneself as voluntary agent" (the latent value for self-efficacy and
locus of control) promotes "Acceptance of disability" (the latent value for acceptance of disability and
attitude toward laryngectomy), which further promotes "Internal value as human being" (the latent value
for anxiety/depression and self-esteem). We analyzed the model by adding two types of support (formal
and informal), communication methods, and social unification by covariance structure analysis. Patients
who signed the consent form or returned a completed survey were deemed to have agreed to participate
in the survey. The study was reviewed and approved by the A Ethics Committee of University.
Results: Participants’ mean age was 70.8 years (range: 39-95 years), and 90.7% were male. Regarding
the amount of time post-surgery, 562 people (65.8%) indicated that they had undergone the operation 5-
20 years ago. The esophageal/tracheoesophageal group comprised 570 people (63.8%), and the others
group included 280 people (31.4%). The structural model was a good fit for the data as demonstrated by
the goodness of fit (GFI = .948), adjusted goodness of fit (AGFI = .927), and root mean square error of
approximation (RMSEA = .05) values. The model showed that informal/formal support and
communication methods had positive influences on the "recognition of oneself as voluntary agent" (path
coefficients: .28/.26 and .24 respectively). We demonstrated the possibility that formal/informal support
and communication methods enhance the “recognition of oneself as voluntary agent,” promoting
psychological adjustment. The “Internal value as human being” component of psychological adjustment
promotes social unification. If Japanese laryngectomized individuals receive informal/formal support and
esophageal/tracheoesophageal speech, their psychological adjustment improves, promoting better social
rehabilitation.
Conclusion: In this study, we clarified that improved psychological adjustment through social support and
communication methods can help enhance Japanese laryngectomized individuals’ social rehabilitation.
We suggest that the self-help group activity is important for these individuals, because they need to
obtain an alternative voice and informal/formal support. Furthermore, we found that professional support,
provided by, for example, nurses and physicians, is important; in particular, human and technical support
as provided by the medical team is highly necessary. Formal support identified in this study included (1)

relate to the patients with interest and empathy, (2) demonstrate sufficient understanding and be
considerate to patients, (3) communicate to soothe their minds, and (4) give appropriate responses (e.g.,
nursing, treatment, and respect for patients' opinions). This study has some limitations. Since the
participants have been enrolled as members of “A” patient association for more than 1 year, patients in
the acute period were not included. As acute-period patients tend to need much more social support, the
association between psychological adjustment and social support for acute-period patients may be
different from that for chronic-period patients. However, we believe that social rehabilitation is possible if
the medical team provides the two forms of support adequately for those who have suddenly lost their
voice and experienced a changed body image.
References
¡¡Bito S., Suzukamo Y., Fukuhara S. (2005). Reappraisal and Sequential Development of the measures of patient
satisfaction for hospitalized patients: From HPSQ-25 to HPSQ-13. Medical Management Academy journal, 6(2),
423©\427. Cathy Donald Sharbourne and Anita L. Stewart (1991)£ºThe MOS Social Support Survey, Social Science
& Medicine, 32(6), 705©\714 Dodds AG, Bailey P, Pearson A, Yates L. Psychological factors in acquired visual
impairment; The development of scale of adjustment. J. Vis. Impair. Blind. 1991; 85: 306-310. Dodds AG, Flannigan
H, Ng L. The Nottingham adjustment scale: A validation study. Int. J. Rehabil. Res. 1993; 16: 177-184. Dodds AG,
Ferguson E, Ng L, Flannigan H, Hawes G, Yates L. The concept of adjustment: A structural model. J. Vis. Impair.
Blind. 1994; 88: 487-497. Dooks P, McQuestion M, Goldstein D, Molassiotis A. Experiences of patients with
laryngectomies as they reintegrate into their community. Support Care Cancer. 2012; 20: 489-498. Fukuhara S., Bito
S., Green J., Hsiao A., and Kurokawsa K. (1998). Translation, adaptation and validation of the SF-36 Health Survey
for use in Japan, Journal of Clinical Epidemiology, 51, 11, 1037 ¨C 1044. Fukuhara S., Ware J. E., Kosinski M., Wada
S. and Gandek B. (1998). Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey, Journal of
Clinical Epidemiology, 51, 11, 1045 ¨C 1053. Fukuhara S. and Suzukamo Y. (2004). SF-36v2 Japanese manual,
NPO iHope International, Kyoto. Suzukamo Y, Kumano H, Iwaya T. Development and validation of ¡°The Nottingham
Adjustment Scale Japanese Version¡± which measures psychological adjustment to the visual impairment. Jpn. J.
Psychosoma. Med. 2001; 41: 609-618. Yaguchi K, Kai I, Sato M, Suzukamo Y. Applicability of a modified the
Nottingham Adjustment Scale-Japan to the patients after laryngectomy. J. Jpn. Acad. Nurs. Sci. 2004; 24: 53-59.
Contact
[email protected]

Pelvic Inclination Angle and Autonomic Nervous Activity While Seated in a
Wheelchair: Using the Seated Posture Measurement Method
Etsuko Yokoyama, MSN, RN, Japan
Yoko Tsuji, ME, RN, Japan
Yuka Saeki, PhD, RN, Japan
Purpose
The purpose of this presentation is to report of the sympathetic and parasympathetic activities while
subjects were seated in a wheelchair. The postures changed in increments of 5° from an intermediate
pelvic backward inclination in the sagittal plane from 0° to 30°.
Target Audience
The target audience of this presentation is wheelchair users and nurses.
Abstract
Purpose: Nursing homes and welfare facilities for the elderly use wheelchairs to improve their level of
activity and prevent them from becoming bedridden. Although wheelchairs are a useful aid, most elderly
individuals who regularly use wheelchairs not only have walking problems but also have functional
problems, such as muscle weakness due to age and paralysis due to cranial nerve disease. Because
80%–90% of the time that elderly people spend in wheelchairs is spent using the wheelchairs as chairs to
sit in, this long usage time causes a problem.
The sitting posture also worsens over time, resulting in either “sacral sitting” with the pelvis tilted
backwards or “slanted sitting” with the trunk inclined to the side. The loss of muscle strength leads to
difficulties in maintaining a sitting posture in the wheelchair. These poor sitting postures can severely
restrict movements of the upper limb and interfere with day-to-day activities. In addition to pressure
ulcers, poor sitting postures can cause eating, swallowing, and digestive difficulties. Furthermore,
respiratory movement and hemodynamics are also affected adversely.
Previously, studies have investigated the effects of different sitting postures qualitatively, assessing
upright sitting, slouching, and forward tilting. Using radiographic imaging, Lin et al. (2006) compared the
angles between individual sacral and lumbar vertebrae in different sitting postures in a portion of their
subjects; however, they did not quantitatively show the pelvic inclination angle in other subjects.
In 2006, an international standard defining clinical guidelines for measuring sitting postures, the
ISO16840-1:2006, was adopted. Following this, quantitative measurements of sitting postures in clinical
settings gained momentum. ISO16840-1:2006 describes in detail, the method to measure a sitting
posture by projecting two-dimensional planes of the sagittal, frontal, and horizontal planes. Measuring
instruments that comply with ISO16840-1:2006 have been developed and are expected to come into use
for various assessments and studies. Kemmoku et al. (2013) used sitting posture measurements to
define bearing surface pressure and displacement force. Bearing surface pressure was divided into two
phases: before and after, with the peak angle being a backward pelvic inclination angle of 15°.
Displacement force increased gradually from 15° to 20°. However, from 20° onwards, displacement force
increased appreciably. Few studies using sitting posture measurements, such as this one, have been
published so far.
This study aims to elucidate and compare changes in autonomic nervous activity as a result of different
wheelchair sitting postures in healthy individuals using postural measurement methods and to convert the
results into normative data. The study also aims to assess assistive technology for wheelchair sitting
postures for preventing secondary disorders in wheelchair-bound elderly individuals due to long periods
of sitting and devise interventions for improving their functional activities.

Methods: Participants of the study comprised 13 healthy adults (without any spinal disorders) who could
maintain a sitting posture throughout the duration of the measurements. All participants were female. The
mean age was 23 ± 6 years.
Changes in autonomic nervous activity were measured for seven different wheelchair sitting postures.
The postures changed in increments of 5° from an intermediate pelvic backward inclination in the sagittal
plane from 0° to 30°.
Pelvic backward inclination angle was noninvasively measured using Horizon (Society for Research on
Sitting Posture Measurement). This instrument measures sitting posture in accordance with ISO16840-
1:2006. We adjusted the sitting position on the bearing surface by having subjects shift back and forth by
small degrees. This was done to attain specific pelvic backward inclination angles as indicated by
pointers on the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Once the
sitting posture was achieved, it was recorded using digital photographs in the sagittal plane (from the right
side). Sitting posture measurement software, Rysis (Handa et al., 2010), was then used to analyze the
participants’ posture and angles of body segment lines(Head line, Neck line, Sternum line, Trunk line,
Abdominal line, Pelvic line) from the images taken.
Between sitting posture measurements, a 5-minute rest period was scheduled. During this time,
electrocardiographic readings were recorded with a BioLog DL-2000 device and DL-320 ECG and
respiration sensor (S&ME, Tokyo, Japan). Using these readings, autonomic nervous activity was
analyzed at a low frequency (LF) of 0.04–0.15 Hz and a high frequency (HF) of 1.15–0.40 Hz using the
frequency analysis program MemCalc (GMS, Tokyo, Japan). Measurement values for each pelvic
backward inclination angle were comparatively analyzed using the statistical software SPSS 18.0 with the
significance level set at 5%.
This study was approved by the research ethics committee of the Japanese Red Cross College of
Nursing. On the test day, the subjects were provided with written and verbal explanations that it was their
right to choose to collaborate in this study, they were free to refuse to participate, and their privacy would
be protected. After they provided their consent, the test was initiated.
Results: A significant difference was seen in the LF/HF ratio, a sympathetic nervous activity index,
between the intermediate pelvic inclination angle of 0° and the angles of 15° and 30°. A significant
difference was also seen between pelvic backward inclination angles of 5°and 25°.
At pelvic backward inclination angles of 30°, 25°, and 20°, the HF ratio, a parasympathetic nervous
activity index, was significantly higher than that with 0°, 5°, and 10°. At a pelvic backward inclination angle
of ≥20°, parasympathetic nervous activity increased compared with that from 0° to 10°. Significant
differences were also seen between 30° and the angles of 15° and 20°, between 25° and the angles of
20°, 15°, and 0°, and between 5°, 10° and the angle of 0°.
Conclusion: It has been reported that parasympathetic nervous activity becomes dominant while resting
in the supine position. In contrast, sympathetic nervous activity dominates when the head is lifted up. In
this study, we found that sympathetic nervous activity was significant in an upright posture with a pelvic
inclination angle of 0° or 5° and parasympathetic nervous activity became dominant during a “slanted
sitting” posture with pelvic inclination angles of ≥20° when compared with those of 0°–10°.
We also found that displacement force in the sacral region increased more at a pelvic inclination angle of
20°. Parasympathetic nervous activity was dominant at 20°, and it appears that the “slanted sitting”
posture along with dominant parasympathetic nervous activity led to subjects being in a prolonged
relaxed state, which made it easy for sitting posture to collapse. This relaxed state was brought about by
a predominant parasympathetic nervous activity while in a slanted position. Furthermore, because pelvic
and trunk inclinations differed between participants, we hope to proceed with further basic research. This
future research should elucidate the postural characteristics of wheelchair-bound elderly individuals and
clarify the assessment viewpoints of elderly individuals requiring assistance for sitting posture.
References
Gavin-Dreschnack, D (2004). Effect of Wheelchair Posture on Patient Safety, Rehabilitation Nursing, 29(6), 221-226.
Handa, T, Hirose, H (2010). Development of Seated Posture Measurement Software Which Enables to Apply
ISO16840-1 standard in a Clinical Setting, Journal of the Japanese Society for Wellbeing Science and Assistive

Technology, 10(2), 27-35. Hirata M, Morita T (2006). Risk of secondary disorder due to inappropriate seating, The
Japanese journal of total care, 16(12), 20-24. Kemmoku T, Furumachi K, Shimamura T (2013). Force on the
sacrococcygeal and ischial areas during posterior pelvic tilt in seated posture, Prosthetics & Orthotics International,
37(4), 282-288. Lin F, Parthasarathy S, Taylor SJ, Pucci D, Hendrix RW, Makhsous M (2006). Effect of different
sitting postures on lung capacity, expiratory flow, and lumbar lordosis, Arch Phys Med Rehabil, 87(4), 504-509.
ISO16840-1 Wheelchair seating-Part 1: Vocabulary, reference axis convention and measures for body segments,
posture and postural support surfaces. 2006/3
Contact
[email protected]

The Influence of Participation in Self-Help Groups on Laryngectomized Patients
Purpose
The purpose of this study is to clarify factors affecting laryngectomized patients' participation in self-help
groups and to examine the support for laryngectomized patients' participation in self-help groups and for
the promotion of their social participation.
Target Audience
The target audience of this presentation is Oncology and Home Nursing.
Abstract
Purpose: The purpose of this study is to clarify factors affecting laryngectomized patients' participation in
self-help groups and to examine the support for laryngectomized patients' participation in self-help groups
and for the promotion of their social participation.
Methods: Subjects were 893 laryngectomized patients who agreed to participate in this research among
1,828 laryngectomized patients registered in self-help groups in Tokyo and Kyushu-Okinawa region in
Japan. Survey content was basic attributes (age, sex, the number of years after undergoing
laryngectomy, occupation at the time of investigation, family structure, and the main method of
conversation) and the experience of participation in self-help groups. We mailed questionnaires to every
subject. We conducted mail questionnaire survey in this study.
We calculated descriptive statistics about basic attributes. For conducting a significance test the types of
communication methods of laryngectomized patients and family structure were separated into two
groups: patients who mainly used either esophageal speech or tracheoesophageal shunt speech and
patients who used other methods for communication, and those who live alone and those who live with
other family members, respectively. A t-test was conducted on the experience of participation in self-help
groups and age (p < 0.05). A χ2 test was conducted on the experience of participation in self-help groups,
communication methods, occupation, and family structure (p < 0.05).
This research was approved by Ethical Review Committee of a university authors belonged to. We
explained to subjects the purpose of this research, voluntary participation in this research, and the policy
that the signing of the letter of consent or the returning of questionnaires was treated as an agreement to
participate in the research.
Results: The average age of subjects was 70.8 years (ranging from 39 to 95 years, the lower quartile is
65 years old). 90.7% of subjects were male. Those who underwent laryngectomy more than 5 years ago
were 562 (65.8%). The subjects who had occupation were 263 (31.4%) and who lived alone were 75
(8.6%). The main methods of communication (multiple answer) were as follows: those who used
esophageal speech, tracheoesophageal shunt speech, electrolarynx, conversation by writing, and
gesture were 565 (63.3%), 20 (2.2%), 244 (27.3%), 189 (21.1%), and 99 (11.1%), respectively. There
were also a few people who used PCs, cellphone's email, fax machines, and the movement of lips as
medium of communication.
On participation in self-help groups, participation was 274 (33.4%) and non-participation was 547
(66.6%). The average age of participation and non-participation was 69.7 years old and 71.2 years old,
respectively. 568 subjects (69.2%) used esophageal or shunt speech and 253 subjects (30.8 %) used

other communication methods. Those who had occupation were 250 (31.2%) and those who live alone
were only 69 (8.3%).
A t-test showed that the average age of those who participated in self-help groups was younger than
those who did not (p = .02). A χ2 test showed that the former were more likely to use esophageal speech
or tracheoesophageal shunt speech than the latter at a statistically significant level (p = .0006). There was
no statistically significant relationship between the participation in self-help groups and occupation. On
family structure those who lived alone were less likely to participate in self-help groups than those who
lived with family members at a statistically significant level (p = .033).
Conclusion: Laryngectomy which is considered to be radical treatment of larynx cancers and cervical
esophageal cancers causes a loss of voice to patients. Therefore, laryngectomized patients were forced
to acquire a new communication method after surgery. Self-help groups of laryngectomized patients in
Japan are the places for exchange on the training of communicative methods such as esophageal
speech and electrolarynx as well as the places for sharing one another's experience and talking to each
other about one's problems such as the life after surgery. In this study we found that patients who use
esophageal speech or tracehoesophageal shunt speech were more likely to participate in self-help
groups. It is considered that this is due to their current activities.
Participants in self-help groups tended to be younger than non-participants. About 25 percent of subjects
in this research were below 65 years. Japanese people at this age usually have jobs and assume a vital
role in social activities. This suggests that participants in self-help groups include those who try to be
reemployed by acquiring esophageal speech. Yet, in this research there was no association between
occupation at the time of investigation and participation in self-help groups at a statistically significant
level. This suggests that although patients are likely to participate in self-help groups for gaining
communication skills with others by esophageal speech for rehabilitation in society, participation in self-
help groups does not necessarily promote their extensive social participation such as their reemployment
or the recovery of their previous vocational status. Previous studies show that about 20 percent of
laryngectomized patients lost their job by the loss of a voice after surgery in Japan (Kotake, et al. 2005).
Therefore, we need to examine factors which promote their social participation in future research.
This research also found out that patients who lived alone were less likely to participate in self-help
groups than patients who lived with family members, implying that the level of daily exchange with family
members might promote their social participation. It also suggested that laryngectomized patients who
lived alone were less likely to gain support not only from their family but also peers. It is reported that
laryngectomized patients suffer not only from physical problems such as the increase of cough and
phlegm due to the change of breathing route and the change of swallowing function and appearance
(Armstrong et al. 2001) and problems of daily life but also from the increase of mental disorder (Bussian
et al. 2010), showing the necessity to examine the support system for laryngectomized patients who live
alone.
References
Armstrong E., Isman K., Dooley P., Brine D., Riley N., Dentice R., et al. (2001). An investigation into the quality of life
of individuals after laryngectomy. Head & Neck, 23 (1), 16 - 24. Bussian C, Wollbrück D, Danker H, et al. Mental
health after laryngectomy and partial laryngectomy: a comparative study. Eur. Arch. Otorhinolaryngol. 2010; 267:
261-266. Kotake K, Sato M. The relationships between communication methods for the patients after laryngectomy.
JSNR. 2005; 28: 109-113.
Contact
[email protected]

Dietary Environment Assessed Using Visual Measurements of Different Seated
Wheelchair Postures
Yoko Tsuji, ME, RN, Japan
Etsuko Yokoyama, MSN, RN, Japan
Purpose
The purpose of this presentation is to report of the visual information obtained from different postural
angles to elucidate the amount of information obtained through the line-of-sight from a wheelchair in a
dietary environment.
Target Audience
The target audience of this presentation is wheelchair users and nurses.
Abstract
Purpose: Elderly individuals experience lower back muscle weakness that limits the upper limb range of
motion while seated in a wheelchair and interferes with their activities of daily living. Furthermore, those
who cannot self-adjust their seated posture are unable to freely move their trunk and head; thus, reducing
their field of vision and further restricting the activities that they can perform. When adjusting one’s
lifestyle to accommodate age-related changes, meals play a crucial role not only in sustaining life, but in
providing taste and happiness.
Important points in nursing intervention for the provision of delicious meals involves choosing cutlery
suited to physical function, providing tableware that allows meals to be easily consumed and dietary
contents to be easily ascertained, arranging seating that allows individuals to concentrate on meal
consumption, and preparing dietary environments in which individuals can interact with others. Meals for
elderly individuals who live in facilities are not provided in their private rooms, but rather in dining rooms
at large tables surrounded by chairs, although majority of the individuals consume their meals while
remaining seated in wheelchairs. The height at which the meal is consumed is identical for everyone
because the meals are served at the same table. However, individuals sit in wheelchairs that are suitable
to their physiques, and differences in the perceptions of meals can also be expected according to the
state of each individual’s visual function. Therefore, it appears important to analyze visual information to
assess the dietary content and gain an understanding of how individuals perceive meals.
To date, previous studies have examined the effects of visual information changes on posture, and
according to measurements collected for subjects who walk, the effect on posture has been reported as
greater in elderly individuals than in young individuals. Further, studies of wheelchairs have analyzed the
wheelchairs while in motion but few studies have focused on “seated wheelchair postures” and the “line-
of-sight.” Therefore, the present study aimed to examine the visual information obtained from different
postural angles to elucidate the amount of information obtained through the line-of-sight from a
wheelchair in a dietary environment.
Methods: The line-of-sight was measured using the Eye Tracking System EMR-8B (NAC Image
Technology, Tokyo, Japan; hereinafter, EMR). This device uses detectors that are attached to a baseball
cap, and thus can visualize the line-of-sight positions of images in the user’s visual field from a relative
distance between the position of near-infrared illumination corneal reflection and the central pupil position.
The EMR is a non-invasive device weighing 250 g. In the present study, we used a visual field camera at
a horizontal angle of 92°, with a data sampling rate of 29.96 Hz and data resolution at a viewing angle of
0.1°. The temperature, humidity, and illumination in the test room were adjusted to be constant.
The test, which was conducted in a private room, aimed to represent an environment in which meals are
consumed while being seated in a wheelchair. Rice, miso soup, egg, and stir-fried vegetables were
placed on a table as dietary models, and 7 pelvic inclination angle patterns (0°, 5°, 10°, 15°, 20°, 25°, and
30°) were examined while subjects were seated in a wheelchair. The line-of-sight and postural angles
were each measured for 3 min. Subjects were instructed to “look at the meals for 3 min” while seated in a

wheelchair, at which time the measurements were initiated. After adjusting the seated posture, recordings
of the posture were made from the right side.
For the analysis, visual information from 1 min in the middle of the 3-min measurement period was used
to analyze the line-of-sight. Time spent gazing at something other than the meal and time spent gazing at
the meal were compared. The height of line-of-sight was examined from the following 2 points taken from
the recorded images: the distance from the corner of the eye to the meal and the vertical height of the
table. Using an angle of 0° as a basic value, we used the Friedman test and Wilcoxon signed-rank test to
examine the values between each postural angle. The SPSS 18.0 statistical software package (SSPS,
Inc., Chicago, IL, USA) was used, and the level of significance was set at 5%.
This study was approved by the ethics committee of the Japanese Red Cross College of Nursing. On the
test day, the subjects were provided with written and verbal explanations that it was their right to choose
to collaborate in this study, they were free to refuse to participate, and their privacy would be protected.
After they provided their consent, the test was initiated.
Results: Subjects comprised 13 healthy adult women with no lower back pain and no visual function
abnormalities. The mean age was 23 ± 6 years, the mean height was 159.8 ± 4.8 cm, and the mean
weight was 51.05 ± 7.27 kg. During the test, almost no head movement or lowering of the jaw position
was observed. During the line-of-sight measurements, no significant differences between the postural
angles were observed with regard to the time spent gazing at things other than the meal. Analysis of the
images revealed significant differences between the angles with respect to the height of the line-of-sight
(p<0.000). When a pelvic inclination angle of 0° was compared with the other angles, significant
differences were seen at angles of 10°, 20°, 25°, and 30°, and the line-of-sight increased with each
increase in angle (p<0.05). Significant differences were also noted between each postural angle with
respect to the distance from the corner of the eye to the meal (front of the tray; p<0.000). Furthermore,
significant differences were observed at angles of 20°, 25°, and 30°, compared with the inclination angle
of 0° (p<0.05). A comparison of the height from the posture and corner of the eye to the table also
revealed significant differences (p<0.001), with differences noted at inclination angles of 10–30° when
compared with an inclination angle of 0° (p<0.05).
Conclusion: No significant differences in the quantity of eye gaze were noted with respect to changes in
posture. However, compared with an angle of 0°, changes in the pelvic inclination angle resulted in an
increase in the height of the line-of-sight, with a shorter distance to the meal, and a shorter distance from
the corner of the eye to the table. This shows that while changes in posture did not result in statistically
significant differences in the meal-related information obtained, there were changes in the information
obtained regarding the meal contents. The visual field images obtained from the EMR showed that the
distances from which the side dishes (egg, stir-fried vegetables) on the far side of the meal tray were
perceived lengthened with the increased pelvic backward inclination angle, suggesting that meal contents
that are placed at a greater distance are not perceived 3-dimensionally, but as a planar image.
Dietary intake is a basic criterion for maintaining quality of life. Therefore, the dietary environment should
be examined in terms of the table height and the meal placement at which the colors and shapes of foods
can be visually perceived to enhance appetite while considering an individuals’ posture. The subjects in
the present study were young, and therefore no significant head movement was noted during the short
measurement time. In the case of elderly individuals without the provision of a dietary environment, the
range of motion will be restricted, starting with the neck; this will result in an increased amount of time
required to consume the meal, thereby making meal consumption a distressful rather than an enjoyable
experience.
An ideal dietary environment for wheelchair-bound individuals would involve the arrangement of a seated
wheelchair posture suited to the individuals’ physical condition, thereby increasing their appetite. To
achieve this, we must consider nursing dietary environment interventions such as adjustments to table
heights and meal placements to accommodate seated wheelchair postures based on the physical status
obtained during the daily health assessments conducted by nurses.
References
Shiota K, Ikeda M(2008).Influence of aging change in visual system on postural control, J Jpn Academy of Health Sci,
11(3),145-152. Turano KA,Geruschat DR, Baker FH, Stahl JW, Shapiro MD(2001).Direction of gaze while walking a

simple route: persons with normal vision and persons with retinitis pigmentosa, Optom Vis Sci, 78(9),667-675. Itho
N,Fukuda T(2004).A study for age effects in reliance on lower visual information of environment while walking : The
sequential change of eye movements, J Jpn Ergonomics,40(5),239-247.
Contact
[email protected]

The Relationships Between Patients' Physical, Psychological Distress and the
Family Caregiver Burden in Hospitalized Gastrointestinal Cancer Patients
In Fun Li, MSN, RN, Taiwan
Purpose
The purpose of this presentation is sharing the results of this research, and for my doctoral program
requirements.
Target Audience
The target audience of this presentation is clinical nurses and researchers.
Abstract
Purpose: A cancer diagnosis impacts not only the patient but also the family. In Taiwan, the majority of
caregivers report taking on the role of caring of the family responsibility. When family caregiver care
patients of cancer, they experienced both physical and mental health due to patients multiple symptoms
and treatments, than might decrease the quality of patient care and the patient’s emotional state can
increase distress in the caregiver. For this reason, the caregiver burden for a cancer patient’s family is an
important issue today.
The purpose of this was to explore the relationship of patient’ physical and psychological distress to
family caregiving burden in hospitalized gastrointestinal cancer patients.
Methods: This was a cross-sectional study involving 136 dyads of patients and families were approached
and completed questionnaires during hospitalization. The data collection instruments including :
demographics of patient and family, disease characteristics of patients, the modified Symptom Distress
Scale for patient’s symptom distress, The Hospital Anxiety and Depression for patient’s psychological
distress, and the caregiver’s burden (measured with the Caregiver Reaction Assessment, CRA).
Descriptive statistics for each variable were examined, and multivariate canonical correlation analysis was
used to explore.
Results: The following results were revealed: 1) The severity of care burden on the primary caregiver
was in the order: disrupted schedule, financial problem, health problem, and lack of family support. 2)
The severity of patients’ symptom distress was between non to mild . 3) 31.3% patients demonstrated
clinical relevant level of anxiety and 58.2% with depression. 4) Depression of patients was the major
factor to effect family caregiving burden. 5) The first and second canonical correlation coefficients
between "patient’s depression”, “patient’s anxiety”, and “patient’s symptom distress” and family caregiving
burden are .748 and .358( p < .001). The canonical variables x1 and x2 were able to explain up to 36.01%
of total variables of family caregiving burden.
Conclusion: These finding showed caregiver might experience caregiving burden, and they also felt
positive emotion, such as elevated self-esteem and self-worth about their role. Patient's depression and
symptom distress were significantly to the caregiving burden. This study suggest healthcare professionals
should systematically assess patients’ and caregivers’ problems and provide timely supportive care
clinically. This is not only for patients , may also assist caregiver provide better quality care and reduce to
the caregiving burden.
References
Chen, S. C., Tasi, M.C., Liu, C.L., Yu, W. P., Liao, C. T., & Chang J. T. (2009). Support needs of patients with oral
cancer and burden to their family caregivers. Cancer Nursing, 32(6), 473-481. Given, B., Given, C., & Kozachik, S.
(2001). Family support in advanced cancer. CA-A cancer Journal for Clinicians, 51(4), 213-231. Given, B., Wyatt, G.,
Given, C., Sherwood, P., Gift, A., DeVoss, D. et al. (2004). Burden and depression among caregivers of patients with
cancer at the end of life. Oncology Nursing Forum, 31(6), 1105-1116. Given, C.W., Given, B., Stommel, M., Collins,
C., King, S., & Franklin, S. (1992). The Caregiver Reaction Assessment (CRA) for caregivers to persons with chronic
physical and mental impairments. Research in Nursing and Health, 15(4), 271-283. Glajchen, M. (2004). The
emerging role and needs of family caregivers in cancer care. The Journal of Supportive Oncology, 2(2), 145-155.

Kim, Y. & Sorensen, S. (2005). Levels of depressive symptoms in spouses of people with lung cancer: effects of
personality, social support, and caregiving burden. Psychosomatics, 46(2), 12-130. Kurtz, M., Kurtz, J. C., Given, C.
W., & Given, B. A. (2004). Depression and physical health among family caregivers of geriatric patients with cancer-
A longitudinal view. Medicine Science Monitor, 10(8), CR447-456. Oechsle, K., Goerth, K., Bokemeyer, C., &
Mehnert, A. (2013). Anxiety and depression in caregivers of terminally ill cancer patients: impact on their perspective
of the patients' symptom burden.Journal of palliative Medicine, 16(9), 1095-1101. Park. B., Kim, S. Y., Shin J. Y.,
Sanson-Fisher R.W., Shin, D. W., Cho, J., & Park, J.H. (2013). Prevalence and predictors of anxiety and depression
among family caregivers of cancer patients: a nationwide survey of patient-family caregiver dyads in Korea.
Psychooncology, 21(10), 2799-2807. Shin, W. M., Hsiao, P. J., Chen, M. L., & Lin, M. H. (2013). Experiences of
family of patient with newly diagnosed advanced terminal stage hepatocellular cancer. Asian Pacific Journal of
Cancer Prevention, 14(8), 4655-4660.
Contact
[email protected]

Effects of Activity Program in Prevention of Functional Decline Among
Hospitalized Elderly: A Pilot Study
Kai-Wen Hung, MS, Taiwan
Chun-Yin Yeh, BS, Taiwan
ChingHuey Chen, PhD, Taiwan
Purpose
The purpose of this presentation is to explore the effect of intervention to prevent functional decline in
hospitalized elderly, and it is a pilot study.
Target Audience
The target audience of this presentation is the health promoters and experts.
Abstract
Purpose: This pilot study was aimed to explore the effect of intervention to prevent functional decline in
hospitalized elderly.
Methods: A total of 15 elderly who were enrolled and randomized allocated into the control group (n=7)
and the experimental group (n=8). Admitted in one of the medical center at southern Taiwan. Patients in
the experimental group were intervened by accumulated 10~60 minutes walking daily from admission to
one month after discharge. The walking plan was designed according to individual physical tolerance and
personal preference. The outcome measures included activities of daily function measured by Modified
Barthel index, hand grip strength, time up and go test, quality of life, discharge destination, hospital length
of stay, 28-day readmission rate.
Results: The improvement in Modified Barthel index at one month after discharge was greater than 2
weeks before admittance in experimental group. The hand grip strength at discharge was greater in
experimental group than in control group. The improvement in respect to time up and go test in
experimental group was better than in control group (-4 8.0second vs -1.3 second).
Conclusion: In conclusion, the walking intervention is shown to be feasible and effective in preventing
functional decline in elderly. We suggested that the walking intervention may implant into in clinical
nursing care in the future.
Contact
[email protected]

Logistic Regression for Predicting Early Postpartum Depressive Symptoms in
Japanese First-Time Mothers Aged 35 and Over
Emi Mori, RN, RM, MNSc, DMSc, Japan
Hiroko Iwata, RN, RM, PhD, Japan
Miyako Tsuchiya, PhD, Japan
Akiko Sakajo, RN, RM, DNSc, Japan
Tomoko Maekawa, RN, RM, MNSc, Japan
Kunie Maehara, RN, RM, DNSc, Japan
Akiko Morita, RN, RM, MNSc, Japan
Harumi Ozawa, RN, RM, PhD, Japan
Yoshimi Mochizuki, RN, RM, MA, Japan
Akiko Saeki, RN, RM, MNSc, Japan
Kyoko Aoki, RN, RM, MNSc, Japan
Miyuki Makaya, RN, PhD, Japan
Koji Tamakoshi, MD, PhD, Japan
Purpose
The purpose of this presentation is to identify factors for predicting postpartum depressive symptoms
during hospital stay after childbirth in Japanese first-time mothers aged 35 and over.
Target Audience
The target audience of this presentation is health care professionals such as nurses, physicians and
psychologists who are responsible for postpartum women’s mental health.
Abstract
Purpose: Currently, Japan is showing a trend towards later childbearing. In 2006, 5.6% of women giving
birth were first-time mothers at age 35 and over (1); this increased to 8.4% in 2011 (2). Older first-time
mothers have been shown to be at increased risk for pregnancy complications compared with younger
women (3, 4). These women also possess several psychosocial characteristics such as increased
autonomy, limited social support and limited prior experiences with children (5), which may potentially
cause poorer maternal adaptation after childbirth. Older first-time mothers may therefore demand more
careful consideration from health care professionals not only during pregnancy but also after childbirth.
Previous studies suggest that women with advanced maternal age, particularly primiparae, are more
vulnerable to postpartum depression (PPD) (6, 7). PPD is a common complication of childbirth.
Prevalence of PPD in Japan is estimated to be between 8.6% and 17.0% (8). It is a significant health
problem that impacts not only women, but also their children and families. Studies suggest that mother-
infant interactions are compromised by PPD, which negatively impacts infant behaviors and development.
The detrimental effects of PPD in more extreme cases include greater risks for child abuse, self-harm and
suicidal ideation. Thus, preventing PPD is an important health issue in Japan.
In the present study, we report some of the findings of a prospective cohort study that we conducted to
examine physical and psychosocial well-being during the first 6 months postpartum in Japanese mothers,
one of three studies from a research project begun in 2011 for this purpose with older Japanese first-time
mothers. The project is still in progress with a goal of developing a nursing guideline to support
childrearing for older Japanese first-time mothers.
The purpose of this study was to identify factors for predicting postpartum depressive symptoms during
hospitalization after childbirth in Japanese first-time mothers aged 35 and over.
Methods: The sample of this study came from the prospective cohort study that we conducted to
examine physical and psychosocial well-being during the first 6 months postpartum in Japanese mothers.
The study was undertaken at 12 hospitals in the Kanto and Kansai areas in Japan from May 2012
through September 2013. Women were recruited by researchers or research nurses during their

hospitalization after delivery. Eligible participants were Japanese women who were 16 and over, 0 to 4
days postpartum, had a singleton live birth vaginally or operatively, and had a fixed address during the 6
months after the time of recruitment. Exclusion criteria included those who had difficulty with
communication in Japanese and those with serious health problems, either in the mother or newborn. We
obtained informed consent forms from all participants. Institutional ethics approvals were obtained if the
institution had any review board before initiation of the study.
Data were collected using self-report questionnaires at 5 points in time: the day before hospital discharge,
1 month, 2 months, 4 months, and 6 months postpartum. The present study specifically reports the
findings during the hospital stay. The self-report questionnaire during hospitalization consisted of the
following contents: demographics and background information; depressive symptoms, as measured by
the Japanese version of the Edinburgh Postnatal Depression Scale (the Japanese-EPDS) (9); fatigue, as
measured by the Postnatal Accumulated Fatigue Scale (PAFS), which we developed; maternal
confidence and maternal satisfaction, as measured by the Postpartum Maternal Confidence Scale and
the Postpartum Maternal Satisfaction Scale, respectively (10); childcare values, as measured by the
Childcare Value Scale (CVS) (11); checklists for physical symptoms; perceptions on childcare and daily
life; and perceptions on the nursing care they received during the hospital stay. In addition to
questionnaire responses by participants, researchers or research nurses obtained additional data from
vital records data at the hospitals.
Data were analyzed using stepwise logistic regression through SPSS ver. 21. The two-category outcome
was whether a woman scored >9 in the Japanese-EPDS. To generate candidate variables for entry into a
stepwise logistic regression analysis, we initially performed univariate analysis via χ2 tests for categorical
variables and Mann-Whitney U-tests or Kruskal-Wallis tests for those with nonparametric distributions.
We introduced significant (p<.05) or nearly significant (p<.10) independent variables from the univariate
analysis into a stepwise logistic regression analysis. When independent variables that were known to be
predictors of postpartum depression from previous studies failed to show significant correlations with the
outcome (the Japanese-EPDS), we decided to enter those variables into a stepwise logistic regression
analysis. Independent variables were entered in two sets: type of delivery (vaginal vs. elective cesarean
section (CS) vs. emergency CS) was entered first, and then all remaining variables were entered based
on the maximum likelihood-ratio statistic.
Results: Of the original 3769 women who agreed to participate, 3633 women responded to the
questionnaire during the hospital stay (96.4% response rate). After deletion of 292 cases (47 women with
diagnosed or previous history of prenatal psychological disorders including depression, 22 women who
did not respond within the specified time limit, 152 women who did not practice rooming-in during the
hospital stay, 70 women with missing values for main outcome measures, and 1 woman without vital
records data), data from 3341 women were available for analysis. From this sample, we created a group
of 461 first-time mothers aged 35 and over, which we used for the analysis of the present study.
Nearly 21% of women scored >9 on the Japanese-EPDS during the hospital stay. Univariate analysis
resulted in 14 independent variables that showed significant correlations with the Japanese-EPDS.
Depressive symptoms were more strongly associated with: emergency cesarean section, gestational
diabetes or diabetes in pregnancy, husband/partner with more advanced age, higher physical burden
during hospital stay, lower satisfaction with sleep, not exclusively breastfeeding, taking more minutes for
baby feeding, lower satisfaction with birth experience, more concerns about newborn caretaking after
discharge, more concerns about one’s own life after discharge, more concerns about social support after
discharge, newborn lower birth weight, newborn long-term complications, and the pregnancy desired
most not by the mother or couple. A stepwise logistic regression analysis showed that only six predictors
provided an adequate model among Japanese first-time mothers aged 35 and over. Emergency cesarean
section (odds ratio (OR) of 2.88, 95% confidence interval (CI) of 1.47, 5.63), lower satisfaction with birth
experience (OR 2.07, 95% CI 1.24, 3.45), higher physical burden in daily life (OR 3.04, 95% CI 1.11,
8.29), newborn long-term complications (OR 4.63, 95% CI 1.79, 11.96), more concerns about newborn
caretaking after discharge (OR 1.21, 95% CI 1.05, 1.39), and more concerns about one’s own life after
discharge (OR 1.24, 95% CI 1.08, 1.41) were associated with depressive symptoms. For the logistic
regression model, the Hosmer and Lemeshow test was not significant (χ2=10.72, df 7, p=0.218),
indicating that the data fit the model well. Of women who scored <9 in the Japanese-EPDS, 95.0% were

correctly classified by the model; of those who scored >9, 29.6% were correctly classified. The overall
success rate of prediction was 81.1%.
Conclusion: The findings of logistic regression analysis indicated that women with lower birth experience
satisfaction showed more depressive symptoms, as did women who experienced emergency CS
compared with those with vaginal delivery. The birth experience is potentially traumatizing for some
women. Mothers may experience distress if they require medical interventions such as vacuum extraction
and emergency CS, especially when they expected to have a natural delivery. Because older first-time
mothers often require more medical interventions during delivery, nurses should be sensitive to women’s
perceptions of their birth experience, especially when women experience emergency CS unexpectedly.
Higher physical burden was found to be another significant predictor for depressive symptoms. This
indicates the importance of assessing women’s perceptions of their physical burden during the
hospitalization. Postpartum hospital stays in Japan are usually 4 to 5 days following a vaginal birth, a few
days longer in cases of CS. Asking postpartum women about their perceived physical burden and
providing appropriate care during hospitalization will help to prevent depressive symptoms. Women who
had more concerns about their own life and newborn caretaking after discharge also showed more
depressive symptoms. An additional predictor of depressive symptoms was newborn long-term
complications that included congenital diseases. Nursing assessment of women should include their
concerns about life including newborn caretaking after discharge and perceptions of newborn long-term
complications. These assessments will lead to appropriate nursing support which may help to prevent
PPD for older first-time mothers.
In summary, logistic regression analysis identified the following six predictors for PPD in Japanese first-
time mothers aged 35 and over: emergency cesarean section, lower satisfaction with birth experience,
higher physical burden during hospital stay, newborn long-term complications, and more concerns about
one’s own life including newborn caretaking after discharge. Recognition of women with these factors will
help nurses to identify those at risk for developing PPD and to provide appropriate care during
hospitalization after childbirth.
References
1. The Ministry of Health, Labour and Welfare. A demographic survey of fiscal yesr 2006 2006 [cited 2013 June 4].
Available from: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei06/hyo4.html. (in Japanese) 2. The Ministry of
Health, Labour and Welfare. A demographic survey of fiscal year 2013 2013 [cited 2013 May 20]. Available from:
http://www.mhlw.go.jp/toukei/list/dl/81-1a2.pdf. (in Japanese) 3. Jolly M, Sebire N, Harris J, Robinson S, Regan L.
The risks associated with pegnancy in women aged 35 years or older. Human Reproduction. 2000;15(11):2433-7. 4.
Matsuda Y, Kawamichi Y, Hayashi K. Issues of the maternal age: Statistics on older and younger women in the
database of Japan Society of Obstetrics and Geynecology. Perinatal Medicine. 2013;43(7):833-6. (in Japanese) 5.
Carolan M. Maternal and child health nurses: a vital link to the community for primiparae over the age of 35.
Contemporary Nurse: A Journal for the Australian Nursing Profession. 2004;18(1-2):133-42. 6. Carolan M. The
graying of the obstetric population: implications for the older mother. Journal of Obstetric, Gynecologic & Neonatal
Nursing. 2003;32(1):19-27. 7. Matsumoto K, Tsuchiya K, Itoh H, Kanayama N, Suda S, Matsuzaki H, et al. Age-
specific 3-month cumulative incidence of postpartum depression: The Hamamatsu Birth Cohort (HBC) study. Journal
of Affective Disorders. 2011;133:607-10. 8. Yamashita H, Yoshida K, Nakano H, Tashiro N. Postnatal depression in
Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood.
Journal of Affective Disorders. 2000;58(2):145-54. 9. Okano T, Murata M, Masuji F, Tamaki R, Nomura J, Miyaoka H,
et al. Validation and reliability of the Japanese version of the Edingurgh Postnatal Depression Scale. Journal of
Diagnostic of Psychiatry. 1996;7(4):525-33. (in Japanese) 10. Maehara K, Mori E. Development of the Postpartum
Maternal Confidence Scale and the Postpartum Maternal Satisfaction Scale: Relaibaility and validity. Journal of
Graduate School of Nursing, Chiba University. 2005;27:9-18. (in Japanese) 11. Chen D, Mori E, Mochizuki Y,
Kashiwabara E, Ando M, Otsuki E. Development of the Childcare Value Scale for parents with infant: Reliability and
validity. Chiba Academy of Nursing Science. 2006;12:76-82. (in Japanese)
Contact
[email protected]

College Students' Attitude Toward the Elderly with Dementia in Japan: A
Comparison Between Nursing and Non-Nursing Students
Miwako Hoshi, PhD, RN, Japan
Chizuru Ikeda, BS, RN, Japan
Yuri Kondo, BS, RN, Japan
Maki Fujimura, BS, RN, Japan
Yurie Maeda, BS, RN, Japan
Purpose
The purpose of this research is to examine the attitude toward elderly people of college nursing students
and those who are not nursing majors, as well as to investigate whether student background data would
affect their attitudes shown.
Target Audience
The target audience of this presentation are nursing educators and researchers who are interested in
gerontological nursing education, especially those striving to improve the quality of care provided for the
elderly with dementia via increasing young generation’s understanding of the elderly people suffering
from dementia.
Abstract
Purpose: The purpose of this study was to evaluate the attitude of Japanese nursing and non-nursing
students toward the elderly with dementia and to investigate the effects of students’ varied background
data on their attitudes shown.
Methods: A total of 214 nursing students (n=137) and non-nursing students (n=77) was recruited to
complete a questionnaire from a national university located in Southern Japan using convenience
sampling method. The criterion of choosing subjects is the level of their professional nursing knowledge
and clinical training experience. Based on their professional nursing knowledge and clinical experience,
subjects were assigned to three groups: Group A-students receiving no formal health-related education
and clinical experience training, Group B-freshman nursing students who have limited professional
knowledge and no clinical experience with demented elderly people, and Group C-senior nursing
students who have profound nursing knowledge and clinical experience with the elderly. A semantic
differential scale with 25 bipolar pairs of adjectives is used to explore the attitudes. Demographic data
collected in the questionnaire consist of age, gender, experience with the elderly suffering from dementia,
whether having family members with dementia, and whether engaging in a volunteer activity held for the
demented elderly. In addition, subjects’ level of empathy is assessed to use as a personality variable.
Methods used in this study include descriptive statistics, Pearson’s correlation analysis and analyses of
variances (ANOVAs). The former were used to examine the correlations among variables, whereas the
latter were used to evaluate group differences in the attitude shown toward the elderly with dementia.
Results: The results showed that the senior nursing students demonstrated a significantly higher positive
attitude toward the elderly with dementia compared to their freshman nursing peers as well as those non-
nursing students. The findings also showed that students with more experience of interacting with or
volunteering for the demented elderly demonstrated a higher positive attitude than those with less
experience in interaction or volunteer work. In addition, the results revealed that people with a higher level
of empathy had a significantly more positive attitude toward these elderly people.
Conclusion: The study indicated that having professional nursing knowledge, clinical and volunteering
experience, or even a simple interaction with the elderly with dementia may result in young college
students’ positive attitude toward these elderly people. Findings of the study could be used to design
courses for college nursing students in facilitating the understanding of old people living with dementia.
Contact

[email protected]

The Relationships Between Fatigue, Depression and Quality of Life Among
Depression Outpatients
Ya-Ting Hsu, BS, Taiwan
Purpose
The purpose of this presentation is to understand the distribution of the depression outpatients with
fatigue, depression, and quality of life. To investigate the factors which influence the depression
outpatient's quality of life.
Target Audience
The target audience of this presentation are clinical nurses.
Abstract
Purpose: The purpose of this study is to understand the distribution of the depression outpatients with
fatigue, depression, and quality of life. To investigate the factors which influence the depression
outpatient's quality of life.
Methods: This study used cross-sectional study design. A total of 150 subjects were recruited by
convenience sampling from a teaching hospital. Research instruments included basic demographic
questionnaire, Visual Fatigue Scale(VFS), Beck Depression Inventory(BDI-ll), and SF-36 Taiwan version.
Results: (1)There were 96 female(64%) and 54 male(36%).Mean age of female was 52.6 years old (SD
= 13.5) and mean age of male was 50.5 years old (SD = 15.8) .
(2)Most of the subjects were moderate depression（N=39，26%）, mean fatigue score was 18. 6（
SD=17.9）, and quality of life score was 52.6（SD=20.9）.
(3)The higher fatigue, the higher depression, showed a positive correlation（r=.767，p<.001）. The
higher fatigue, the lower quality of life（r=-.781，p<.001）.
(4) The multiple linear regression models showed that fatigue and depression are the best predictors of
quality of life. Multiple regression model explained quality of life .302 variances.
Conclusion: Clinical nurses can understand the distribution of fatigue, depression, and quality of life. And
understand the factors which influence the depression outpatient's quality of life. Clinical nurses can give
depression outpatients supports and interventions to enhance their quality of life.
References
Fava M, Ball S, Nelson JC, Sparks J, Konechnik T, Classi P, Dube S, Thase ME. (2013). Clinical relevance of fatigue
as a residual symptom in major depressive disorder. Journal of Depression and Anxiety. Bould H, Collin SM, Lewis
G, Rimes K, Crawley E. (2013). Depression in paediatric chronic fatigue syndrome. Archives of disease in childhood,
98(6), 425-428. Asberg M, Nygren A, Nager A. (2013). Distinguishing between depression and chronic fatigue
syndrome. Lakartidningen, 110(9-10), 484-486.
Contact
[email protected]

The Project of Improving the Rate of Access Site Bleeding after Femoral Artery
Cardiac Catheterization
Hui-Yi Pan, BS, Taiwan
Pei-Jing Wu, RN, BS, Taiwan
Chia-Chi Liu, RN, BS, Taiwan
Ying-Ju Lin, RN, BS, Taiwan
Hsin-Mei Wu, RN, BS, Taiwan
Cheng-Kang Chen, RN, BS, Taiwan
Tzu-Chia Lin, MS, Taiwan
Purpose
The purpose of this presentation is to reduce the rate of access site bleeding after femoral artery cardiac
catheterization.
Target Audience
The target audience of this presentation is health professionals and cardiovascular technicians.
Abstract
Purpose: Access site bleeding is the most common complication after cardiac catheterization. The
classic sand bag method is widely used for control of bleeding and prevention of vascular complications.
It is also crucial for nurses to monitor and assess the access site after the procedure. In 2012, the
incidence of access site bleeding after cardiac catheterization is 15.4% (12/91) in our intensive care unit,
and all of them have the procedure via femoral artery. The aim of the project was to improve the
incidence of access site bleeding after the procedure.
Methods: The characteristics of nurses (n = 20) and patients (n =12) were analyzed. Half of the nurses
have work experience less than three years. The average age of patient is 61 years old. Most of them
were overweight (71.4%), having at least one chronic disease (e.g., heart disease, hypertension,
diabetes, kidney disease, and liver disease) and taking anticoagulant medicine (78.5%). Through the
situation analysis and field observation, the causes of access site bleeding were identified as follows:
patient characteristics, a lack of evaluation indicators of nursing standard, inadequate professional ability
and experience of novice nurses, displacement of sand bag due to longer periods of bed rest,
inappropriate fixed equipment for the sand bag, and insufficient orientation program. To resolve problems
such as those listed above, we created equipment with elastic material to fix the sandbag and compress
the access site. The guideline and evaluation indicators of post-cardiac catheterization were also built.
The novice nurses were arranged to care post-cardiac catheterization patients and were supervised by
senior nurses. An educational audiovisual and in-service education supervised by a licensed cardiologist
were established to enhance nurses’ knowledge.
Results: The incidence of access site bleeding after cardiac catheterization decreased from 15.4% to
0%.
Conclusion: Through implementing those strategies, the incidence of access site bleeding after cardiac
catheterization significantly decreased. Also, the experience of using the elastic equipment for fixing the
sandbag and compressing the access site is spread to other intensive care unit. However, considering
that some of the patient characteristics are irreversible, nurses and cardiologist should carefully assess
the risks factors of access site bleeding. The project could serve as a reference for clinical practice.
References
1.Cale, L., & Constantino, R. (2012). Strategies for decreasing vascular complications in diagnostic cardiac
catheterization patients. Dimensions of Critical Care Nursing, 31(1), 13-17. doi: 10.1097/DCC.0b013e31823a52f5
2.Sulzbach-Hoke, L. M., Ratcliffe, S. J., Kimmel, S. E., Kolansky, D. M., & Polomano, R. (2010). Predictors of
complications following sheath removal with percutaneous coronary intervention. Journal of Cardiovascular Nursing,
25(3), E1-8. doi: 10.1097/JCN.0b013e3181c83f4b 3.Sedlacek, M. A., & Newsome, J. (2010). Identification of vascular

bleeding complications after cardiac catheterization through development and implementation of a cardiac
catheterization risk predictor tool. Dimensions of Critical Care Nursing, 29(3), 145-152. doi:
10.1097/DCC.0b013e3181d24e31
Contact
[email protected]

The Association Between Obesity and Asthma in Children
Pei-Ching Liu, MSN, RN, Taiwan
Bih-Shya Gau, PhD, Taiwan
Purpose
The purpose of this presentation is to explore the relation and related covariates between childhood
asthma and obesity.
Target Audience
The target audience of this presentation is health professionals paying special attention on the health
issues encountered by pediatric populations.
Abstract
Purpose: The simultaneous increase in asthma and obesity prevalence has been widely discussed in
past twenty worldwide. However, the research finding is still inconsistent and scanty in Taiwan. Therefore,
this study was conducted to explore the relationship between obesity and asthma in Taiwanese children.
Methods: A cross-sectional study was conducted in National Taiwan University Hospital in Taiwan from
December 2009 till December 2011. Children with diagnosed asthma were recruited. Demographic data,
asthma history, diet pattern and daily activity were recorded through questionnaires. Each child‘s current
weight and height were measured to acquire their age- and gender-adjusted BMI values. Asthma control
level was defined by a summary score from the Children Asthma Control Test (C-ACT). The food
frequency questionnaire (FFQ) was adopted to evaluate children diet pattern.
Results: 94 children with asthma were recruited. Higher BMI was correlated with a worse C-ACT score
(OR 1.15, 95% CI 0.99 to 1.37). A more frequent intake of hamburger, oily snacks, sweetened drinks and
chocolate or candies was associated with the worse asthma control (OR 1.85, 95% CI 0.89 to 3.99). In
addition, children from lower SES (OR 4.66, 95% CI 1.43 to 16.22) and born with mothers in older ages
(OR 1.14, 95% CI 1.03 to 1.31) suffered from worse asthma control. On the other side, children had
better asthma control if parents reported that the doctor had ever encouraged their children to engage in
more physical activities (p<0.02).
Conclusion: Higher BMI is correlated with a worse asthma control among children with asthma in
Taiwan. A more intake of unhealthy food may also contribute to their asthma severity. Children with both
epidemics form a unique group and should receive specific care.
References
Ahmad, N., Biswas, S., Bae, S., Meador, K. E., Huang, R., & Singh, K. P. (2009) Association between obesity and
asthma in US children and adolescents. Journal of Asthma 46(7), 642-646. Gilliland, F. D., Berhane, K., Islam, T.,
McConnell, R., Gauderman, W. J., Gilliland, S. S., . . . Peters, J. M. (2003) Obesity and the risk of newly diagnosed
asthma in school-age children. American Journal of Epidemiology 158(5), 406-415. Liu, P. C., Kieckhefer, G. M., &
Gau, B. S. (2013). A systematic review of the association between obesity and asthma in children. Journal of
Advanced Nursing, doi: 10.1111/jan.12129
Contact
[email protected]

Hope and Learned Resourcefulness Among Parents of Disabled Children
Ozlem Aslan, PhD, Turkey
Sekmen Kamile, MSN, Turkey
Mesut Akyol, Turkey
Purpose
The aim of this presentation was to explain nurses the hope and learned resorcefulness levels among
parents of disabled children.
Target Audience
Nurses
Abstract
Purpose: The aim of this reseach was to determine the hope and learned resorcefulness levels among
parents of disabled children.
Methods: 105 parents of disabled children in a school for disabled children in Ankara were included in
the study in March 2003. Herth Hope Scale (HHS) and Rosenbaum’s Learned Resourcefulness Scale
(RLRS) were used to collect the data. Descriptive statistics, Student’s t test, Mann-Whitney U Test,
Kruskall Wallis Variance Analysis, Spearman Correlation were used to analyze tha data in SPSS
program. In the resliability analysis, cronbach’s alpha was 0.90 for HHS, cronbach’s alpha was 0.82 in
RLRS.
Results: The mean age of parents was 33.59± 6.01 years. 50.5% of children had a neurological disease.
The mean disease duration was 7± 4.7038 years. The mean HHS score was 71.72± 14.848 and mean
RLRS score was 69.49± 9.791. The mean HHS score was statistically higher than that of female parents
(z=2.028, p=0.043). Hope scores didn’t differ with parent’s social support, parent’s and spouse’s
education level, child congenital disease and child diagnosis (p>0.05). RLRS scores didn’t differ with
parent’s gender, parent’s social support, parent’s and spouse’s education level, child’s congenital disease
and child’s diagnosis (p>0.05). There was a statistically significant positive correlation between HHS
scores and RLRS scores (rho=0.85, p<0.001).
Conclusion: This research showed that hope and learned resourcefulness levels of parents of disabled
children were above middle level. Male parents’ hope scores were higher than those of female parents.
Defining and supporting parents who have problems during nursing care process will provide an
uninterrrupted adaptation process and positive care outcomes.
References
1.Cramm JM, Nieboer AP, “Psychlogical Well-Being of Caregivers of Children with Intellectual Disabilities: Using
Parental Stress As A Mediating Factor”, J Intellect Disabil, 2011, June, 15(2), pp.101-113. 2.Huang YP, Kellett U, St
John W, “Being Concerned: Caregiving for Taiwanese Mothers of A Child With Cerebral Palsy”, J Clin Nurs, Jan,
2012, 21(1-2), pp. 189-197. 3.Kuhlthau KA, Bloom S, Van Cleave J et all, “Evidence for family-Centered Care for
Children With Special Heath Care Needs: A Systematic Review”, Acad Pediatr, 2011, Mar-Apr, 11(2), pp.136-143.
Contact
[email protected]

Measured Noise Levels in the Hospital with Correlating Patient Perception
Rachel Marie Lyle, USA
Mercy N. Mumba, Honors BSN, RN, CMSRN, USA
Deborah Behan, PhD, RN-BC, USA
Purpose
The purpose of this presentation is to present and educate healthcare professionals about the findings of
our study, including: noise levels found in the hospital along with correlating patient perceptions, the most
disturbing noises for patients, and recommendations for improving patient satisfaction related to
quietness.
Target Audience
The target audience of this presentation is all healthcare professionals involved in direct patient care in an
acute care facility.
Abstract
Purpose: The primary objective of this study were to (1) determine de-identified patient perceptions of
noise and compare with the actual current noise levels within their rooms. Other objectives of this study
were to: (2) determine the actual decibels of noise within the hospital, including the nurse’s station,
hallways, and patient rooms; (3) determine the noise sources occurring within the rooms and hallways at
the time of decibel measurement; and (4) identify the most disturbing causes of noise to the de-identified
patients.
Methods: This was a quantitative study with a two-part design. It is both a correlational study correlating
patient perceptions of noise levels within their rooms and the actual current noise levels within their
rooms. The other part is a descriptive study describing the most disturbing sources of noise to patients.
The hospital investigated for this study was a hospital with a size of approximately 300 beds located in
north central Texas. A decibel meter was used to measure sound levels in the hallways, nurse’s stations,
and patient rooms of different floors of the hospital on different days of the week at differing times of the
day. Patient rooms were randomly selected from the floor to measure noise levels within and 187
observations were recorded. No identifying information was collected and participation was voluntary.
After obtaining verbal consent, two dB measures were taken in each patient’s room: (1) in the doorway at
the extent of the length of the door with the door open, and (2) in the room at the foot of the patient’s bed
with the door closed. Two questions were asked of the patient, “Is the noise level right now okay for you?”
and “What would you say has been the most disturbing cause of noise during your hospital stay?” An
observation log was used to record these decibel readings, as well as to record the sources of noise
occurring within the room at the time of the dB measurement. Answers to the question “Is the noise level
right now okay for you?” were recorded in the observation log as a “Y” or “N”. Patient answers to the
open-ended question, “What would you say has been the most disturbing cause of noise during your
hospital stay?” were recorded verbatim. Statistical software called SPSS was used to determine
differences and correlations between noise levels and patient perceptions.
Results: A significant negative correlation was found between patient perception of noise levels and
decibels recorded in patient rooms with the door open. The morning time frame was found to be the
noisiest and the time with the lowest patient satisfaction with noise levels, followed by nighttime and then
late afternoon. The majority of the most cited disturbing noise sources to patients were those occurring
outside the patient rooms. Alarms, beeping noises, and staff talking in the hallway were cited most often.
Conclusion: Excess noise is often reported by patients as one of the most disturbing factors during their
hospital stay. Scores on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and
Systems) Survey from the particular hospital studied have also shown poor patient satisfaction in the area
of hospital noise. The majority of patients were okay with the current noise levels at the time of our
interview, however many stated that there were periods during their hospital stay in which the noise level
was not okay. There is a need for staff education involving findings of this study regarding the current

noise levels, causes of patient disturbance, and ways to reduce noise levels on the floor. Because
patient satisfaction with noise levels decreased as noise levels with the door open increased, one
recommendation would be to keep patient doors closed when possible. Other recommendations to
improve patient satisfaction with quietness of the hospital would be for staff to keep conversations in the
nurse’s stations or away from patient rooms and attend to alarms or other beeping noises as quickly as
possible.
References
Buxton, O. M., Ellenbogen, J. M., Wei, W., Carballeira, A., O'Connor, S., Cooper, D., & ... Solet, J. M. (2012). Sleep
Disruption due to Hospital Noises. Annals Of Internal Medicine, 157(3), 170-179. Choiniere, D. B. (2010). The Effects
of Hospital Noise. Nursing Administration Quarterly, 34(4), 327-333. doi: 10.1097/NAQ.0b013e3181f563db Marqués,
P., Calvo, D., Mompart, M., Arias, N., & Quiroga, E. (2012). Multi-center study of noise in patients from hospitals in
Spain: A questionnaire survey. Noise & Health, 14(57), 83-85. doi:10.4103/1463-1741.95136 Richardson, A.,
Thompson, A., Coghill, E., Chambers, I., & Turnock, C. (2009). Development and implementation of a noise reduction
intervention programme: a pre- and postaudit of three hospital wards. Journal Of Clinical Nursing, 18(23), 3316-3324.
Ryherd, E., Okcu, S., Hsu, T., & Mahapatra, A. (2011). Hospital Noise and Occupant Response. ASHRAE
Transactions, 117(1), 248-255. Vehid, S., Erginöz, E., Yurtseven, E., Çetin, E., Köksal, S., & Kaypmaz, A. (2011).
Noise Level of Hospital Environment. TAF Preventive Medicine Bulletin, 10(4), 409-414. Wiese, C. H., & Wang, L. M.
(2011). Measured Levels of Hospital Noise Before, During, and After Renovation of a Hospital Wing, and a Survey of
Resulting Patient Perception. ASHRAE Transactions, 117(1), 256-263. World Health Organization. (1999a).
Conclusions and Recommendations. In Guidelines for Community Noise (6). Retrieved from
http://www.who.int/docstore/peh/noise/Comnoise6.htm World Health Organization. (1999b). Guideline Values. In
Guidelines for Community Noise (4). Retrieved from http://www.who.int/docstore/peh/noise/Commnoise4.htm
Contact
[email protected]

The Effectiveness of Acupressure in the Quality of Sleep of the Head and Neck
Cancer Patients Receiving Chemotherapy: The Application of Rogers' Theory
Shu-Ya Chan, RN, MSN, Taiwan
Purpose
1.The purpose of this presentation is identify the protocol of acupressure program, the Head and Neck
cancer patients receiving chemotherapy. 2.The purpose of this presentation is recognize the beneficial
effects of the protocol of acupressure program on the Head and Neck cancer patients receiving
chemotherapy.
Target Audience
1.The target audience of this presentation is know the quality of sleep of Head and Neck cancer patients
receiving chemotherapy. 2. The target audience of this presentation is recognize the beneficial effects of
the protocol of acupressure program on the Head and Neck cancer patients receiving chemotherapy.
Abstract
Purpose: The purpose of this study is to examine the effectiveness of acupressure in regards to the
Quality of Sleep of Head and Neck Cancer Patients receiving Chemotherapy. Purposive sampling is used
in this study of 58 Head and Neck Cancer Patients (PSQI>5) receiving Chemotherapy from the Head and
Neck Cancer units of a medical center in Southern Taiwan.
Methods: An experimental design is used for this study. By controlling the effect of hypnotics, age, and
gender (male), subjects are randomly assigned to either an experimental group or a control group. The
experimental group has 25 subjects, and the control group has 33 subjects. The total sample size is 58
subjects. The experimental group received two weeks of acupressure protocol. The sessions were
conducted five days per week, two times per day with one session in the morning and one in the evening.
Each session lasted 12 minutes. The control group did not receive the acupressure protocol. Five series
of data were collected from the fifty eight subjects during the one month experiment.Research
instruments include the Demographic Inventory of Patients, Pittsburgh Sleep Quality Index, and Richards-
Campbell Sleep Questionnaire. Statistical analysis of all collected data were performed with descriptive
analysis, Chi-Square, two-sample t-test, two-way ANOVA with repeated measures, and three-way
ANOVA with repeated measures.
Results: Results: Acupressure significantly improved the quality of daily sleep, as well as the sleep
quality in the previous one month of Head and Neck cancer patients receiving chemotherapy. Subjective
sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance were all
significantly improved.
Conclusion: Based on the research results and a thorough literature review, we suggest that four week
long acupressure research study be conducted. Continuous intervention shall result in better treatment
effectiveness. This study serves as a reference for medical practitioners to help improve sleep quality of
Head and Neck cancer patients receiving chemotherapy.
References
1.Andrykowski, M. A., Carpenter, J. S., Greiner, C. B., Altmaier, E. M., Burish, T. G., Antin, J. H., Gingrich, R.,
Cordova, M. J., & Henslee-Downey, P. J. (1997). Energy level and sleep quality following bone marrow
transplantation. Bone Marrow Transplantation, 20(8), 669-279. 2.Athanasiadis, I., Taylor, S., Vokes, E. E.,
Rademaker, A., Mittal, B. B., Ganzenko, N., Blough, R., Lester, E. P., & Kies, M. S. (1997). Phase II study of
induction and adjuvant chemotherapy for squamous cell carcinoma of the head and neck, a long-erm analysis for the
illiois cancer center. Cancer, 79(3), 588-594. 3.Buysse, D. J., Reynolds III, C. F., Monk, T. H., Hoch, C. C., Yeager, A.
L., & Kupfer, D. J. (1991). Quantification of subjective sleep quality in healthy elderly men and woman using the
Pittsburgh Sleep Quality Index(PSQI). Sleep, 14(4), 331-338. 4.Beal, M. W. (1992). Acupuncture and related
theatment modalities Part É: Theoretical Background. Journal of Nurse-Midwifery, 37(4), 254-259. 5.Creak, A. L.,
Harrington, K., & Nutting, C. (2005). Treatment of recurrent head and neck cancer: Re-irradiation or chemotherapy.

