Day 3 :
- Nursing Education and Research
Session Introduction
Marianne Hattar-Pollara
California State University, USA
Title: Global Guidelines for Culturally Competent Nursing Practice
Biography:
Marianne Hattar-Pollara is Chair of the Nursing Programs at California State University Northridge. Her research and publications examine cross cultural and global women’s health issues and international nursing. She holds a Doctoral degree from the University of California, San Francisco, a Master’s degree in psychiatric nursing from the University of California, Los Angeles. She is a Fellow of the American Academy of Nursing (FAAN)) and past Chair of the Expert Panel of the Global Nursing and Health of the American Academy of Nursing. She is a Fulbright scholar and currently serves on national and international Board of Trustees.
Abstract:
Globalization and migration of populations including professional nurses has heightened the challenge of caring for patients and groups with different life experiences from those of health providers. It has also heightened the awareness of health and care inequities in populations within a society and across different countries. A task force comprised of members of the American Academy of Nursing and the Transcultural Nursing Society was formed for the purpose of proposing standards of nursing practice that promotes culturally congruent/competent and equitable care for diverse populations worldwide. The first draft was published in the Journal of Transcultural Nursing and subsequently presented at the 24th quadrennial ICN Congress. Nurses around the globe were invited to comment on the standards’ applicability, relevance, and completeness using the worldwide web. This presentation incorporates the input and feedback form nurses across the globe and discusses the process of global implementation of the guidelines.
Cara Gallegos
Boise State University, USA
Title: The Case for an Undergraduate Nursing Research Class
Biography:
Cara Gallegos received her PhD from University of New Mexico where her dissertation focused on stress and coping in parents of critically ill children in the Pediatric Intensive Care Unit (PICU). She also holds an MSN– Advanced practice in Pediatrics specializing in Pediatric Cardiology, and a BScN from the University of Alberta in Canada. She is currently an Assistant Professor at Boise State University in Idaho. She teaches research, leadership, and evaluation in the undergraduate, graduate, and doctoral programs. Her areas of scholarship are parental stress and coping of critically ill infants and children, evidence-based practice, and educational research.
Abstract:
The Institute of Medicine's (IOM, 2001) report set in motion sweeping quality initiatives for reform of the healthcare system. The nursing profession responded by including core competencies of utilizing research and incorporating evidence-based practice in undergraduate baccalaureate nursing education. Yet, nursing students often struggle to recognize the importance of EBP/research and faculty struggle to engage and facilitate learning. The purpose of this pilot study was to determine whether an undergraduate nursing research class increases students’ confidence in their ability to understand evidence based practice and research. Secondly, student learning was compared to see if there was a difference between content delivered in a traditional course management format or in a game-based format. One class received content through Blackboard and the other in 3D Game lab. Participants in this study filled out a short demographic questionnaire, pre/post Nursing Research Self-Efficacy Scale (NURSES), and a pre/post EBP survey (EBP-COQ). Preliminary results demonstrate that student confidence did increase from pre to post test score. Students using 3D Game lab struggled to access course information; however, preliminary results show that there were no significant differences in assignment scores. There is evidence to show that an undergraduate research course gives nursing students the skills to more effectively utilize research findings in their practice thus meeting the competencies set forth in the Essentials of Baccalaureate Education for Professional Nursing Practice (2008) and the call by the IOM (2001). Gaming is useful in K-12 education; however, the benefits may not translate to an undergraduate research class.
Christine Roland-Levy
University of Reims, France
Title: Nurses Social Representation of their Profession and Professional Practice
Biography:
Christine Roland-Lévy has completed her PhD at la Sorbonne University in 1980. She then held a position of Senior Lecturer at the University of Paris Descartes for 20 years and now holds a tenured position as a full Professor of Social Psychology at the University of Reims Champagne-Ardenne, France. She published 50 papers in international academic journals. She is currently the President of the Consortium of French Psychology Associations, A-CIPA, and the President-Elect of the International Association of Applied Psychology (IAAP).
