Marah Yousef Debo   Marwan Ali Issa   and Azeiza Mustafa Haddad   

Objective: This study aimed to assess body image disturbance among women diagnosed with Polycystic Ovary Syndrome (PCOS) in Latakia. It represents the first study of its kind within the Syrian context, where cultural and religious factors influence body image perception. Design: A descriptive study utilizing a structured questionnaire that included demographic and health data, along with the Body Image Scale. Data were analyzed using SPSS version 25. Setting: The study was conducted in the gynecology and obstetrics clinics of Latakia University Hospital and the Maternity and Children's Hospital in Latakia. Subjects: Women diagnosed with PCOS (n = 40) who attended gynecology and obstetrics clinics during the study period. Results: The study found that 72.5% of women had a negative body image, while 20% had a neutral perception. Married women, those aged between 25 and under 35 years, non-obese women, and those without hirsutism showed higher body image evaluations compared to other groups. Conclusion: Participants exhibited a generally negative perception of their body image. The study identified that women aged between 25 and under 35 years, of normal weight, and without hirsutism had significantly higher body image evaluations. This study did not assess psychological disorders associated with PCOS (such as depression). Future studies in Syria are recommended to incorporate this aspect for a deeper understanding.

Usep Somantri   Susanti Niman   Henri Suntoro   Stephanus Prihasto   Tina Shinta Parulian   and Timothy Rothhaar   

Introduction: Palliative patients who receive palliative care are only 14% of over 40 million around the world. Palliative patients who find meaning in their lives also find purpose despite their illness. Family support is one of the factors that help palliative patients find meaning in life. It can be in the form of emotional support, instrumental support, informational support, appraisal and appreciation from others. The past and present life experiences such as, the disease suffered, can also influence the meaning of life. This study aims to study the relationship between family support and the meaning of life in palliative patients. This study adopted a quantitative-correlational method with data collection techniques using purposive sampling. The number of respondents was 107 people. The questionnaire used the Family Support scale and the Meaningfulness of Life questionnaire. Data analysis utilized Kendall's Tau and Kruskal Wallis tests. Results: Family support obtained an average of 100.63 with a standard deviation of 14.150. Meaningfulness of life obtained an average of 76.96 and a standard deviation of 14.540. The result is that there is a correlation between family support and meaningfulness of life, with a p-value of 0.012. When viewed from the coefficient correlation (r) value = 0.173, there is a correlation between family support and meaningfulness of life in palliative patients. The level of family support between different types of caregivers had a p-value of 0.0005. Husbands had the highest mean family support scores. Conclusion: Families should pay more attention and provide support during treatment, and palliative patients should be more active in activities to foster a sense of meaning in life.

Marah Yousef Debo   Marwan Ali Issa   and Azeiza Mustafa Haddad   

Objective: The study aimed to assess the educational and psychological needs of women with polycystic ovary syndrome (PCOS). Design: This was a descriptive study using a structured questionnaire which examined demographic characteristics, health data, as well as women's knowledge about polycystic ovary syndrome, and two scales to assess PCOS-associated depression and anxiety. The data were analyzed using SPSS version 25. Setting: This study was conducted in the Gynecology and Obstetrics clinics of both the Obstetrics and Children's Hospital and Tishreen University Hospital in Lattakia. Subjects: All women attending the Gynecology and Obstetrics clinics at the time of the study were diagnosed with polycystic ovary syndrome (n = 40). Results: The current study showed that 57.5% of women are correctly informed about polycystic ovary syndrome, and about 42.5% are either misinformed of or have no knowledge about the syndrome at all. About 77.5% of them have a mild level of depression, and 60% have a high level of anxiety. Conclusion: Participants had an average level of information, a mild level of depression, and a high level of anxiety, highlighting the need to raise overall awareness around polycystic ovary syndrome, e.g. through conducting educational courses about the syndrome, which may aid sufferers in applying strategies to reduce anxiety and depression.

Giovanni Sarritzu   Riccardo Cabiddu   Vincenzo Pedace   and Marco Della Valle   

Parastomal hernia (PSH) can occur after an ostomy operation, leading to a significant morbidity for patients. Considering the difficulties to manage this complication, prevention measures should be investigated. Purpose: Assessing the efficacy of an ostomy support belt (Brava®) in preventing the development of PSH after ostomy operation. We conducted a retrospective observational study collecting data of 238 patients who underwent ostomy operation. Of them, 103 patients didn't wear the support belt and 135 patients have worn it since hospital discharge. Differences in incidence of PSH between the two groups were evaluated, and a multivariate logistic regression model was used to identify associations between independent risk factors and PSH onset. PSH occurred more frequently in patients who didn't wear the belt compared with patients who have worn it immediately after the hospital discharge (P=0.0015). Risk factors associated with PSH onset were non-use of the support belt (P=0.0005) and colostomy (P=0.0193). Preoperative design and emergency surgery were protective factors (P=0.0002 and P=0.0017 respectively), whereas age and gender were not associated with PSH development. The use of Brava® Ostomy Support Belt seems to be an effective preventive measure for PSH development. Further studies are needed to confirm the effectiveness of the belt.

Blessing Benjamin Awu   Hyellavala Joseph Fomnya   Stella Aiden Medugu   Anoye Joel Bulus   Benjamin Nazwala Aftikus   and Barka Stephen Ghaji   

The World Health Organization report indicated that diseases associated with psychoactive substance use account for over 12% of the total burden of diseases affecting humanity. The immoderate use of chemical agents especially illegal drugs is termed as drug abuse. This is a cross-sectional study aimed at determining the prevalence of psychoactive substance use among students in the College of Nursing and Midwifery Yola, Adamawa State. To constitute the study's sample size, a stratified random sampling technique was used to select two hundred students from the Nursing Science and Midwifery departments across different academic levels. Data was collected through a self-structured questionnaire, and a descriptive statistical technique was used in analyzing the collected data. The study findings revealed that the majority, 157(78.5%) of the students use psychoactive substances with caffeinated beverages (42.0%) and kola nut (28.0%) being identified as the most common substances used by students. Substance abuse was highly associated with final-year students (300 levels) and those in remedial programs. The rate of psychoactive substance use is high in students living on campus and those renting apartments outside the campus. The majority, 97(61.8%) of the students use psychoactive substances for academic-related purposes, including the desire to stay awake at night and study, the quest to improve academic performances, and be active during lecture hours. A good number, 86(54.8%) of the students reported dependence on psychoactive substances, and some experience body weakness 26(16.6%), headache 13(8.3%), and drowsy feelings 34(21.6%) with the use of the substances. It was concluded that students in the College of Nursing and Midwifery Yola use psychoactive substances to enhance their studies. Most of these substances commonly used are readily available on campus.

Amani Mahmoud Fadul Mokhtar   Mohammed Hassan Moreljwab   Eltayeb Abdelazeem Idress   Hamza Hussain Ahmed Balola   Murtada Mustafa Gabir Tia   Abdalla Mohamed Ahmed Osman   Mohammed F Alharbi   Ahmed Abdalla Jarelnpe   and Hammad Fadlalmola   

Introduction: The TIME framework is a practical tool for wound care assessment that includes tissue viability, infection/inflammation, moisture imbalance, and wound edges. However, it is not widely practiced in Sudanese health institutes, and literature on its use is limited. This study aimed to evaluate the impact of a TIME framework education program on the performance of nurses in wound care. Methods: This study used a prospective pretest-posttest one group design to evaluate the impact of a TIME framework education program on nurses' performance in wound care. Data were collected using questionnaires, observation checklists, and a 5-Likert scale for attitude evaluation, and analyzed using nonparametric tests. Results: The study found that the TIME framework education program had a significant positive impact on nurses' performance in wound care. The results showed a significant improvement in both knowledge (pretest score of mean=4.96, SD=0.20 versus posttest score of mean=3.33, SD=1.34) and practice (pretest score of mean=2.15, SD=0.90 versus posttest score of mean=1.2083, SD=0.50). Nurses' attitudes towards using the TIME framework in wound care also improved significantly. Conclusion: This study concludes that the TIME framework education program is an effective intervention for improving nurses' performance in wound care. The program resulted in significant improvement not only in knowledge and practice but also in attitude. Continuous professional development programs on wound care practice with TIME assessment tool and wound care models are recommended.

Haeril Amir   Andi Masyitha Irwan   and Ariyanti Saleh   

Background: Reflective case discussion (RCD) is part of performance management development (PMD). RCD can be done in Hospital and Public Health Center. Nurses carried out RCD to discuss the Nursing issues and create a new Standard Operating Procedure (SOP) through reflective method. Objective: increase nurse professionalism and knowledge by holding discussions, sharing experiences so that mistakes in doing actions that have occurred do not happen again. All nurses must participate in RCD at least once a week. This activity was performed between half an hour and an hour. Method: Qualitative method with action research approach, involving 8 participants until the end in the operating room with three stages namely assessment, implementation and evaluation. Each stage is a reflective process, namely Plan, Action, Observe and Reflect stages. Results: This study found several themes regarding supporting factors, namely stakeholder support, and Nurse motivation, while inhibiting factors were lack of socialization and time and lack of evaluation and supervision. Conclusion: RCD did occur at Ibnu Sina Hospital because of lack of knowledge and socialization. Besides that, supervision and evaluation also did not work. The Head Nurse and Hospital management department must ensure that RCD activities are running and scheduled, because this activity is very important to improve the professionalism of nurses in their work as well as efforts to encourage the development of performance management.