Clinical Oncology, 17(3), 138-147. 6.Cho, Y., C., & Tsay, S. , L. (2004). The effect of acupressure with massage on
Fatigue and depression in patients with end-stage renal disease. Journal of Nursing Research, 12(1), 51-59.
7.Gunther, M. E. (2002). Rogers: Unitary Human Beings. In Marriner-Tomey, A., & Alligood, M. (Ed.), Nursing
Theorists and Their Work(3rd., pp.226-249). St. Louis: Mosby. 8.Lu, W. (2005). Acupuncture for side effects of
chemoradiation therapy in cancer patients. Seminars in Oncology Nursing, 21(3), 190-195. 9.Ortego, N. E. (1994).
Acupressure: An alternative approach to mental health counseling through bodymind awareness. Nurse Practioner
Forum, 5(2), 72-76. 10.Pivot, X., Awada, A., Gedouin, D., Kerger, J., Rolland, F., Cupissol, D., Caponigro, F.,
Comella, G., Lopez-Pousa, J. J., Guardiola, E., Giroux, B., Gerard, B., & Schneidr, M. (2003). Result of randomized
phase II studies comparing s16020 with methotrexate in patients with recurrent head and neck cancer. Annals of
Oncology, 14(3), 373-377. 11.Richards, K. , Nagel, C., Markie, M., Elwell, J., & Barone, C. (2003). Use of
complementary and alternative therapies to promote sleep in critically ill patients. Critical Care Nursing Clinics of
North America, 15(3), 329-340. 12.Richardson, S. J. (1997). Assessment techniques: A comparison of tools for the
assessment of sleep pattern disturbance in critically ill adults. Dimensions of Critical Care Nursing, 16(5), 226-242.
13.Rogers, M. E. (1970). An introduction to the theoretical basis of nursing. Philadelphia: F.A. Davis. 14.Sok, S. R.,
Erlen, J. A., & Kim, K. B. (2003). Effects of acupuncture therapy on insomnia. Journal of Advanced Nursing, 44(4),
375-384. 15.Tsay, S. L., & Chen, M. L. (2003). Acupressure and quality of sleep in patients with end-stage renal
disease-a randomized controlled trial. International Journal of Nursing Studies, 40(1), 1-7.
Contact
[email protected]

Avoiding Litigation: Legal-Based Mediation Education for Nurses
Takako Hiramatsu, RN, MSN, Japan
Michiko Senda, RN, Japan
Purpose
The purpose of this presentation is to describe our mediation education program. We hope that sharing
our experience would facilitate discussion of how to design an effective training program for medical
mediators.
Target Audience
The target audiences of this presentation are nurse managers and clinical nurses.
Abstract
Purpose: In response to an increasing number of litigations relating to medical errors and growing
awareness of patients’ rights, training for a medical mediator, who engages in a mediating role in a
hospital, is in progress. Mediation is a dialogue based negotiation, and is one of conflict management
models, which aims to resolve confrontations resulting from different values and interests held between
individuals or nations. Mediation also aims to manage individuals’ psychological and emotional conflicts.
Following the establishment of a medical safety administration department at our institution in 2003,
multidisciplinary teams including nurse medical safety officers have taken the lead in tackling prevention
of in-house medical errors. The activities included mediation education for nurses, in which the legal
aspects of various problem cases were discussed with the guidance from the hospital’s legal advisors. By
enabling nurses to act as first responders to a problem using mediation skills based on direct
conversation, it was expected that nurses could promote good communication between patient and
medical staff prior to escalation of a situation to something serious like medical litigation.
This poster describes our mediation education program. We hope that sharing our experience would
facilitate discussion of how to design an effective training program for medical mediators.
Methods: Nursing administrators presented problem cases they were personally dealing with and then
discussed these cases in groups. The hospital’s legal advisors commented on legal aspects and
participants learned how to build good legal and ethical relationships as a nurse.
Results: The first session - In the first session, 20 nursing administrators and 6 legal advisors examined
two cases regarding “dealing with family”. Key words included “family registration law”, “legal heirs” and
“livelihood protection law”, and the definition of family was thoroughly debated. The second session - In
the second session, a topic of “dealing with a patient’s verbal abuse and violence” was discussed by 22
nursing administrators and 6 legal advisors. Key words of this session were “patient’s competence in
decision-making”, “a charge relating to infliction of bodily injury”, and “criminal intimidation”. The nursing
administrators received legal advice on how to deal with situations where nurses are exposed to
immediate danger. In particular, nursing administrators realized the importance in discussing these issues
in nursing and multidisciplinary conferences, if the issue can be solved by medical teams or if patients’
violence and verbal abuse result from their illnesses. The third and fourth sessions - A further two
sessions were held based on different themes. One of the topics was “the right to self-determination”, and
nursing administrators discussed the pros and cons of a related advance directive system and a method
of writing nursing records during problematic situations were shared. Another topic was medical
procedures defined in the Medical Practitioners Acts and Act on Public Health Nurses, Midwives and
Nurses. Managerial topics relating to patients’ violence was also discussed. The example included how to
document patients’ behaviors, which break the hospital regulations and obstruct nursing practice.
Conclusion: In addition to providing an opportunity for thinking from an ethical perspective, which is
integral to nursing, consideration of problem cases from a legal standpoint during discussion with legal
advisors enables nurses to acquire the skills to not only build relationships with patients but also protect
themselves as nurses. The outcomes of this educational program have not yet been evaluated. However,

it is expected the continuance of this educational program would lead to desirable changes in the
behaviors of nursing administrators.
Contact
[email protected]

Sparks Code-Blue Ability Questionnaire of Novice Nurses in the ICU
Madelyn Marie Sparks, RN, BSN, USA
Purpose
The purpose of this presentation is to discuss the creation and testing of a questionnaire to accurately
and reliably measure the confidence of novice nurses before and after a mock code-blue simulation.
Target Audience
The target audience of this presentation is nursing researchers and nursing educators from ICU’s around
the world that are in charge of training novice nurses.
Abstract
Purpose: The need for intensive care nurses worldwide is growing. Turnover rates of critical care nurses
in excess of 12% and an aging population living with more complex health issues has created a
continuing need to educate novice nurses who are working in intensive care units with little to no
experience in this specialty. A comprehensive literature review of the literature was conducted to
determine the existence of a tool to test the confidence level of novice nurses during code-blue
resuscitation. No standardized questionnaire was found to measure the effectiveness of education on the
confidence of novice nurse’s in code-blue skills before and after mock code-blue simulations. The
purpose of this project therefore was to develop and test the initial reliability and validity of the Sparks
Code-Blue Ability Questionnaire of the Novice Nurse in the ICU.
Methods: A mixed-methods design will be used in this study. A 10-point Likert-type questionnaire was
developed to assess confidence of the novice nurse in a code-blue scenario. The research questions for
this study are: 1) What is the initial reliability and validity of the Sparks Code-Blue Ability Questionnaire of
Novice Nurses in the ICU (SCBAQ)? 2) What is the confidence of novice nurses before and after the
mock code-blue simulation as measured by the SCBAQ. In order to assess the validity of the
questionnaire the item-level I-CVI method will be used. A panel of (n=5) experts will be recruited to
determine the content validity index of the SCBAQ. Data will be collected from a population of novice
nurses (n=30). The SCBAQ will be administered at pre and post test during simulated code blue
scenarios on both day and night shifts over a period of two months. A paired t-test, alpha < 0.05, will be
used to compare mean pre-test post-test scores on the SCBAQ.
Results: IRB approval for this study has been obtained. Data collection for research questions one and
two are in progress.
Conclusion: The ability to retain qualified ICU nurses is essential to the health of the public. The Sparks
Code-Blue Ability Questionnaire of the Novice Nurse in the ICU is a newly created tool that may help to
determine the confidence level of the novice nurse during a code blue and further research is merited.
Contact
[email protected]

Quality of Life Among Family Caregivers for Stroke Patients Discharged from
Hospital within Six Months in Northern Taiwan
Yu-Hsia Tsai, RN, MS, Taiwan
Purpose
The purpose of this presentation is to share our study that we assessed the quality of life of caregivers
who took care of home-bound stroke patients discharged from hospital within 6 months and to identify its
associated factors.
Target Audience
The target audiences of this presentation are researchers, educators, administrators, clinicians, and
policy makers in medical associative disciplines.
Abstract
Purpose: The aims of this study were to assess the QoL of caregivers who took care of home-bound
stroke patients discharged from hospital within 6 months and to identify its associated factors.
Methods: This was a cross-sectional study. Participants: Name lists of stroke patients discharged within
6 months were provided by several agents located in a suburban county in the northern Taiwan.
Process: After screening by the selection criteria, participants were contacted by phone call first and then
completed the questionnaires by face-to-face interview at their home. Instruments: The instruments
selected for data collection were Caregiver Quality of Life Index (CQLI), patients’ characteristics (including
Barthel Index, BI; Short Portable Mental Status Questionnaire, SPMSQ), caregivers’ characteristics
(including Caregiver Strain Index, CSI), and family resources. Data analysis: All data was managed by
PSSPC-Win18.0. Descriptive statistics (means, frequencies, and percentage) were used to describe the
distribution of each variable. The results of Kolmogorov-Smirnov test showed that none of these variables
were normally distributed (p>.05). Therefore, non-parametric statistical analysis (Spearman correlation,
Mann-Whitney test, Kruskal-Wallis test) was performed. In addition, multiple regression was performed to
identify the predictors of the caregivers’ QoL. The significant level of this study was 0.05.
Results: A total of 184 family caregivers completed questionnaires. Most patients were characterized as:
elderly (67.3±12.3 years old), male (61.4%), married (81%), and unemployed (62.5%), first being
diagnosed as stroke (70.1%), no surgery (91.3%), no intubation (89.7%), no rehabilitation (65.2%), not
using devices (52.7%), no need for institutional care (BI ≥ 60, 72.8%), and intact cognitive function
(SPMSQ> 5, 77.7 % ). Participants’ average duration of hospitalization was 16.5 days (SD= 21.3, range=
2 to 214 days). Most family caregivers were characterized as: middle age (49±13.7 years old), female
(67.9%), high school educated (52.2%), married (84.8%), non-spouse (58.2%), co-resident (83.7%), fair
health (54.3%), and their CSI was ≥ 7 (the mean score of CSI was 6.2±4.7, ranging from 0 to 13). The
family resources were characterized as: most family income was around NT $20,000 to 60,000 per month
(47.8%), major payer was patients’ offspring (50.5%), and the average number of co-resident family were
4.2 ± 2.6 (range: 0-22) persons. Most family had someone to help (81%), but no hired caregiver to share
with their caregiving tasks (77.2%). The total CQLI was 255.1±53.9 (ranging from 0 to 400). The total
CQLI were associated with patients’ characteristics (employment, using devises, BI, SPMSQ); caregivers’
characteristics (education, self-perceived health, CSI); and family resources (monthly family income,
became major payer for medical fees, hired other caregiver or not).The CSI was negatively correlated
with the overall CQLI (r = -.31, p<.01). Multiple regression revealed the following factors determined the
caregivers’ QoL: poor and fair self-perceived health of the caregivers, CSI score, monthly family income
below NT $20,000 and 2-60,000, and medical fees paid by spouse were significant predictors of the
CQLI. These factors explained 33% of the total variance in this regression model.
Conclusion: Caregivers’ care strains were correlated with their QoL. Caregivers with poorer self-rated
health condition, with higher CSI, lower monthly family income, and patient’s spouse who paid patient’s

medical fees reported a lower QoL. Caregivers’ characteristics and their financial situations are the main
factors of caregivers’ QoL among these stroke patients. In order to improve stroke caregivers’ QoL,
facilitating communities’ care system and providing appropriate assistance for medical fee for these long-
term stroke patients would decrease caregivers’ care strains and physical burden. Thus, caregivers’
issues should be considered in discharge planning and community care system.
Contact
[email protected]

Health Perspectives and Lifestyle Issues of First-year Nursing Students: As
Revealed Through a Seminar in Health Self-Management
Shu Chun Chien, RN, PhD, Japan
Toshie Yamamoto, PhD, RN, PHN, Japan
Yoshiko Wazumi, PhD, RN, Japan
Shinobu Saito, PhD, RN, Japan
Akiko Nagata, MN, RN, Japan
Fusako Kawabe, PhD, RN, PHN, Japan
Takashi Maeda, PhD, RN, PHN, Japan
Tomoko Katagiri, MSN, RN, Japan
Purpose
1) The learner will become able to find strategies to assist nursing students with examining and reflecting
upon the relationships between their lifestyles and health conditions. 2) The learner will learn how to
utilize the concept of the Meridian to improve the symptoms and discomfort experienced by students.
Target Audience
The presentation aims to discuss a “Seminar in Health Self-Management” and the benefits this has for
been shown to have for first-year nursing students. The target audience is researchers and educators
with an interest in developing courses that promote the health of students.
Abstract
Purpose: The leading causes of mortality in Japan are related to lifestyle diseases. One need only
consider the top three causes of death: cancer, cardiac disease, and cerebrovascular disease,
respectively. In addition to the pathology and treatment of diseases, it is necessary to offer lectures that
guide students towards thoroughly understanding the principles of health at all stages of development, so
that they may grasp preventive methods. The course “Seminar in Health Self-Management” was
designed to address the principles of health and ways of arranging daily life through applying concepts
from Traditional Chinese Medicine (TCM). The first step is to teach freshmen students how to assess their
lifestyle and identify symptoms or signs of discomfort as health issues. Next, they are guided towards
understanding the relationships between their lifestyles and those issues. The purpose of this study is to
describe the educational strategies of the course, which is designed to improve the health perspectives of
first-year nursing students, and assess how their health perspectives concerning their lifestyles and
health issues changed after attending the course.
Methods: The course “Seminar in Health Self-Management” was organized around several key
elements, including 1) how to monitor physical condition through Ryodoraku – an approach to
acupuncture developed by Dr. Nakatani Yoshio and which employs a machine to measure the electric
potential difference of meridians on the skin – and through 24-hour records of daily life that include such
information as the time the person wakes up and goes to sleep, their diet, exercise, and health conditions
involving symptoms or signs of discomfort on those days; 2) the value of traditional Japanese traditional
food and its efficacy for our health; 3) the functions of our stomach and bowels, and how to select and
cook natural food; 4) effective breathing and exercises and how to apply meridian yoga to adjust one’s
health condition; 5) reflection on lifestyle and health conditions to clear up the students’ health issues.
Ten nursing students who attended the course were measured with Ryodoraku every after lecture, and
submitted their daily life and health condition records for seven weeks. Aside from Ryodoraku, blood
pressure, spirometry, weight, height, bone density, and subcutaneous fat were also measured in the
classes. Researchers analyzed the relationships between daily life patterns, health conditions, and the
Ryodoraku results.
Results: 90 percent of the students could identify the relationships between their lifestyles and health
conditions. One example that illustrates the resulting change in health perspective is that of a female
student, A. A had two little children, of two and four years of age, and suffered from subjective symptoms

such as sensitivity to cold and lower back pain. She related how she had been a conscientious flight
attendant before being married, and had to do her best to ensure the safety of her passengers. Now
simultaneously a mother and a college student, she continues to feel that she must do everything
perfectly, despite this resulting in her often sleeping only three hours per night. From the daily life records,
researchers realized that she had been taking care of her children and her college matters every day
almost entirely without support from the rest of the family. She believed that she could sufficiently handle
everything by herself. However, her Ryodoraku results revealed that her physical strength was lower than
the average for women of the same age. She reflected upon this and noted that she would have to re-
arrange her lifestyle, such as sleeping time and the content of meals. Her daily life records for the last two
weeks showed that she went to bed before twelve o’clock at night and planned to enjoy outside activities
on the weekend with her children.
Conclusion: As A’s case illustrates, not only the daily lives of the students themselves but also those of
their family members need to be arranged together. This course is useful for enabling students to reflect
on their lifestyle and change their perspectives towards health.
Contact
[email protected]

“Back to School”: An Educational Collaboration and Tool for School Nurses and
Their Patients with Chronic Headache and School Absence
Lori A. Lazdowsky, RN, BSN, USA
Alessandra J. Caruso, BA, USA
Elyse D. Mahoney, BS, USA
Ashley M. McCarthy, BA, USA
Victoria E. Karian, NP, USA
Karen J. Kaczynski, PhD, USA
Rupa Gambhir, PsyD, USA
Laura Simons, PhD, USA
Alyssa A. LeBel, MD, USA
Purpose
The purpose of this project is to develop an effective teaching tool to facilitate communication among
medical providers, students and families, and school administration on how to best meet the complex
needs of students with chronic pediatric headache as they transition back to school after an extended
medical absence.
Target Audience
The target audience of this presentation includes school nurses, guidance counselors, teachers,
principals, adjustment counselors, school psychologists, social workers, and other school administrators
of public, private, and parochial elementary, middle, and high schools across the United States, and with
the potential of expanding globally.
Abstract
Purpose: The purpose of this project is to develop an effective teaching tool to facilitate communication
among medical providers, students and families, and school administration on how to best meet the
complex needs of students with chronic pediatric headache as they transition back to school after an
extended medical absence.
In recent decades, the number of children with chronic illnesses transitioning back to school has
increased (Kliebenstein & Broome, 2000). Though medical professionals provide much of the necessary
physical and psychological care to facilitate school reentry, the process may be delayed for several
weeks to months. Of the approximately 20% of all children suffering from a chronic illness, about one-
third of that number experiences consequences severe enough to interfere with school functioning and
performance (Kaffenberger, 2006). Chronic pediatric headache, including diagnoses of new daily
persistent headache, tension-type headache, and chronic migraine, is becoming an increasingly prevalent
pain condition in children and adolescents. One study reported that 15% of the pediatric patients
presenting to neurology clinics at Royal Manchester, Booth Hall, and Birmingham Children's Hospitals
were diagnosed with daily headaches (Viswanathan, Bridges, Whitehouse, & Newton, 1998), while a US-
based study cited pediatric migraine as one of the five most prevalent childhood disorders in the US,
affecting up to 10% of children and 28% of adolescents (Split & Neuman, 1999). Chronic headache is
often associated with significant impairment of daily functioning, including difficulty with school
performance and attendance (Hershey & Winner, 2007) and higher rates of school absenteeism than
children with other chronic illnesses (Powers et al., 2006). As Freudenberg and Ruglis (2007) note the
intricate connection between good health and education, minimizing school drop-out rates for children
with pain conditions such as chronic pediatric headache has evolved beyond individual patient care
towards a global public health issue.
Methods: Chronic headache patients seen at the Pediatric Headache Program at Boston Children’s
Hospital meet with an integrated team of psychologists, neurologists, nurse practitioners, and nurses who
provide comprehensive care during initial and follow-up evaluations. At initial assessment, patients report
missing an average of 8.73 days of school per three months; at follow-up evaluation, the number drops to

5.06 absent days (McDonald, 2010). While many of the patients’ school attendance and disability improve
between initial and follow-up appointment in utilizing this multidisciplinary approach to chronic pain
management, addressing the patients’ medical and psychological needs is the beginning of rehabilitation.
Successful school reintegration and academic performance for patients with prolonged absenteeism due
to headache pain mark the primary objectives of medical professionals, school administration, and the
families of children and adolescents suffering with chronic pain conditions. School nurses are key players
in this process, as they are the daily medical contact for these patients, are psychologically and culturally
knowledgeable regarding the needs of this age group, and work consistently with the academic staff.
Per review of questionnaires completed by patients attending the Pediatric Headache Program at Boston
Children’s Hospital, as well as school nurses in the greater Boston area, the Pediatric Headache Program
has developed a two-armed study addressing the necessity, implementation, and efficacy of an
educational tool designed for school nurses in supporting the complex needs of chronic pain patients
reentering school. Phase I of the study surveyed a total of 73 child and adolescent patients and their
parent(s) and school nurses in 6 Massachusetts districts presenting to or involved with the Pediatric
Headache Program. Questionnaire items address the specific actions, support skills, and knowledge-
base of school nurses caring for the physical and psychological needs of students with chronic pediatric
headache conditions. When asking patients about their actions at the onset of headache pain, 37.6%
reported visiting the school nurse, 21.1% took prescribed or over-the-counter medications, 33.0% ignored
the pain, and 8.3% texted or called their parents. In asking the school nurses to report which actions are
most helpful when headache and migraine sufferers report to their offices, 27.3% checked “providing
snacks and drinks,” 18.2% reported “providing over-the-counter medications,” and 9.1% indicated
“allowing time for a nap.” Regarding emotional support provided by school nurses during acute pain,
49.2% of patients and their families reported feeling “very” supported by their school nurses. However,
when questioning whether the patients and families perceived their school nurse to be knowledgeable
about their chronic headache condition, 16.4% reported “not at all knowledgeable” and 29.5% reported
“somewhat knowledgeable.”
Results: While nurses possess varying degrees of knowledge and experience in dealing with chronic
pediatric headache conditions, school nurses should be provided with an educational tool and checklist to
ensure proper medical services are being offered to these unique students. This tool, currently being
developed by the nurses, neurologists, psychologists, and clinical support staff at the Pediatric Headache
Program, include specific suggestions regarding atmosphere (environment), hydration, relaxation
techniques, stress and anxiety management, and over-the-counter medication available in the nursing
office, as well as information on sleep, medication overuse and rebound headaches, and the interplay of
headaches and social, family, and financial stressors. When asking school nurses whether they would be
interested in access to such a tool, 66.7% of the nurses responded “yes.”
Conclusion: Phase II of the study (in progress) will focus on the efficacy of the tool from the perspectives
of the school nurses, patients, and families. Through the development and implementation of an
educational tool available to school nurses, this study seeks to bridge the gap between medical and
psychological care provided at chronic pain centers (like the Pediatric Headache Program) and
successful reintegration into school for chronic pediatric headache patients. Though this project is being
developed at a pediatric headache center in the northeast United States, this tool may also be globally
applicable to patients with non-headache chronic pain.
References
Freudenberg, N. & Ruglis, J. (2007). Reframing school dropout as a public health issue. Preventing Chronic Disease:
Public Health Research, Practice, and Policy, 4(4), 1-11. Hershey, A. & Winner, P. (2007). Epidemiology and
diagnosis of migraine in children. Current Pain and Headache Reports, 11(5), 375-382. Kaffenberger, C. (2006).
School reentry for students with a chronic illness: A role for professional school counselors. Professional School
Counseling, 9(3), 223-230. Kliebenstein, M. & Broome, M. (2000). School re-entry for the child with chronic illness:
Parent and school personnel perceptions. Pediatric Nursing, 26(6), 579-584. McDonald, L., (2010, March).
Management of intractable headaches at a multidisciplinary pediatric program: Patient characteristics and
recommendations for ongoing treatment. Poster session presented at the 8th International Symposium on Pediatric
Pain, Acapulco, Mexico. Powers, S., Gilman, D., & Hershey, A. (2006). Headache and psychological functioning in
children and adolescents. Headache: The Journal of Head and Face Pain, 46(9), 1404-1415. Split, W. & Neuman W.
(1999). Epidemiology of migraine among students from randomly selected secondary schools in Lodz. Headache, 39

(7), 494-501. Viswanathan, V., Bridges, S., Whitehouse, W., & Newton, R. (1998). Childhood headaches: Discrete
entities or continuum? Developmental Medicine & Child Neurology, 40, 544-550.
Contact
[email protected]

The Relationship Between Percieved Self-Efficacy and Postpartum Self-Care
Behaviors in Adolescent Mothers
Atcharobon Sangpraseart, RN, Thailand
Purpose
This descriptive research study aimed to determine the relationship between perceived self – efficacy and
postpartum self – care behaviors in adolescent mothers. The Bandura,s Perceived Self – Efficacy Theory
(1977) was employed as a theoretical framework.
Target Audience
This research aims to health promotion in postpartum self-care behaviors of adolescent mothers
Abstract
Purpose: This descriptive research study aimed to determine the relationship between perceived self-
efficacy and postpartum self-care behaviors in adolescent mothers. The Bandura’s Perceived Self-
Efficacy Theory (1977) was employed as a theoretical framework.
Methods: A questionnaire was developed to gather data in relation to perceived self-efficacy and
postpartum self-care behaviors in adolescent mothers. Content validity was examined by five experts.
The Cronbach’s alpha coefficient of the two parts of the questionnaires (perceived self-efficacy and
postpartum self-care behaviors) were 0.82 and 0.70 respectively. A sample of 229 adolescent mothers
who delivered a baby and admitted at the postnatal care unit Sawanpracharak Nakhonsawan Hospital
from January to August 2013 participation in this study.
Results: The findings indicated that 50.1 percent of adolescent mothers had the moderate level of
perceived self-efficacy. And 80.2 percent of adolescent mothers had the high level of postpartum self-
care behaviors.
Conclusion: There was a significantly positive correlation between perceived self-efficacy and
postpartum self-care behaviors in adolescent mothers. (r = 0.39 , p-value less than 0.01).
References
Bandura, A.J. (1986). Social Foundations of Thought and Action : A Social Cognitive Theory. New Jersey: Prentice-
Hill.
Contact
[email protected]

Spouse Support, Family Support Influencing Maternal Role Attainment in
Adolescent Mothers
Sudkanya Pancharean, MNS, Thailand
Purpose
This research aims to report factors associated with maternal role attainment among adolescent mothers.
Personal factors and social support were consistently identified as important variables. These findings
may be used as a guideline to enhance maternal fetal attachment for adolescent mother's achievement of
their new maternal roles.
Target Audience
The target audience of this presentation is Nurse/ Healthcare provider/ Adolescent mothers.
Abstract
Purpose: The purpose of this predictive descriptive research was to examine influences of spouse
support, family support and personal factors on maternal role attainment in adolescent mothers.
Methods: The purposive sample included 200 adolescent mothers bringing their 4 months - 1 year
infants to well baby clinic at Sawanpracharak Hospital. Mean age of the mothers were 17.23 years (S.D.
= 1.04, range = 15 - 18). Data were collected from January to May 2012. Research instruments included
a demographic questionnaire, the spouse support questionnaire, the family support questionnaire, and
the maternal role attainment questionnaires. Their Cronbach’s alpha reliability were .92, .91, and .95,
respectively. Data were analyzed by using frequency, percent, mean, standard deviation and range.
Pearson’s correlation and Chi-square were used to test correlation between variables. Hierarchical
regression analysis were employed to test the predictors.
Results: Results revealed as follows:
1. Mean total scores of spouse support, family support, and maternal role attainment were good level (X =
56.19, S.D. = 10.49; X = 59.14, S.D. = 9.61; X = 211.21, S.D. = 24.95, respectively.
2. Spouse support, family support and income were positively correlated to maternal role attainment (r
=.42 p<.01; r = .89 p<.01; r = .25 p<.01, respectively). Education were positively correlated to maternal
role attainment (p<.01).
3. Family support and Education were significant predictors, and they accounted for 38.5 % in the
prediction of maternal role attainment. The best predictor was family support (β = .54, p< .01), and the
second predictor was education (β = .16, p< .01).
Conclusion: These findings indicate that family, nurses should provide intervention to promote and
encourage family support to adolescent mothers. Thus, outcome of the intervention can lead to increase
appropriate maternal role attainment among adolescent mothers.
Contact
[email protected]

Effects of Telephone-Based Support Group Program for Family Caregivers of
Elders
Eun-Young Kim, RN, MPH, PhD, South Korea
Purpose
The purpose of this presentation is to develop a telephone-based support group program for family
caregivers of elders and to identify its effects on depression, caregiving burden and satisfaction.
Target Audience
The target audience of this presentation are nursing researchers.
Abstract
Purpose: To develop a telephone-based support group program for family caregivers of elders and to
identify its effects on depression, caregiving burden and satisfaction.
Methods: A non-equivalent control pre-post design was used. Participants were recruited from support
groups in 3 long-term care agencies and were assigned to the experimental group (n=16) or control group
(n=19) receiving usual care. For the experimental group, the telephone-based support group intervention,
consisting of self-help group activity in small group, was given for 8 weeks. Outcomes included changes
in depression, caregiving burden and satisfaction. Data were analyzed using Fisher’s exact test and
Mann-Whitney U-test with SPSS 21.0.
Results: After 8 weeks intervention, the experimental group had a significantly increase caregiving
satisfaction (Z=-2.390, p= .017) than the control group. Within the experimental group, there was a
significant decrease in depression (Z=-2.261, p= .024) scores but not the caregiving burden.
Conclusion: The results indicate that a telephone-based support group program is effective increasing
aregiving satisfaction, and decreasing depression. Therefore, it can be useful utilized in the field of
nursing for family caregivers of elders.
Contact
[email protected]

Medication Adherence Intention and Health Status Among People with
Osteoarthritis in Korea: Pilot Study for Development of Medication Adherence
Program
Yang Heui Ahn, PhD, RN, HHC-APN, South Korea
Purpose
The purpose of this study was to explore medication adherence intention and health status among people
with osteoarthritis in Korea, to provide data that could be utilized to develop intervention strategies for
medication adherence.
Target Audience
The target audience of this presentation is individuals including community/public health nurses or case
managers in a community or hospital nurses who take care of patients with osteoarthritis, or researchers
who have an interest in medication adherence.
Abstract
Purpose: The purpose of this study was to explore medication adherence intention and health status
among people with osteoarthritis in Korea, to provide data that could be utilized to develop intervention
strategies for medication adherence.
Methods: A survey design was employed. The participants were 157 patients with osteoarthritis in a rural
community of Korea who were interviewed on adherence to prescribed medications. A direct interview
method was carried out in January, 2013. Instruments were the Modified Morisky Scale, the Korean
Western Ontario McMaster Universities, the Stanford Health Assessment Questionnaire, the Korean
Center for Epidemiologic Studies Depression Scale. The MMS includes three questions each on
medication motivation and medication knowledge, which are measured on nominal scale (yes, no). An
adherence quadrant is identified by MMS scoring. Data were analyzed using descriptive analysis and
ANOVA.
Results: The mean age of participants was 73.2(SD=8.05), and 80.9% (n=127) were women. The
adherence quadrant was identified as 16.6% (n=26) of the participants who were low on both medication
motivation and medication knowledge, with being 56.1% (n=88) high both, 13.4% (n=21) having low
motivation and high knowledge, and 14.0% (n=22) having high motivation and low knowledge. ANOVA
analysis showed that there were significant differences in physical functioning and depression by type of
medication adherence (p<.0001), but no difference in pain (p>.05). These results illustrated that those
with both high medication motivation and medication knowledge had better physical functioning, and less
depression than those low both.
Conclusion: The results indicated that nurses should be aware that 43.9% of patients with osteoarthritis
taking a prescribed medicine have low medication motivation or low medication knowledge, or low both.
Medication adherence strategies to bridge the gap in medication knowledge and enhance motivation are
needed, which mean coaching and empowerment services considering factors related to medication
motivation and knowledge.
Contact
[email protected]

The Effectiveness of Supportive Nursing Care in Sleep Quality of Patients with
Heart Failure
Ai-Fu Chiou, PhD, RN, Taiwan
Yia-Ling Chang, RN, Taiwan
Purpose
The purpose of this presentation is to provide an evidence-based nursing intervention for those who are
interesting in issues related to sleep disturbance in patients with heart failure.
Target Audience
The target audience of this presentation is those who are interesting in issues related to sleep
disturbance in patients with heart failure.
Abstract
Purpose: Sleep disturbance is one of the most common complaints in heart failure patients. Up to 74%
heart failure patients reported poor sleep. However, research related to sleep disturbance of heart failure
patients is limited in Taiwan. This study aimed to examine the effects of supportive care program in sleep
disturbance of heart failure patients.
Methods: An experimental design was used. Subjects were selected using a purposeful sampling and
were randomly assigned to the intervention (n=30) or control group (n=30). Patients in the intervention
group received an 12-week supportive care program including education on sleep hygiene, coaching self-
care, emotional support and nursing visit monthly at home. The control group received regular nursing
care. Data is collected by structural questionnaire. Participants completed structural questionnaire in pre-
test, fourth, 8th and 12th weeks after intervention. The instruments included basic data, Pittsburgh Sleep
Quality Index, Epworth Sleepiness Scale, Symptom Distress Scale, Hospital Anxiety and Depression
Scale and Social Support Scale. Data analysis included descriptive statistics, independent t-test, chi-
square, Mann-Whitney U test, and generalized estimating equation.
Results: data collection is on-going.
Conclusion: The results of this study will contribute to the knowledge of nursing care of patients with
health failure.
Contact
[email protected]

Knowledge, Attitude, and Rejecting Use Behavior of Trans-Fatty Acid Among
Children
Chun-Hsia Huang, MA, RN, Taiwan
Purpose
The purpose of this presentation is to investigate children’s knowledge, attitude, and rejecting trans-fatty
acid (TFA) use behavior and to identify influencing factors and predictors of the behavior.
Target Audience
The target audience of this presentation is nurses (particularly to community health nurses and school
nurses), school teachers, health educators, nutritionists, and public health policy makers etc.
Abstract
Purpose: Health damage due to trans-fatty acid (TFA) is an important issue around the world, however
there is a relatively few studies to explore TFA, particularly for children. The main purpose of this study
consisted of investigating children’s rejecting TFA use behavior as well as identifying influencing factors
and predictors of the behavior.
Methods: A cross-sectional research design was conducted to 1086 children studying in the fifth and
sixth grader in Taiwan (562 male occupied 51.75%; 524 female occupied 48.25%). A questionnaire was
used to collect data.
Results: The main finding indicated that the mean score on a ’knowledge’ questionnaire was 11.00; total
score ranging from 0 to 23; SD = 5.26). Gender comparison indicating that female’s knowledge was
significantly higher than male (t = -2.39, P = 0.017). For attitudes, a mild tendency of passive attitude was
found in this study (Mean ± SD = 48.81 ± 9.70; total score was 100). Gender comparison indicating that
male’s attitude was significantly more positive than female (t = 4.11, P = 0.001). For rejecting TFA use
behavior, a moderate level of behavior was revealed by this study (the mean score was 90.68 out of a
possible score of 145; SD = 26.15), however, no gender difference was found between two genders.
Regarding the relevant factors, a multiple stepwise regression analysis on rejecting TFA use behavior
indicating four variables (including attitude, knowledge, grade, and gender) could be singled out as
significant predictors and accounted for 24.6% of the variance.
Conclusion: Based on this study, we emphasize that education and health administrators and health
professionals should actively provide broader health educational programs and health services regarding
TFA use to children in Taiwan, not only improving knowledge and behavior but also building a correct and
active attitude.
Contact
[email protected]

What is the Impact of Progressive Mobility on a Medical Cardiology Ward in a
Tertiary Hospital in Saudi Arabia?
Catherine Buckley, BSc, HDip, Saudi Arabia
Sofia Macedo, BSN, PG, Saudi Arabia
Purpose
to demonstrate the positive impact of Early Mobilization in an adult medical cardiology ward in a tertiary
hospital in Saudi Arabia. Predomintely, bed rest is used as a recovery tool due to the values and beliefs in
the midle easternen culture.
Target Audience
being a multidisciplinary approach, all areas of healthcare will benefit from this presentation. However,
nurses will be the predominant beneficiary of this information.
Abstract
Purpose: The main purpose of this study is to measure the impact of the progressive mobility approach
outside of the critical care setting in terms of length of stay (LOS), hospital acquired harm and cultural
change within nurses and patients in regards to bed rest. This study aims to trial the progressive mobility
tool within the medical cardiology setting while providing education for both staff and patients, in turn
trying to change the culture of bed rest in Saudi Arabia.
The anticipated outcomes are:
1. Decrease Length of Stay (LOS) by 1,5 bed days per patient

2. Decrease Pressure Ulcers Incidence, Falls incidence and Hospital Acquired Infections measured
through the National Database of Nursing Quality Indicators (NDNQI®)
3. Increase staff nurse’s level of education on Progressive Mobility
Methods: This study is a prospective cohort study. We are applying the Progressive Mobility Tool and
providing education sessions and materials to staff and patients that are admitted to the Adult Medical
Cardiology Ward at the King Faisal Specialist Hospital and Research Centre. The patients that are
eligible to the study are assessed utilizing the Progressive Mobility tool and depending on their score, the
nurse implements the guidelines accordingly, until the day of discharge. The educational sessions
targeting nurses start with them entering the organization during their orientation program. They are
trained in manual handling, effective use of the equipment and the risks associated with immobility.
The total sample size is 334 patients.
Results: The study is on its early stages, therefore no preliminary results are being able to be
announced.
Conclusion: Early mobility provided through a multidisciplinary team approach will reduce risk of
immobilization which can lead to pressure ulcers, HAIs, increases falls risk, prolonged use of antibiotics,
unnecessary respiratory treatments which all in turn can lead to increase of length of stay and poor
quality of life. Therefore early mobility will significantly reduce hospital expenditure due to the reduction of
the comorbidities mentioned above.
References
Brahmbhat N., Murugan R., Milbrandt E. B. (2010) Early mobilization improves functional outcomes in critically ill
patients. Critical Care. Vol. 14, pp.321 Bassett RD, Vollman KM, Brandwene L, Murray T. (2012) Integrating a
multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit
Care Nurs. 2012 Apr;28(2):88-97 Knight J., Nigam Y., Jones A. (2009) Effects of bedrest 1: cardiovascular,
respiratory and haematological systems. Knight, J. et al (2009) Nursing Times; 105: 21. Markey DW, Brown RJ.

(2002). An interdisciplinary approach to addressing patient activity and mobility in the medical-surgical patient. J Nurs
Care Qual. 2002 Jul;16 (4):1-12.
Contact
[email protected]

Views of Women Regarding Infant Feeding Practices of HIV Exposed Children in
Vhembe District, Limpopo Province South Africa
Patrone Rebecca Risenga, DipNsg, BACur, HonsCur, MACur, MHPE, DCur, South Africa
Purpose
The purpose of this presentation is to describe the views of women regarding infant feeding practices of
HIV exposed children in Vhembe District, Limpopo Province South Africa
Target Audience
Nurses
Abstract
Purpose: South Africa consists of many cultural groups who manage pregnancy and lactation differently.
Infant feeding is one of the best practices to promote life and reduce infant mortality rates that are
escalating due to various issues including HIV/AIDS. HIV infection can be spread from mother to child
during pregnancy, labour and delivery and as well as during breastfeeding. During PMTCT programme
women are advised on feeding options such as breast feeding, and advised on measures to reduce the
spread of HIV during the feeding process. The aim is to ensure zero HIV infections in new-born babies
from 2015. South Africa has 5.6 million people who are HIV positive including children. Parents have
choice of choosing the feeding method deemed to be relevant and appropriate for them within their
communities. It is not surprising that mothers of new-born infants are somewhat bewildered by what
constitutes best practice, and hence they are highly susceptible to the (ill) advice of individual health
workers or family members. There is scant literature on how choices are made and what influences
change more specifically amongst the Tsonga speaking people in Limpopo Province, South Africa. The
purpose of the study was to describe the views of women regarding infant feeding practices of HIV
exposed children in Vhembe District, Limpopo Province South Africa
Methods: This study adopted a qualitative approach using an exploratory, descriptive and contextual
design in order to explore and describe the views of women regarding infant feeding practices of HIV
exposed children. A non-probability purposive sampling was used. The target population was females
between 20 and 35 years, who are having new-born babies between one month and a year. All of them
were Tsonga speaking people and were interviewed in Xitsonga. They were from three different villages
in Vhembe District Limpopo Province.
Results: Three themes emerged from the findings of women with regards to infant feeding practices.
- Community reactions and in-laws regarding infant feeding fuelling the spread of HIV to infants and new-
born babies as well as children.
- Mothers have mixed reactions regarding feeding options
- Physical problems experienced by mothers who are breastfeeding
Conclusion: The use of the findings will contribute to the reduction of HIV and AIDS by promoting the
use of correct infant feeding options by mothers and other members in the communities:
Contact
[email protected]

Ineffective Peripheral Tissue Perfusion: Construct Validation Using Rasch
Analysis
R. C. G. Silva, RN, MSc, PhD, Brazil
Erika de Souza Guedes, MSc, RN, Brazil
Diná de Almeida Lopes Monteiro da Cruz, PhD, Brazil
Purpose
To describe what defining characteristics were validated by Rasch Analysis To provide elements for
discussion about the construct analysis of Ineffective Peripheral Tissue Perfusion
Target Audience
Nurses and other health care professionals interested in vascular health, nursing diagnosis and validation
methods.
Abstract
Purpose: The validation of nursing diagnoses is important to nursing practice in clinical, educational and
research settings. It allows the refinement of nursing diagnoses classification. Moreover, validation
studies allow the identification of diagnostic elements which are able to measure what they are intended
to measure, i.e., the diagnosis. There are many methods that can be used to verify the validity of a
nursing diagnosis. Fehring’s models are the most frequently used. Among the methods proposed by
Fehring the content validation model is the most widely used because it is easier and less expensive. In
this context, several nursing diagnoses have been validated. Researchers carried out studies in which
Ineffective Peripheral Tissue Perfusion (IPTP) was clinically validated. However, in our best knowledge,
there are no studies in which IPTP construct validation by Rasch Analysis was performed. The aim of this
study was to verify the IPTP construct validity in patients with intermittent claudication by Rasch Analysis.
Methods: We performed a reanalysis of a previous study database that was carried out by our group and
was approved by Ethical Committee. The mentioned study included 65 adult patients with intermittent
claudication which did not need assistive devices for ambulation. The reanalysis included data from
physical examination, arterial stiffness (carotid-femoral pulse wave velocity – CF-PWV) and functional
capacity (six minute walk test). The construct validation was carried out through Rasch Analysis. The
concept of construct validity is useful to explain the nature of the nursing diagnosis. In this context, the
nursing diagnosis is a defined variable which is placed in a concept system whose relations are explained
by a theory. The Rasch analysis is taken as a criterion for the structure of the responses because it
considers that the comparison of two people is independent of which items may be used within the set of
items assessing the same variable.
Results: Skin color alteration was the most frequent defining characteristic, i.e., the item with the highest
response probability. It measure was -2.54 logito. Skin temperature alteration was the less frequent
defining characteristic, i.e., the item with the lowest response probability. It measure was 2.49 logito. CF-
PWV and altered walking distance (AWD) response probabilities were 0.05 logito, i.e., very close to the
average of items. All defining characteristics (n=14) had appropriate Infit values (between 0.7 and 1.3
logito). It means that they are well adjusted to the model. However, the Outfit values of altered left femoral
pulse (FE) and CF-PWV were 2.33 and 1.63 logito, respectively. In other words, FE and CF-PWV
seemed to not properly identify outlier patients. The biserial correlation of FE was -0.2, i.e., it did not
belong to the group. Then, we decided to exclude FE of the analysis. It causes an alteration in the
adjustment of altered right femoral pulse which, in turn, was excluded of analysis. Twelve items remained
in the model. A new Rasch analysis was performed. The remained defining characteristics had good
adjustment to the model. The items with the highest and lowest response probabilities were skin color
alteration and skin temperature alteration. The probabilities of CF-PWV and AWD were -0.14 logito.
Despite this, AWD had better adjustment than CF-PWV. No items had negative correlation or equal to
zero. Model reliability was 0.62 and the separation was 1.27.

