Day 3 :
- Track 10: Emergency Nursing
Track 11: Public Health
Kristianstad University, Sweden
Title: A new model for dealing with patients who frequently arrive spontaneously at hospital emergency departments requiring health care – A pilot study
Time : 09:20-09:40
Lena Persson completed her Ph.D. 1998 at the Medical Faculty, Lund University, Sweden. She is working with implementing evidence based nursing in different health-care organizations. She has published more than 15 papers in international journals with focus on daily life problems from a nursing perspective in patients with leukemia, prostate cancer and food distribution to home-living elderly people. She was involved in staring and since 2008 she is the Chairman of the Research Platform for Collaboration for Health, which is a unique collaboration between Kristianstad University, the County Council Region Skåne and six municipalities in the northeast county of Skane.
Lena Persson completed her Ph.D. 1998 at the Medical Faculty, Lund University, Sweden. She is working with implementing evidence based nursing in different health-care organizations. She has published more than 15 papers in international journals with focus on daily life problems from a nursing perspective in patients with leukemia, prostate cancer and food distribution to home-living elderly people. She was involved in staring and since 2008 she is the Chairman of the Research Platform for Collaboration for Health, which is a unique collaboration between Kristianstad University, the County Council Region Skåne and six municipalities in the northeast county of Skåne.
University of Minnesota Medical Center, USA
Time : 09:40-10:00
Molly Bridget (Shapiro) Delaney completed her BS and MS in Nursing and MBA, all from the University of Colorado. Her PhD was awarded from Columbus University in New Orleans. She is the Nurse Manager of the University of Minnesota Medical Center, Fairview in Minneapolis, Minnesota. She has taught budgeting at Winona State University in Rochester MN, where Mayo nurses obtain Masters’ degrees. She has written 5 books, published multiple journal articles and serves as a peer reviewer for the Journal of Emergency Nursing.
The purpose of this article is to review the literature regarding the multiple challenges that contribute to ED bedside toileting and examine best practices that will reduce fecal exposure, cross-contamination among patients, and employee splash injuries. We searched the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Cochrane database for information about the multiple challenges involved in bedside toileting, using the following search terms: bedside toileting, gastroenteritis, macerator, sluice machine, fecal pathogen exposure, and splash injury. In addition, costs and benefits of reusable versus disposable bedside toileting equipment were compared and contrasted. Emergency departments have a higher exposure rate to fecal pathogens with current methods of bedside toileting. Short incubation periods may not allow the proper lead time needed for patients to access primary care providers. As a result, emergency departments and urgent care centers become a likely point of entry into the health care system. Although most inpatient rooms have built-in bathrooms, most emergency departments and outpatient examination rooms do not. Although many patients are ambulatory, restrictive monitoring equipment is required. For safety reasons, staff must bring toileting equipment to the bedsides of both ambulatory and non-ambulatory patients. Hopper dependence creates longer walking distances and delays. These delays may lead to incontinence events, skin breakdown, more frequent bed changes, and higher linen and labor costs. Reusable bedside toileting equipment is associated with at-risk behaviors. Examples are procrastination and sanitization shortcuts. These behaviors risk cross-contamination of patients especially when urgent situations require equipment to be reused in the interim. ED patients and staff are 5 times more likely to undergo fecal exposure. The 5 phases of ED bedside toileting at which risks occur are as follows: equipment setup, transport of human waste to drainage areas, transfer of waste, pre-cleaning, and equipment disinfection. Therefore it is imperative that ED staff have a full understanding of hazardous materials involved, know safer bedside toileting practices, and have safer equipment available to protect all involved. Upgrading our knowledge, equipment, and practices must become a higher priority for ED leadership. BIAS/DISCLOSURE The East Bank Emergency Department of the University of Minnesota Medical Center, Fairview, will be moving toward 100% disposable bedside commode pails in addition to disposable bedpans, currently in use. On the basis of a literature review to understand best-practice ED bedside toileting, the following article was created. As a result of our learning, the University of Minnesota Medical Center emergency staff has designed, patented, and developed a landfill-compliant disposable commode pail that absorbs waste while reducing splashes and spills. Disposable commode pails (bags) are conveniently wall mounted for quick availability, and "at-risk behavior" is reduced. Advantages are all point-of-care. Both setup and waste treatment and disposal start and end at the bedside. The advantages are faster response times, reduction of soiled linens and bed changes, prevention of incontinence and skin breakdown events, and reduced splash injuries or pathogen transmission. Patient satisfaction improves with shorter bedside toileting delays. Employee satisfaction increases with reduced human waste handling. The cost of each unit is comparable to an adult overnight diaper. Bariatric commode pails or bags are in the planning phase, and a "green" disposable commode pail, made from biodegradable corn byproducts, will be made available at a higher cost.
