Search results for: Kangaroo mother care
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4064

Search results for: Kangaroo mother care

3974 The Effects of Parents’ Personality Traits and Family Variables on Aggressive Behavior in Children from the State of Kuwait

Authors: Eisa Al-Balhan

Abstract:

This study explores the effects of parents’ personality and family variables on aggressive behavior in children from the State of Kuwait. The sample of 117children aged between 6 and 10 years (M=7.79 years, SD =1.4 years),117 fathers, and 117mothers from Kuwait. The following tools were used: a) the Aggressive Behavior Scale for Children (ABSC), b) the Personality Scales Inventory (PSI), and c) the Family Climate Scale (FCS). The results show that there were significant differences between children with highly aggressive behavior and those with low aggressive behavior for most of the personality traits of the father and mother, as well as most of the family climate and its different dimensions according to the father’s knowledge and the mother’s knowledge. Furthermore, there was a significant difference between males and females in the total score of aggressive behavior, verbal aggression, physical aggression, self-aggression, and aggression toward others, with higher scores occurring among males. Most of the correlations of the children’s aggressive behavior were with the personality traits of the father. The personality traits of the mother, family climate, and most of its different dimensions according to the father's and mother's knowledge had significant negative correlations with the child's aggression. There was no effect of the mother's and father's education levels on their child’s aggressive behavior. There was a significant difference between normal families and separated families in the total score of aggressive behavior, verbal aggression, and self-aggression, with a higher score occurring among separated families, and there was no significant difference between the two groups in physical aggression and aggression towards others.

Keywords: aggressive behavior, personality traits of parents, family variables, parents

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3973 Exclusive Breastfeeding Abandonment among Adolescent Mothers: A Cohort Study

Authors: Maria I. Nuñez-Hernández, Maria L. Riesco

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Background: Exclusive breastfeeding (EBF) up to 6 months old infant have been considered one of the most important factors in the overall development of children. Nevertheless, as resources are scarce, it is essential to identify the most vulnerable groups that have major risk of EBF abandonment, in order to deliver the best strategies. Children of adolescent mothers are within these groups. Aims: To determine the EBF abandonment rate among adolescent mothers and to analyze the associated factors. Methods: Prospective cohort study of adolescent mothers in the southern area of Santiago, Chile, conducted in primary care services of public health system. The cohort was established from 2014 to 2015, with a sample of 105 adolescent mothers and their children at 2 months of life. The inclusion criteria were: adolescent mother from 14 to 19 years old; not twin babies; mother and baby leaving the hospital together after birthchild; correct attachment of the baby to the breast; no difficulty understanding the Spanish language or communicating. Follow-up was performed at 4 and 6 months old infant. Data were collected by interviews, considering EBF as breastfeeding only, without adding other milk, tea, juice, water or other product that not breast milk, except drugs. Data were analyzed by descriptive and inferential statistics, by Kaplan-Meier estimator and Log-Rank test, admitting the probability of occurrence of type I error of 5% (p-value = 0.05). Results: The cumulative EBF abandonment rate at 2, 4 and 6 months was 33.3%, 52.2% and 63.8%, respectively. Factors associated with EBF abandonment were maternal perception of the quality of milk as poor (p < 0.001), maternal perception that the child was not satisfied after breastfeeding (p < 0.001), use of pacifier (p < 0.001), maternal consumption of illicit drugs after delivery (p < 0.001), mother return to school (p = 0.040) and presence of nipple trauma (p = 0.045). Conclusion: EBF abandonment rate was higher in the first 4 months of life and is superior to the population of women who breastfeed. Among the EBF abandonment factors, one of them is related to the adolescent condition, and two are related to the maternal subjective perception.

Keywords: adolescent, breastfeeding, midwifery, nursing

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3972 Maternal Awareness of Sudden Infant Death Syndrome: A Jordanian Study

Authors: Nemeh Ahmad Al-Akour, Ibrahem Alfaouri

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Objective: To examine the level of maternal awareness of SIDS and its prevention amongst Jordanian mothers in the north of Jordan, as well as to determine their SIDS-related infant care practices. Design: A cross-sectional design. Setting: The study was conducted in maternal out-patients clinics of two teaching hospitals and three maternal and child health clinic in three major health care centers in Northern Jordan. Participants: A total of 356 mothers of infants attending the maternal and child health clinics were included in this study. Measurements and findings: A self-administered questionnaire was used for collecting data study. In this study, 64%of mothers didn’t hear about SIDS, while only 7% of mothers were able to identify factors risk-reducing recommendations. Avoidance of prone sleeping was the most frequently identified recommendation (5%). There were 67.7% of mothers who put their infant in a lateral position to sleep, 61% used soft mattress surface for their babies sleep and 25.8% who shared a bed with their babies. Employed mother, mothers of higher age, and mothers living within a nuclear family were the only factors associated with maternal awareness of SIDS. Friends were the highest a source of knowledge of SIDS for mothers (44.7%). Key conclusions: There was a low level of awareness of SIDS and its associated risk factor among the mothers in Jordan. The mothers' misconception about smoking and sleeping position for their infants requires further efforts. Implications for practice: To ensure raising awareness of infant care practice regarding SIDS, a national educational intervention on SIDS risk reduction strategies and recommendations is necessary for maintaining a low rate of SIDS in the population.