Conclusion: AWD and CF-PWV seem to contribute to IPTP construct whereas femoral pulses do not.
References
López AT. Analisis de Rasch para todos: una guía simplificada para evaluadores educativos. San Luís de Potosí,
Mexico: Instituto de Evaluación e Ingeniería Avanzada, 2013. Herdman TH. NANDA International. Nursing
diagnoses: definition and classification, 2012-2014. Oxford: Wiley-Blackwell. Silva RCG. Validation of defining
characteristics of the nursing diagnosis Ineffective Peripheral Tissue Perfusion in patients with peripheral arterial
disease in the lower limbs [Thesis]. Sao Paulo: “Faculdade de Medicina, Universidade de Sao Paulo”; 2010. 161p.
Contact
[email protected]

Self-Care Related Factors in Patients with Heart Failure
Pi-Kuang Tsai, MSN, RN, Taiwan
Hsing-Mei Chen, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to share the study findings in terms of correlates of self-care in
Taiwanese patients with heart failure.
Target Audience
The target audience of this presentation is nurses and researchers who are interested in understanding
and promoting self-care of patients with heart failure.
Abstract
Purpose: Heart failure is a complex syndrome and requires the patient to engage in long-term self-care
activities, in order to stabilize the condition. American Heart Association has issued a scientific statement
advocating self-care as one of heart failure treatment modalities. Self-care adequacy has been viewed to
have great influence in determining the heart failure outcomes. Identifying correlates of self-care is
important to help patients engage in better self-care practice. The purpose of this study was to analyze
thecorrelates of self-care in patients with heart failure
Methods: The study used a questionnaire survey with a non-probability sampling for the data collection.
A total of 71 inpatients who met the inclusion criteria were face-to-face interviewed to complete
demographic and clinical questionnaires, the Dutch Heart Failure Knowledge Scale (DHFKS), and the
Self-Care of Heart Failure Index (SCHFI).Data analyses included t-tests, one-way ANOVA, and Pearson
correlation methods.
Results: The results showed significant positive correlations among self-care maintenance, self-care
management, and self-care confidence (r = .50 to r =.63, p< .001). Self-care maintenance was
significantly positively correlated with the DHFKS scores, heart failure duration, admission frequency, and
number of comorbidities; self-care management was significantly positively correlated with the DHFKS
scores, admission frequency, and number of comorbidities.Self-care confidence was significantly
positively correlated with the DHFKS scores (r =.46, p< .001) and admission frequency.
Conclusion: Admission frequency and HF knowledge were important correlates of the three self-care
variables. The more admission frequency, the better HF knowledge and the better self-care the patient
had. Improving patients’ knowledge is therefore a task which brooks no delay.Nurses should discuss with
patients about the home self-care suitable for them by using case sharing or successful case
referral.Families of the patients should also be included in health education program to facilitate them in
giving patients psychological support and improving patients’ self-care abilities.
Contact
[email protected]

Disaster Preparedness of Mothers Raising Preschool Children: Lessons from the
Great East Japan Earthquake
Akemi Matsuzawa, PhD,RN, Japan
Yuko Shiroki, RN, Japan
Shigeko Tsuda, PhD, RN, Japan
Purpose
The purposes of this presentation are providing information about situation after the Great East Japan
Earthquake and discuss this problem among other researchers.
Target Audience
The target audiences of this study are public health nurse, community nurse, and researcher of pediatric
nursing, community nursing, disaster nursing.
Abstract
Purpose: The purpose of this study was to determine the degree to which mothers raising preschool
children in disaster areas are prepared for disasters and to identify factors related to preparedness.
Methods: A quantitative cross-sectional analytical design was used. Data were collected from 272
mothers whose children attended one of three institutions (two certified public nursery schools and one
kindergarten) in one city using a self-administered questionnaire. Participants were asked about the
presence or absence of disaster-prevention and disaster-mitigation measures in their homes as well as
about the characteristics of such measures, their knowledge and ideas regarding preparedness, and
disaster-induced influences. The study was conducted between January and February 2013, and 166
parents returned questionnaires, a 61.0% response rate.
Results: According to the results, more than 90% of participants were prepared for disasters, as they
commonly stored flashlights, candles, drinking water, spare batteries, and emergency food. In contrast,
fewer mothers discussed the actions to be taken at the time of a disaster with family members,
determined how to contact family members and relevant institutions (nursery schools or kindergartens) in
the case of an emergency, or informed their children about an emergency phone number. Mothers who
were more prepared for disasters were more likely than were other mothers to believe they should be
prepared (p = 0.01).
Conclusion: The results of this study suggest the need to promote and maintain preparedness, including
knowing how to contact others in an emergency. Therefore, it is important to provide education and
training about disaster preparedness for families and for staff members of the nursery schools and
kindergartens in Japan.
References
Matsuzawa A, Yamaoka Y, Tamiya N,Taniguchi K, Kato G, Yamazaki K DFamilyof
problems caregiving
suspected
elderly neglect:A review of forensic autopsy cases in Japan DJournal of Research on
Sciences 3( 9);117-124:2013 Kobayashi @M, Tamiya N, Kas
related to positive feelings of caregivers who provide home-based long-term care for their family members in Japan.
Journal of Research on Humanities and Social Sciences 3(16);27-37:2013
Contact
[email protected]

A Comparison of Health Promoting Behavior and Quality of Life Among Early
Stage of CKD and Healthy Adults in Taiwan
Hsiu-Lan Teng, RN, MS, Taiwan
Purpose
This study was to compare 1-3 stage of CKD and healthy adults in terms of: (a) the differences in health
promoting behaviors and quality of life; (b) the relationships between health promoting behavior and
quality of life.
Target Audience
The target audience of this study for health professional who care the patient with chronic kidney disease.
Abstract
Purpose: This study was to compare 1-3 stage of CKD and healthy adults in terms of: (a) the differences
in health promoting behaviors and quality of life; (b) the relationships between health promoting behavior
and quality of life.
Methods: This cross-sectional study was conducted through a convenience sample of 78 CKD subjects
and 87 healthy adults recruited in southern Taiwan. The Chinese version of the Health Promotion
Lifestyle Profile-II (HPLP-II) was used to measure the health promotion behaviors. Quality of life was
measured using Taiwan version of the WHOQOL-BREF. Independent t-tests were used to compare the
means of the HPLP-II and QOL. Pearson correlation coefficient was used to measure relations between
the HPLP-II and QOL.
Results: Of the 165 participants who completed the questionnaires, 87 (52.7%) werehealthy adults and
78 (47.3%) were CKD patients. The mean age was 46.4 (±7.13) years for healthy adults and 49.1 (±9.86)
years for CKD patient. The data revealed no statistically significant differences between the two groups
for most of the demographic variables. Health promotion lifestyle behaviors scores for CKD and healthy
adults were significant different in health responsibility, nutrition and spiritual growth subscales. QOL of
CKD patients was found to be significantly impaired in comparison to QOL of healthy adults, particularly
with respect to the overall health and psychological domains, but not in the physical, social and
environment domain. Person’s correlation showed a positive relation between the health promotion
behavior and QOL.
Conclusion: The early stage of CKD is often asymptomatic and similar to general population. The
performed of healthy behaviors may be more strongly associated with QOL in the two groups.
References
Berger A. M. & Walker S. N. (2004) Measuring health lifestyle. In Instruments for clinical health care Research
(Frank-Stromborg. M. & Olsen. S. J., eds.), Huang H. C., Chou C. T., Lin K. C., & Chao Y. F. (2007) The relationships
between disability level, health-promoting lifestyle, and quality of life in outpatients with systematic lupus
erythematosus. The Journal of Nursing Research 15(1), 21-32. Huang Y. H., & Chiou C. J. (1996) Assessment of the
health-promoting lifestyle profile on reliability and validity. The Kaohsiung Journal of Medical Sciences 12 (9), 529-37.
Lee R. L. & Loke A. J. (2005) Health-promoting behaviors and psychosocial well-being of university students in Hong
Kong. Public Health Nursing 22 (3), 209-220. Sudbury, Mass: Jones and Bartlett. pp. 401-416. Walker S. N. Sechrist
K. R. & Pender N.J. (1987) The Health-Promoting Lifestyle Profile: development and psychometric characteristics.
Nursing Research 36 (2), 76-81. Yeh L., Chen C. H., Wang C. J., Wen M. J. & Fetzer S. J. (2005) A preliminary study
of a healthy-lifestyle-promoting program for nursing students in Taiwan. Journal of Nursing Education 44 (12), 563-
565.
Contact
[email protected]

Effectiveness of a Trans-Theoretical Model-Based Stage-Matched Intervention to
Promote Lifestyle Modification Among Chronic Kidney Disease in Taiwan
Miaofen Yen, PhD, RN, FAAN, Taiwan
Purpose
The purpose of this presentation is to examine the effects of a lifestyle modification consultation program.
Lifestyle modification has been promoted for the control of chronic kidney disease. The Trans-Theoretical
Model has become increasingly influential as a framework for understanding health-related behaviors and
directing targeted interventions to promote health behavior.
Target Audience
The target audiences of this presentation are health care providers who care for people with chronic
kidney disease.
Abstract
Purpose: Chronic Kidney Disease (CKD) is a global public health issue. To following a healthy lifestyle is
good for people with CKD. Therefore, lifestyle modification has been promoted for the control of various
chronic disease included CKD. The Trans-Theoretical Model (TTM) has become increasingly influential
as a framework for understanding health-related behaviors and directing targeted interventions to
promote health behavior. The study apply the transtheoretical model (TTM) to assess the effectiveness of
a lifestyle modification consultation program on subjects with stage 1 to 3 CKD at baseline, 6, 12, 18, 24,
30 and 36 months later by examining the changes in health promotion lifestyle factors, and overall
knowledge of renal protection and quality of life through a longitudinal follow-up survey.
Methods: A repeated-measures study design applied to evaluate the effectiveness of lifestyle
modification intervention using random controlled trail. A total of 103 participants were recruited, 51 and
52 subjects were in control and experimental group, respectively. Data were collected six times over 3
years. The generalized estimating equations (GEE) was used to assessed the main effects of the
intervention on the outcome variables after adjusting for the difference in outcome variable baseline
scores.
Results: At baseline, CKD patients in both groups showed no significant difference in the stage of
change in diet behavior (χ= 9.35, p =.05). The number of patients in the experimental group reporting a
change in the stage of diet behavior with regard to action and maintenance increased across the 36
months, from 13.6% at baseline to 43.7%. Over the 36-month intervention period, there were significant
differences for both groups in the follow-up visits for the renal protection knowledge variable. The post
hoc analysis showed the 36 months (p = 0.045) and 24 months (p = 0.007) and 18 months (0.016) renal
function protection knowledge scores were higher than those at six months. In addition, there were
significant differences for both groups in the follow-up visits for the total health promoting lifestyle scores.
After using a post hoc test, the 30 (p = 0.027) and 36 month (p = 0.012) total health promoting lifestyle
scores were higher than that at 12 months. Between the two groups, there was a significant difference in
the follow-up visits for the health responsibility (P = 0.04). However, no differences in quality of lifestyle
scores between the two groups were found.
Conclusion: These results partial support the applicability of the Trans-theoretical model stage-matched
for lifestyle modification intervention that may promote renal protection knowledge scores and partial
health lifestyles scores in patients with early stage of chronic kidney disease.
References
Clarke, P. (2009).Understanding the experience of stroke: a mixed-method research agenda. The Gerontologist.
49(3), 293-302. Costantini, L., Beanlands, H., McCay, E., Cattran, D., Hladunewich, M., & Francis, D. (2008). The
self-management experience of people with mild to moderate chronic kidney disease. Nephrology Nursing Journal,
35 (2), 147-155. Dirks, J. H., De Zeeuw, D., Agarwal, S. K., Atkins, R. C., Correa-Rotter, R., & D’Amico, G.. et al.,
(2005). Prevention of chronic kidney and vascular disease: Toward global health equity—The Bellagio 2004

Declaration. Kidney International. 68, S1-S6. Giorgi, A. (1997). The theory, practice, and evaluation of the
phenomenological method as a qualitative research procedure. Journal of Phenomenological Psychology.28(2),235-
260. King, N., Carroll, C., Newton, P., & Dornan, T. (2002). “You can’t cure it so you have to endure it”: The
experience of adaptation to diabetic renal disease. Qualitative Health Research. 12(3), 329-346. Lincoln, Y.S., &
Guba, E.G.(1985) Naturalistic Inquiry. Newbury Park: Sage. Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2002).
Health promotion and nursing practice (4th ed). Upper Saddle River, NJ: Prentice Hall. Polkinghorne, D. E.
(1995).Narrative configuration of curriculum studies.In J. A. Hatch & R. Wisniewski (1995) (Eds.),Life history and
narrative (pp.5-23).London: The Falmer Press. PREMIER Collaborative Research Group (2003). Effects of
comprehensive lifestyle modification on blood pressure control. JAMA. 289(16), 2083-2093. Sakraida, T. J.,
Robinson, M. V. (2009). Health literacy self-management by patients with type 2 diabetes and stage 3 chronic kidney
disease. Weatern Journal of Nursing Research. 31(5), 627-647. Stone, N. J. (2004). Focus on lifestyle change and
the metabolic syndrome. Endocrinology and Metabolism Clinics of North America. 33, 493-508. Stone, N. J., &
Saxon, D. (2005). Approach to treatment of the patient with metabolic syndrome: lifestyle therapy. The American
Journal of Cardiology. 96, 15E-21E. Thomas, N., Brayar, R., & Makanjuola, D. (2008).Development of a self-
management package for people with diabetes at risk of chronic kidney disease (CKD).Journal of Renal Care. 34(3),
151-158. Tonstad, S., Alm, C. S., Sandvik, E. (2007). Effect of nurse counselling on metabolic risk factors in patients
with mild hypertension: A randomised controlled trial. European Journal of Cardiovascular Nursing. 6, 160-164. Tong,
A., Sainsbury, P., Carter, S. M., Hall, B., Harris, D. C., Walker, R. W., …Craig, J. C. (2008). Patients’ priorities for
health research: focus group study of patients with chronic kidney disease. Nephrology Dialysis Transplantation, 23,
3206- 3214. doi: 10.1093/ndt/gfn207 Tong, A., Sainsbury, P., & Craig, J. C. (2008). Support interventions for
caregivers of people with chronic kidney disease: a systematic review. Nephrology Dialysis Transplantation, 23,
3960-3965. Tong, A., Sainsbury, P., Chadban, Steven., Walker, R. G., Harris, D. C., Carter, S. M., et al (2009).
Patients’ Experiences and Perspectives of Living With CKD. American Journal of Kidney Disease, 53:689-700.
Vupputuri, S., Sandler, S. (2003). Lifestyle risk factors and chronic kidney disease. Annals of Epidemiology, 13 (10),
712-720. Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The Health-Promoting Lifestyle Profile: development
and psychometric characteristics. Nursing Research, 36, 76-81. Wen, C. P., Cheng, T. Y. D., Tsai , M. K., Chang, Y.
C., Chan, H. T., & Wen, S. F. (2008). All-cause mortality attributable to chronic kidney disease: a prospective cohort
study based on 462 293 adults in Taiwan. Lancet, 371, 2173-2182. Whittemore, R., Melkus, G., Wagner, J., Dziura,
J., Northrup, V., & Grey, M. (2009). Translating the diabetes prevention program to primary care: a pilot study.
Nursing Research. 58(1), 2-12. WHO (2009). http://www.who.int/chp/chronic_disease_report./en.
Contact
[email protected]

IMRT-Induced Acute Fatigue in Patients with Head and Neck Cancer: A
Prospective Study
Canhua Xiao, PhD, RN, USA
Jonathan Beitler, MD, USA
Kristin Higgins, MD, USA
Luke Ong, RN, USA
Andrew Miller, MD, USA
Deborah Bruner, PhD, RN, USA
Purpose
The purposes of this study were to 1) describe acute fatigue changes from pre to one-month post IMRT,
2) examine the risk factors for IMRT-induced acute fatigue changes, and 3) explore the relationship
between fatigue and other most common treatment-induced symptoms during the acute phase.
Target Audience
The target audience of this presentation is nursing researchers, clinical nurses, and other health care
providers.
Abstract
Purpose: Fatigue profoundly impacts a cancer patient’s quality of life,1 treatment adherence,2 and health
care utilization.3 Pre or post radiotherapy (RT) fatigue is a prognostic factor for pathologic tumor
response4 and survival.5,6 Patients with head and neck cancer (HNC), who are usually treated with RT
because of the structural complexity and functional importance of cancer sites, have particularly high
rates of fatigue during treatment.7 Most recent research on Intensity-modulated Radiation Therapy
(IMRT), a commonly used new radiotherapy that targets tumors with higher doses while avoiding normal
structures, has shown that patients experience even higher fatigue compared to conventional-RT.8,9
The purposes of this study were to 1) describe acute fatigue changes from pre to one-month post IMRT,
2) examine the risk factors for IMRT-induced acute fatigue changes, and 3) explore the relationship
between fatigue and other most common treatment-induced symptoms during the acute phase.
Methods: This was a prospective study investigating 44 patients with HNC from pre to one-month post
IMRT. Only patients diagnosed with histological proof of squamous cell carcinoma and without distant
metastasis were enrolled into the study. Fatigue was measured by the Multidimensional Fatigue
Inventory (MFI)-20 that includes five dimensions: general fatigue, physical fatigue, reduced activity,
reduced motivation, and mental fatigue. Other common symptoms were collected using the Patient-
Reported Outcomes version of the Common Terminology Criteria for Adverse Events (CTCAE) that
categorizes depressive symptoms, sleep problems, cognitive problems, pain, dry mouth, difficulty
swallowing, skin burn from radiation, mouth or throat sores, taste change, nausea, vomiting, and
sensation of thirst. Fatigue was also collected by the CTCAE for the purpose of comparing fatigue with
other symptoms. Risk factors (age, gender, race, education, marital status, alcohol and smoking history,
BMI, HPV, surgery, chemotherapy, cancer stage, and cancer site) were collected through chart
review. Paired t-test was used to examine fatigue changes from pre to post IMRT. Regression modeling
was used to correlate risk factors with fatigue changes over time. Correlation coefficients and regression
modeling were used to explore the relationship between fatigue and other symptoms.
Results: All patients received IMRT. The majority of the patients was male, white, married, and with a
history of tobacco use. Most of them were diagnosed with non-laryngeal cancer, had stage IV cancer,
received current chemoradiotherapy, and had feeding tubes. Among patients with oropharyngeal cancer
(a total of 17), 88% of them were either HPV or P16 positive, and all of them received concurrent
chemoradiotherapy.
Patients’ overall fatigue increased significantly from pre (47 ± 16) to one-month post (60 ± 16) IMRT
(t=5.27, p=0.000). Of all the patients, 40% experienced severe fatigue (MFI ≥ 65) at one-month post

IMRT, while only 10% had severe fatigue at pre IMRT. Additionally, all five dimensions of fatigue
increased statistically significantly in the following order from the highest to the lowest: physical fatigue,
reduced activity, general fatigue, reduced motivation, and mental fatigue.
Multivariate analysis revealed that chemotherapy and pre-IMRT fatigue were significantly correlated with
fatigue changes over time (F=10.89, p=0.000). The patients receiving chemotherapy experienced
increased fatigue changes from pre to one-month post IMRT (t=2.29, p=0.027). Interestingly, patients
with lower pre-IMRT fatigue were more likely to have increased fatigue change over time, compared with
patients with higher pre-IMRT fatigue (t=-3.56, p=0.001).
Fatigue was the third severest symptom among the 13 common symptoms at pre-IMRT in our sample
(the first two were sleep problems and pain), and the second severest symptom at one-month post IMRT
(the first was taste changes). Fatigue at either pre or post-IMRT was significantly correlated with other
biobehavioral symptoms, including depressive symptoms, sleep problems, and cognitive problems at
either or both time points. Pre IMRT fatigue explained the most variance (20%) in a previously identified
HNC specific symptom cluster,10 involving symptom of pain, dry mouth, difficulty swallowing, skin burn
from radiation, mouth or throat sores (mucositis) and taste change, after controlling other variables, such
as sleep problems and chemotherapy (F=9.22, p=0.000).
Discussion: Patients with HNC reported remarkably increased fatigue at one-month post IMRT, compared
to pre IMRT, and 40% of them experienced severe fatigue (MFI ≥ 65). It appears that different
dimensions of fatigue were affected by the treatment in different severity levels. The fatigue dimensions
related to physical function and activity were more significantly influenced by the treatment than the
dimensions related to motivation and metal function. This finding may guide future studies to pay
attention to different dimensions of fatigue.
Consistent with previous studies,11,12 chemotherapy is a significant risk factor for fatigue. Our study
further showed that patients receiving current chemoradiotherapy experienced significantly higher
increased fatigue at one-month post IMRT than patients receiving only radiotherapy or radiotherapy plus
surgery. This finding indicates the negative synergistic effect of multiple concurrent treatment modalities
on fatigue. Interestingly, patients with lower pre IMRT fatigue experienced much more significant
increases in fatigue from pre to one-month post IMRT than those with higher pre IMRT fatigue did. The
reason for this is unclear, and future larger studies are warranted.
By comparing fatigue with other most common treatment-induced symptoms for patients with HNC, our
study demonstrated that fatigue was the only symptom that was consistently among the top three
severest symptoms experienced by patients at both pre and post IMRT. Furthermore, pre IMRT fatigue
was the most predictive variable for the HNC specific symptom cluster, involving the most common
radiation-induced symptoms in this population.
Conclusion: Fatigue is one of the major treatment-related symptoms experienced by patients with
HNC. HNC patients receiving IMRT report significantly increased acute fatigue from pre to one-month
post IMRT. Concurrent chemotherapy further worsens the symptom of fatigue. Fatigue, in turn, is the
most significant risk factor for other common radiation-induced symptoms, or the HNC specific symptom
cluster. Although these findings are from a prospective longitudinal study design, further larger studies
are needed to verify our results. Additionally, as there is no Food and Drug Administration (FDA)-
approved pharmacological agent that reliably prevents or treats fatigue,13 future research on
understanding the molecular and genetic mechanisms of fatigue is critical to its successful management.
References
1. Janaki MG, Kadam AR, Mukesh S, et al. Magnitude of fatigue in cancer patients receiving radiotherapy and its
short term effect on quality of life. J Cancer Res Ther. Jan-Mar 2010;6(1):22-26. 2. Solberg Nes L, Ehlers SL, Patten
CA, Gastineau DA. Self-regulatory Fatigue in Hematologic Malignancies: Impact on Quality of Life, Coping, and
Adherence to Medical Recommendations. Int J Behav Med. Sep 18 2011. 3. Goldstein D, Bennett B, Friedlander M,
Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent
of, mood disorder: a longitudinal study. BMC Cancer. 2006;6:240. 4. Park HC, Janjan NA, Mendoza TR, et al.
Temporal patterns of fatigue predict pathologic response in patients treated with preoperative chemoradiation therapy
for rectal cancer. Int J Radiat Oncol Biol Phys. Nov 1 2009;75(3):775-781. 5. Ackerstaff AH, Rasch CR, Balm AJ, et
al. Five-year quality of life results of the randomized clinical phase III (RADPLAT) trial, comparing concomitant intra-
arterial versus intravenous chemoradiotherapy in locally advanced head and neck cancer. Head Neck. Aug 4 2011. 6.

Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature
from 1982 to 2008. Health Qual Life Outcomes. 2009;7:102. 7. Hickok JT, Morrow GR, Roscoe JA, Mustian K,
Okunieff P. Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients
during radiotherapy for cancer. J Pain Symptom Manage. Nov 2005;30(5):433-442. 8. Gulliford SL, Miah AB,
Brennan S, et al. Dosimetric explanations of fatigue in head and neck radiotherapy: an analysis from the PARSPORT
Phase III trial. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.
Aug 2012;104(2):205-212. 9. Powell C, Schick U, Morden JP, et al. Fatigue during chemoradiotherapy for
nasopharyngeal cancer and its relationship to radiation dose distribution in the brain. Radiotherapy and oncology :
journal of the European Society for Therapeutic Radiology and Oncology. Aug 13 2013. 10. Xiao C, Hanlon A, Zhang
Q, et al. Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy. Oral
oncology. Apr 2013;49(4):360-366. 11. Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR.
Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. Feb
2000;18(4):743-753. 12. Jereczek-Fossa BA, Santoro L, Alterio D, et al. Fatigue during head-and-neck radiotherapy:
prospective study on 117 consecutive patients. Int J Radiat Oncol Biol Phys. Jun 1 2007;68(2):403-415. 13. Minton
O, Richardson A, Sharpe M, Hotopf M, Stone P. Drug therapy for the management of cancer-related fatigue.
Cochrane database of systematic reviews (Online). 2010(7):CD006704.
Contact
[email protected]

Influences of Women's Childbirth Experiences Related to Husband's Supports for
during Childbirth and Attitudes Toward Husband's Childbirth Presence
Yu-Jin Lee, RN, MSN, South Korea
Sun-Hee Kim, RN, PhD, South Korea
Purpose
The purpose of this presentation is to to inform the relations among husband’s supports during childbirth,
attitudes toward husband’s childbirth presence, and women's childbirth experiences in Korea. This
presentation will give the audience the evidence based information to improve childbirth experiences of
women at the chilbirth center. .
Target Audience
The target audience of this presentation is mainly nurses and mid-wives who work in the childbirth
centers.
Abstract
Purpose: The purpose of this study was to identify the relations among husband’s supports during
childbirth, attitudes toward husband’s childbirth presence, and the childbirth experiences in women.
Methods: The study was conducted at five women's hospital in the D city of Korea. The participants in
this study were 178 women who were within 2 days after normal spontaneous vaginal delivery. Data were
collected from September 1st to September 30th, 2013 using a structured questionnaire. Collected data
were analysed by t-test, one way ANOVA, Pearson's correlation coefficient, and stepwise multiple
regression using IBM SPSS/WIN Ver. 19.0 program.
Results: (a) Husband’s total support scores was moderate. Physical support scores were under
moderate, emotional support scores were over moderate, informational support scores were moderate.
Attitudes toward husband’s childbirth presence were 'positive attitude'. Childbirth experience scores were
over moderate.
(b) The significant factors affected on the women's childbirth experiences were husband's supports during
childbirth (emotional supports)(β=.33), psychological preparation for childbirth (β=.28), attitudes toward
husband's childbirth presence (β=.22), childbirth supporters to except for husband (β=.14). These
variables explained 35% of the childbirth experiences in women.
Conclusion: Based on the outcomes of this study, in order to increase positive childbirth experiences in
women, it would be necessary to develop nursing intervention programs that increasing husband's
supports during childbirth (emotional supports), psychological preparation for childbirth, positive attitudes
toward husband's childbirth presence, and childbirth supporters. Nurses should be more attention on
participating in the process of childbirth as a family-centered nursing intervention.
References
Bae, S. Y. (2012). A Study on the Stress and Anxiety of Pregnant Women Immediately Before Deliver. Unpublished
doctoral dissertation, Chosun University of Korea, Kwangju. Bryanton, J., Gagnon, A. J., Johnston, C., & Hatem, M.
(2008). Predictors of women’s perceptions of the childbirth experience. Journal of Obstetric, Gynecologic, and
Neonatal Nursing, 37(1), 24-34. Callister, L. C. (2004). Making meaning: Women’s birth narratives. Journal of
Obstetric, Gynecologic, and Neonatal Nursing, 33(4), 508-518. Cho, M. Y. (1988). Primiparas' perceptions of their
delivery experience and their maternal-infant interaction: Compared according to delivery method. Unpublished
doctoral dissertation, Ewha Womans University of Korea, Seoul. Choi, J. S. (2008). The effect of Doula labor support
on anxiety, labor pain, and childbirth experience perception of primiparas. Unpublished master's thesis, Ewha
Womans University of Korea, Seoul. Chun, N. M. (2001). The effect of childbirth education on primipara's childbirth
experience and postpartum maternal adaptation. Unpublished master's thesis, Seoul National University of Korea,
Seoul. Chung, I. N., Kim, K. S., Ryu, S. Y., & Na, B. J. (2002). Anxiety of pregnant women and its related factors. J.
Korea Soc Maternal Child Health, 6(1), 137-146. Eim, Y. L. (2004). The Effect of Childbirth knowledge, Labor agentry,
Labor pain on the postpartum Mothers's Perception of Delivery Experience. Unpublished master's thesis, Gyeong

Sang National University of Korea, Gyeongnam. Eom, S. Y., Kim, E. S., Kim, H. J., Bang, Y. O., Chun, N. M. (2012).
Effects of a One Session Spouse-Support Enhancement Childbirth Education on Childbirth Self-Efficacy and
Perception of Childbirth Experience in Women and their Husbands. J Korean Acad Nurs. 42(4), 599-607. Figueiredo,
B., Costa, R., Pacheco, A., & Pais, A. (2009). Motherto-infant emotional involvement at birth. Maternal and Child
Health Journal, 13(4), 539-549. Hardin, A. M., & Buckner, E. B. (2004). Characteristics of a positive experience for
women who have unmedicated childbirth. The Journal of Perinatal Education, 13(4), 10-16. Hodnett, E. D. (2002).
Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol, 186(5),
160-172. Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2007). Continuous support for women during
childbirth. Cochrane Database of Systematic Reviews, 3. Hur, M. H. (2001). Effects of one-to-one Labor Support on
Labor Pain, Labor Stress Response, Childbirth Experience and Neonatal Status for Primipara. Korean Journal of
Women Health Nursing, 7(2), 348-364. Ip, W. Y., Tang, C. S., & Goggins, W. B. (2009). An educational intervention
to improve women's ability to cope with childbirth. Journal of Clinical Nursing, 18, 2125-2135. Jang, M. J. & Park, K.
S. (2002). Effect of Family-Participated Delivery in a Labor Delivery Room on the Childbirth of Primiparas. Korean
Journal of Women Health Nursing, 8(3), 371-379. Jeon, M. H. (2003). A Study on Anxiety, Support-Degrees,
Childbirth-Experience of Wives of First Childbirth and Their Spouses. Unpublished master's thesis, Hanyang
University of Korea, Seoul. Jeon, M. H. & Yoo, E. K. (2004). A Study on Primiparous Husband's State Anxiety,
Perceived Support and the Perception of Childbirth Experience. Korean Journal of Women Health Nursing, 10(1), 51-
58. Kwak, I. J., Park, K. H., Lee, M. Y., Kim, M. R., Lee, H. S., Hong, Y. M., et al. (2004). The effect of one session
spouse's support reinforcement prenatal education program to participation and support degree of spouse to
pregnant women during labor. Journal of Korean Clinical Nursing Research, 10(1), 42-55. Lee, M. K. (2005). Factors
Influencing Self Confidence during Delivery in Laboring Women. Korean Journal of Women Health Nursing, 11(1),
20-26. Lee, Y. O. (2003). Comparsion & Analysis of Childbirth Experience which Labor Women Perceived at L.D.R.
and General Delivery Room. Unpublished master's thesis, Catholic University of Busan, Busan. Lim, H. Y., Baek, Y.
M., Oh, K. E., & Moon, H. K. (2006). Labor and delivery experience of women who have had lamaze education.
Journal of Korean Clinical Nursing Research, 12(1), 33-42. Marut, J. S., & Mercer, R. T. (1979). Comparison of
primipara's perception of vaginal and cesarean births. Nurs Res, 28(5), 260-266. Modarres Nejad, V. (2005).
Couples' attitudes to the husband's presence in the delivery room during childbirth. Eastern Mediterranean Health
Journal, 11(4), 828-834. Oh, H. L., Sim, J. S., & Kim, J. S. (2002). The effects of prenatal education on primiparas'
perception of delivery experience, self-confidence and satisfaction in maternal role performance. Korean Journal of
Women Health Nursing, 8(2), 268-277. Oh, J. H., Lee, H. J., Kim, Y. K., Min, J., & Park, K. O. (2006). The effect of
childbirth education and family participated delivery in a labor-delivery-recovery room on primiparas' anxiety, labor
pain and perception of childbirth experience. Journal of Korean Clinical Nursing Research, 12(2), 145-156. Park, K.
H., Kwak, I. J., Lee, M. Y., Lee, M. S., Lee, S. J., Park, H. J., Hong, Y. M., & Kim, I. (2002). The Need of Pregnant
Woman and Spouses About Spouse's Support During Labor, Journal of Korean Clinical Nursing Research, 8(1), 17-
35. Park, M. J., Oh, H. J., Yun, J. H., Kim, E. S., & Yi, Y. H. (2012). Attitudes of Wives and Husbands to the
Husband’s Presence during Labor and Delivery. Korean Journal of Women Health Nursing, 18(1), 74-85. Park, M. R.
(2010). Mothers’ perception of childbirth experience, labor pain, newborn’s pain and maternal attachment behaviors
with Leboyer Method, Unpublished master's thesis, Keimyung University of Korea, Daegu. Premberg, A., & Lundgren,
I. (2006). Fathers' experiences of childbirth education. Journal of Perinatal Education, 15(2), 21-28. Sapkota, S.,
Kobayashi, T., & Takase, M. (2012). Husbands’ experiences of supporting their wives during childbirth in Nepal.
Midwifery, 28(1), 45-51. Shin, G. S. (1995). Analysis Pregnant Women's Perceived Delivery Experiences According
to Delivery Supporters. Unpublished master's thesis, Yonsei University of Korea, Seoul. Soet, J. E., Brack, G. A., &
DiIorio, C. (2003). Prevalence and predictors of women's experience of psychological trauma during childbirth. Birth,
30(1), 36-46. Sung, M. H., Ju, M. S., & Ju, K. S. (2003). Effects of a Prepared Childbirth Education on the Knowledge
and Delivery Participation Levels of the Spouses of Primiparas. Korean Journal of Women Health Nursing, 9(3), 213-
223.
Contact
[email protected]

Transnational Care: Perceptions of Filipino Nurses Working in Japanese
Hospitals Under the Japan-Philippine Economic Partnership Agreement (JPEPA)
Cora A. Anonuevo, PhD, RN, Philippines
Purpose
The purpose of this presentation is to impart the realities of Filipino nurses who were deployed in Japan’s
hospitals. Specifically, it presents their perceptions on their work status after passing the Japanese
Licensure Examination; their personal and professional plans; and their views about the JPEPA
implementation.
Target Audience
The target audience of this presentation are nurses who may intend to work in Japan and in other host
countries; and those in administrative position who may potentially deal with nurses coming from source
countries.
Abstract
Purpose: This paper is an exploration of the perceptions of Filipino nurses on their current status and
work conditions after passing the Japanese Licensure Examination for nurses, their plans in light of
their conditions, and their views on the implementation of Japan-Philippine Economic Partnership
Agreement or JPEPA.
Methods: Individual interviews were conducted in July 2012 with six Filipino nurses who passed the
Japanese licensure examination. The study parrticipants have been working as staff nurses in five
tertiary health care facilities in Japan. The interview was held in the hospital premises. Permission to
conduct the interview was given by the participants themselves, with consent of their employers.
Results: The narratives of the six Filipino nurses revealed that preparation for the Japanese licensure
examination was a difficult challenge that required personal effort and institutional support. Passing the
national examination has brought encouraging changes in their nursing functions, salaries and
benefits, interpersonal relationships, and professional image. However, language barrier and
communication problems persist. Most of them were uncertain whether to stay long or not in Japan.
Conclusion: In pursuit of international cooperation particularly on the movement of natural persons,
JPEPA can have a bright prospect if both countries address difficulties arising from language and cultural
barriers. Further, regulatory measures need to be strengthened to ensure the quality and protection of
nurses and care workers.
References
Agreement Between Japan and the Republic of the Philippines for an Economic Partnership. Specific Commitments
for the Movement of Natural Persons. Annex 8, Chapter 9. Accessed October 20, 2011,
http://www.mofa.go.jp/region/asia-paci/philippine/epa0609/annex8.pdf . Cirujales, S. Ma. Remegia M. and S. Letty
Kuan. 2012. “Nurse Migration, Deployment, Enrolment and Board Passing Trends in the Philippines (1999-2008).”
Philippine Journal of Nursing. 82 (1): 4-17. Itami, Masako, Yoshinori Morooka and Kiyoshi Itami. Migration of
Internationally Educated Nurses from Southeast Asia to Japan: Proposals on educational supports to combat brain
loss in Japan. Accessed December 10, 2012. http:// ir.kochi-u.ac.jp/dspace/bitstream/10126/4812/1/kuro4-1.81.pdf.
Contact
[email protected]

The Relationship Between Executive Dysfunction and Instrumental Activities of
Daily Living in Early-Stage Dementia
Daisuke Fukuta, RN, PHN, MS, Japan
Chizuru Mori, RN, PhD, Japan
Purpose
The purpose of this study is to investigate the relationship between executive dysfunction and IADL in
early-stage dementia.
Target Audience
Psychiatric and geriatric nurses
Abstract
Purpose: One of the key clinical features of early symptoms of dementia is the cognitive deficits in
everyday activities. Until a few years ago, it was considered that early-stage dementia is typically
characterized primarily by memory impairment. In the latest survey for early-stage dementia, executive
dysfunction has been attracting attention to not only memory impairment in the significant cognitive
deficits. The cognitive deficits are often mild and may get worse very gradually, but it has been suggested
that executive dysfunction affects the Instrumental activities of daily living (IADL) of early-stage dementia.
Executive function consists of complex attention, working memory, verbal and visual organization,
planning, judgment, and reasoning. IADL includes activities related to independence, organization, and
judgment abilities, such as the ability to use a telephone, shopping, food preparation, housekeeping,
laundry, transportation, responsibility for one’s own medication, and handling finances. In the recent
studies, executive dysfunction and IADL impairment are thought to be associated with prefrontal
dysfunction of mild cognitive impairment (MCI).
Several studies using executive function tests have revealed differences in performance between healthy
control subjects and patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). However,
some of the most widely used tests of executive functions, such as the Wisconsin Card Sorting Task
(WCST) and the Trail Making Test (TMT), can be performed normally by patients with clear executive
impairments. The observations are not consistent across all studies.
To assess executive functions in the context of more ecologically relevant behaviors, Wilson (1996)
developed the Behavioral Assessment of Dysexecutive Syndrome (BADS). The BADS is a valid battery of
tests which assesses problems in everyday behavior which are typically found in patients with
dysexecutive syndromes. There are no studies which revealed the association between IADL and
executive dysfunction using the BADS to patients with early-stage dementia, although executive function
is an important cognitive function for individuals efficiently performs IADL.
The purpose of this study is to investigate the relationship between executive dysfunction and IADL in
Methods: Participants - 29 participants (6 male and 23 female) were recruited in the present study.
Inclusion criteria were as follows: 1) age older than 60 years; 2) a Mini-Mental State Examination (MMSE)
score > 20; 3) the Beck Depression Inventory (BDI) score ≦ 14; 4) absence of vascular lesions; 5)
absence of psychiatric disease which could cause cognitive impairment.
Measurement Instruments - Executive function assessment - The Behavioral Assessment of
Dysexecutive Syndrome (BADS): The BADS (Kashima H, 2003) is a standardized battery that includes
six subtests and two forms of the Dysexecutive Questionnaire (DEX). The six subtests consists of the
Rule Shift Card Test, Action Program Test, Key Search Test, Temporal Judgment Test, Zoo Map Test,
and Modified Six Elements Test. A profile score, ranging from 0(severely deficient) to 4 (normal
performance), is determined of each subtest, and the sum of each subtest is calculated as the overall
profile score. The maximum total score is 24. From the results, the overall classification is obtained:

impaired, borderline, low average, average, high average, superior, and very superior. The DEX
questionnaire comprises 20 items constructed to examine the range of problems associated with the
dysexecutive syndrome. Two versions are used: DEX self-rating (patients) and DEX other-rating
(caregivers). The maximum score is 80 points on each questionnaire. In all cases, the BADS was
performed on a single session and it took approximately 45 minutes on average.
Instrumental activities of daily living (IADL) assessment: The Instrumental Activities of Daily Living
(IADL) scale is an appropriate instrument to assess independent living skills (Lawton, 1969). There are 8
domains of function measured with the IADL scale: using the telephone, shopping, food preparation,
housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle
finances. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent).
Until this point, women were scored on all 8 domains of function, men were not scored in the domains of
food preparation, housekeeping, and laundry. However, current recommendations are to assess all
domains for both genders.
Analyses: Spearman’s correlation test was used to investigate the relationship between the BADS and
the IADL scale, the BADS and sample descriptive data. The Mann-Whitney U test was used to detect
difference between DLB and AD in relation to sample descriptive data, the BADS, and the IADL scale.
We used the Statistical Package for Social Sciences (SPSS) version 21, at the 95% confidence level.
Ethical considerations: This study was approved by University of Tsukuba Faculty of Medicine, Ethics
Committee. Written informed consent was obtained from participants, before the initiation of any research
procedures.
Results: The BADS was performed on 27 inpatients and 2 outpatients (13 Dementia with Lewy bodies,
13 Alzheimer's disease, and 3 Suspected Dementia).
The BADS overall profile score was significantly correlated with MMSE score (r = 0.61; p < 0.01) and
IADL score(r = 0.54; p < 0.01). There was no correlation between the BADS overall profile score and age
(r = -0.20). The BADS overall profile score was correlated with DEX other-rating score(r = -0.48), but no
correlation with DEX self-rating score(r = 0.03). Correlations between BADS subtests and IADL score
were statistically significant(r = 0.41 to 0.49; p < 0.05), except for the Temporal Judgment Test(r = -0.04)
and Modified Six Elements Test(r = 0.23). IADL score was correlated with DEX other-rating score(r = -
0.67; p < 0.01), but no correlation with DEX self-rating score(r = -0.04).
There was no statistically significant differences between DLB patients and AD patients in age (patients
mean = 74.75, SD = 7.61 [range 60 to 87]; p = 0.40), MMSE score (patients mean = 25.24, SD = 3.13
[range 21 to 30]; p = 0.56), IADL score (patients mean = 4.31, SD = 1.85 [range 1 to 8]; p = 0.56), BADS
overall profile score (patients mean = 10.34, SD = 4.04 [range 3 to 19]; p = 0.77), DEX self-rating score
(patients mean = 8.82, SD = 8.37 [range 0 to 29]; p = 0.25), and DEX other-rating score (patients mean =
16.94, SD = 17.99 [range 0 to 58]; p = 1.0).
The BADS overall profile score was 18 impaired, 5 borderline, 2 low average, and 4 average.
Conclusion: The BADS was a useful battery that can evaluate the relevance of executive dysfunction
and IADL. We found that executive function was associated with IADL. So, it is recommended that nurses
should assess the executive function to patients with early-stage dementia. IADL score was significantly
correlated with the 4 subtests. But, the Temporal Judgment Test was no correlation with IADL score. The
Temporal Judgment Test was shown to be not appropriate for the evaluation of the relevance of
executive function and IADL.
The BADS overall profile score was correlated with MMSE score, and 23 patients (79.3%) were classified
into impaired or borderline. The presence of executive dysfunction in early-stage dementia was
suggested. The BADS overall profile score was no correlation with age, and there was no significant
difference between BLD and AD. In previous research, correlation between age and executive
dysfunction has been suggested, and difference in the progression of executive dysfunction of BLD and
AD has been shown by observation by psychiatrist. However, it was not evident in this study sample of

The evaluation of the executive dysfunction by patients (DEX self-rating) was lower than caregivers (DEX
other-rating). It is considered that the evaluation of caregivers is important in the assessment of executive
function to patients with early-stage dementia.
References
Kashima H (2003): Behavioural assessment of the dysexecutive syndrome, Japanese edn. Shinkoh Igaku Shuppann
Company, Tokyo Wilson BA, Alderman N, Burgess PW, et al (1996): Behavioural assessment of the dysexecutive
syndrome. St Edmunds, UK: Thames Valley Test Company Lawton MP, Brody EM (1969): Assessment of older
people: Self maintaining and instrumental activities of daily living. Geroulologist 9(3): 179-86
Contact
[email protected]

The Influence of Helping Relationships from Significant Others on Healthy
Lifestyle Among Patients with Chronic Kidney Disease
Shu-Mei Chao, MS, RN, Taiwan
Fang-Ru Yueh, RN, Taiwan
Purpose
The helping relationships is that significant others provide support to people for living with healthy life
style and conducting healthy behaviors. The aim of this study was to explore that significant others¡¯
positive and negative supports help patients with chronic kidney disease (CKD) to adopt healthy life style.
Target Audience
Abstract
Purpose: The aim of research is to study and explore helping relationships impact on establishing
healthy lifestyle among patients with chronic kidney disease (CKD). The positive behaviors and negative
behaviors of helping relationships from significant others assist patients with chronic kidney disease to do
health behaviors about diet and exercise. Therefore, the patients will get higher possibilities to insist in
suggestions from medical staff and act healthy lifestyle for maintaining healthy behavior and delaying
deteriorated disease. Addition to helping relationships from perspectives of Transtheoretic Model, the
study explores influence how helping relationships from significant others set and maintain healthy
behaviors of patients. According to literature review, there is no helping relationships instrument.
Therefore, this study will develop helping relationship of significant others instrument for patients with
CKD.
Methods: Firstly, three nursing or medical experts in chronic disease field discussed and evaluated the
item equivalence, clarity and readability about the helping relationship of significant others instrument. A
validity index was calculated and any item scoring less than 3 was reconsidered by the experts and
suggestions would be incorporated. Secondly, this study will recruit 200 Taiwanese Mandarin-speaking
patients aged 20 or older and with a diagnosis of CKD. The psychometric properties of the instrument
including the internal consistency, factor analysis and parallel analysis will be performed.
Results: The study is in progress. Descriptive statistics will express frequencies, percentage, or mean±
SD. Internal consistency of the helping relationships from significant others will be assessed by
determining Cronbach’s alpha coefficients for the overall scale and subscales. Confirmatory factor
analysis, exploratory factor analysis, scree plot examination, eigenvalues greater than 1, and parallel
analysis will be also performed.
Conclusion: The helping relationship of significant others instrument may show good reliability and
validity. The positive behaviors and negative behaviors of helping relationships from significant others
may assist patients with CKD to do healthy lifestyle about diet and exercise.
References
Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with
chronic conditions: A review. Patient Education and Counseling,48(2), 177£187. Bellizzi, V., Di Iorio, B. R., De Nicola
L et al (2007).Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney
disease. Kidney Int, 71, 245¨C251. Borg, M.& Kristiansen, K.(2004). Recovery-oriented professionals: Helping
relationships in mental health services. Journal of Mental Health, 13(5), 493 ¨C 505. Clements, L., & Ashurst, I.
(2006). Dietary strategies to halt the progression of chronic kidney disease. Journal of Renal Care, 32(4), 192-197.
Cohen, S. & Lichtenstein, E.(1990). Partner behaviors that support quitting smoking. Journal of Consulting and
Clinical Psychology, 58(3), 304-309. Cohen, S.(2004).Social Relationships and Health. American Psychologist,
November, 676-684. Di Noia, J.& Thompson, D.(2012). 1Processes of change for increasing fruit and vegetable
consumption among economically disadvantaged African American adolescents. Eating Behaviors, 13, 58¨C61.

Mapes, D. L., Lopes, A. A., Satayathum, S., McCullough, K. P., Goodkin, D. A., Locatelli, F., et al. (2003). Health-
related quality of life as a predictor of mortality and hospitalization: the Dialysis Outcomes and Practice Patterns
Study (DOPPS). Kidney International, 64(1), 339-349. Park, E. W., Tudiver, F., Schultz, J. K.,& Campbell, T.(2004).
Does Enhancing Partner Support and Interaction Improve Smoking Cessation? A Meta-Analysis. Ann Fam Med , 2,
170-174. DOI: 10.1370/afm.64 Parsons, Y. L., Toffelmire, E. B., & King-VanVlack , C E.(2006). Exercise Training
During Hemodialysis Improves Dialysis Efficacy and Physical Performance. Arch Phys Med Rehabil, 87,680-687.
Prochaska, J.O., Redding, C.A., Evers, K.E.(2008). Chapter 5: The transtheoretical Model and Stages of Change. In
Glanz, K., Rimer, B. K., & Viswanath, K.(2008). Health Behavior and Health Education/Theory, Research, and
Practice. San Francisco:Jossey-Bass Qi, M. K., Ang, A., Yee, J.,& Martin, C.(2011). Meeting the nutrition challenge of
stage 3 kidney failure: considers for nursing practice. Singapore Nursing Journal, 38 (4), 10-13. Redman, B. K.
(2004). Patient self-management of chronic disease. Jones & Bartlett: USA. Sakraida, T. J., & Robinson, M. V.
(2009). Health literacy self-management by patients with type 2 diabetes and stage 3 chronic kidney disease.
Western Journal of Nursing Research, 31(5), 627-647. Teta, D. (2010). Weight loss in obese patients with chronic
kidney disease: who and how? Journal of Renal Care, 36(Suppl. 1), 163¨C171. Tsai, Y. C., Hung, C. C., Hwang, S.
J., Wang, S. L., Hsiao, S. M., Lin, M. Y., et al. (2010). Quality of life predicts risks of end-stage renal disease and
mortality in patients with chronic kidney disease. Nephrol Dial Transplant, 25(5), 1621-1626. United States Renal
Data System (2009). 2009 USRDS ADR-international comparisons. Retrieved March 16, 2010, from
http://www.usrds.org/2009 /pdf/ V2_12_09.PDF United States Renal Data System (2009). 2009 USRDS ADR-
international comparisons. Retrieved March 16, 2010, from http://www.usrds.org/2009 /pdf/ V2_12_09.PDF Weir, M.
R.(2007). Is it the low-protein diet or simply the salt restriction? Kidney International, 71 (3), 188-90. Wen, C. P.,
Cheng, T. Y., Tsai, M. K., Chang, Y. C., Chan, H. T., Tsai, S. P., et al. (2008). All-cause mortality attributable to
chronic kidney disease: a prospective cohort study based on 462293 adults in Taiwan. Lancet, 371(9631), 2173-
2182.
Contact
[email protected]

An Evaluation of Motivators for Colonoscopy Screening Compliance
Holly Marcusen Wright, RN, BSN, USA
Purpose
to reveal what motivates people to comply with colonoscopy screening guidelines. We are finding that
doctor recommendations, family history of colon cancer and family pressure are among the most
significant influences that help people choose to have a screening colonoscopy. This information can be
used to increase colonoscopy screening compliance.
Target Audience
Healthcare workers and individuals who have potential influence on people who need to have a screening
colonoscopy.
Abstract
Purpose: Polyp removal, which is done during a colonoscopy screening, has been shown to reduce
colorectal cancer by as much as 90%. Only 53% of Americans who are age 50 comply with colorectal
cancer screening guidelines. More people need to have colonoscopy screenings. This study aims to learn
what motivators are working to get people to comply with colonoscopy screening so that this information
can be used to motivate more people to have the screening done.
Methods: We used mixed-methods with qualitative and quantitative features in a one-on-one interview
and a questionnaire with 206 participants
Results: We are finding that doctor recommendations, family history of colon cancer and family pressure
are among the most significant influences that help people choose to have a screening colonoscopy
Conclusion: This information can be utilized to increase colonoscopy screening compliance.
References
American Cancer Society. (2011). Colorectal Cancer Facts & Figures 2011-2013. Retrieved from
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-028323.pdf
http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/five-myths-about-colorectal-cancer
http://www.nejm.org/doi/full/10.1056/NEJM199312303292701
Contact
[email protected]

Parenting Stress, Social Support, Re-Birth Intention of Mother with Infant or Child
Jung Kim, RN, South Korea
Purpose
The purpose of this presentation is to provide understanding the correlation among variables such as
married women's pregnancy intention, social support and parenting stress.
Target Audience
The target audience of this presentation is professor, nurse and students in the field of women health
nursing.
Abstract
Purpose: This study was performed to examine the correlation among the parenting stress, social
support and re-birth intention of married women with infant or child.
Methods: A self-administered questionnaire survey was carried out for 123 mothers having infant or child
between March 01 and April 01, 2011 in Daegu-city of Korea. This study was investigated parenting
stress, social support and re-birth rate of married women with infant or child.
Results: Among the parenting stress scores, parent's pain score as the sub-items of the parenting stress
was significantly different according to the sex composition of children(p<0.05). Parent's pain of mother
with each other different genders children was higher than parent's pain of mother with same gender
children(p<0.05). The re-birth intention rate of married women with infant or child was 31.7%. The major
reasons why they avoided giving birth were 'economic burden', followed by 'to bring up present child well',
'not to want more children', 'to be subjected to individual and marital relation', and 'non-confidence in
playing a role of parents'. The reasons of the subjects intending to give births were 'to need siblings for
their child', 'to be pleased to see their children grow', 'to achieve family plan', and 'to be asked by family
seniors' request or derived from a sense of obligation' in order. In bivariate analysis, re-birth intention rate
was higher as the mother was younger(p<0.05), in the mothers who had job(p<0.05), in the mothers who
had only one child(p<0.01), and in the mothers who had only girl or girls(p<0.01). In multiple logistic
regression analysis, the variables affecting re-birth intention were the gender composition of children and
number of child(p<0.05). Re-birth intention of the mother who had only girl infant or children was higher
than re-birth intention of the mother who had boy and girl infant or children. And re-birth intention rate was
lower as number of child was increasing. In correlation of re-birth intention, parenting stress and social
support, parent's pain as sub-item of parenting stress and re-birth intention were negatively
correlated(p<0.05). The parent's pains and dysfunctions between parents and children as sub-item of
parenting stress were negatively correlated with social support(p<0.01), And Children's difficult
characteristic as sub-item of parenting stress showed significant negative correlation with husbands'
cooperation as social support(p<0.05).
Conclusion: Low birth rate is associated with national existence, and it causes various social problems.
If the birth rate of Korea remains at the current level, it will raise the average working age of Korea; it will
weaken global competitiveness of industry; it will eventually reduce the rate of increase in national
income. As a result, the younger generation will have to shoulder the burden of supporting the older
generation, and the overall crisis of the social security system will hit the nation. As our society is rapidly
becoming an aging society, consciousness of crisis on low birth rate in Korea has increased. To increase
this low birth rate, an active political, economic and social involvement should be carried out. However, it
is very difficult to increase low birth rate thorough policy because birth rate is affected by complex
factors. Currently, the social participation of the married woman becomes enlarged and the desires to
make their dream come true are strengthened. But most of married women have to take on the major
responsibilities of parenting. Therefore, we should identify mother's needs. We should establish a policy
to suit their own desires by analyzing the factors to affect their birth intention. In conclusion of above
findings, parenting stress is associated with social support. And the parent pains as sub-item of
parenting stress is associated with re-birth intention. The parent's pains as sub-item of parenting stress

were negatively correlated with social support. To encourage re-birth and reduce mothers' parenting
stress, we need create a social mood to reinforce social support.
References
Abidin. R : Parenting Stress Index(PSI) Charlotterville, VA : Pediatric Psychology Press, 1990. Ahn, N. and P. Mira :
"A note on the changing relationship between fertility and female employment rate in developed countries, "Journal of
Population Economics", 15, 2002. Brewster, K. L., & Rindfuss, R. R. : uAnnual Review of
women's employment in industrialized nations, 2000. Cric. K. A., & Greenberg, M. T. : Minor parenting stresses with
young children. Child Development, 61: 1628-1637, 1990. Cutrona, C. E., & Troutman, B. R. : Social support, infant
temperament and parenting self-efficacy: A mediational model of postpartum depression. Child Development, 57,
1507-1508, 1986. Gamble, W., Belsky, J. : Stressors, support, and matternal personal resources as determinants of
mothering : A comparison of three models. Unpublished manuscript, The Pennsylvania State University Park, PA,
1984. Lazarus, R. S., & Folkman S. : Stress, appraisal, and coping NY. Springer, 1984. Mitchell, R. E., Billings A. G.,
& Moos, R. H. : Social support and well-being : implications for prevention programs. Journal of primary prevention, 3,
77-98, 1992. Osmond, M. W. AND R. Y. Martin. : "Sex and Sexism : A Comparison of Male and Female Sex-Role
Attitudes." Journal of Marriage and the Family 37: 744-758, 1975. Webster-Stratton, C. : Mother's and father's
perceptions of child deviance roles of parent and child behaviors and parent adjustment. Journal of consulting and
Clinical Psychology, 56(6): 990-915, 1988.
Contact
[email protected]

Using Field Theory to Explore the Resourcefulness of Patients with Depression
Chun-O Chien, RN, MSN, Taiwan
Chien-Yu Lai, RN, PhD, Taiwan
Purpose
The purpose of this study is to explore the resourcefulness in patients with depression and to understand
the personal or social resourcefulness expected by them.
Target Audience
The target audience of this presentation is clinical staffs in medical facilities. The findings of this study
provide psychiatric and mental health clinical staffs to have better understanding about depressed adults’
skills of resourcefulness which they usually used.
Abstract
Purpose: The purpose of this study was to explore the resourcefulness in patients with depression and to
understand the personal or social resourcefulness expected by them.
Methods: A qualitative research design based on Field Theory with the method of focus group
interviewing was used.The participants were recruited via purposive sampling from outpatients
department of a medical center in Southern Taiwan. Totally, seven adults with depression were invited
and completed the full courses of focus group in this study. Closed groups with six interviews, two hours
per time, were implemented to collect data. Content analysis was used to analyze the findings of this
study.
Results: Three themes in terms of resourcefulness in patients with depression were concluded as
follows. The first theme was “Personal resourcefulness”, including four subthemes such as “relieving
emotional tension by self”, “problem solving”, “positive thinking”, and “self-efficacy”. Depressed adults
were used to crying, writing diary, shouting and exercise to relieve their emotional tension. They had tried
to avoid the stressors, shifting attention, using relaxation skills and doing some things they enjoyed to get
rid of the distress. They also used active approaches such as positive self-encouragement and positive
thinking to change their mind. Additionally, they possessed their religious belief and self-efficacy to
believe that they can overcome the adversity.
Another theme, “social resourcefulness” was also used to get help from two types of social resources.
The first subtheme is “informal resources” including families, friends and/or relative others. “Conveying a
help-seeking message”, “talking to others”, “asking help from the right person”, and “being with people”
were the means they would apply. The second subtheme is “formal resources” indicating physicians,
psychologists, family education centers and community counseling services.
The third theme involved “the ways to get resourcefulness” with two accesses, including “the way for
personal resourcefulness” and “the way for social resourcefulness”. Depressed adults expected
themselves to effectively use self-efficacy, positive thinking and ways of relieving emotional tension by a
well-planned daily schedule or a notice board to remind ones of their personal resources. In addition, in
order to acquire listening, company, and timely guidance from others, “to get involved in social support
systems” was what they need.
Conclusion: The findings of this study provide clinical staffs to have better understanding about
depressed adults’ skills of resourcefulness which they usually used. Knowing the gaps in successfully
performing the ability of resourcefulness, the training programs constituting resourcefulness skills will be
suggested to develop for patients with depression.
Contact
[email protected]

The Self-Concept of Shizoprenia
Hiromi Sugawara, RN, NS, Japan
Chizuru Mori, RN, PhD, Japan
Purpose
The Purpose of this study was to elucidate the self concept of patients with schizophrenia.
Target Audience
The target audience of this presentation is psychitiric nuring.
Abstract
Purpose: According Self-concept theory, “Self “was divided “I” and “Me” (James.W1890).“I”is the self who
recognized “Me”, “Me”is the self who is recognized. When we think about and image ourselves, “I” and
“Me” are distinguished. Therefore, we can be conscious ourselves objectively. Self-concept is said that
basic concept structure which supports self- consciousness tacitly (Kajita 1988). It is thought that self-
concept is basis of the relationship between “I” and “Me”. Self-concept is developed in childhood, and
established from adolescence to adulthood (David 1992). Especially, a number of life events occur,
people change individual role from adolescence to adulthood. Each time change of social role, people
conscious to self objectively. As a result, self-concept would be more complex. Self-worth and self-
development are increasing (David 1992). In case of patients with Schizophrenia, their self-monitoring is
poor because of cognitive deficit. Therefore, it is hard to they have objective view to themselves. In
addition, they have hospitalization experience, stigma, and loss of the social role (McCay 1998). Also,
Schizophrenia often develops in a prime of life from youth where numbers of life events occur. So, their
self-concept has influence since they were diagnosed with Schizophrenia. It suggests that their self-
concept might be ambiguous. In review, Kajita(1988) said that the patients with psychiatric disorder, who
have incorrect self-concept like “I an emperor”are difficult to adapt social life. Not adaption in social life
leads to their low self-worth and self-esteem. There are a lot of reports about self-concept, but most
report were academic self-concept which means self-evaluation. And the research that focuses on the
self concept of patients with schizophrenia is not found. That why we focus on the self concept of patients
with schizophrenia and explore nursing approach for patients with schizophrenia in this study. The
Purpose of this study was to elucidate the self concept of patients with schizophrenia
Methods: Subject: Our study’s Subjects were patients with schizophrenia in three psychiatry hospitals
and out-patients in a community workshop.
Procedure: First, we recruited subjects that their doctors and nurses decided patient’s condition could
stand our study. Because there are not doctors and nurses in community workshop, subjects were
recruited by staff. Then, we ask to consent with each subject. After we adjusted convenient time with
subject, we conducted semi-structured interviews with participants 1 time or 2 times. Considering their
condition, interviews was set less than 30 minutes each time. And also, we investigated Demographic
information from medical record (age, sex, disease duration, chlorpromazine equivalent) in hospitals. In
case of out-patients, we investigated Demographic information by asking them.
Analysis: About the transcription of all interviews, we used QCA to analyze our material. We focus on self-
concept that Kajita (1988) proposed, categories were added in a concept-driven procedure. Self-concept
that Kajita proposed is consist of Present cognition and definition to the self, Feeling and evaluation to the
self, The self that is seen from others, Past self-image, The self-image about possibility and future, What
should do and ideal about the self (1988).To assess content validity, expert who is familiar with self-
concept check coding frame.
Ethical considerations: Our study obtained organization of the Ethics Committee’s proposal. We
explained the purpose and method of this study, the participation is free, keeping anonymous in
document. Participants Signed on Consent form.