Time : 10:00-10:20
Christa Them has obtained her nursing degree in Vienna in 1982. She attended the diploma studies of pedagogics in Vienna as well as the doctoral studies of pedagogics. In 2003, she was promoted to professor in health sciences under special consideration of nursing science at UMIT in Hall in Tirol. In 2006, she was appointed university professor at UMIT. She has been Rector of UMIT, the Private University for Health Sciences, Medical Informatics and Technology since 2009, and has been head of the Institute of Nursing Science at UMIT in Hall in Tirol (Austria) since 2006. She has published more than 30 papers in reputed journals with the focus on Nursing pedagogics, Educational policy, Qualitative nursing research and Care of people suffering from age-related diseases.
Background: Within the framework of counselling sessions provided to people aged 70(+) living in the Austrian province of Tirol, the functional health status was measured by registered nurses. Vital in this context seems the utilisation of household help and/or care by family members and/or external institutions as they represent a great challenge as to the needs assessment, acceptance and exhaustion of family members. The aim is to identify groups of people aged 70+ (incl. their personal background) who live at home and do or do not use household help and/or care provided by external institutions or on an informal basis. Method: Based on the WHO ICF-Classification, the functional health status of 345 70+ aged people living at home was assessed. Health indicators for the utilisation of household help and/or care by family members and/or external institutions were identified. To identify groups and their characteristics Decision Tree Analysis was used. The CRT method maximises leaf homogeneity. The result was approved by a tenfold cross validation. The results illustrate that family members support the 70+ year-olds mainly in housekeeping (70%) and care (54%). Household help and care by external providers were used to a smaller extent (41% vs. 29%). The presentation deals with the identification of groups of people and their characteristics who do or do not use household help and/or care. A special focus is on those people who do not use household help and/or care since specific counselling is of utmost importance in the case of identified problems and resources. Key words: elderly people, functional health status, nursing assessment, household help and care, external institutions, family members
Coffee Break 10:20-10:40 @ Versailles Foyer
Eva Schulc studied Sports and Health Sciences and is a registered physiotherapist. She completed her PhD in Nursing Science at UMIT, the Health & Life Sciences University, in Tyrol/Austria in 2010. She has worked as a Scientist at the Institute of Nursing Science at UMIT since 2006. Her research focuses on mobile care provided to elderly people.
The use of technologies by elderly people is a challenge due to their lack of acceptance towards new technologies. The results of counseling in seniors in Austrian confirmed that 75.9% of 345 elderly people with a mean age of 83 years and 33% with a minimum frequency of one fall in the previous year did not make use of an emergency wrist watch (EWW). The aim of the study was to identify groups of people who are at risk considering their health indicators and who did not use an EWW in order to be able to provide individually tailored counseling. Based on the WHO ICF-Classification, the functional health of 70+ aged people living at home was assessed. Classification and regression trees served to identify potential groups and their health indicators for the non-use of an EWW in order to identify potential candidates for further analyses. Five trees, which represented the five components of the ICF-Classification, were created on the basis of the CHAID method in order to produce homogeneous branches. The result was validated using the tenfold cross-validation.The following health indicators best characterize four out of five groups of people who did not use an EWW: Group, who lived together with family members (p≤0.001), who took sleep-inducing drugs on an irregular basis and who did not use any objects or tools for their own safety in the flat (p=0.003), who had urine continence (p=0.045), and who made use of household assistance once per month (p=0.001). It can be assumed that with the applied assessment procedure groups of elderly people were identified to whom the use of EWW is not important or relevant. Further analyses for the use of EWW are required.