Mimi M. H. Tiu   

The concept of dignity is an essential value of nursing practice and its attributes frequently include control, respect and self-esteem. In Hong Kong, elderly people have negative impressions about living in private nursing homes because they perceive these attributes of dignity will be lost. This study aims to understand and gain a deeper insight of the lived experience of being dignified for elderly Chinese residents in a private nursing home in Hong Kong. This study employed an interpretative qualitative design. A purposive sampling strategy was used to recruit 14 nursing home residents to participate in this study. The data were collected through in-depth, unstructured face-to-face interviews. Interviews were audiotaped, transcribed, and then analysed using van Manen's phenomenological method of qualitative research. Five themes that emerged from this study were: possessing inherent dignity, owning dignified-self perspectives, endeavouring to exercise dignity-conserving practices, receiving dignified care, and dwelling in a dignified home environment. Outcomes identified in this study showed the different ways dignity is conceptualised by the residents in the nursing home. The results enhance our understanding of dignity among residents in private nursing homes and can contribute to the development of strategies for providing dignified care in future.

Kathryn Weaver   and Judith Spiers   

Video technology is increasingly popular for disseminating research results because its multi-sensory avenues for communication provide richer information than is often available in printed reports. Despite this advantage, issues inherent in video-based dissemination research have not been well articulated in nursing literature. In this article, issues of power, representation, participant autonomy, confidentiality, informed consent, intellectual property, and commercial use and profits are described and critically analyzed. The discussion is contextualized with examples from two original qualitative research projects involving women recovering from eating disorders and adolescents living with diabetes. Recommendations for future video research include giving as much control as possible to participants through negotiation of consent, confidentiality, and copyright ownership issues on an on-going case by case basis.

InĂȘs Rocha   Margarida Reis Santos   and Regina Pires   

Purpose: The purpose of the study was to construct and validate a questionnaire that assesses the frequency with which the Clinical Supervision (CS) strategies are implemented and the frequency with which the nurses want them to be implemented in their services. Design: The research is carried out under a quantitative paradigm, of the descriptive and exploratory type, and of a transversal nature. The non-probabilistic sample comprised 273 nurses. The data was collected by applying the Questionnaire for Assessment of Clinical Supervision Strategies in Nursing (QACSSN), between May and September 2012. Methods: A descriptive statistical analysis was made of the data obtained. The content collected from the QACSSN was validated by a group of 11 experts. Cronbach's alpha coefficient was also ascertained. Findings: The results show the experts agree with the inclusion of the 16 CS strategies in the QACSSN. The QACSSN has good internal consistency indices, both in terms of the frequency of implementation of the CS strategies and concerning the level of desire for their implementation. Conclusions: The QACSSN is a reliable instrument with valid content, and therefore can be used in the context of Mentorship, Preceptorship or CS. Clinical Relevance: The study contributes to improved quality of care by identifying the most appropriate CS strategies for the process of supervision in health contexts, enabling the nurses to play an active role in this process.

Amal Ibrahim Khalil   Mawdah Hasan Alshanqiti   and Amani 51ÊÓÆ”ed AlHarbi   

Background: Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder strike people who have experienced or witnessed a traumatic event. Parents' of children with cancer are at risk of PTSD. The aim of the study is to assess the posttraumatic stress disorder symptoms among Saudi mothers who have a child newly diagnosed with cancer. Methodology: A descriptive exploratory design was used with a convenient sample of 110 Saudi mothers. Mothers were recruited from pediatric oncology (Ward 11) at King Khalid National Guard Hospital (KKNGH), Jeddah. Mothers completed a questionnaire of self-report PTSD Checklist (PCL-C) The PTSD severity was determined by totaling the 20 PDS-5 as the higher the score the more the severity of PTSD. Results: the results revealed that the mean age of children and mothers was (4.43±SD3.6) and (37.6±SD9.3) respectively. More than half(57.2%) of mothers experienced with shock at the time of diagnosis. More than one-third (32.7%) meet the criteria of PTSD and severity of symptoms ranged from mild to very severe as (44.5%) have mild symptoms (14.5%), moderate (17.3%) severe compared by (6.4) experienced very severe symptoms of PTSD. Furthermore, there was a significant correlation between the severity of PTSD with the number of children, the age of parents, gender, literacy and economic state (P = 0.001). Conclusion and recommendation: the study concluded the presence of PTSD symptoms among participants of the current study. Additionally, factors such as age, sex, the number of children, educational state and economic state of the family can influence the severity of PTSD. Therefore, health professionals might screen the parents of children with chronic illnesses to ascertain whether they could benefit from stress management. By the same token, clinicians should recognize that most parents tend to cope well through reinforcing their adaptive coping skills.

Nida Mullins   and Laura McQueen   

Compassion fatigue is an unrecognized and understudied phenomenon that occurs in practicing nurses and most likely to affect nurse educators in practice. This unique form of burnout can impede nurse educators in caring for themselves and their students, patients, colleagues, schools and healthcare agencies. It is important to recognize the outcomes and implications of compassion fatigue and the growing need to mentor and care for both current and future nurse educators. Further research studies are needed on compassion fatigue in nurse educators to minimize the impact on educator health and professional nursing care.

Petra Sumnitsch   Bernd L. Hartmann   Daniela Zanolin   Christoph H. Saely   and Alois Lang   

Aim/object: The aim of this survey was to identify psycho-oncological and psycho-social need in the routine patient care of oncological patients. Material and Methods: A total of 200 oncological patients underwent the paper-based Hornheider questionnaire, a validated instrument to identify the need of psycho-oncological and psycho-social care at first contact. Hornheider sum-scores ≄4 were considered to indicate psycho-oncological and psycho-social need. Results: Overall, 149 (75%; 68 women and 81 men, 74 ≄ 65 and 75 < 65 years) questionnaires were correctly filled out and returned. Hornheider sum-scores were ≄4 in 47 patients, i.e. in 31,7%. Psycho-oncological and psycho-social need did not differ significantly between women and men (57,5% vs. 42,5%; p=0,732) but was significantly higher in patients <65 years than in those ≄65 years (66% vs. 34%; p=0,002). Discussion: The results of this pilot project show that a high proportion of oncological patients are in need of psycho-oncological and psycho-social support; this in particular holds true for younger patients.

Promise E. Adat   Ndifreke E. Udonwa   Abraham N. Gyuse   and Chibuike M. Okeke   

Objectives: The study aimed at determining the hypertensive patients' illness experience, using the patient-centred consultation approach in order to form a better partnership with the patients. Design: This was a cross-sectional hospital-based study using a semi-structured questionnaire that assessed the socio-demographic characteristics of the respondents. The respondents' fears about hypertension, ideas about its cause and expectations from consultation were explored. The response was based on a Likert scale. The data were analysed with the SPSS software version 15. Settings: This study was conducted at the GOPC, UCTH Calabar. The GOPC is the "window" of the Hospital. Subjects/participants: Two hundred and sixty eight hypertensive patients were recruited into the study. Results and Conclusions: The respondents expressed fear regarding most aspect of hypertension. Most (74.7%) agreed that hypertension could be caused by stress. A few participants gave non-biomedical views of the aetiology of hypertension, including attributing it to spiritual forces. Over three quarters of respondents (85.1%), expected their medications to give them corrective measures to hypertension. The study supports the fact that hypertensive patients have varying illness experiences that should be explored using the patient-centred consultation style and recommends that doctors should manage individual patients to suit the patients' unique experience. There was an established significant relationship between expectation and fears/ideas.

Paige Wimberley   

Firefighters fall behind in the general public in meeting optimal levels of the seven American Heart Association metrics of cardiovascular health. Selected interventions for decreasing firefighter cardiovascular disease and risks are reviewed. Many cardiovascular risk factors are related to lifestyle and firefighters are at increased risk for cardiovascular events. Healthy People 2020 and the American Heart Association have goals to improve cardiovascular health nationally. The American Heart Association [1] defined ideal cardiovascular health as the absence of clinically manifested cardiovascular disease and the presence of optimal levels of seven metrics. These seven metrics include diet quality, physical activity, smoking, body mass index (BMI), blood cholesterol, blood pressure, and glucose. However, evidence demonstrates that firefighters whether career or volunteer fall woefully behind the general public in meeting these optimal levels for several reasons.

Papke J   and Lux E A   

Specialised outpatient palliative caring (SAPV) has been available in Germany for nearly ten years. SAPV structures exist in all German federal states but coverage is still not comprehensive. For further development, assessment at the level of care providers, quantitative and qualitative composition of the PCT, networking, coordination and organisational structures is important. This survey was conducted in physicians from independent practices and hospitals if it was known that they worked within SAPV structures with the aim of collecting and analysing data from everyday German healthcare practice. It is the first survey to include physicians from different specializations and to ask specifically about SAPV in Germany. SAPV is undertaken predominantly on a multi-professional basis; qualified general practitioners are the most strongly represented group of specialists. They cooperate closely with colleagues from other specializations and from non-medical professions. Mostly, physicians deliver SAPV alongside their activity in an independent practice or hospital, which further increases the high workload involved. In Germany, SAPV has developed into an essential structural element of palliative care. Its further development must be systematically promoted.