Abstract:
This presentation is about a comparative study between France and Gabon. It approaches what female nurses share of their profession and their professional practices. This study, with nurses (French: 103; Gabonese: 140), is based on the theory of social representations, with a free association task around the target term “nurse”. It is completed by questions concerning the valence of each of the spontaneously produced terms. The participants were also asked to fill in 20 five point Likert-type scales measuring the type of behavior and relationship with their patients; this instrument covers two dimensions: the behavior focuses more on the relation with patients or more on the technical “taking care of”, with the same number of positive items and negative ones for each of the two dimensions. The data shows that both French and Gabonese nurses share in the center of the social representation of their profession the idea of “taking care of” (French: 70%; Gabonese 63.6%). But, what differs is that, for almost half of the Gabonese nurses, it is completed by the importance of “welcoming” (46.4%) the patients, whereas for the French nurses it is followed by “listening” (29%), “empathy” and “relation” (for 23% of the nurses). Concerning their practice with patients, the Gabonese nurses obtain a higher score in favor of the relational dimension (Gabonese relational score=3.88; French relational score=2.74). These results will be discussed in terms of the social representations of the profession in connection to their professional practices.
Lars Brorson Fich
Aalborg University, Denmark
Title: Can architectural space be healing ? A virtual stress experiment
Biography:
Lars Brorson Fich is educated as an architect, graduating from the School of Architecture Aarhus, Denmark, in 1984. He has worked for 24 years in an architectural office part wise specialized in hospital design, the last 10 years as a partner, before turning to research at the Department of Architecture and Media Technology at Aalborg University, Denmark, in 2008. He completed his PhD entitled “Towards a Neuroaffective Approach to Healing Architecture” in 2014. His research is concentrated on how architectural space might influence health, concentrating on how space might influence physiological stress reactions.
Abstract:
In this study, we wanted to examine whether it was thinkable, that architectural space could influence healing processes. Part of the field of Evidence Based Design, which has gained increasing influence within hospital design, has been to promote patient healing by the manipulation of environmental factors. Perhaps the most well-known study is still the study by Ulrich (1984) in which it is shown, that views to nature versus a view to another hospital block can reduce the length of hospitalization. However, these studies all have some environmental factor as the variable, and the space e.g. identical wards as the constant. As a consequence, the results offer no or very little information for hospital designers about the design of the space itself. Our aim was therefor to make space the variable and furthermore, we wanted to have physiological measures to help understanding the underlying physiological mechanisms. Our focus was on stress because of the long established connection between stress and the immune system. As a stressor, we used a virtual version of the so called Trier Social Stress Test, a much used laboratory test for research in psychosocial stress. Because a virtual version was used, the architecture of the space could be systematically varied. Our result shows, that the design of the space influenced the release of cortisol, and thereby potentially has an immune regulatory effect.
Vivien Xi WU
National University of Singapore, Singapore
Title: Perspectives of Hospital Nurse Educators, Clinicians and Managers on Clinical Assessment for Undergraduate Nursing Students
Biography:
Vivien Xi Wu is a Lecturer at Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, and National University of Singapore. She is a central committee member in the Centre for Healthcare Simulation at National University of Singapore. She has facilitated simulation-pedagogical workshops for local and international medical and nursing clinicians. Currently, she works on the collaborative project that focuses on the Holistic Clinical Assessment for nursing students at Transition to Practice with two tertiary hospitals in Singapore. She also works on project to enhance the knowledge and awareness of chronic conditions for working population.
Abstract:
Achieving clinical competency in the final year of nursing education is a key element in the development of professional standards and patient safety. Assessment of clinical competence requires explicitly defined standards meeting national standards of the nursing profession. It is a complex process due to the diverse nature of nursing practice. Assessment of clinical competence is a crucial task for nursing educators and administrators. The study aims to explore the perceptions of hospital nurse educators, clinicians and managers on clinical assessment tool and practices for undergraduate nursing students. An exploratory qualitative approach using focus group discussion was adopted. A purposive sample of 14 hospital nurse educators, clinicians and managers from two tertiary hospitals in a cosmopolitan city was recruited to participate in two focus group discussions. Five themes emerged from data analysis: need for a valid and reliable clinical assessment tool, preceptors’ efforts and techniques in reflection and feedback, challenges and support system for preceptors, challenges and support system for students, and support system for hospital nurse educators, clinicians and managers. The study has raised the awareness of the professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors were deemed to influence quality of students’ clinical learning and assessment. Nursing leaderships in hospitals and educational institutions have a joint responsibility to shape the clinical environment to ensure a holistic clinical learning and assessment for students. Involvement of all stakeholders in the development of a valid and reliable assessment tool is essential.
Biography:
Melek Sahin, graduated from Hacettepe University School of Nursing in 2004. Then she earned her Master’s degree in 2013 from the Institute of Health Science, Fundamentals of Nursing Department, Ege University. She is a Doctorate student in the same institute since 2014. She has been working as a nurse at Ministry of Health Hospital since 2002.