Osaka University, Japan
Title: Agreement between patients’ and proxies’ reports of health related quality of life in patients with end-stage lung cancer in Japan
Time : 11:00-11:20
Tomoyuki Takura, Ph.D.-medicine, now is a Professor of Health Economics and Industrial Policy Department, Program faculty of Interdisciplinary Program for Biomedical Sciences, Committee member of hospital management planning office (Osaka University hospital), Special examination committee of national insurance (Ministry of Health, Labour and Welfare), Committee of health care industrial platform (Ministry of Economy, Trade and Industry), Member of councilor (Japanese Association of Cardiac Rehabilitation and Japanese Society for Artificial Organs, etc.). He got his Engineering Master’s degree (MEng.) at Hokkaido University graduate school of engineering, Specialist in healthcare economics and technology assessment, Medicine Doctor's degree (Ph.D.) at Tokyo Women's Medical University graduate school of Medicine. And Dr. Tomoyuki Takura got the Student Entrepreneur Championship Award of Tokyo Metropolitan Government in 2003. Currently his researches focus on socioeconomic evaluation of renal transplantation and cost effectiveness analysis of revascularization for ischemic heart disease.
The number of death from lung cancer in Japan has ranked first since 1988 and tends to increase hereafter. However, there are few reports on value evaluation of palliative care for lung cancer patients with end-stage, especially the research is rare concerning medical economic evaluation related to palliative care. For performance analysis focusing on the ratio between utility and cost related to intervention of palliative care, it is indispensable to calculate Quality Adjusted Life Year that is one of outcome indexes. However, it is usually difficult to obtain data of health related quality of life (HRQoL) from the patients themselves at the end stage. Therefore, we verified appropriateness of proxy reporting of HRQoL by Health professionals (nurses). 16 lung cancer patients (aged 67.75±6.74) at the stage IV participated in the study. Euro-QoL Five-Dimension Questionnaire (EQ-5D) was reported for three days per patient. Proxy reporting of EQ-5D was executed by five certified nurses in the field of cancer nursing. Inter-rater agreement levels for the reporting of EQ-5D by patients and proxies were verified. The total score of EQ-5D was found to be statistically significant positive correlation between patients reporting and proxies reporting (Rs=0.654, p<0.01). Also, the scores for each item of EQ-5D had statistically significant positive correlation in “mobility”, “self-care”, and “pain/ discomfort” between patients and proxies (p<0.01). From the above, it is presumed that proxy reporting by nurses possesses certain explanation capability even at the end stage of lung cancer patients.
Paulista University School of Nursing, Brazil
Time : 11:20-11:40
Maria Meimei Brevidelli has completed his Ph.D. at the age of 39 years from São Paulo University, Brazil. She is a Professor of Postgraduate and Undergraduate Nursing School, and member of Research Group on Public Health of Paulista University. She has published about 15 papers in reputed journals.
The aim of the study was to evaluate the effectiveness of Health Program Easy Breezy (HPEB), whose goal was to encourage the adoption of healthy habits, based on Bandura's Social Cognitive Theory. The pilot study used a pretest-posttest design and was developed with a population served in Nursing Clinics, at Paulista University in São Paulo, Brazil. The HPEB contained four appointments with a 15 days interval, to encourage the practice of regular physical activity, consumption of healthy foods and to develop self-efficacy to change behavior. We investigated the dietary pattern, physical activity level and degree of self-efficacy to change behavior. Out of 103 participants, only 39 underwent the four appointments. Thus, participants were divided into two groups: partial compliance and complete adhesion. Only in the latter, the efficacy of the program was evaluated. There was significant change in eating pattern of the participants who reported increased consumption of fruits and vegetables (p≤0.01), and decreased consumption of fried foods (p≤0.05) and soft drinks (p≤0.0001). The results revealed the importance of implementing health education programs that promote effective behavior changes, consistent with public health policies.