Erin Sebtiarini   Erni Rosita Dewi   and Linda Dewanti   

Background/ Objectives and Goals: Undernourished is one of the health problems faced by the world today, especially in Indonesia with the percentage of undernourished children under 5 years old is 19.6% or 4,646,933 from 23,708,844 children. For young children, breastmilk is the best food and complementary food after six months that is usually produced from cow milk is needed. Another problem comes, 2-7,5% children has the allergy of cow milk and choose soy milk as recommended by health workers, although it is more expensive (100,000,00 IDR or 6.9 USD/1000 grams) than cow milk (68,000,00 IDR or 4.74 USD/1000 grams). To solve this issue, goat milk is one of good alternatives food for considering as a complementary food. Goat milk has beneficiary things such as treating malabsorption syndrome and undernourished children. Besides that, according to the Statistic Center Board/Badan Pusat Statistik (BPS), the number of the goat population in Indonesia is 18,879,596, more than cow population which is 16,019,459. For further evaluating the advantage of goat milk, we conducted a review study. Methods: We search all literature published in the year 2004-2014 on PubMed and science direct using keyword "goat milk", "nutrition", "content". Result: There are 311 journals appeared in the selection, but we select 10 journals which showed the clear comparison between goat and cow milk especially in young children. After making the table with special consideration on population, place, age of the subject and nutrient content in both kinds of milk, we conclude all the studies. The studies showed that goat milk has the advantage not only for treat undernourished children but also many disorder and disease such as malabsorption syndrome, malnutrition in infants and children, and cardiovascular (heart) disease, due to its small globule of fat which is digestible and short and medium chain fatty acid. Mineral content in goat milk such as Calcium, Phosphor, Magnesium, Natrium, Potassium, Chloride, Iron, and Zinc is higher than human's, that's all useful for preventing bone demineralization and iron deficiency anemia which is still high in Indonesia. Conclusion: goat milk treated undernourished children and prevented several diseases and food disorder and it is suitable due to economic reason compared to the cow milk. Furthermore, we could state that cow milk seemly could be a promising treatment for undernourished children in developing countries to reduce morbidity and mortality related to the malnutrition related diseases.

En-Chi Shih   Wen-Li Hou   Pi-Li Lin   Szu-Mei Hsiao   Chien-An Sun   Yu-Ching Chou   and TsanYang   

The purpose of this study was to investigate the factors influencing occupational burnout among psychiatric nurses. Psychiatric nurses are often misunderstood and subjected to social bias due to the nature of their work. Their work entails responding to emergencies and they must endure the psychological stress of the threat of aggression from patients. Thus, it is easy for such nurses to experience occupational burnout. A cross-sectional study was undertaken from February to April 2012 among hospitals psychiatric nurses in southern Taiwan. Of 235, 217 nurses eligible for the study completed survey (response rate 92.3%). Information on personal characteristics, workplace stressors (QMWS), and burnout (MBI) was obtained through structured questionnaire survey. The results indicated that a nurse's age, hospital level, work unit, seniority, psychiatric work, and overtime work were associated with the nurse's level of occupational burnout and its three dimensions. According to our findings, there is positive correlation between job stress and burnout. In addition, our study also showed that overall job stress, total years in nursing, age, maintenance of relationships with patients, personal assessment system, and encountering medical disputes are predictive factors for psychiatric nurses' overall occupational burnout and its three dimensions of emotional exhaustion, depersonalization, and personal accomplishment. In conclusions, our study could help psychiatric nurses to be more aware of their working stress. In order to improve the quality of professional care, hospital management should provide psychiatric nurses with positive and healthy coping strategies.

Hajer Fadlalla Ali   Ali Arabi   and Jalal Ali Bilal   

Severe acute malnutrition is associated with mortality in young infants. Associated risk factors and management were not well addressed. The aims of this study were to identify factors associated with severe acute malnutrition in children < 6 months of age and to evaluate the outcome of treatment after feeding them diluted therapeutic formula milk (F-100) along with breast-feeding. This interventional hospital-based study was conducted at 2 major children hospitals in Khartoum during the period between September 2011 and January 2014 among malnourished children less than 6 month of age. Infants' demographic, clinical and anthropometric measurements were recorded and then received routine medications and breastfeeding and/or 130ml/kg/day diluted F100 formula for 5 consecutive days and weight gain was recorded. All recruited infants (N=83) received diluted F-100 with breast milk. They had a mean±SD age of 3.8±5.8 months. The male to female a ratio was 1.3. The majority was from poor socioeconomic background and most mothers were below 40 years of age. Only 36 (43.3%) were exclusively breastfed and 37 (44.6%) of infants fed on food other than milk. Following feeding for 5 days, 76 out of 83 (91.6%) malnourished under the age of 6 months infants were discharged with adequate weight gain, 5 (6%) prematurely left the hospital and thus the study, 2 (2.4%) were defaulters and there was no deaths. Infants <6 months of age with severe acute malnutrition were mostly from poor backgrounds and developed malnutrition despite breast-feeding. Diluted F-100 formula was beneficial in treatment along with breastfeeding.

Sharon Jacobs   Lesley Wilkes   Christine Taylor   and Kathleen Dixon   

Critical thinking, clinical reasoning, clinical decision making and clinical judgment, are used interchangeably in nursing literature. This presents a problem for nurses educating students to develop their clinical judgement. This paper reports on an integrative review undertaken to uncover whether it is feasible to continue using these concepts interchangeably. Data collection involved a search of relevant electronic databases for publications between 1980 and 2015 using such keywords as critical thinking, clinical reasoning, clinical decision making and clinical judgment. 23 papers met the inclusion criteria for the integrative review. Content analysis of the papers generated a total of 13 characteristics shared by the four concepts, which means that any one of the concepts can be used as a variable to measure changes in student nurses' thought processes.

Jan Sitvast   

Our aim was to develop and evaluate an intervention that can be used in recovery oriented care to promote recovery processes and goals as found in the CHIME framework [1]. Using the Appreciative cycle and principles from the MRC-Framework for the development and Evaluation of complex interventions an intervention with photography has been designed and tested on 3 long stay wards of a mental health care hospital. 15 Service users participated and were photographed during 4 sessions. The intervention built on the expertise that already existed about rehabilitation approaches; especially the Strengths approach [2] and the findings from earlier studies into hermeneutic photography by the author. The intervention proved to inspire hope and meaning giving in service users and contributed to a transformation of relationships between service users and their mentor nurses. These relationships became more reciprocal and equal. The intervention yielded opportunities for service users to express their wishes and values in life. In this way they made a representation of the persons who they are. The photographs probably contribute to a greater self-esteem of the service users and may inspire them to use the action and what it meant to them for further recovery. The intervention put the service user in the lead and contributed to more mutuality in the relationship with the mentor nurse.

Muaadh Abdulghani Ghaithan Al-samawi   and Higazi Mohammed Ahmed Abdallah Awad   

Background: Globally, Low Back Pain (LBP) comprises a significant occupational hazard in nursing profession. Objectives: To estimate the incidence, to identify risk factors, and impact of illness of LBP among nurses in AL-Mak Nimer university Hospital at Shendi city. Subjects and Methods: A cross-sectional study was applied including nurses in AL-Mak Nimer university Hospital at Shendi city, republic of Sudan throughout the period May -June, 2015. Sample was chosen by using total coverage sample. A predesigned questionnaire was used for data collection. The questionnaire included demographic data, work-related factors as well as effect and management of LBP data obtained were analyzed using manually and by used SPSS soft program. Results: The results revealed that the overall incidence of low back pain among nurses was (n=70, 87.5%) Female participants complaining of LBP were significantly more than male participants (85%) of the total female reported LBP. There were significantly relate between age and working hours (.015) it can be seen that about (40%) of the participants experienced LBP at least once a week or more frequently. 52.9% subjects rated their pain as moderate pain. 35.7% nurses' concept regarding factors contributing to their LBP were lifting as well as 28.6% working load,(52.9%) sleep disturbance, (64.3%) restrict activities were nurse comment regarding LBP effect. Conclusion: LBP is a common health problem among working nurse, lifting, work load, were the most perceived work-related risk factors for LBP, restrict activities, taking many days off, might be the most predisposed effect related to LBP. Recommendation: These findings suggest that hospitals should focus and attempt to improve the ergonomics of nursing activities. In addition, effective methods of implementing changes in work systems are needed.

Carrie S. Klima   Susan C. Vonderheid   Kathleen F. Norr   and Chang G. Park   

Patient-centered care that empowers individuals to take control of their health can improve health outcomes, especially during pregnancy. This study developed and tested a pregnancy-related empowerment scale (PRES). Phase 1 developed and validated a 16-item scale using expert panel review, focus group and think-aloud interviews with pregnant women and a small pilot. Phase 2 used committee translation and cognitive interviews to establish a conceptually equivalent Spanish version. Phase 3 used survey data from 365 pregnant women to establish high scale reliability (α > 0.90). Confirmatory factor analysis was consistent with four conceptual dimensions of empowerment: provider connectedness, skillful decision-making, peer connectedness and gaining voice. The PRES offers a reliable and valid measure for English and Spanish-language women in clinical practice and research related to prenatal care innovations.