Results: 39 patients with schizophrenia participated in our study. We excluded four partisepants of those,
because they have thought disorder.That why we analysed interview contents from 35 partisepants.
Among 35 partisepants, 14 partisepants admitted the recording of interview contents and other
partisepants admitted that a researcher wrote down interview contents in a memo. We interviewed
partisepants 1-2 times.The interview time of the average was 25 minutes earch time. Participants were
21men and14 female, the average age was 46.7 years old.
Following a concept-driven procedure in QCA, first we treated six component (Present cognition and
definition to the self, Feeling and evaluation to the self, The self that is seen from others, Past self-image,
The self-image about possibility and future, What should do and ideal about the self)of the self-concept
Kajita proposed as main categories. All labes of transcription divied to subcategories by considering
related maincategories.
1) Present cognition and definition to the self
Present cognition and definition to the selfis consisited of three subcategories(State of the self, Emotional
intention and attutide of the self, self-difinition). The labels which means their feeling sense of
incongruity,like “A voice order and advice me in various ways”“I feel heavy at a body because of the sleep
shortage”were integrated into the self who feels sense of incongruity. And the labels which means state of
the self in delusion, like“I am God of the religion” were integrated into. The self who feels sense of
incongruity and the self that changed by a disease were integrated into State of the self. In Emotional
intention and attutide of the self,exression about like or dislike as“I like walking”“I don't like to cook” were
integrated. In self-difinition,attributes of the self like “I am schizophrenia” “I have family”were integrated.
2) Feeling and evaluation to the self
Feeling and evaluation to the self is consisited of three subcategories (Self-confidence and pride, Sense
of superiority and inferiority complex, Self-acceptanece). In Self-confidence and pride, the confidence that
understands an illness than anyone else like “I know my illness than psysician” , Resistance to stigma like
“I don’t have metal illness”,pride to the self like, “I have worked for the major company”were integrated. In
Sense of superiority and inferiority complex,“I envy healthly person”“I have a power of the telepathy” were
integrated. The labels which means feeling about the self who is under medical treatment like“I hate
having to take medicin”, evaluation about change of the state of the self like“I feel getting better from my
illness”evaluation of modified the self to the self like“I do not understand effect of the medicine clearly, but
the medicine may work”acceptance of the patient role like “There is me who cannot beat the self who
have illness” were integrated into Self-acceptanece.
3) The self that is seen from others
The self that is seen from othersis consisited of two subcategories (image and difinition from others,
Feeling and evaluation from others). In image and difinition from others , difinition of schizophrenia by
others were integrated In Feeling and evaluation from others,evaluation about the self who have illness
like“I am seen strange mentally by others” were integrated.
4) Past self-image
Past self-image is consisited of three subcategories(Past experience, image and difinition to past self,
Feeling to past self ). Interpretation to Past self , a sense of guilt to Past self and so on were integrated
into this category.
5) The self-image about possibility and future
The self-image about possibility and futureis consisited of four subcategories (Possibilty of prediction and
conviction, Image for plane for future, Image for will and intention, Desire to the self).Self-image for state,
action and will when I became ill badly, were integrated into this category.
6) What should do and ideal about the self
This main categories is consisited of two subcategories (What should do and ideal about the self). the
labels which means What should “I”do , ideal and dream were integrated into this category.
Conclusion: In our study, shizoprenia were consious to themselves objectivly like“A voice order and
advice me in various ways” “There is me who cannot beat the self who have illness” but some label

means the self that changed by a disease like “I am God of the religion”. According old review in Japan,
when shizoprenia want to talk about experience of delusion, they already couldn’t make“me”objective,and
they feels something enter into “me” (Kimura1978).Therefore our study suggested that shizoprenia have
two sides of the self.One side was the self and other side was the self that was influenced by illness.It
thought that this result is charactristic of schizophrenia
References
David H(1992) FThe self
-concept overtime-Reserch Issues and Directions ,Annual Reviews Social ,18,303-26 Kajita
E(1988) FPsychology of the self edn,University of Tokyo press,Tokyo Kimura B(1978):
-consciousness,Japanese
Psychopathology of the awareness , Japanese edn, Kinokuniya Co.,Ltd,Tokyo McCay EA, Seeman MV(1998):A
Scale to Measure the Impact @of a Schizophrenic
-Concept, lllnesson an Individual's Self
Archives of Psychiatric
Nursing,XII(1),41-49 James W(1890):Principles of psychology,Chicago, encyclopedia Britannica.
Contact
[email protected]

The Effect of a Community-Based Fitness and Aerobic Exercise Program for
Older Adults: A Randomized, Controlled Trial
Chiung-Hua Lin, MSN, RN, Taiwan
Ruenn-Ching Wang, MSN, RN, Taiwan
Purpose
The purpose of this presentation is to share a good model of a community-based fitness program for
improving health and preventing chronic conditions in community-dwelling older adults.
Target Audience
The target audience of this presentation is clinic nurses and health promotion workers and every
audience who are interesting in health promotion.
Abstract
Purpose: The purpose of study aimed to examine the effects of a fitness and aerobic exercise (FAE) on
muscle strength, flexibility, cardiorespiratory fitness and balance in community-dwelling older adults.
Methods: Participants F A sample of 64 older adults (aged_60+) was recruited from community centers.A
prospective, single blind, randomized, controlled intervention trial was undertaken. The participants were
randomly assigned to the intervention or control group. Participants were randomized into intervention
group (n=31) or control group (n=33). The intervention group underwent a fitness and aerobic exercise
(FAE) program which designed for older adults to improve leg muscle strength, flexibility cardiorespiratory
fitness, agility and balance training program. This is 1-hour session and twice per week for 8 weeks. The
control group underwent a walking program. Measurement FMuscle strength (Chair stand test and Arm
curl test), flexibility (Chair sit-and reach test and Back scratch test), cardiorespiratory fitness (2-minute
step test), agility (8-foot up-and-go test) and balance (Gait balance).
Results: At baseline both groups were well matched in their physical performance, health and activity
levels. The intervention group had significantly more gains in leg and arm Muscle strength, balance and
agility than controls. There were no significant trends for improvement on flexibility and cardiorespiratory
fitness.
Conclusion: These findings indicate that participation in FAE program can improve muscle strength;
balance and agility. The FAE program is a feasible and beneficial for improving physical conditions in
older adults. FAE program may serve a good model of a community-based fitness program for improving
health and preventing chronic conditions in community-dwelling older adults.
References
Agency for Healthcare Research and Quality( 2006). Centers for Disease Control and Prevention. Physical activity
and older Americans: benefits and strategies. June 2002. Retrieved from http://www.ahrq.gov/ppip/activity.htm
Accessed on November 25. Blair SN, Kohl HW III, Paffenbarger RS Jr, et al(1989). Physical fitness and all-cause
mortality. A prospective study of healthy men and women. JAMA 262: 2395-401. Blumenthal JA, Babyak MA, Moore
KA, et al(1999).Effects of exercise training on older patients with major depression. Arch Intern Med 159: 2349-56.
Campbell A, Robertson M, Gardner M, et al(1997). Randomised controlled trial of a general practice programme of
home based exercise to prevent falls in elderly women. BMJ 315: 1065-9. Collins, K., Rooney, B. L., Smalley, K. J., &
Havens, S. (2004). Functional fitness, Disease and Independence in Community- Dwelling Older Adults in Western
Wisconsin. Wisconsin Medical Journal, 103(1), 42-48. Crawford, A., Hollingsworth, H. H., Morgan, K., & Gray, D. B.
(2008).People with mobility impairments: Physical activity and quality of participation. Disability and Health Journal 1,
7-13. Kosma, M., Ellis, R., Cardinal, B. J., Bauer, J. J., & McCubbin, J. A. (2009). Psychosocial predictors of physical
activity and health-related quality of life among adults with physical disabilities: An integrative framework. Disability
and Health Journal, 2, 104-109. Gregg EW, Cauley JA, Stone K, et al(2003). For the Study of Osteoporotic Fractures
Research Group. Relationship of changes in physical activity and mortality among older women. JAMA 289: 2379-86.

Goodman C., Davies S.L., Dinan S., Tai S.S & Iliffe S.(2012). Activity promotion for community -dwelling older
people: a survey of the contribution of primary care nurses. British Journal of Community Nursing 16(1),12-17.
Hawkins, S.A., Cockburn, M.G., Hamilton, A.S., Mack, T.M. i2004j.An
ate of physicalestim
activity prevalence in a
large population-based cohort. Medicine & science in sports & exercise 36(2),253-260. Happanen, N., Miilunpalo, S.,
Vuori, I., Oja, P., & Pasanen, M. (1996). Characteristics of leisure time physical activity associated with decreased
riskof premature all-cause and cardiovascular disease mortality in middle-aged men. Medicine and Science in Sports
and Exercise, 143, 870-880. Lan TY, Chang HY, Tai TY(2006). Relationship between components of leisure physical
activity and mortality in Taiwanese Older adults. Prev Med 43: 36-41. Lotan, M., Yalon-Chamovitz, S., & Weiss, P. L.
(2009). Improving physical fitness of individuals with intellectual and developmental disability through a virtual reality
intervention program. Research in Developmental Disabilities, 30, 229-239. McAuley E, Rudolph D(1995). Physical
activity, aging, and psychological well-being. J Aging Phys Activity 3: 67-96. Mol V, Baker D.(1991). Activity
intolerance in the geriatric stroke patient. Rehabil Nurs 16:337- 343. Paffenbarger RS Jr, Hyde RT, Wing AL, et
al(1993).The association of changes in physical-activity level and other lifestyle characteristics with mortality among
men. N Engl J Med 328: 538-45. Pang M.Y.C., Eng J.J., Dawson A.S. McKay H.A., Harris J.E.(2005). A Community-
Based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke. Journal American Geriatric
Society 53:1667-1674. Pan WH, Hung YT, Shaw NS, et al(2005). Elderly Nutrition and Health Survey in
Taiwan - -2000 j
i1999 : research design, methodology and content. Asia Pac J Clin Nutr 14: 203-10. Pate, R. R.,
Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., et al. (1995). Physical activity and public health. A
recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.
Journal of American Medical Association, 273, 402-407. Rikli, R. E., & Jones, C. J. (1999). Functional fitness
normative scores for community residing older adults, ages 60-94. Journal of Aging & Physical Activity 7(2), 162-181.
Jones, C. J.(2001). Senior fitness test manual. Champaign: Human Kinetics. Singh MA(2004). Exercise and aging.
Clin Geriatr Med 20: 201-21. Singh MAF(2006). Physical Fitness and Exercise. In: Pathy MSJ, Sinclair AJ, Morley JE,
eds. Principles and Practice of Geriatric Medicine. 4th ed. P:123-40.UK: John Wiley & Sons Ltd. Weiss, M. R., & Gill,
D. L. (2005). What goes around comes around: Re-emerging themes in sport and exercise psychology. Research
Quarterly for Exercise and Sport, 76, 2.
Contact
[email protected]

Weight Gain in Breast Cancer Survivors
Su-Ying Yu, MSN, ANP, RN,, Taiwan
Purpose
Purpose : Weight gain is a common issue that may lead to poor prognosis or adverse health outcomes in
breast cancer (BC) survivors. The aims of this study was to investigate the pattern and degree of weight
gain within 2 years after BC diagnosis and to identify its risks.
Target Audience
Methods: The study cohort consisted, 1954 women, stage I-III, primary, operable BC between
2008~2010. Their body weight, body mass index (BMI) were measured before surgery and followed by 1,
3, 5, 12, 24 months after. The analysis of weight gain was stratified by demographic data, menopausal
status and adjuvant therapy.
Abstract
Purpose: Weight gain is a common issue that may lead to poor prognosis or adverse health outcomes in
breast cancer (BC) survivors. The aims of this study was to investigate the pattern and degree of weight
gain within 2 years after BC diagnosis and to identify its risks.
Methods: The study cohort consisted of 1954 women with stage I-III, primary, operable BC between
2008~2010. Their body weight, body mass index (BMI) were measured before surgery and followed by 1,
3, 5, 12, 24 months after. The analysis of weight gain was also stratified by demographic data, chronic
illness, menopausal status and adjuvant therapy.
Results: This sample had a mean age of 50.5. Before the BC surgery, a majority of them were
menopause (56.7%), without history of DM, hypertension or heart disease (89.5%); and they had a mean
weight of 58.2kg (SD=9.55kg) and 23.8 (SD=3.9) for the BMI. Weight gain was accounted for 50% or
more with the maximum of 17.3kg increased at 1, 3, 5, 12, 24 months after. The weights changed
significantly along the time course, with the peak at the 5the month after the surgery. The analysis of GLM
with repeat measure indicated that the risks factors of history of DM, hypertension, chemotherapy and
menopausal status.
Conclusion: The finding can assist oncology nurses and clinicians to develop future intervention to
improve the care for health promotion and risk reduction for weight gain in BC women.
References
Basaran, G., Turhal, N. S., Cabuk, D., Yurt, N., Yurtseven, G., Gumus, M., . . . Yumuk, P. F. (2011). Weight gain after
adjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey. Med Oncol, 28(2), 409-415. doi:
10.1007/s12032-010-9463-x Demark-Wahnefried, W., Campbell, K. L., & Hayes, S. C. (2012). Weight management
and its role in breast cancer rehabilitation. Cancer, 118(8 Suppl), 2277-2287. doi: 10.1002/cncr.27466 Demark-
Wahnefried, W., Winer, E. P., & Rimer, B. K. (1993). Why women gain weight with adjuvant chemotherapy for breast
cancer. J Clin Oncol, 11(7), 1418-1429. Epping-Jordan, J. E. (2005). Integrated approaches to prevention and control
of chronic conditions. Kidney Int Suppl(98), S86-88. doi: 10.1111/j.1523-1755.2005.09816.xFaber-Langendoen, K.
(1996). Weight gain in women receiving adjuvant chemotherapy for breast cancer. JAMA, 276(11), 855-856. Flegal,
K. M., Kit, B. K., & Graubard, B. I. (2013). Overweight, obesity, and all-cause mortality--reply. JAMA, 309(16), 1681-
1682. doi: 10.1001/jama.2013.3101
Contact
[email protected]

Exploring Significant Others Provide Helping Relationship for Mid-Adulthood
Diagnosed with Early-Stage Chronic Kidney Disease
Fang-Ru Yueh, RN, Taiwan
Shu-Mei Chao, MS, RN, Taiwan
Purpose
The helping relationship means seeking social support to protect healthy life style. According TTM
(Transtheoretical model) illustrate helping relationship include positive and negative support. The aim of
this study is to explore significant others provide helping that can improves individual's motivational for
healthy life style and healthy behavior.
Target Audience
Clinical practice nursing.
Abstract
Purpose: The helping relationship means seeking social support to protect healthy life style. According
TTM (Transtheoretical model) illustrate helping relationship include positive and negative support.
This qualitative study aimed to describe the helping relationship context within significant others and
early-stage chronic kidney disease(CKD).
Methods: A qualitative content analysis approach put to use analyzing semi-structured, open-ended, in-
depth interview.
Purposive sampling is to recruit patients diagnosed with early-stage CKD from the nephrology education
departments of medical centers.Participants are eligible for the study if they are between the age of 40 to
60 and with a diagnosis of early-stage CKD.
The rigor and trustworthiness of this study will evaluate using Lincoln and Guba's criteria.
Results: This study is in the process. No studies have yet explored the helping relationship between
significant others and patients, therefore implement pilot study to allow us to clarify and refine the
interview question.
Conclusion: Findings from this study is to know relationship of significant others helping patients, that
include positive and negative support. This finding can help healthcare professionals insight into health
education necessary to assess significant other of patients, that can improve patients motivation, and
keep healthy style and behavior.
References
Berge, J. M., MacLehose, R., Eisenberg, M. E., Laska, M. N., & Neumark-Sztainer, D. (2012). How significant is the
‘significant other’? Associations between significant others’ health behaviors and attitudes and young adults’ health
outcomes. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 35. Prezza, M., & Giuseppina
Pacilli, M. (2002). Perceived social support from significant others, family and friends and several socio‐demographic
characteristics. Journal of Community & Applied Social Psychology, 12(6), 422-429. Prochaska, J.O., Redding, C.A.,
Evers, K.E.(2008). Chapter 5: The transtheoretical Model and Stages of Change. In Glanz, K., Rimer, B. K., &
Viswanath, K.(2008). Health Behavior and Health Education/Theory, Research, and Practice. San Francisco: Jossey-
Bass. Przybylinski, E., & Andersen, S. M. (2012). Making interpersonal meaning: Significant others in mind in
transference. Social and Personality Psychology Compass, 6(10), 746-759. Romano, J. M., Jensen, M. P.,
Schmaling, K. B., Hops, H., & Buchwald, D. S. (2009). Illness behaviors in patients with unexplained chronic fatigue
are associated with significant other responses. Journal of behavioral medicine,32(6), 558-569. Shiozaki, M., Hirai,
K., Koyama, A., Inui, H., Yoshida, R., & Tokoro, A. (2011). Negative support of significant others affects psychological
adjustment in breast cancer patients. Psychology & health, 26(11), 1540-1551.
Contact

[email protected]

Personal Weight Beliefs Predictive of Eating Behavior Patterns and Actual Weight
in Young African-American Women
Stephanie Pickett, PhD, MSN, BSN, RN, USA
Purpose
to determine whether personal weight beliefs were predictive of eating behavior patterns and weight in
young AA women.
Target Audience
Anyone interested in the belief/behavior relationship and its application with weight management
Abstract
Purpose: Over 80% of African American (AA) women in the United States (US) are overweight or
obese. Weight management in AA women is multifaceted and not completely understood. However,
cultural beliefs about weight suggest that many AA women hold beliefs about their weight that may
interfere with a desire to engage in behaviors for weight management, it is not known whether personal
weight beliefs are predictive of weight management behavior. Personal weight beliefs were defined as a
multidimensional concept consisting of three domains including the descriptive characteristics, causal
attributions, and consequences of one’s personal weight. The objective of this study was to determine
whether personal weight beliefs were predictive of eating behavior patterns and weight in young AA
women.
Methods: A sample of one hundred-fifty AA women, 18-40 years old (mean age = 28.4, mean years of
education =13.78, mean BMI = 31.5) in Metropolitan Detroit completed a preliminary version of a newly
developed Beliefs about Personal Weight Survey (BPW) based on the definition of personal weight
beliefs. Responses from BPW were analyzed by domain using principal component analysis, composites
were developed from components. The Eating Behavior Pattern Questionnaire (EBPQ) was used to
measure eating behavior patterns (low fat diet, snacking on sweets, haphazard meal planning, and meal
skipping and emotional eating). BMI was calculated from measured weight and height. Multiple linear
regressions using stepwise entry was used to examine the ability of personal weight beliefs to predict
eating behavior patterns and BMI.
Results: Stepwise regression results show that the weight belief composites significantly predicted all five
of the eating behavior patterns and BMI. Two composites were most predictive. The descriptive weight
composite (describing personal weight as overweight) explained 51% of the variance in BMI (F = 154.16,
p =.001). Causal belief composites (unhealthy eating behaviors, not eating healthy behaviors, and stress
factors) explained 34% of the variance in emotional eating (F = 24.91, p = .001).
Conclusion: Beliefs about the descriptive characteristics, and causal attributions, of one’s personal
weight predicted eating behavior patterns and BMI in young AA women.
References
References Befort, C. A., Thomas, J. L., Daley, C.M., Rhode, P. C., & Ahluwalia, J. S. (2008). Perceptions and beliefs
about body size, weight and weight loss among obese African American women: A qualitative inquiry. Health
Education and Behavior, 35(3), 410-426. Blixen, C. E., Singh, A., & Thacker, H. (2006). Values and beliefs about
obesity and weight reduction among African American and Caucasian women. Journal of Transcultural Nursing 17(3),
290-297. Center for Disease Control (2013).The health effect of overweight and obesity. Retrieved July, 20, 2013
fromhttp://www.cdc.gov/healthyweight/effects/index.html Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C.L. (2012).
Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA, 307(5),
E1-E7. Flynn, K. J., & Fitzgibbon, M. (1998). Body images and obesity risk among black females: A review of the
literature. Annals of Behavioral Medicine, 20(1), 13-24. Kong, A., Odoms-Young, A. M., Schiffer, L. A., Berbaum, M.
L., Porter, S. J., Blumstein, L., & Fitzgibbon, M. L. (2012). Racial/ethnic differences in dietary intake among WIC
families prior to food package revisions. Journal of Nutrition Education and Behavior. 45(1), 39-46. doi:
http://dx.doi.org/10.1016/j.jneb.2012.04.014 Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense
representation of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7-30). New York: Pergamon

Press. Orem, D. (2001). Nursing: Concepts of practice (6th ed.). St. Louis Missouri: Mosby, Inc Roger, V. L., Go, S.
A., Lloyd-Jones, D. M., Benjamin, E.J., Berry, J. D. Borden, W. B.,…Turner, M. B. (2012). Heart disease and stroke
statistics- 2012 update. A report from the American Heart Association. Circulation, 125, e2-e220. Schlundt, D. G.,
Hargreaves, M. K., & Buchowski, M. S. (2003). The Eating Behavior Patterns Questionnaire predicts dietary fat intake
in African American women. Journal of the American Dietetic Association, 103(3), 338-345.
Contact
[email protected]

Prevalence of Colorectal Cancer in Psychiatric Patients: the Preliminary Results
of Colorectal Cancer Screen
Yu-Cheng Chen, BS, Taiwan
Shu-Hui Wang, BS, Taiwan
Luan- Chen Lin, BS, Taiwan
Chiou-Shiang Wu, BS, Taiwan
Ya-Lin Ciou, MS, Taiwan
Shih-Hsien Kuo, RPh, PhD, Taiwan
Purpose
The purpose of this presentation is to identify the risk of colorectal cancer in psychiatric patients through
colorectal cancer screen and to explore the association of health behavior and colorectal cancer.
Target Audience
The target audience of this presentation is nurses in the fields of psychiatrics, oncology, and internal
medicine and other health related professionals.
Abstract
Purpose: The aim of this study was to demonstrate colorectal cancer prevalence in Taiwanese
psychiatric patients to provide the reference for psychiatric professionals to improve the physical care for
these patients.
Methods: A "Quantitative immunoassay fecal occult blood test " and a questionnaire of habitual diet and
daily health behavior were used to screen colorectal cancer and related health behaviors to determine the
prevalence an its correlations with habitual diet and health behavior in psychiatric patients. Samples of
this study were recruited from a psychiatric hospital in southern Taiwan.
Results: 2088 psychiatric patients (1011, 48.4% male and 1077, 51.6% female) were invited to complete
this screen. Average age was 57.33 ± 5.47 years. The positive rate of colorectal cancer was 9.9% and
8.1% for male and female respectively. In the number of diagnostic items aspect, the more psychiatric
diagnostic items the patients had, the more positive rate of colorectal cancer the patients had (7.9%,
9.6%, and 12.1% for the patients had 1, 2, and 3 psychiatric diagnosis, respectively, p = 0.045), and
patients with 3 psychiatric diagnostic items had 1.62 fold risk of colorectal cancer to with 1 diagnostic item
(p = 0.02).
Conclusion: This survey showed that psychiatric patients are in the risk of colorectal cancer, and the
more items of psychiatric diagnosis, the more risk of colorectal cancer these patients have. These
preliminary data of this survey hopefully can be the reference for psychiatric professionals to improve the
physical care for these patients.
References
1. Sanchez MI, Bercik P (2011)¡EEpidemiology and burden of chronic constipation.¡ECan Journal Gastroenterol, 25
2. Safari A, Shariff ZM, Kandiah M, Rashidkhani B, Fereidooni F.(2013)¡EDietary patterns and risk of colorectal
cancer in Tehran Province: a case-control study¡EBiomed Central Public Health Journal, 13 3. Robb KA, Miles A,
Wardle J. (2004)¡EDemographic and psychosocial factors ssociated with perceived risk for colorectal
cancer¡ECancer Epidemiol Biomarkers Prevention, 13(3) 4. Aune, D, Chan, DS, Lau, R, Vieira, R, Greenwood, DC,
Kampman, E and Norat, T (2011)¡EDietary fibre, whole grains, and risk of colorectal cancer: systematic review and
dose-response meta-analysis of prospective studies¡EBritish Medical Journal, 343
Contact
[email protected]

The Role of Substance Abuse in the Lives of Childhood Trauma Survivors
Linda Grabbe, PhD, PMHN-BC, FNP-BC, USA
Weihua Zhang, PhD, APRN, USA
Purpose
Purpose: This qualitative, descriptive study aims 1) to summarize critical childhood events for a sample of
8 women trauma survivors, who were in treatment for addiction, and 2) to identify the experience and
meanings of substance use in their lives.
Target Audience
The target audience is nurses in academic and practice settings.
Abstract
Purpose: Traumatic events early in life have been associated with substance abuse problems and
mental health disorders (Adverse childhood experiences study, 2013). The development of addictions is
a result of complex interactions among genes, environment, chronic stress, and neurobiology (Stephens
& Wand, 2012). For persons who have experienced severe childhood abuse or neglect, there are
fundamental changes in brain development (DeBellis et al., 1999), and many individuals deal with lifelong
mental health problems such as depression, anxiety, post-traumatic stress disorder, and emotion
dysregulation. One theory of substance use associated with mental distress is “self-medication,” that is,
persons with mental health conditions use substances for short-term benefit--relief from stress and
psychological pain.
This qualitative, descriptive study aims 1) to summarize critical childhood events for a sample of 8 women
trauma survivors, who were in treatment for addiction, and 2) to identify the experience and meanings of
substance use in their lives.
Methods: Life narratives of 8 women trauma survivors in recovery from addiction were audiorecorded
and transcribed. The transcripts were coded, summarized, and clustered into themes. NVivo software
was used for data management. The different meanings of trauma and drugs and alcohol use will be
presented.
Results: These women experienced significant levels of abuse and neglect during childhood. Alcohol
was predominantly the first substance they used. Early adolescence was marked by a lack of nurturance
from significant figures, leaving home, and early involvement in drug or street culture. The perceptions of
the women regarding their drug use will be presented.
Conclusion: Insights gained from this research may serve to inform preventative interventions for both
mental health and substance use disorders in this high-risk population.
References
Adverse childhood experiences study. (2013). Retrieved from http://www.cdc.gov/ace/about.htm Stephens, M. A., &
Wand, G. (2012). Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol research : current
reviews, 34(4), 468-483. De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., . . .
Ryan, N. D. (1999). A.E. Bennett Research Award. Developmental traumatology. Part II: Brain development. Biologic
Psychiatry, 45(10), 1271-1284.
Contact
[email protected]

Correlation Between Food Allergy Response Capabilities of Mothers Who Raise
Children with Food Allergy and the Quality of Life
Satoko Aika, MNS, Japan
Misae Ito, RN, RMW, MSN, PhD, Japan
Purpose
The purpose of this presentation is to discuss care toward food allergy response capabilities in mothers of
children with food allergy.
Target Audience
The target audience of this presentation is the clinical nurses who are interested in food allergy.
Abstract
Purpose: The objective of this study is to clarify the correlations among food allergy response capabilities
of mothers, factors affecting it and quality of life (QOL).
Methods: Subjects were mothers who raised children between the ages of 0-6 years (preschool age)
who had been diagnosed by physicians as having a food allergy. A self-recorded questionnaire was
distributed and collected via post. The evaluation period was from September 2010 to March 2011. A total
of 650 self-recorded questionnaires were distributed to hospitals with a pediatric allergy outpatient clinic
(8 institutions) and general clinics (11 institutions) or pediatricians specialized in allergy (2 institutions).
Questionnaire items included the subject’s background such as mother’s age, working condition, health
condition, allergic disease, gender, health condition, removed items, number of removed items,
consultation facilities, hospital transfer experience, number of hospital transfers, anaphylactic experience,
allergic disease apart from food allergy, commuting to kindergarten, self-made lunch box for kindergarten,
and the family health condition. In addition, in total 26 items of the Japanese version of the World Health
Organization Quality of Life-26 (WHOQOL26) which composed of satisfaction on 4 domains and an
added 2-item health condition and QOL subjective evaluation; food allergy response capability proposed
by Aika et al., which consisted of 5 factors and 17 items (Cronbach’sα coefficient 0.81); and the
of food allergy on daily life, were used for evaluation.
All statistical analyses were conducted using statistical analysis software IBM SPSS ver.19.0. Pearson’s
correlation was used to analyze the correlation between food allergy response capabilities and QOL. In
addition, multiple regression analysis (stepwise method) was carried out with QOL as the dependent
variable and food allergy response capabilities, the effect of food allergy on daily life, health condition,
removed food items, anaphylactic experience, and hospital transfer experience as the independent
variables.
Ethical considerations: A written explanation on the study objectives and significance, methods, voluntary
based participation, anonymity, and privacy protection were enclosed in the survey, and the written
consent was received via post. This study was proceeded following an approval from the Kawasaki
University of Medical Welfare Ethics Committee.
Results: The questionnaire response was obtained from 328 subjects, with a response rate of 50.5%.
Among them, 23 subjects were excluded due to missing data. In addition, those with 0 number of
removed items in food and those without the description of number of removed food (25 subjects) were
excluded, resulting in 280 subjects to be included in the analysis (effective answer rate: 45.0%). Mean
age of mothers was 33.6±4.6 years and mean age of children was 35.6±19.8 months. Ratio of male and
female was 1.7:1. As for working status of the mother, those who answered full-timer were 74 subjects
(26.4%), part-timer mothers were 44 subjects (15.7%), and unemployed mothers were 162 subjects
(57.9%). Mean value of food allergy response capabilities was as follows: “Stress coping” 2.96±0.80,
“skills in performing the elimination diet” 3.57±0.96, “gathering information from the healthcare

professionals” 2.96±0.80, “knowledge on food allergies” 2.96±0.80, and “husband’s cooperation”
2.96±0.80.
WHOQOL26 score of the mother was 3.42±0.42. As for the score grouped by the domains, physical
domain was 3.55±0.51, mental domain was 3.41±0.52, social relationships was 3.50±0.56, and
environmental domain was 3.32±0.49. From a multivariate regression model (R20.49,p<0.001), it was
found that mother’s QOL consisted of food allergy response capabilities (β=0.31, p<0.001), mother’s
health condition (β=0.29, p<0.001), feelings of stress, anxiety and difficulty in one’s overall life except
child care (β=-0.24, p<0.001), and family health condition (β=0.13, p<0.05).
Conclusion: In order to prevent reduction of mother’s QOL, it is important to improve food allergy
response capabilities as early as possible following the diagnosis. It is important for nurses to have
correct knowledge on food allergy, to understand the situation and feelings of mothers, to deliver
appropriate information, to introduce individually-adjusted menus as well as possible eating-out places, to
provide practical information supply in cooperation with the dietician, to draw mother’s stress coping
capability, to ensure cooperation between the mother and the husband, to recommend the presence of
the husband during consultation, and to introduce the importance of husband’s cooperation for child care
with food allergy using pamphlets.
Contact
[email protected]

The Preliminary Study of Family Resilience and Its Correlates Among Cancer
Parents
Wei-Ching Chen, RN, BS, Taiwan
Chin-Mi Chen, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to share the preliminary findings that included the relationships of
perceived stress, parent-adolescent communication, and family resilience among the parents with cancer.
Target Audience
The target audiences of this presentation are nurses, Psychologist, Social Worker, and Oncologists.
Abstract
Purpose: The purpose of this study was to explore the relationships of perceived stress, parent-
adolescent communication, and family resilience among the parents with cancer. The family resilience
framework that was developed by Walsh (2003) was used as the theoretical framework of this study.
Methods: The study was a cross-sectional design, and participants were included by convenience
sampling. Inclusion criteria were 1) diagnosed with cancer over 3 months, and 2) being parents with
adolescent children. Data were collected by a structured questionnaire that consisted of a demographic
information datasheet and three scales: perceived stress scale, family resilience scale, and parent-
adolescent communication scale. The IRB approvals ensured that participants’ human rights were
considered and protected.
Results: Eleven patients (6 fathers; 5 mothers) were recruited from a medical center in the northern of
Taiwan. Mean score of the perceived stress were 23 (SD=1.732) for fathers, and 19 (SD=3.194) for
mothers. Mean score of the parent-adolescent communication were 66 (SD=5.489) for fathers, and 68.2
(SD=2.691) for mothers. Mean score of the family resilience were 93.83 (SD=7.855) for fathers, and 89.6
(SD=9.19) for mothers. In addition, family resilience negatively correlated with perceived stress (r = -
0.170), and positively with parent-adolescent communication (r = 0.245).
Conclusion: These results reveal the feasibility of this study and showed this mean score of each scale
may be various between fathers and mothers. Perceived stress and parent-adolescent communication
may be the correlates of family resilience. Therefore, we need more participants to prove these
preliminary findings.
References
Walsh, F. (2003). Family resilience: A Framework for clinical practice. Family Process, 42(1), 1-13.
Contact
[email protected]

Adolescent Mothers' Experiences With Decision Making During Labor and Birth
Carrie Jacobson, MS, CNM, RN, WHNP, USA
Audrey Lyndon, PhD, RN, FAAN, CNS-BC, USA
Purpose
The purpose of this presentation is to highlight the particular risks and vulnerabilities of US adolescent
mothers, their developmentally unique decision making process, and the ways in which decision making
during labor and birth may impact adolescent maternal/child health. Areas for further research and
nursing intervention will be reviewed.
Target Audience
The target audience of this presentation is maternity nurses, nurse midwives, family physicians,
obstetrician gynecologists, maternal and child health researchers, adolescent health experts, advocates,
and those concerned with regulating care and policy in support of young families.
Abstract
Purpose: US adolescent mothers face higher risks of postpartum depression and traumatic experiences
than adult mothers, and have developmentally unique needs and decision making patterns. While a poor
experience of decision making during labor and birth has been shown to increase the risk of postpartum
depression and birth-related post-traumatic stress disorder in adult women, it is unknown how US
adolescent mothers experience decision making during labor and birth. Better understanding of how
adolescent mothers experience decision making during labor and birth could help guide efforts to
decrease the risk of poor postpartum outcomes in this vulnerable population. The purpose of this study is
to develop a mid-range theory of adolescent mothers’ experiences of decision making during labor and
birth.
Methods: A constructivist grounded theory design using individual, semi-structured interviews and
participant observations is employed, using methods from Clarke (situational analysis) and Schatzman
(dimensional analysis). 20 participants attending clinics and/or schools providing specialized services for
adolescent parents in an urban area of the Western United States were interviewed 1 to 2
times. Observations took place in a childbirth class for adolescents. Findings are developed through
constant comparison, theoretical sampling, and member reflection until theoretical saturation is reached.
Rigor is maintained through reflexivity, peer analysis, data triangulation, and use of an audit trail.
Results: US adolescent mothers desire to be engaged in decision making during labor and birth.
However, their knowledge regarding available options and their right to participate in healthcare decision
making are variable. Mothers' decisions are guided by what they feel is best for their baby, and are
sometimes at odds with heathcare providers' recommendations. Most mothers in this study express a
preference for “going natural,” or having a vaginal birth without pain medication, in order to prove their
worth as mothers as well as avoid health risks they perceive could result from epidural anesthesia. Some
mothers opt for epidural anesthesia in order to “stay calm” to protect their baby from the harm they
perceive will result from a mother’s emotional upset. Mothers describe often feeling unheard or
overlooked when family members or care providers made decisions for them, and report that at times
they do not receive sufficient or timely information from providers. Mothers express resilience in their
response to decision making experiences that are frequently negative, and rely on support from family,
friends, and/or doulas to help them navigate decision making during labor.
Conclusion: Adolescent mothers show surprising resilience in coping with frequently negative
experiences of decision making during labor and birth. However, they also assign significance to the way
in which a mother chooses to go through birth, in particular her ability to cope with the pain and fear of
labor. The lack of emotional support and involvement in decision making some adolescent mothers
experience during labor and birth may represent a missed opportunity to provide crucial support for their
perceived competence and self-efficacy as new mothers.

References
Anderson, C., & Logan, D. (2010). Impact of traumatic birth experience on Latina adolescent mothers. Issues in
Mental Health Nursing, 31(11), 700-707. doi: 10.3109/01612840.2010.518784 Ayoola, A.B., Brewer, J., & Nettleman,
M. (2006). Epidemiology and prevention of unintended pregnancy in adolescents. Primary Care: Clinics in Office
Practice, 33, 391-403. doi:10.1016/j.pop.2006.01.005 Behruzi, R., Hatem, M., Goulet, L., Fraser, W., Leduc, N. &
Misago, C. (2010). Humanized birth in high risk pregnancy: Barriers and facilitating factors. Medicine Health Care and
Philosophy, 13, 49-58. Birkeland, R., Thompson, J. K., & Phares, V. (2005). Adolescent motherhood and postpartum
depression. Journal of Clinical Child Adolescent Psychology, 34(2), 292-300. doi: 10.1207/s15374424jccp3402_8
Bryant, K.D. (2006). Update on adolescent pregnancy in the black community. ABNF Journal, 17(4), 133-136.
Charmaz, K.C. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks,
CA: Sage Publications. Christiaen, W., & Bracke, P. (2007). Assessment of social psychological determinants of
satisfaction with childbirth in a cross-national perspective. British Medical Journal of Pregnancy and Childbirth, 7, 26.
Clarke, A.E. (2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks, CA : Sage
Publications. Creedy, D.K., Shochet, I.M., & Horsfall, J. (2000). Childbirth and the development of acute trauma
symptoms: Incidence and contributing factors. Birth, 27(2), 104-111. doi: 10.1046/j.1523-536x.2000.00104.x
Czarnocka, J., & Slade, P. (2000). Prevalence and predictors of post-traumatic stress symptoms following childbirth.
British Journal of Clinical Psychology, 39(Part 1), 35-51. Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010).
Women’s perceptions and experiences of a traumatic birth: A meta-ethnography. Journal of Advanced Nursing
66(10), 2142–2153. doi: 10.1111/j.1365-2648.2010.05391.x Gardner ,M., & Steinberg, L. (2005). Peer influence on
risk taking, risk preference, and risky decision making in adolescence and adulthood: An experimental study.
Developmental Psychology, 41(4), 625-635. doi: 10.1037/0012-1649.41.4.625 Gibbins, J., & Thomson, A.M. (2001).
Women's expectations and experiences of childbirth. Midwifery, 17(4), 302-313. Goldberg, H. (2009). Informed
decision making in maternity care. Journal of Perinatal Education, 18(1), 32-40. Goodall, K., McVittie, C., & Magill, M.
(2009). Birth choice following primary cesarean section: Mothers' perceptions of the influence of health professionals
on decision-making. Journal of Reproductive and Infant Psychology, 27(1), 4-14. Goodman, P., Mackey, M., &
Tavakoli, A. (2004). Factors related to childbirth satisfaction. Journal of Advanced Nursing, 46(2), 212-219. Gray, J.
(2005). Implications of perceived control for recovery from childbirth for unplanned cesarean, planned cesarean and
vaginal deliveries. Journal of Prenatal and Perinatal Psychology and Health, 19, 251-267. Green, J. M., & Baston, H.
A. (2003). Feeling in control during labor: Concepts, correlates, and consequences. Birth, 30(4), 235-247.
Halldórsdóttir, S., & Karlsdóttir, S.I. (1996). Empowerment or discouragement: Women's experience of caring and
uncaring encounters during childbirth. Health Care of Women International, 17(4), 361-79. Harrison, M. J., Kushner,
K. E., Benzies, K., Rempel, G., & Kimak, C. (2003). Women's satisfaction with their involvement in health care
decisions during a high-risk pregnancy. Birth, 30, 109-115. doi: 10.1046/j.1523-536X.2003.00229.x Hodnett, E. D.
(2002). Pain and women's satisfaction with the experience of childbirth: a systematic review. American Journal of
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Experiences of non-progressive and augmented labour among nulliparous women: A qualitative interview study in a
grounded theory approach. BMC Pregnancy and Childbirth, 7, 15. Koniak-Griffin, D., Logsdon, M. C., Hines-Martin,
V., & Turner, C. C. (2006). Contemporary mothering in a diverse society. JOGNN, 35(5), 671-678. doi:
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women's views of factors contributing to a positive birth experience. Midwifery, 15, 40-46. Lesser, J., & Koniak-Griffin,
D. (2013). Using qualitative inquiry and participatory research approaches to develop prevention research: Validating
a life course perspective. Family and Community Health, 36(1), 34-41. Lobel, M., & DeLuca, R.S. (2007).
Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications. Social Science &
Medicine, 64, 2272-2284. doi:10.1016/j.socscimed.2007.02.028 Logsdon, M. C., Ziegler, C., Hertweck, P., & Pinto-
Foltz, M. (2008). Testing a bioecological model to examine social support in postpartum adolescents. Journal of
Nursing Scholarship, 40(2), 116-123. doi: 10.1111/j.1547-5069.2008.00215.x Reyna, V.F., & Farley, F. (2006). Risk
and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psychological
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influence: A fuzzy-trace theory of emotion in adolescence. Developmental Review, 28, 107–144.
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interventions. Current Opinions in Pediatrics, 34(4), 446-452. doi: 10.1097/MOP.0b013e3283557b89 Santelli, J.S., &
Melnikas, A.J. (2010). Teen fertility in transition: Recent and historic trends in the United States. Annual Review of
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Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28(1), 78–
106. doi:10.1016/j.dr.2007.08.002 Weber, E.U., & Johnson, E.J. (2009). Mindful judgment and decision making.
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Contact
[email protected]

Difference of Knowledge and Attitude about Human Papillomavirus in Male and
Female College Students
Dong Sook Cho, PhD, South Korea
Purpose
The purpose of this presentation is to identify the gender difference of knowledge and attitude about
Human Papillomavirus(HPV) in college students.
Target Audience
The target audience of this presentation is women health nursing researcher or college student health
care provider.
Abstract
Purpose: This study was done to identify the gender difference of knowledge and attitude about Human
Papillomavirus(HPV) in college students.
Methods: A cross-sectional survey design with a convenient sampling was used. The subjects were 215
college students. Data collection was done by self-reporting method from September 10 to 22, 2012. The
reliablilty of the instruments were from .81 to .83. Descriptive statistics were used to analyze the
characteristics of the sample and knowledge and attitude about Human Papilomavirus(HPV). The
independent t-test and x2test were performed using SPSS 18.0 to confirm gender differences.
Results: The participants in this study were 100 male and 115 female students. 7.2% of the
participants has family history of cancer of cervix, ovarian cancer and uterine cancer. The percentage of
correct answer of knowledge items toward the HPV were 4.2% to 42.8%. 84.7% of the participants were
heard about cancer of cervix, 31.6% of the participants were heard about HPV, and 68.4% were heard
about HPV vaccine. There was a significant differences in the correct answer rate about knowledge items
toward the HPV between the gender. Female students were more correct answers than male student
about “HPV can be prevented with vaccine”(x2 =5.90, p=.019), but male students were more correct
answers than female student about “low risk virus make dysplasia of cervix area”( x2=.01, p<.001) and
“for man, HPV can occur genital cancer, so preventive exam is necessary”(x2 =.7.26, p=.013). In attitude
of HPV vaccine, male was higher attitude score than female about “I am afraid of side effets of HPV
vaccine”(t=2.704, p=.007). But female was higher attitude score than male about “I don’t need HPV
vaccine”(t=-1.984, p=.049), “I am not interest in HPV vaccine”(t=-2.339, p=.020), “HPV vaccination may
lead to unsafe sex”(t=-2.304, p=.022).
Conclusion: Subjects’s knowledge about HPV were low level. College students were more aware of the
HPV vaccine rather than HPV. The significantly differences between the gender were due to differences
in gender characteristics
References
1. Eileen F. Dunne, Elizabeth R. Unger, Maya Sternberg, Geraldine McQuillan, David C. Swan, Sonya S. Patel, Lauri
E. Markowitz : Prevalence of HPV Infection Among Females in the United States, JAMA 297: 813-819, 2007 2.
Vinodhini Krishnakumar, Shanmughapriya Santhanam, Das Bhudev C. : Prevalence and Risk Factors of HPV
Infection Among Women from Various Provinces of the World, Arch Gynecol Obstet 285:771-777, 2012 3. Hee Sun
Kang, Linda Moneyham : Attitudes toward and intentions to receive the human papilloma virus (HPV) vaccination and
intention to use condoms among female Korean college students, Vaccine 28:811-816, 2010 4. Korean Society of
Obstetrics and Gynecology : Annual Report of Gynecologic Cancer Registry Program in Korea for 2004(Jan. 1st,
2004-Dec. 31st, 2004), Korean J Obstet Gynecol 50:28-78, 2007 5. Ministry of Health & Wealfare, Korea Central
Cancer Registry, National Cancer Center : Annual report of cancer statistics in Korea in 2008, 19-23, 2010 6. Kyoung
A Choi, Jung Hye Kim, Kyoung Soon Lee, Jin Kyoung Oh, Shan Ni Liu, Hai Rim Shin : Knowledge of human
papillomavirus infection and acceptability of vaccination among adult women in Korea, Korean J Obstet Gynecol
51:617-623, 2008 7. Thomas W. Weiss, Gregory D. Zimet, Susan L. Rosenthal, Susan K. Brenneman, Jonathan D.
Klein : Human Papillomavirus Vaccination of Males: Attitudes and Perceptions of Physicians Who Vaccinate
Females, J Adolesc Health 47:3-11, 2010 8. Hae Won Kim : Comparison of Factors Associated with Intention to

Receive Human Papillomavirus Vaccination Between Male and Female Undergraduate Students, Korean J Women
Health Nurs 17:415-425, 2011 9. Hae Won Kim, Hye Young Ahn : Study on the Knowledge of Human Papilloma
Virus in Female University Students, Korean J Women Health Nurs 13:13-20, 2007 10. You Jung Han, Sa-Ra Lee,
Eun Ji Kang, Mi Kyoung Kim, Nam Hee Kim, Hyun Jin Kim, Woong Ju, Seung Cheol Kim : Knowledge regarding
cervical cancer, human papillomavirus and future acceptance of vaccination among girls in their late teens in Korea,
Korean J Obstet Gynecol 50:1090-1099, 2007
Contact
[email protected]

Correlations Between Psychological Symptoms and Quality of Life in Resident
Elderly: A Regional Hospital in Taiwan
Liao Sujung, RN, Taiwan
Liu Tse-Tsung, Taiwan
Rong Jiin-Ru, PhD, Taiwan
Purpose
This study aims to evaluate and quantify the possible effect of psychological symptoms on resident
elderly fs quality of life
them.
Target Audience
The target audience of this presentation is: 1.Investigate relevance of the elderly inpatient quality of life,
psychiatric symptoms and suicidal ideation. 2.Understand the mind of the elderly residents and
psychological needs to feel. 3.Providing the reference of clinical care in the elderly related medical
personnel and health education.
Abstract
Purpose: According to the Council for Economic Planning Committee in Taiwan, said the United Nations
and our population data and comparison of the data with the U.S. Census Bureau found that Taiwan's
population is aging while compared with 193 countries in the United Nations, and our ranked world No. is
48 in 2010(1). At present, Taiwan's population’s "aging index" is only 69% (the so-called aging index is
defined as the population aged 65 and over accounted for 0 to 14 year-old the proportion of the elderly
population is a young population that's 0.6 times) (2). However, Taiwan's fertility rate is too low, leading to
aging rate increases. Council for Economic Planning Committee released data show that Taiwan will
surpass Japan to become the world's most "old" country in 2033, when the population’s aging index in
Taiwan as high as 251%, that is, the elderly population will be 2.51 times the juvenile population (Council
for Economic Planning, 2011)(1). As medical technology and advances in medical care, life expectancy
has been increasing, the increase in seniors general trend is not only the world, but also the future world
while facing one of the important issues need to be solved. Taiwan’s elderly people entered the aging
society since 1993 and the proportion of people over 65 years old continues to rise. According to Ministry
of the Interior Department, to 2010 the number of 23,150,000 population in Taiwan, the elderly population
is 2.48 million, accounting for 10.72% of the overall population (Ministry of the Interior and Statistics
Department in Taiwan, 2010)(3) BCouncil for Econom
increase the proportion was 14.0% in 2017. Formally entered the aged society and then increased to
20.1% in 2025, will be entering the so-called super-aged society (Ministry of Economic construction
Committee, 2008)(2). Taiwan's young population structure has been converted into a pyramid with larger
populations are young lantern type, estimated mainly elderly population will be converted to the inverted
Admiralty type in 2050 (Republic of China Statistical Information Network, 2007). (4) In the majority of
countries, suicide rates increase progressively with age, the highest suicide rates occurring in men above
75 years. In order to understand the needs of hospitalized aging elderly and to help them.The This study
aims:
1.Investigate relevance of the elderly inpatient quality of life, psychiatric symptoms and suicidal ideation.
2.Understand the mind of the elderly residents and psychological needs to feel.
3.Providing the reference of clinical care in the elderly related medical personnel and health education.
Methods: During this study were enrolled from February 7, 2012 to December 24, 2012, for 65 years or
psychiatric inpatients General Division conducted a comprehensive screening, received a total of 2199
cases hospitalized elderly, those who do not meet the inclusion criteria with 35, accounting for 1.64%, of
which there are eight younger than 65 years old, 27 have significant cognitive impairment (1.23%), the
final number of samples collected 2165 (98.41%), in which a result of completing the questionnaire

completion rate below 60%, the excluded, the final data analysis included in the total number of
hospitalized elderly sample 2164 (N = 2164).
Inclusion criteria: (1) 65 years (or more) of the hospitalized patients (2) clear consciousness, attention
sustainability 30 minutes, depressive symptoms will not interfere with interviews and gather
information, vision, hearing acuity and oral communication without prejudice (3) no alcohol or drug
dependence phenomena (4) willing to participate in this study sample and other conditions.
Exclusion criteria: (1) Impairment of cognitive function, moderate or severe dementia and mental
retardation (2) Mental disorder such as schizophrenia or bipolar disorder with manic episodes (3)
patients with substance addiction (4) cannot communicate and talks (5) Concentration inability to last
30 minutes.
Based on ethical considerations, this study oath by the body through the audit committee , parties to
close the case.
The 5 questions style Brief Symptom Rating Scale were retrieved from the Scale for Suicide Ideation;
SSI BScale for Suicide
from one of the tools by Bech et al 1979. The evaluation project contains the frequency of suicidal
ideation and suicidal intent in the past wanted. Scale for Suicide Ideation of Beck et al 1985 was used in
psychiatric inpatient and ambulatory patient assessment, but also widely used in various units, including
hospitalization, emergency care, rehabilitation, private clinics, as well as college students and clinical
elderly population. This scale has a medium to high degree of internal consistency, Cronbach's alpha
value of .89 (Beck et al., 1997), who also has a very high consistency reliability of the test, the correlation
coefficient was .83 (Beck et al. , 1997). A total of 21 questions, the entire time of the completed
questionnaire will take about 10 minutes, compared with time-consuming. The five questions formula
Brief Symptom Rating Scale(BSRS-5), Inventoried by NTU Professor Li Ming-been and Wang (2005)
captured Scale for Suicide Ideation(SSI) among the translated version translated from SSI. Mainly as a
mental illness in the screening table, the purpose of being able to quickly understand the psychological
care needs of individuals, and thus provide the necessary mental health services. In this study, this scale
of the top 5 questions (BSRS-5) for hospitalized elderly suicidal ideation assessment, scoring more than
six points above expressed suicidal ideation, and if questionnaires to express any active or passive
suicidal intent, also expressed suicidal ideation scale scores higher, which means that the stronger
suicidal ideation. This scale applies to the elderly in the community of internal consistency reliability
Cronbach's alpha value of .84 BUsed in different popu
reliability. Obviously the extensiveness of its reliability and validity for a good internal consistency. (BSRS-
5’s Cronbach's α= 0.77-0.90, Test-retest reliability was 0.82) Which sensitivity was 78.9% and specificity
of 74.3%. Compare with the mental illness diagnostic results of Mini-International Neuropsychological
Interview schedule. To six points as the cut-off point scale can be obtained 76.3% of the correct
diagnosis.
Results: 1. A hospitalization for the elderly quality of life and the presence of suicidal ideation score
situation
The results showed that the age distribution of elderly residents in the 65 to 101 years old, of which 65-74
years old (44.8%), 75-84 years old at most (39.0%) followed. Mean age 76.5±7.4 years, males accounted
for 55.8% majority, females 44.2%. Up to literacy education level (35.8%), followed by the junior high
school (31.0%). Hospitalized elderly States (including) accounted for 84.1% the following display
generally low level of education. Most hospitalized elderly live with their children (28.4%) or living with
their spouse (25.6%). Conscious state of the economy as "fair" (76.6%), however, 55% perceived health
status "bad". BSRS-5 <6 points accounted for 74.9% and ³a 6 points accounted for 25.1%, which is more
than 1/4 of the screening of elderly hospitalized with suicidal ideation, more worthy of our investment in
more research and tracking.
2. Elderly residents socio-demographic characteristics on the differences of suicidal ideation compared
Compare Brief Symptom Rating Scale (BSRS-5) is less than 6 points, and greater than or equal to 6
points(with or without suicidal ideation) and elderly residents of the differences in socio-demographic

characteristics analysis of the results: gender, education level, economic status and health status
significant differences were reached. Among elderly residents of the age, marital status and state of
residence of the statistical analysis on the presence or absence of suicide ideation found no statistic
difference exists.
3. Correlation between Elderly residents BSRS-5 and Quality of Life Scale
The elderly residents of suicidal ideation and quality of life scores for conduct Pearson correlation
analysis found Brief Symptom Rating Scale and physical health domain (QoL1), psychological domain
(QoL2), environmental aspects (QoL3) social category (QoL4) and quality of life score (QoL Total) were
statistically significant differences in the correlation coefficients between the scales 0.062 ~ 0.79, are
moderate to strong correlation, but in order to score with suicidal ideation the correlation coefficient
between the comparative scales are negatively correlated.
Conclusions: The BSRS-5 score is predictive for scores of all four domains and 28 items of the
Taiwanese version of the WHOQOL-BREF for resident elderly. This study aimed to investigate relevance
of the elderly inpatient mental function, quality of life, psychiatric symptoms (insomnia, nervousness and
depression) and suicidal ideation, and impact of patient factors associated with suicidal ideation in the
elderly.
Suicide among the elderly is a complex and multi-faceted problem, and the suicide mortality rate ranks
the highest of all ages. The development of preventive, risk screening and case management strategic
plan should be positive for the elderly suicide and timely assessment of the effectiveness of prevention in
order to gradually reduce the incidence of suicide among the elderly.
In order to understand the mind of the elderly residents and psychological needs to feel in order to be
able to collect more elderly suicidal ideation associated with a message, providing the reference of clinical
care in the elderly related medical personnel and health education.
References
Ajit Shah.(2007).The relationship between suicide rates and age: an analysis of multinational data from the World
Health Organization, 2007 International sychogeriatric Association West London Mental Health NHS Trust and
Imperial College School of Medicine, London,U.K. Berk, Michael., Dodd, Seetal., •Henry, Margaret. (20
Effect of economic Variables on Suicide. Psychological Medicine,36(2),181-89.
DeLeo,D.,Hickey,P.A.,Neulinger,K.,&Cantor,C.H.(2001).Ageingand suicide. Australia Commonwealth Department of
Health and Aged Care, Canberra. Lapierre, Erlangsen, A., Waern, M., DeLeo, D., Oyama, H., Scocco, P., Gallo,
J.,Szanto, K., Conwell, Y., Draper, B., Quinnett, P. (2011). A systematic review of elderly suicide prevention
programs. Crisis32(2) 88-98. Prabhu, S., Molinari, V., Bowers, T., & Lomax, J. (2010). Role of the Family in suicide
prevention: An attachment and family systems perspective. Bulletin of the Menninger Clinic, 74(4), 301-327.
Shah,A.(2009).The relationship between elderly suicides rates, household size and family structure: A cross-national
study. International Journal of Psychiatry in Clinical Practice,13(4), 259-264. Wu, Ruo-Ning., Cheng, Ya-
Wen. i2008j
-2006. Trendsin
Taiwan suicide
J Public mortality in Taiwan, 1959
Health,27(2),110-120.21. Powell LE,
Myers AM: The Activities-specific Balance Confidence (ABC) scale. J Gerontol Ned Sci 1995;50:M28-34.
Contact
[email protected]

The Effects of Communication Skills, Compassion Satisfaction, Compassion
Fatigue on Burnout Among Staff of Long-Term Care Insurance in National Health
Insurance Corporation in Korea
Kyongeun Lee, MSN, South Korea
Hyoungshim Choi, MSN, South Korea
Purpose
This study was a descriptive research to identify the effects of communication skills, compassion
satisfaction, compassion fatigue on burnout among staff of long term care insurance for the elderly in
National Health Insurance Corporation in Korea.
Target Audience
The target audience of this presentation is a interested administratives about staff of Long-term care
insurance corporation to eventually promote elderly person.
Abstract
Purpose: This study was a descriptive research to identify the effects of communication skills,
compassion satisfaction, compassion fatigue on burnout among staff of long term care insurance for the
elderly in National Health Insurance Corporation in Korea.
Methods: The participants were 203 full-time employees at Long-term Care Insurance for elderly in
National Health Insurance Corporation in Korea. Data were collected via mail from the 24 branch offices
of Long-term Care National Health Insurance Corporation which were randomly selected among the total
of 226 centers of National Health Insurance Corporation. A survey was conducted by using structured
questionnaire from November 16 to 29, 2013. Stamm’s professional quality of life (ProQOL) and
Communication Skills Test tool were included in questionnaire. SPSS WIN 20.0 was used to conduct the
descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression.
Results: The results showed that burnout was associated with communication skills, compassion
satisfaction, compassion fatigue, education, perceived health, favor of client’s family, support of
colleagues, and intention to seperation. The cases with low communication skills, low compassion
satisfaction, high compassion fatigue, low education status, low perceived health, low favor of client’s
family, low support of colleagues, and high intention to seperation showed significantly high burden.
Conclusion: The result of this study is expected to contribute to developing Long-term Care Insurance
for the elderly into a high quality tasked with Long-term Care Insurance for elderly and eventually promote
health promotion of elderly. The findings suggest that further studies examine ways to develop proper
intervention to decrease burnout for staff of long term care insurance for the elderly in National Health
Insurance Corporation.
References
Braga, E. M., & Silva, M. J. (2007). Competent communication: a view of nurse experts in communication. Acta
Paulista de Enfermagem, 20(4), 410-414. Crino, M. D., & White, M. C. (1981). Satisfaction in communication: An
examination of the Downs-Hazen Measure. Psychological Reports, 49, 831-838. Friedman, R. (2002). The importane
of helping the helper. National child welfare resource center for family-centered practice. Best Practice/Next Practice,
3(1), 16-21. Frigley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C. R.
Figley(Ed.), compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized.
Brunner-Mazel. New York. Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 118-121. Papa, M. J.
(1989). Communicator competence and employee performance with new technology. Southern Communication
Journal, 55(1), 87-101. Pines, A., & Maslach, C. (1978). Characteristics of staff burnout in mental health setting.
Hospigal and Community Psychiatry, 29(4), 233-237. Sexton, I. (1999). Vicarious traumatization of counsellors and
effects on their workplace. British Journal of Guideline and Counselling, 27, 393-403. Stamm, B. H. (2010). The
ProQOL Concise Manual. Retrieved October 19, 2013 , http://www.proqol.org/proQOL_Test_Manuals.html Stamm,
B. H., & Figley, C. R. (2009). Advances in the theory of compassion satisfaction and fatigue and its measurement
with the ProQOL 5. Retrieved October 19, 2013, http://www.proqol.org/ProQol_Test.html.