Raquel Machado Cavalca Coutinho has completed his Ph.D. at the age of 41 years from Federal University of São Paulo, Brazil. She is the Director of Postgraduate and Undergraduate Nursing School and Member of the Research Group on Public Health of Paulista University. She has published more than 35 papers in reputed journals and serving as an Editorial Board Member of Journal Health of Science Institute and Member of the Editorial Board of the Brazilian Society of Nurses of Operating Room.
The research aimed to determine whether the registration of adolescents from public schools required the submission of portfolio immunization as a pre-requisite to identify if the assessment of vaccination status of adolescents occurs, verify the occurrence of the schools reporting outbreaks of diseases immune-preventable the last 5 years. The methodology is in an exploratory, non-experimental research, quantitative, cross conducted in 21 public schools in Campinas city west area, in 2012. Among the main results we have in four (19.04%) schools no requirement the vaccine portfolio at the time of registration and the remaining 17 (80.96%) do not. It was observed that among the four schools where the verification of the portfolios of vaccine occurred, only one (25%) had an outbreak of vaccine-preventable diseases, while the other three (75%) did not. Of 21 (100%) schools, three (14.28%) received vaccine, 7 (33.34%) shares received only educational activities on the subject, 9 (42.86%) never received vaccine and two actions (9.52%) received vaccine stocks in an outbreak situation. We conclude that the SchoolHealth Program recommends checking the portfolio immunization and vaccination status update of adolescent students. The results did not corroborate this guideline. We emphasize the importance of strengthening and interaction between health professionals and education enabling better control of the vaccination status of adolescents
Troy University, USA
Time : 12:00-12:20
Robin Gosdin Farrell has completed her DNP in 2010 from University of Alabama in Birmingham. She returned for her terminal degree after practicing for 25 years in family practice and college health. She is an Assistant Professor at Troy University School of Nursing and is lead faculty for all FNP program courses and lead faculty for DNP residency clinical courses. This is the beginning of her 4th year. She has presented podium and poster presentations at numerous regional and national professional conferences.
Healthcare focus regarding Human Papilloma Virus (HPV) has been primarily directed toward the role the virus plays in the formation of cervical pre-cancerous lesions and cancer. However, there has been little information of HPV in oral or anal cancer formation. Education and prevention are the keys to decrease prevalence rates and curb medical costs involved with HPV infections and cancers. HPV can be prevented by vaccines, preventative measures, and training of health providers on who, what and where to look during health exams. Knowledge regarding the association of HPV with various oral lesions and anal lesions is being presently published and shared with the medical community. Some of these lesions are asymptomatic and benign, and then there are those that are cancerous upon further investigation. HPV 16 and 18 are the most common high risk viruses that cause cervical cancer and have also been isolated in oral and anal cancers. Other forms of HPV associated with oral lesions include 2, 4, 6, and 11. These lesions have been found to be communicable as well as transmitted by self- inoculation. Even with education regarding the high risk of sexual intercourse, many teens and young adults engage in sex at an earlier age and more openly with multiple partners, casual sex, oral sex and even open mouth kissing. Sites where oral lesions are prevalent are the base of the tongue, vocal cords, tonsils, and other areas of the oral cavity. HPV prevalence has been shown to be 35.6% in oropharyngeal cancers, 23.5% in oral cancers, and 24.0% in laryngeal cancers. If the prevalence of oral HPV continues at this rate, it will surpass cervical HPV by 2020. Experimentation with anal intercourse is increasing in sexual relationships as well. HPV can be prevented by vaccines, preventative measures, and training of health providers on who, what and where to look during health exams. Anal cancers associated with HPV account for close to 5,000 cases of cancer per year. HPV lesions located in and around the anal sphincter, buttocks cheeks, and inside the rectal vault are associate with heterosexual couples that engage in rectal sex, men who have sex with men (MSM), bisexual or males on the down-low. HPV is now being discovered in a new identified group of women who have sex with women (WSM) through vaginal secretions directly and transference from vaginal appliances and toys.