Abstract:
This research was carried out as a single-blind, randomized controlled study. The aim of study to investigate the effect of Buzzy application on pain and injection satisfaction in adult patients who received intramuscular (IM) injection. Research was carried out in Physical Therapy Service of 75th Year Milas State Hospital between November 2012 and January 2013. A total of 65 patients (experimental group=33, control group=32) for whom IM diclofenac sodium injection was ordered and who met the selection criteria comprised the sample of research. Data of the research were collected by using “Patient Information Form”, “Visual Analog Scale” and “Injection Satisfaction Scale”. Intramuscular injections were applied to ventrogluteal site. Each patient received only one injection. Randomization technique was used when forming groups according to age and gender. In experimental group of patients 30 seconds before and during process Buzzy® was used. Standard injection was applied to control group. Pain and satisfaction scores were measured by the nurse. In evaluation of data chi-square, Mann-Whitney U and Kruskal Wallis tests were used. According to findings of research; the post-injection pain scores and injection satisfaction scores of patients in experimental group were found higher than in control group (p<0,05). Consequently, it was determined that Buzzy® device was an effective method in decreasing injection pain and in improving post injection satisfaction in adult patients received IM injection.
Hana Kadhom
Royal Collage of Surgeon in Ireland, Kingdom of Bahrain
Title: Safe patient-handling techniques: does the theory match the practice?
Biography:
Hana Kadhom has 33 years experience in nursing as a practitioner and educator. Her experience has been across the Middle East and UK. She obtained her PhD from the University of Hull (UK) and she has Postgraduate diplomas from British universities (in nursing education and Health & Safety). She is currently a senior Lecturer and Director of a Nursing Degree Bridging program in Bahrain and Saudi Aramco.
Abstract:
Back pain is prevalent among nurses. Specific manual handling tasks are associated with an increased risk of lower back pain. Employing mechanised methods of patient transfer reduces this risk. The early introduction of student nurses to safe patient transfer techniques is now part and parcel of preparation for clinical practice. Manual handling courses incorporate theoretical knowledge combined with practical applications within the clinical-skills classroom. To assess the appropriateness of a manual handling course, delivered to student nurses, we surveyed participants regarding their real life patient-handling experiences in relation to aspects of manual handling theory. The study included 230 student nurses who had started their clinical attachments as part of a University degree program. A 25-item questionnaire was used; designed to document the participants’ experiences in clinics and canvass their opinions on why unsafe transfers were sometimes practiced. 205 completed questionnaires were returned (response rate 89%). Back pain was reported by 115 (61%) participants during their clinical training. 47% of respondents had been asked to move patients without use of equipment during their practicum period. 44% claimed no equipment was available in the clinics they attended and 18% claimed patient transfer equipment was ‘never’ used in their experience. Out of those that reported this lack of usage, 56% attributed this to the non-availability of equipment. Fewer than 4 out of 10 students reported their clinical experience to be a pain-free experience. Poorly equipped clinics may be a factor leading to a gap between classroom theory and clinical practice.
Fusun Terzioglu
Hacettepe University, Turkey
Title: Innovative Teaching Strategies: Examples from Practice-Hybrid Simulation to High Fidelity Simulation
Biography:
Fusun Terzioglu graduated in first place from Hacettepe University in 1989. She won the Ä°hsan Dogramacı Superior Merit Award and Student Science Incentive Award. She studied about counseling on assisted reproductive techniques at Liverpool Women’s Hospital Reproductive Medicine Unit in United Kingdom. In 2007, she worked on a project named “Development of Leadership Skills in Nursing Doctoral Students” at University of Michigan Faculty of Nursing. She worked as a Research Assistant at Hacettepe University School of Nursing in the Maternity and Women's Health Nursing Division from 1990 to 1997. She was promoted to Assistant Professor in 1998, Associate Professor in 2006 and Professor in 2012. She worked as a Co-Head of Nursing Department, Erasmus Department Coordinator, Head of Strategic Planning Group and board member of Hacettepe University Women’s Research and Implementation Center (HUWRICH) between 2009 and 2011. Her interest subjects are sexuality and reproductive health and management and leadership. She is member of national and international nurse’s organizations such as INDEN and Sigma Theta Tau. She has been working as a Director of Nursing Services at Hacettepe University Hospitals since September 2012 and Founding Dean of Faculty of Nursing between 2012- 2013.