Contact
[email protected]

Outcomes of Reciving Service-Learning Activities Among Elders Living in a
Long-Term Care Facility
Chia-shan Wu, RN, MSN, Taiwan
Purpose
The purpose of this presenation is to present the effectivess of service-learning for elders living in a long-
term care facility.
Target Audience
The target audience of this presentation will be nursing educators and administators of long-term care
facilities.
Abstract
Purpose: Service-Learning is a form of experiential education. Teaching Long-Term Care Nursing via
service-learning activities, students can learn how to communicate with elders, present caring, and meet
the needs of elders. However, outcomes of receiving service-learning among elders living in long-term
care facilities in Taiwan were limited studied. The purpose of the study was to exam outcomes of
receiving service-learning activities among elders living in a long-term care facility.
Methods: This is a single group, pre and post test research design. The service-learning activities were
provided by 4th-year nursing students in a five-year Junior College located in southern Taiwan. Each
service-learning activity was provided 2 hours a week for six weeks in a morning of weekday. During the
service-learning activities performed, students not only accompany elders, but also review elders’ prior life
with elders.
Results: There were 52 elders living in a long-term care facility in southern Taiwan participated in the
study, Results showed that no statistically significant changes in mood status (t = 0.825) and self-esteem
(t = 0.084). Although the self-perceived health status have improved, but no statistical significant
improved in self-perceived physical health (t = 3.071) and mental health (t = 2.537). Hence, elders’ life
satisfaction score showed statistical significant declined (t = 2.537). These results might relate to a short
period of service-learning activities provided. Elders might feel unhappy due to lack of student visits.
Conclusion: Nursing faculties who plan service-learning activities in the curriculum, teachers should
prepare students knowledge and skills on how to say goodbye with elders, and than to decrease elders’
separation anxiety. Hence, continuing social visits might be provided to decrease elders’ feeling of loss.
Elders might increase their life satisfaction, improve mood status and self-esteem.
Contact
[email protected]

Risk Factors and Outcomes Associated with Initial Use of Inappropriate
Indwelling Urinary Catheters Among Hospitalized Elderly Patients
Shih-Ting Piao, RN, Taiwan
Purpose
The purpose of this presentation is to explore the risk factors and clinical outcomes for initiation of
inappropriate urinary catheterization among hospitalized elderly in Southern Taiwan.
Target Audience
The target audience of this presentation is clinical care providers including clinicians, nurses, and
patients' caregivers.
Abstract
Purpose: The aim of this study was to explore the risk factors and clinical outcomes for initiation of
inappropriate urinary catheterization among hospitalized elderly in Southern Taiwan.
Methods: The subjects were selected with a purposive sampling method at a medical center in Southern
Taiwan from October 29, 2012 to May 19, 2013. A prospective study was conducted to collect data from
hospitalized elders who used IUCs within 48 hours after admission. One hundred and fifteen patients
were recruited. Data was collected including: demographic variables, Charlson Comorbidity Index, Katz
Index of Independence in Activities of Daily Living, Geriatric Depression Scale Short–Form, Short
Portable Mental Status Questionnaire, and information of IUCs placement. The outcomes associated
medical care was collected at discharge. SPSS software for windows version 19.0 was applied to analyze
the data through descriptive statistic, chi-square, t-test, and binary logistic regression analyses.
Results: The results indicated that the incidence rate of inappropriate use of IUCs was 37.4%. The most
frequent indication for catheterization was surgical intervention (43.1%), the second most frequent
indication was accurate assessment of urinary output (37.5%). The most common reasons that
inappropriate IUCs use was for convenience (62.8%), and used for manage acute urinary retention
without assessment (18.6%). The findings of logistic regression analysis suggested that the diagnosis of
urinary tract infection (OR=7.75, 95%CI=1.84-32.73, p=.005), lower scores of SPMSQ (cognitive function)
(OR=0.77, 95%CI=0.62-0.96, p=.02), and higher Katz scores (activities of daily living) (OR=1.17,
95%CI=1.04-1.33, p=.012) were risk factors associated with inappropriate IUCs use among hospitalized
elderly. Inappropriate catheterized patients also had a poor recovery in activities of daily living at
discharge, but were not associated with such outcomes as catheter- associated urinary tract infection,
length of hospital stay, nursing home admission, mortality, and catheters reinsertion.
Conclusion: Urinary catheters were inappropriately used more commonly among the diagnosis of urinary
tract infection, poor cognitive function, and better activities of daily living status in older patients. Careful
attention to this aspect of medical care may increase the degree of recovery in activities of daily living at
discharge. Given the significance of these results can help identify groups at increased risk for
inappropriate urinary catheters placement. Multiple approaches are needed to reduce inappropriate
utilization, including avoiding the placement of unnecessary urinary catheters and education about
appropriate indications for indwelling urinary catheters.
Contact
[email protected]

Application of Root Cause Analysis to Improve the Safety of Patients: A Case
Study of Adverse Event
Fang-Ru Lin, RN, Taiwan
Purpose
Head trauma and limb fracture are common consequences of falls in children. The aim of this study was
to describe the adverse event with falls children in hospitalized. We used root cause analysis to survey
the adverse event on practices relevant to improving patient safety.
Target Audience
Clinical staff(nurse,doctor),Child Life and play Specialist.
Abstract
Purpose: Head trauma and limb fracture are common consequences of falls in children.The aim of this
study was to describe the adverse event with falls children in hospitalized. We used root cause analysis
to survey the adverse event on practices relevant to improving patient safety.
Methods: The setting of this study was about a 24-bed pediatric oncology ward in northern regional
teaching hospital in Taiwan from January, 2010 to November, 2013.The first applied instrument was
based on literatures review. We wouldretrospectively chart review and “reporting system of medical
incidents” describing in detail the adverse event and activities to leading up this. Then, we constructed the
event diagram to show the steps in the process where fail maybe. We were made based on these root
cause to avoid adverse events.
Results: The total errors events 23 adverse events (Systemic errors:2; personal errors: 21).We found
those questions:
1. Children are largely dependent on the age of the child is main risk factor. Mean age of the children
was 5.8 years old. More than half of all fall-related childhood injuries occur among children age 3 years
(about 56.6%).
2. Lack of main caregiver on the alert (lack of main caregiver watched closely) is a common cause of falls
(about 86%).
Conclusion: Falls are a leading cause of children morbidity, mortality and high risk of interruption or
delaying chemotherapy in cancer patients. Based on our results, we suggested to provide appropriate the
tools to educate children and main caregivers of the potential risk of falls and was to develop
individualized management plans of care to reduce risk for high risk children.
References
Brook, U., & Boaz, M.(2003). Children hospitalized for accidental injuries: Israeli experiences. Patient Education and
Counseling, 51. 177–182 Cooper, C L.,& Nolt, J. D. (2007) Development of an evidence-based fall prevention
program. Journal of nursing care Quality, 22(2), 107-112 Lowrey, G. H. (1963). The problem of hospital accidents to
children. Pediatrics, 32(6), 1064-1068. Razmus, I., Wilson, D., Smith, R., & Newman, E.(2006). Falls in hospitalized
children. Pediatric Nursing,32(6), 568-72.
Contact
[email protected]

The Effects of a Dash Diet-Based Nutritional Intervention Program for Elderly
Women's Bone Health
Haeyoung Lee, RN, PhD, South Korea
Purpose
The purpose of this study is to examine the effects of Korean DASH diet education and calcium/vitamin D
supplementation on nutrient intake and bone turnover markers in older women.
Target Audience
The target audience of the study is healthcare providers and healthcare educators who want to help
improve musculoskeletal health and lifestyle habits of elderly women at high risk for osteoporosis.
Abstract
Purpose: Despite to high prevalence of osteoporosis, elderly women show overall nutritional deficiency
including calcium intake. The DASH diet (Dietary Approach to Stop Hypertension) encourages reducing
saturated fat intake and increasing the potassium and calcium intake. The effectiveness of Korean DASH
on bone mineral density has been validated. However, the effectiveness of the DASH diet education with
calcium and vitamin D supplements women is unknown among Korean elderly. Thus, the purpose of the
study was to investigate the impact of the DASH diet education with calcium/vitamin D supplements on
the nutritional intake and the bone turnover marker among Korean elderly women.
The DASH (Dietary Approach to Stop Hypertension) that focuses on food high in calcium and potassium
was originally designed to regulate high blood pressure. And its positive effects on bone density have
been reported in studies conducted in many countries including Korea (Kim et al., 2010; Lin et al., 2003).
So if the DASH diet food choices are modified in favor of Korean elderly and provided to them (Korean
DASH diet), it would be possible to see increased intake of calcium, potassium and other nutrients that
are helpful for bone health. Unlike young people, however, older people may have difficulty increasing
calcium and potassium intake from food because they may find their long-lived eating habits hard to and
may have some degrees of dental problems.
From the meta-analysis of calcium supplementation effects on bone density, the effects were better for
those who had consumed less calcium and who were older(Tang, Eslick, Nowson, Smith, & Bensoussan,
2007). Therefore, elderly women with serious calcium deficiency need to have increased nutrient intake
and supplementation of calcium from means other than food to maintain and improve their bone
density(Bae et al., 2006).
Methods: This study is carried out with a non-equivalent control group pre- and post-test and quasi-
experimental research design to evaluate the effects of Korean DASH diet education and calcium/vitamin
D supplementation on nutrient intake and bone markers in elderly women.
We examined 48 women aged 65 or over who enrolled in a senior welfare center in Seoul, Korea. A total
of 108 elderly people were initially recruited through advertisements in the center. At the initial screening,
however, 23 participants were excluded due to their sex (male), cognitive disabilities and not filling in
questionnaires. The remaining 85 subjects were seen in the first blood sampling, but another 30 were
excluded again. In the process of this research, a total of 7(surgery, n=1; start osteoporosis medication,
n=4; refuse to participating, n=2) were withdrawn, leaving 26 subjects in experimental group and 22 in
control for analysis.
The tools used for data collection were as follows.
General characteristics and health information of subjects were obtained through one-on-one interviews
with questionnaires. Participants were interviewed with a questionnaire concerning age, levels of
education, living alone or not, monthly expenses(allowance), self-rated economic status, regular
exercises, ages at menarche and menopause, parity, history of hormonal replacement treatment, history
of fracture after age 50, family history of osteoporosis and dental problems.

Weight and standing height were recorded in light clothing without shoes using the automatic scale(DS-
101, Dong Sahn JENIX Corporation, Korea) to produce BMI(Body Mass Index, kg/m2).
DASH diet knowledge and adherence measurement tool (Kim et al., 2010) was used after being adapted
partly and reviewed its content validity by an expert group(2 adult nursing professors, 1 nutrition professor
and 2 nursing doctors)(CVI=.84, KR20=.70). Dietary knowledge scale comprises of 10 questions with
answers of Yes/No/Don’t Know. Correct answer was scored 1 point and incorrect or Don’t Know answers
0 point. Those who get higher totals are interpreted to have more knowledge (Kim et al., 2010). The tool
to measure DASH diet adherence consists of 9 questions with 5-point scales(never true/rarely true/
neutral/ usually true/ always true). With higher totals, participants have stronger adherence to the diet(Kim
et al., 2010). The Cronbach’s α reliability coefficient of this tool was .68 when it was developed, and is .68
in this study.
Nutrient intake was measured with participants’ 3-day dietary records(2 week and 1 weekend day) using
24-hour recall method. Average daily intake was calculated using CAN-pro 3.0(Computer Aided Nutrition
Analysis Program version 3.0)(The Korean Nutrition Society, 2007).
Bone turnover markers were analyzed from blood samples obtained after fasting for more than 8
hours(Eone Reference Laboratory).Electrochemiluminescence Immunoassay(ELISA) was used to assess
two kinds of bone markers, CTx(C-telopeptide of collagen cross-links) for bone resorption and
osteocalcin for bone formation.
Bone density was assessed with ultrasound measurements using the Achilles Express Ultrasonometer
(GE Lunar Healthcare Corporation, USA). The measured site was calcaneus and recorded in stiffness
index (Kim et al., 2010).The effectiveness of our program was examined by comparing stiffness indexes
taken before and after intervention.
Data collection and intervention programs were executed with following process.
The Institutional Review Board in the Nursing School of S University approved this study. After acquiring
approval from the welfare center, we explained the purpose of this study to the elderly who enrolled in the
center and obtained consent from them for data collection.
To evaluate the effectiveness of interventions, data were collected pre and post interventions. Five
graduate nursing students who had participated in nutrition studies conducted one-on-one interviews with
the subject to assess general characteristics and dietary intake records. All the participants were required
to write food diaries records at pre and post interventions. The dietary records were collected after food
intake on the days of tests and ways of food preparation were evaluated. For those who had trouble
writing food diaries, their daughters or in-law daughters wrote the diary. Real-sized food models were
used to help subjects recall the foods they had eaten. Anthropometry and bone density were measured
by 4 undergraduate nursing students who had been trained beforehand for their assigned areas. Data
collection for the two cohorts was conducted on the same day by research assistants who did not know
which subjects were in which group. Researchers participated only in providing the intervention program,
not directly involved in data collection to avoid any probable impact on study results.
Korean DASH diet is a modified DASH diet for Korean foods that Korean elderly can consume while
retaining DASH’s original emphasis on fruits, vegetables, low-fat milk and dairy products together with
whole grains, poultry, fish and nuts. Diet education program was developed after advised by two nutrition
professors and one nursing professor. Diet counseling was made a total of 12 times through our center
visits (6 times) and telephone calls(6 times) over 12 weeks. Individual counseling was made in the center
every other week, and in those weeks without our visits, telephone counseling was made to encourage
diet and calcium supplementation compliance. In this study, calcium/vitamin supplementation is defined
as the provision of white pills containing 1200m of calcium and 800IU(20µg) of vitamin D every other
week or 6 times over 12 weeks to the participants. The pills were put into 7-day pill holders for a 2-week
use and provided.
Collected data were analyzed using PASW Statistics 18.0. General characteristics were analyzed with
frequency, percentage, average, and standard deviation. Homogeneity before interventions and variable
differences after intervention between the cohorts were assessed using χ2-test and independent t-test.

Reliability of the tools was evaluated with KR20 and Cronbach's α coefficient. Statistical significance was
accepted at p<.05.
Results: Participants in the intervention group showed the higher knowledge score (8.7 ±1.0 vs 7.7±1.3,
p=.002) and better compliance to the Korean DASH diet (36.9±4.5 vs 30.8±4.7, p<.001) than the control
group. In terms of other nutritional intake, the intervention group showed higher vitamin C intake than
control group after the program(p=.026). The intervention group also showed higher intake of
vegetable(p=.013), milk and dairy product(p=.041), whereas the control group showed no changes.
Consequently animal calcium intake from milk and dairy product was increased in intervention
group(p=.023). In terms of biochemical bone turnover marker, the intervention group showed the
significant decrease in carboxy-terminal collagen crosslinks(CTx) than the control group (0.30±0.15 vs
0.40±0.16, p=.030) after the intervention. There was no significant difference in osteocalcin and bone
mineral density among both groups.
Conclusion: This study examined the effects of Korean DASH diet education and calcium/vitamin D
supplementation on bone health in elderly women ages 65 or over. Based on the results, our
interventions are believed to have a positive influence on bone turnover in older women. Nonetheless, the
time was limited to fully evaluate changes in bone marker levels and the sample size was small, which
raises concerns of selection bias. This limitations warrant the need for extensive research over more than
one year. Considering that elderly have difficult to remember and maintain acquired knowledge for a long
term and to change dietary habits, we suggest a study that provides Korean DASH diet meals to
participants directly and reconfirm its effectiveness on their bone turnover.
References
1. Bae, Y. J., Choi, M. K., Kim, M. H., Kim, E. Y., Lee, J. Y., & Sung, C. J. (2006). The relation between net rate of
endogenous noncarbonic acid production from diet potassium and protein intakes and bone mineral density in
Korean women. Journal of the Korean Society of Food Science and Nutrition, 35(9), 1200-1206. 2. Kim, J. H., Choi-
Kwon, S., Park, Y. H., Park, K. A., Suh, M. H., & Lee, S. O. (2010). The Effect of the Dietary Approaches to Stop
Hypertension (DASH) Diet Education Program on Bone Mineral Density in the Middle-aged Women: A Pilot Study.
Journal of Korean Biological Nursing Science, 12(3), 195-205. 3. Lin, P. H., Ginty, F., Appel, L. J., Aickin, M.,
Bohannon, A., Garnero, P., et al. (2003). The DASH diet and sodium reduction improve markers of bone turnover and
calcium metabolism in adults. The Journal of Nutrition, 133(10), 3130-3136. 4. Tang, B. M., Eslick, G. D., Nowson, C.,
Smith, C., & Bensoussan, A. (2007). Use of calcium or calcium in combination with vitamin D supplementation to
prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet, 370(9588), 657-666. 5.
The Korean Nutrition Society (2007). Computer Aided Nutritional Analysis Program (CAN ]Pro) version 3.0
Contact
[email protected]

On the Use of Count Model to Predict Falls in Community-Dwelling Elderly: Using
Klosa (Korean Longitudinal Study of Ageing) Data
Sehoon Hong, RN, PhD, South Korea
Heun Keung Yoon, RN, MSN, South Korea
Jihea Choi, RN, CPNP, PhD, South Korea
Purpose
The objectives of the study were: (1) to ascertain the risk factors for falls in elderly; (2) to determine
whether risk factor profiles differ between first time fallers and recurrent fallers; and (3) to build decision
tree map of fall down risks in elderly and to suggest effective interventions.
Target Audience
The target audience of this presentation is health care providers who are interested in elderly’s falls and
effective interventions for prevention.
Abstract
Purpose: Falls has been caused of increasing rates of morbidity or mortality in elderly population
(Centers for Disease Control and Prevention, 2013). In community-dwelling adults aged 65 years or older,
one in three in the US (Kannus et al., 2007) and 17.2% of South Korean (Korea Ministry of Health and
Welfare, 2009) suffers a fall each year. It’s been led to spend of much of budgets from medical finance.
And, the severity of complications of fall accidents has increased the length of stay of the old in hospital
or care facility (Donaldson et al, 2005). Even though many of studies have been proposed the predictors
or solutions for fall prevention, falls are still methodological issues in geriatric nursing field. This study
suggests predicting the causes of increasing fall accidents in elderly by analyzing the national data with
count model. The objectives of the study were: (1) to ascertain the risk factors for falls in community-
dwelling elderly; (2) to determine whether risk factor profiles differ between first time fallers and recurrent
fallers; and (3) to build decision tree map of fall down risks in elderly and to suggest effective
interventions for first time fallers and recurrent fallers each.
Methods: Secondary data analysis was conducted on information collected Korean Longitudinal Study of
Aging (KLoSA). KLoSA is a national panel data set that is publicly available. Data collected from 4,163
community-dwelling elderly in 2006 and 2008. Each subject was assessed by individual records of history
and physical performance tests. Falls were recorded in frequency of fall for past 2 years. Data were
analyzed by Chi-square, t-test, and zero-inflated negative binominal regression. Count models were
estimated using STATA version 10.0 and regression tree with R program.
Results: The incidence of falls among community-dwelling elderly in Korea was 6.5%. Significant
predictors of being a non-faller or a faller were vision, place of residence, pain and depression (p < .05).
And significant predictors of being a recurrent faller were place of residence, alcohol and fear of falls (p <
.05). For diagnosis and predicting regression trees of recurrent fallers were as follows (characteristics of
high risk group): fear of falls (always worried), height (<175.5cm), age (<78.5year), vision (very bad),
Quality of life (lower), and then height (<159.5cm).
Conclusion: These results provide new points of view of nursing implication for fall prevention of elderly
in Korea. First, this study provides additional methodological option to study for prevention of falls and
decrease the numbers of recurrent falls in elderly. This paper summarizes information to help guide the
health care providers in choosing the high risk group of falls and the most appropriate preventing
intervention. Second, this secondary-analysis provides comprehensive evidence-based assessment of
risk factors for falls and recurrent falls in older people, confirming their multifactor etiology. Thus, the
findings of this study will be the basis for effective intervention program to prevent falls and repeat falls.
References
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury
Statistics Query and Reporting System (WISQARS). Available from: http://www.cdc.gov/injury/wisqars. Accessed

May 3, 2013. Donaldson, M. G., Khan, K. M., Davis, J. C., Salter, A. E., Buchanan, J., McKnight, D., Janssen, P. A.,
Bell, M., McKay, H. A. (2005). Emergency department fall-related presentations do not trigger fall risk assessment: a
gap in care of high-risk outpatient fallers. Arch Gerontol Geriatr, 41(3), 311-317. Hausdorff, J. M., Rios, D. A.,
Edelberg, H. K. (2001). Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch
Phys Med Rehabil, 82(8), 1050–1056. Kannus, P., Palvanen, M., Niemi, S., & Parkkari, J. (2007). Alarming rise in the
number and incidence of fall-induced cervical spine injuries among older adults. J Gerontol A Biol Sci Med Sci, 62(2),
180–183. Korea Ministry of Health &Welfare. (2009). 2008 National Elderly Survey: the living condition and welfare
needs for older adults. Author, Seoul.
Contact
[email protected]

Physical and Psychological Care of Breast Cancer Patients Receiving Chemical
Therapy
Yi-Chiu Ou, RN, Taiwan
Chia Jung Lin, RN, Taiwan
Min Juan Zeng, RN, Taiwan
Ruo-Nan Jueng, RN, Taiwan
Purpose
The purpose of this exploratory study was to investigate and describe searching for physical and
psychological care of breast cancer patients receiving chemical therapy in Taiwan.
Target Audience
Nursing intervention included promoting physical health, helping patients face the change of body
appearance and uncomfortable, and encouraging patients joining families activities, to improve physical
and psychological status and keep life of quality. This research provided nurses with a reference for
caring similar patients in the furture.
Abstract
Purpose: This exploratory study was to investigate and describe searching for physical and
psychological care of breast cancer patients receiving chemical therapy in Taiwan. The study was
conducted in a community’s hospital in east Taiwan.
Methods: Eleven adult women with breast cancer, who indicated their present followed up in outpatient
department and were able to communication well, were recruited. A hermeneutical, phenomenological
research method was employed to guide the study. Interview were used to explore the structure of the
study participants.
Results: Three themes emerged include (1)loss of control ,(2)health and choice, (3) to live. They were
impaired insomnia causes severe distress, vomiting, feel nauseated, disturbance of body image. However
sleep disturbance not only make patients uncomfortable and interfere with their mental health.
Conclusion: Nursing intervention included promoting physical health, helping patients face the change of
body appearance and uncomfortable, and encouraging patients joining families activities, to improve
physical and psychological status and keep life of quality. This research provided nurses with a reference
for caring similar patients in the furture.
References
1.Hoskins,C.N.,& Haber, j.(2000).Adjusting to breast cancer. American Journal of Nursing, 100(4),26-33. 2.Smith,
M.T., pERLIS, m.l., Carmody, T.P., Smith, M.S.,& Giles, D.E.(2001)prwsleep cognitions in patients with insomnia
secondary to chronic pain, Journal of Behavioral Medicine, 24(1),93-114. 3.Lee, H.L., Chung, M.H., Chau,S.C.,& Ku,
N.P.(2001).Fatigue and related factors in women with breast cancer receiving chemotherapy. Journal of Medicine.
Science, 21(3),123-133.
Contact
[email protected]

Effects of Self-Regulated Exercise Maintenance Program (SR-EMP) on Cognitive
and Behavioral Changes and Musculoskeletal Health of Elderly Women with
Osteoporosis
MiJeong Park, RN, PhD, South Korea
Sue Kim, RN, PhD, South Korea
Purpose
The purpose of this study is to determine the effects of the self-regulated exercise maintenance program
(SR-EMP) on the cognitive aspects, such as self-efficacy and expected outcome, the behavioral aspects,
such as exercise frequency and time, and the musculoskeletal health aspects, such as bone density,
balance and muscular strength.
Target Audience
The target audience of this study comprised the health care providers or health educators who wanted to
help the elderly women with osteoporosis maintain and improve their musculoskeletal health.
Abstract
Purpose: As Korea becomes an ageing society rapidly, geriatric diseases recently increased in the
South Korean society. Especially, over the past decade, osteoporosis has drastically increased in the
elderly women in their sixties and seventies (Ministry of Health and Welfare), so active social, economic
and scientific attention should be paid. The osteoporosis is a disease which enhances a risk of fracture by
weakening bone strength through bone mass reduction, bone tissue atrophy, and fine structure damage
(Kotz, Deleger, Cohen, Kamigaki, & Kurata, 2004). The disease is treated by means of exercise, intake of
calcium and vitamin, no alcohol, no smoking, weight control, medication etc. Among them, exercise
therapy is effective for reducing facture, since it gives mechanical load to bone, thus preventing bone
loss, increasing bone strength and improving muscular quantity and strength and sense of balance
(Lewiecki, 2011). Therefore, continuous exercise should be strongly emphasized for elderly osteoporosis
women. Six months or more are needed to make the temperament of bone formed again in response to
the transformed load caused by exercise (Spirduso, Francis, & MacRae, 2005). Hence, elderly
osteoporosis women should do continuous exercise in everyday life, not during a short term. However,
there is a preceding study according to which 50% of the elderly stop exercise after 3-6 months of
exercise (Resnick & Spellbring, 2000). This indicates that it is very difficult for old people to maintain their
habit of exercise for a long time. The present study paid attention to Park et al. (2013)'s self-regulated
exercise maintenance program (SR-EMP), a new strategic program to induce elderly osteoporosis
women to do exercise continuously in everyday life and eventually to improve musculoskeletal
health. The SR-EMP was developed to lead elderly osteoporosis women into continuous exercise by
using self-observation, goal setting, social and environmental support and reinforcement, time
management and relapse prevention, which are sub-concepts of self-regulation, as the tactics of the
intervention program, but the practical efficacy of the program should be verified among elderly
osteoporosis women. Therefore, this study aims to determine the effects of the SR-EMP program on
cognitive and behavioral changes and musculoskeletal health improvement by applying the program to
the elderly women having osteoporosis.
Methods: The present study was performed using the pretest-posttest design with a comparison group at
two silver schools in C and W cities for about six months from April 26 to October 22, 2012. The subjects
were the women of 65 to 74 years old who were diagnosed as osteoporosis and recommended to do
regular exercise but did not take the drugs which are likely to affect osteoporosis without restricting
physical activities. The study was joined by 19 subjects in the test group (C city) and 18 subjects in the
control group (W city) to the end. There was no statistically significant difference in the demographic
characteristics and study.
This study applied the SR-EMP and a general exercise program to the test group and the control group,
respectively in order to check how effective the SR-EMP with reinforced self-regulated strategy were for

study factors, as compared to the existing exercise programs. To determine self-regulation abilities, an
intermediate test was performed after pretest and 12-week introduction and adaptation period, during
which regular exercise was maintained by the investigator, and posttest was performed after 12-week
maintenance period, during which the subjects maintained exercise (24 weeks after the prior test).
The SR-EMP was developed through the six steps of need assessment, goal setting, selection theory-
based intervention methods and performance strategies, development of program application and
performance schemes and development of program effect assessment methods, and consists of the
health education using self-control strategy's sub-factors, self-observation, goal setting, social support,
environmental aids, reinforcement and relapse prevention, and the strategic intervention methods, such
as complex exercise, self-help meeting, exercise notebook and telephone consulting.
In order to help elderly osteoporosis women exercise at home after completing intervention, the program
is composed of one-time health education, complex exercise three times a week, self-help meeting once
a week in the 8-week introduction period; complex exercise once a week, self-help meeting once a week
and telephone consulting two times a week in the 4-week adaptation period; keeping and updating an
exercise notebook in the 12-week period.
This study used the tools to measure self-efficacy, expected outcome, exercise frequency and time,
osteoporosis, balance and muscular strength in order to determine the effects of the SR-EMP on
cognitive and behavioral aspects and health aspects. For self-efficacy, 6 questions (Won In Sook, 2009)
of 10 point VAS scale were used, and for expected outcome, 16 questions of 4-Likert scale (Kim Yul,
2009) were used. Higher average points mean greater self-efficacy and expected outcome. This study
analyzed the exercise notebooks that the subjects kept during the study period to measure behavioral
aspects, exercise frequency and time. For exercise frequency, average values were obtained by adding
up the › (exercise)
-exercise) andevery
marks × (nonweek. Higher values mean higher exercise
frequency. For exercise time, average values were obtained by adding up practical exercise hours among
complex exercise hours (5-minute preparatory exercise, 25-minute aerobic exercise, 25-minute resistance
exercise and 5-minute finishing exercise) every week. Higher values mean more exercise hours. For bone
density, T scores were measured in the calcaneus at a simple test using a mobile bone density measurer
for quantitative ultrasonometry. Higher T-score values mean higher bone density. For balance, static
balance measurement was used. Higher values mean higher sense of balance. For back strength, a back
muscle dynamometer was used. Higher values mean better back strength. The collected data was using
the IBM SPSS Statistics version. A repeated measure ANOVA was used to analyze the differences in
self-efficacy, expected outcome, exercise frequency and time, bone density, balance and muscular
strength.
Results: The effects of the SR-EMP on cognitive aspects are as follows. First, self-efficacy was no
statistically significant difference between the test and control groups (F=0.72, p=.401), but there were
statistically significant differences between periods (F=34.50, p<.001), and there was no statistically
significant difference in interaction effect between groups and periods (F=3.07, p=.053). Second, the
expected outcome was no significantly significant difference between the test and control groups (F=1.03,
p=.318) and periods (F=0.72, p=.492). However, there were statistically significant differences in
interaction effect between groups and periods (F=6.00, p=.004).
The effects of the SR-EMP on elderly osteoporosis women’s behavioral aspects are as follows. First, the
exercise frequency were statistically significant differences between the test and control groups (F=4.43
p=.043) and periods (F=277.49, p<.001). However, there were no statistically significant difference in
interaction effect between groups and periods (F=6.00, p=0.103). Second, the exercise time were
statistically significant differences between the test and control groups (F=6.96, p=.012), periods
(F=239.33, p<.001), in interaction effect between groups and periods (F=4.99, p=.024).
The effects of the SR-EMP on the musculoskeletal health of elderly osteoporosis women are as follows.
First, the bone density was no significantly significant difference between the test and control groups
(F=1.03, p=0.566) and periods (F=0.72, p=0.329). However, there were statistically significant differences
in interaction effect between groups and periods (F=6.00, p=0.005). Second, the balance was no
statistically significant difference between the test and control groups (F=0.17, p=.684), but significant
differences between periods (F=12.12, p<.001). There was no statistically significant difference in
interaction effect between groups and periods (F=6.00, p=0.130). Third, the muscular strength was no

statistically significant difference between the test and control groups (F=3.01, p=.092), but significant
differences between periods (F=34.77, p<.001). There were statistically significant differences in
interaction effect between groups and periods (F=6.05, p=.004).
Conclusion: The present study was performed to determine the effects of the SR-EMP on the cognitive
and behavioral changes and musculoskeletal health of elderly osteoporosis women. As a result, the SR-
EMP proved to continuously promote expected outcome, a cognitive factor, and increase exercise time, a
behavioral factor, and thus have positive effects on bone density and muscular strength. The SR-EMP is
expected to be used in various fields as an intervention tool for elderly osteoporosis women to do
effective and continuous exercise.
References
Bartholomew, L. K., Parcel, G. S., Kok, G., Gottlieb, N. H., & Fernandeze, M. E. (2011). Planning health promotion
programs: an intervention mapping approach. San Francisco: Jossey-Bass Kim, Y. (2008). Factors related with
leisure-time exercise in high grade students of some elementary schools: Applying social cognitive theory.
Unpublished doctoral dissertation, Chosun University, Gwangiju, Korea. Kotz, K., Deleger, S., Cohen, R., Kamigaki,
A., & Kurata, J. (2004). Osteoporosis and health-related quality-of-life outcomes in the Alameda county study
population. Prevention Chronic Disease, 1(1), 1-9. Lewiecki, E. M. (2011). In the clinic: Osteoporosis. Annals of
Internal Medicine, 155(1), 1-15. Park, M. J., Kim, S., Cho, E. H., Park, S. M., & Kang, H. C. (2013). A study on the
development of a self-regulated exercise maintenance program for osteoporotic elderly women: Using intervention
mapping protocol. Journal of the Korean Gerontological Society, 33(2), 419-437. Resnick, B., & Spellbring A. M.
(2000). Understanding what motivates older adults to exercise. Journal of Gerontological Nursing, 26(3), 34-42.
Spirduso, W. W., Francis, K. L., & MacRae, P. G. (2005). Physical dimensions of aging (2nd Ed.). Champaign, IL:
Human Kinetics Publishers. Won, I. S. (2009). A study on osteoporosis knowledge, self-efficacy, health promoting
behaviors and BMD among adult women. Unpublished master's thesis, Eulji University, Daejeon. Korea.
Contact
[email protected]

The Development of Educational Tool to Support Disease Management Nurses for
Preventing the Recurrence of Brain Infarction
Yasuko Fukuoka, MSN, RN, PHN, Japan
Yae Takeshita, MSN, RN, PHN, Japan
Masahiro Kamouchi, PhD, MD, Japan
Purpose
In this study, we have developed the educational tool to support nurses who newly came into to DM field
for them to understand and be able to practice evidence-based DM programs. This reports development
of the Stroke educational tool for nurses.
Target Audience
The target audience of this presentation is disease management nurses.
Abstract
Background: Stroke, including brain infarction, is the top cause of producing care-needy condition and
one of the highest disease categories of national medical expenditure in Japan(Health and Welfare
Statistics Association., 2010) as well as other developed countries(Johnston, 2008). Stroke is reported as
a high recurrence rate(Hata et al., 2005), and is aggravated by a recurrence even if it was a mild disability
at the first time(Hankey, Jamrozik, & Broadhurst, 2002).
For preventing the recurrence, Stroke evidence-based clinical guideline 2009, Japan, recommends to
control risk factors with medication and lifestyle modification(Shinohara et al., 2011). From medical care
delivery system's perspective, one of the methods to solve the recurrence of stroke is disease
management (DM) system(Howe, 2005; Warren & David, 2001).
DM is defined as "a system of coordinated health care interventions and communications for populations
with conditions in which patient self-care efforts are significant. DM supports the physician or
practitioner/patient relationship and plan of care; Emphasizes prevention of exacerbations and
complications utilizing evidence-based practice guidelines and patient empowerment strategies; and
Evaluates clinical, humanistic, and economic outcomes on an on-going basis with the goal of improving
overall health"(Care Continuum Alliance., n.d.). Developed nations such as United States, Germany and
Australia have adopted DM as a national strategy. Following those countries, national council on social
security system reform, the Japanese government, in 2013, finally recommended developing DM
strategies to prevent chronic disease aggravation into the integrated community care system, and to
effectively use nurses in this disease management system. DM is the key to resolve preventing disease
aggravation/recurrence and the reduction of the medical expenditure as a result(Moriyama et al., 2009;
Moriyama, Takeshita, Haruta, Hattori, & Ezenwaka, 2013; Otsu & Moriyama, 2011). Therefore, we are
now in the process of developing DM system in Japan.
Purpose of this study: In order to effectively operate the DM system in Japan, we have developed the
disease management center outside of medical facilities, and started to provide DM to clients who have
been discharged from acute care hospitals and also clients of medical insured who are targeted through
analysis of medical receipt/claim data and health check-up data.
In this study, we have developed the educational tool to support nurses who newly came into to DM field
for them to understand and be able to practice evidence-based DM programs. This reports development
of the Stroke educational tool for nurses.
Significance of this study: Nurses providing DM programs (Disease Management Nurse: DMN) assess
clients’ health conditions through physiological laboratory data, physical examinations, and interviewing
lifestyle of clients, and focus target risk factors. DMNs also need to acquire skills of behavior modification,
motivational interviewing, and communication skills to feed back to clients' physicians. These are high

abilities which need to educate to DMNs even who have clinical experiences at hospitals. When DMNs
use this educational tool, they can provide high quality, stable skills to clients, and this tool makes reliable
quality condition to DMNs, as consequently, clients can receive reliable DM services.
Methods: Process of the development of education tool for DMN - The target - The target
population, using this educational tool is DMN. Clients who receive DM services through this trained DMN
are clients who had brain infarction whose modified Rankin scale is 0-3, who can conduct self-
management after having an education from DMN.
Scheme and contents of the tool - This tool is based on a critical pathway format, including intervention
timeline, intervention contents to both clients and their physicians. Intervention contents were extracted
from evidence-based clinical guidelines of stroke, hypertension, diabetes, dyslipidemia, chronic kidney
disease (CKD), alcohol, and smoking cessation, and arrhythmia. We placed those items with criteria.
Decision map/algorithms were embedded. Nurse’s intervention such as self-management education
(understanding of disease/condition, diet, exercise, self-monitoring and etc.), motivation interviewing
tools, and nursing actions such as foot examination were included.
The goal setting, planning, and stratification - As the education subjects vary depending on risk
factors of each client, we set a stratification groups divided by hypertension, diabetes, dyslipidemia, CKD,
and atrial fibrillation. The criteria values for the stratification were extracted from clinical guidelines. Then,
the frequency and the subjects of the intervention were set in every stratification group.
We create an algorithm to do automatic select of necessary extra medical data and education subjects. In
addition, the education methods were arranged due to the clients’ level of understanding and
enforcement for the self-management of the disease.
How the algorithm works - According to the inserted basic client information (e.g., risk factor, medical
history, and physiological data), the necessary extra data, education subjects and other information
needed are automatically displayed on the screen. During input the data, if there are some abnormal
data, the warning appears on the screen. Furthermore, reminding function is added. The actions need to
be taken to the abnormal data (e.g., additional patient education and report to the physician) appears on
the screen automatically.
Intervention method - The intervention period is three months. DMN make a face-to-face interview for
the first time, and total phone calls are 5 times for every 2 weeks.
Validity verification - The validity of the tool is clinical indicators and educational contents were checked
and compared to the neurologists and clinical nurse specialist nurses. Also for checking validity, we
compared the extracted indicators with the examination subjects and those frequencies by using medical
records of brain infarction outpatient.
Ethical consideration
This study was approved by the Ethics Committee of Hiroshima University.
Results: The purpose of this educational tool is to ensure a certain level of patient education quality for
preventing of brain infarction recurrence. For the achievement of this goal, there are two distinctive
characteristics of the tool.
1. The reminding function automatically selects strategies which cope with the abnormal data. This
function ensures the proper action to choose what kind of intervention to take and also reduce omissions
the necessary intervention.
2. As the stratification groups are made due to the risk factors, this tool customizes support to match the
risk factors of the clients. This function made it possible to standardize the thinking process for disease
management. It is important to customize the support depending on the risk factor which the client has,
because the brain infarction has many risk factors.
Conclusion: Those functions help to keep the quality of DM even when inexperienced nurse need to
perform the intervention. The practicability of this tool, however, is not confirmed yet. Now we are in the
process to check and proof the ability of the tool.

This work was supported by JSPS Scientific Grant A Number 22249069 ” Construction of a new model of
providing chronic disease care by the role function expansion of a nurse and the medical
insurer”(Representative Michiko MORIYAMA).
References
Care Continuum Alliance. Disease Management Defined. Retrieved from:
http://www.carecontinuumalliance.org/dm_definition.asp (Last acceses Dec 13,2013) Hankey, G., Jamrozik, K., &
Broadhurst, R. (2002). Long-term disability after first-ever stroke and related prognostic factors in the Perth
Community Stroke Study, 1989–1990. Stroke, 33(4), 1034–1040. Hata, J., Tanizaki, Y., Kiyohara, Y., Kato, I., Kubo,
M., Tanaka, K., … Iida, M. (2005). Ten year recurrence after first ever stroke in a Japanese community: the
Hisayama study. Journal of neurology, neurosurgery, and psychiatry, 76(3), 368–372. Health and Welfare Statistics
Association. (2010). Trends for national hygiene 2010. Tokyo, Japan: Health and Welfare Statistics Association.
Howe, R. S. (2005). The disease manager’s handbook. (1 edition.). Jones and Bartlett publishers,Inc. Johnston, S. C.
(2008). The 2008 William M. Feinberg lecture: prioritizing stroke research. Stroke; a journal of cerebral circulation,
39(12), 3431–3436. Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani, M., & Nakaya, T. (2009). Efficacy of a self-
management education program for people with type 2 diabetes. Japan journal of nursing science: JJNS, 6, 51–63.
Moriyama, M., Takeshita, Y., Haruta, Y., Hattori, N., & Ezenwaka, C. E. (2013). Effects of a 6-Month Nurse-Led Self-
Management Program on Comprehensive Pulmonary Rehabilitation for Patients with COPD Receiving Home Oxygen
Therapy. Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses. Otsu, H., & Moriyama,
M. (2011). Effectiveness of an educational self-management program for outpatients with chronic heart failure. Japan
journal of nursing science: JJNS, 8(2),140-152 Shinohara, Y., Yanagihara, T., Abe, K., Yoshimine, T., Fujinaka, T.,
Chuma, T., … Minematsu, K. (2011). II. Cerebral infarction/transient ischemic attack (TIA). Journal of stroke and
cerebrovascular diseases: the official journal of National Stroke Association, 20(4 Suppl), S31–73. Warren, T. E., &
David, N. (2001). Disease management:A system approach to improvingpatient outcomes.(J-B AHA Press) (1
edition.). San Francisco, CA, USA: Jossey-Bass.
Contact
[email protected]

Epigenetic Risk Factors in Women with Breast Cancer: A Family Case-Control
Study
Mildred C. Gonzales, RN, MSN, USA
Shyang-Yun Pamela K. Shiao, PhD, RN, FAAN, USA
Purpose
The purpose is to disseminate the current scientific evidence, including meta-analyses and a pilot
prospective family-based case-control study on genome health on epigenetic risk factors for breast
cancer.
Target Audience
Target audiences include nurses and inter-professionals who are interested in understanding genome
health and epigenetic risk factors for breast cancer.
Abstract
Purpose: The purpose is to disseminate the current scientific evidence, including meta-analyses and a
pilot prospective family-based case-control study on genome health on epigenetic risk factors for breast
cancer.
Breast cancer is the most common malignancy and the second leading cause of cancer death among
women worldwide. Methylenetetrahydrofolate reductase (MTHFR) is critical for methylation pathways for
deoxyribonucleic acid (DNA) repair and normal cellular development. Methylation pathways are affected
by health behaviors such as folate intake, alcohol consumption, and tobacco smoking.
Methods: Meta-analyses and a prospective pilot study on the associations of MTHFR gene variations,
and health behaviors with breast cancer.

Results: Preliminary meta-analyses results included 55 studies for a total of 22,077 breast cancer cases
and 25,419 controls including 27 studies with Whites, 21 studies with Asians, and 7 studies with mixed
Euramericans. From the selected studies with MTHFR gene counts, there were 12 studies with folate
intake levels for 8,032 cases and 10,482 controls; 5 studies with alcohol consumption for 3,068 cases and
5,157 controls; and 5 studies with tobacco smoking status for 909 cases and 1,233 controls. MTHFR
C677T was associated with increased risk of breast cancer (P < 0.005). The results also suggested that
low folate intake, heavy alcohol consumption, and tobacco smoking contributed to increased risks for
breast cancer. Preliminary results of the prospective pilot study conducted in southern California will be
presented.
Conclusion: The results of this study can be translated into individual differences in gene variations and
personalized behavioral interventions for cancer prevention. In addition, it has implications for the role of
the nurses as advocates for their clients through knowledge interface from epigenetic advances to
efficient health promotion in the clinical and community settings.
References
1. ACS. (2013). What`s new in breast cancer research and treatment? Retrieved 11/14/13, from
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-new-research 2. Christensen, B. C., Kelsey,
K. T., Zheng, S., Houseman, E. A., Marsit, C. J., Wrensch, M. R., . . . Wiencke, J. K. (2010). Breast cancer DNA
methylation profiles are associated with tumor size and alcohol and folate intake. PLOS Genetics, 6(7), e1001043.
doi: doi:10.1371/journal.pgen.1001043 3. Lee, C. J., Evans, J., Kim, K., Chae, H., & Kim, S. (2014). Determining the
effect of DNA methylation on gene expression in cancer cells. Methods Molecular Biology, 1101, 161-178. doi:
10.1007/978-1-62703-721-1_9. PMID: 24233782 [PubMed - in process] 4. Yu, L., & Chen, J. (2012). Association of
MHTFR Ala222Val (rs1801133) polymorphism and breast cancer susceptibility: An update meta-analysis based on
51 research studies. Diagnostic Pathology, 7, 171-181. doi: 10.1186/1746-1596-7-171. PMID: 23217001. 5. Zhang,
J., Qiu, L.-X., Wang, Z.-H., Wu, X.-H., Liu, X.-J., Wang, B.-Y., & Hu, X.-C. (2010). MTHFR C677T polymorphism
associated with breast cancer susceptibility: A meta-analysis involving 15,260 cases and 20,411 controls Breast
Cancer Research and Treatment, 123, 549-555. doi: 10.1007/s10549-010-0783-5
Contact
[email protected]

Telling It like It Is: The Lived Experience of Young People with Type 1 Diabetes in
Rural Australia
Ainsley M. James, BN, GradCertPaeds, GradCertHigherEd, MN, Australia
Purpose
The purpose of this presentation is to provide an understanding or awareness of what life is like for a
young person with type 1 diabetes living in a rural environment, the challenges they face and the impact
(or influence) chronic illness may have on these aspects.
Target Audience
The target audience for this presentation are health care professionals involved in the care of young
people with type 1 diabetes. Healthcare professionals will be better placed to provide relevant, contextual
and adolescent specific care to young people experiencing chronic illness.
Abstract
Purpose: The purpose of this research is to provide an understanding or awareness of what life is like for
a young person with Type 1 diabetes living in a rural environment, the challenges they face and the
impact (or influence) chronic illness may have on these aspects. Healthcare professionals will be better
placed to provide relevant, contextual and adolescent specific care to young people experiencing chronic
illness; care that takes into consideration the impact Type 1 diabetes has on a young person at various
points in their life by tailoring care that ‘fits’ into the young person’s life. There was a plethora of literature
relating to management of symptoms, control of glycaemic levels complications, lifestyle, insulin pumps,
activity, nutrition, monitoring and more importantly, searching for a cure; this list is not exhaustive. The
missing link appeared to be a lack of published research into the actual meanings of experiences had by
young people with type 1 diabetes.
Methods: A qualitative approach was implemented and underpinned by Max van Manen’s method of
phenomenological inquiry. Phenomenological inquiry provides opportunity to explore and describe lived
experience of a particular phenomenon, to ‘paint a picture’ of what living with type 1 diabetes is actually
like. The challenges faced and the impact (or influence) chronic illness may have will be highlighted.
Participants were male or female, 16-24 years of age, living in rural Victoria Australia, and had type 1
diabetes. Interviews were digitally recorded and transcribed and transcriptions analysed for themes,
utilising van Manen’s approach to phenomenological inquiry. Themes were utilised to describe what life is
like for young rural people with type 1 diabetes, essentially, their lived experience.
Participants were also invited to participate in creating an individual piece of art (of their choosing) that
represented their experience of having type 1 diabetes while living in a rural setting. They were asked to
interpret the artwork to the researcher, thus adding further depth to their lived experience. The artwork
took various forms and included drawings, paintings, photograph/s, poems etc.
Results: Results continue to be under investigation. At present participants were provided with a voice to
tell their story of what life is like living in a rural setting with type 1 diabetes with the aim to inform
healthcare professionals about the participants’ experiences. Results will strive to improve the care of
young people with type 1 diabetes living in a rural setting by the development of recommendations
enabling healthcare professionals to tailor care provided to young people. Results will also inform other
young people with type 1 diabetes about the participants’ experiences so that these experiences may
resonate with other young people
Conclusion: Adolescence can be a time of great change both physically and emotionally and is a
challenging period in a young person's life, even without alterations to their health. Adolescents
diagnosed with a chronic illness, such as type 1 diabetes experience lifelong changes that some may find
difficult to accept and cope with. Being adolescent, living with a chronic illness and residing in a rural
environment triples the challenges. Healthcare professionals will be better placed to provide relevant,
contextual and adolescent specific care to young people experiencing chronic illness; care that takes into

consideration the impact type 1 diabetes has on a young person at various points in their life by tailoring
care that ‘fits’ into the young person’s life. Support networks and programs can be designed specifically to
meet the needs of young rural people with type 1 diabetes.
Contact
[email protected]

Part VII: Invited Posters
RSG STR - Rising Stars of Scholarship and Research Invited Student
Posters
Postpartum Urinary Retention and Contributing Factors in Taiwanese Women
Ya-Ling Tzeng, RN, PhD, Taiwan
Ya-Wen Lin, RN,MS, Taiwan
Pei-Shun Ning, RN,BS, Taiwan
Purpose
Postpartum Urinary Retention is one of the most common urinary symptoms of women during the early
postpartum period.The objectives of this study were to describe the incidence, duration, type, clinical
management and its effect of postpartum urinary retention and to identify the factors influencing PUR.
Target Audience
Nursing staff ought to evaluate the bladder function of the postpartum women, especially primiparas,
those who adopted epidural anesthesia, and with severe perineal laceration. Though not being the major
reason causing PUR, episiotomy does affect postpartum women’s urinary function.
Abstract
Objectives: The purposes of this study were to describe the incidence, duration, type, clinical
management and its effect of postpartum urinary retention and to identify the factors influencing PUR.
Method: A prospective observational study was adopted. 270 women who had vaginal delivery, were
recruited from a medical center in central Taiwan. We used either bladder scan or urine output to
measure the post voiding residual volume, and further record the participants’ information related to
Postpartum Urinary Retention with a structural questionnaire.
Result: The PUR incidence of our participants was 7.78%, including 38.10% overt PUR and 61.90%
covert PUR. 23.80% of the women could self-urinate after one-hour helping measure; 9.52% with
indwelling catheterization and 66.67% adopted intermittent catheterization. Based on the logistic
regression, women who are primiparas (OR,0.2; p=0.000), who have perineal laceration (OR,3.2;
p=0.000), and who adopt epidural anesthesia (OR,2.8; p=0.000)have higher incidence of PUR.
Conclusion: Evaluate the bladder function of the women after birth is suggested, especially primiparas,
those who adopted epidural anesthesia, and with severe perineal laceration. Though not being the major
reason causing PUR, episiotomy does affect postpartum women’s urinary function. The result of this
study contributes to the understanding of the characteristics and risk factors of resulting in postpartum
urinary retention, which could either help prevent or control postpartum urinary retention as well as
increase the quality of the nursing care in the early postpartum period.
References
Carley, M.E., Carley, J.M, Vasdev, G., Lesnick, T.G., Webb, M.J, Ramin, K.D., & Lee, R.A. (2002). Factors that are
associated with clinically overt postpartum urinary retention after vaginal delivery. American Journal of Obstetrics &
Gynecology, 187(2), 430-433. Cunningham, F., Gant, N. F., Leveno, K. J., Gilstrap, L., Hauth, J. C., & Wenstrom, K.
D. (2005). Williams Obstetrics. New York: McGraw-Hill Professional. Glavind, K. & Bjørk, J. (2003). Incidence and
treatment of urinary retention postpartum. International Urogynecology Journal, 14(2), 119-121. Lee, S. N., Lee, C.
P., Tang, O. S., & Wong, W. M. (1999). Postpartum urinary retention. International Journal of Gynaecology &
Obstetrics, 66(3), 287-288. Lewis, N.A. (1995). Implementing a bladder ultrasound problem. Rehabilitation Nursing,
204, 215-217. Liang, C. C., Chang, S. D., Tseng, L. H., Hsieh, C. C., Chung, C. L., & Cheng, P. J. (2002). Postpartum
urinary retention: assessment of contributing factors and long-term clinical impact. Australian & New Zealand Journal
of Obstetrics & Gynaecology, 42(4), 365-368. Musselwhite, K.L., Faris, P., Moore, K., Berci, D., & King, K.M. (2007).
Use of epidural anesthesia and the risk of acute postpartum urinary retention. American Journal of Obstetrics &
Gynecology, 196(5), 472.e1-472.e5. Teng, Y.C., Huang, Y.H., Kuo, B.J. & Bih, L.I. (2005). Application of Portable
Ultrasound Scanners in the Measurement of Post-Void Residual Urine. Journal of Nursing Research, 13(3), 216-224.
Teo, R., Punter, J., Abrams, K., Mayne, C., & Tincello, D. (2007). Clinically overt postpartum urinary retention after

vaginal delivery: a retrospective case-control study. International urogynecology journal and pelvic floor dysfunction,
18(5), 521-524. Van Os, A.F., & Van der Linden, P.J. (2006). Reliability of an automatic ultrasound system in the post
partum period in measuring urinary retention. Acta Obstetricia et Gynecologica Scandinavica, 85(5), 604-607.
Weiniger, C.F., Wand, S., Nadjari, M., Elchalal, U., Mankuta, D., Ginosar, Y., & Matot, I. (2006). Post-void residual
volume in labor: a prospective study comparing parturients with and without epidural analgesia. Acta
Anaesthesiologica Scandinavica, 50(10), 1297-1303. Yip, S.K., Brieger, G., Hin, L.Y., & Chung, T. (1997). Urinary
retention in the post-partum period. The relationship between obstetric factors and the post-partum post-void residual
bladder volume. Acta obstetricia et gynecologica Scandinavica. 76(7), 667-72. Zaki, M.M., Pandit, M., & Jackson, S.
(2004). National survey for intrapartum and postpartum bladder care: assessing the need for guidelines. BJOG: an
international journal of obstetrics and gynaecology, 111(8), 874-876.
Contact
[email protected]

Posters
Musculoskeletal Pain in Newly Diagnosed Type 2 Diabetics in Taiwan
Pai Lee-Wen, Taiwan
Li-Li Chen, PhD, RN, Taiwan
Hung Chin-Tun, PhD, Taiwan
Chang Shu-Chuan, Taiwan
Chen Wei, MS, Taiwan
Purpose
The objective of this study was to investigate musculoskeletal pain occurring in newly diagnosed type 2
diabetics in Taiwan between 2001 and 2010.We hoped to estimate incidence rate and occurring region by
the actual medical records. The result was provided the evidence of musculoskeletal pain in type 2
diabetics.
Target Audience
The target audience of this presentation is incluing the clinical professionals.
Abstract
OBJECTIVE: The objective of this study was to investigate musculoskeletal pain occurring in newly
diagnosed type 2 diabetics in Taiwan between 2001 and 2010.We hoped to estimate incidence rate and
occurring region by the actual medical records. The result was provided the evidence of musculoskeletal
pain in type 2 diabetics.
RESEARCH DESIGN AND METHODS: The research data was obtained from the Taiwan National Health
Insurance Research Database from 2000 to 2010.This study utilized a retrospective cohort method. We
recruited 6,586 newly diagnosed type 2 diabetics from 18 to 50 years of age in Taiwan in 2001 as the
diabetes subject group, and 32,930 age- and sex-matched controls without diabetes between 2001 and
2010. We tracked the outpatient medical records for musculoskeletal pain from 2001 to 2010 for both
groups and according to which, we calculated the incidence and occurring region for musculoskeletal pain
and compared the results.
RESULTS: The results showed that patients with diabetes had higher incidence rates as compared to
controls for musculoskeletal pain from 2001 to 2010 (p<0.05). The relative risk of musculoskeletal pain
occurrence for both groups was the highest(relative risk =1.33) for patients 31to 40 years of age; the
lowest relative risk (1.17) was seen in patients 41 to 50 years of age, and the relative risk for female
patients was always higher than male patients. The most occurring region was the lumbar and back area.
CONCLUSIONS: The study result indicated that patients with diabetes had higher incidence rates as
compared to controls for musculoskeletal pain. Therefore, to assess the musculoskeletal pain in type 2

diabetics is necessary, the early intervention will help to maintain ideal physical activity for type 2
diabetes.
References
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al., et al. Global and regional mortality from
235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease
Study 2010. Lancet 2012; 380: 2095-2128 2. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et
al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic
analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197-2223 3. World Health Organization:
National Diabetes Fact Sheet [article online], 2013. Available from
http://www.who.int/mediacentre/factsheets/fs312/en/index.html. Accessed 4 May 2014. 4. Reeves ND, Najafi B,
Crews RT, Bowling FL. Aging and type 2 diabetes: consequences for motor control, musculoskeletal function, and
whole-body movement. Journal of Aging Research 2013; 508756. 5. Lega I, Ross NA, Zhong L, Dasgupta K.
Gestational Diabetes History May Signal Deprivation in Women with Type 2 Diabetes. Journal of Women's Health
2011; 20: 625-629. 6. Oza-Frank R, Narayan KM. Overweight and diabetes prevalence among US immigrants.
American Journal of Public Health 2010;100: 661-668. 7. Tuchman AM. Diabetes and race. A historical perspective.
American Journal of Public Health 2011;101: 24-33. 8. Wang J, Yuan S, Zhu L, Fu H, Li H, Hu G, Tuomilehto J.
Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a
Chinese population with high post-prandial glucose. Diabetes Research & Clinical Practice 2004; 66 : 183-91. 9.
Riddell M, Perkins BA. Exercise and glucose metabolism in persons with diabetes mellitus: perspectives on the role
for continuous glucose monitoring. Journal of Diabetes Science and Technology 2009; 3: 914-923. 10. Rosenbloom
AL, Silverstein J. Connective tissue and joint disease in diabetes mellitus. Endocrinal Metab Clin North Am 1996;
25:473-483. 11. Arkkila PE, Gautier JF. Musculoskeletal disorders in diabetes mellitus: an update. Best Practice &
Research. Clinical Rheumatology 2003;17, 945-970. 12. Sherif EM, Abd Al Aziz MM, Elbarbary NS, Ahmed AM.
Insulin-like growth factor-1 in correlation with bone mineral density among Egyptian adolescents with type 1 diabetes
mellitus. International Journal of Diabetes in Developing Countries. 2011;31:104-112. 13. Esteghamati A, Etemad K,
Koohpayehzadeh J, Abbasi M , Meysamie A ,Noshad S, Fereshteh A, Mousavizadeh M, Rafei A, Sheikhbahaei S,
Nakhjavani M. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran:
2005-2011. Diabetes Research & Clinical Practice 2014;103 : 319-327. 14. Xu, F.; Wang, Y.; Ware, R. S.; Tse, L. Ah;
Dunstan, D. W.; Liang, Y.; Wang, Z.; Hong, X.; Owen, N. Physical activity, family history of diabetes and risk of
developing hyperglycaemia and diabetes among adults in Mainland China. Diabetic Medicine 2012 ; 29 : 593-9. 15.
Kemmis K. Common Musculoskeletal Disorders in Older Adults With Diabetes.Topics in Geriatric Rehabilitation
2010;26: 264-272. 16. Wyatt LH; Ferrance RJ. The musculoskeletal effects of diabetes mellitus. Journal of the
Canadian Chiropractic Association 2006; 50 : 43-50. 17. Loprinzi P D. Accelerometer-assessed Physical Activity,
Functional Disability, and Systemic Inflammation: A National Sample of Community-dwelling Older Adults with
Diabetes. Cardiopulmonary Physical Therapy 2014 ; 25 : 5-10. 18. Wee HL, Cheung YB, Li SC, Fong KY, Thumboo
J. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole
greater than the sum of its parts? Health And Quality Of Life Outcomes 2005;3:2. 19. Molsted S, Tibler J; Snorgaard
O. Musculoskeletal pain in patients with type 2 diabetes.. Diabetes Research & Clinical Practice 2012; 96 :135-40.
20. Zamani B, Matini SM, Jamali R , Taghadosi M. Frequency of musculoskeletal complications among the diabetic
patients referred to Kashan diabetes center during 2009-10. Feyz Journal of Kashan University of Medical Sciences
2011;15: 225-231. 21. Slater M, Perruccio AV,Badley EM(2011). Musculoskeletal comorbidities in cardiovascular
disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study.
BMC Public Health 2011;11:77. 22. Hoff OM, Midthjell K; Zwart JA; Hagen K. The association between diabetes
mellitus, glucose, and chronic musculoskeletal complaints. Results from the Nord-Trøndelag Health Study. BMC
Musculoskeletal Disorders 2008; 9:160. 23. Wilkie R,Tajar A,McBeth J. The onset of widespread musculoskeletal
pain is associated with a decrease in healthy ageing in older people: a population-based prospective study. PLoS
ONE 2013; 8: 1-11. 24. Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand
and shoulder in patients with diabetes mellitus. The American Journal of Medicine 2002;112:487-490. 25.
Douloumpakas I, Pyrpasopoulou A, Triantafyllou A, Sampanis Ch, Aslanidis S. Prevalence of musculoskeletal
disorders in patients with type 2 diabetes mellitus: a pilot study. Hippokratia 2007;11:216-218 26. Ramchurn N,
Mashamba C, Leitch E, Arutchelvam V, Narayanan K; Weaver J; Hamilton J, Heycock C,Saravanan V, Kelly C.
Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. European Journal of Internal
Medicine 2009;20 :718-21. 27. Du Y, Heidemann C, Gößwald A, Schmich, P, Scheidt-Nave C. Prevalence and
comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national
telephone health interview survey 'German Health Update (GEDA)' 2009. BMC Public Health 2013;13:166. 28.
Mathew AJ, Nair JB, Pillai SS. Rheumatic-musculoskeletal manifestations in type 2 diabetes mellitus patients in south
India. International Journal of Rheumatic Diseases 2011;14 :55-60. 29. Aydeniz A, Gursoy S, Guney E. Which
musculoskeletal complications are most frequently seen in type 2 diabetes mellitus? The Journal of International
Medical Research 2008;36 :505-511.
Contact

[email protected]

Posters
A Nurse-Led, Evidence-Based Stroke Self-Management Program for Community-
Residing Stroke Survivors: Development and Design
Hoi Shan Lo, RN, BN, MSc, Australia
Purpose
The purpose of this presentation is to illustrate the process of developing a nurse-led, theory-based
stroke self-management program for community-residing stroke survivors based on the best available
research evidence.
Target Audience
The target audience of this presentation includes nurses and healthcare professionals interested in stroke
care.
Abstract
Background: Stroke recovery is long-term and demanding. It is important to optimise stroke survivors’
capability to manage their own health after stroke. Previous systematic reviews showed potential benefits
of stroke self-management programs. However some programs were not well designed with a theoretical
framework.
Aim: The aim of this paper is to illustrate the design and development of a nurse-led, evidence-based,
self-efficacy enhancing stroke self-management program for community-dwelling stroke survivors.
Methods: The development of the program is divided into two phases. Phase I included the conduct of a
systematic review to assess the best available research evidence regarding the effectiveness of
community-based stroke self-management programs underpinned by a theoretical framework. Phase II
included the development of a theory-based stroke self-management program for community-dwelling
stroke survivors based on the review findings.
Results: The results of the systematic review showed that Bandura’s self-efficacy theory was frequently
adopted to underpin the stroke self-management programs. Significant improvement in quality of life and
self-efficacy among stroke survivors after receiving the program was reported. However some of the
included studies did not measure stroke survivors' changes in self-efficacy. Description about strategies
to enhance stroke survivors' self-efficacy in performing stroke self-management behaviours were also
limited. Based on the review results, a nurse-led stroke self-management program underpinned by
Bandura’s self-efficacy theory for community-dwelling stroke survivors is developed. It is a three-week
program including an individual home visit, two group sessions, and two follow-up phone calls.
Individualised assessment and education on self-management skills will be provided to enable mastery
experience. Video clips about experience sharing by stroke survivors were developed to provide vicarious
experience. Verbal persuasion and skills in reinterpreting the signs and symptoms will also be provided.
Furthermore stroke survivors' outcome expectation of performing stroke self-management will be
assessed to tailor-make the strategies to enhance their participation in self-management.
Discussion and Conclusion: This new program adopts multifaceted strategies driven by the self-
efficacy theory to enhance stroke survivors’ self-efficacy in performing stroke self-management
behaviours. A randomised controlled trial will be conducted to evaluate the program.
Contact
[email protected]

Posters
Methods of Developing and Evaluating an Acupressure Protocol for Managing
Agitation in Dementia
Rick Y. C. Kwan, RN, MSc, Hong Kong
Claudia K. Y. Lai, PhD, RN, Hong Kong
Mason C. P. Leung, PhD, BSc, BM(TCM), PDPT, Hong Kong
Purpose
The purpose of this presentation is to explicate the procedures on how a standardized acupressure
protocol was developed methodologically from an evidence base and how its effects were evaluated in a
randomized controlled trial.
Target Audience
The target audience of this presentation is researchers interested in the development of evidence-based
protocols and evaluation of complementary and alternative therapies.
Abstract
Background: Agitation is prevalent among people with dementia (PWD) in nursing homes. It frustrates
both the PWD and their caregivers. Acupressure is a complementary therapy whose effect can be
explained by different theories, such as the meridian theory in traditional Chinese medicine. Preliminary
studies supported its effectiveness in reducing agitation on PWD. However, acupressure is a multiple
modality therapy that can comprise various different types of intervention components. There is a dearth
of evidence to support which intervention components to use and to explain their effect. The purposes of
this paper are to discuss, using an actual example, how an acupressure protocol was developed
according to evidence-based procedures and how its effect was evaluated by an experimental study.
Methods/Design: Methods of developing an acupressure protocol - This intervention protocol was
developed according to the 2008 Medical Research Council guideline for developing complex
interventions. The intervention was developed based on three methods: a literature review, the Delphi
process and a pilot study.
The literature review identified articles discussing the theories possibly connecting the use of acupressure
and agitation. Evidence relevant to the use of acupressure on agitation in PWD was retrieved by a
systematic review from the major databases. The literature review highlighted the existing evidence and
developed theories to explain why acupressure might work. The relevant information retrieved from the
literature was then organized for the subsequent Delphi process.
In the Delphi process, a panel of six TCM experts specialized in acupuncture was consulted. The Delphi
process first asked the panel experts to suggest the intervention components (i.e. the selection of
acupoints), the intervention dosage, and the rationales for the selection of components. They were then
asked to give suggestions with reference to the information provided in the literature and their own
professional knowledge and experience. Finally, consensus on the procedural details and possible
effective components of the intervention protocol was reached through three cycles of stepwise
anonymous discussion. Although consensus on the intervention dosage (i.e. the duration and frequency)
was reached in the Delphi process, the narrative comments from the Delphi process showed that the
dosage was based on the experts’ experience only because TCM theory does not discuss dosage.
A pilot study was performed to provide supporting evidence for the dosage selection. In the pilot study,
within the range of dosage suggestions given in the Delphi process, the effect of acupressure was
compared among various dosages. The dosage that showed the largest and most significant effect was
used in the intervention protocol. Finally, all the details of the intervention protocol were confirmed after
the three methods. The intervention protocol was then evaluated in the subsequent experimental study.