Halmstad University, Sweden
Time : 12:20-12:40
Jeanette Källstrand Eriksson is a RN and ophthalmic nurse who completed her PhD in Medical Science with a specialization in Healthcare Sciences at Örebro University in May 2014. She is also responsible for the education at an advanced level for RNs to become ophthalmic nurses at Halmstad University in Sweden; the only education at this level (MScN) in ophthalmic nursing in Scandinavia.
Falls and fall injuries among today´s seniors are an important public health issue especially since it is known that old age is an independent risk factor of falling. It is a major problem since the ageing population is estimated to increase worldwide. Deterioration in quality in life such as fear of falling, loss of confidence and social isolation caused by accidental falls is calculated to cost even more than the direct costs such as medical treatment, healthcare and rehabilitation. Visual impairment occurs increasingly as people age and is also besides age one of the most predictive factors of falling. When measuring visual ability usually only performance-based measurements such as visual acuity are considered but nothing regarding a person’s functional visual ability in daily life is taken into account. Therefore, the purpose of our study was to assess the perceived vision-related health among independently living seniors using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association between the vision-related health status and falls. As many as 43% of the 212 seniors in our study reported falling at least once. Our study indicated that the seniors had an impaired perceived vision-related health status where general health was the only NEI VFQ-25 variable significantly associated with falls. Among the men though near and distance activities, vision-specific social functioning, role difficulties and dependency, colour and peripheral vision were related to falls. Therefore the NEI VFQ-25 might be a useful tool when identifying risk of falling.
Lunch Break 12:40-13:20 @ Monaco
Doctor Acasa Clinics, Romania
Time : 13:20-13:40
Dan Radut is a Medical Doctor, Master of Science and Public Health PhD. He accomplished his two medical residencies and completed his (Public Health) Doctoral Program in America and Europe. He is now working in the field of clinical medicine and research in Europa (Romania); he published several scientific papers, attended numerous national/international conferences and delivered talks and lectures for several educational (university/professional) institutions in Europe and Asia.
Even though the Earth’s age was deducted, it is maybe impossible to predict how long it can really last in time & Universe. In a current environment, balanced human life or any other species' life are all vital for the smooth running of life on Earth and the climatic factor is essential. Human body works perfectly at given normal body temperatures, even though research findings talk about the population’s adaption to heat in a climate change context. Earth’s temperature is growing. Several species have disappeared and others are predicted to follow. The climate change can affect the human health. Melting ice glaciers could release bacteria, fungi and viruses trapped in the ice during the freezing process that have been lying dormant for thousands of years, was said few years ago. In 2014 a giant virus that had been locked in the Siberian permafrost for more than 30,000 years was found. Wakening the long-dormant virus serves as a warning that unknown pathogens may be roused by global warming. The virus found belongs to wildlife. What will happen when such news will concern humans? Wildlife minds its business and assures the balanced life on Earth. But it seems it is now struggling under the “human experiment’ in the long run: multiplication-expansion, industrialization, development, “comfort-zation’, politicization, globalization, ‘unhealthy-zation’, ‘job-zation’, ‘money-zation’, ‘arm-zation’, ‘IQ decline-zation’. The habitat loss, globalization of trade, land-use pressure and climate change are real threats for the wildlife, which depends on humans. What do they do? What should they do?
Sonal Foundation, India
Time : 14:00-14:20
Alpesh Barot has been working as community nursing assistant in Gujrat, India for last 9 years. Completing his masters, he is preparing to pursue his PhD under the department of psychology from Gujraat University. While working in the community, he joined Sonal Foundation and been in-charge of Indo-UK collaborative program preventing child abuse and neglect. Spurgeons UK and Sonal Foundation, India collaboratively worked on safeguarding and child protection training programs to train health and nursing professionals in India. He is certified safeguarding trainer for nurses, research manager on a project to help preventing girl child neglect on a multicenteric research study in Northern state of India, Rajasthan, Haryana and Gujarat.