Abstract:
Background: Nursing is a profession that theoretical and practical training need to be integrated. Different education strategies have been used to improve students’ psychomotor and communication skills such as simulation, standardized patients and part-task trainers. Students can examine all other parts of each other’s bodies during the learning process; the sensitive parts of the anatomy remain areas that are not routinely appropriate. Performing a clinical procedure required integration of the acquisition of a technical skill with effective communication skills. Purpose: Hybrid simulation allows students to practice complex skills and therapeutic communication simultaneously. Emergencies that require manual and verbal skills can be trained with ‘hybrid’ simulation. Increase realism and allow communication between team members and the patient. Method: We used to hybrid simulation in this study. Standardized patients provide feedback from the patient’s viewpoint, highlighting a perspective that is often overlooked in clinical skills teaching and assessment. Hybrid simulation has also taken the form of pairing simulators with other simulators. Results: This study indicated that nursing students’ satisfaction and confidence/competency were high after participating in hybrid simulation sessions. According to the study results, it is recommended to use hybrid simulation in nursing education as an innovative teaching strategy to develop students’ clinical competencies and confidence. Conclusion: The outcomes following hybrid simulation experiences are of an incredible benefit to nursing students and faculty. It allows students to practice skills and communication techniques simultaneously and gives them the multitasking experience that they would get on the clinical floor. It can increase the diversity and complexity of simulation activities that can be offered to students to cover complex scenarios and ensure patient safety, respect, and dignity during real-life encounters.
Bani issa
University of Sharjah, UAE
Title: Congruency between educators’ teaching beliefs and electronic health records as a teaching strategy
Biography:
Baniissa W has completed her PhD from University of Kansas Medical Center, USA and earned a Masters degree in Nursing from University of Windsor, Ontario, Canada. She is currently an Assistant Professor at University of Sharjah, UAE. She has published several publications in nursing education and diabetes care in reputed journals and has been serving as a reviewer of repute.
Abstract:
Background: Technology has changed healthcare institutions into automated settings with the potential to greatly enhance the quality of healthcare. Implementation of electronic health records (EHRs) to replace paper charting is one example of the influence of technology on healthcare worldwide. In the past decade nursing higher education has attempted to keep pace with technological changes by integrating EHRs into learning experiences. Little is known about educators' teaching beliefs and the use of EHRs as a teaching strategy. Aim: This study explores the composition of core teaching beliefs of nurse educators and their related teaching practices within the context of teaching with EHRs in the classroom. Methods: A collective case study and qualitative research approach was used to explore and describe teaching beliefs of seven nurse educators teaching with EHRs. Data collection included open-ended, audio-taped interviews and non-participant observation. Content analysis of transcribed interviews and observational field notes focused on identification of teaching belief themes and associated practices. Findings: Two contrasting collective case studies of teaching beliefs emerged. Constructivist beliefs were dominant, focused on experiential, student-centered, contextual and collaborative learning, and associated with expanded and a futuristic view of EHRs use. Objectivist beliefs focused on educators' control of the context of learning and were associated with a constrained, limited view of EHRs. Constructivist educators embrace technological change, an essential ingredient of educational reform. Conclusions: We encourage nurse educators to adopt a constructivist view to using technology in teaching in order to prepare nurses for a rapidly changing, technologically sophisticated practice.
Sevil Telli
Izmir University of Economics, Turkey
Title: Examination of nurses state anxiety and tendency to medical error in different working hours
Biography:
Telli Sevil was born in Izmir in 1983. Undergraduate education in 2004, Süleyman Demirel University School of Health and graduated in Burdur. Master's degree in 2013, Ege University Faculty of Nursing at the department of fundamentals of nursing has been completed. Between the years 2005-2013 she worked as a nurse in the ministry of health. 2014 – Still Izmir University of Economics, Health Services Vocational School Elderly Care Program has been working as a lecturer in Ä°zmir University Of Economics
Abstract:
Objective: This prospective, descriptive and cross sectional study research was implemented with the aim to compare the state anxiety and the tendency for nursing medical mistake during day working and night shift. Method: Research has been made in Aydin, Aydin Atatürk, KuÅŸadasi, Germencik, Söke State Hospital between 30 November 2012-30 May 2013 with 317 nurses. Data were collected by using “Individual Identification Form”, “Trait Anxiety Inventory” and “Nursing Medical Mistake Scale”. Results: Trait Anxiety Inventory” and “Nursing Medical Mistake Scale” were applied to the same nurses during both their day and night shift. It was determined that nurses were experienced state anxiety during day and night shift. Work units, anti depressant touse, and individuals who care for their children was effected the experienced state anxiety of nurses during day and night shift. It was determined that the error tendency was related to “The medication and Transfusion administration”, “Nosocomial infections” and “Patients monitoring and “Equipment Safety” of the most nurses during night shift according today shift. It was founded that the error tendency changed “Communication” of the nearly half of the nurses during night shift according today shift. Conclusion: There is difference between the medical error tendencies and state anxiety during day and night shift. State anxiety and the error tendencies are higher with in day shift.