Constance Visovsky   and Janique Corripio   

Resistance exercise can maintain muscle strength & physical functioning in women undergoing chemotherapy for breast cancer. Few studies examined resistance exercise for reducing the neuromuscular side effects of chemotherapy. The purpose of this analysis was to examine the feasibility and acceptability of a resistance exercise intervention for women undergoing chemotherapy for the treatment of breast cancer. The data reported are from the final data collection interview of the intervention group (n=47) who participated in a randomized clinical trial testing a resistance exercise intervention for women with breast cancer. Data regarding feasibility and acceptability was collected using an investigator-developed questionnaire consisting of 6 Likert-scale items (range = 1-5), and 4 additional open-ended questions concerning exercise benefits and barriers. Descriptive statistics were used to analyze the Likert-scale questions. A mean score of 3.0 or greater indicated that the intervention was acceptable. A content analysis was performed on the open-ended items. Five of six questions exceeded the 3.0 set point indicating women found the remaining aspects of the intervention feasible and acceptable. Challenges in exercise were symptoms, fatigue, and time constraints. The benefits from the exercise program consisted of increased strength and energy, emotional well-being, physical well-being. Study results suggest that resistance exercise intervention conducted during chemotherapy for breast cancer is feasible and acceptable. Social support for exercise was the most important factor in continuing an exercise program during chemotherapy. Study participants can be successfully recruited into a resistance exercise program during chemotherapy for breast cancer. However, stronger emphasis in symptom management during the early phases of the study is needed to prevent study withdrawal.

Rosana Svetic Cisic   and Sanda Frankovic   

This article explains the pilot project and results of a peer review which, according to the data available, is the first such review carried out in the Croatian nursing practice. The goals of this project were to identify standards of professional performance which describe behaviour of competent professionals. Peer review is the evaluation of an individual's professional performance for relevant competency categories by using multiple sources of data. Semi-structured interviews were carried out with all nursing staff (N=16) in St. Catherine Hospital. This system of peer feedback is generally acceptable to the participants. The experience suggests that the approach enhances understanding of roles and responsibilities and is supportive to inter professional team development. The peer review had positive outcomes, particularly in the planning of future development of education and staff training, as well as in general professional development of the nurses and the nurse leader.

Lesley Wilkes   Debra Jackson   John Daly   and Wendy Cross   

Purpose- The purpose of this paper is to report the results of a study which aimed to describe the ways a group of deans of nursing integrated their professional and personal lives in their worlds. Methods- Oral histories were collected from a group of 30 deans from three countries – Canada, England and Australia. The data from the interviews were content analysed for themes related to the deans' personal and professional life experiences. Through contrast and comparison of these themes, the researchers wrote a description of how the deans integrated their personal and professional lives. Results- The major themes that emerged from the analysis were: work demands, dual career partnerships, children come first, obtaining educational qualifications, other professional activities, and out of work activities. Conclusion- The world of the dean of nursing working in a complex university structure is complex and often impacts on the rest of their lives. However, it is important to see that their personal lives and how they live them can revitalise and give them emotional strength for their professional life. The study has implications for deans who need to reflect on how they integrate the two lives in their worlds by identifying stress and taking advantage of developmental opportunities.

Klaus Martin Beckmann   and Zena Hume   

Assessing and managing mental health issues in minors in the emergency department (ED) can be different from the management of adults. This may cause confusion to newly recruited staff in an ED. This paper aims to give a broad overview of some of the Commonwealth-based legal concepts which apply to minors with reference to basic medical standards such as good medical practice. Practice points are emphasised that apply to the management of minors which applies to many jurisdictions. The aim is to give personnel commencing in ED a simplified but comprehensive overview. For out-of-hours a template and aide memoire, up to date in early 2015, is given on how to clarify and streamline reflection on client management, disposition and reduce potential confusion about the diverse legal frameworks that pertain to mental health care of minors.

Amal I., Khalil   Aziza G. Alsulami   and Alaa Alfaisal   

Objective: Despite the evidence based effectiveness of ECT in treating mental disorders, there are many misconception and lack of knowledge among nurses who are typically at the forefront of providing care before, during and after the procedure. The aim of the present study was to explore the impact of educational program on the knowledge and attitudes towards ECT among nursing staffs working in psychiatric hospital, Jeddah. Participants and Methods: Quasi-experimental design was used with a convenient sample of 20 nurses' working at psychiatric hospital Jeddah affiliated to Ministry of Health. Saudi Arabia. A self-administered questionnaire consists 28 – items was administered before and after the educational program. Results: 80% of participants had more than 3 years of work experience The paired Test sample showed the significant difference the mean score of participants on ECT program pre-test was 65.4 and that their mean score of the total post-test was 71.4 and the difference is statistically significant in favor of the post-test ( t = 2.80, P < .011)The mean score of participants' knowledge and attitudes was 45.15, 25.25 respectively, with no significance (P>0.05) difference with their demographic background. Conclusion: Providing and expanding accurate knowledge about ECT is necessary in order to improve the attitudes towards ECT. Despite the limitations of the study, the findings were extremely promising.

Holly M. Simmons   

The purpose of this research study was to determine whether a high level education session with a nurse during the preoperative clinic visit improved the patient's ability to identify signs, symptoms, and risk factors of lymphedema, which is a possible complication related to breast cancer surgery. The study used a pretest posttest descriptive research design. The participant sample included 23 female patients, scheduled to undergo either a sentinel node biopsy or an axillary dissection for their breast cancer. Prior to specific interventions, participants were given a baseline assessment to evaluate current knowledge of lymphedema and to collect demographic data. Post-education assessments were completed immediately after the educational sessions, and again at the participants post-operative clinic visit. Scores from all time points were examined, with the average score on patient surveys improving by nearly 15% after the education session, indicating that knowledge was retained. The results of the study suggest that a specific nurse guided education session with breast cancer surgery patients during the preoperative visit is effective in improving identification of lymphedema signs, symptoms and risk factors. Additional research into the effects of a continuing education program is warranted to improve upon knowledge retention and self-care practices.

Hirokazu Madokoro   Nobuhiro Shimoi   and Kazuhito Sato   

This paper presents an unrestrained sensor system that analyzes predictive behavior patterns that occur when a patient leaves a bed. Our system comprises three sensors: pad sensors installed under a bed mat, a pillow sensor to detect head movements, and a bolt sensor mounted to a bed handrail. We used a triaxial accelerometer for a pillow sensor and piezoelectric elements for the pad sensors and bolt sensor. The salient features of these sensors are their easy installation, low cost, high reliability, and toughness. Moreover, we developed a method of recognizing bed-leaving behavior patterns using machine-learning algorithms from signals obtained using the sensors. We evaluated our system by examining ten subjects in an environment representing a clinical site. The mean recognition accuracy for seven behavior patterns was 75.5%. Furthermore, the recognition accuracies for longitudinal sitting, terminal sitting, and left the bed were 83.3%, 98.3%, and 95.0%, respectively. In contrast, falsely recognized patterns remained inside of respective categories of sleeping and sitting. We believe that our system is applicable to an actual environment as a novel sensor system with no restraint of patients.

Wong S. L.   Lee L. Y. K.   Lam S. C.   and Yeung C. Y.   

This study aims to assess the relationship of the levels of physical activities among working adults over a period of seven consecutive days, between working days and days off. This cross-sectional study used a sealed pedometer to measure the physical activity of working adults in terms of their number of daily walking steps on working days and days off. A voluntary sample of 745 working adults aged 18 – 64, who were recruited from different occupational categories in Hong Kong, had completed the study. The participants were fairly active when compared against the recommended levels of physical activity. The average daily walking steps reached 8,400 over a period of seven consecutive days. A significant difference was found between the number of walking steps on working days and that on days off. Two groups of working adults who walked less at work were plant and machine operators and assemblers, and clerks. A significant positive correlation was also found between physical activities on working days and those on days off. One's walking steps on working days were found to significantly increase one's walking steps on days off when the effect of age and gender were controlled in the analysis of multiple regressions. Physical activities on a working day are likely to determine those on a day off. Sedentary work habits may induce sedentary activities on days off. The results inform us that health promotion campaigns, for allowing exceptional levels of activities at workplaces should be undertaken to encourage working adults in Hong Kong.

Minoo Pakgohar   and Samira Malekian   

Introduction: Female sexual function may be affected by negative or positive effects of contraceptive methods, which needs more investigation. The aim of this study was to determine the impact of low dose oral contraceptive pills (OCPs, LD) and condoms on female sexual function. Material & Methods: A sample of 62 Iranian women, who were first time users of OCPs, LD (n=32) and condoms (n=30) were assigned for the study. The women's sexual function was assessed using a standard questionnaire both before and four months after using the contraceptive methods. Results: In the OCPs, LD group, there was a significant increase in total sexual function score (p<0.001) and the four domains of sexual function (desire, arousal, orgasm, and satisfaction) four months after the recruitment. In the condom group a significant reduction was found in the five domains as well as the total sexual function score (p<0.001) four months after recruitment. Conclusion: The results of this study indicated an improvement in sexual function after using OCPs, LD and a significant negative effect on women's sexual function with the use of condoms.