Background: In Northern India, skewed sex ratios, female feticide and higher child mortality rates for girls have become serious concern. The female child mortality as a result of son preference have increased during the last several decades .Since families cannot know the sex of the fetus due to Indian government policies, they now 'neglect' girl child to ensure there are few survivors. Survival chances of second and third daughters are plunging neglecting healthcare and nutrition has become tool for death as 'good riddance'.
Objectives: To develop and test the effect of a nurse-led interdisciplinary intervention program for preventing girl child maltreatment in high risk families. DESIGN: prospective randomized controlled trial PARTICIPANTS: The sample included 134 families who met risk criteria for child neglect and who were randomly assigned to receive either a nurse led counseling intervention or a usual care/nonintervention.
Intervention: Nurses were trained by certified psychotherapist and family counselors along with the help of safeguarding trainers. Nurses delivered the intervention from last term of pregnancy through three months and then were followed till the first birthday of the child. After the program ended, self-report and observational data were analyzed. Results for the entire sample indicated positive changes in protective factors (parenting attitudes and attachment); and improved child survival rate (physical, nutritional and psychological care of children) and lesser injuries and reported emergencies. Further testing of the intervention with other target populations is being conducted.
Conclusions: This study demonstrated significant change with greater collaboration between health, social and family disciplines. It spells out the reasons for potential collaboration and suggests some specific ways it can occur. The beneficial effects of an intervention program focusing on early recognition and supporting families to prevent infant and toddler gender related maltreatment and mortality.
Kingdom of Saudi Arabia
Title: Evaluate the effectiveness of the closed eye care method on outcome indicators in critically ill patients
Time : 13:40-14:00
Helen Shaji completed her PhD at the age of 35 years from The Tamilnadu Dr.M.G.R.Medical University, Tamilnadu, India. She has 15 years of teaching experience in the field of Nursing. Presently she is working as a faculty at Majmaah University, Saudi Arabia. She has presented many papers and is the invited resource person at local, National and International conferences. She has number of publications in both National and International peer reviewed indexed journals and also has been serving as an editorial board member of an International Journal. She has passion on teaching nursing and scientific research. She has completed various research projects.
Background: Critically ill patient’s eyes are exposed to a wide array of problems and complications. These include eye dryness, incomplete eyelid closure conjunctival injection, conjunctival edema, eyelid edema, eye discharge, and impaired corneal integrity. The most commonly evident eye problem is the eye dryness. Eye care standards are not applied completely for critically ill patients Aim: To evaluate the effect of closed eye care method on outcome indicators in critically ill patients who got admitted in Intensive Care Units and to answer the research question that whether Closed Eye Care metod is more effective than Routine Eye Care method in preventing eye problems and complications of critically ill patients. Materials and Methods: Quasi experimental research design was used to conduct the current study. Specifically, time series non-equivalent control group design was used because data collection was done over a period of time. A convenient sample of 50 adult patients “100 eyes” were selected from the ICUs and were randomly divided into two groups; the CEC and the REC group (25 Patients “50 eyes” per group). Results: The closed eye care is more effective than the routine eye care where, patients receiving the closed eye care have fewer problems such as eye discharge which indicates an eye infection, lesser eye complications such as impaired corneal integrity, and lesser incidence of eye dryness than that in patients receiving the routine eye care.
