Institute of Health and Science, UAE
EARLY MOTHERS IN CABANATUAN CITY: THEIR EXPERIENCES IN RAISING A CHILD
Jasper Kim Wagan currently work as an Infection Control Nurse in a newly established Private Hospital in Abu Dhabi, Nation Hospital managed by Medical University of Vienna International.
As a young professional, he was exposed into the field of research during his college years, earning him an academic award. After graduating, he passed his board exam and worked as a licensed nursed in his home country, Philippines, for more than 2 years. He ventured to take the Health Authority Abu Dhabi exam and passed last 2013 and started working in Abu Dhabi in March 2014.
He was appointed to continue the Prevention and Control of Infection Program last 2016 and currently finishing his Post Graduate Degree in Infection Control at the University of Essex, United Kingdom. He works diligently with the Chief Executives and Senior staff to ensure proper compliance with the Prevention and Control of Infection Program.
In the increasing number of early pregnancies in the country, Philippines, numerous adolescents enter early parenthood.In understanding this condition, the study seeks to understand their experience. The researchers chose mothers who had encountered and faced early parenthood at a young age of not greater than 19.
This study uses a Descriptive Phenomenological Method.A total of seven participants were interviewed in the study, using the one-on-one interview method. Using Giorgi’s Phenomenological approach, 3 themes were described from the data: ‘Dilemma caused by Early Motherhood’, ‘Remorse as a result of Early Motherhood’ and ‘Fruition as a realization of Early Motherhood’.
The findings of this study are useful in that they provide a glimpse of how some adolescent females perceive early maternity and parenthood after giving birth. Moreover, the findings revealed some needs that nurses and other healthcare workers may address and may use for future studies using a quantitative type of research.
Latifa Women and Children Hospital , UAE
The introduction of Problem-Based Learning in Nursing Education
In nursing continuous education and staff development educational programs, Using of didactic and lecture-based teaching, are found insufficient to meet the purpose clinical education. Change is needed to improve nursing abilities to be independent in exploring and solving patient problems.
The focus of this study was to introduce the Problem-Based Learning in nursing education as well as its effectiveness and efficiencyto achieve whole-person development and life-long learning.Problem-based learning based on the principle of using problems as a starting point for the acquisition and integration of new knowledge.” H.S. Barrows 1982
This project used Health Service (HSE) as a change model, tointroducethe problem-based training in nursing education. Furthermore, Kirkpatrick model implemented as a design strategy. The survey questionnaire distributed among nursing staff to assess the satisfaction level from using the PBL as a teaching/learning approach, pre-test and post-test to check the changes in the knowledge level after getting the training using PBL, and critical thinking case study introduced to assess the effect of using the PBL on nursing generic skills. A total number of 24 mixed skill level nurses participated.
The results show that 34% nurses were highly satisfied with the PBL approach while in the opinion of 61% this approach is very good, concerning the critical thinking and problem solving skills, that gained, and the knowledge that improved by the percentage of 85%, which show the understood level of the importance of using PBL in the education.
Overall findings was expected as shown in the previous PBL studies , the effectiveness of using the problem-based learning as an instructional approach, increase knowledge level, improves problem-solving and improve the critical thinking skills, and the self-directed learning.
Nursing staff need the motivation and the system to improve their self-learning skills.
King Fahad Medical City, Saudi Arabia
The Impact of Creating A Child-Friendly Hospital Environment in Pediatric Cancer Patients and Their Families in Comprehensive Cancer Center at King Fahad Medical City.
Background: Hospital admission can be scary for a child, most especially for hospitalized pediatric cancer patients, but studies show that there is growing evidence that environmental modification has a great impact in patient experience and health outcomes. Majority of pediatric cancer patients and their family was not satisfied with the unit environment. The aim of this study was to explore the impact of creating a child-friendly hospital environment in pediatric cancer patients and their families.
Method: General surveys were conducted. Performance improvement team studied the result of the surveys, a specific survey was formulated. Relevant data were collected.
After studying the results, suggestions for improvement were considered. Contributing factors for their dissatisfaction were also analyzed in a form of Cause-and-Effect Diagram. A post-intervention survey was conducted.
Result: Result of general, specific survey and repeated focus group discussion showed that we need to create a child friendly hospital environment.