Methods of evaluating an acupressure protocol = The experimental study was a multicenter, assessors-
participants-statistician-blinded, parallel group, randomized controlled trial conducted in Hong Kong
nursing homes. We targeted PWD over 65 years old in nursing homes, who were experiencing agitation.
We invited the participation of 157 nursing homes registered under the Hong Kong Social Welfare
Department. 21 nursing homes agreed, and 12 were selected randomly to participate in the study in order
to recruit an adequate number of participants (estimated to be 99) to demonstrate a significant effect
difference (i.e. f = 0.27) with a power of 0.8 and a significance level of 0.05 among the three groups. All
residents in the 12 nursing homes (n=2014) were primarily screened by the nursing home staff. After the
screening, the staff compiled a list of potential participants (n=214). With the consent of the participants
and/or their families, we further screened all potential participants against the selection criteria. 121
participants were finally recruited.
All participants were assigned by permuted block randomization into three groups in a 1:1:1 ratio. In the
acupressure group (AG), participants received acupressure at the Fengchi (GB20), Baihui (GV20),
Shenmen (HT7), Niguan (PC6) and Yingtang (EX-HN3) acupoints. In the sham-acupressure group (SG),
participants received pressure on five non-acupoints. In the usual-care group (UG), participants received
no intervention apart from the care provided by the nursing homes. Participants assigned to the SG and
UG received free acupressure, like that received by the acupressure group, as compensation after
completion of the study.
The main outcomes being evaluated were agitation and stress. The effect of acupressure on moderating
the participant’s use of psychotropic drugs was also monitored. Agitation was measured by the Cohen-
Mansfield Agitation Inventory (CMAI). Stress was measured by salivary cortisol. The measurements were
carried out four times: before the commencement of the intervention (T0), the first week after completion
of the intervention (T1), the third week after completion of the intervention (T2), and the sixth week after
completion of the intervention (T3).
To ensure the quality of the intervention implementation and data collection, all research personnel, those
conducting the intervention, and data collectors attended an eight-hour training course provided by two of
the six members of the TCM expert panel. All personnel conducting the intervention took a skill
examination administered by one of the six members of the TCM expert panel. All data collectors and
research assistants had to pass the skill examination stipulated by the researchers before they could
become involved in this study. The training content for the personnel conducting the intervention strictly
followed the intervention protocol of the study, with complete agreement by the expert panel. In order to
monitor the quality of the intervention and data collection, all the data collectors and those conducting the
intervention had to attend a separate skill evaluation provided to the research team monthly. On-site visits
were also conducted, once to each site, to monitor the skill of the data collectors and those conducting
the intervention. Dropouts, withdrawals, undelivered interventions and uncollected data were recorded
until completion of the study. The whole study lasted for 30 weeks. The intervention and data collection of
the study were completed. Data analysis of the results is under way.
Discussion: This paper followed the MRC 2008 guideline to elucidate the methods of developing and
evaluating a standardized acupressure protocol. Acupressure is like many other complementary therapies
in that it has been used without strict regulations and strong consensus. For this reason, intervention
components and implementation methods may vary largely from one context to another. It is difficult to
evaluate the effects of an intervention with too many varying possible effective components.
This paper discussed three methods of developing an intervention. A literature review was used to
identify the existing evidence. The Delphi process was used to gather experts’ opinions and to reach a
strong consensus based on experience and theories. A pilot study was used to provide empirical
evidence on areas that could not be explained by theories or previous experience in the literature review
and expert consultation steps. These methods standardized an intervention protocol with many possible
effective components by using evidence-based procedures and making the intervention comparable and
researchable in a trial.
Acupressure is a complex intervention and its effects can be confounded by many factors. This paper
elucidated methods to control many of these confounding factors. Apart from the fundamental methods
usually used in an RCT, many added methods were used. For example, a sham-acupressure group was

set up in order to explain the added effect beyond the placebo. The use of sham-acupressure also made
blinding to the outcome observers feasible in order to reduce observers bias. Compensation (or the wait-
list-control) was provided to clients who were randomized into the non-acupressure groups at the end of
the trial, in order to reduce the dropout rate. Tight controls on the intervention and data collection skills
(e.g. regular training and on-site visits) were used in order to enhance the intervention fidelity and data
collection reliability.
This is the first paper on this topic to explicate how the effect of acupressure was evaluated by disclosing
the steps from the stage of developing a standardized intervention protocol to that of the experimental
evaluation. By explicating these steps, the effectiveness of acupressure (or other complementary
therapies) can be better understood and further studied.
Conclusion:Acupressure is like many other complimentary therapies that can be difficult to evaluate for
effectiveness because of largely varying active components and implementation methods. This paper
explained how an intervention protocol can be developed based on a literature review, the Delphi
process, and a pilot study. In evaluating the effects of acupressure, this paper also elucidated many
additional methods besides the basic ones usually used in an RCT. These included: use of sham-
acupressure, use of blinding to the outcome observers, use of intervention compensation, and use of tight
control on the intervention implementation and data collection.
Contact
[email protected]

Part VIII: Research Symposia
A 11 - Face-to-Face to Email to HELPP Zone App: Delivering
Intervention in Intimate Partner Violence
Face-to-Face to Email to HELPP Zone App: Delivering Intervention in Intimate
Partner Violence
Rose E. Constantino, RN, BSN, MN, JD, PhD, FAAN, FACFE, USA
Purpose
1.To discuss the results of a research study on Face-to-Face to Email to HELPP Zone app: Delivering
Intervention in Intimate Partner Violence. 2.To outline the steps the researchers took in developing the
HELPP Intervention.
Target Audience
general population of healthcare providers-novice to experts.
Abstract
Purpose: To compare the effectiveness of HELPP (Health, Education on safety, and Legal Participant
Preferred) intervention among three groups of participants experiencing IPV: online, face-face and waitlist
controls.
Methods: A sequential transformative design in mixed methods was used. Participants were randomly
assigned to one of three study groups (Online (ONL [n=11]), Face-to-Face (FTF [n=10]) and Waitlist
Control (WLC [n=11]) by permuted block randomization after informed consent process and baseline
testing were completed. Researchers were blinded to treatment allocation.
Results: The HELPP intervention was offered to a sample 32 female participants experiencing IPV who
were predominantly Asian 45.2% (n=14), 32.3% (n=7) were White, 22.5% (n=10) Black and on average
40 years of age. Primary outcomes were anxiety, depression, anger, personal support, and social
support. Secondary outcomes were IPV experience <18 years old, experience of pain, and 4 types of
social support: tangible, appraisal, belonging, self-esteem (TABS) social support. The qualitative data
analysis will be excluded from this presentation. Sixty-five percent of the 20 participants experienced IPV
before age 18 years. The Anxiety, depression, anger, personal resource and social support mean scores
pretest to posttest differences were significant for ONL (p<0.001).
Conclusions: The HELPP intervention was instrumental in decreasing participants’ feelings of anxiety,
depression, and anger and increasing personal support and social support with significant reported
improvements in the ONL group. The acceptability of online intervention, specifically email-delivered
HELPP intervention was shown to be feasible and effective compared to waitlist controls. Further
research may determine whether email alone or combined with mobile devices could also be used to
deliver intervention in IPV survivors.
Contact
[email protected]
Text Messaging Information for Survivors of Intimate Partner Violence

Linden Wu, USA
Purpose
to discuss the therapeutic value of TMI in recognizing and responding to prevent IPV.
Target Audience

General population of healthcare providers - novice or experts.
Abstract
Purpose: Disruptive Innovations (DI), using an intentionally and deliberately developed product or service
that becomes part of daily human activity such as Text Messaging Intervention (TMI) is the conceptual
framework we used. Our specific aim is to evaluate text messaging as a feasible disruptive and
protective tool on IPV. Three research questions are: Will TMI 1) increase participants’ awareness of
potential IPV? 2) improve participants’ knowledge of the warning signs of IPV? and 3) improve
participants’ knowledge of actions to take to prevent IPV?
Methods: A mixed methods design was used to examine the feasibility of text messaging qualitatively
and quantitatively. We recruited 20 participants to receive one text message once every week five days a
week for 4 weeks. Examples of the TMI are “Roses are red, violets are blue, dating is sweet but should
not leave marks on you”, and “Concerned for your safety? Move to an area where witnesses are plenty”.
One-way ANOVA, Chi-square test or other nonparametric statistical procedures will be used as
appropriate to analyze quantitative data from the pre-TMI and post-TMI survey. Change in scores from
pretest to posttest will be computed and compared.
Results: Of the 20, 14 owned and have used it for the past 5 years. Twelve of the participants reported
texting as their first mode of communication via a smartphone, 9 reported texting every hour. Fourteen of
the 20 respondents felt somewhat confident in their knowledge of dating violence warning signs. Posttest
results will also be reported in this presentation.
Conclusions: Preliminary data suggest that texting is a primary form of communication for college
students. If TMI will be found to be feasible, we will explore TMI’s effectiveness in reducing IPV in a larger
study to show the importance of evaluating and developing evidence-based IPV prevention programs
using mobile devices.
Contact
[email protected]
The HELPP Zone App for Survivors of IPV

Joseph Burroughs, USA
Purpose
to provide an orientation on how the HELPP Zone app was developed and its user outcomes.
Target Audience
General population of healthcare providers.
Abstract
Purpose: Our objective was to build a mobile app called HELPP (Health, Education on safety, and Legal
Participant Preferred) Zone app to help users of mobile technology recognize, respond and prevent
Intimate Partner Violence (IPV). IPV is a serious, preventable public health problem. It is described as
physical, sexual, or psychological harm inflicted by a current or former partner or spouse. IPV has brought
serious public health and social justice issues to people, especially the young who may not report it
because they are afraid to tell friends and family. If IPV is left unchecked, it will bring short term and/or
long term negative effects to the survivors, they may binge drink, attempt suicide, and argue and fight
with friends and family. IPV comes at an enormous cost to physical, mental, economic, and social well-
being to the U.S. at $13.6 billion and is expected to rise to $15.6 billion by 2020.
Methods: We collaborated with the School of Information Sciences faculty and students in building the
HELPP Zone (Health, Education on safety, and Legal Participant Preferred) app. In building the HELPP
Zone App, we addressed the fundamental paradigm of Diffusion of Disruptive Innovations (DDI) as
evidence-based theoretical framework. A DDI is defined as a deliberately and intentionally developed
product that functions as a disruptive innovative tool. The HELPP Zone app was designed as a simple

product that enters the transformative service arena as a common activity. The HELPP Zone app is free
and currently available for Android as an inexpensive and more widespread platform.
Results: We will seek resources to field test the app for its feasibility and effectiveness in reducing or
disrupting IPV. A prototype of the HELPP Zone app is available.
Conclusions: The app was designed as a simple product that enters the transformative service arena as
a common activity. If t offers a convenient service that enhances users’ capacity to recognize, respond,
and prevent or stop RV through just-in-time communication, educational resources, and intervention from
pre-set trusted contacts and is found to be feasible and effective, we will disseminate the app into a
diverse population of users first regionally, then nationally and internationally.
Contact
[email protected]

B 11 - The Asian Women’s Health Research Network: A Showcase of
Studies by the Korean Side
Effects of Shift Work Change on Occupational Stress in South Korean Female
Nurses
Bokim Lee, PhD, South Korea
Hyesun Jung, PhD, South Korea
Purpose
The purpose of this presentation is to understand the association between shift work schedule change
and job stress among Asian female nurses and to discuss international collaborative research on it.
Target Audience
The target audience of this presentation is a diverse group of individuals and organizations with an
interest in shift work and health and health care professionals working to improve health of Asian female
nurses worked shift.
Abstract
Purpose: For adequate care of shift workers’ health, it is essential to understand the relationship
between shift work schedule change and job stress. However, there is no published research on the
association between shift work schedule change and job stress among South Korean workers, especially
South Korean female nurses. The purpose of this study was to examine differences in job stress by shift
work schedule change and to determine the association of shift work schedule change to job stress
among South Korean female nurses.
Methods: A cohort of 781 nurses was established in 2012 (Time Point [TP] 1). Participants were
registered nurses from three large hospitals in South Korea. At TP2 (one year after TP1), the same
nurses were asked to complete a new set of questionnaires. A total of 659 female nurses were selected
for this analysis. Among them, 419 nurses kept the shift work, 190 nurses kept the non-shift work, 45
nurses changed from shift work (TP1) to non-shift work (TP2), and 25 nurses changed from non-shift
work (TP1) to shift work (TP2). The data were analyzed using descriptive statistics, ANOVA, and multiple
regression analysis.
Results: The nurses who changed from non-shift work to shift work reported higher job stress than others
(p<.01). The change in shift work schedule, especially from non-shift work to shift work, is relevant to
higher level of job stress (p<.01). Changes in working position, the number of night shift, and shift work
schedules were significant predictors of job stress (p < .05).
Conclusion: Shift work is an integral part of labor markets all over the world. Therefore, it is necessary to
help mitigate the negative effects of changes in shift work schedule change on workers’ occupational
stress, especially female workers. Also, to confirm the association between shift work schedule change
and job stress, it is required to conduct additional internationally-joint research projects.
Contact
[email protected]
Predictors of Depression among Midlife Women in South Korea

Ok-kyung Ham, PhD, RN, South Korea
Purpose
The purpose of this study was to determine the prevalence of depressive symptoms and identify
predictors of depressive symptoms among midlife women in Korea.

Target Audience
Researchers and practitioners who conduct intervention studies to promote Asian women's mental health.
Abstract
Purpose: Across the globe, depressive symptoms are more prevalent in women compared with men.
Especially among Korean midlife women in South Korea, the prevalence of depressive symptoms ranged
from 14 to 22%. Furthermore, within the population, women with specific characteristics (e.g., low income)
were reported to experience depressive symptoms more than their counterparts. The purpose of this
study was to determine the prevalence of depressive symptoms and identify predictors of depressive
symptoms among midlife women in Korea.
Methods: A cross-sectional study was conducted among a convenient sample of 200 midlife women
recruited from a community health center and a branch office of the Planned Population Federation of
Korea located in one metropolitan area. Self-administered questionnaires included questions on
socioeconomic characteristics, lifestyle behaviors, and the Beck Depression Inventory. The data were
analyzed using descriptive statistics and multiple regression analyses.
Results: The mean age was 52.48 (SD=8.82, range = 35-65). Sixty-seven percent had monthly income
of less than 1 million Won (US $1,000), and 39.5% were living without a spouse. Mild depression was
reported in 20.0% of the women. Moderate and severe depression was reported in 25.0%. Depressive
symptoms were significantly associated with income (≤ US $ 1,000), marital status (single, separated,
divorced, or widowed), and menopausal status (p < .05). All the variables considered in the model
accounted for 21.5% of the total variance in depressive symptoms (F=3.318, p< .001).
Conclusions: The study results indicated that certain groups of Korean midlife women with specific
characteristics (e.g., low income, divorced, peri-menopausal, etc.) were more vulnerable to depressive
symptoms. Therefore, future development of interventions to promote mental health should target high
risk groups of women with specific characteristics. However, further international collaborative studies are
needed to confirm the characteristics of midlife women that make them more vulnerable to depression.
Contact
[email protected]
Does Social Activity Decrease the Depression in the Elderly?: An Analysis of a

Population-Based Study in South Korea
Seung Hee Lee, PhD, MPN, RN, South Korea
Young Bum Kim, PhD, South Korea
Purpose
The purpose of this study was to investigate whether social activity decreases depressive symptoms in
elderly Korean women and to provide directions for future development of interventions to prevent
geriatric depression.
Target Audience
The target audience of this presentation is the nurses or nursing scholars who are interested in Asian
women’s health problem, health study to decrease heath problem, and future directions for research
collaboration.
Abstract
Purpose: Geriatric depression is a common condition in elderly Asian women including South Koreans.
Geriatric depression also becomes an imminent challenging health concern with an increasing number of
geriatric populations in Asian countries. In South Korean alone, the prevalence of probable depression in
elders was 15.5% and increased with age (19.0% in female and 10.7% in male). The purpose of this
study was to investigate whether social activity decreases depressive symptoms in elderly Korean women
and to provide directions for future development of interventions to prevent geriatric depression.

Methods: For this study, we used the data of 2,114 women who were aged ≥65 years from the 2011
Korean Longitudinal Study of Ageing (KLoSA). This survey was a nationally representative study of
community-dwelling Korean older adults for obtaining information on diverse aspects of ageing.
Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale 10,
and the 10 + cutoff was applied to define the presence of significant depressive symptoms. Social
activities were measured using the questions on the number of formal associations that the women were
participating, the number of meeting close friends, and the number of contacting children living
separately. The data were analyzed using multiple logistic regression analyses.
Results: After adjustment for potential confounders, frequent contacts with children and friends were
negatively associated with depressive symptoms. However, the number of formal associations that the
women participated in showed no significant association with depressive symptoms.
Conclusions: These findings suggest that encouraging informal social activity may protect against
depressive symptoms in elderly Asian women including South Koreans. In order to confirm these results
in other ethnic groups of Asian elderly women and to provide directions for future intervention
development, we need further international comparative studies on the association of social activity to
geriatric depression across Asian countries.
Contact
[email protected]

C 11 - Establishing and Maintaining International Research
Collaboration: Processes, Outcomes, and Exemplars
Experiences, Benefits, and Challenges of Initiating and Maintaining International
Research Collaborations
Joan E. Haase, PhD, RN, FAAN, USA
Li-Min Wu, PhD, Taiwan
Purpose
The purpose of this presentation is to (1) describe processes for and outcomes from establishing and
maintaining international collaboration between researchers in the United States and Taiwan, and (2)
describe the researchers' perspectives of benefits and challenges.
Target Audience
The target audience for this presentation is PhD students, nurse researchers, clinicians, and
administrators who want to facilitate or participate in international research collaboration and/or
individuals specifically interested in learning about international collaboration related to
children/adolescents with cancer and their families.
Abstract
Purpose: Processes for establishing international research collaboration often seem elusive; there are
few descriptions of successful strategies for establishing or maintaining productive international
collaborations. This presentation describes ways researchers in Taiwan and the United States effectively
established and maintain international research collaboration.
Methods: Our collaboration began through semester-long study-abroad programs required of PhD
nursing students in Taiwan. Two students, now Drs Chen and Wu, selected Dr. Haase, a faculty at
Indiana University, as mentor. Their study-abroad experience required planning for family care and costs,
completing pilot work prior to studying abroad as a basis for collaborating on a dissertation proposal,
adjusting to life in another country, overcoming language barriers, and taking courses. From a mentor’s
perspective the experience included sensitivity to students’ adjustment needs, becoming acquainted with
their projects and learning styles, and establishing collaborative, rather than hierarchical, communication.
The goals of our collaborations were dissertation proposals ready for implementation upon return to
Taiwan. Dr. Haase served as an external member of both committees. Following dissertation completion,
because we all had positive experiences and common research interests, our collaboration continues
productively into its 7thyear, through internet conferencing, visiting lectureships, attending professional
meetings, and formal university partnerships.
Results: We experienced challenges (e.g. obtaining funding support and time commitments), developed
strategies to overcome them (e.g. establishing mutually beneficial goals, writing grants, establishing
formal university partnerships) and derived many benefits (e.g., productive, culturally sensitive research
programs addressing important questions, lasting friendships, travel enrichment). Products of our work
include grants for mixed method studies, publications and presentations.
Conclusions: By understanding potential challenges and strategies, researchers who want to have
international collaboration can anticipate and plan appropriately to make connections, conduct research
that will can be universally applied and reap personal and professional benefits. Examplars
of collaboration can serve as one model.
Contact
[email protected]

Cross-Cultural Comparison of the Haase Resilience in Illness Scale:
Psychometric Properties Testing
Li-Min Wu, PhD, RN, Taiwan
Purpose
Describe the translational process and evaluating the equivalence between the English and Mandarin
version of the Haase Resilience in Illness Scale. Cross-cultural comparison of reliability and validity for
the HRIS were done between American adolescents and Taiwanese adolescents.
Target Audience
The target audience of this presentation are pediatric physician, pediatric nurses, psychologists, social
workers.
Abstract
Background: The quality of studies using translated scales is determined by the equivalence between
the original and translated versions. It is important to validate the cultural appropriateness prior to using
the translated version of the Haase Resilience in Illness Scale (HRIS) in Taiwan.
Purpose: Describe the translational process and evaluating the equivalence between the English and
Mandarin version of the HRIS. In addition, cross-cultural comparison of reliability and validity for the HRIS
were done between American adolescents with cancer and Taiwanese adolescents.
Methods: A forward-backward translation and the conceptual and semantic equivalences were examined
between the original and translated version of HRIS, a 13 item Likert-type scale. Thirty bilingual university
students tested the two instrument versions. Internal consistency reliability of the translated versions was
evaluated. Confirmatory factor analysis was used to examine the construct validity of the translated
version. The factor loadings and mean scores were compared across groups: adolescents with cancer
(Group 1, N=111 American; Group 2, N=160 Taiwanese) and healthy Taiwanese adolescents (Group 3,
N=120).
Results: No significant difference was found between the original and translated versions. The two
versions demonstrated moderately high correlations (Pearson correlation coefficient = 0.87, p< .01). All
groups had similar item-to-factor loadings, except on 2 items related to perspectives of measuring up to
one’s own and to other’s expectations. A single factor structure explained 71.71% of variance in Group 1),
42.75% in Group 2, and 34.47% in Group 3. Cronbach's alpha coefficients ranged from 0.81-0.86 across
three groups.
Conclusion: The HRIS is appropriate for comparative cross-cultural studies. Two items with strikingly
different loadings, “It is important to live up to my own expectations of myself” and “I know others look up
to me“ seem to reflect cultural differences in emphasis on self verses others, should be further
investigated.
Contact
[email protected]

Experience of Taiwanese Mothers of Children Completing Cancer Treatments
Li-Min Wu, PhD, RN, Taiwan
Purpose
The purpose of this presentation is to describe the essential structure of the experience of Taiwanese
mothers’ caregiving experiences for their child after completion of cancer treatments.
Target Audience
The target audience of this presentation is pediatric oncology nurse researchers and clinicians, nursing
students, and individuals interested in international research collaboration, especially in pediatric
oncology.
Abstract
Background: More than 60% of childhood cancer survivors have at least one long-term treatment side
effect; over 30% experience moderate to severe delayed effects. Most parents have lingering concern
about their child’s health, especially perseveration of uncertainty and anxieties about the possibility of
cancer relapse, however, most studies have focused on parents’ experiences during the course of
treatment. Information about the crucial post-treatment period is lacking.
Purpose: In this presentation we describe the essential structure of the lived experience of mothers in
Taiwan caring for their child after cancer treatments.
Methods: A phenomenology approach was used. The sample of 10 mothers of children ages 13-20 who
had completed cancer treatments within the past 24 months consented to participate and were
interviewed in a pediatric setting. Data were generated using open-ended questions about their
experiences of life following treatments. Data were transcribed and analyzed using Giorgi's four-step
procedures to derive the essential structure caring for a child post-cancer treatment. Credibility strategies
included a systematic approach to data collection, analysis, and management using audit trail.
Results: Two theme categories were found. Living under the Cloud of Relapse included the sub-themes:
Cancer Relapse is the Sword of Damocles, Vigilance Is a Way of Life, and Maintaining a Good Healthy
Lifestyle. Changing to Face the Future included sub-themes: Becoming My Child’s Healthcare Provider,
Adjusting Expectations, and Moving Forward by Making Family Adjustments.
Conclusion: Mothers never stop worrying about their child’s cancer returning, but they understand the
need to move forward and face the future. They attempt to return to normalcy, to accept the
consequences of the treatments, and to compromise dreams with reality. After treatments, mothers of
children need continued support to understand the symptoms and signs of relapse, manage uncertainty,
and adjust to a new normal for the family.
Contact
[email protected]

D 11 - More Than Vital Signs: Reframing nurses’ Recognition and
Response to Clinical Deterioration
Development of the Barriers to Nurses' Use of Physical Assessment Scale
Clint Douglas, RN, BN, PhD, Australia
Purpose
The purpose of this paper is to describe and discuss development and psychometric testing of the
Barriers to Nurses’ Use of Physical Assessment Scale and the implications of findings for nursing
assessment practice.
Target Audience
The target audience of this presentation is nurse clinicians, managers, educators and researchers with an
interest in current trends, debates and challenges surrounding the concept and practice of recognition
and response of clinical deterioration of hospitalized ward patients.
Abstract
Purpose: There is growing evidence of failure to recognise hospitalised patients at risk of clinical
deterioration, in part due to inadequate physical assessment by nurses. Yet, little is known about the
barriers to nurses’ use of physical assessment in the acute hospital setting and no validated scales have
been published. Complex intervention studies designed to address these barriers and improve nursing
assessment skills are also needed. However, before interventions targeting nurses’ assessment practices
can be developed, a valid and reliable measure of barriers to physical assessment skills is required. The
purpose of the study was to develop and psychometrically test the Barriers to Nurses’ use of Physical
Assessment Scale.
Methods: Scale development was based on a comprehensive literature review, focus groups, expert
review and psychometric evaluation. The scale was administered to 434 acute care registered nurses
working at a large Australian teaching hospital between June and July 2013. Psychometric analysis
included factor analysis, model fit statistics and reliability testing.
Results: The final scale was reduced to 38 items representing seven factors, together accounting for
57.7% of the variance: (1) reliance on others and technology, (2) lack of time and interruptions, (3) ward
culture, (4) lack of confidence, (5) lack of nursing role models, (6) lack of influence on patient care, and
(7) specialty area. Internal reliability ranged from .70 to .86.
Conclusion: Findings provide initial evidence for the validity and reliability of the new scale and point to
the importance of understanding the organisational determinants of nurses’ assessment practices.
Barriers to nurses’ use of physical assessment may impair timely recognition of patient deterioration and
interventions targeting these factors may improve patient outcomes. This new measure should encourage
future researchers and clinicians to assess the barriers to nurses’ use of physical assessment, to better
understand how to support nursing assessment in acute care settings.
Contact
[email protected]
Factors Influencing Nursing Assessment Practices

Carol Reid, PhD, MAppSc, GradCertHlth (Sexual Health), BHSc(N), RN, Australia
Purpose
The purpose of this presentation is to present findings from a research study exploring Registered
Nurses' use of, and perceived barriers to, physical assessment skills used in routine assessment and
recognition and response to patients at risk of deterioration.
Target Audience

Abstract
Purpose: Changing acuity of hospitalised patients means sicker patients with more complex needs are at
greater risk of becoming seriously ill during their stay. Frontline registered nurses (RNs) play an essential
role in detecting patients at risk of clinical deterioration through ongoing assessment and timely,
appropriate action in response to changing health status. Government agencies worldwide have
developed guidelines for recognition of and response to acute clinical deterioration. Nevertheless, clinical
deterioration continues when it may have been prevented. Little research has examined factors related to
registered nurses’ use of assessment skills. The purpose of this study was to explore RNs’ use of and
perceived barriers to physical assessment skills used in routine assessment, recognition and response to
patients at risk of deterioration.
Methods: A cross-sectional survey of RNs was undertaken. Data collectioninstruments included the
validated Physical Assessment Skills Inventory, Barriers to Registered Nurses’ Use of Assessment Skills
Scale and demographic data.
Results: A minimum data-set of seven skills were used by most nurses most of the time: temperature,
oxygen saturation, blood pressure, evaluation of breathing effort, skin assessment, wound assessment,
and mental state/level of consciousness assessment. Multivariable modelling controlling for specialty area
and role revealed reliance on others and technology (p=0.001) and lack of confidence (p=0.019) were
associated with use of physical assessment skills (p=0.001).
Conclusion: Results show the majority of nurses regularly assess those physiological markers that
typically form the core of early warning and rapid response protocols. Furthermore, nurses lack
confidence in using the full breadth of assessment practices and indicate a reliance on technology and
other clinicians. These factors pose barriers to nursing assessment practices. This, together with the
assessment focus on overt signs of deterioration, may well be distracting nurse attention away from
holistic patient assessment and surveillance that could detect more subtle signs of change in health
status earlier; thus, possibly preventing patients spiral down the clinical deterioration pathway.
Contact
[email protected]
Exploring Patient Assessment Practices in the Acute Hospital Environment: An

Ethnography
Sonya R. Osborne, RN, BSN, GradCert (Periop Nsg), GradCert (HigherEd), MN, PhD, Australia
Purpose
The purpose of the study was to improve understanding of the unexamined factors that influence patient
assessment practices by exploring patterns of behaviour, and interpersonal, cultural and geographical
factors related to nursing assessment practices in the acute care hospital environment.
Target Audience
Abstract
Purpose: In Australia, as in other countries, recognising and responding to clinical deterioration in
hospitalised patients has become a national priority. Ward nurses play an essential role in detecting acute
care patients at risk of clinical deterioration through attentive surveillance, diligent assessment, and timely
intervention. Much attention in the literature has been given to the efferent limb of the clinical deterioration
pathway, such as hospitals’ implementation of the use of early warning scores, track and trigger systems,

and rapid response teams. Yet, unrecognised clinical deterioration continues to be a significant problem.
The literature is consistent in viewing the situation of clinical deterioration from the perspective of
improving detection and documentation of clinical deterioration with scant attention to the nature of
assessment practices.
The purpose of the study was to improve understanding of the unexamined factors that influence patient
assessment practices by exploring patterns of behaviour, and interpersonal, cultural and geographical
factors related to nursing assessment practices in the acute care hospital environment.
Methods: The study design was a hospital ethnography using participant observation and informal and
formal interviews. Data, collected in the form of field notes and transcribed audio-recorded interviews,
was analysed using an iterative process
Results: Nurses’ assessment and surveillance of patients is practiced in the context of the medical
emergency response framework. As such this creates a culture that dominates and dictates a focus on
monitoring and recording of patient’s vital signs for medical team review and response. This focus
influences multidisciplinary relationships and roles and the organisation factors that govern nurses’ work.
Conclusion: The study findings illustrate the complex interplay of factors that influence nurses’
assessment practice in the acute care setting. Development of holistic picture of patient assessment
practices will inform development of effective health service improvements in managing patients at risk for
clinical deterioration.
Contact
[email protected]

E 07 - Workplace Behaviors Affecting Patient Safety: Role of Nurses
and Physicians as Partners in Change
Disruptive Behavior and its Effects on Workplace Safety: What Can Nurse
Leaders Do?
Ann Marie T. Brooks, DNSc, RN, MBA, FAAN, FACHE, FNAP, USA
Purpose
The purpose of this presentation is to address the issue of disruptive behavior between nurses and
physicians. Using data from an IRB approved survey and other evidence, the presenter will examine
innovative methods for addressing disruptive behavior in collaboration with physician colleagues.
Target Audience
The target audience are nurses interested in improving patient safety and fostering a positive work
environment through communication, collaboration and partnership.
Abstract
Purpose: Disruptive behavior between nurses and physicians in healthcare interferes with care delivery
and negatively affects patient safety and outcomes. Throughout the three year process of building a
culture of safety at a five hospital system, considerable attention and focus was devoted to educating staff
and physicians on error prevention tools and minimizing the power gradient that has been recognized as
a major obstacle in speaking up for safety by nurses with physicians. Following the completion of error
prevention training of over 10,000 employees and physicians, staff across the system continued to
express reluctance in speaking up for safety when it involved a physician and a perceived power gradient
issue. Based on this feedback, one system nurse executive and one vice president for medical affairs
from the same hospital developed and submitted a proposal to the system IRB for approval to replicate a
survey on disruptive behavior between nurses and physicians previously conducted by the American
College of Physician Executives in partnership with the American Organization of Nurse Executives.
Methods: Following approval from the system IRB, an announcement of the survey was sent to all
nurses and physicians in the system. An e-mail blast followed the next week including a consent form
and a link to the survey. Protection of subject confidentiality was maintained throughout the online survey
process with limited access to data. A reminder was sent to all nurses and physicians across the system
during the data collection phase.
Results: Seven hundred and eighty six nurses and physicians from across the system participated in the
online survey and verified that disruptive behavior occurs on a regular basis with physicians identified as
the most frequent cause of the disruption. Yelling was identified as the most frequently occurring
disruptive behavior.
Conclusion: Disruptive behavior continues to occur in the system with a lack of significant change
despite the education and focus on use of error prevention tools in daily practice. The 'power gradient'
between nurses and physician remains an issue and contributes to the reluctance to speak up for safety.
Contact
[email protected]
Disruptive Behavior Between Physicians and Nurses: The Role of the Physician
Leader
Helen M. Kuroki, MD, USA
Purpose

is to examine the effect of disruptive behavior on safety through a comparison of 2013 survey findings
from a five hospital system and 2009 survey from the American College of Physician Executives and
American Organization of Nurse Executives by a practicing and vice president of medical affairs.
Target Audience
nurses who are interested in how physicians view disruptive behavior and are seeking further
understanding of strategies to engage them in a shared accountability for change and problem solving.
Abstract
Purpose: Disruptive behavior interferes with building a culture of safety and teamwork. Physicians and
nurses play a major role in patient outcomes. Physicians often view their role as providing care solely for
a patient, rather than as a collaborator, partner or member of the healthcare team. As part of a culture of
safety program, physicians within a hospital system were educated about error prevention tools with
specific emphasis on understanding the power gradient and how it negatively affects safety, teamwork
and the work environment. The education included role play and group discussion of a clinical situation
that involved disruptive behavior. Discussion focused on strategies needed to build collaborative
relationships among the healthcare team in order to ensure quality outcomes and a safe environment for
patients and staff. Measurement of changes in behavior related to the training was of interest. The Vice
President of Medical Affairs and Vice President of Patient Care Services who had been involved in
physician nurse collaboration processes decided to use an established survey related to disruptive
behavior as a method to collect baseline data from physicians and nurses across the system and assess
the current environment. The results are being used to improve safety and communication.
Methods: The 2009 American College of Physician Executives (ACPE) survey related to disruptive
behavior was replicated following approval of the system IRB in March 2013. A blast e-mail announcing
the survey was sent to all nurses and physicians across the system and then the online survey was
launched the following week, including directions for informed consent.
Results: Seven hundred and eighty six physicians and nurses participated in the survey with participants
recorded from all five hospitals. Using the 2009 ACPE survey for comparison, survey findings were similar
in type of disruptive behavior and frequency of occurrence, with yelling as the primary disruptive behavior
followed by degrading comments and insults. The respondents from both the 2009 ACPE study and the
2013 study indicate that the problem of disruptive behavior still overwhelmingly exists in their
organizations.
Conclusion: Disruptive behavior continues to affect patient safety and the work environment. Findings
from this survey are being used to identify and address nurse-physician relationship issues that
negatively influence patient care and the work environment.
Contact
[email protected]

Disruptive Behavior Between Physicians and Nurses: Building the
Interdisciplinary Toolkit for Change
Nikki S. Polis, PhD, RN, FNAP, USA
Purpose
The purpose of this presentation is to use the results of IRB approved studies and other evidence from
the literature to identify strategies for building a toolkit for nurses leaders to use in partnering with
physicians and other leaders to address disruptive behavior.
Target Audience
The target audience is nurses interested in learning more about disruptive behavior, its effects on patient
safety and strategies that can be implemented to address the issue.
Abstract
Purpose: Healthcare organizations face the challenge of disruptive behavior every day. Addressing these
behaviors involves more than talking with the individuals involved. Acknowledging the power gradient as
an underpinning of disruptive behavior, the lack of infrastructure to address the issue, the lack of policies
and procedures and inconsistent support from leadership to resolve the issues in a meaningful way are
essential to developing a zero tolerance culture.
Methods: Using results from IRB approved surveys about disruptive behavior from two healthcare
organizations and other evidence, behavioral issues and patterns related to disruptive behavior were
identified and used as the basis to develop an interdisciplinary toolkit. The intent was to provide
comprehensive strategies to deal collaboratively with the power gradient and to identify the required
structures and processes needed to resolve this organizational challenge.
Results: Survey results were similar between the two healthcare systems and with the 2009 American
College of Physician Executive Survey. Disruptive behavior still exists within healthcare organizations,
and a comprehensive approach is critical to finally resolve this enduring issue.
Conclusion: Developing an evidence based toolkit is an important first step in addressing disruptive
behavior. Recognition of the factors influencing disruptive behavior, from the power gradient to the lack of
organizational supports, informs the strategies included. Developing policies and procedures and
educating all involved about behavioral expectations are approaches to demonstrating the organizational
commitment to zero tolerance.
Contact
[email protected]

E 11 - Empirically-Based Bystander Education Programmes to
Prevent Dating Violence in University Students: Lessons from U.S.
and Hong Kong Experience
Friends Helping Friends: A Peer-Based Programme in Responding to Dating
Violence in U.S.
Angela Frederick Amar, PhD, RN, DF-IAFN, FAAN, USA
Purpose
The purpose of this pilot study was to evaluate the effectiveness and feasibility of Friends Helping
Friends, a community level education program to teach young women to recognize and intervene to
prevent and respond to interpersonal violence.
Target Audience
The target audience of this presentation is nurses, academic nursing faculty, nursing educator,
researchers, teachers and social workers.
Abstract
Dating violence is a public health issues, affecting young women in the college campus. Despite the
importance of dating violence, few prevention programs address peer roles and target community
responses to dating violence. Providing education to peers on how to help a friend could increase their
confidence to help and in turn, increase reporting to formal sources. As a result, we would provide the
support and resources that could mitigate health, academic, and social consequences of interpersonal
violence.
Purpose: The purpose of this pilot study was to evaluate the effectiveness and feasibility of Friends
Helping Friends, a community level education program to teach young women to recognize and intervene
to prevent and respond to interpersonal violence.
Methods: This was a quasi-experimental study with 101 undergraduate students aged 18-22 years
participated in Friends Helping Friends and assigned to either a treatment group or control group.
Participants completed pre- and post-test measures of attitudes related to sexual and partner violence
and willingness to help. Repeated measures analysis of variance was used to examine changes in scores
between pre and post-test conditions and to compare the treatment group to the control group.
Results: As compared to the control group, treatment group participants reported increased perceived
responsibility to help, skills to act as a positive bystander, and intention to help, and decreased rape myth
acceptance.
Conclusion: Friends Helping Friends shows promise as an effective strategy for older adolescent
females in the prevention and response to dating violence.
Contact
[email protected]
Dating Café Ambassadors Programme: A Bystander Education Programme to

Prevent Dating Violence in Hong Kong
Janet Yuen Ha Wong, PhD, RN, MNurs, Hong Kong
Purpose
The purpose of this presentation is to evaluate the Dating Café Ambassadors Programme. This is a pilot
study to provide evidence on dating violence prevention program addressing local needs.
Target Audience

Abstract
Hong Kong was the median city with prevalence of physical victimization being 25.6% and sexual
coercion being 13% among dating partners in university campus. The study also found 37.7% of
university students in Hong Kong reported suicidal ideation, which was above average among 32
countries. The high prevalence of dating violence and severity of suicidal ideation among university
students in Hong Kong accentuate the need to tackle dating violence by interventions specifically
targeting the Chinese population.
Purpose: The Dating Café Ambassadors Programme is evaluated in this pilot study. The programme is
the first to provide evidence on dating violence prevention program addressing local needs.
Methods: Twenty Chinese university students were recruited and joined Dating Café Ambassador
Programme in Hong Kong. They underwent a face-to-face 7.5 hours training program (3 weekly
sessions, 2.5 hours per session) that based on Ajzen’s Theory of Planned Behaviors. Four modified real
dating violence stories were used in the training session to enhance the relevance, appropriateness, and
acceptability of the program. Apart from training, homework was assigned as practical application. Pre
and post-test were conducted for outcome measurements.
Results: The results showed that the Dating Café Ambassadors Programme enhanced the behavioural
intention of students to help peers experiencing dating violence.
Conclusion: The programme was feasible and acceptable to the university students.
Contact
[email protected]
Am I Responsible to Help Peers in Abusive Dating Relationships?: Learning from

a Qualitative Study
Claudia Kor Yee Chan, RN, MSc, Hong Kong
Purpose
This study explored the university students’ intention to prevent dating violence and identify the barriers in
responding peers in abusive dating relationships by using qualitative approach.
Target Audience
Abstract
Young people’s attitude towards dating violence and perceived barriers in responding peers in abusive
dating relationships may contribute to their willingness to help peers in abusive relationships.
Purpose: This study explored the university students’ intention to prevent dating violence and identify the
barriers in responding peers in abusive dating relationships by using qualitative approach.
Methods: Twenty university students were recruited at Dating Café Ambassadors Programme to educate
peers in helping to prevent dating violence on university campus. Participants were followed for 3
workshops of participant observations and a focus group interview. An interview guide was used for data
collection. Interview questions included what is the definition of dating violence, why do you / don’t you
help peers in abusive relationships, do you perceive it is your responsibility to help, and describe your
expectation of a healthy relationship. Data were analysed using content analysis.
Results: Results showed that the barriers in responding peers in abusive dating violence included low
awareness of dating violence on campus; and lack of skills and resources to help.

Conclusion: The lessons learned from the qualitative study findings will help in develop and refine dating
violence prevention and intervention for university students.
Contact
[email protected]

F 09 - A Place at the Table: Voices of Nursing at the UN, Bringing the
Voice of the UN to Nurses
On the Ground and from Afar: STTI & Global Nursing Organization
Representatives to UN NGO community: A Place at the Table
Holly Shaw, PhD, RN, USA
Purpose
The purpose of this presentation is to describe and illustrate the responsibilities and activities of NGO
representatives. Presenters will share the unique perspective of an insider’s view of establishing a distinct
role for nurse advocates associated with the UN System, as members and leaders in the global NGO
community.
Target Audience
The target audience of this presentation is STTI members and Chapter and Regional representatives who
are interested in learning about the UN System and opportunities for civil society participation within it,
particularly in shaping the Post 2015 Agenda and SDGs.
Abstract
Purpose: In the inception of the UN, civil society was included to participate through representatives of
NGOs. This presentation will focus on the experience of STTI representatives inside the UN NGO
community and in the transnational CoNGO (Conference of NGOs in Consultative Status with the
UN). Through DPI-NGO (Department of Public Information) and ECOSOC (Economic and Social
Council) programs and NGO Committee participation, a voice for the nursing profession is emrging,
providing an opportunity to contribute to global health issues.
Methods: STTI members will learn about the NGO UN Committees in the UN System world wide,
addressing issues of Health and Mental Health, gender equity, social justice, human rights, including
UNICEF, Mental Health, NGO Health Committee, NGO Working Group on Girls, and NGO Commission
on the Status of Women, which facilitates the annual CSW in NYC attracting over 5,000 participants from
all countries in the world. and oportunities for participation using web casting, social media and electronic
communication. Opportunities for participation in these and other events will be discussed, as well as
suggestions for stimulating chapter and regional activities.
Results: Representatives will describe and illustrate the responsibiliies of NGO representatives, and
share the unique perspective of an insider’s view of the UN System as members and leaders in the global
UN NGO community, establishing a distinct role for nurse advocates within the UN System.
Conclusion: The presentation will focus on a description of opportunities for STTI members to participate
in the development of the UN Post 2015 Agenda and the shaping of the Sustainable Development Goals
(STGs). Tthe NYC UN Headquarters team's experience can provide encouragement and support for
participation of all members, chapters and regions.
Contact
[email protected]
Sustaining Global and Local Nursing Voice at the United Nations

Gloria Chan, BSN, RN-BC, CCRN-CSC, PCCN, USA
Raissa Lynn Sanchez, BSN, RN, TNCC, USA
Purpose
The purpose of this presentation is to educate STTI members about the UN interest group created within
the NYC region.

Target Audience
The target audience of this presentation is STTI members interested in the United Nations.
Abstract
Purpose: This presentation will describe the development of chapter and regional programs and projects
that focus on UN goals and initiatives, highlighting the STTI Region 14 UN Interest group and the NIGH
UN Interest Group Team. The response among STTI and NIGH members to these initiatives has been
positive and enduring, with members demonstrating interest in pursuing meaningful opportunities to
collaborate on global health and nursing issues. Programs have included evening education and all day
symposia, networking, and fundraising events held at universities and UN Headquarters. UN goals and
activities have provided young and experienced members with opportunities to collaborate and particpate
in global health projects.
Methods: UN Interest Group leaders will present their experiences in the development of events,
activities and projects related to Millennium Development Goals and the post 2015 Agenda and
Sustainable Development Goals. They will discuss their experiences engaging chapter and regional
leaders to provide information and coordinate programming.
Results: The UN Interest Group initiatives have resulted in sucessful, ongoing UN programming and
bringing over 400 nursing professionals on site to UN Headquarters in NYC.
Conclusion: The UN Interest Group can be a model for sucessful endeavors to stimulate interest and
provide opportunities for contribution to UN goals and global health and nursing issues. While the
proximity to UN Headquaters has provided an extra dimension to this experiences, the presenters will
discuss methods for replication for all chapters and regions of STTI.
Contact
[email protected]
Youth UN Representatives: Emerging Roles for Youth at the UN

Timothy Shi, BSN, RN, USA
D. J. Schnabel, BSN, RN, USA
Purpose
The purpose of this presentation is to educate STTI members about UN Youth Representatives.
Target Audience
The target audience of this presentation is STTI members interested in the UN.
Abstract
Purpose: This purpose of this presentation is to describe the newly established Youth Representative
role within the UN System,and activities associated with the DPI NGO (Department of Public
Information) and ECOSOC (Economic and Social Council). Youth engagement in the UN is regarded as
a crucial focus for developing leadership and particpation in the resolution of transnational issues.
Activities and opportunities for youth participation (18-24) will be explored and discussed.
Methods: The experience of the UN Youth Representatives will be highlighted for STTI members
interested in enagement of young members. Mentorship and collaboration on global health and nursing
projects demonstratesucessful and meaningful intergenerational and colleagal activities.
Results: UN Youth Representatives formm nursing NGOs will share their experiences in the UN System
and provide information for members and chapters interested in promoting youth activity in the UN.
Conclusion: The youth representatives will disucss the UN System, and offer suggestions for engagment
of young members.
Contact

[email protected]

F 11 - Practical Interventions to Improve Adherence
Review of the Predictors of Medication Non-Adherence and Adherence
Kathy Wheeler, PhD, BSN, MSN, APRN-FNP, NP-C, FAANP, USA
Purpose
To review, in detail, the research on predictors of medication non-adherence and medication adherence.
Target Audience
Nurses, Nurse Practitioners, Advanced Practice Nurses
Abstract
Purpose: This is the second of a three part series on Medication Adherence in which the authors
describe the continuum of adherence to non-adherence of medication usage.
Methods: Research articles through Medline and PubMed.
Results: The research review showed medication adherence and non-adherence can be categorized
according to the following: patient demographic characteristics, patient psychological and behavioral
characteristics, social factors, disease related factors, financial and other health system factors, patient-
provider relationships, and treatment related factors.
Conclusion: The implications for advanced practice nurses and other prescribers is that it is important to
evaluate the patient according to unique predictor qualities in order to tailor responses and activities,
thereby assuring the highest medication adherence possible.
Contact
[email protected]
A Review of the Patterns, Predictors, and Interventions to Improve Adherence

Mary Neiheisel, BSN, MSN, EdD, FNP-BC, CNS-BC, FAANP, USA
Purpose
Open a dialog on the enormity of the problem of non-adherence to medications prescribed for disease
conditions, reasons for the non-adherence, the significance of non-adherence, and the interventions by
health care providers which will improve medication adherence rates is presented.
Target Audience
Nurses, Nurse practitioners, advanced practice nurses
Abstract
Purpose: This is the first of a three part series on Medication Adherence in which the authors describe
the continuum of adherence to non-adherence of medication usage.
Results: Understanding the magnitude and scope of the problem of medication non-adherence is the first
step in reaching better adherence rates. The second step is to evaluate the risk factors for each patient
for medication adherence/non-adherence. Steps are then taken to prevent non-adherence.
Conclusion: The implications for nurse practitioners include using time with patients to assist them in
adherence, building a trusting relationship with patients, and developing protocols for assessing and
preventing non-adherence.
Contact
[email protected]

Strategies for Improving Adherence
Mary Ellen Roberts, DNP, RN, APN, FAANP, FAAN, USA
Purpose
develope protocols for assessing and preventing non-adherence.
Target Audience
Nurses, Nurse Practitioners, Advanced Practice Nurses
Abstract
Purpose: This is the third of a three part series on Medication Adherence in which the authors describe
the continuum of adherence to non-adherence of medication usage.
Results: Understanding the magnitude and scope of the problem of medication non-adherence is the first
step in reaching better adherence rates. The second step is to evaluate the risk factors for each patient
for medication adherence/non-adherence. Steps are then taken to prevent non-adherence.
Conclusion: The implications for nurse practitioners include using time with patients to assist them in
adherence, building a trusting relationship with patients, and developing protocols for assessing and
preventing non-adherence.
Contact
[email protected]

G 11 - Challenges in the Context of Self-Care and Family Caregivers
Self-Management on Chronic Diseases
Fernanda Bastos, PhD, MsC, Portugal
Purpose
Create an explanatory model on self-management carried out by people with demonstration of
ineffectiveness, in order to infer the elements of a health intervention that promotes a responsible self-
management.
Target Audience
The target audience is health professionals and educators
Abstract
Purpose: Chronic disease and its comorbidities represent the cause of episodes of hospitalization for
lack of disease control, or its consequences. Ineffective self-management contributes to hospital
readmissions and the high number of episodes of specialized care, indicates deficiencies in primary care.
The study purpose was creat an explanatory model on self-management carried out by people with
demonstration of ineffectiveness, in order to infer the elements of a health intervention that promotes a
responsible self-management.
Methods: Selected for study were those with chronic illness, with five or more hospitalizations. Twenty-
two participants were followed for a maximum of a year and a half, in a multicases study(1). Data were
obtained from the analysis of documentation, participant observation and interviews.
The data were analyzed according to the method proposed by Strauss and Corbin, to generate a
Grounded Theory(2,3). Beginning with a microanalysis, which was organized in an open coding, than
grouping the concepts and their relationships through an axial analysis, and summarizing the data,
drawing up theoretical reduction in a selective coding, finally, presenting the theory.
Results: In this study emerge a pattern of vulnerability with personal and contextual conditions. Socio-
economic and cultural poverty arises like the context of greater vulnerability straight by family
background(4).
Conclusion: Analysis of personal circumstances showed that attitude toward life and illness and personal
attributes grouped participants in four patterns, which we named as "style": responsible, independent,
formally guided and negligent. Some of these conditions are hardly conducive to a healthy transition(5)
and Identify the style of self-management can enable nurses to anticipate some difficulties.
Contact
[email protected]
Critical Factors on Autonomy Reconstruction after Self-Care Dependency

Alice Brito, RN, McN, PhD, Portugal
Purpose
to develop a theory on rebuilding of autonomy in self-care, after an event generator of dependence.
Target Audience
the target audience is health professionals and educators
Abstract
Purpose: to characterize the phenomenon of dependence on self-care at discharge moment and to
explore in depth the process of self-care autonomy reconstruction

Methods: qualitative study
Results: During the transition there are factors considered critical to the personal conditions, community
resources, the support and the health condition that determines the way of experiencing the transition.
Personal condition identified that interfere in the process was awareness, motivation, engagement, self-
care attitude, make decisions capacity, understand self-care as “situation” or “condition; meanings
attributed to the changes and health status. Support in the process of rebuilding of autonomy is
fundamental and may be economic, spiritual, family and community level. Society can promote
socialization, promoting the involvement and facilitating the process or increase and promote social
stigma associated with this very issue of dependency.
Conclusion: The nursing therapeutics promoters of healthy transition that emerged throughout the study
were: promoting awareness; promoting self-care; facilitating decision making; promoting use of
equipment; promoting housing changes; and, promoting access to available resources.
Contact
[email protected]
Family Vulnerability
Maria Joana Campos, RN, MScN, Portugal
Abel Paiva Silva, PhD, MScN, RN, Portugal
Purpose
Characterize the family transition experienced by caregivers of dependent people on self-care
Target Audience
the target audience is health professionals and educators
Abstract
Purpose: Characterize the family transition experienced by caregivers of dependent people on self-care
Methods: Grounded Theory (Strauss & Corbin, 2008) .
Results: A main category emerges from analysis: “vulnerability”. The vulnerability is related with social
exclusion, since the dependent needs a lot of care, cope with social isolation and most of them are
unknown of the health system. On the other hand, family caregivers aren´t prepare for care, they have
conflict of interests with their usual roles in family and society. The resources available by the families
usually are insufficient. They search for more support but is difficult to find the professionals and
equipment’s to help them with this hard task.
Consequently, they marginalize themselves and there are feelings like “everybody forgets us”.
Conclusion: The understanding of this complex transition is crucial to provide care with quality for these
families.
Contact
[email protected]
Educacional Tool to Improve Caregiver Role

Maria José Lumini Landeiro, RN, MScN, Portugal
Teresa Martins, PhD, Portugal
Purpose
The purpose is divulgate a research developed with family caregivers and nursing professionals
Target Audience

The target audience is health professionals and educators
Abstract
Purpose: The development of new technologies in the health area is a strategic axis to improve family
caregiving role.
Methods: Develop “Caring for dependent persons” an interactive tool in order to provide information
tailored to the needs of family caregivers of dependent patients to complement the given guidance and
promote their autonomy.Using an instrument to evalauate this educacional tool through 6 experts in the
area of family caregivers.
Results: Quantitative and qualitative study, quasi-experimental field, with two study groups. To be
implemented in an Oporto`s hospital. Consisting of three phases:
1.ª - Identify the importance to have an interactive tool to improve family caregiving role.
2.ª- Develop of interactive tool based on Instructional Design in Context for caregivers.
3.ª- Evaluate the impact of the interactive tool
Conclusion: The experts consider that the interactive educational tool is good concerning very items like
accessibility, main areas, utility, Simplicity airworthiness, graphical presentation, Quality videos, Clarity of
language.The major innovative element will be the platform’ interactivity with the users’ needs helping
their decision making, allowing family caregivers to decide which information want to know and learn
about.
Contact
[email protected]

H 09 - Working with Communities to Address Obesity Across the
Lifespan
Establishing the Reliability and Validity of HeartSmartKids Cardiovascular Risk
Assessment for Children 2-18 Years
Bonnie Gance-Cleveland, PhD, RNC, PNP, FAAN, USA
Purpose
To describe the development of a computerized decision support technology to prevent pediatric obesity
and report on reliability and validity of screening questions used in the screening tool.
Target Audience
researchers.
Abstract
Purpose: To describe the development of a computerized decision support technology to prevent
pediatric obesity and report on reliability and validity of screening questions used in the screening tool.
Background: Experts have developed guidelines for childhood obesity. Clinicians report difficulty
incorporating the screening and counseling components into routine care. HeartSmartKidsTM (HSK) is a
decision support tool for implementation of the obesity guidelines. HSK assesses family health behaviors
and provides tailored guidance. Patients complete a bilingual screening interview on health behaviors
using a touchscreen computer. Clinic staff add the clinical measurements and print the tailored guidance
for families. The purpose of this study was to document the reliability and validity of the screening
questions included in this technology for assessing eating, activity, and inactivity.
Methods: This study was part of a larger intervention study. Children aged 11-14 years old were enrolled
in a community-based healthy eating and activity after school program. Children in the control group
(n=35) completed the HSK at two time points 8 weeks apart to establish test-retest reliability. Baseline
reponses from children in the intervention and control groups (n=103) on the HSK and HABITS, a 19-item
questionnaire with subscales for diet, activity, and sedentary behaviors, were used to establish concurrent
validity.
Statistical Analysis: A multitrait/multimethod correlation matrix (MTMM) was used to examine the reliability
and validity of HSK relative to HABITS.
Results: Reliability of HSK using the main diagonal elements in the monomethod blocks established that
reliability coefficients were equal to or higher for HSK than for HABITS. Convergent validity using the
main diagonal of the monotrait/heteromethod block was established. Convergent validity was good for all
items (r values ranged from .33 to .62, all p’s <0.05) with the exception of milk consumption (r = .28, p <
0.05) and eats at restaurants (r = 0.16, n.s.) where questions differed considerably on the questionnaires.
Conclusion: The questions used in the HSK are equivalent or superior to the HABITS questionnaire and
are integrated into technology that is user friendly and generates a tailored patient education handout.
Contact
[email protected]
The Relationship of Maternal BMI and Child Body Size, Home Environment, and
Food in Low-Income Minority Women and Children Participating in a Child
Obesity Primary and Secondary Prevention Project
Elizabeth Reifsnider, PhD, FAAN, WHNP, PHNCS-BC, USA
Purpose

to discuss the primary and secondary obesity prevention projects which were developed through
community-based participatory research with a local grass-roots organization and local WIC program.
Target Audience
researchers.
Abstract
Purpose: The primary and secondary obesity prevention projects were developed through community-
based participatory research with a local grass-roots organization and the local WIC program. Both
programs focused on nutrition guidance to mothers and encouragement of more physical activity with less
time devoted to screen viewing (television and computer). The projects are based on the Ecological
Model of Growth (EMG).
Methods: The mothers and children were recruited through several WIC clinics within the same county.
The instruments used to collect data were based on the EMG and reflected the food environment (24
hour diet recall, Household Food Inventory [HFI]), the level of stimulation in the home (HOME Screening
Questionnaire [HSQ], hours of TV viewing), and maternal body size. The results from the first data
collection time period for both projects are presented in this paper.
Results: The association between fiber and protein was non-significant although approaching
significance; the association between fiber and fat were non-significant, and the association between fat
and protein was highly significant (p <.000). There were no significant associations between types of food
intake and child or maternal BMI. There were significant associations between the Household Food
Inventory and the HSQ (p<.03) and between HFI and TV hours (p =.05).
Conclusion: The types of food in the home affect mother and child body size. Hours of TV watching and
the level of high calorie foods in the house are positively associated. In addition, the amount of high
calorie food in the household is associated with the level of stimulation in the home. This could possibly
demonstrate that interactions between mother and child involve pleasurable foods (high sugar, high fat).
The relationships of maternal and child body sizes may possibly be positively related to number of high
calorie foods in the house although this was not conclusively shown in this project.
Supported by National Institute of Diabetes, Digestive, and Kidney Diseases 1R01DK096488-01A1; and
National Institute of Nursing Research 7R21NR010362-04
Contact
[email protected]
Cultural Relevance of the Healthy Choices Intervention Program

Diana L. Jacobson, PhD, RN, PNP-BC, USA
Purpose
to discuss the acceptability, applicability and cultural relevance of the Healthy Choices Intervention (HCI)
program for underserved, Hispanic overweight and obese 9 to 12 year old children and their parents who
utilize the healthcare services at an inner city pediatric primary care clinic.
Target Audience
researchers.
Abstract
Background: The burden of obesity and its health consequences disproportionately affects Hispanic
children and families. In Arizona, nearly 18% of the state’s children and adolescents are obese (up from
12.2% in 2003) with the rate rising by nearly 46% between 2003 and 2007. Researchers have determined
that multi-component; comprehensive obesity interventions are feasible in the primary care setting. In
addition, it has become evident that intervention effectiveness is improved when obesity interventions are
individualized to address the family’s social and cultural influences on health.