Nahla AL Ali   Zaid Alhamdan   and Najwa Almughrabi   

This survey sought to measure the respiratory health effects and the prevalence of second-hand smoke exposure among school children. A sample of 370 parents selected from primary health care centres in Zarqa governorate, Jordan. International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to gather the data. Descriptive statistics, Person correlation coefficient, and Pearson Chi-Square were used to analyse the data. The prevalence of "at home" exposure was 3.82 hours/day. The main location for exposure was at home (22.1%), with the homes of others (17.3%) and the in vehicle exposure (14.3%) being the next two most commonly cited indoor locations. A significant association was found between exposure to second-hand smoke at home, indoors-other, in vehicles, and in the restaurants and other recreational areas, and asthma and rhinitis symptoms. The number of rooms and people per room, parents' educational achievement were also associated with respiratory symptoms of children. These results shed light on the importance to protect children from the harm of smoking and to carry out home smoke free policy.

Lesley Wilkes   John Daly   Wendy Cross   and Debra Jackson   

Purpose: This paper aims to describe the education and career pathways of a group of nursing deans in the late 20th and 21st centuries. The study explores nursing deans to understand the career development process and to develop recommendations for succession planning. Methods: A qualitative interview captured the oral histories of 30 nursing deans from Canada, United Kingdom and Australia in 2011 and 2012. Career and educational pathways were mapped, tabulated and exemplars used to emphasise key education and career decisions. Results: Findings show that there are four distinctive pathways to becoming a nursing dean and these are: 1. Same university pathway: Clinical work to teaching and thence the promotion and leadership in education route and pursuit of deanship in the same institution; 2. Different university pathway: Clinical work to teaching thence the promotion and leadership in education route and pursuit of deanship at a different institution in the same country; 3. Different country pathway: Clinical work to teaching thence the promotion and leadership in education route and pursuit of deanship at a different institution in different country; and 4. Health pathway: Clinical work to clinical management to dean route. Conclusion: The career and educational pathways of the 30 deans described will inform aspiring deans and highlight the importance of doctoral qualifications, management experience and leadership qualifications. Importantly, these aspirants need to determine the particular institutional culture into which they aspire to commit to becoming a dean of nursing.

Louise Eulau   Christina Sundman   Max Scheja   and Bjöörn Fossum   

In the present study, a model which enables a combination of individual, formative assessment with summative assessment in a group was introduced and evaluated in clinical education. Based on a qualitative design, the study embodies research based on participation and theory founded on empirically practical try-outs. The one-year project included two Swedish universities and related health care settings within one hospital. Three groups participated in the study. A survey was conducted at the end of each period to measure the students’ learning attitudes. Narrative data from the surveys were compared to the impressions of the teachers using a hermeneutic approach. The implementation of assessing students in a group was successful in this study. The model is developed for a nursing program but has general qualities which, combined with a customized form of assessment, could be applicable to various educational programs.

Masumi Goto   Naoko Morita   Fumie Katagiri   and Toshiyuki Tsukamoto   

Korea has led the way within Asia with its pioneering nursing care insurance system. This study examines the current state of end-of-life care for the elderly, along with future trends, based on surveys and interviews of managers and employees of institutions related to nursing care and nursing care insurance. Korea is seeing a gradual increase in its latter stage elderly population. It naturally follows that this puts pressure on dealing with end-of-life care, and this study revealed concern that the care environment cannot keep pace with the concurrent increase in medical needs. Korea's system restricts end-of-life care to hospital facilities, so care facility staff lack experience and certain kinds of awareness. Workers’ own attitudes toward life and death, as well as those toward caring for the sick, influence the quality of end-of-life care. It was found that these attitudes are significantly influenced by religious beliefs and work experience. Social workers had longer experience in caring for the infirm and a stronger tendency to be cognizant of care which focuses on a patient’s family. Results indicated that in the future, it will be necessary to consider how care workers can best think about and approach end-of-life care as a team.

Myung Sook Choi   and Hyunjeong Shin   

Objectives: The purpose of this study was to examine the relationships of self-efficacy, social influences, decisional balance, consistency in past contraceptive use, and stages of change for contraceptive use in college students. Study design: A cross-sectional correlational study was conducted on a convenience sample of 185 Korean college students. Data collection was conducted by three trained research assistants over a six-month period in 2013. Path analysis with AMOS software was used to identify the effects of predictor variables on stages of change for contraceptive use. Results: Social influences, consistency in past contraception use, and self-efficacy had a direct effect on the stages of change for contraception use. Although decisional balance did not show a direct effect, it had a significant indirect effect on the stages of change through self-efficacy. These predicting variables explained 40% of the variance of stages of change for contraception use. Conclusions: The results suggested that the TTM is useful in explaining college students’ contraceptive behavior and that self-efficacy partially mediated the role of cognitive (social influence) and behavioral (past contraception use) factors on the stages of change for contraceptive use.

Machudo, S. Y.   and Mohidin, S   

Nursing documentation is a legal record and a communication for continuity of care. Nurses should understand the implications of incorrect documentation could lead to sentinel events. The study aimed to examine the current practice of nursing care documentation and develop project for improvement. The project conducted from January to March 2014. It was based on the fundamental concepts of assessment; planning; implementation and evaluation. A prospective cross sectional method used to evaluate nursing 'Focus Chart' documents. Two nurses' documentation per unit per day for two weeks was assessed and analyze from all units using the hospital's measurement tool. Findings showed that 980 nurses are providing direct patients care and performing documentation on patients chart. Fifty percent (n= 16) unit has started focus charting and ten units are utilizing narrative and six units using other methods in documentation respectively. Documentation improvement package developed and processes put in place to readdress the documentation concern. The nursing care plan, patient assessment and activity flow sheets were reviewed and recommendation made to nursing administration to use a multidisciplinary approach to develop policies and guidelines on nursing documentation. In addition to provide sustained continuing training opportunities for nurses on effectiveness of documentation.

Sujatha Shanmugasundaram   

Background: Globally, the demand for palliative care services is markedly increased for the past decade due to emerging chronic diseases and ageing population. As a result, the health system needs to recognise and meet the needs of the people with life limiting illness. Palliative care is a specialised discipline of health care with the aim of providing care for the patient with terminal illness. Furthermore, there is evidence that minority ethnic groups have lack of knowledge on palliative care services in Australia. Purpose: To explore the issues in accessing palliative care services in Australia and provide recommendations to improve access. Methods & design: The research design chosen was constructivist grounded theory approach. Ethics approval was obtained from the study setting and from the university. Data collection was carried out in two phases. Semi-structured interview guide was used to collect the data. An in-depth interview was conducted and each interview lasts for 45 min to one and half hours. Snow ball sampling technique was done to recruit the participants. The inclusion criteria were: first generation Indian migrants; who understands, read and write English; Indian people receiving or already received palliative care services. Data was analysed by using grounded theory analytic technique. Findings: After analysing the data, two major themes were identified: knowledge about health care services, and knowledge on palliative care services. Conclusion: Although palliative care services are delivered effectively across Australia, still there are issues in accessing palliative care services among minority ethnic groups. Therefore, identifying these gaps and fulfilling these needs are the major focus in the Australia health care system.

Nancy Hinchcliffe Duphily   

The Road Taken: Addressing the Needs of the LPN Returning to Academia. The purpose of this article is to present and to highlight a newly created course created to support the educational needs of the LPN returning to academia for a baccalaureate degree in nursing. From an extensive literature review, and in discussions with practicing LPNs, LPNs in Bridge programs, staff nurses, nursing educators, and nursing administrators, this need was identified. Their contributions regarding what to include/omit in an LPN to BSN transition program provided its focus, that of supporting this population of nurses who articulate areas they consider challenging and often times overwhelming in their return to the educational setting. The intent of this article is that the reader will: 1acknowledge the experience and skills that LPNs bring to the educational table. 2. describe the process of scaffolding new knowledge onto an existing solid nursing foundation. 3. identify the need for a seamless and successful transition to the new professional role. 4. discuss the challenges and strategies surrounding areas of successful role acquisition. 5. examine the purpose and rationale for the design of an introductory "Transitions" course.

Christy L. Skelly   and Suzan Ulrich   

Birth defects are the leading cause of infant mortality. New tests offer screening for many fetal aneuploidies. These tests are offered very early in pregnancy and clients are faced with many options. This has made the education of the client more challenging and threatens the ability of the client to make an informed choice. The purpose of this project was to measure the level of informed choice women reported after making a decision on whether or not to have the many optional prenatal genetic screening tests. The level of informed choice was measured using the Multi-dimensional Measure of Informed Choice (MMIC), at a Midwestern private OB-GYN office. This capstone project was a small pilot study which included 26 prenatal clients. Seventy-five percent of the prenatal clients had good knowledge and 57 percent made an informed choice. Future studies and methods will focus on improving this reported level.

Tsang Y.K.A.   and Wong S.L.   