Nihal Taskiran
Adnan Menderes University Soke School of Health, Turkey
Title: Investigation of Nursing Students Opinions Related to Their Pharmacology Knowledge Levels
Biography:
Nihal Taskiran first doctorated in 2014, department of Physiology at Afyon Kocatepe University Healthy Sciences Institute and now is an ongoing PhD student in Ege University of Turkey in Principles of nursing care. She worked a clinical nurse at the deparment of coronary intensive care at Afyon Kocatepe University Ahmet Necdet Sezer Practice and research hospital in 2006-2011. For four years, she is working as a Lecturer at Adnan Menderes University Soke School of Health.
Abstract:
This descriptive study was conducted to investigate nursing students' opinions related to their pharmacology knowledge levels. The study was conducted in February 2015 and March 2015, at Ege University Faculty of Nursing and Celal Bayar University Faculty of Health Sciences both of which are located in the Aegean region of Turkey. The study sample consisted of 173 final-year students who agreed to participate in the study. To conduct the study, written/verbal permissions/consents were obtained from the scientific ethics committee, institutions where the study was conducted and the students participating in the study. To collect the data, a questionnaire including items questioning the students’ sociodemographic characteristics and their opinions regarding their pharmacology knowledge levels was used. The data were analyzed using the SPSS for Windows 21.0, numbers, percentage distribution and the Chi-square test. Upon the completion of the study, the students' mean age was determined as 22.87±1.61. Of the students, 83.8% were female. While 70.5% were not satisfied with the length of the pharmacology course, 67.1% were dissatisfied with content of the pharmacology course. On the other hand, 56.6% considered the length of the drug administration course insufficient whereas 54.9% had the opinion that the content of the drug administration course was inadequate. Of the students, 12.7% considered their knowledge about drugs and drug applications as enough, 67.1% considered partly enough and 20.2% considered inadequate. While the topic about which the highest proportion of the students (52.6%) perceived their knowledge level as satisfactory was the “ways of administering medicine”, the topic about which the lowest proportion of the students (13.9%) perceived their knowledge level as satisfactory was the “drug-drug interaction”. The analysis revealed no difference between the students in both schools in terms of considering their pharmacology knowledge levels as adequate (p>0.05).
Prathana Langkarpint
Payap University, Thailand
Title: Human patient simulation: A global teaching method for global nursing education
Biography:
Prathnana Langkarpint has completed her PhD in Nursing Studies in 2005 from University of Hull, UK and Postdoctoral Research Fulbright Scholar from Valparaiso University, Indiana, USA in 2012. She is a former Dean of McCormick Faculty of Nursing and Assistant to the President for International Affairs. Currently she is Assistant Professor in Nursing at Payap University, Chiang Mai, Thailand.
Abstract:
The Human Patient Simulation (HPS) was originally developed in the 1960s to enhance the clinical skills in healthcare staff training. HPS is increasingly used in the USA, Europe, and throughout the world. This study aims to investigate nursing students’ perception, satisfaction, and self-confidence after using HPS. The two research instruments used were the Student Perception of Simulated Learning Experiences Student Feedback Form (SPSL) developed by the College of Nursing Valparaiso University and the Learner Satisfaction and Self-Confidence in Learning form (LSSL) developed by the National League for Nursing. The research project was given approval by the Valparaiso University Institutional Review Board. Data were collected at the Virtual Nursing Lab Center (VNLC) at College of Nursing Valparaiso University, USA in the fall semester 2011. Forty-three participants were voluntarily recruited. Two questionnaires were incomplete, so forty-one questionnaires were analyzed. Students reported their satisfaction on the use of HPS in terms of helpfulness, suitability, effectiveness, how motivating it was, the materials used and the way the instructor taught. It can be summarized that students have a high level of satisfaction with HPS and reported an increase in their confidence in clinical skills.
Adel F. Almutairi
King Abdullah International Research Center, Saudi Arabia
Title: Complexities of Cross-Cultural Interaction in a Multicultural Healthcare Environment: Toward a Promising Approach
Biography:
Adel Almutairi has completed his PhD from Queensland University of Technology in Australia, and Postdoctoral fellowship from University of British Columbia, School of Nursing in Canada. Almutairi is currently working as Associate Research Scientist at King Abdullah International Research Center- Saudi Arabia. Dr. Almutairi has published a number of papers in reputed international journals.