Purpose: The purpose of this study was to determine the acceptability, applicability and cultural
relevance of the Healthy Choices Intervention (HCI) program for underserved, Hispanic overweight and
obese 9 to 12 year old children and their parents who utilize the healthcare services at an inner city
pediatric primary care clinic. This study was funded by a 2012 Sigma Theta Tau International Small
Grant.
Methods: Research Design - Phase 1. The preliminary efficacy of the HCI with overweight and obese 9-
12 year old Hispanic children (N=20) and their parents/legal guardians (N=20), recruited from a clinic that
delivers health care to the medically underserved was evaluated utilizing a quasi-experimental design.
Phase 2. A descriptive qualitative design, utilizing parent and child focus groups, informed as to the
acceptability and cultural relevance of the HCI.
Outcomes Measured - Demographics, anthropometrics and self-reported measures of beliefs, behaviors
and psychosocial functioning were obtained.
Results: The parents and children reported high acceptability and applicability of the HCI. Parental
feedback included recommendations pertaining to the cognitive skills building activities and nutritional
content of the intervention.
Conclusion: Incorporating feedback from the participants strengthened the HCI. The HCI has been now
been adapted, not only to be culturally relevant to the Hispanic families, but also addresses the current
recommendations for comprehensive obesity management in primary care settings.
Contact
[email protected]
Overweight and Obesity in Young Children: A Critical Period for Intervention

Leigh Small, PhD, RN, CPNP-PC, FNAP, FAANP, FAAN, USA
Purpose
for attendees to discuss the four weight-related factors and the behavioral factors predictive of later life
obesity; and to outline the evidence that supports early childhood as a critical time point in weight
development in the life course and effective strategies to intervention with preschoolers and their parents.
Target Audience
researchers.
Abstract
Background and Significance: While there has been a surge in prevalence rates of overweight and obese
children over the last three decades; recent epidemiological data suggest that the trends have stabilized
for all child age groups except preschool-aged children. Furthermore, the increase in the prevalence of
obesity across child age groups continues to be the greatest between the preschool and school-age
groups; underscoring the importance of intervening with young children.
Purpose: The purpose of the study was to appreciate the effect of a parent-focused intervention
conducted in an office setting on child (4-8 years of age) anthropometric and behavioral outcomes.
Methods: Following IRB approval, study recruitment and baseline assessments, parent-child dyads (N =
60) were randomly assigned to either the treatment or control condition. Four intervention sessions were
conducted with the parents in their child’s healthcare office. The impact of the intervention was evaluated
by assessing child anthropometric (e.g., waist, waist-by-height ratio, BMI) and behavioral measures (e.g.,
internalizing and externalizing behaviors) immediately, 3, and 6 months following the intervention period.
Results: ANOVA models suggested that children in the experimental group were found to have
significantly reduced waist circumference and waist-by-height ratio immediately following the intervention
that persisted for 3 and 6 months. BMI and BMI percentile decreased over time but was not differentially
affected. The internalizing scores decreased significantly following the intervention but there were not

significant differences 3-, or 6-months later. The parent-reported externalizing behaviors of hyperactivity
and aggression significantly decreased at each time point when compared with baseline.
Conclusion: Specific child weight-related and behavioral factors have been found to be reliably
predictive of adult obesity and can be identified during adiposity rebound suggesting that this may be a
critical period related to weight development. This intervention demonstrated arrest of obesity-related
anthropometric measures and improved child behavioral changes.
Contact
[email protected]

H 11 - ICU Diary: Supporting the Intensive Care Patients Transition
from the ICU
ICU Diary: Mind the Gap
Judy Martin, MSN, BSN, RN, USA
Purpose
The purpose of this presentation is to educate the registered nurse as to the positive clinical benefits the
ICU diary has on the critically ill patient’s transition from the ICU setting. Evidence-base knowledge has
demonstrated the diary improves patient outcomes and enhances the clinical experience of family
members.
Target Audience
The target audience of this presentation is registered nurses, academic and administrative leaders
concerned with improved patient outcomes and the move to embrace population health management.
The ICU diary is a cost effective tool that has been demonstrated to benefit both patient and family
members.
Abstract
Purpose: Critically ill patients have reported gaps in their memories, distorted perceptions and
hallucinations which can contribute to the development of posttraumatic stress disorder (PTSD). A review
of literature indicated patients have reported not believing they had been that sick causing mistrust of
family members and their healthcare team. The purpose of this project was to better understand the
effect of the ICU diary on the critically ill patient’s transition from the ICU setting.
Methods: An evidence-based practice project, based on the IOWA Model of EBP, was conducted in an
intensive care setting located in Central Texas, USA. Critically-ill patients (n = 6) who were on the
ventilator for at least 24 hours were enrolled in the study. Registered nurses, ancillary staff and family
members wrote in the diaries. Photographs were taken of the patient on the ventilator and at various
points during their stay with the purpose of providing a visual timeline.
Results: One patient was discharged from the hospital but died shortly afterwards. One patient was
unenrolled from the study. Four patients completed the study. Results of the study indicated the diary is
a therapeutic tool: 1) the four patients chose to keep their diary and to include the photographs in the
diary: 2) three of the four patients reported no memories of their stay in the ICU and; 3) one patient had
memories of the ICU which included “horrible” hallucinations. Four patients reported the ICU diary helped
them with their transition. Four patients reported the photographs helped them with their transition.
Conclusion: The diary is a cost-effective therapeutic instrument. Observed implications included: 1)
family members appeared calmer 2) improved communication between nursing staff and family members
and, 3) diary and pictures had a positive effect as evident by the reaction of the patients at the point of
delivery.
Contact
[email protected]
The Emergence and Evolution of the Intensive Care Patient Diary

Ingrid Egerod, PhD, MSN, RN, Denmark
Purpose
members.

Target Audience
members.
Abstract
Purpose: The intensive care patient diaries originated in the Scandinavia countries of Denmark, Norway
and Sweden. In the 1990’s, the ICU nurses began keeping the ICU diary with the purpose of helping their
patients come to terms with their illness following being discharged from the hospital. The diaries were
written by the nurses, with the patient’s family contributing as well. Following being critically ill and being
cared for in the intensive care setting, patients were found to be developing psychological problems such
as nightmares, hallucinations, delusions, anxiety, depression and symptoms of posttraumatic stress. The
purpose of this study was to compare and describe the emergence and evolution of the intensive care
patient diary among the ICU units located in Denmark, Norway, and Sweden.
Methods: This study was a meta-analyses comparative international multicenter design. The qualitative
secondary analysis sought to examine data previously developed to describe the practice of keeping
intensive care diaries for critically ill patients. The research questions were: (1) what are the differences
and commonalities in using patient diaries in the three Scandinavian countries and (2) how did it start and
where are we now?
Results: The results of the study indicated the diaries were introduced concurrently in Denmark, Norway
and Sweden. The concept of the ICU diary began as a cross-national grass-roots initiative and evolved
into an evidence-base knowledge domain of inquire. Reoccurring terms described the diary as: (1) a
therapeutic instrument; (2) an act of caring; (3) an expression of empathy, and (4) a combination of all of
the above.
Conclusion: Diaries have the potential to fulfill the innate needs of the patient who struggles to
understand what happened to them and aids them as they constructs their own story of what happened.
Contact
[email protected]
ICU Diaries Reduce Post Traumatic Stress Disorder after Critical IIllness in
Patients and Family Members
Christina Jones, PhD, MPhil, PgD, Bsc RN, United Kingdom
Purpose
members.
Target Audience
members.
Abstract
Purpose: Delusional memories from the period of critical illness have been shown to be a major
contributor to the later occurrence of post traumatic stress disorder (PTSD). The experience of watching
the patient being critically ill is also traumatic to families, making them at risk of PTSD. It

was hypothesised that an ICU diary could help patients and their families come to terms with their
differing memories and so reduce the incidence of PTSD.
Methods: A prospective randomised, controlled study was performed in 12 ICUs across 6 European
countries. 1 week after ICU discharge the ICU Memory Tool was used to identify recall for delusional
memories. 1 month post ICU discharge PTSD related symptoms was assessed using the PTSS-14 and
the patients were randomised to receive their diary at this point or after the next interview 3 months post
ICU discharge. At 3 months a diagnosis of PTSD was made using the PDS. After the final interview, the
control patients also received their diaries. In 2 of the study ICUs relatives were asked to complete the
PTSS-14 at 1 month and 3 months post ICU discharge.
Results: 352 patients were randomised, 322 (91.5%) completing the 3 month follow-up. 11 patients with
undiagnosed, pre-existing PTSD were excluded from the final analysis. The incidence of new PTSD in the
intervention group was 5% (8/154), and 13.4% (21/157) in the control group; this was statistically
significant (p = 0.013). 30 relatives (15 in the intervention group and 15 in the control group) completed
questionnaires at 1 and 3 months. Relatives in the intervention group had reduced PTSD symptom (P =
.03).
Conclusion: This randomised, controlled trial confirms that an ICU Diary helps patients come to terms
with critical illness and reduces PTSD incidence. In addition the diary helps reduce symptoms of PTSD in
relatives.
Contact
[email protected]
ICU Diaries: The Journey to Psychological Recovery for Critically Ill Patient's
Family Members
Carl Gosta Backman, PhD, BSc, RN, Sweden
Purpose
members.
Target Audience
members.
Abstract
Purpose: Delusional memories from the period of critical illness have been shown to be a major
contributor to the later occurrence of post traumatic stress disorder (PTSD). The experience of watching
the patient being critically ill is also traumatic to families, making them at risk of PTSD. It
was hypothesised that an ICU diary could help patients and their families come to terms with their
differing memories and so reduce the incidence of PTSD.
Methods: A prospective randomised, controlled study was performed in 12 ICUs across 6 European
countries. 1 week after ICU discharge the ICU Memory Tool was used to identify recall for delusional
memories. 1 month post ICU discharge PTSD related symptoms was assessed using the PTSS-14 and
the patients were randomised to receive their diary at this point or after the next interview 3 months post
ICU discharge. At 3 months a diagnosis of PTSD was made using the PDS. After the final interview, the
control patients also received their diaries. In 2 of the study ICUs relatives were asked to complete the
PTSS-14 at 1 month and 3 months post ICU discharge.

Results: 352 patients were randomised, 322 (91.5%) completing the 3 month follow-up. 11 patients with
undiagnosed, pre-existing PTSD were excluded from the final analysis. The incidence of new PTSD in the
intervention group was 5% (8/154), and 13.4% (21/157) in the control group; this was statistically
significant (p = 0.013). 30 relatives (15 in the intervention group and 15 in the control group) completed
questionnaires at 1 and 3 months. Relatives in the intervention group had reduced PTSD symptom (P =
.03).
Conclusion: This randomised, controlled trial confirms that an ICU Diary helps patients come to terms
with critical illness and reduces PTSD incidence. In addition the diary helps reduce symptoms of PTSD in
relatives.
Contact
[email protected]

I 09 - Utilization of Nursing Classification Systems for the Depiction of
the Nursing Process in Electronic Patient Records in Order to
Improve Evidence-Based Nursing
Aims of Utilization Nursing Process Data in Electronic Patient Records
Monika Linhart, RN, PhD, Germany
Purpose
The purpose of this presentation is to lay the basis for the overall goal of this symposium to spur a
scientific discussion of the requirements nursing classification in general should have to be most
beneficial for the use in electronic patient records and the further development of Evidence-based
Nursing
Target Audience
The target population of this presentation is first, clinicians who use nursing classification systems in
practice, secondly academics who are interested in the development of nursing terminology and/or
electronic patient records and lastly, administrative personnel who are interested in utilizing electronic
nursing process data e.g. for outcome measurement
Abstract
Purpose: While the use of nursing classification systems in nursing practice is increasing, there is still
unclarity about the variety of aims which could be met by additionally implementing these systems for the
nursing process documentation in electronic patient records.
Methods: Therefore, the first presentation will illustrate and discuss a selection of these potential aims,
like improving the communication of healthcare professionals with one another, supporting process flows
such as the transfer from one institution to another, supporting the performance transparency of nursing
and outcome measurement, and last but not least supporting decision-making by nurses within the
framework of the nursing process by presenting up-to-date nursing knowledge.
Results: None stated.
Conclusion: None stated.

Contact
[email protected]
Illustration of Aims for Utilization Nursing Process Data in Electronic Patient

Records with the Aid of the European Nursing Care Pathways (ENP)
Sebastian Kraus, RN, BS, Germany
Purpose
The purpose of this presentation is to deepen the understanding of the content presented in the first
presentation of this symposium
Target Audience
Abstract
Purpose: The before delineated aims will be illustrated in more detail with the aid of the European
Nursing Care Pathways (ENP).
ENP is a classification system which has been developed in Germany since 1989 by a scientific
development team with diverse nursing competences. ENP consists of nursing diagnosis with
characteristics, etiologies, resources, outcomes, interventions as well as detailed guiding interventions. In
Germany and other European countries, ENP is currently used by many hospitals, nursing homes and
home health care services as an electronic patient record for nursing process documentation.
Methods: None stated.
Conclusion: None stated.
Contact
[email protected]
Requirements of Nursing Classification Systems for an Useful Application in

Electronic Data Records
Pia Wieteck, RN, PhD, Germany
Purpose
The purpose of this presentation is to finalize the content input and to spur a scientific discussion of the
requirements nursing classification in general should have to be most beneficial for the use in electronic
patient records and the further development of Evidence-based Nursing
Target Audience
Abstract
Purpose: In the final presentation, the necessary requirements of nursing classification systems for an
useful application in electronic data records will be discussed. The main question will be which

abstraction level or granulation is needed for nursing terminologies to enable nursing documentation and
all of the before presented aims in an electronic patient record.
Methods: To support the discussion the levels of granulation of a number of nursing diagnoses in
different nursing terminologies and the results of a cross-mapping of ENP and NANDA will be presented.
Conclusion: This and the other presentations of this symposium should spur a scientific discussion of the
requirements nursing classification in general should have to be most beneficial for the use in electronic
patient records on the one hand and the further development of Evidence-based Nursing on the other
hand.
Contact
[email protected]

J 09 - New Evidence-Based Practice Competencies for Practicing
Nurses and Advanced Practice Nurses: From Development to Real
World Implementation
The Development of New Evidence-Based Practice Competencies for Practicing
Registered Nurses and Advanced Practice Nurses
Purpose
The purpose of this presentation is to disseminate the findings of tow Delphi surveys created to develop
new evidence-based competencies for practicing registered nurses and advanced practice nurses.
Target Audience
The target audience of this presentation is clinicians and administrators who are building, promoting and,
or sustaining a culture of EBP in their healthcare organization.
Abstract
Purpose: Research supports that evidence-based practice (EBP) promotes high value healthcare,
including enhancing the quality and reliability of healthcare, improving health outcomes and reducing
variations in care and costs. Even with its tremendous benefits, EBP is not the standard of care that is
practiced consistently by clinicians throughout the United States and globe. Although there is a general
expectation of healthcare systems globally for nurses to engage in EBP, much uncertainty exists about
what exactly that level of engagement encompasses. Lack of clarity about EBP expectations and specific
EBP competencies that nurses and advanced practice nurses (APNs) who practice in real world
healthcare settings should meet impedes institutions from attaining high-value, low cost evidence-based
healthcare. Therefore, the aim of this study was to develop a set of clear EBP competencies for both
practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in
their quest to achieve high performing systems that consistently implement and sustain EBP.
Methods: Seven national EBP leaders developed an initial set of competencies for practicing registered
nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80
EBP mentors across the United States to determine consensus and clarity around the competencies.
Results: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, yielding a final
set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs.
Conclusion: Incorporation of these EBP competencies into healthcare system expectations, orientations,
performance appraisals, job descriptions and clinical ladder promotion processes could drive higher
quality, reliability and consistency of healthcare as well as reduce costs. Research is now needed to
develop valid and reliable tools for assessing these competencies as well as linking them to clinician and
patient outcomes.
Contact
[email protected]
Partnering with Healthcare Organizations to Pilot the Implementation of EBP

Competencies
Lynn Gallagher-Ford, PhD, RN, DFPNAP, NE-BC, USA
Purpose
The purpose of this presentation is to disseminate process used to pilot new EBP competencies.
Target Audience

Target audience is clinicians and administrators who are building, promoting and, or sustaining a culture
of EBP in their healthcare organization.
Abstract
Purpose: There has been a lack of clarity about EBP expectations and specific EBP competencies that
nurses and APNs who practice in real world healthcare settings should meet in healthcare organizations.
This uncertainty has impeded institutions from attaining high-value, low cost evidence-based healthcare.
The development of clearly articulated EBP competencies that align with the EBP process are a valuable
contribution that healthcare organizations can integrate support an environment where EBP is the
measurable expectation and practice for all.
Methods: Engagement with a variety of healthcare organizations to pilot the integration of EBP
competencies into programs and processes was undertaken. The intent of the pilots was to evaluate the
barriers, facilitators, and outcomes of these projects. The healthcare organizations are piloting the
integration of the EBP competencies in unique ways such as: integration into job descriptions and
performance appraisals; integration into a Nurse Practitioner Fellowship onboarding program; integration
across the membership of an interdisciplinary policy and procedure committee.
Results: The pilot projects are providing valuable information about the integration experience and
strategies for success in implementing the EBP competencies. The projects are very diverse and create a
rich assortment of information and guidance that will serve healthcare organizations undertaking these
activities in the future. A range of pilot project activities and experiences that have been systematically
collected will be presented. The unique barriers and challenges as well as unexpected champions that
emerged will be highlighted.
Conclusion: Clearly articulated EBP competencies are a valuable new resource that will help healthcare
organizations achieve high value healthcare. Implementing new innovations is always a challenge and
having real world exemplars to guide these endeavors is tremendously helpful in terms of effectiveness
and efficiency. Key findings from EBP competency implementation pilot projects as well as effective
strategies discovered will be presented.
Contact
[email protected]
Integration of EBP Competencies Exemplar: The Interdisciplinary Policy and

Procedure Committee Experience
Cheryl L. Boyd, PhD, WHNP-BC, NE-BC, RN, USA
Purpose
The purpose of this presentation is to disseminate the findings of the pilot organization implementing the
new EBP competencies.
Target Audience
The target audience is clinicians and administrators who are building, promoting and, or sustaining a
culture of EBP in their healthcare organization.
Abstract
Purpose: Creating an environment where EBP is the foundation of clinical decision making and practice
is a challenging undertaking in real world healthcare organizations. Resources to promote the transition
to an EBP culture can accelerate this process. Having clear set of scientifically derived EBP
competencies that are reasonable to expect of clinicians in practice would be a helpful tool. When
presented with opportunity to pilot the integration of EBP competencies, our organization energetically
accepted. Our engagement was based on our interest in enhancing our own ongoing work in advancing
EBP in our organization as well as participating in work that could accelerate the integration of EBP in
other organizations as well.

Methods: Our organization integrated the EBP competencies into the skill set of the members of our
policy and procedure committee. The committee had expressed interest in learning more about EBP in
the past however a framework to build upon had not been selected. The EBP competency pilot project
was an excellent fit for designing a program to provide EBP education for the group with a clear set of
measurable outcomes (competencies) that could be evaluated along the way.
Results: The implementation and results of the EBP competency integration pilot will be discussed
including; initial discussions, obtaining group engagement and buy-in, barriers, facilitators, critical
strategic recommendations for success, and individual as well as organizational outcomes.
Conclusion: EBP competencies are a valuable tool and resource for organizations seeking to build a
culture of EBP. A pilot project to integrate scientifically derived EBP competencies into an important,
interdisciplinary team in our organization had significant impact. The impact to the organization and plans
for next steps in integrating EBP competencies throughout the organizations will be presented.
Contact
[email protected]

K 09 - Improving Health Outcomes in Haiti through Nursing Education
Collaborating Globally to Transform Haiti's Healthcare
Odiane Medacier, MSN, APRN, FNP-C, USA Jacqueline Cassagnol, RN, MSN, PMC, USA
Purpose
The purpose of this presentation is to share the experience of one nursing organization partnering with a
corporation to improve healthcare in Haiti, and to evaluate the impact of HANA’s Teaching Initiative on
Faculté des Sciences Infirmières de Léogane(FSIL) and Haiti’s healthcare.
Target Audience
The target audience of this presentation are nurse educators, nurse leaders, nurse researchers, nursing
students, all clinicians, and/or anyone who is interested and engaged in the improvement of global
healthcare;
Abstract
Purpose: Haiti is facing a serious healthcare delivery crisis (Jerome & Ivers, 2010).) The Haitian
American Nurses Association (HANA) is addressing this issue by collaborating with
corporations/organizations in order to initiate projects that will transform Haiti’s health care. Two main
focuses of HANA have been community health and disaster preparedness in Haiti. The purpose of the
Faculté des Sciences Infirmières de Léogane (FSIL)/Disaster Preparedness and community projects,
sponsored by HANA, is to establish sustainable non-governmental policies and procedures for disasters
at FSIL and the surrounding community, through Worldwide Community First Responder, Inc (WCFR).
Methods: The community health projects were created to ensure that FSIL students provide necessary
community health care. WCFR nurse educators guided FSIL students to assess community health
through health surveys and to analyze both access to and adequacy of existing community resources.
The importance of health promotion in the community was emphasized.
Results: The results were very promising. The FSIL/Disaster Preparedness and community projects
engaged nurse educators and student nurses in making FSIL and its surrounding community safer, more
prepared, and more resilient for future disasters. It also contributed to the improvement of the health of
the community in Leogane, Haiti.
Conclusion: The collaboration between HANA and WCFR has proven to be beneficial for all
stakeholders. Being that nursing is such a vital segment of the healthcare delivery system, more
emphasis should be put on building capacity through collaboration. Similar partnerships between nursing
organizations and corporations must be sought and established.
Contact
[email protected]
Fill in the Blank...The Experience of a Nurse Educator in Haiti

Louise Aurelien, EdD, MS, ARNP, NP-C, USA
Purpose
The purpose of this presentation is to discuss the experience of a Haitian-American nurse educator, who
studied and practiced in the United States for over 20 years and went to teach in her native land.
Strategies to overcome barriers and maximize the teaching and learning experience are also
emphasized.
Target Audience

The target audience of this presentation are primarily nurse educators, nurse leaders, nursing students.
However, any nurse who has some experience in any field and seeking to share his/her knowledge and
skills with future generations of nurses would greatly benefit.
Abstract
Purpose: The scarcity of qualified nurse educators is a global issue and even more pronounced in
developing countries, like Haiti, due to the lack of educational infrastructure. Sponsored by HCR Manor,
Care, The Haitian American Nurses Association of Florida (HANA) initiated a “Teaching Initiative Project”
at the Faculté des Sciences Infirmières de Léogane (FSIL)” in Haiti. FSIL recruits nursing students who
possess brilliant and hungry minds simply waiting to be stimulated, challenged and engaged. These
future nurses are eager for learning opportunities. The purpose of this project was to engage Haitian
American nurse educators from the United States to travel to Haiti to teach at FSIL and to introduce
Haitian nursing students to innovative, interactive teaching/learning methods.
Methods: Assignments, interactive class activities and exams were developed and administered to afford
nursing students the opportunity to correlate theory to practice in order to stimulate and develop critical
thinking skills.
Results: The Students met the course objectives and obtained passing grades on the exams. They also
demonstrated critical thinking skills during interactive classroom presentations and skills performance.
Conclusion: Using innovative teaching approaches to empower future Haitian nurses with higher level of
critical thinking skills is a worthy investment necessary to revolutionize Haiti’s health system. Strategies to
overcome barriers and maximize the teaching and learning experience are further discussed.
Contact
[email protected]
Empowering Nursing Students at the Faculté des Sciences Infirmières de

Léogane (FSIL) to Promote Evidence-Based Practice in Haiti
Marie-Carole France, EdD, MSN, BSN, USA
Purpose
The purpose of this presentation is to share how Haitian nursing students at the Faculté des Sciences
Infirmières de Léogane (FSIL) circumvented their traditional subject-focused learning approach to a
process-driven learning method using problem-based learning (PBL) in nursing research.
Target Audience
The target audience of this presentation are nurse educators wanting to explore an innovative teaching
strategy to promote lifelong learners, especially when teaching students who were taught in a subject-
focused learning approach.
Abstract
Purpose: Nursing research is considered one of the most important courses in nursing curricula to
prepare baccalaureate-nursing students for evidence-based practice. The purpose of this project was to
evaluate how Haitian nursing students at the Faculté des Sciences Infirmières de Léogane (FSIL)
circumvented their traditional subject-focused approach of learning to a process-driven method using
problem-based learning (PBL) to stimulate their cognitive skills in the nursing research course.
Methods: To accomplish this goal, innovative teaching strategies: concept mapping, technology support,
clinical case scenario, reflection, and group presentations were implemented in the course to help
students develop the analytical skills necessary in critical thinking and evidence-based nursing skills,
problem solving and self-evaluation skills, co-operation and teamwork, and interpersonal communication.
These learning activities were fundamental for helping the students identify gaps in their knowledge to
retrieve, access, and exercise information to critique and analyze the process of nursing research.

Results: The students at the Faculté des Sciences Infirmières de Léogane (FSIL) reported that PBL
instructional teaching model promoted a higher order of thinking, improved group collaboration, and
provided them with a better understanding of nursing research process, thus making the course more
relevant to real life health care situations in Haiti. By implementing this innovative teaching model, the
students were able to acquire critical thinking skills and direct their own learning. Problem-based learning
was the teaching pedagogy that supports students' active participation in research.
Conclusion: PBL is an appropriate pedagogical framework for empowering the students at FSIL to take
charge of their own learning. Nurse educators can make the learning experience stimulating, appealing,
realistic, and applicable to the health care practices in Haiti by using this model. By guiding the students’
lifelong learning, nurse educators can empower FSIL students to become the voices that will transform
the health care delivery system in Haiti.
Contact
[email protected]

K 11 - Translating Interventions to Practice: Dissemination and
Implementation Research Methods
Research Designs for Dissemination and Implementation
Usha Menon, PhD, RN, FAAN, USA
Purpose
The purpose of this presentation is to define translation research, determine readiness for dissemination
and implementation research and identify appropriate study designs, funding sources, and feasibility and
adaptation methods.
Target Audience
The target audience of this presentation is academicians and clinicians interested in dissemination and
implementation methods.
Abstract
Purpose: The purpose of this presentation is to define translation research, determine readiness for
dissemination and implementation research and identify appropriate study designs, funding sources, and
feasibility and adaptation methods.
Methods: We will describe differences between key terminologies used in this area. Algorithms will be
presented for assessing your program of research for readiness for D & I, and to differentiate between
efficacy and effectiveness testing. Within the context of translation to community and clinical practice
settings, methods will be described for adaptation, adoption, fidelity, outcomes and impacts, scalability
and sustainability and the limitations and advantages of each.
Results: Exemplars of the key concepts above will focus on previous community-centered interventions
designed to change health promotion behaviors. We will also address cost-effectiveness aims, feasibility
of D & I designs, and empirical testing of evidence-based interventions both in the U.S. and abroad.
Conclusion: For optimal health benefits, efficacious interventions must be tested for Dissemination and
Implementation. Dissemination and Implementation evaluation models must account for both
effectiveness testing, adaptation and reach in practice settings.

Contact
[email protected]
Putting Evidence into Practice: Dissemination and Implementation of a Cervical

Cancer Prevention Project in Ethiopia
Jennifer Kue, PhD, USA
Purpose
The purpose of this presentation is to describe a dissemination and implementation study of an evidence-
based alternative, low-tech approach to preventing cervical cancer using visual inspection with acetic acid
(VIA) and cryotherapy.
Target Audience
Abstract
Purpose: Cervical cancer incidence rates are astonishingly high among women in Ethiopia (35.9 per
100,000). Almost 6,000 Ethiopian women die annually from the disease. In developed countries, cervical
cancers are prevented by early detection using the Papanicolaou (Pap) test; however, in low resource
countries, Pap tests are not readily available. An evidence-based alternative, low-tech approach to
preventing cervical cancer using visual inspection with acetic acid (VIA) and cryotherapy has successfully
reduced morbidity and mortality from cervical cancer in India and Uganda. Dissemination and
implementation (D & I) of this evidence-based procedure can save women’s lives when cancer treatment
and providers are scarce.
Methods: We will detail the process of: 1) partnership building with an academic institution and non-
governmental organizations in Gondar, Ethiopia for D & I of a VIA program, and 2) building capacity of a
nursing program at a partner academic institution by training nurses and midwives in D & I of VIA
procedures. We also describe the challenges of conducting a cancer prevention project in a global health
setting.
Results: High degree of communication and collaboration between institutions are critical in
implementing a cancer prevention program. Challenges include communication with in-country staff,
competing international cancer prevention programs, high cost of using a standardized cervical cancer
screen and treat curriculum, and cultural and linguistic differences.
Conclusion: D & I of an evidence-based screen and treat program for cervical cancer with nurses in low-
resource settings is critical in countries with limited assets and skilled human capital. Enhancing the skills
and competency of nurse faculty and students to conduct VIA can eliminate the burden of cervical cancer
and untimely death of thousands of Ethiopian women. This presentation offers new insight into building
capacity of nursing programs in a global context and provides guidance on carrying out global health
research.
Contact
[email protected]
Dissemination and Implementation Studies: The Statistician/Methodologist's Role

and Responsibilities
Laura Szalacha, EdD, USA
Purpose
The purpose of this presentation is to address the delay between health and healthcare research findings
and everyday practice using dissemination and implementation methodology.

Target Audience
Abstract
Purpose: The long delay between health and healthcare research findings and everyday practice is
critical. The science of dissemination and implementation (D & I) addresses this gap by understanding
how to create, evaluate, report, disseminate, and integrate evidence-based interventions to improve
health and prevent disease within clinical and community settings and how to recast the nature or
conduct of the research itself to make it more relevant and actionable in those settings. While the D & I
field is growing, there are only a few training programs for D & I research.
Methods: This presentation will focus on the roles and responsibilities of the statistician and/or
methodologist in a D&I study and how those procedures and practices differ from those in a randomized
control trial. This includes the design of a study, appropriate models or theoretical frameworks,
frameworks for evaluation (i.e., RE-AIM), measurement issues, concerns of fidelity and re-invention or
adaptation of successful interventions and the diffusion of innovation principles.
Results: We will frame our discussion with the 5 core values for D & I proposed by the NIH: rigor and
relevance, efficiency, collaboration, improved capacity, and cumulative knowledge.
Conclusion: We have successfully developed many interventions demonstrated to significantly treat and
prevent illness. It is imperative that we hasten the translation of these findings.
Contact
[email protected]

L 09 - Factors Influencing Overweight and Healthy Lifestyles in
Adolescents: Supporting Evidence to Guide Effective Interventions
Sleep and Adolescent Obesity: Results from the Creating Opportunities for
Personal Empowerment (COPE) Randomized Controlled Trial
Diana L. Jacobson, PhD, RN, PNP-BC, USA
Purpose
The purpose of this presentation is to report baseline findings related to sleep, gender, weight and mood
in adolescents participating in the NIH funded, COPE Healthy Lifestyles intervention.
Target Audience
The target audience of this presentation are clinicians and academicians.
Abstract
Purpose: The purpose of this presentation is to report baseline findings related to sleep, gender, weight
and mood in adolescents participating in the NIH funded, COPE healthy lifestyles intervention which was
delivered by trained health teachers in high schools in a large, southwest metropolitan area.
Methods: Several analyses were conducted on this large sample of 14-17 year old adolescents
including: (1) chi square (2) t-tests, (3) frequencies, and (4) Pearson’s correlations. Comparisons were
conducted between males/females and overweight/non-overweight participants.
Results: There were 779 teens in this study. The majority of adolescents were Hispanic (67.52%). A
large proportion of teens were overweight including 43.2% males and 41.8% females. Adolescent self-
reported the number of hours of sleep obtained on school nights. Adolescents who were overweight or
obese reported significantly less sleep each night (p<.001). Females also reported significantly less sleep
at night (p=.028). There also was a significant relationship between hours slept at night and depressive
symptomology (r=-.29, p<.01) and anxiety (r=-.31, p<.01).
Conclusion: Findings from this study support a relationship between sleep and weight. Additionally,
duration of sleep was related to negative mood indicators. Addressing sleep patterns in adolescence as
a component of a healthy lifestyle intervention has the potential to improve overall health.

Contact
[email protected]
Differences in BMI, Self-Concept and Perceived Difficulty in Leading a Healthy

Lifestyle between Hispanic and Non-Hispanic Teens
Purpose
The purpose of this presentation is to disseminate findings from the NIH funded, COPE Healthy Lifestyles
intervention and specific areas to target in interventions.
Target Audience
The target audience are clinicians and academicians.
Abstract
Purpose: Overweight/obesity is a major public health problem in adolescence. The prevalence of
overweight/obesity is even higher in minority populations. Understanding differences in key variables that
may impact overweight/obesity is important for designing culturally sensitive interventions to address and
prevent this problem. Cognitive theory guided the study and contends that how individuals think affects
how they feel and how they behave.
The sample was comprised of 779 adolescents at 11 high schools in the Southwest United States who
were participating in a randomized controlled trial to assess the efficacy of the COPE Healthy Lifestyles
TEEN program on their physical, mental health and academic outcomes.
Methods: Baseline measures obtained included BMI along with valid and reliable scales, acculturation,
perceived difficulty in leading a healthy lifestyle, self-concept, depression and anxiety.
Results: The mean age of respondents was 14.8 years with approximately 48% male and 52% female.
Sixty-seven percent of the sample was Hispanic. Independent sample t-tests identified several significant
differences between Hispanic and non-Hispanic teens. Beck Self-concept t-scores were significantly
lower in Hispanic teens (p=.001). All four acculturation subscales were significantly different, including
assimilation (p=.000), separation (p=.000), integration (p=.000), and marginalization (p=.011). Hispanic
teens had significantly higher BMI percentiles (p=.003). Hispanic teens also perceived it was more
difficult to live a healthy lifestyle (p=.046). There were no significant differences on their steps per day,
self-reported healthy lifestyle behaviors, anxiety or depression.
Conclusion: Adolescence is an important time to influence healthy lifestyle beliefs and behaviors. Beliefs
regarding living a healthy lifestyle and self-concept should be targeted in interventions to enhance healthy
lifestyle behaviors in Hispanic teens in order to prevent and treat obesity.
Contact
[email protected]
Critical Components of Evidence-Based Interventions to Prevent

Overweight/Obesity in Adolescents
Jacqueline Hoying, MS, RN, NEA-BC, USA
Purpose
None stated.
Target Audience
None stated.
Abstract

Purpose: The incidence of adolescents who are overweight or obese has increased dramatically over the
past 20 years across the globe, with approximately 34.2 percent of teens now being overweight (i.e., a
gender and age-specific body mass index [BMI] at or above the 85th percentile, or obese, which is defined
as a gender and age-specific body mass index (BMI) at or above the 95th percentile). Being overweight
predisposes adolescents to adverse health outcomes compared to their non-overweight counterparts,
including Type 2 diabetes, hypertension, dyslipidemia, sleep apnea, increased asthma symptoms and a
shortened life span. Overweight and obese adolescents, in comparison to normal weight adolescents,
also have a higher prevalence of school and mental health problems, including poor academic
performance and self-esteem, depressive disorders, and a greater number of reported suicide
attempts. Therefore, it is imperative to deliver evidence-based interventions to prevent overweight and
obesity in at-risk teens. The purpose of this evidence review was to identify key components of
efficacious interventions that prevent overweight and obesity in adolescents.
Methods: An evidence review was conducted identifying randomized controlled trials of interventions to
prevent overweight and obesity in adolescents.
Results: Multi-component interventions lead to the best outcomes in preventing overweight/obesity in
teens, including those that contain cognitive-behavior skills building, nutrition education and physical
activity.
Conclusion: It is necessary to translate evidence-based interventions into real world practice settings in
order to prevent the growing incidence of overweight and obesity in adolescents. Future research should
include randomized controlled trials with long-term follow-up and dissemination/implementation studies in
real world clinical and school-based settings.
Contact
[email protected]

L 11 - Engaging Interprofessional Teams: Promoting Community and
Global Health Initiatives for Education, Practice, Research and Policy
Implementation of an Innovative Interprofessional Curriculum for Community
Assessment, Practice, and Research for Masters' and Doctoral Education
Quannetta T. Edwards, PhD, RN, FNP, WHNP, FAANP, USA
Purpose
The purpose of this presentation is to: Describe the implementation of an innovative inter-professional
curriculum for community assessment practice, and research for doctoral education and to discuss the
use of theoretical models as frameworks to guide community assessment.
Target Audience
The target audience of the presentation is Health care providers including nurses (advanced practice,
community health, public health; physicians; allied health)
Abstract
Purpose: Describe the implementation of an innovative inter-professional curriculum for community
assessment practice, and research for doctoral education and discuss innovative approaches utilizing
vulnerability and community assessment models.
Methods: Descriptive summary of an innovative curriculum designed for doctoral students (i.e. nurses
and physicians) using inter-professional collaborative team approach at multi-centers at one large Health
Science University (centers in Oregon and California). The program uses a myriad of approaches to
provide a thorough assessment of community/populations that includes an analysis of social,
epidemiological, behavioral , environmental and predisposing, enabling and reinforcing factors that impact
the overall health and quality of life of populations at the community and global health level. This
assessment includes the use of an ecological/ educational model (i.e. Precede/Proceed) and Vulnerability
models as frameworks to evaluate populations and identify at-risk groups so that students at master's and
doctoral levels (i.e. nurses and physician) can provide evidence based strategies to improve health
outcomes
Results: Curriculum development of an innovative program with in-depth community/population
assessment resulting in mentored practicum experiences across discipllnes; implementation of health
promotion and quality safety programs for the community; development of research initiatives including
grant funded projects and community based-participatory research and policy changes.
Conclusion: Assessing the needs of the community is an important part of healthcare and integral to the
development, initiation and evaluation of health education programs, policies and regulations
that promote population, community and public health and quality of life that resulted from this curriculum
development.
Contact
[email protected]
Community Engagement: Implementation of an Innovative Interprofessional

Curriculum for Community Assessment and Practice for Master's Education
Ruth Trudgeon, RN, MSN, PHN, USA
Purpose
The purpose of this presentation is to describe the implementation of an innovative inter-professional
curriculum for community assessment and practice for master’s education and discuss the utilization of
theoretical models as a framework to guide the assessment

Target Audience
The target audience of this presentation are nurses, educators and students
Abstract
Purpose: The purpose of this presentation is to describe the implementation of an innovative inter-
professional curriculum for community assessment and practice for master’s education and to discuss the
use of theoretical approaches as a framework to guide the assessment
Methods: Descriptive summary of an innovative curriculum that focuses on community assessment,
education and practice for master's education using inter-professional approach
Results: Comprehensive in-depth analysis of communities using a wide-range of modalities resulting in
strategies to improve outcomes. Practice implementation that focuses on health promotion across the life
span has been implemented to vulnerable populations incorporating various disciplines (nurses, faculty,
dentist, etc...)
Conclusion: The program meets the American Association of College of Nurses 'Essentials' that targets
the following:
Lead change to improve quality outcomes; Advance a culture through life-long learning; Build and lead
collaborative interprofessional care teams; Navigate and integrate care services across the healthcare
system; Design innovative nursing practices
Contact
[email protected]
Implementation of an Innovative Interprofessional Global Health Curriculum for

Doctoral Education
Ivy Tuason, RN, MSN, FNP-BC, USA
Purpose
The purpose of this presentation is to describe the implementation of an innovative inter-professional
global health curriculum for doctoral education
Target Audience
The target audience of this presentation is nurses who are involved in academia or who are interested or
working in the area of global health or in inter-professional collaborative teams or with vulnerable
populations
Abstract
Purpose: The purpose of the presentation is to describe the implementation of an innovative inter-
profession global health curriculum for doctoral education; and to discuss global health experiences that
can be applied to doctoral students
Methods: Curriculum development of an innovative global health program within an existing course in
doctoral education using inter-professional collaborative teams of global health experts. Emphasis is on
core concepts of global health, global health core competencies and practice experiences
Results: Comprehensive modules were implemented enabling students an in-depth analysis of global
health including its importance andrelevance to health and quality of life. Vulnerable populations are
discussed including cultural and social determinants that impact overall health. Focus on: Leading
change to improve quality outcomes; life-long learning and exploring future global health opportunities
Conclusion: This is the first implementation of this innovative module and evaluations are currently
underway; however thus far practice experiences overseas have been promising in providing stimulating
experiences to enhance student's life-long learning and critical analysis of at risk populations.
Contact

[email protected]

M 09 - Evidence-Based Practice Mentors and Their Impact on Patient
Outcomes and Healthcare Quality
EBP Mentors Improving Healthcare Practice and Impacting Outcomes in Real
World Clinical Settings
Lynn Gallagher-Ford, PhD, RN, DFPNAP, NE-BC, USA
Purpose
to share information and experience in developing EBP mentors which are a critical component for
successfully implementing and sustaining EBP in real world clinical settings
Target Audience
clinicians and administrators from healthcare organizations and settings of any type that are seeking to
implement EBP effectively.
Abstract
Purpose: Evidence-based practice mentors have been shown to be critical to effectively integrating and
sustaining evidence-based practice and decision-making in clinical organizations. The Advancing
Research and Clinical Practice through Close Collaborations Model (ARCC), developed by Melnyk and
Fineout-Overholt, is a systemwide model for implementation and sustainability of evidence-based
practice. In this model, development of a cadre of EBP mentors is a central and essential mechanism for
success in implementing and sustaining EBP in an organization. Melnyk and Fineout-Overholt's work
has described EBP mentors as healthcare providers who work with point-of-care staff to implement and
sustain EBP. Effective EBP mentors must have deep skills and knowledge not only related to the actual
EBP process but they must also be prepared to strategically lead change in organizations.
Methods: The knowledge and skills needed to be an EBP mentor are provided to clinicians through a 5-
day education program that employs evidence-based adult learning principles such as; combining
didactic content with activities to imbed learning, multi-modal delivery mechanisms, “guide on the side”
techniques and individual work projects with expert facilitation to teach clinicians the essential attributes
needed to perform effectively as an EBP mentor.
Results: Participants in the education program are guided through the entire EBP process and complete
the program with an evidence-based practice change action plan to take back to their organization for
implementation. The EBP mentors who participate in the education program are able to stay connected
with their EBP mentor peers across the globe through listservs and bi-monthly synchronous webinars to
share stories as well as resources and maintain the bonds and common passion for EBP that developed
during the program.
Conclusion: The evidence-based education program has generated hundreds of EBP mentors who are
working to improve healthcare practices and outcomes across the globe. The impact of EBP mentors will
be highlighted.
Contact
[email protected]
EBP Mentors in Action in a Real World Clinical Setting to Improve Care and
Outcomes
Purpose
to provide information and reflect on the experience of the impact of a cadre of skilled EBP mentors in
successfully addressing a quality challenge in a large, complex healthcare organization

Target Audience
clinicians and adminstrators interested in creating and sustaining an EBP culture in the their organization
to improve heathcare practices and outcomes
Abstract
Purpose: Evidence-based practice mentors have been shown to be critical to effectively integrating and
sustaining evidence-based practice and decision-making in clinical organizations
Methods: An exemplar of EBP mentors in action in a large, complex academic organization to improve
care, outcomes, and cost will be presented. This healthcare organization had been building a cadre of
EBP mentors over the past two years and when faced with a quality challenge, they called upon the
knowledge and skills of their EBP mentors to find the best, evidence-based solutions and implement
action plans to improve practices and outcomes related to this practice challenge.
Results: The evidence-based quality improvement initiative designed and led by EBP mentors will be
presented. The processes involved, including; accurately articulating the clinical challenge that involved
many stakeholders, developing the PICOT question to drive the search for best evidence, the search for
evidence to answer the question, the critical appraisal and synthesis of the body of evidence to underpin
the practice change recommendations, and finally the implementation and embedding of two innovative
evidence-based practice change interventions as well as the outcomes of the projects will be described.
Conclusion: The highlights and strengths of the systematic EBP approach in addressing clinical
challenges will be discussed and the return on the investment made by this organization to develop a
cadre of EBP mentors will be highlighted.
Contact
[email protected]
Creating an Environment Where EBP Is Reality: Engagement and Critical

Contributions of the Nurse Executive
Mary G. Nash, PhD, RN, FAAN, FACHE, USA
Purpose
To provide information and the lived experience about the unique and critical role and contributions of the
nurse executive in making EBP a reality and success in clincal organizations.
Target Audience
Clinicians and administrators, at every level of the organization, interested in creating environments
where EBP is supported and sustianed.
Abstract
Purpose: There are critical components of an organizational culture that must be embraced and
imbedded in order for EBP to become a reality. These components must be actualized throughout an
organization; however a commitment from the executive level is absolutely essential for success. The
critical components include: a philosophy, mission and commitment to EBP; an environment where the
spirit of inquiry is encouraged, acknowledged, and rewarded; a cadre of EBP mentors who have in depth
knowledge and skills in EBP, mentoring others, and overcoming barriers to individual and organizational
change; administrative role modeling of EBP and provision of the needed resources to sustain EBP;
infrastructure (tools, space, time and resources) to promote and enhance EBP across the organization;
and meaningful, timely recognition of individuals and units for EBP work.
Methods: The commitment and work of the nurse executive in a large, complex healthcare organization
to create an environment that effectively integrated EBP Mentors and the EBP process to guide problem
solving and practice change decision making will be presented.

Results: Challenges faced, solutions enacted, and unexpected champions discovered will be
discussed. Critical aspects related to setting the strategic vision as well as innovating within the
operational context of a complex nursing enterprise will be highlighted.
Conclusion: The rewards and return on investment of integrating evidence-based, best practice
solutions experienced by individuals, teams, patients and the organization overall will be shared.
Contact
[email protected]

M 11 - Meta-Analyses of Human Genome Studies: Epigenetic Risk
Factors and Population Health Issues in the World
Meta-Analyses of Human Genome Studies: Epigenetic Risk Factors and
Population Health Issues in the World
Shyang-Yun Pamela K. Shiao, PhD, RN, FAAN, USA
Purpose
The purpose of this symposium is to disseminate current evidence on population genome health, through
the meta-analyses of epigenetic risk factors, for population health.
Target Audience
learning about population genome health and epigenetics risk factors to prevent chronic diseases.
Abstract
Purpose: The purpose of this symposium is to disseminate current evidence on population genome
health, through the meta-analyses of epigenetic risk factors, for population health.
The new discoveries in human genome sciences show that mutations in the genome of normal human
cells can lead to the development of chronic diseases for oneself and future generations. Lifestyles have
a major effect on the development of chronic diseases for oneself and future generations through
epigenetics and methylation pathways. Western dietary habits cultivated under the modern industrial era
may induce gene expression changes in key regulatory pathways and affect metabolic processes, which
may play a mediating factor with ages in lifespan for the development of chronic diseases including
cancer and cardiovascular syndromes.
Methods: Literature searches, quality scores, and inter-rater evaluation on data coding were completed
to ensure data accuracy for pooled meta-analyses.
Results: The results of meta-analyses for various genes associated with cardiovascular health and
cancer development including colorectal cancer and lung cancer, across populations for various race-
ethnicity groups will be presented for mutation variations and epigenetics. Pollution indexes for past 10
years in the world will be associated with the gene mutations. Particulates matters (PM) smaller than 2.5
micrometers, PM2.5, can pass through lungs, leading to plaque deposits in cardiovascular systems
causing systematic inflammation. Whereas, PM10are smaller than 10 micrometers, that can deposit in the
pulmonary system causing pulmonary system inflammations. Both PM particles can cause health
hazards. In addition, meta-analyses on lifestyles affecting methylation pathways for cancer and
cardiovascular health with gene mutations for epigenetics, including dietary nutrient intake, smoking and
alcohol intake will be summarized.
Conclusion: Goals for health behaviors will be explored with motivation activation through participants’
active learning and participation process.
Contact
[email protected]
Meta-Analyses of Epigenetics Risk Factors for Lung Cancer Prevention: MPO and
GSTM1 Human Gene Variations Across Different Race-Ethnicity Groups
Po-Jui Yu, MSN, RN, Taiwan Shyang-Yun Pamela K. Shiao, PhD, RN, FAAN, USA Maria Suarez, MSN,
RN, USA
Purpose

through meta-analyses of epigenetic risk factors, for lung cancer (LC) prevention.
Target Audience
learning about population genome health and epigenetics risk factors for LC prevention.
Abstract
Purpose: The purpose of this presentation is to disseminate current evidence on population genome
health, through meta-analyses of epigenetic risk factors, for lung cancer (LC) prevention. LC is one of the
most common cancers worldwide and has the highest mortality rate among all cancers. Glutathione S-
transferase that belongs to the mu class (GSTM1) and myeloperoxidase (MPO) gene polymorphisms
have been cumulating in the literature, associating epigenetics factors and LC.
Methods: Literature searches, quality scores for the studies, and inter-rater evaluation on data coding
was completed to ensure data accuracy for pooled meta-analyses.
Results: Preliminary analyses included 31,146 LC cases and 38,736 controls from 122 studies. The
MPO gene mutations (GA and AA subtypes) in Asians were lower (16.7-33.3%) than Caucasians (31.8-
49.1%) across the world, for control and case groups. However, the GSTM1 gene mutation variation (null
subtype) was highest in Italians (87.5%) than other populations. Pollution indicators were checked and
shown worse in Asia than other countries. For lifestyle related meta-analyses, smoking was associated
with an increased risk of LC (98 studies, 28,831 cases, 35,069 controls, RR=1.40, p < 0.0001). Low
vegetable intakes were associated with increased LC risk (RR = 1.26, P < 0.05) in 7 studies. No second
hand smoking (6 studies) and limiting indoor pollution (3 studies) were protective for LC (RR=0.73 and
0.77, both P<0.05).
Conclusion: For association of GSTM1 gene variations, genotype present (44.3% cases, 47.9%
controls) was protective against LC for all populations combined in the world (RR = 0.94, p < 0.0001).
Future studies are needed to examine epigenetic factors for population health associated with MPO and
GSTM1 gene variations in the prevention of LC.
Contact
[email protected]
Meta-Analyses of Epigenetics Risk Factors for Heart Disease Prevention: NOS3

Human Gene Variations Across Different Race-Ethnicity Groups
Nien-Tzu Chang, PhD, RN, Taiwan Shyang-Yun Pamela K. Shiao, PhD, RN, FAAN, USA Lisa Delacruz,
MN, RN, USA
Purpose
through meta-analyses of epigenetic risk factors, for heart disease prevention.
Target Audience
learning about population genome health and epigenetics risk factors for heart disease prevention.
Abstract
health, through meta-analyses of epigenetic risk factors, for heart disease prevention. Ischemic heart
disease (IHD) is the major leading cause of deaths worldwide. Epidemiological studies have revealed the
association between nitric oxide synthase 3 (NOS3) gene mutation variations with increased risks of IHD
in various populations in the world. NOS3 is a gene affects metabolism in the urea cycle of the
methylation pathways, critical for preventing systematic inflammation as an epigenetics risk factor for
heart health.