The aim of this study was to examine independent variables such as socio-demographic, psychopathologic, and rehabilitative support background that might predict re-hospitalization among psychiatric residents of a long-stay care home (LSCH) in Hong Kong. The re-hospitalization of psychiatric residents with mental health needs who were admitted to a long-stay care home during a 2-year period was analyzed retrospectively in this study. Descriptive statistics were gathered to study the distribution of the sample data. Logistic regression was used to examine the predictors of re-hospitalization. 176 residents (mean age 56.9, SD 8.4 years) were included, of whom 73% were male. The psychopathologic characteristics of most residents were similar in that 94.9% of them had been diagnosed with schizophrenia. Within the 2-year period the incidence of re-hospitalization among the LSCH residents was 267 out of a population of 1,000. Gender, age, a history of suicide attempts, referral from an acute psychiatric setting, and lack of participation in a rehabilitative training program were the predictors of re-hospitalization. Strategic interventions to improve the current rehabilitative support services of LSCHs are discussed.

Constance Visovsky   James A. Bovaird   Cindy Tofthagen   and Janique Rice   

Early detection methods and novel therapies have increased the life span of individuals with breast cancer. These survivors are living longer lives with the effects of disease and treatment. Chemotherapy-induced peripheral neuropathy (CIPN) has become a significant dose-limiting toxicity of breast cancer treatment with taxane-based chemotherapy such as paclitaxel. The sensory and motor neuron dysfunction accompanying taxane chemotherapy can interfere with physical functioning, and impair quality of life. The purpose of this pilot study was to determine the efficacy or feasibility of an aerobic and strength training exercise program on neuropathic symptoms, gait and balance, and quality of life (QOL) in individuals treated for breast cancer with paclitaxel as compared to those in an attention control group. Nineteen women receiving weekly paclitaxel for two months were randomized to receive a home-based aerobic/strength training exercise program (EG) or breast cancer educational information (AC). Data were collected at before chemotherapy was initiated, and at every 4 weeks during the intervention phase for a total of 12 weeks (4, 8, and 12 weeks), and then at 3 months post-intervention (24 weeks). An intent-to-treat data analysis plan utilizing a combination of linear mixed modeling (LMM) and analysis of covariance (ANCOVA) was employed. Results indicate there was a differential negative trend in neuropathy symptoms, with fewer neuropathy symptoms present at post-intervention and follow-up in the EG compared to AC groups over time. There were no differences in gait and balance and QOL during the intervention period between the AC and EG groups. However, the EG showed improved gait and balance and improved QOL at follow-up.

Antoinette Towle   and Karen Breda   

Working on the front lines of patient care, nurses play a vital role in helping our nation meet the objectives of the Future of Nursing IOM report and the Affordable Care Act. Nursing schools have a new challenge to prepare students to function in vital roles as leading change agents in this different environment. Simultaneously, millennials, a new generation of learners with unique learning needs have inundated our nursing classrooms. How best to effectively teach millennial students is a pressing issue. Millennials think and learn differently than previous generations and nurse educators are being asked to change their teaching styles to meet their needs. The purpose of this article is to introduce the nuts and bolts of "Flipping the Classroom" as a new approach to teaching millennial students. This model offers a revolutionary way to teach millennial nursing students. Designed especially for the millennial-aged student, "flipping the classroom" can result in superior learning outcomes, higher knowledge retention, enhanced critical thinking skills and improved clinical judgment. "Flipping" in nursing requires educators to move away from lecturing as the primary way to deliver information and instead to use various engaging tools and activities to help students make sense of theory and to connect key concepts with realistic experiences. It asks learners to use online resources innovatively and to explore the material prior to class. "Flipping" sets the platform for knowledge application in the classroom. Teachers and students use class time to problem solve, create, critique, and synthesize in a dynamic and engaging environment. Ultimately, both nurse educators and students can be transformed with this unique "flipped" model.

Sara Hagen   Cheryl L. Woods-Giscombe   Jeehae Chung   and Linda S. Beeber   

Borderline personality disorder (BPD) involves a complex constellation of symptoms including suicidal threats, suicidal gestures, and self-harming behaviors. There are limited effective treatment options for adolescent patients with BDP or BDP traits in the inpatient hospital setting. This paper discusses BPD and BPD traits in adolescents, examines challenges faced by inpatient nurses, summarizes evidence supporting Dialectical Behavioral Therapy (DBT) for adolescents with BPD traits, and proposes specific inpatient setting programming to address the needs of this population. This paper suggests that DBT may be successfully implemented to optimize outcomes. DBT has typically been used in adult outpatient settings. However, research suggests that the integration of DBT strategies in inpatient settings serving adolescents could facilitate effective outcomes. Nurses in particular are critical members of the hospital treatment paradigm. Outcomes could be enhanced if nurses have a better understanding of DBT and if they received training to enable them to contribute to DBP programming.

Ae Kyoung Lee   and Young-Mi Lee   

The purpose of this study was to assess the educational needs of nurses in small- and medium-sized hospitals to develop an educational program. The participants were 243 nurses in three small- and medium-sized hospitals. The educational needs were measured using Borich’s needs assessment method based on the required competence level and the present competence level. The present competence level was significantly lower than the required competence level in all areas. The educational needs were ranked from highest to lowest as “action and reaction of drugs”, “acid-base balance”, and “medication”. The educational needs were significantly different according to turnover intention. We recognize that nurses in small- and medium-sized hospitals have low self-competence and want to learn direct patient care regarding patients’ safety. Nursing educators and administrators should consider their needs when they prepare educational programs for nurses in small- and medium-sized hospitals.

Suha Omran   Mohammad Al Qadire   Nahla AL Ali   and Mohammed Fouad Al Hayek   

Optimal pain management is one of the most important aspects of patient care. Nurses play a pivotal role effective in pain management. The aim of this study is explore and describe oncology and non-oncology Jordanian nurses’ knowledge and attitudes regarding pain management. The study sample consisted of 263 nurses from three hospitals in Jordan. The Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to measure the nurses’ pain management knowledge and attitudes. Of the nurses who participated in the study, 64% were between the ages of 21 and 32 years, with a mean age of 30.9 years (SD 5.7). A total of 89% of the nurses had a baccalaureate degree. The mean years of nursing experience were 7.3 (SD 5.3). The average correct response rate was 42.7%, ranging from 10.5% to 75%. Out of the 40 pain knowledge questions assessed, the mean number of correctly answered questions was 17.1 (SD 5.0), with a range of 4 to 30. No significant differences between nurses’ characteristics and pain knowledge were found. Nurses’ pain knowledge differed significantly according their educational level (P = 0.020), previous pain education related to cancer (P < 0.007), regular cancer pain care (P = 0.010), knowledge score and attendance of conferences related to pain management (P = 0.002), knowledge score and in-services training, modules, protocols and other knowledge and skills related to pain management (P = 0.004), knowledge score and nurses’ rate of their experience with pain (P < 0.001), and adequate professional training preparation in regard to pain management (P < 0.001). The present study in Jordan provides important information about knowledge deficits in pain management. Pain education content and allocated hours in nursing curricula need to be evaluated for their adequacy and reformed accordingly. In addition, regular courses on pain management for nurses within their clinical setting are highly recommended.

Anne Bruce   Lori Rietze   and Angela Lim   

Concerns raised about the relevance of philosophy to the work of nurses have prompted us to examine the importance of philosophy in professional nursing. We introduce diverse understandings of what philosophy is, provide an overview of analytical and continental philosophies, and describe how philosophy is central to the work of nurses, educators and researchers. The discussion is situated in what some scholars view as a growing milieu of anti-intellectualism, instrumentalism, and neoliberalism. A three-pronged framework of philosophy is presented to help demonstrate the pervasiveness and magnitude of philosophy in nursing practice today. Philosophy helps nurses to think more critically and reflect on how their own values influence their practice and way of being. A better understanding of the importance of philosophy in the nurses’ world is not only relevant but vital to our discipline and professional practice. A broader understanding of the interdependence of practical and philosophical matters in professional nursing is needed.

Louise Chadwick   and Joanne Porter   

The aim of this study is to evaluate the effect of a mental health clinical placement on student nurses attitudes towards mental illness and mental health nursing. Health holds different definitions for different people. The term health can mean wellness or a state of being. Mental health in our society still is wrought with stigma. It is the use of negative labels to identify someone living with a mental illness. Stigma can be a barrier and may discourage families and individuals from seeking help. In the health care system, these barriers need to be broken, from the first contact with the health profession, these being the nurses. Nurse’s attitudes can develop for many different reasons, these being, and lack of knowledge, stigma, and prior experience with mental illness. As a health care profession, we need to start at the beginning, with assessing and encouraging more understanding and tolerance of mental illness with our student nurses. This study used a longitudinal descriptive pre-post survey design to determine the degree to which a clinical placement with a psychiatric/mental health agency changed student nurses’ attitudes towards mental illness and mental health/psychiatric nursing. Bachelor of nursing students are required to complete a mental health unit of study within the Bachelor of Nursing Degree. This unit of study required student nurses to complete a 4 week clinical placement in a mental health facility. Students were invited to complete a survey before the clinical placement and at the completion of the clinical placement. Of the (n=184) nurses invited to participate in this study, 65 completed the pre and post clinical placement surveys, giving a response rate of 35%.The results show that there is a statistical significance of .001 in the mean attitude scores towards mental illness for pre and post placement. The attitudes towards psychiatric nursing show a statistical significance of .01.Results from this study support recent literature towards a positive change in student nurses attitudes towards mental illness and mental health nursing on the completion of a clinical placement in a mental health facility.