Keywords: bed sharing, infant care, Jordan, sleep position, sudden infant death

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3971 Elimination of Mother to Child Transmission of HIV/AIDS: A Study of the Knowledge, Attitudes and Perceptions of Healthcare Workers in Abuja Nigeria

Authors: Ezinne K. Okoro, Takahiko Katoh, Yoko Kawamura, Stanley C. Meribe

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HIV infection in children is largely as a result of vertical transmission (mother to child transmission [MTCT]). Thus, elimination of mother to child transmission of HIV/AIDS is critical in eliminating HIV infection in children. In Nigeria, drawbacks such as; limited pediatric screening, limited human capital, insufficient advocacy and poor understanding of ART guidelines, have impacted efforts at combating the disease, even as treatment services are free. Prevention of Mother to Child Transmission (PMTCT) program relies on health workers who not only counsel pregnant women on first contact but can competently provide HIV-positive pregnant women with accurate information about the PMTCT program such as feeding techniques and drug adherence. In developing regions like Nigeria where health care delivery faces a lot of drawbacks, it becomes paramount to address these issues of poor PMTCT coverage by conducting a baseline assessment of the knowledge, practices and perceptions related to HIV prevention amongst healthcare workers in Nigeria. A descriptive cross-sectional study was conducted amongst 250 health workers currently employed in health facilities in Abuja, Nigeria where PMTCT services were offered with the capacity to carry out early infant diagnosis testing (EID). Data was collected using a self-administered, pretested, structured questionnaire. This study showed that the knowledge of PMTCT of HIV was poor (30%) among healthcare workers who offer this service day-to-day to pregnant women. When PMTCT practices were analyzed in keeping with National PMTCT guidelines, over 61% of the respondents reported observing standard practices and the majority (58%) had good attitudes towards caring for patients with HIV/AIDS. Although 61% of the respondents reported being satisfied with the quality of service being rendered, 63% reported not being satisfied with their level of knowledge. Predictors of good knowledge were job designation and level of educational attainment. Health workers who were more satisfied with their working conditions and those who had worked for a longer time in the PMTCT service were more likely to observe standard PMTCT practices. With over 62% of the healthcare workers suggesting that more training would improve the quality of service being rendered, this is a strong pointer to stakeholders to consider a ‘healthcare worker-oriented approach’ when planning and conducting PMTCT training for healthcare workers. This in turn will increase pediatric ARV coverage, the knowledge and effectiveness of the healthcare workers in carrying out appropriate PMTCT interventions and culminating in the reduction/elimination of HIV transmission to newborns.

Keywords: attitudes, HIV/AIDS, healthcare workers, knowledge, mother to child transmission, Nigeria, perceptions

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3970 Increase of Completion Rate of Nursing Care during Therapeutic Hypothermia in Critical Patients

Authors: Yi-Jiun Chou, Ying-Hsuan Li, Yi-Jung Liu, Hsin-Yu Chiang, Hsuan-Ching Wang

Abstract:

Background: Patients received therapeutic hypothermia (TH) after resuscitation from cardiac arrest are more dependent on continue and intensive nursing care. It involves many difficult steps, especially achieving target body temperature. To our best knowledge, there is no consensus or recommended standards on nursing practice of TH. Aim: The aim of this study is to increase the completion rate of nursing care at therapeutic hypothermia. Methods: We took five measures: (1) Amendment of nursing standards of therapeutic hypothermia; (2) Amendment of TH checklist items to nursing records; (3) Establishment of monitor procedure; (4) Design each period of TH care reminder cards; (5) Providing in-service training sections of TH for ICU nursing staff. Outcomes: The completion rate of nursing care at therapeutic hypothermia increased from 78.1% to 89.3%. Conclusion: The project team not only increased the completion rate but also improved patient safety and quality of care.

Keywords: therapeutic hypothermia, nursing, critical care, quality of care

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3969 Slipping Through the Net: Women’s Experiences of Maternity Services and Social Support in the UK During the COVID-19 Pandemic

Authors: Freya Harding, Anne Gatuguta, Chi Eziefula

Abstract:

Introduction Research shows the quality of experiences of pregnancy, birth, and postpartum impacts the health and well-being of the mother and baby. This is recognised by the WHO in their recommendations ‘Intrapartum care for a positive childbirth experience’. The COVID-19 pandemic saw the transformation of the NHS Maternity services to prevent the transmission of COVID-19. Physical and social isolation may have affected women’s experiences of pregnancy, birth and postpartum; especially those of healthcare. Examples of such changes made to the NHS include both the reduction in volume of face-to-face consultations and restrictions to visitor time in hospitals. One notable detriment due to these changes was the absence of a partner during certain stages of birth. The aim of this study was to explore women’s experiences of pregnancy, birth, and postnatal period during the COVID-19 pandemic in the UK. Methods We collected qualitative data from women who had given birth during the COVID-19 pandemic. In-depth, semi-structured interviews were conducted with twelve participants recruited from mother and baby groups in Southeast England. Data were audio-recorded, transcribed verbatim, and analysed thematically using both inductive and deductive approaches. Ethics permission was granted from Brighton and Sussex Medical School (ER/BSMS9A83/1). Results Interviews were conducted with 12 women who gave birth between May 2020 and February 2021. Ages of the participants ranged between 28 and 42 years, most of which were white British, with one being Asian British. All participants were heterosexual and either married or co-habiting with their partner. Five participants worked in the NHS, and all participants had professional occupations. Women felt inadequately supported both socially and medically. An appropriate sense of control over their own birthing experience was lacking. Safety mechanisms, such as in-person visits from the midwife, had no suitable alternatives in place. Serious health issues were able to “slip through the net.” Mental health conditions in some of those interviewed worsened or developed. Similarly, reduced support from partners during birth and during the immediate postpartum period at the hospital, coupled with reduced ward staffing, resulted in some traumatic experiences; particularly for women who had undergone caesarean section. However, some unexpected positive effects were reported; one example being that partners were able to spend more time with their baby due to furlough schemes and working from home. Similarly, emergency care was not felt to have been compromised. Overall, six themes emerged: (1) Self-reported traumatic experiences, (2) Challenges of caring for a baby with reduced medical and social support, (3) Unexpected benefits to the parenting experience, (4) The effects of a sudden change in medical management (5) Poor communication from healthcare professionals (6) Social change; with subthemes of support accessing medical care, the workplace, family and friends, and antenatal & baby groups. Conclusions The results indicate that the healthcare system was unable to adequately deliver maternity care to facilitate positive pregnancy, birth, and postnatal experiences during the heights of the pandemic. The poor quality of such experiences has been linked an increased risk of long-term health complications in both the mother and child.