University of Chester, UK
Time : 14:20-14:40
Andi Mabhala: is a reviewer for the National institute of health research, International Journal of Preventive Medicine; and International Journal for public health research and environment. He is a senior research fellow at Newman University and Fellow of the Royal Society for Public Health. He was an invited speaker at the “UK public health Festival in Manchester in 4 July 2013, presented a research paper at the International Public Health Conference in Kuching, Malaysia in August 2013. He contributed several chapters in Key Concepts in public Health wrote several (2009), London: Sage edited book Key concepts in public health (2009) London: Sage. He contributed a chapter “Policy Drivers” in Key Concepts in Palliative Care (2010). London: Sage. His recent book is “Health Improvement and wellbeing” due to be published in October 2014.
Background: Nurses have long been identified as key contributors to strategies to reduce inequalities in health. However, health inequalities increased in the UK despite measures put in place to reduce them. This raise questions about: 1) the effectiveness of strategies to reduce health inequalities, and 2) nurses’ understanding of how inequalities in health are created and sustained, their nature and level of contribution to reducing inequalities, and their preparedness in terms of political consciousness and/or educational preparation. Aim: The aim of this qualitative research project is to determine nurses’ understanding of public health as a strategy to reduce inequalities in health. Methods: 26 semi-structured interviews were conducted with higher education institution-based public health nurse educators. Findings: Public health nurse educators described inequalities in health as the foundation on which a public health framework should be built. Two distinct views emerged of how inequalities should be tackled: some proposed a population approach focusing on upstream preventive strategies, whilst others proposed behavioural approaches focusing on empowering vulnerable individuals to improve their own health. Conclusion: Despite upstream interventions to reduce inequalities in health being proved to have more leverage than individual behavioural interventions in tackling the fundamental causes of inequalities, nurses are likely to perform individual interventions rather than take population approaches.
Seattle University, USA
Danuta, PhD, RN, FAAN is an Associate Professor and Department Chair, Seattle University College of Nursing, Seattle, WA. She completed the project on Registered Nurses roles in Primary Care as a member of the Leadership Action Learning group along with six other RWJF Executive Nurse Fellows.
Background: Healthcare delivery in the United States requires fundamental redesign to become effective, sustainable, and less costly. Early and consistent utilization of primary health care services is associated with improved patient health outcomes, reduced health disparities, and more efficient spending of health care dollars. Nurses have a long and distinguished career of improving population health through service in primary health care. Still, with swiping changes in how care was delivered in the 20th century, nursing education and practice has moved to acute care and currently only about 10% of RNs are employed in primary health care. Purpose: This presentation will explore the scope of practice, current role, and economic implications of RNs in the delivery of primary health care and offer recommendations for policy, education, and practice to optimize the use of the RN skill set and knowledge in the context of interprofessional team-based care delivery. Methods: The authors interviewed RNs, physicians, and other members of interprofessional teams, employed within a variety of exemplar primary health care practices across the country. We selected 10 practices identified previously as models of quality primary care delivery. The unique roles for RNS in these primary health care settings that improved care outcomes, costs of care, and patient and care team’s job satisfaction included: Episodic and preventive care delivery, chronic disease management, and care coordination. Discussion: RNs are well positioned to contribute to direct care delivery, care coordination, and leadership of interprofessional teams in primary health care. There is a compelling need to expand the contribution and optimize the scope of practice of RNs in primary health care to address a rapidly expanding primary health care access crisis, promote the creation of healthy and satisfying work environments for RN’s and interprofessional team members, and to enhance the health of our nation. Recommendations: Findings from the literature review and interviews of exemplary practices we recommend: Creating incentives for clinicians, provider organizations, payers, states, and the federal government to adopt primary health care delivery models. Expansion of RN’s role in primary care; revising nursing curricula and expanding educational opportunities in primary health care for nursing students; and lastly, preparing workplaces in primary health care, and clarifying and optimizing the roles of all professionals on the healthcare delivery team.
Tel Aviv University, Israel
Shulamith Kreitler is a Professor of Psychology at Tel Aviv University and Head of the Psychooncology Research Center at the Sheba Medical Center, Tel Hashomer, in Israel. She is a certified Clinical Psychologist and Health Psychologist. Her major research is focused on psychological risk factors of different physical and mental disorder, quality of life and coping. She has taught at the Nursing Department at the University of Haifa. She has published about 200 research papers and 10 books.