Series of interventions applied like Wall posters designed to mimic a zoo, play rooms designated for certain age groups, quiet patient rooms for families to rest, an attractive waiting room and plasma televisions with kid channels. Post intervention satisfaction survey have shown an increase satisfaction rate of 90% from the pre-intervention satisfaction data which was 68%, with around 95% of hospital staff interviewed were very positive with the effects of the interventions to the patient’s journey of stay in the hospital.
Conclusion: A hospital or healthcare setting needs essential tools to improve the quality of care continuously for their patient population to enhance comfort for the patient and the entire family. A small initiative to address the emotional needs of the patient can bring a huge difference in their health condition; thus, giving positive health outcome and an excellent journey of patient experience.
Keywords: Child-friendly, Cancer, Pediatric, Recreation, Satisfaction.
Nursing Education; Clinical Reasoning, Decision making, and Action
Ruba Ibrahim;A highly motivated, an enthusiastic, hardworking and competent healthcare professional who possess the required level of healthcare quality experience needed to deliver high quality,customer focused, and clinically effective patient care in a modern well equipped clinical setting.
Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years.The definitions of critical thinking have evolved over the years,The American Philosophical Association (APA) defined critical thinking as purposeful, self-regulatory judgment that uses cognitive tools such as interpretation, analysis, evaluation, inference, and explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations on which judgment is based.(Patricia Benner; Ronda G. Hughes; Molly Sutphen,2008),Professional and regulatory bodies in nursing education have required that critical thinking be central to all nursing curricula, but they have not adequately distinguished critical reflection from ethical, clinical, or even creative thinking for decisionmaking or actions required by the clinician.
Critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case. Critical reflective skills are essential for clinicians; however, these skills are not sufficient for the clinician who must decide how to act in particular situations and avoid patient injury,An essential point of tension and confusion exists in practice traditions such as nursing and medicine when clinical reasoning and critical reflection become entangled, because the clinician must have some established bases that are not questioned when engaging in clinical decisions and actions, such as standing orders.
Research continues to find that using evidence-based guidelines in practice, informed through research evidence, improves patients’ outcomes, Research-based guidelines are intended to provide guidance for specific areas of health care delivery. The clinician—both the novice and expert—is expected to use the best available evidence for the most efficacious therapies and interventions in particular instances, to ensure the highest-quality care, especially when deviations from the evidence-based norm may heighten risks to patient safety. Otherwise, if nursing and medicine were exact sciences, or consisted only of techne, then a 1:1 relationship could be established between results of aggregated evidence-based research and the best path for all patients.
Tamayo Medical University, Philippines
Integrationof Transcultural Nursing Course Into The Bsn Curriculum: Enhancement On Core Competencies
Today, expectations worldwide are intensified for the nursing profession because of the increasing multicultural diverse society with cultural specific needs, which is the access to universal care. Through the basic nursing education, conceptualizing the cultural diversity and cultural awareness develops cultural characteristics. Transcultural nursing is a humanistic discipline, a combination of anthropology and nursing in both theory and practice wherein, the cultural interrelationships were studied from the perspectives of nursing. Through the Baccalaureate programs, nurse leaders and nurse educators believed that it is an ideal vehicle to promote cultural competence. Competency is essential to the nursing profession that provides the foundation into nursing curriculum. Nursing education subscribes to the following core competencies: 1) safe and quality care, 2) management of resources and environment, 3) health education, 4) legal responsibility, 5) ethico-moral responsibility, 6) personal and professional development, 7) quality improvement, 8) research, 9) record management, 10) communication, and, 10) collaboration and teamwork.
The global challenge now is to increase the cultural level of competence among nursing students to ensure a culturally competent workforce prepared to deliver congruent care. Because of the multicultural issues and needs of the diverse population across countries, the study was endeavored to integrate the transcultural-nursing course into the Philippines’ Bachelor of Science in Nursing (BSN) curriculum to enhance the core competencies of the graduating nursing students. Specifically,it sought answers to the following questions: 1) what are the core competencies of the senior nursing students with integration of Transcultural Nursing (TCN) course? 2) What are the core competencies of the senior nursing students without the integration of the TCN course? 3) Is there a significant difference in the core competencies of with and without the integration of TCN course? 4) What are the problems encountered in during the integration of TCN course into the BSN curriculum?