Keywords: pregnancy, birth, postpartum, postnatal, COVID-19, maternity, social support, qualitative, pandemic

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3968 Community Involvement in Reducing Maternal and Perinatal Mortality in Cross River State, Nigeria: 'The Saving Mother Giving Life' Strategic Approach in Cross River State

Authors: Oluwayemisi Femi-Pius, Kazeem Arogundade, Eberechukwu Eke, Jimmy Eko

Abstract:

Introduction: Globally, community involvement in improving their own health has been widely adopted as a strategy in Sub-Saharan Africa principally to ensure equitable access to essential health care as well as improve the uptake of maternal and newborn health services especially in poor-resource settings. Method: The Saving Mother Giving Life (SMGL) Initiative implemented by Pathfinder International with funding support from USAID conducted a Health Facility Assessment (HFA) and found out that maternal mortality ratio in Cross River State was 812 per 100,000 live birth and perinatal mortality was 160 per 1000 live birth. To reduce maternal and perinatal mortality, Pathfinder International mobilized, selected and trained community members as community volunteers, traditional birth attendants, and emergency transport service volunteer drivers mainly to address the delay in decision making and reaching the health facility among pregnant women. Results: The results showed that maternal mortality ratio in Cross River State decrease by 25% from 812 per 100,000 live birth at baseline to 206 per 100,000 live birth at June 2018 and perinatal mortality reduced by 35% from 160 per 100,000 at baseline to 58 per 1000 live birth at June 2018. Data also show that ANC visit increased from 7,451 to 11,344; institutional delivery increased from 8,931 at baseline to 10,784 in June 2018. There was also a remarkable uptake of post-partum family planning from 0 at baseline to 233 in June 2018. Conclusion: There is clear evidence that community involvement yields positive maternal outcomes and is pivotal for sustaining most health interventions.

Keywords: maternal mortality, Nigeria, pathfinder international, perinatal mortality, saving mother giving life

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3967 Perinatal Ethanol Exposure Modifies CART System in Rat Brain Anticipated for Development of Anxiety, Depression and Memory Deficits

Authors: M. P. Dandekar, A. P. Bharne, P. T. Borkar, D. M. Kokare, N. K. Subhedar

Abstract:

Ethanol ingestion by the mother ensue adverse consequences for her offspring. Herein, we examine the behavioral phenotype and neural substrate of the offspring of the mother on ethanol. Female rats were fed with ethanol-containing liquid diet from 8 days prior of conception and continued till 25 days post-parturition to coincide with weaning. Behavioral changes associated with anxiety, depression and learning and memory were assessed in the offspring, after they attained adulthood (day 85), using elevated plus maze (EPM), forced swim (FST) and novel object recognition tests (NORT), respectively. The offspring of the alcoholic mother, compared to those of the pair-fed mother, spent significantly more time in closed arms of EPM and showed more immobility time in FST. Offspring at the age of 25 and 85 days failed to discriminate between novel versus familiar object in NORT, thus reflecting anxiogenic, depressive and amnesic phenotypes. Neuropeptide cocaine- and amphetamine-regulated transcript peptide (CART) is known to be involved in central effects of ethanol and hence selected for the current study. Twenty-five days old pups of the alcoholic mother showed significant augmentation in CART-immunoreactivity in the cells of Edinger-Westphal (EW) nucleus and lateral hypothalamus. However, a significant decrease in CART-immunoreactivity was seen in nucleus accumbens shell (AcbSh), lateral part of bed nucleus of the stria terminalis (BNSTl), locus coeruleus (LC), hippocampus (CA1, CA2 and CA3), and arcuate nucleus (ARC) of the pups and/or adults offspring. While no change in the CART-immunoreactive fibers of AcbSh and BNSTl, CA2 and CA3 was noticed in the 25 days old pups, the CART-immunoreactive cells in EW and paraventricular nucleus (PVN), and fibers in the central nucleus of amygdala of 85 days old offspring remained unaffected. We suggest that the endogenous CART system in these discrete areas, among other factors, may be a causal to the abnormalities in the next generation of an alcoholic mother.

Keywords: anxiety, depression, CART, ethanol, immunocytochemistry

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3966 Family Quality of Life in the Context of Pediatric Sickle Cell Disease in Oman

Authors: Wafa Al Jabri

Abstract:

Sickle cell disease (SCD) is a genetic blood disorder that is characterized by a severe painful crisis. SCD among children requires long term dependencies and high caregiving demands that increase the overall family burdens. It is, therefore, essential to examine, support, and promote the well-being of families of children with SCD. Although there has been considerable progress in the international research on family quality of life (FQOL) in recent years; however, research in this field is relatively recent and diverse. Oman is a country in which family quality of life has definitely been under-researched. Therefore, the purpose of the study is to describe the FQOL in families of children with SCD in Oman. The study will also examine the relationships between child, mother, and family-related factors that may influence the overall FQOL. Theoretical Framework: The study is guided by the unified theory of family quality of life to help in understanding the concept of FQOL and the factors that shape it. Method:A convenience sample of 98 mothers of children with SCD will be recruited from the pediatric hematology clinic at Sultan Qaboos University Hospital in Oman to participate in this descriptive, cross sectional, correlational study. Data will be obtained using a self-administered questionnaire that includes child and mother socio-demographic data, questions about the number of visits and admissions to health care facilities for vaso- occlusive crises (VOCs), the Perceived Stress Scale-10, and the Beachcenter-FQOL scale. Anticipated Results: It is expected to find an association among frequency of VOCs, mother’s perceived stress level, and FQOL in families of children with SCD in Oman. Family type, socio-economic status, and number of SCD children in the family are also expected to influence the overall FQOL. Conclusion: The findings of the study might be pivotal in designing and implementing tailored family-based interventions to improve families’ wellbeing.