Abstract:
Constant change in the demographic profile of many societies around the globe caused by a wide range of factors, such as colonization, immigration, acculturation and the mobility of workforces, contributes to the creation of multicultural environments. Regardless of the degree of pre-existing cultural diversity, people from different cultures bring with them their own languages, values, beliefs, traditions, ethical and moral perspectives, and attitudes to illness, health and healthcare as well as their historical, political and economic circumstances. Such diversity can create difficulties for healthcare providers and patients alike due to the potential for cultural clashes, misunderstandings and discrimination, and individual power differences which eventually will impinge on the health and safety of all the parties involved. In this paper, I will argue that Almutairi’s model of critical cultural competence (CCC) is a promising approach that can address the complexities that arise from cross-cultural interactions in healthcare settings, which ultimately can improve the standard of healthcare for patients, families and the community as a whole. I will close by discussing how his approach can influence organizational policy, orientation programs and continuous professional development initiatives.
Biography:
Neesha is an experienced district nurse who has worked in the community for the last ten years. She continues to work in clinical practice, spending one evening a week working as a district nurse.Since qualifying as a registered nurse, Neesha has progressed as a district nurse and associate matron. Neesha joined Kingston & St George's with a focus on community care delivery and diabetes.Her professional interests lie in community nursing with a particular focus on district nursing theory and skills, as well as caseload and diabetes management.Externally, Neesha is a Queen's Nurse and external examiner at Brighton University.
Abstract:
The education sector faces major challenges in providing learning experiences so that newly qualified nurses feel adequately prepared to work in a community setting. With this in mind, HEIs need to develop more innovative ways to deliver the community nurse experience to student nurses. Simulation provides an opportunity for educators to evaluate student performance in an environment that models a complete patient encounter. As senior lecturers, two being district nurses and one experienced in ward simulation, we came together proactively to enrich student learning and develop a highly realistic community learning environment in a non-conventional manner. We used each other’s skills and knowledge to challenge thoughts, reinforce thinking, prevent task orientated care and promote the use of efficient and effective communication as well as autonomy. Both quantitative and qualitative data was collected. Various questions were asked using a Likert scale and the answers were analysed by a group of senior lecturers to identify possible solutions for issues raised. Most changes occurred on the second day however they slowly continued throughout the week. This can be evidenced in the analysis of evaluation which represents a higher proportion of students giving a more positive rating towards the end of the simulation week.
Evelyn Chilemba
University of Malawi, Malawi
Title: Educator perceptions of the Bsn programme at the university of Malawi
Biography:
Evelyn Chilemba completed her PhD from the University of Witwatersrand in Johannesburg, Republic of South Africa, in 2010. She is a senior Lecturer at the University of Malawi where she teaches medical-surgical nursing courses, ethics and human rights, and nursing education to both undergraduate and Master of Science degree students. She has published 10 research articles, contributed to four book chapters and has four international conference proceedings. She won a fellowship grant with an International Organization Sigma Theta Tau International in collaboration with International Doctoral Educational Network which she shall undertake at University of North Carolina at Chapel Hill.
Abstract:
Learning for optimal practice demands good teaching and is a dynamic curriculum requirement pertinent to the needs of the society. The stakeholders’ growing concerns and observations on the BSN programme at Kamuzu College of Nursing in Malawi formed foundational bases for exploring the educators’ perceptions on this programme. Educational level makes a difference on how graduate nurses’ practice, the study explored on how the nurse educators’ had perceived the BSN graduate education towards learning for practice. A two–phased, cross sectional, sequential explanatory mixed research design was deployed to investigate the educators’ perceptions on their graduate nurses’ educational processes. An analysis of quantitative data from phase one informed the construction of an interview guide that formed basis for the epistemological assumptions of the educators’ perceptions. Purposive intensity sampling strategy was utilized while observing the principle of saturation was deployed to recruit ten participants who were invited to participant during phase one. Content analysis approach, systematic classification process coding, themes and patterns identification was used to interpret text data. Trustworthiness ensured through strategies of prolonged observation, peer debriefing and member checking. Safety and rights of participants were observed and respected. The results had three sub-themes that emerged from the main theme of “educators’ perceptions”, these are lectures preferred, created student dependency and learner characteristics guide teaching. The educators were skeptical about learners’ reliance on lecture notes, saying that their practice resulted in poor learning empowerment and that the educators had preferred teaching methods that were not based on curriculum benchmarks.