Mixed methods were employed in this study, combining both quantitative and qualitative approaches to better understand, explain, or build on the results, wherein, priority was given to quantitative approach that is focused on strategies of enquiry – the questionnaires and the experiment. Qualitative approach (interviews) was also utilized to provide a better understanding of research problems rather than approach alone.
Of the 100 graduating nursing students, fifty students with integration of TCN course, resulted to overall weighted mean of 3.27, which showed that the grouped participants were all competent. The other fifty graduating students grouped as without the integration of TCN course, their core competencies resulted to an overall weighted mean of 3.32, which revealed that all were competent. Finally, there was no significant difference in each of the core competencies when grouped according to with or without the integration of TCN course into the BSN curriculum.
Based on the aforementioned summary of findings, the following conclusions were made: 1) the eleven nursing core competencies had always been part of the standards for professional practice. With and without integration of TCN course, graduating nursing students were all competent in the standard competencies. 2) When grouped according to the core competencies of with and without the integration of TCN course, t-test was used and assessed whether the means of two groups were statistically different from each other. The t-critical value was used in statistics to construct a confidence interval, a range of values that is likely to include a parameter being studied. With this, the t-values of the 11 core competencies showed a non-significant difference at t-critical value of – 1.984. 3)Transcultural nursing course is relevant to the BSN curriculum expansion, to the growth and development of both the faculty and students, to the success of the graduating nursing students and be globally competent. 4) The problems encountered in the integration of transcultural nursing course into the BSN curriculum were, no certified faculty to teach with limited time and cover the whole concept of the TCN course. Nursing profession needs to sustain the basic information in the areas of practice, education, and leadership. School administrators can think of expanding programs proposing accelerated graduate degrees to augment the production of graduate and post graduate highly competent nurses, possible cross cultural exposure program to enhance nursing theoretical and clinical practice, professional development program may be offered with cross cultural exposure to global exchange program be globally equipped and to improve the competence of the nursing faculties and students.
Keywords: transcultural, nursing curriculum, nursing core competencies,
National Institute of Public Health, Mexico
Development of an instrument to measure the quality of prenatal, delivery, postpartum, and newborn care
Dr. HéctorLamadrid-Figueroa is head of the Department of Health and Gender in the National Institute of Public Health of Mexico (INSP). He was a consultant with MEASURE Evaluation from 2011 to 2015, facilitating Regional Workshops of Program Impact Evaluation in Mexico, South Africa,India and Nepal. He is a collaborator of the Global Burden of Disease study since 2015. His research interests are in Epidemiology, Maternal & Child Health, Program Impact Evaluation and Applied Statistical Methods.
Context: The World Health Organization and others have identified quality of care (QoC) before, during, and after childbirth as priority areas for research and intervention. Some studies have revealed substandard QoC and mistreatment of women in Mexican Hospitals. Currently, no validated instruments exist to measure QoC in Mexico.
Objective: To develop and validate items to produce a research instrument in order to measure obstetric QoC in Mexico.
Participants: A total of 69 experts in various fields related to maternal and newborn health working in Mexico.
Intervention: Utilizing a modified Delphi method, we conducted: 1) two brainstorming workshops to define QoC and its associated variables; 2) systematization; 3) ranking and selection; 4) instrument design; 5) validation; 6) verification based on practice guidelines and norms, 7) elaboration of QoC indicators.
Main Outcome: An instrument to measure QoC in Mexican health units.
Results. During the first workshop, participants defined QoC and identified more than 400 QoC. We achieved consensus on the selection of variables and potential indicators that would comprise 3 research instruments, all of which were subsequently validated before dissemination. Finally, we developed QoC indicators.
Conclusions. This paper describes the first effort in Mexico to define and measure QoC during prenatal, delivery, postpartum, and newborn care stages. This will permit consistent QoC measurement and impact evaluation studies across providers and institutions at the hospital-level throughout the country. While further validity and reliability research is needed before a single quality index can be used to define and measure QoC, dissemination of results stemming from this pilot study could contribute to improve QoC and, ultimately, health outcomes for women and newborns in Mexico.