Keywords: family quality of life, sickle cell disaes, children, family well-being

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3965 Nursing Experience of Helping the Mother of a Dying Baby by Applying Watson's Theory of Human Caring

Authors: Ya-Ping Chang

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Starting from the early stages of pregnancy, parents begin to form hopes and dreams about the future of their child. They will think about the appearance and personality of their child and may even develop many expectations. The patient in this study experienced a successful pregnancy following multiple attempts at artificial insemination. However, due to arrested embryonic development, and based on the physician’s evaluation, a caesarean section was performed at week 25. However, the baby suffered from infections and subsequently died from multiple organ failures. This study collected and analyzed objective and subjective data through observation, interviews, recording, and interactions with the patient. The following nursing issues of the patient were identified: anxiety, anticipatory grief, and adjustment disorder. The psychology of caring as proposed in Watson’s theory was applied to address these nursing issues. Comprehensive and continuous care was provided to the patient on the basis of mutual trust and individual nursing guidelines in order to alleviate the patient’s anxiety, help her to cope with grief, and prepare her for the eventual death of her child. The author helped the patient to say goodbye to her child and accept the child’s death calmly, such that she had no regrets about the experience. This nursing experience may serve as a reference to nurses managing similar cases in the future.

Keywords: dying baby, mother, grief, Watson’s theory

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3964 The Effects of Incompetence in the Use of Mother Tongue on the Spoken English of Selected Primary School Pupils in Abeokuta South Local Government Ogun State, Nigeria

Authors: K. G. Adeosun, K. Osunaiye, E. C. Chinaguh, M. A. Aliyu, C. A. Onifade

Abstract:

This study examined the effects of incompetence in the use of the mother tongue on the spoken English of selected Primary School pupils in Abeokuta South Local Government, Ogun State, Nigeria. The study used a structured questionnaire and interview guide as data collection instruments. The target population was 110 respondents. The sample was obtained by the use of simple random and stratified sampling techniques. The study samples were pupils from Government Primary Schools in Abeokuta South Local Government. The result revealed that the majority of pupils exhibited mother tongue interference in their oral production stage and that the local indigenous languages interfered with the pronunciation of English words to a large extent such that they pronounced ‘people’ as ‘fitful.’ The findings also revealed that there is no significant difference between inadequate teaching materials, shortage of funds towards the promotion of the mother tongue (Yoruba) and spoken English of Primary school pupils in the study area. The study recommended, among other things, that government should provide the necessary support for schools in the areas of teaching and learning materials, funds and other related materials that can enhance the effective use of the mother tongue towards spoken English by Primary School pupils. Government should ensure that oral English is taught to the pupils and the examination at the end of Primary school education should be made compulsory for all pupils. More so, the Government should provide language laboratories and other equipment to facilitate good teaching and learning of oral English.

Keywords: education, effective, government, learning, teaching

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3963 Attitudes of Grade School and Kindergarten Teachers towards the Implementation of Mother-Tongue Based Language in Education

Authors: Irene Guatno Toribio

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This study purported to determine and describe the attitudes of grade school and kindergarten teachers in District I, Division of City Schools in Parañaque towards the implementation of mother tongue-based multilingual education instruction. Employing a descriptive method of research, this study specifically looked into the attitudes of the participants towards the implementation of mother tongue-based language in terms of curricular content, teaching methods, instructional materials used, and administrative support. A total of nineteen teachers, eight (8) of which were kindergarten teachers and eleven (11) were grade one teachers. A self-made survey questionnaire was developed by the researcher and validated by the experts. This constituted the main instrument in gathering the needed data and information relative to the major concern of the study, which were analyzed and interpreted through the use of descriptive statistics. The findings of this study revealed that grade one and kindergarten teachers have a positive attitude towards the integration and inclusion of mother-tongue based language in the curriculum. In terms of suggested teaching methods, the kindergarten teacher’s attitude towards the use of storytelling and interactive activities is highly positive, while two groups of teachers both recommend the use of big books and painting kit as an instructional materials. While the kindergarten teachers would tend to cling on the use of big books, this was not the case for grade school teachers who would rather go for the use of painting kit which was not favored by the kindergarten teachers. Finally, in terms of administrative support, the grade one teacher is very satisfied when it comes to the support of their school administrator. While the kindergarten teachers has developed the feeling that the school administration has failed to give them enough materials in their activities, the grade school teachers, on the other hand, have developed the feeling that the same school administration might have failed to strictly evaluate the kindergarten teachers. Based on the findings of this study, it is recommended that the school administration must provide seminars to teachers to better equip them with the needed knowledge and competencies in implementing the Mother-Tongue Based, Multilingual Education (MTB-MLE).

Keywords: attitude, grade school, kindergarten teachers, mother-tongue

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3962 Flashover Detection Algorithm Based on Mother Function

Authors: John A. Morales, Guillermo Guidi, B. M. Keune

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Electric Power supply is a crucial topic for economic and social development. Power outages statistics show that discharges atmospherics are imperative phenomena to produce those outages. In this context, it is necessary to correctly detect when overhead line insulators are faulted. In this paper, an algorithm to detect if a lightning stroke generates or not permanent fault on insulator strings is proposed. On top of that, lightning stroke simulations developed by using the Alternative Transients Program, are used. Based on these insights, a novel approach is designed that depends on mother functions analysis corresponding to the given variance-covariance matrix. Signals registered at the insulator string are projected on corresponding axes by the means of Principal Component Analysis. By exploiting these new axes, it is possible to determine a flashover characteristic zone useful to a good insulation design. The proposed methodology for flashover detection extends the existing approaches for the analysis and study of lightning performance on transmission lines.