- Emergency Nursing
Session Introduction
Shirley Strachan-Jackman
Canada
Title: Family Presence during Resuscitation: To Be or Not To Be
Biography:
Shirley Strachan-Jackman is a Nurse Practitioner at the Toronto Western Hospital, University Health Network in the department of Emergency Medicine. University Health Network is Canada’s largest research hospital and a major teaching hospital of the University of Toronto. Shirley obtained her Masters of Nursing and Nurse Practitioner designation from the University of Toronto and also holds a certification in Emergency Nursing. She is cross appointment to the University of Toronto and is very active with precepting nurse practitioner students from the University as well as York University and Ryerson University. Her interests lies in education, conference planning and is just getting her feet wet in research activity.
Abstract:
Family presence during resuscitation (FPDR) is an area that has gained increased attention over the past few decades. For years the question that is under debate is, “Should health care providers recommend family presence during resuscitation or should they recommend against it.” In North America, traditional paternalistic views have prevented the practice of the more family-centred approach of FPDR, where as in the UK 79% of emergency departments (EDs) allowed FPDR. Although FPDR has been accepted as best practice by the Emergency Nurses’ Association and the American Heart Association, fears concerning increased liability for the institution, and practitioner fears such as disruption of clinical activities and lack of space for the family and staff have prevented many institutions from offering the option to family members. Although incorporating family practice into resuscitation events can be challenging, our philosophy at Toronto Western Emergency is that families should be given the opportunity to be in the room in what may be the last minutes of their loved one’s life. Our belief is that FPDR will allow for a final goodbye by a spouse, sibling, adult child or parent who can’t fathom being separated at the moment of death. Thus our service provides a dedicated nurse to provide guidance, explanation and support to the family members who decide to remain in the room during a resuscitation event. As a new practice, we were interested in better understanding members’ experiences. This presentation will discuss the findings of our phenomenological study that was undertaken to describe the live experiences of families when given the choice to be present during cardiopulmonary resuscitation (CPR) in the emergency department setting. Six relatives or significant others elected to stay with their family member during the resuscitation, participated in a semi-structured personal interview within 3 months of the event. Findings will be discussed in light of practice, education and future research needs.
Katarzyna Matusiak
AGH University of Science and Technology, Poland
Title: Body temperature control and regulation-Educational mechanical model of blood flow regulation
Biography:
Katarzyna Matusiak has completed her PhD in 2009 at the AGH University of Science and Technology in Krakow. From the beginning, her work is specifically involved in the search for new methods of teaching. Her search activity focuses on issues related to the dosimetry and imaging techniques in medicine.
Abstract:
Maintaining body temperature within an optimum range, so called thermoregulation, is a complex process based on a number of mechanisms (e.g. sweat secretion, shivering and blood flow regulation). Visualization of selected control and regulation processes may be attractive way of teaching. The aim of the study was to design and construct a mechanical model of a body response to temperature changes. Presented device consists of elements used in home appliance (e.g. electrovalve, thermostat and pump) and generally reachable materials (e.g. tubes, plastic box, hydraulic tees, silicon, metal zip-ties, heater and electronic thermometer). All of them have been chosen, taking into account the criterion of analogues into the human body. Plastic box filled with water simulates human’s body because of the similar density. Thicker tube, situated on the bottom, correspond to the deep blood vessels whereas the thinner one joined above symbolize those surficial. Water circulation in the tubes is provided by the pump so as to simulate the work of the heart pumping blood into the vessels. Thermostat sensor represents thermoreceptors and thermostat on his own, sending an electrical impulse to the electrovalve, is a well representative of hypothalamus. Mechanism is quite simple-when water temperature reaches 38°C, sensor sends signal to the thermostat which is conjunct with the electrovalve. Then electrovalve opens and the water flow through the upper tube starts. This leads to heat exchange with environment and decrease of water temperature. When temperature falls to about 36°C, the electrovalve closes what stops water flow through smaller tube.
Sevil Olgun
Adnan Menderes University School of Health, Turkey
Title: Effect of Nursing Ethics Course on Ethical Decision Making Status of Students
Biography:
Sevil Olgan obtained a license of nurse from adnan menderes university school of health. She became a graduate in 2006 from celal bayer university of health sciences. In 2013 she completed her PhD from Ege university institute of health sciences. Her research interests include fundamentals of nursing.