National Institute of Public Health, Mexico, Mexico
Evidence based delivery care: design and evaluation of an innovative obstetric and neonatal training intervention
Dr. Jimena Fritz is a Physician and a PhD in Health Sciences. She has been in academic exchanges at Emory University, University of California at San Francisco and University of North Carolina at Chapel Hill. Also since 2009 to date she has been assistant professor of Biostatistics in the INSP. She has presented different results of these studies at national and international level. Currently she collaborates in the Division of Reproductive Health at the National Institute of Public Health (INSP) in Mexico where she coordinates several projects on Maternal Health.
Context:In Mexico, 96% of births are attended in health facilities, however, more than 90% maternal deaths occur in these same facilities. These data suggest a lack of quality of care (QoC), as poor practices during the attention of delivery are prevalent.
Objective:To foster a better QoC within health services by creating and evaluating an innovative interprofessional training.
Methods:We conducted 109 semi-structured interviews to health personnel, and users of health services in three hospitals and their network of primary care facilities, in two states of Mexico. With this information and a multidisciplinary team of trainers, we completed the training design.
Patient(s): The median age of the participants was 40 years; the majority (80%) were women, mostly nursing staff (45%) and general practitioners (30%). Only 5% were medical interns, but 17 nurse-midwives and 2 perinatal nurses participated.
Intervention(s):The themes imparted during training were: teamwork, communication, evidence based-medicine, prenatal care, labor, birth attention, postpartum, mindfulness, breastfeeding, neonatal resuscitation, prevention of teen pregnancy and nutrition.
Main Outcome Measure(s):The effect of the training was assessed through pre-post changes in knowledge scores and in the performance of practices during birth, by direct observation of deliveries.
Result(s): The main findings were an increase in the active management of the third stage of labor (AMTSL), increased oral fluid consumption, free movement, skin-to-skin contact, as well as inspection of the placenta. Non-recommended practices such as routine IV access, induction of labor, Kristeller maneuver and episiotomy were reduced.
Conclusions: Lack of infrastructure and consumables as well as deficiencies in the knowledge and ability of health personnel difficult the implementation of evidence-based midwifery practices. The results from this study are beginning to be important for the discussion among experts in order to outline a public policy aimed at training professionals entrusted with low-risk deliveries in the Mexican health system.
Jordan University of Science and Technology, Jordan
Cognitive and Emotional Empathy in Adolescents with ADHD: Are Comorbidities, Gender, and Parental Acceptance-Rejection Important Factors?
Ghada Shahrour, PhD, RN is an assistant professor of nursing at Jordan University of Science and Technology in Jordan. She finished her PhD in nursing from Kent State University, USA in 2017. She had her master degree in child and adolescent psychiatric/mental health from Kent State University as well. She worked as a research assistant, an instructor, and an RN in the USA. Her research interest is in adolescents with ADHD and other child and adolescent psychiatric disorders. She intends to further her research in the field of child and adolescent mental health.
Empathy is considered an important aspect of effective social communication. Adolescents with ADHD experience social difficulties and are intensified when ADHD diagnosis is accompanied with comorbidities such as oppositional defiant disorder (ODD) and major depressive disorder (MDD). To date, empathy in ADHD has been studied in isolation of those comorbidities although they have been reported to be common among adolescents with ADHD. Gender and parenting affect empathic responses and literature is lacking on the role of these variables on empathy in ADHD. Therefore, this study investigated the role of ODD and MDD comorbidities, gender, and parental acceptance-rejection on cognitive (CE) and emotional empathy (EE) among adolescents with ADHD.
One hundred and three adolescents (12-18 years old) with the diagnosis of ADHD-C, ADHD-C and ODD, and ADHD-C and MDD were recruited. Adolescents completed two measures; the Interpersonal Reactivity Index (IRI) to assess empathy, and mother and father versions of the Parental Acceptance-Rejection Questionnaire-Child Version (Short-Form). Two-way ANOVA and hierarchal multiple regression analyses were used.
The findings showed no differences in CE according to gender and diagnoses. Females scored higher than males on EE. Adolescents with ADHD-C and ODDcomorbidityscored significantly lower than the other two groups on EE. Parental acceptance-rejection moderated the relationship between ADHD-C and MDD diagnosis and both CE and EE. Paternal rejection resulted in lower fantasy scores among subjects with ADHD-C and MDD, while maternal rejection yielded lower emotional concern.These findings have important implications for future research and practice.