Keywords: mother function, outages, lightning, sensitivity analysis

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3961 Improvement plan for Integrity of Intensive Care Unit Patients Withdrawn from Life-Sustaining Medical Care

Authors: Shang-Sin Shiu, Shu-I Chin, Hsiu-Ju Chen, Ru-Yu Lien

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The Hospice and Palliative Care Act has undergone three revisions, making it less challenging for terminal patients to withdraw life support systems. However, the adequacy of care before withdraw is a crucial factor in end-of-life medical treatment. The author observed that intensive care unit (ICU) nursing staff often rely on simple flowcharts or word of mouth, leading to inadequate preparation and failure to meet patient needs before withdraw. This results in confusion or hesitation among those executing the process. Therefore, there is a motivation to improve the withdraw of patient care processes, establish standardized procedures, ensure the accuracy of removal execution, enhance end-of-life care self-efficacy for nursing staff, and improve the overall quality of care. The investigation identified key issues: the lack of applicable guidelines for ICU care for withdraw from life-sustaining, insufficient education and training on withdraw and end-of-life care, scattered locations of withdraw-related tools, and inadequate self-efficacy in withdraw from life-sustaining care. Solutions proposed include revising withdraw care processes and guidelines, integrating tools and locations, conducting educational courses, and forming support groups. After the project implementation, the accuracy of removal cognition improved from 78% to 96.5%, self-efficacy in end-of-life care after removal increased from 54.7% to 93.1%, and the correctness of care behavior progressed from 27.7% to 97.8%. It is recommended to regularly conduct courses on removing life support system care and grief consolation to enhance the quality of end-of-life care.

Keywords: the intensive care unit (ICU) patients, nursing staff, withdraw life support systems, self-efficacy

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3960 Sib-Care and Attachment in Zambia and the Netherlands

Authors: Haatembo Mooya

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Cross-culturally, exclusive maternal care of infants is an exception, rather than a rule. In most traditional non-Western societies, child care is shared within the family while in most middle class Western societies parents tend to rely more on ‘hired hands’ for support. In both contexts however, a common caregiver is the sibling. Despite this, the phenomenon of sib-care has remained relatively understudied. Cultural and gender differences in sib-care and attachment were explored using a retrospective survey instrument comparing Zambian and Dutch college students. The total study sample (N = 394) comprised of 200 Zambian students from the University of Zambia and 194 Dutch students from Leiden University, the Netherlands. We tested four main hypotheses. Firstly, we hypothesized that the Zambian subjects performed more sib-care than Dutch subjects. Secondly we hypothesized that female participants performed more sib-care than males participants, both among the Zambian and Dutch subjects, especially when parents are not at home. Thirdly, we hypothesized that larger family size was associated with more sib-care. Finally, we hypothesized that securely attached participants performed more sib-care than their less securely attached peers. Results indicated that sib-care was prevalent in both Zambian and Dutch samples. Zambian subjects performed more sib-care than Dutch subjects, with females performing more sib-care than males, both when parents were at home (F(2, 244) = 62.09, p < .01) and when parents were not at home (F(2, 237) = 51.28, p < .01). We also found that family size and attachment related avoidance and anxiety were not significant predictors of sib-care. It is concluded that sib-care is understudied, not only in Africa but also in Western societies and that females perform more sib-care than males, especially when the parents are not at home. In addition, attachment related avoidance and anxiety appear to be more related to the quality than the quantity of sib-care provided.

Keywords: sibling, sib-care, attachment, Africa, Zambia, the Netherlands

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3959 Examining How the Institutional Policies Affect LGBT Residents Living in Long-Term Care

Authors: Peter Brink

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Much of the research examining sexuality in long-term care focus on individual experiences, specifically their past, present, and future lived experiences. We know little about long-term care home policies, how they relate to the LGBT community, or how accommodating long-term care homes are to the LGBT+ community. In many ways, residents who identify as LGBT+ have been invisible in long-term care homes. Up until the not-to-distant past, homosexuality was illegal, and discrimination was acceptable. Canada’s LGBT population has also suffered because of the HIV/AIDS epidemic. For these and other reasons, members of the LGBT community might resist entering long-term care or attempt to keep their sexuality secret. The goal of any long-term care home is to be a welcoming place, to display signs of inclusion, and to help residents and staff feel that they are embraced. From the perspective of the long-term care home, it is possible that many of these facilities do not necessarily see the need to mention gender identity or sexual orientation in their welcoming materials. However, from the perspective of the invisible minority, it may be important that these homes be more than just welcoming. This study examined the role of institutional policies in long-term care for residents who identify as LGBT.

Keywords: long-term care, LGBT, HIV/AIDS, policy

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3958 Palliative Care and Persons with Intellectual Disabilities

Authors: Miriam Colleran, Barbara Sheehy-Skeffington

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Background: Patients with intellectual disabilities have specific palliative care needs, which can affect how resources and services are planned for this type of patient population. Aim: The purpose of this practice review is to assess the indications for, numbers of and outcomes of care for adults with intellectual disabilities referred to a specialist palliative care service over a two-year period. Service utilization aspects considered included the frequency of home visits by a specialist palliative care doctor or clinical nurse specialist and the number of hospice admissions that occurred for the patients. Method: A retrospective review was carried out of persons 18 years and older with intellectual disabilities referred to a specialist palliative care service. A manual review was carried out of the register using the place of residence and diagnosis in addition to the patients known to the clinicians who had intellectual disabilities. Results: 16 persons with intellectual disabilities were identified as being referred during that time. However, this may be an underestimate. 8 women and 8 men were referred with an age range of 50 to 81 years old. 4 patients referred did not have home visits from the specialist palliative care team. A range of 2 to 12 phone calls per person occurred by the specialist palliative care team regarding this cohort of patients. For some patients, the care is ongoing. Sadly, other patients died. Conclusion: Providing specialist palliative care for adults with intellectual disabilities is an important element of palliative care. Further research is necessary, and education to inform, support and empower specialist palliative care professionals in optimizing palliative and end-of-life care for persons with intellectual disabilities and to inform service development and provision.