Pammla Petrucka   Sarah Brooks   George Smadu   Bev McBeth   Sandra Bassendowski   April Mackay   Mike Gerrand   and Stefany Fudger   

Street Involved Youth (SIY) are part of a diverse, complex, and heterogeneous group which is underestimated, under resourced, and often ignored in programs and planning for health and social wellness. As the numbers of SIY continue to grow, so do the issues and challenges related to the roles of nursing in working with this vulnerable population. Study Intent: The goal was to engage SIY to gather, share, and exchange information (learnings + voice) about experiences, lifestyles, needs, opportunities, and strengths of SIY from their perspectives; and to inform programs/services, policies, and interventions to achieve preferred futures. Method: The project used a qualitative community-based participatory research (CBPR) approach with an arts-based method – specifically music. Results: Two thematic groups with sub-themes were derived. The first thematic grouping is LOCATION which had four sub-themes - ‘Individual Orientation’; ‘Collective (Culture/Sub-culture) Orientation’; ‘Behavioral Orientation’; and ‘Time Orientation’. The second thematic group is DIRECTION with three sub-themes - ‘Path of Disempowerment’; ‘Path of Empowerment’; and ‘Shifting Paths’. Study Limitations: This study was conducted in partnership with a single SIY agency in a relatively small urban setting in Canada. Conclusions: In working with SIY, it is imperative to ‘meet them where they are’ with research methods that are innovative and engaging. In this study, the use of music as an arts-based method was found to be highly suitable, efficient, and mutually beneficial.

Mei-Chin Chen   Ying-Wei Huang   Wen-Li Hou   Chien-An Sun   Yu-Ching Chou   Su-Feng Chu   and Tsan Yang   

The purpose of this study was to investigate the correlation between job stress, job satisfaction, and quality of life for nurse anesthetists at medical centers in Southern Taiwan. The study adopted a cross-sectional study design. The interviewees were nurse anesthetists at three medical centers in Southern Taiwan who had been employed in their respective units for over 6 months. The recruitment period was from January 2012 to March 2012. Data was collected using a structured questionnaire composed of the following sections: basic personal characteristics, perceived source of job stress for medical work scale, job satisfaction for nurses scale, and SF-36 quality of life scale. A total 150 nurses participated in the study. The results showed a statistically significant difference in monthly overtime amounts in relation to overall job stress. Hospital, age, work place, overtime amount, intention to resign, and nurse anesthetist work terms also showed significant differences in relation to subjects’ overall job satisfaction. After using stepwise multiple regression, the average quality of life score for subjects with intention to resign was 8.231 points lower than that of those without such intention; for each increase of 1 point in the “overall job satisfaction” section, the score for quality of life rose by 0.481 points; those with exercise habits scored 5.942 points higher than those without; those in a subspecialty showed an average score of 5.287 points higher than those without. In conclusion, intention to resign, overall job satisfaction, exercise habits, and having a subspecialty are the critical factors influencing quality of life among anesthesia nurses.

Gary E Day   and Sharon Brownie   

All nations are currently challenged by the increasing prevalence of non-communicable and chronic disease [1]. In Australia, by 2051, over 50% of the population over 50 will have a chronic disease [2]. In addition to increased levels of chronic disease, services will be stretched through workforce shortages, and government policies to provide greater access to services. Within the United States of America demand for primary care services will further increased by the passage and progressive implementation of the Affordable Care Act (ACA), which expands Medicaid coverage to millions of low-income Americans [3]. Given the increasing levels of disease burden, all staff, not just doctors, need to be viewed as part of the solution and encouraged to innovate and search for better and more affordable ways of delivering effective and appropriate care [4]. Globally, nurses are the largest and most accessible cohort within the health workforce. It is not surprising; therefore, that increasing reference to nurse-led services is present within the literature. This paper reports the findings of a focused literature review aimed at identifying the range of leadership skills and attributes required of nurses involved in the leading roles in the provision of nurse-led services and the management of nurse-led clinics. The implications for nursing education are highlighted and discussed.

Jamie Irvine   and Siu Fung Chung   

This review investigates the topic of treatment decision-making for early prostate cancer patients. The research question to be addressed is "What can oncology nurses do to support men with early prostate cancer in making treatment decisions?" Reports of primary research found by CIHNAL and Ovid search engines using the term "prostate cancer decision-making" are reviewed. A total of 18 studies have been identified. It is found that men with prostate cancer all need support and information when making treatment decisions. However, little has been said about the types of support and information needed or the best way to deliver them. The undesirable situation is coupled with people's seemingly innate wish to solve crises quickly and making decisions based on individual experience and misconception. As such, reciting treatment options simply and handing out generic literature cannot ensure that the patient and his family members fully understand the options available. It is argued that individualized treatment, with informed decision made jointly by the patient, his family and a treating team, offers the best chance for satisfactory outcomes. Nurses can make use of their research to design interventions and inform the patient of the treatment approach to better assist men in making treatment decisions. It is hoped that individualized and patient-centered treatment will become the norm in healthcare.

Kristin Bonstingl   and Laura McQueen   

The purpose of this pilot study was to investigate the effectiveness of an educational intervention to improve nursing students’ basic knowledge of Muscle Dysmorphia. Muscle Dysmorphia (MD) is a disorder found largely in the male population and is characterized by the obsession to gain large amounts of muscle mass while still perceiving oneself as too small. An interventional study was conducted through an electronically disseminated survey to a selected population of baccalaureate nursing students. The 88 participants were surveyed before and after an educational intervention to assess improved awareness of MD as a disorder. Investigators found that students had improved awareness of MD after educational intervention, but did not demonstrate improvement in identification of clinical symptoms. This topic serves as an important area of research as it links education for nursing students and clinicians with awareness and identification of this emerging disorder.

Joseph P. De Santis   Beatriz Valdes   Elias Provencio-Vasquez   Carol A. Patsdaughter   and Karina A. Gattamorta   

Background/Significance: Substance use is a public health concern in the United States. Hispanic men in the United States experience disproportionate rates of substance use when compared to other ethnic groups. Previous research with the general population of Hispanic men has identified factors that are related and may contribute to substance use. In addition, Hispanic men who have sex with men (HMSM) may experience additional social factors that may result in substance use. Despite the body of research on substance use among Hispanic men, no study to date has compared the substance use behaviors of Hispanic men by sexual orientation. Objectives: The purpose of this study was to compare the substance use behaviors of Hispanic men by sexual orientation. Methods: A cross-sectional descriptive design was used to collect data from 164 community-dwelling Hispanic men (i.e., 77 heterosexual men and 87 HMSM) who resided in the South Florida area. Participants completed standardized measures of substance use and demographic characteristics. Results: Findings suggested that heterosexual men had higher rates of substance use when compared to MSM. No differences were found among the two groups of men in terms of alcohol intoxication. Religion, education, and income were not predictors of substance use. When health insurance status was controlled, MSM were less likely to report substance use. Implications: As a population, Hispanic men continue to experience health disparities in terms of substance use. Because substance use renders Hispanic men at risk for other health issues, more research is needed to understand the co-occurring health disparities experienced by Hispanic men who reside in the United States.

Marjorie Hammer   Sylvia Fox   and Michelle DeCoux Hampton   

Nurse educators are challenged to prepare students to graduate with a high level of communication skill to effectively work with patients, families and professional colleagues. This manuscript describes an innovative pedagogical model developed for teaching therapeutic communication skills to pre-licensure nursing students through the use of simulation. This novel, theoretically based teaching and learning strategy is a replicable model that includes student and faculty preparation; pre- and post-assignments; tools for active engagement of students as role players or observers who utilize therapeutic communication techniques and critical thinking about therapeutic communication theory; tools for self and peer evaluation; and opportunities for inter-professional communication skill development. The model also serves as an alternative milieu to the clinical site. A brief literature review provides a theoretical and socio-economic framework.

AndrĂ© Heitmann    Rosana Svetić ČiĆĄić    and Iris Meyenburg-Altwarg   

In the United States the Magnet Recognition ProgramÂź is an established nursing-oriented organizational model. Accredited Magnet hospitals succeeded in attract and retention of qualified nurses. This demonstrated the future potential of this model. However, a direct transfer of the model to European conditions seemed to be limited. It raised the question concerning a European model that could give hints to organize the hospital of the future. This exploratory and descriptive study attempted to create a European framework in order to made recommendations for the hospital of the future. Following recommendations were made: 1. Designation of nursing as connecting health profession, 2. In-depth structural integration of nursing into the hospital organization, 3. Lived professionalism and quality.