Methods: Literature searches, quality scores for the studies, and inter-rater evaluation on data coding
was completed to ensure data accuracy for pooled meta-analyses.
Results: Preliminary analyses include a total of 49 case-control studies with13,830 cases and 10,595
controls. The gene mutation variations (GT and TT subtypes) were higher in Caucasians (47.5-64.8%)
than Africans (42.9-55.9%), Eurasians (33.9-45.1%), and Asians (13.5–30.7%) across the world, for
control and case groups. Pollutions in the world were documented worse in selected European countries
from 2004-2009, and in Asia in recent years. Pollution particles smaller than 2.5 micrometers, PM2.5, can
pass through lungs, leading to plaque deposits in cardiovascular systems causing systematic
inflammation. For lifestyle related meta-analyses, smoking was associated with an increased risk of IHD
(24 studies, 6,889 cases, 5,685 controls, RR=1.68, 95% Confidence Interval = 1.39-2.04, p < 0.0001).
The history of diabetes mellitus (RR=3.16, 2.4-4.17, P<0.0001) and hyperlipidemia (RR=2.92, 1.97-4.33,
p<0.0001) were associated with IHD.
Conclusion: Wild-type GG subtype (52.5% cases, 59.3% controls) was protective
against IHD for all populations combined (RR = 0.92, 0.89-0.96, p < 0.0001). Future
studies are needed to investigate the interactions between epigenetic risk factors,
through methylation pathways, and NOS3 gene variations for cardiovascular health in
various populations to prevent IHD.
Contact
[email protected]
Meta-Analyses of Epigenetics Risk Factors for Cardiovascular Health: APOA5

Human Gene Variations Across Different Race-Ethnicity Groups
Yen-Chiun Lin, PhD, RN, Taiwan Veronica Nunez, MSN, FNP, USA Shyang-Yun Pamela K. Shiao, PhD,
RN, FAAN, USA
Purpose
through the meta-analyses of epigenetic risk factors, for cardiovascular (CV) health.
Target Audience
learning about population genome health and epigenetics risk factors for CV health.
Abstract
health, through the meta-analyses of epigenetic risk factors, for cardiovascular (CV) health. CV Disease
(CVD) continues to be the leading cause of death worldwide. Studies have associated Apolipoprotein A5
(APOA5, 1131T>C, rs662799) gene polymorphism with plasma triglyceride levels for CVD. Life style risk
factors such as smoking, alcohol intake, and physical inactivity were associated with increased risks for
CVD.
Methods: Literature searches, quality scores, and inter-rater evaluation on data coding
were completed to ensure data accuracy for pooled meta-analyses.
Results: Preliminary analyses included 11,340 CVD cases and 18,758 controls from 37 studies. The
gene mutation variations (TC and CC subtypes) in Asian populations were higher (53.1-42.4%) than
Caucasian populations (21.4–10.2%) across the world, for control and case groups. For validation,
pollution indicators were checked and shown worse in Asia than other countries. For lifestyle related
meta-analyses, smoking was associated with an increased risk of CVD (18 studies, 5,035 cases, 9,140
controls, RR=1.70, 95% Confidence Interval = 1.39-2.08, p < 0.0001). However, alcohol intake (5 studies,
1,646 cases, 3094 controls, RR=1.42, 0.86-2.34) and physical inactivity (4 studies, 466 cases, 1,005
controls, RR=0.91, 0.74-1.13) were not significant for pooled meta-analyses.

Conclusion: For association of APOA5 gene variations, genotype TT (61.1% cases,
69.9% controls) was protective against CVD for all populations combined (RR = 0.78,
0.74-0.83, p < 0.0001). APOA5 is a key gene for triglyceride metabolism to reduce
inflammation for epigenetics in the methylation pathways. Future studies are needed to
examine epigenetic factors for population health associated with APOA5 gene
variations in the prevention of CVD.
Contact
[email protected]

N 09 - The Impact of an Enculturated Evidence-Based Practice
Environment on the Roles and Responsibilities of Nursing Leaders
The Changing Role of the Hospital-Based Clinical Nurse Scientist in an
Enculturated Evidence-Based Practice Environment
Esther M. Chipps, PhD, RN, USA
Purpose
1.The learner will be able to discuss the impact of an enculturated evidence-based environment on the
role of the Hospital-Based Clinical Nurse Scientist. 2. The learner will be able to identify strategies to
faciliatate the role change for the Hospital-Based Nurse Scientist as they support enculturated evidence-
based practice environments.
Target Audience
Nurse Scientists and Nurse Administrators/Leaders
Abstract
Purpose: This presentation will discuss the necessary transitions in the role of the Hospital-Based
Clinical Nurse Scientist to work successfully in a fully enculturated evidence–based practice
environment.
The role of the Hospital-Based Nurse Scientist is relatively new. Nurse Scientists who are employed in
hospital- based settings are educated in the traditional research paradigm and many have very limited
exposure to evidence-based practice.
Methods: The traditional Nurse Scientist views himself/herself as a research generator 1and therefore
approaches mentorship of clinical staff from this paradigm. The overarching goal of the role has been to
encourage and facilitate research among clinical staff. This includes grant writing, proposal development,
data collection, data analysis and dissemination. In fact, the success of the role is often measured by the
number of research projects funded, initiated and disseminated by the clinical staff. As hospital settings
become more steeped in evidence-based practice, the Hospital- Based Nurse Clinical Scientist must
incorporate and support the principles of EBP into their coaching and mentoring of staff.
Results: Recognition that a culture of high quality scholarly activity includes both EBP and clinical
research is essential in sustaining the EBP culture.
Conclusion: The successful Hospital-Based Nurse Scientist must expand their base of scholarly
activities and collaborate with the EBP leaders of their respective institutions.
Contact
[email protected]
The Changing Role of the Administrator of Nursing Quality, Evidence-Based

Practice and Research in an Enculturated Evidence-Based Practice Environment
Purpose
The purpose of this session is to discuss the impact of an enculturated evidenced-based practice
environment on the role of the Administrator for Nursing Quality, Research and Evidence-Based Practice
and to identify strategies to facilitate role changes as the Administrator supports an enculturated EBP
environment
Target Audience
The target audience will be mid-level and senior nurse leaders in the clinical setting.

Abstract
Purpose:
This presentation will discuss the transitions in the role of the senior administrator of nursing quality, EBP
and research to work successfully in a fully enculturated evidence –based practice environment.
Methods:
This includes the process of identifying and selecting nurse leaders to work in this department who
support a comprehensive vision of the EBP culture and are able to sustain the enculturation.
Results:
The Administrator must leverage the talents of his/her nurse leaders to balance the quality, EBP and
research needs of his/her organization. Furthermore, the Administrator must encourage and support
collaboration with the experts in nursing research, EBP, nursing education and nursing quality within
his/her department.
Conclusion:
To sustain fiscal support, the Administrators must be able to demonstrate the link between the scholarly
pursuits of EBP and nursing research to patient and fiscal.
Contact: [email protected]
The Changing Role of the Chief Nursing Executive in an Enculturated Evidenced-

Based Practice Environment
Mary G. Nash, PhD, RN, FAAN, FACHE, USA
Purpose
The purpose of this presentation is to discuss the modifications in the role of the Chief Nursing Executive
in an enculturated evidence-based practice environment.Examples of how organizational issues/problems
were resolved and the provision of mentorship to less experienced nurse leaders will be discussed.
Target Audience
The target audience of this presentation is mid-level and senior nurse leaders
Abstract
Purpose: This presentation will discuss the transitions that the most senior nurse leader, Chief Nursing
Executive (CNE) must make in his/her role to sustain the EBP culture and support mid-level nurse
leaders.
Methods:
As the most senior nursing leader in the organization, the Chief Nursing Executive (CNE) creates the
vision and simultaneously maintains overall accountability for promoting a culture of evidence-based
practice within a healthcare organization.
Results:
Nursing staff empowerment is reported as a positive outcome of establishing an EBP practice
environment. Nursing staff experience a renewed sense of confidence which can translate into a greater
sense of autonomy and a heightened desire to question administrative decisions. Less experienced
nurse leaders may see this as a threatening shift in the balance of power.
Conclusion:
The CNE must thoughtfully support the spirit of inquiry among clinical staff and simultaneously mentor
mid-level nurse leaders in the organizations as they acquire comfort with a renewed empowerment and
engagement among their clinical nursing staff.

Contact: [email protected]

Index of Authors
A B
Adachi, Noriko, 770
Adeniran, Rita K., 204 Babi, Kidest, 750
Ahn, Jung Won, 364 Bacani, Grace Carla, 763
Ahn, Yang Heui, 1044 Backman, Carl Gosta, 1155
Aika, Satoko, 1084 Bae, Sung-Heui, 584, 889
Ailey, Alison L. B., 559 Bai, Jennifer, 673
Aimyong, Natnaree, 486 Bai, Jinbing, 463
Akyol, Mesut, 1026 Baik, Sunghee, 931
Alexander, Maryann, 443 Bajnok, Irmajean, 57, 130, 147, 249, 254
Alexandrov, Anne Wojner, 691 Baldwin, Carol M., 551
Allana, Saleema Mansoor, 648 Barker, Elizabeth R., 256
Aloweni, Fazila, 299 Barlas, Gul Unsal, 287
Alper, Paul, 774 Basbozkurt, Mustafa, 730
Alvina Santos, Mariana, 279 Bastos, Fernanda S., 530, 1146
Amar, Angela Frederick, 1138 Beck, Alan M., 304
Amatuli, Dean J., 486 Befus, Montina B., 673
Andrews, Jeannette, 663 Behan, Deborah, 1027
Andrews, Taylor, 881 Beitler, Jonathan, 1057
Anglade, Debbie, 509 Belaya, Vina Grace, 415
Angosta, Alona, 523 Berry, Diane C., 486
Anonuevo, Cora A., 1062 Beswick, Susan, 594
Anyanwu, Ngozi, 818 Betts, Kelly J., 161
Aoki, Kyoko, 1017 Binks, Martin, 818
Aoun, Samar, 276 Black, Sally, 125
Apa, Zoltan L., 673 Black, Stephanie, 110
Apple, Kathy, 222 Bloomer, Melissa, 876
Ardic, Elif, 287 Bogossian, Fiona, 495
Arevalo-Flechas, Lyda, 338 Bonham, C. Elizabeth, 319
Arif, Shazia, 174 Bonugli, Rebecca, 903
Aroian, Karen, 427 Bormann, Jill, 881
Arredondo, Ana María, 975 Bortz, Anat Peles, 248, 403
Aruffo, Sylvia, 260 Boswell, Carol, 818
Asano, Yoshinobu, 885 Botma, Yvonne, 413
Ashkenazi, Tamar, 403 Bournes, Debra A., 147
Aslan, Ozlem, 718, 1026 Boursaw, Blake, 542
Atalanta Wan, Lai Ping, 682 Bowen, Felesia Renee, 186
Atherton, John, 359 Bowers, Barbara, 617
Aungsuroch, Yupin, 777 Boyd, Cheryl L., 1161
Aurelien, Louise, 1163 Braaf, Sandy C., 390
Ayoola, Adejoke B., 274, 864 Brito, Alice, 530, 1146
Azuma, Tomomi, 874, 901, 912 Brooks, Ann Marie T., 1135
Brown, Cary, 471
Brown, Sharon, 338
Bruner, Deborah, 1057
Buck, Jaclyn, 659, 1175, 1182
Buckley, Catherine, 1047

Buettner-Schmidt, Kelly, 542 Chen, Chung-Hey, 154
Buijck, Bianca Ivonne, 179 Chen, Hong-Sen, 570
Bulduk, Serap, 287 Chen, Hsing-Mei, 526, 1052
Bultemeier, Kaye I., 611, 973 Chen, Hung-Hui, 429
Burch, Aimee L., 759 Chen, Jih-Yuan, 566, 570
Burkard, Joseph F., 209, 881 Chen, Kuan-Ting, 853
Burrage, Joe, 843 Chen, Li-Li, 1116
Burroughs, Joseph, 1124 Chen, Mei-Ling, 985
Butell, Sue, 188 Chen, Meng-Chin, 680
Chen, Pin-Yuan, 712
C
Chen, Ping-Ho, 769, 781
Chen, Shiah-Lian, 291, 810
Chen, Shing-Chia, 958
Chen, Shu-Chuan, 832, 988, 1075
Chen, Shu-Ming, 313
Campbell, Heather, 594
Chen, Shu-Wen, 272, 807
Campos, Maria Joana, 461, 1147
Chen, Tzu-Chun, 891, 929
Campos, Peter E., 574
Chen, Wei-Ching, 1086
Carbonu, Dora Maria, 194
Chen, Wei-Jen, 926
Carhuapoma-Acosta, Mistral, 1002
Chen, Wei-Yu, 866
Caricativo, Ruel Dupan, 375, 434
Chen, Wen-Kuei, 878
Carrillo-Cervantes, Ana Laura, 1002
Chen, Wen-Ting, 580
Caruso, Alessandra J., 1038
Chen, Yao-Mei, 539
Casey, Baretta R., 559
Chen, YiChun, 765
Casey-Lockyer, Mary, 241
Chen, Ying-Hsiu, 580
Chae, Sena, 811
Chen, Yu-Cheng, 1082
Chan, Claudia Kor Yee, 1139
Cheng, Chi-Yun, 866
Chan, Gloria, 1141
Cheng, Chia-Hsin, 933
Chan, Helen Y. L., 220, 713
Cheng, Wei-Ping, 687
Chan, M. Y., 507
Cheng, Ya-Ching, 698
Chan, Shu-Ya, 1029
Chen-Lim, Mei Lin, 289
Chang, Anne M., 253, 359
Cheung, Eric, 439
Chang, Chia-Chi, 865, 900
Chi, Kwan-Hwa, 722
Chang, ChiaoWen, 396
Chi, Mei-Ting, 588
Chang, Hsiang Han, 836
Chi, Wan Yu, 907
Chang, Kuang-Yi, 498
Chiang, Chun-Ying, 589, 926
Chang, Nien-Tzu, 1179
Chiang, Hsien-Hsien, 269
Chang, Shu-Chen, 955
Chiang, I-Chyun, 819
Chang, Shu-Fang, 782
Chiang, Li-Chi, 959
Chang, Su-Hsien, 252, 929, 1097
Chiang, Vico C. L., 507
Chang, Sun Ju, 839
Chiarella, Mary, 474
Chang, Wen-Yin, 886
Chien, Chun-O, 1071
Chang, Yia-Ling, 1045
Chien, Li-Yin, 406, 428, 429, 498, 769, 781
Chang, Yuan-Ping, 924
Chien, Shu Chun, 998, 1036
Chao, An-Na, 832, 988, 1075
Chien, Wai Tong, 439
Chao, Mei-Chyn, 570
Chin, Yen-Fan, 721
Chao, Shu-Mei, 1066, 1078
Chin-Tun, Hung, 1116
Chau, Janita Pak-Chun, 205, 688, 740
Chiou, Ai-Fu, 1045
Chee, Wonshik, 476, 867
Chiou, Chou-Ping, 743, 943, 963
Chen, Ai-Chieh, 428
Chiou, Shu-Ti, 406
Chen, Chen-Mei, 909
Chipps, Esther M., 1182
Chen, Cheng-Kang, 1023
Chiu, Hsiao-Yean, 712
Chen, Chin-Mi, 1086
Chiu, Wan-Wen, 539
Chen, Ching-Huey, 396, 1016
Cho, Dong Sook, 1090
Chen, Chin-Mi, 1129, 1130, 1131
Choi, Hanna, 947
Chen, Ching-Min, 886, 977
Choi, Hyoungshim, 1095

Choi, Jihea, 827, 1103 Degroote, S., 622
Choi, Kyung Sook, 316, 783 Delabra-Salinas, Maria Magdalena, 1002
Choi, Suyoung, 746, 839 Deleon, Diego, 804
Choi, Yun-Kyoung, 364 Delesie, L., 622
Chou, Fan-Hao, 819, 836 Dello Stritto, Rita Ann, 668
Chou, Li-Na, 832, 847 DeRanieri, Joseph, 619
Chou, Yiing-Jenq, 498 deRose, Barbara, 624
Choudhury, Rachel, 123 DeVon, Holli A., 646
Chow, Joyce, 415 Dickison, Philip, 222
Chow, Susan Ka Yee, 555 Digby, Robin, 876
Chu, Kuei-Hui, 428 Dinndorf-Hogenson, Georgia A., 374
Chua, Rowena Escolar, 336 Dixon, Kathleen, 177
Chugn, Hui-Ju, 907 Dobbins, Maureen, 299
Chung, Tsui-Fen, 955 Dodd, Sara L., 818
Cianelli, Rosina, 425, 446, 509 Dongol, Merina, 521
Ciliska, Donna, 299 Douglas, Clint, 1132
Ciou, Ya-Lin, 1082 Doumit, Rita, 417
Clark, Mary Jo, 216 Drury, Vicki, 276
Clark, Myra Leslie, 466 Duffield, Christine, 586
Cleveland, Lisa M., 388, 903 Duffy, Joanne R., 777
Cleverley, Kristin, 128 Dy Bunpin, Jose J., 371
Code, Marc E., 791 Dyches, Tina, 314, 837
Cohen, Bevin, 774
E
Colin, Jessie M., 634
Concepcion, Chanell Jan C., 469
Conroy, Shelley F., 151
Constantino, Rose E. , 1123
Conway, Laurie, 774
Ea, Emerson Eresmas, 833
Cope, Vicki, 133, 358
Edwards, Helen Ethel, 253
Corcoran, Christine Marie, 320
Edwards, Nancy E., 304, 331
Cornett, Stephanie, 119
Edwards, Sara Mitchell, 665
Costa, Linda, 203
Edwards, Quannetta T., 754, 1172
Cote-Arsenault, Denise, 614
Egerod, Ingrid, 1153
Cotton, Antoinette, 335
Eldridge, Marlo Ann Michelle, 699
Courtney, Mary, 359
Eley, Robert M., 650
Covey, Robin, 758
Epel, Orna Baron, 431
Cowan, Stephanie, 628
Epeneter, Beverly J., 188
Craigie, Leanne, 628
Craigie, Mark, 276
F
Crawford, Kimberley, 441, 876
Criscitelli, Theresa M., 764
Cullen, Laura, 57
Curran, Connie R., 149
Curtis, Laura H., 151 Fairbrother, Greg, 582
Custard, Kristi M., 379 Fan, Jun-Yu, 418
Fang, Su-Ying, 891
D
Fang, Yueh-Yen, 539, 580, 655
Fazylova, Natalya, 213
Ferrans, Carol Estwing, 500
Ferrer, Lilian, 446
Ferris, Ella, 594
Daramola, Iyabo, 216
Fillmore, Laura, 193
De Gagne, Jennie Chang, 684
Finlayson, Kathleen, 253
De Natale, Mary Lou, 226
Flogen, Sarah, 294
De Santis, Joseph P., 804
Flores, Bertha Eloisa, 338
Decker, Sally A., 251
Fong, Yao, 779

Ford, Cindy, 417 Groenwald, Susan L., 149, 330
Fowler, Kimberly A., 143 Guedes, Erika de Souza, 279, 1050
Fox-Young, Stephanie, 650 Gul, Raisa, 654
France, Marie-Carole, 1164
H
Francis, Karen, 276
Freeborn, Donna, 314, 837
Freeze, Desirae, 606
French, Kempa (Kim), 182
Friese, Tanya R., 117
Haase, Joan E., 1129, 1130, 1131
Frohman, Rena, 175
Haba, Kaori, 940, 1003, 1009
Fu, Tz-Ling, 866
Hai-Peng, Yung, 979
Fujimura, Maki, 1020
Hall, Emily Gail, 486
Fukuoka, Yasuko, 1109
Ham, Ok Kyung, 476, 867, 1126
Fukuroku, Keiko, 207
Hamahata, Akiko, 948
Fukuta, Daisuke, 1063
Hammonds, Carol L., 483
Fulton, Cathy R., 835
Han, Hae-Ra, 467
Han, Kihye, 488
G
Hand, Mikel W., 404
Hande, Karen A., 132
Hanes, Patricia Frohock, 758
Hanohano, Carolyn, 758
Galbraith, Adrienne A., 387 Hanson, Julie, 820
Gallagher-Ford, Lynn, 1160, 1175 Hao, Sheng-Po, 722
Gambhir, Rupa, 1038 Harris-Cobbinah, Deborah A., 262
Gan, Zhang-Ya, 866 Hawkins, Shelley, 763
Ganann, Rebecca, 299 Hayden, Jennifer K., 443
Gance-Cleveland, Bonnie, 1149 Haynie, Keith Bryan, 109
Gannaway, Paula, 417 Hazoref, Rivka, 248
Ganz, Freda DeKeyser, 136 Hazzan, Afeez, 299
Garcia-Houchins, Sylvia, 536 He, Jinai, 258
Garcia-Meza, Wendy, 1002 Hebert, Maude, 334
Gardner, Marcia, 157 Hegney, Desley G., 276
Gatto, Janet A., 659 Helgesen, Kathleen, 763
Gau, Bih-Shya, 748, 1025 Hemsworth, David, 276
Gearhart, John Phillip, 699 Hendel, Tova, 202
Gehrs, Margaret, 752 Henderson, Shakira, 271, 987
George, Sino S., 824 Hendricks, Joyce M., 133, 358
Gibb, Michelle, 253 Heneka, Nicole, 608
Gibson, Annette, 283 Heo, Narae, 922
Gibson-Young, Linda M., 113 Hershorin, Indra, 106
Gill, Sara, 338 Hickman, Louise D., 608
Glazer, Greer L., 297 Hickson, Josiane, 139
Glew, Paul J., 177 Hickson, Shondell, 182
Golea, Gabriella, 752 Higajima, Sayaka, 919
Gomez, Carmen Maria Urruita, 702 Higgins, Kristin, 1057
Gonzales, Mildred C., 1111 Higgins, Melinda, 512
González, Hermes, 975 Hillege, Sharon Patricia, 177, 640
Gonzalez-Guarda, Rosa Maria, 425, 446 Hilliard, Wanda L., 806
Good, Anthony, 177 Hinderer, Katherine A., 674
Gowani, Ambreen Amirali, 532 Hiramatsu, Takako, 1031
Grabbe, Linda, 1083 Hiyama, Akiko, 927
Green, Amanda Constance, 813 Ho, Chiung-Fang, 701
Griffiths, Peter, 407 Ho, Hsueh-Jen, 832, 988, 1075
Grigsby, Rebekah, 255 Hodges, Pamela J., 112
Grinspun, Doris, 130, 249, 254 Hohashi, Naohiro, 822

I
Holmes, Carol, 254
Holt, Lindsay Cosco, 881
Honda, Junko, 822
Honda, Teruko, 885
Hong, OiSaeng, 517
Ignacio, Alfie Jay C., 197, 676
Hong, Rei-Mei, 418, 798, 866
Iino, Hidechika, 885
Hong, Sehoon, 1103
Ikeda, Chizuru, 1020
Hoogbruin, Amandah L., 642
Ikoma, Chie, 596
Hooshmand, Mary A., 385
Im, Eun-Ok, 476, 867, 1126
Horton, Eleanor S., 332
Im, Mihae, 855
Hoshi, Miwako, 1020
Infanti Mraz, Megan A., 229
Ho-Shing, Donna, 326
Ip, Wan Yim, 465
Hoying, Jacqueline, 1170
Iqbal, Sajid, 654
Hrabe, David P., 659
Ito, Misae, 1084
Hsiao, Chiu-Yueh, 623
Iwamoto, Teruyo, 885
Hsiao, Fei-Hsiu, 958
Iwanaga, Kazuyo, 940, 1003, 1009
Hsiao, Li Yu, 318
Iwata, Hiroko, 1017
Hsiao, Shu-Chen, 678
Hsieh, Li-Wei, 720
J
Hsieh, Ming-Hsien, 958
Hsieh, Pi-Ching, 946, 954
Hsieh, Ya-Hui, 955
Hsu, Lan-Fang, 708
Hsu, Mei-Hwa, 428 Jacobson, Carrie, 1087
Hsu, Shu-Chen, 704 Jacobson, Diana L., 1150, 1169
Hsu, Su-Ping, 694 James, Ainsley M., 578, 1113
Hsu, Ya-Ting, 1022 James, Kathy, 216
Huang, Chia-Ju, 933 Jang, Haena, 164
Huang, Chiung-Yu, 878, 962 Jarrett, Sara L., 641
Huang, Chun-Hsia, 1046 Jefferson-Walker, Maria, 716
Huang, Guey-Shiun, 750 Jeffs, Lianne P., 594
Huang, Hsiu-Mei, 891 Jelley, Amy, 973
Huang, Mei-Chih, 916 Jeng, Chii, 796
Huang, Min-Feng, 389 Jenkins, Peggy A., 502
Huang, Nicole, 406 Jensen, Linda E., 239, 603
Huang, Pei-Chen, 858 Jeong, Geum-Hee, 931
Huang, Sheng-Miauh, 769, 781 Ji, Eun Joo, 993
Huang, Tsai-Wei, 810 Jiang, Nan, 463
Huang, Tzu-Ting, 721 Jiin-Ru, Rong, 1092
Huang, Yi-Ying, 722 Johnson, Emily, 274
Huang, Yu-Chen, 269 Jones, Christina, 1154
Huang, Yun-Yi, 814 Joo, Jee Young, 695
Hummel, Faye I., 641 Jueng, Ruo-Nan, 1105
Hung, Chich-Hsiu, 956 Jung, Hyesun, 1126
Hung, Kai-Wen, 1016 Jurado, Leo-Felix M., 378
Hunt, Leanne, 640
K
Hwang, Eunkyung, 707
Hwang, Fang-Ming, 406, 429, 819
Hwang, Ji Young, 873
Hwang, Won Ju, 517
Hyatt, Kyong S., 571
Kaczynski, Karen J., 1038
Hyatt, Lauren, 971
Kadoviæ, Marija, 246
Kaelber, Lorena, 446
Kai, Ichiro, 940, 1003, 1009
Kain, Victoria, 650

Kajiwara, Emi, 885 Kitchens, Jennifer L., 843
Kamile, Sekmen, 1026 Klakovich, Marilyn D., 302
Kamouchi, Masahiro, 1109 Klein, G. Jean, 456
Kane, Helen S., 234 Klopper, Hester C., 57, 58, 60
Kang, Chulhee, 487 Ko, Jen-Kuei, 566
Kang, Duck-Hee, 411 Ko, Shuk Yee, 740
Kang, Fung-Yu, 733 Kobiyama, Atsuko, 912
Kang, Hee Sun, 911, 1001 Koh, Choon Huat, 363
Kang, Mei-Yu, 955 Komatsu, Misa, 948
Kang, Sunjoo, 285 Kondo, Yuri, 1020
Kang, Youjeong, 476, 867 Koren, Ainat, 342
Kangchanakul, Suthanithi, 854 Kostner, Karam, 359
Kanha, Suthada, 711 Kotake, Kumiko, 940, 1003, 1009
Kao, Feng-yu, 498 Koyano, Yasuko, 685
Kaplan, Barbara, 159 Kozachik, Sharon, 545, 990
Karian, Victoria E., 1038 Kraus, Sebastian, 1158
Kasedluksame, Suthathip, 710 Krouse, Melissa, 456
Katagiri, Tomoko, 1036 Ku, Yu-Hui, 798
Kato, Mariko, 901 Kue, Jennifer, 1167
Kawabe, Fusako, 998, 1036 Kulik, Susan, 203
Kawahara, Yukari, 882, 896, 930 Kuo, Hui-Ting, 858
Kawamoto, Rieko, 940, 1003, 1009 Kuo, Shih-Hsien, 1082
Kawi, Jennifer, 528 Kuo, Shu-Fen, 886
Kearney, Lauren, 628 Kuo, Yu-Chen, 698
Keinan-Boker, Lital, 431 Kuroda, Hiromi, 919
Kelley, Susan J., 574 Kuroki, Helen M., 1135
Kennison, Monica, 105 Kwan, Rick Y. C., 1120
Kent, Bridie, 363 Kwon, Eunok, 316
Khouri-Stevens, Zeina, 699
L
Kiguchi, Sachiko, 927
Kim, D. H., 911
Kim, Eun-Young, 1043
Kim, Hee Soon, 487
Kim, In-Sook, 285
Ladores, Sigrid Lynn, 427
Kim, Jeung-Im, 964
Laforteza, Jozelle, 216
Kim, Jiin, 155, 693
Lai, Chi Shiu, 915
Kim, Jiyoung, 922
Lai, Chien-Yu, 1071
Kim, Jung, 1069
Lai, Claudia K. Y., 62, 1120
Kim, Keum Soon, 364
Lai, Hui-Ling, 878, 962
Kim, Kim B., 467
Lam, Lai Wah, 465, 553
Kim, Kyung-mi, 935
Lam, Lawrence T., 608
Kim, Kyungwon, 931, 738
Landrum, Peggy A., 668
Kim, Min Young, 707
Lane, Shana, 505
Kim, Miyong T., 467
Larson, Richard S., 505
Kim, Myogyeong, 364
Larson, Elaine, 673, 774
Kim, Oksoo, 938
Lassegard, Julia, 540
Kim, Se-an, 746, 839
Lauer, Maria E., 606
Kim, Sue, 1106
Lavender, Julie A., 235
Kim, Sung Reul, 817
Lazdowsky, Lori A., 1038
Kim, Sun Hee, 1001, 1060
LeBel, Alyssa A., 1038
Kim, Sun-Hee, 893
LeBlanc, Natalie, 804
Kim, Sunhwa, 968
Lee, Bokim, 1126
Kim, Yeon Hee, 783
Lee, Chee-Siong, 526
Kim, Young Bum, 1127
Lee, Ching-Fang, 819
Kim, Young Mee, 707
Lee, Diana T. F., 220, 361, 401, 729
Kitagawa, Akira, 596

Lee, Eunkyoung, 993 Lin, Hung-Yen, 589
Lee, Fung-kam Iris, 401 Lin, Kai Ching, 915
Lee, Hae-Kyung, 695 Lin, Kuan-Chia, 946
Lee, Haeyoung, 1100 Lin, Kuei-Ching, 706
Lee, Hanju, 911 Lin, Li-Wei, 680
Lee, Hyeonkyeong, 487 Lin, Luan-Chen, 1082
Lee, Ja-yin, 487 Lin, Pei-Chao, 956
Lee, Kuen-Tai, 694 Lin, Quinran, 258
Lee, Kwang Ok, 873 Lin, Shu-Yuan, 808
Lee, Kyongeun, 1095 Lin, Tzu-Chia, 1023
Lee, Kyoung Suk, 559 Lin, W. L., 507
Lee, Li Hua, 687 Lin, Wei-Chun, 904
Lee, Mei Ching, 674 Lin, Ya-Wen, 1115
Lee, Nam-Ju, 164 Lin, Yen-Chiun, 1180
Lee, Pei-Yu, 788 Lin, Yi-Chen, 891
Lee, Seung Hee, 1127 Lin, Ying-Hui, 566
Lee, Shiuyu Katie C., 267 Lin, Ying-Ju, 1023
Lee, Shu-Hung, 808 Lin, Yu-Chen, 706
Lee, Soo Jin, 746, 839 Lin, Yueh-E., 742
Lee, Tae Wha, 487 Lin, Yu Fang, 900
Lee, Tsorng-Yeh, 410, 960 Lin, Yu-Huei, 796
Lee, Wen-Lieng, 291 Linhart, Monika, 1157
Lee, Yaelim, 867 Lipowich, Dina, 232
Lee, Yu-Jin, 893, 1060 Liu, Chia-Chi, 1023
Lee-Wen, Pai, 1116 Liu, Hsiu-Chu, 706
Lefkowitz, Amanda, 644 Liu, Hsueh-Erh, 394, 722, 1034
Lei, Hsiu Hui, 687 Liu, I-Chao, 689
Lemcke, Pamela M., 175 Liu, Lin, 881
Lennie, Terry A., 559 Liu, Meng-Chi, 570
Leung, Angela Yee Man, 362 Liu, Pei-Ching, 748, 1025
Leung, Doris Y. P. , 713, 729 Liu, Sara Hsin-Yi, 958
Leung, Mason C. P., 1120 Liu, Wen-I, 825
Leung, Yuen Ling, 688 Liu, Xueyan, 768
Levitt, Cheryle G., 600 Livingston, LaDean J., 691
Li, Chia-Chien, 884 Lo, Hoi Shan, 1119
Li, Ching Ching, 729 Lo, Joyce, 594
Li, Chiu-Hua, 943 Lo, Wen-Yen, 406
Li, H. C., 507 Lobo, Marie L., 542
Li, I-chuan, 392 Lockwood, Craig, 57
Li, In Fun, 1014 Loke, Alice Yuen, 616
Li, Polly W. C. , 361 Lombardo, Lien, 177
Li, Wan-Jing, 452 Lo-Montano, Romina, 761
Liang, Hui-Yu, 602, 915 Long, Ann, 588
Liang, Jiun-Ying, 655 Long, JoAnn D., 417, 818
Liao, I-Chen, 291, 810 Lou, Meei-Fang, 984
Liao, Yuan-Ju, 748 Low, Jac Kee, 441
Liao, Yu Chen, 914 Lowder, Emily, 125
Liew, Danny, 390 Lowe, Katharine, 456
Likitwong, Pavadee, 711 Lowy, Franklin D., 673
Lim, Enjung, 331 Lu, Chu-Yun, 589
Lim, Fidelindo, 282 Lu, I-Chen, 744
Lin, Chia-Jung, 916, 1105 Lu, Ming-Huei, 392
Lin, Chiung-Hua, 1075 Lu, Ti, 588
Lin, Chiung Yu, 915 Lu, Ying-Chin, 853
Lin, Fang-Ru, 1099 Lubbe, Johanna Catharina (Irene), 593
Lin, Feng Lien, 840 Luiking, Marie-Louise, 829

Lumini Landeiro, Maria José , 1147 Melkus, Gail D'Eramo, 486
Lyle, Rachel Marie, 1027 Mellott, Karen G., 112
Lyndon, Audrey, 1087 Melnikov, Semyon, 403
Melnyk, Bernadette Mazurek, 57, 659, 1160,
M
1170
Meng, Jing, 437
Menon, Usha, 1166
Macedo, Sofia, 1047 Merrill, Katreena, 490
Macintosh, Christopher I., 490 Mesler, Donna M., 157
Messmer, Patricia R., 283
Macintosh, Janelle L. B., 490
Metsch, Lisa R., 421
Mackert, Michael, 338
Miller, Andrew, 1057
Macomber, Catherine, 387
Maeda, Takashi, 1036 Miller, Cathy, 225
Maeda, Yurie, 1020 Miller, Megan, 536
Maehara, Kunie, 1017 Minter, Bonnie, 512
Mitchell, Emma, 509
Maekawa, Tomoko, 1017
Mitchell, Karen Elizabeth, 201
Maekawa, Yasuko, 770
Mitrani, Victoria B., 421, 509, 804
Mahoney, Ashley Darcy, 512
Mahoney, Elyse D., 1038 Miyashita, Tomoko, 919
Mak, Yim Wah, 616 Mochizuki, Yoshimi, 1017
Makaya, Miyuki, 1017 Mokoboto-Zwane, Theresa Sheila, 656
Molina, Wendy, 975
Mandleco, Barbara L., 314, 837
Monteiro da Cruz, Diná de Almeida Lopes, 279,
Maneval, Rhonda E., 143
Manias, Elizabeth, 390, 441 1050
Manila, Vanessa, 479 Montgomery, Susanne, 631
Mannix, Judy, 577, 797 Moorman, Meg, 670
Mordiffi, Siti Zubaidah, 363
Maradiegue, Ann H., 754
Mori, Chizuru, 1063, 1072
Mariappan, Umapathi, 340, 775
Mori, Emi, 1017
Markley, Valerie N., 170
Martin, Judy, 1153 Mori, Makiko, 725
Martins, Teresa, 1147 Morita, Akiko, 1017
Maruyama, Akiko, 874, 912 Moriyama, Michiko, 790, 951, 1109
Moroney, Tracey L., 970
Mathibe-Neke, Johanna M., 575
Morris, Jenny, 121
Matsui, Miho, 652, 870
Morse, Cheranne, 751
Matsuzawa, Akemi, 1053
Mavhandu-Mudzusi, Azwihangwisi, 308, 424, Moser, Debra K., 559
Mudd-Martin, Gia, 559
795
Mawhinney, Janet, 128 Mueller, Martina, 663
Mui, Jolene, 439
McArdle, Traci, 411
Mukherjee, Dhritiman, 673
McCabe, Brian E., 421, 425, 804
Mumba, Mercy N., 1027
McCarthy, Ashley M., 1038
McConnell, Bridget Anne, 382 Munyewende, Pascalia Ozida, 515
McConnell, Heather, 249, 254 Murray, Meghan, 774
Muya, Makiko, 898
McCormack, Brendan, 57
McDonald, Glenda E., 640
N
McFall, David Curk, 218
McGlown, K. Joanne, 60
McKibbon, Ann, 299
McLemore, Monica, 266
McMurray, Robert G, 486 Nagamatsu, Yuki, 940, 1003, 1009
Medacier, Odiane, 1163 Nagata, Akiko, 998, 1036
Mee, Cheryl L., 196 Nakamura, Megumi, 948
Meek, Julie, 835 Nakashima, Tomoharu, 770
Meininger, Janet C., 483 Nakaya, Takashi, 790
Nam, Chung-Mo, 487

P
Nantsupawat, Apiradee, 278
Nash, Mary G., 1176, 1183
Nash, Robyn E. , 175
Nation, Austin, 801
Naugton, Krissy, 342
Page, Gayle G., 545, 990
Neal, Madeline, 486
Pajarillo, Edmund J. Y. , 369
Neiheisel, Mary, 1144
Pakieser-Reed, Katherine, 125, 536
Newman, Kristine, 299
Palaganas, Erlinda Castro, 375, 434
Newsom, Terri L., 568
Pan, Hui-Yi, 1023
Newton, Scott M., 180
Pan, Wan-Lin, 849
Ng, Linda C., 650
Pancharean, Sudkanya, 1042
Ng, Mi Fun, 713
Paper, Bruce, 388
Ng, Wai I, 293
Park, Jiyoung, 487
Nho, JuHee, 817
Park, MiJeong, 1106
Nicolas, Marie Guerda, 509
Paterson, Jane, 752
Niemi, Charlene, 758
Pau, Margaret Mei Lin, 454
Ning, Pei-Shun, 1115
Pechaty, Theresa Ann, 244
Nishimura, Naoko, 770
Peker, Haia, 445
Noguchi, Yoshimi, 770
Pennings, Kendra, 274, 864
Nogueira, Lilia de Souza, 279
Peragallo, Nilda (Nena), 425, 446, 509
Noonil, Naiyana, 621
Pereira, Filipe Miguel Soares, 496, 530
Novak, John M., 559
Perez, Maria Julia, 702
Perkins, Jayne, 806
O
Peterkin, RoseMarie, 343
Peters, Kath, 335, 797
Petsirasan, Rewwadee, 167
Pettigrew, Amy C., 283
Oda, Hideko, 885 Pfaff, Teresa A., 702
Ogawa, Keiko, 882, 896, 930 Phanjam, Nongnapas, 710
Ogaz, Veletta, 758 Phelan, Carey Marie, 561
Oh, Hyunjin, 935 Phillips, Candice, 123
Oh, Jina, 684, 855 Phillips, Jane L., 608
O'Hara, Tricia, 366 Phillips, Judy Lynn, 264
Ohue, Takashi, 790 Phillips, Leah M., 606
Okpomeshine, Christine, 458 Phillips, Nicole M., 363
Ong, Luke, 1057 Phom, Shu-Ling, 779
Ong, Shu Fen, 845 Piamjariyakul, Ubolrat, 799
Ono, Satoko, 885 Piao, Shih-Ting, 1098
Oosthuizen, Martha, 412 Pickett, Stephanie, 1080
Opperman, Cathleen, 141 Pien, Li-Chung, 872
Ordona, Ron Billano, 856 Pilkington, F. Beryl, 410
Orr, Patty M., 182 Pires, Regina Maria, 496, 547, 548
Oruche, Ukamaka Marian, 513 Polis, Nikki S., 1137
Osborne, Sonya R., 1133 Pollard, Melissa A., 635
Ossey, Shamika Tishema, 227 Polsook, Rapin, 777
Otsuka, Shizuka, 948 Pontes, Manuel C. F., 511
Ou, Yi-Chiu, 1105 Pontes, Nancy M. H., 511
Oulanov, Alexei, 369 Poon, Wai Sha, 653
Ozawa, Harumi, 1017 Porter, Joanne, 317
Porter, Luz S., 557
Powell, Idona N., 582, 773
Pretzer-Aboff, Ingrid, 619

R
Sato, Shiho, 921
Sato, Yukiko, 901, 912, 921
Sau Man Conny, Chan, 205
Scanlon, Jordan, 837
Schaefer, Florence, 380, 851
Rajcan, Lois, 229
Scharf, Mary Ann, 343
Rauscher, Garth, 500
Schipper, Laura, 864
Raymond, Rebecca, 973
Schnabel, D. J., 1142
Reeder, Sandra, 384
Schreiner, Barb, 196
Reid, Carol, 1132
Schwartz, Todd A., 486
Reifsnider, Elizabeth, 1149
Schwindt, Rhonda Garrett, 306
Reis dos Santos Ferreira, Maria Margarida,
Senda, Michiko, 1031
547, 548
Seo, Kyoungsan, 746, 839
Reynaga-Ornelas, Luxana, 551
Serratt, Teresa D., 450
Richard, Lauralie, 658
Shaibu, Sheila, 268
Ricossa, Katherine, 518
Shannon, Marcia Rucker, 258, 521
Risenga, Patrone Rebecca, 1049
Sharoff, Leighsa, 150
Rispel, Laetitia C., 409
Shaw, Holly, 1141
Rixon, Sascha P., 390
Shaw, Tim, 608
Roberts, Lisa R., 631
Shen, Chi-Hsiang, 766
Roberts, Mary Ellen, 1145
Shi, Timothy, 1142
Rocha, Inês Alves da Rocha e Silva , 547
Shiao, Shyang-Yun Pamela K., 750, 1111, 1178
Roche, Michael A., 586
Shiau, Shu-jen, 958
Rodríguez-Pérez, Christian, 551
Shida, Kyoko, 898
Roe, Elizabeth, 199, 251, 387
Shih, Miao-Fung, 847
Roets, Lizeth, 593
Shirey, Maria R., 319
Rogers, Toby, 818
Shiroki, Yuko, 1053
Roh, Hyerin, 855
Shrestha, Unisha, 521
Rong, Jiin-Ru, 694, 704, 825
Shu-Chuan, Chang, 1116
Roper, Susanne Olsen, 314, 837
Shun, Shiow-Ching, 884
Rosenfeld, Anne, 646
Silva, Abel Paiva, 461, 1147
Ross-Adjie, Gail, 459
Silva, R. C. G., 1050
Ru, Yang-Jing, 866
Silva-Fhon, Jack Roberto, 1002
Rudyung, Thanat, 710
Simmons, Anne Marie, 356
Ruey-Hsia, Wang, 926
Simons, Laura, 1038
Ryan, Teresa W., 612
Sinnott, Loraine, 659
Slizewski, Nancy J., 756
S
Small, Leigh, 1151
Smith, Carol E., 799
Smith, Claudia DiSabatino, 379
Smith, Elaine, 590
Saad, Levina, 970 Smith, Gilly, 358
Sadahiro, Wakako, 927 Smith, Graeme D., 309, 734
Saeki, Akiko, 1017 So, Winnie Kwok Wai, 401
Saeki, Yuka, 1006 Solis, Linda Grace, 388
Saengsiri, Aem-orn, 854 Somani, Rozina, 345
Saiman, Lisa, 774 Song, Misoon, 746, 839
Saito, Miyuki, 874, 901, 912 Sousa, Regina Márcia Cardoso de, 279
Saito, Shinobu, 998, 1036 Sowicz, Timothy J., 476
Sakajo, Akiko, 1017 Sparks, Madelyn Marie, 1033
Salamonson, Yenna, 177 Springer, Janice D., 241
Samson, Linda F., 260, 637 Spurlock, Darrell, 107
Sanchez, Marian Caterial, 375 Srivastava, Rani Hajela, 128, 752
Sanchez, Raissa Lynn, 1141 Stanik-Hutt, Julie A., 214, 736
Sandy, Peter Thomas, 308, 424, 795 Stanton, Jennifer, 342
Sangpraseart, Atcharobon, 1041 Steffan, Alana, 646

Sternas, Kathleen A., 343 Travers, Mark J., 542
Stewart, Diane, 157 Trevathan, Enna E., 226
Stewart-Pyne, Althea, 130, 249 Trudgeon, Ruth, 119, 1172
Su, Hui-Fang, 946, 954 Tsai, Hsiao-Wei, 190
Su, Ji-An, 798 Tsai, Jen-Chen, 525
Su, Mei-Chen, 859 Tsai, Liang-Miin, 526
Su, Shu-Fang, 539 Tsai, Pei-Shan, 525, 647, 689, 708, 900
Su, Yi-Lin, 793 Tsai, Pi-Kuang, 1052
Suemitsu, Junko, 885 Tsai, Shin-Yann, 734
Sugawara, Hiromi, 1072 Tsai, Yu-Hsia, 394, 1034
Sujung, Liao, 1092 Tsao, Lee-Ing, 859
Summerly, Janet, 343 Tsay, Pei Kwei, 722
Sun, Fan-Ko, 588, 589, 926 Tseng, Chien-Ning, 984
Sung, Huei Chuan, 359, 734 Tse-Tsung, Liu, 1092
Suzukamo, Yoshimi, 940, 1003, 1009 Tsuchiya, Miyako, 1017
Suzuki, Eiko, 874, 901, 912 Tsuda, Shigeko, 1053
Swanson, Christine, 603 Tsuji, Yoko, 1006, 1011
Sylvers-Sidney, Sharon E., 227 Tuason, Ivy, 119, 1173
Sylvia, Martha, 492 Tuazon, Josefina A., 479, 661
Szalacha, Laura, 1167 Tuckett, Anthony G., 495, 650
Tung, Wan-Chun, 891
T
Turner, Laureen E., 115
Turrini, Ruth Natalia Teresa, 279
Tzeng, Yu-Fen, 748, 1115
U
Tai, Chen-Jei, 769, 781
Takahashi, Aya, 940, 1003, 1009
Takase, Miyuki, 944
Takayama, Yuko, 912
Takeda, Keiko, 871 Unal, Nursemin, 730
Takeshita, Yae, 951, 1109 Ura, Darla, 159
Tam, Mee Ling Bonnie, 533 Urata, Hideko, 919
Tamakoshi, Koji, 1017
V
Tanaka, Sachiko, 882, 896, 930
Tanaka, Sayuri, 861
Tang, Fu-In, 979
Tao, Xingjuan, 555
Taylor, Bonnie, 388
Van Rensburg, Gisela H., 599
Tejero, Lourdes Marie S. , 479
Vandijck, D., 622
Teng, Helen, 867
Varga, Christine Amalia, 966
Teng, Hsiu-Lan, 1054
Vera-Delgado, Karla Susana, 551
Teraoka, Sachiko, 944
Verasia, Shirin Badruddin, 174, 372
Terhaar, Mary, 492
Vermeir, P., 622
Terry, Anina, 702
Vernon, Rachael A., 474
Thanasilp, Sureeporn, 777
Vetter, MaryJo, 134
Thanomlikhit, Chanya, 711
Vieira, Joana Isabel, 548
Thomas, Christine, 229
Villarreal-Reyna, María de los Ángeles, 975,
Thompson, David, 299
1002
Throckmorton, Terry, 110, 568
Villegas, Natalia, 425, 446
Tigges, Beth Baldwin, 505
Vogelaers, D., 622
Tingen, Martha S., 663
Von Eeden, Lorraine A., 168
Tobback, E., 622
Todd, Midhael, 551
Tokushige, Atsuko, 861
Tosun, Betul, 718, 730

W
Wu, Jih-Hsuan, 865
Wu, Li-Fen, 914
Wu, Li-Min, 1129, 1130, 1131
Wu, Linden, 1123
Walton-Moss, Benita, 736 Wu, Mann-Chian, 734
Wang, I-Ching, 580 Wu, Mei-Ling, 643
Wang, Mei-Yeh, 689 Wu, Mei-Yun, 981
Wang, Ruenn-Ching, 1075 Wu, Pei-Jing, 1023
Wang, Shu-Hui, 1082 Wu, Shyh-Jong, 526
Wang, Ya-Fen, 288
X
Wang, Yen-Ting, 525
Wang, Yu-Rung, 977
Watanabe, Yoriko, 871
Waters, Donna Louise, 473
Watson, Karen L., 628 Xiao, Canhua, 1057
Wattenberger, Dustin, 611
Y
Wattradul, Duangkamol, 854
Wazumi, Yoshiko, 998, 1036
Wei, Chen, 1116
Weiju, Chen, 258
Weiss, Dorit, 248 Yamaguchi, Sanae, 921
Wheeler, Kathy, 1144 Yamaguchi, Satomi, 919
White, Kathleen M., 57, 214 Yamamoto, Miwa, 770
Yamamoto, Toshie, 998, 1036
Whitley, Deborah M., 574 Yamauchi, Toyoaki, 879
Whitney, Kathleen, 641 Yamazumi, Yasue, 596
Whyte, James, 448 Yang, Fang, 309
Wickens, Kathleen, 635 Yang, Hui-Ju, 498
Wieteck, Pia, 1158 Yang, Kyeongra, 644
Wilhelm, Dalit, 639 Yang, Li-Yen, 680
Wilkinson, Carole, 509 Yang, Li-Yu, 766
Williams, Allison Fiona, 390, 441, 876 Yang, Shu-Chen, 807
Williams, Jeffrey, 165 Yang, Ya-Ling, 211
Willis, Marilyn, 500 Yang, Young-Mi, 964
Yang, Yu-Ching, 858
Wilson, Linda, 234, 419
Yarimizo, Kazuko, 882, 896, 930
Wilson, Robin, 973 Yariv, Limor, 248
Winne, Andrea M., 521 Yasukata, Fumiko, 596
Witney, Cynthia A., 133 Yedinak, Christine G., 328
Wonder, Amy Hagedorn, 107 Yeh, Chun-Yin, 1016
Wong, Alice Kar Yan, 172 Yehle, Karen S., 331
Wong, Cho Lee, 465 Yen, Hsiang, 847
Wong, Frances Kam Yuet, 555 Yen, Hsueh-Wei, 526
Wong, Janet Yuen Ha, 1138 Yen, Miaofen, 720, 1055, 1066, 1078
Wong, W. M., 507 Yen, Ming-Hong, 566
Yeung, Wing Yan, 454
Wong, W. S., 507 Yi, Tsai-Tzu, 866
Woo, Ada, 222 Yim Ip, Wan, 205
Wright, Holly Marcusen, 1068 Yoder, Linda H., 218
Wu, Chia-Ling, 925 Yoho, Mary Judith, 606
Wu, Chia-shan, 1097 Yokoyama, Etsuko, 1006, 1011
Wu, Chiou-Shiang, 1082 Yoon, Heun Keung, 1103
Wu, Chiung-Jung (Jo), 359 Yoon, Ju Young, 617
Wu, Hsin-Mei, 1023 Yoshida, Fumiko, 879

Yost, Jennifer, 299
You, Mei-Huei, 698
Young, Jeanine, 628
Youngwanichsetha, Sununta, 311
Yu, Chin-Ching, 807
Yu, Ching-Len, 252, 832, 929, 988, 1097
Yu, Doris S. F., 361
Yu, Jie, 305
Yu, Pei-Jung, 733
Yu, Po-Jui, 1178
Yu, Shu, 190, 602, 1046
Yu, Su-Ying, 1077
Yueh, Fang-Ru, 1066, 1078
Yuen, Ricky W. K., 454
Yumoto, Atsuko, 882, 896, 930
Z
Zamora, Herlinda, 399
Zandee, Gail Landheer, 274, 864
Zauszniewski, Jaclene A., 288
Zeng, Min Juan, 1105
Zhang, Weihua, 159, 1083

Index of Participant Countries
A J
Australia: 57, 133, 175, 177, 253, 272, 276, Japan: 207, 596, 652, 685, 725, 770, 790, 822,
317, 332, 335, 358, 359, 363, 382, 390, 441, 861, 870, 871, 874, 879, 882, 885, 896, 898,
459, 473, 474, 495, 577, 578, 582, 586, 608, 901, 912, 919, 921, 927, 930, 940, 944, 948,
628, 640, 650, 773, 797, 820, 876, 970, 1113, 951, 998, 1003, 1006, 1009, 1011, 1017, 1020,
1119, 1132, 1133 1031, 1036, 1053, 1063, 1072, 1084, 1109
B L
Belgium: 622 Lebanon: 417
Botswana: 268
M
Brazil: 279, 1002, 1050
C Macau: 293
Malaysia: 340, 775
Canada: 57, 128, 130, 147, 194, 249, 254, 276, Mexico: 551, 975, 1002
294, 299, 334, 410, 594, 642, 658, 752, 960
N
Chile: 446
China: 205, 258, 309, 437, 463, 465, 469, 555,
678, 729, 768
Croatia: 246 Nepal: 521
Netherlands: 179, 829
D
New Zealand: 474, 628
Nicaragua: 702
P
Denmark: 1153
G Pakistan: 345, 532, 648, 654

Peru: 1002
Germany: 1157, 1158 Philippines: 336, 375, 415, 434, 479, 661,
1062
H
Portugal: 461, 496, 530, 547, 548, 1146, 1147
Hong Kong: 62, 172, 205, 220, 361, 362, 401,

439, 454, 465, 507, 533, 553, 608, 616, 688,
S
713, 729, 740, 1120, 1138, 1139 Saudi Arabia: 174, 372, 1047
Singapore: 299, 363, 845
I
South Africa: 57, 58, 60, 308, 409, 412, 413,
424, 515, 575, 593, 599, 656, 795, 966, 1049
South Korea: 155, 164, 285, 316, 364, 476,
Israel: 136, 202, 248, 403, 431, 445, 639 487, 488, 517, 684, 693, 695, 707, 738, 746,
783, 811, 817, 827, 839, 855, 867, 873, 893,
911, 922, 931, 935, 938, 947, 964, 968, 993,

1001, 1043, 1044, 1060, 1069, 1090, 1095, USA: 57, 60, 105, 106, 107, 109, 110, 112,
1100, 1103, 1106, 1126, 1127 113, 115, 117, 119, 123, 125, 132, 134, 139,
Sweden: 1155 141, 143, 149, 150, 151, 157, 159, 161, 165,
168, 170, 180, 182, 186, 188, 193, 196, 197,
T
199, 201, 203, 204, 209, 213, 214, 216, 218,
222, 225, 226, 227, 229, 232, 234, 235, 239,
241, 244, 251, 255, 256, 258, 260, 262, 264,
Taiwan: 154, 190, 211, 252, 267, 269, 291, 266, 271, 274, 282, 283, 288, 289, 297, 302,
313, 318, 359, 389, 392, 394, 396, 406, 418, 304, 305, 306, 314, 319, 320, 326, 328, 330,
428, 429, 452, 498, 525, 526, 539, 566, 570, 331, 338, 342, 343, 356, 366, 369, 371, 374,
580, 588, 589, 602, 623, 643, 647, 655, 680, 378, 379, 380, 384, 385, 387, 388, 399, 404,
687, 689, 694, 698, 701, 704, 706, 708, 712, 411, 415, 417, 419, 421, 425, 427, 443, 446,
720, 721, 722, 733, 734, 742, 743, 744, 748, 448, 450, 456, 458, 463, 466, 467, 471, 476,
750, 765, 766, 769, 779, 781, 782, 788, 793, 483, 486, 490, 492, 500, 502, 505, 509, 511,
796, 798, 807, 808, 810, 814, 819, 825, 832, 512, 513, 517, 518, 521, 523, 528, 536, 540,
836, 840, 847, 849, 853, 858, 859, 865, 866, 542, 545, 551, 557, 559, 561, 568, 571, 574,
872, 878, 884, 886, 891, 900, 904, 907, 909, 584, 590, 600, 603, 606, 611, 612, 614, 617,
914, 915, 916, 924, 925, 926, 929, 933, 943, 619, 624, 631, 634, 635, 637, 641, 644, 646,
946, 954, 955, 956, 958, 959, 962, 963, 659, 663, 665, 668, 670, 673, 674, 676, 682,
977, 979, 981, 984, 985, 988, 1014, 1016, 684, 691, 695, 699, 702, 716, 736, 750, 751,
1022, 1023, 1025, 1029, 1034, 1045, 1046, 754, 756, 758, 759, 761, 763, 764, 774, 777,
1052, 1054, 1055, 1066, 1071, 1075, 1077, 791, 799, 801, 804, 806, 813, 818, 824, 833,
1078, 1082, 1086, 1092, 1097, 1098, 1099, 835, 837, 843, 851, 856, 864, 867, 881, 889,
1105, 1115, 1116, 1129, 1130, 1131 903, 971, 973, 987, 990, 995, 1027, 1033,
Thailand: 167, 278, 311, 621, 710, 711, 777, 1038, 1057, 1068, 1080, 1083, 1087, 1111,
854, 1041, 1042 1123, 1124, 1126, 1129, 1130, 1131, 1135,
Turkey: 287, 718, 730, 1026 1137, 1138, 1141, 1142, 1144, 1145, 1149,
1150, 1151, 1153, 1160, 1161, 1163, 1164,
U
1166, 1167, 1169, 1170, 1172, 1173, 1175,
1176, 1178, 1179, 1180, 1182, 1183
United Kingdom: 57, 121, 309, 363, 407, 588,

653, 734, 1154

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25th INTERNATIONAL NURSING

25th INTERNATIONAL NURSING RESEARCH CONGRESS

24-28 July 2014

Congress 2014 CP cover.indd 1 7/10/14 11:10 AM

Enhanced Abstracts of Oral and Poster

Held 24-28 July 2014

© 2015 by Sigma Theta Tau International 2 ISBN: 9781940446134

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PDF ISBN: 9781940446134

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An oral presentation is a brief 15-20 minute individual presentation time moderated by

A poster presentation is the presentation of research information by an individual or

A symposium is a presentation coordinated by an organizer similar to a panel

A peer-reviewed paper is simply an individual abstract that has been reviewed by at

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