Keywords: palliative care, intellectual disabilities, service planning, practice review

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3957 Narrative Family Therapy and the Treatment of Perinatal Mood and Anxiety Disorders

Authors: Jamie E. Banker

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For many families, pregnancy and the postpartum time are filled with both anticipation and change. For some pregnant or postpartum women, this time is marked by the onset of a mood or anxiety disorder. Experiencing a mood or anxiety disorders during this time of life differs from depression or anxiety at other times of life. Not only because of the physical changes occurring in the mother’s body but also the mental and physical preparation necessary to redefine family roles, responsibilities, and develop new identities in the life transition. The presence of a mood or anxiety disorder can influence the way in which a mother defines herself and can complicate her understanding of her abilities and competencies as a mother. The complexity of experiencing a mood or anxiety disorder in the midst of these changes necessitates specific treatment interventions to match both the symptomatology and psychological adjustments. This study explores the use of narrative family therapy techniques when treating a mother who is experiencing postpartum depression. Externalization is a common technique used in narrative family therapy and can help client’s separate their identity from the problems they are experiencing. This is crucial to a new mom who is in the middle of defining her identity during her transition to parenthood. The goal of this study is to examine how the use of externalization techniques help postpartum women separate their mood and anxiety symptoms from their identity as a mother. An exploratory case study design was conducted in a single setting, private practice therapy office, and explored how a narrative family therapy approach can be used to treat perinatal mood and anxiety disorders. The therapy sessions were audio recorded and transcribed. Constructivism and narrative theory are used as theoretical frameworks and data from the therapy sessions, and a follow-up survey was triangulated and analyzed. During the course of the treatment, the participant reports using the new externalizing labels for her symptoms. Within one month of treatment, the participant reports that she could stop herself from thinking the harmful thoughts faster, and within three months, the harmful thoughts went away. The main themes in this study were building courage and less self-blame. This case highlights the role narrative family therapy can play in the treatment of perinatal mood and anxiety disorders and the importance of separating a women’s mood from her identity as a mother. This conceptual framework was beneficial to the postpartum mother when treating perinatal mood and anxiety disorder symptoms.

Keywords: externalizing techniques, narrative family therapy, perinatal mood and anxiety disorders, postpartum depression

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3956 Socioeconomic Inequality in Physical Activity: The CASPIAN-V Study

Authors: Roya Kelishadi, Mostafa Amini-Rarani, Mostafa Qorbani

Abstract:

Introduction: As a health-related behavior, physical activity (PA) has an unequal distribution relating to individual's socioeconomic status. This study aimed to assess socioeconomic inequality in PA among Iranian students and their parents at national level and according to socioeconomic status (SES) of the living regions. Method: This study was conducted as part of a national surveillance program conducted among 14400 Iranian students and their parents. Non-linear principal component analysis was used to construct the households' socioeconomic status, and the concentration index approach was applied to measure inequality in father, mother, and student’s PA. Results: The data of 13313 students and their parents were complete for the current study. At national level and SES regions, students had more PA than their parents (except in the lowest SES region), and fathers have more PA than mothers. The lowest means of mother and student's PA were find in the highest SES region. At national level, the concentration indices of father and mother’s PA were -0.050 (95 % CI: -0.067 ~ -0.030) and -0.028 (95% CI: -0.044 ~ -0.012), respectively; indicating pro-poor inequality and, the CI value of student PA was nearly equal to zero (P > 0.05). At SES regions, father and mother's PA were more concentrated in the poor, except for lower middle region. Regional concentration indices for students reveal that inequality not statistically significant at all regions. Conclusion: This study suggests that reliable evidence that comparing different aspects of inequality of PA, based on socioeconomic status and residence areas of students and their parents, could be used for better planning for health promotion programs. Moreover, given the average of mother's and student’s PA in the richer regions were low, it can be suggested that richer focused-PA planning may further increase the level of PA across higher SES and, consequently, reduce inequality in PA. These findings can be applied in the health system services.

Keywords: concentration index, health system services, physical activity, socioeconomic inequality

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3955 Ageing in Place: Facing the Challenges

Authors: Daniella Arieli

Abstract:

As human population is ageing, globally, we are faced with the need to find solutions for the care of older people who have reached the stage of needing full-time nursing care. Basically, there are two basic alternatives: 1. moving the individual to an institutional setting, a care home, or other form of residency, and 2. Arranging care for them in their own home, what is known as “ageing in place”. As ageing in place is becoming popular in many parts of the world, there is a need to understand its’ everyday consequences for all the involved parties: the care recipient, her/his family members and the live-in care workers. This is crucial because choosing home care means that the role of the care recipient’s relatives becomes very demanding and requires a level of support and responsibility that is often beyond what families can offer. This is particularly challenging when the older person faces dementia. While most Western countries offer a range of social services, many citizens around the world find the care provided by governments and associated social support structures insufficient. Individuals and families find themselves in the position of having to take on the responsibility themselves and find a path for the care of frail members, while facing considerable personal burdens and challenging dilemmas. The aim of this work is to discuss those challenges. The study is based on an ethnographic study of home care for older people in Israel.