In recent years, there has been increasing evidence that stress and burnout in nurses affects their health and quality of life. The objective is to present three studies with applications for moderating the detrimental effects of stress and promoting health in nurses. Study 1 examined the role of stress- generating factors and relief factors on experienced stress in nurses in a pediatric oncology institute. The subjects responded to questionnaires assessing sources of stress, sources of relief, perceived stress, quality of life, burnout and compassion fatigue. The results showed that stress and relief were independent factors affecting burnout, and that relief had a greater impact. The major sources of stress were family and daily issues, and of relief - people and bodily activities. Study 2 examined the impact of stress vulnerability on quality of life. 100 nurses responded to questionnaires assessing stress vulnerability, perceived stress, and quality of life. The results showed that stress vulnerability correlated significantly with perceived stress and quality of life. Study 3 examined the impact of attitudes relevant for physical health. The responses to the questionnaire of the cognitive orientation of physical health by 52 nurses showed that attitudes on themes such as sharing experiences, expressing emotions, controlling perfectionism and cooperating with others contribute to mental and physical well-being. The major conclusions are that the mental and physical quality of life of nurses could be improved by promoting relief-generating activities, moderating stress vulnerability and enhancing specific attitudes that contribute positively to one’s well-being.
University of Venda, South Africa
Tshililo Azwidihwi Rose has completed her magister curationis degree at the age of 46 years from University of Venda. She is the lecturer at the University of Venda, Department of Nursing Sciences. She directs activities of the Department of Advanced Nursing Science. Since joining the department of Advanced Nursing Science in 2012, she has taught a variety of courses at undergraduate level. She has published 5 papers in accredited journals.
Background: Due to the uncertainties of job availabilities among rural communities, poverty stricken families find it hard to supply enough food to their family members. However, food insecurity has been defined by Weiser and Bangsberg (2006) as the limited or uncertain availability of nutritionally adequate, safe foods or the inability to acquire personally acceptable foods in socially acceptable ways. Tshililo (2006) also warned that immune system of a person with HIV and AIDS needs to be boosted with nutritious food. Purpose: The purpose of this study was to explore food insecurity among HI sero-positive patients in rural Vhembe district of Limpopo Province. Methods: A qualitative, exploratory, descriptive and contextual design was used. Probability, purposive sampling method was used to select family members who care for HI seropositive patients at home. In-depth interviews were conducted to 30 participants. Data were analyzed according to Tesch’s open-coding method. Results: This study revealed that due to financial constrains; family socio-economic status is affected. Therefore patient’s conditions are deteriorated as well balanced diet cannot be maintained.
Daphney St-Germain is a nurse that has completed her Ph.D. in 2007 in public health at Medicine Faculty of Montreal University. For up to 15 years, she worked in clinical, administration, educational and research fields. For now, it is been many years that she works as an Associate Professor in the nursing faculty at Laval University, in Quebec, Canada and a researcher in a rehabilitation center. She has published many national and international papers to optimize rehabilitation nurses role by promoting “caring” approach through quality of care and patient safety issues.
In the last 50 years, the role of nurses has evolved and diversified. The emancipation of the role, the specialization of the practice and nurses recognition of their own role are some examples of these changes. It was Virginia Henderson (1980) who suggested that nurses are, or at least have the potential to be, “rehabilitators par excellence”. But what does that role involve? What perspective could we have on this role? The rehabilitation nurse’s role has grown over the years, but it remains relatively unknown, especially regarding the all potential of its caring aspect. The brand-new Caring-DCP (Disability Creation Process) model reveals an efficient way to promote humanization of care in rehabilitation settings. This model and its underlying concepts introduce to a comprehensive approach in the recognition of the added value of caring by the contribution of rehabilitation nurses making an optimal development of the individual’s potential and achieving successful social participation. It introduces as well a new perspective in a continuous improvement in quality of care and patient safety through interprofessional team.