Ha Hoang   Quynh LĂȘ   and Daniel Terry   

This study investigates the maternity experiences of rural women in Tasmania; and whether the childbirth experiences between women who have had childbirth experiences within the last five years and those more than five years ago are different due to closure of local maternity services. A questionnaire explored women’s experiences of rural maternity services from antenatal to postnatal care in six rural communities in Tasmania, Australia. 210 women completed the questionnaire with a response rate of 35%. Nearly 50% (n=100) of surveyed women did not have a choice where they could get antenatal care, while more than 50% (n=108) of participants lacked the choice about who would provide care during their pregnancy. Women who gave birth recently were more likely to have to travel further to the nearest maternity units. These women were less likely to experience continuity of care and to be satisfied with the antenatal care and care during labour. In contrast, the women who gave birth more than five years ago had shorter travel time to the nearest maternity units and were more likely to have experienced continuity of care and greater satisfaction with care given during their pregnancy, labour and delivery. Maternity experiences of Tasmanian rural women have not improved with time due to the closure of small rural maternity units. Reopening small rural maternity units would not be feasible with the current shortage of health workforce in Australia. However, in order to improve maternity experiences for rural women, it is recommended that basic services including antenatal and postnatal services should be provided in their local communities. The existing maternity health providers in rural communities such as GP obstetricians and multi-skilled rural nurses should be encouraged and provided with incentives to deliver greater antenatal and postnatal care for women. In addition, maternity health providers from major hospitals could come to a local hospital regularly to provide antenatal check-ups and antenatal classes. This will reduce the need of traveling to access services and increase opportunities for continuity of care which in turn may increase the satisfaction with care of rural women.

Shaikh, Javaria Manzoor   

This paper investigates on space syntax depth map software case studies of ICU design for four plan typologies, for investigation of the nurse station location, the layout design for the typology is been analyses on the space syntax program. There is a vacuum in the field of the Nurse Station location and ICU spatial composition. Since Evidence-Based Design (EBD) is the deliberately attempting to base ICU layout building decisions on the best available evidence with the goal of achieving the best possible outcomes . The aim of this paper is that the hospitals in Karachi should have increased of number of single room accommodation. Moreover the typical ICUs is suggested to be to larger bed spaces = 20 meter square. ICUs may have 10-20% single rooms A healing environment is the result of a design that has demonstrated measurable improvements in the physical and/or psychological states of patients and/or staff, physicians, and visitors. To identify the mechanisms by which sun light impacts child human health and performance and review the literature linking daylight with health outcomes in Pakistan healthcare settings. A window may provide variable degree of comfort for hospital buildings as that of high energy consumption hospitals. Window is a physical aspect in hospital design which creates a healing environment. This paper validates the role of daylight on patients satisfaction.

Karyn Taplay Jane Moore and Michelle Richardson 

Internationalization is an objective of many academic institutions and programs. Hosting international students was one way to raise the international profile of a nursing program and the institution. In order to plan, implement and evaluate the experience of hosting exchange students the nursing faculty used the principles of primary health care (PHC), which are the fundamental tenants of the program. Although the principles of PHC focus primarily on the health of a client or population they served well as a framework for hosting international students and provided the structure needed to facilitate a student exchange program that could be sustained between an Austrian and a Canadian nursing program.

Khaldoun M. Aldiabat and Michael Clinton 

Aim: To explore retrospectively how male Jordanian psychiatric nurses became regular smokers. Background: Smoking is endemic in Jordan and there is a high smoking rate among university students including nursing students. Smoking is a risk factor for morbidity and mortality not only among those future nurses themselves but also among their patients. A better understanding of how male Jordanian psychiatric nurses became regular smokers is needed if smoking reduction and smoking cessation programs are to be effective. Method: A classical grounded theory study of eight male Jordanian psychiatric nurses employed in Amman. Findings: Jordanian universities and faculties of nursing play a paradoxical role in socializing male nursing students into regular smoking behaviours while instructing them in the importance of health promotion and patient education. As a result, male nursing students learn to become regular smokers after they were occasional smokers, but not how to access resources or use techniques to help them reduce their smoking or stop smoking. This transition responds to five contextual factors: the stressful demands of nursing programs; encouragement from other students; neglect of university no-smoking policies; no access to smoking cessation programs; and gaps in nursing curricula. Conclusion: It has been concluded that there are different contextual and cultural factors in Jordanian universities and faculties of nursing influence nursing students to become regular smokers after they were occasional smokers. The findings reported provide a basis for smoking prevention programs and smoking cessation programs. These findings are particularly relevant to university administrations, nursing faculty, and other health promotion specialists in Jordanian universities and to managers with occupational health and safety responsibilities in Jordanian mental health facilities and services.

Christina Hanson, MSN, ACNS-BC Kara Aalfs, MSN, ACNS-BC and Donna J. Plonczynski, PhD, APRN, FNP-BC 

Background: Heart failure (HF) is the primary cause of hospitalizations and readmissions to a hospital within 30 days of initial discharge. In 2010 HF cost an estimated $39.2 billion in health care services, lost productivity and medications. Optimizing outpatient care is vital to effectively manage this patient population. Objective: The purpose of this paper is to describe and evaluate the effectiveness of an optimized outpatient HF clinic. Patient outcomes from a Midwestern community hospital were based on quality of life (QOL) and readmission rates. Methods: A retrospective chart audit was conducted on a random sample of patients enrolled in the Heart Failure Recovery Center (HFRC). The QOL outcomes were measured using the Minnesota Living with Heart Failure¼ Questionnaire. Results: Enrolled patients demonstrated improvement in their QOL in the emotional, physical, and overall scores across the first 6 months of care. In addition, there were significantly fewer 30-day all-cause readmissions when compared to non-Clinic patients. Conclusion: Utilization of an APN-managed multidisciplinary HF clinic improved patient’s QOL and contributed to one hospital’s decreased all-cause readmission rates for the HF population.

Hirokazu Madokoro Nobuhiro Shimoi and Kazuhito Sato 

This paper presents a sensor system that predicts behavior patterns that occur when a patient leaves a bed. We originally developed plate-shaped sensors using piezoelectric elements. Existing sensors such as clip sensors and mat sensors require that patients be restrained. The features of our sensors are that they require no power supply or patient restraint for privacy problems. Moreover, we developed machine-learning algorithms to predict behavior patterns without setting thresholds. We evaluated our system for ten subjects at an experimental environment constructed in reference to a clinical site. The mean recognition accuracy was 75.0% for seven behavior patterns. Especially, the recognition accuracies of lateral sitting and terminal sitting were 90.0% and 96.7%, respectively. We consider that these capabilities are useful for bed-leaving prediction in practical use.

Laura McQueen and Lynn  Zimmerman 

This study examines a group of middle school students who are Hispanic and their interest in attending college and pursuing a career in nursing. Although males and females both participated, mostly females expressed an interest in nursing as a profession. In this study investigators examined Hispanic middle school students knowledge and interest in attending college for a nursing degree and discussed methods to assist in developing more interest in nursing as a career choice for middle school students who are Hispanic. This project supports the need for creating a diverse nursing workforce through inclusion of underrepresented populations. The significance of this study is that it can be used to develop programs aimed at recruitment and retention of student nurses who are Hispanic.

Shaikh Javaria Manzoor and Park Jae Seung 

The purpose of this study is to identify the determinants by which sun light increases the effectiveness of human health and performance and review the literature associating daylight with health outcomes in Pakistan healthcare settings. A skylight may provide variable degree of comfort for hospital buildings as that of high energy expenditure hospitals. Skylight is physical aspects in hospital design which devices a healing environment. This paper validates the role of daylight on patient’s relief. Methods include determinants of day light design identification in the basement plan of six bedded nightingale ward which is a case study for this research. For verification a field survey was conducted along with designed questionnaires which were filled by patients upon request along with nurses and visiting families. This study is based on the Ulrich [9-13] proposal that: a view of natural elements serves to evoke positive emotions and governs trauma.

Irene J. Su  

This article is a case study of medication errors in a psychiatric hospital in the Midwestern region of the United States. A survey was conducted among nursing staff regarding the likelihood of reporting medication errors. A few case scenarios were presented for discussion. Measures to improve safety of medication administration were proposed.

Amy Brackett and Nancy Duphily 

In considering the overall health of an individual, mental health plays an important role. Data from a search of the literature illustrate that for the number of children and adolescents experiencing mental health crises, resources are decidedly lacking, and many times, unavailable. The aim of this paper is to highlight the scarcity of mental health resources available for the at-risk adolescent, to address why these resources are crucial to access early on, and to discuss interventions to prevent, identify, and treat at-risk adolescents. Incorporated into this discussion is the impact of parents, peers, school, and home life as major contributors to the mental health of the adolescent.

Eleni Jelastopulu Thomaella Tsouvaltzidou Evangelia Vangeli Fani Messolora John Detorakis and Evangelos C Alexopoulos 

Occupational stress has been associated with low job satisfaction and poor quality of work performance. The aim of this study was to identify sources of stress among the nursing staff and to evaluate job satisfaction, quality of nursing care and the collaboration between the nursing and medical staff, in order to improve the quality of the provided health care and the working conditions. In this cross sectional study, a questionnaire survey was conducted among 494 randomly selected nurses working in 5 hospitals in the prefecture of Achaia, West-Greece. Statistical analysis was performed using software SPSS v.17.0. The results indicate that stress and work satisfaction are negatively related and that the hospital and the department the participants worked in play a significant role in their work performance. Supervisors’ and doctors’ support, respect and acceptance influenced the variables under study as well. Additionally, another major factor that emerged from the analysis was the inadequacy of time for care which reveals the lack of personnel and resources. This study underlines the need of creating a supportive and positive working environment for the nursing staff, by reducing sources of stress and introducing intervention programs.