Keywords: aging in place, family caregivers, policy making, qualitative research

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3954 Knitting Stitches’ Manipulation for Catenary Textile Structures

Authors: Virginia Melnyk

Abstract:

This paper explores the design for catenary structure using knitted textiles. Using the advantages of Grasshopper and Kangaroo parametric software to simulate and pre-design an overall form, the design is then translated to a pattern that can be made with hand manipulated stitches on a knitting machine. The textile takes advantage of the structure of knitted materials and the ability for it to stretch. Using different types of stitches to control the amount of stretch that can occur in portions of the textile generates an overall formal design. The textile is then hardened in an upside-down hanging position and then flipped right-side-up. This then becomes a structural catenary form. The resulting design is used as a small Cat House for a cat to sit inside and climb on top of.

Keywords: architectural materials, catenary structures, knitting fabrication, textile design

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3953 Impact of Out-Of-Pocket Payments on Health Care Finance and Access to Health Care Services: The Case of Health Transformation Program in Turkey

Authors: Bengi Demirci

Abstract:

Out-of-pocket payments have become one of the common models adopted by health care reforms all over the world, and they have serious implications for not only the financial set-up of the health care systems in question but also for the people involved in terms of their access to the health care services provided. On the one hand, out-of-pocket payments are used in raising resources for the finance of the health care system and in decreasing non-essential health care expenses by having a deterrent role on the patients. On the other hand, out-of-pocket payment model causes regressive distribution effect by putting more burdens on the lower income groups and making them refrain from using health care services. Being a relatively incipient country having adopted the out-of-pocket payment model within the context of its Health Transformation Program which has been ongoing since the early 2000s, Turkey provides a good case for re-evaluating the pros and cons of this model in order not to sacrifice equality in access to health care for raising revenue for health care finance and vice versa. Therefore this study aims at analyzing the impact of out-of-pocket payments on the health finance system itself and on the patients’ access to healthcare services in Turkey where out-of-pocket payment model has been in use for a while. In so doing, data showing the revenue obtained from out-of-pocket payments and their share in health care finance are analyzed. In addition to this, data showing the change in the amount of expenditure made by patients on health care services after the adoption of out-of-pocket payments and the change in the use of various health care services in the meanwhile are examined. It is important for the incipient countries like Turkey to be careful in striking the right balance between the objective of cost efficiency and that of equality in accessing health care services while adopting the out-of-pocket payment model.

Keywords: health care access, health care finance, health reform, out-of-pocket payments

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3952 Addressing Factors Associated with Vertical HIV Transmission among Pregnant Women in Rwanda

Authors: Murorunkwere Marie Claire

Abstract:

Introduction: In Sub-Saharan Africa and specifically in Rwandan rural areas, mother-to-Child human immunodeficiency virus transmission remains a big challenge. This is mainly due to lack of awareness and ignorance among pregnant rural women, leading to neglect regular taking of prophylactic antiretroviral treatment and to persistently beliefs in traditional healers and home deliveries. This paper explores the factors associated with stagnant reduction in human immunodeficiency virus vertical transmission among pregnant rural women and provides solutions to tackle it. Methodology: The first phase of this research will be a qualitative survey was conducted to assess the knowledge, attitudes and practices towards vertical human immunodeficiency virus transmission among pregnant women in one rural district in Rwanda. The data generated from phase one of this research will be used to address the main factors revealed through community mobilization and motivation on attending required antenatal consultations and hospital deliveries, proper and regular antiretroviral treatment taking, and discouraging beliefs in traditional healers and home deliveries. Refresher training seminars will also be organized for healthcare providers qualified on conducting deliveries about current measures to maximize the reduction of chances that can lead to mother -child contamination (to avoid early rupture of membranes and to prevent any source of contamination). Results: This paper is expected to contribute in a significant reduction of the vertical human immunodeficiency virus transmission burden among pregnant rural women. Conclusion: Strong campaigns on prevention of mother- to-child human immunodeficiency virus transmission and community mobilization of pregnant rural women, and house to house education and continuous reminders as well as training seminars to health care personnel on updated measures is, key in addressing vertical human immunodeficiency virus transmission.

Keywords: attitudes transformation, community mobilisation, pregnant rural women, vertical HIV transmission

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3951 Pastoral Care and Counseling and Psychology as Sciences of Human Caring: Exploring the Interconnectedness of the Two Disciplines

Authors: Baloyi Gift Tlharihani

Abstract:

This paper explores the relationship between pastoral care and counselling and psychology. It will critically review the variety of views and debates regarding this relationship while acknowledging the different sides of the debates on the sameness and difference of these notions, this paper argues for the inevitable interconnectedness of the two. There has always been a close relationship, between pastoral care and counselling and psychology, although these are two totally different notions. Even though pastoral care and counselling are thought of as more spiritually focused and psychology with emotional and mental challenges, the components that connect these two sciences are represented by the care of human being. Therefore, this paper is interested in the interconnectedness of these two science as they both makes a vital contribution to human caring. It indicates that whether we take the dualistic difference between the body and soul, the trichotomous difference between the body, soul and spirit, our essential nature is found in the unity of those constituent elements.

Keywords: anthropology, human care, pastoral care and counseling, psychology

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3950 Prospective Study to Determine the Efficacy of Day Hospital Care to Improve Treatment Adherence for Hospitalized Schizophrenic Patients

Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

Abstract:

Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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3949 Primary Health Care Vital Signs Profile in Malaysia: Challenges and Opportunities

Authors: Rachel Koshy, Nazrila Hairizan Bt. Nasir, Samsiah Bt. Awang, Kamaliah Bt. Mohamad Noh

Abstract:

Malaysia collaborated as a ‘trailblazer’ country with PHCPI (Primary Health Care Performance Initiative) to populate the Primary Health Care (PHC) Vital Signs Profile (VSP) for the country. The PHC VSP provides an innovative snapshot of the primary health care system's performance. Four domains were assessed: system financing, system capacity, system performance, and system equity, and completed in 2019. There were two phases using a mixed method study design. The first phase involved a quantitative study, utilising existing secondary data from national and international sources. In the case of unavailability of data for any indicators, comparable alternative indicators were used. The second phase was a mixed quantitative-qualitative approach to measure the functional capacity based on governance and leadership, population health needs, inputs, population health management, and facility organisation and management. PHC spending constituted 35% of overall health spending in Malaysia, with a per capita PHC spending of $152. The capacity domain was strong in the three subdomains of governance and leadership, information system, and funds management. The two subdomains of drugs & supplies and facility organisation & management had low scores, but the lowest score was in empanelment of the population under the population health management. The PHC system performed with an access index of 98%, quality index of 84%, and service coverage of 62%. In the equity domain, there was little fluctuation in the coverage of reproductive, maternal, newborn, and child health services by mother’s level of education and under-five child mortality between urban and rural areas. The public sector was stronger in the capacity domain as compared to the private sector. This is due to the different financing, organisational structures, and service delivery mechanism. The VSP has identified areas for improvement in the effort to provide high-quality PHC for the population. The gaps in PHC can be addressed through the system approach and the positioning of public and private primary health care delivery systems.

Keywords: primary health care, health system, system domains, vital signs profile

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3948 The Perspective of Health Care Professionals of Pediatric Palliative Care

Authors: Eunkyo Kang, Jihye Lee, Jiyeon Choo

Abstract:

Background: Pediatric palliative care has been increasing, and the number of studies has focused on the age at which pediatric patient can be notified their terminal illness, pediatric advanced care planning (ACP) and palliative care. However, there is a lack of research on health professionals’ perception. Aim: We aimed to investigate the perceptions of healthcare professionals about appropriate age disclosing terminal illness, awareness of ACP, and the relationship between ACP knowledge and the preference for palliative care for children. Methods: We administered nationwide questionnaires to 928 physicians from the 12 hospitals and the Korean Medical Association and 1,241 individuals of the general Korean population. We asked about the age at which the pediatric patients could be notified of their terminal illness, by 4 groups; 4 years old or older, 12 years old or older, 15 years old or older, or not. In addition, we surveyed the questionnaires about the knowledge of ACP of the medical staff, the preference of the pediatric hospice palliative care, aggressive treatment, and life-sustaining treatment preference. Results: In the appropriate age disclosing terminal illness, there were more respondents in the physicians than in the general population who thought that it was possible even at a younger age. Palliative care preference in pediatric patients who were expected to expire within months was higher when health care professionals had knowledge of ACPs compared to those without knowledge. The same results were obtained when deaths were expected within weeks or days. The age of the terminal status notification, the health care professionals who thought to be available at a lower age have a higher preference for palliative care and has less preference for aggressive treatment and life-sustaining treatment. Conclusion: Despite the importance of pediatric palliative care, our study confirmed that there is a difference in the preference of the health care professionals for pediatric palliative care according to the ACP knowledge of the medical staff or the appropriate age disclosing terminal illness. Future research should focus on strategies for inducing changes in perceptions of health care professionals and identifying other obstacles for the pediatric palliative care.

Keywords: pediatric palliative care, disclosing terminal illness, palliative care, advanced care planning

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3947 Accepting the Illness and Moving toward Normality: Providing Continuous Care to a Patient by Utilizing Community Mental Health Nursing Skills

Authors: Szu-Yi Chang, Jiin-Ru Rong

Abstract:

This paper discussed a case involving a young female patient with schizophrenia. The patient's condition was deteriorating, and she was becoming increasingly reliant on her family to take care of her, and as her father did not understand the illness well and was afraid that others will learn about the presence of a mentally ill individual in their family, he and the patient's mother were thus unable to cope with the patient's deteriorating condition, which in turn caused her to suffer from a lack of self-confidence and low self-esteem. The patient received nursing care from July 26th to October 25th, 2017, during which counseling, family visits, and phone interviews were carried out, and her condition was monitored. By referring to the practical ability indicators for community psychiatric mental health nursing that were developed by the psychiatric mental health nurses' association of the Republic of China, defining categories such as 'self-construction,' 'self-management,' 'disease management,' and 'family nursing,' and incorporating indicators for empowerment and various skills into the steps and strategies used for nursing care, we will able to help the patient to construct her own identity, raise her self-esteem, improve her ability to independently perform activities of daily living, strengthen her disease management ability, and gradually build up her life management skills. The patient's family was also encouraged to communicate more among themselves, so as to align them with the nursing care objectives of improving the patient's ability to adapt to community life and her disease. The results indicated that the patient was able to maintain her mental stability within her community. By implementing effective self-management and maintaining a routine life, the patient was able to continue her active participation in community work and rehabilitation activities. Improvements were also achieved with respect to family role issues by establishing mutual understanding among the patient's family members and gaining their support. It is recommended that mental health nurses can leverage their community mental health nursing skills and the related strategies to promote adaptation to community life among mental life patients.

Keywords: community psychiatric mental health nursing, family nursing, schizophrenia, self-management

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3946 Nurse Practitioner Led Pediatric Primary Care Clinic in a Tertiary Care Setting: Improving Access and Health Outcomes

Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

Abstract:

Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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3945 Therapeutic Touch from Primary Care to Tertiary Care in Health Services

Authors: Ayşegül Bilge, Hacer Demirkol, Merve Uğuryol

Abstract:

Therapeutic touch is one of the most important methods of complementary and alternative treatments. Therapeutic touch requires the sharing of universal energy. Therapeutic touch (TT) provides the interaction between the patient and the nurse. In addition, nurses can be aware of physical and mental symptoms of patients through therapeutic touch. Therapeutic touch (TT) is short-term provides the advantage for the nurse. For this reason, nurses have to be aware of the importance of therapeutic touch and they can use it from the primary care to tertiary care in nursing practices at in health field.

Keywords: health care services, complementary treatment, nursing, therapeutic touch

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