Abstract:
Nursing ethics is a winning concept topicality parallel to bioethics. Nursing students to take courses in ethics training process, in terms of the creation of responsibility is important both very important in terms of raising awareness of the professional identity. In order to measure the status of ethical decision based on this research, students who take courses in ethics course was planned by the students. The research was done by Soke Adnan Menderes University Medical School studying in 90 nursing students. Data were collected using a data collection form and Ethical Dilemmas in Nursing Test contains the demographic characteristics of the students. Descriptive statistical methods to evaluate the data (number, percentage, mean, and standard deviation, median) were used. During the course the students ethical nursing education students, by the students who take the course of the ethical decision-making level is considered to be more advanced.
Oznur kavakli
Gulhane Military Medical Academy, Turkey
Title: The analysing of the hypertension reasons that are required admission to the emergency department
Biography:
Oznur Kavakli is a PhD student from Gülhane Military Medical Academy. She is a major nurse in Turkish Army. She is interested in emergency nursing and had an education for emergency nursing at University of North Carolina in 2013.
Abstract:
Hypertension is a chronic disease that will continue long life which requires change of nutritional behavior and life style. In this study, we aimed to investigate the hypertension reasons that are required for admission to the emergency department. Medical records of 53 patients who were admitted to the Emergency Department of a University Hospital for hypertension crisis in 2014 were reviewed, prospectively. The data collection form was developed according to literature findings and expert opinion. Most of the patients were women (64%), low education level (64%) and unemployed (80%). 18% of the patients were smokers. The rate of family history of hypertension was 70%. The rate of recurrent admission for hypertension crisis was 63%. The rate of determination of urgency was 60%. We found that 57% of the patients have used drugs regularly. Emotional stress (60%) and patients who had no diet (66%) were the most common reasons for admission. Only 7.5% of the patients have done regular exercise. In conclusion, we found that the most common reasons for admission to the emergency department were emotional stress and patients who had no diet. The patient should be educated for their life style and the control of hypertension before admission to the emergency department.
- Healthcare
Session Introduction
Merav Ben Natan
Stanford University, USA
Title: Israelis’ Perceived Motivation for Choosing a Nursing Career
Biography:
Merav Ben Natan completed her PhD at the Haifa University Faculty of Health Professions. She is the Director of the Pat Matthews Academic School of Nursing, at the Hillel Yaffe Medical Centerin Hadera, Israel, and an instructor at the Department of Nursing, Tel Aviv University. She is the Chairman of the Israel Nurse Association of Nursing Research and Editor of the Hebrew academic journal "Body of Knowledge". She has published more than 55 papers in reputed journals.
Abstract:
Recruitment problems are one of the main reasons for the shortage of nurses in Israel and elsewhere. The purpose of this study is to clarify factors affecting choice of ideal careers and nursing careers among the general population. A questionnaire constructed by McCabe, Nowak et al., (2005) was administered to 309 men and women aged 18-50. Data were analyzed by quantitative methods. Research findings indicate that 8% of respondents expressed interest in studying nursing. Significant differences were reported between the choice of ideal and nursing careers. Nursing careers were perceived as lacking interest, challenge, creativity, responsibility, varied wages, high status, comfortable conditions, versus ideal careers. A moderately positive correlation was identified between choice of a nursing career and intrinsic factors affecting this choice. People motivated by desire to help others rather than personal interest or challenges are predisposed to choose a nursing career. Finally, a negative correlation was identified between psychometric scores and choice of a nursing career. The study also identified a positive correlation between both the image of nursing as a profession and the availability of nursing jobs and the decision to choose a nursing career. This study may facilitate the development of nurse recruitment programs.
Vladimir Obolensky
Russian National Research Medical University, Head & Associate Professor. Russia
Title: No-air-plasma currents and ozone therapy in treatment of patients with diabetic foot syndrome
Biography:
V N Obolenskiy, PhD (2002) is the Head of the Septic Surgery Unit, City Clinical Hospital â„– 13, Moscow. He is also an Associate Professor of the Department of Surgery of the Russian National Research Medical University named after N.I. Pirogov, Moscow; correspondent member of the Russian Academy of Natural Sciences (RANS). He is a member of several professional societies, including EWMA, AO Trauma, participant EBJIS. He has published more than 40 articles in reputed journals and 8 tutorials. He has been serving as an Editorial Board Member of the journal "Wound Medicine" and "International Academic Journal of RANS".
Abstract:
Aim: To determine the effect of joint use of NO-air-plasma currents (APC) and ozone therapy (OT) on cellular elements and the level of bacteriological contamination of wounds occurring as a result of diabetic foot syndrome (DFS). Methods: A total of 160 patients suffering from purulo-necrotic feet wounds arising from DFS were selected. Patients’ average age was 63.9+9.7 years, with men slightly outnumbering women, 57.1 vs. 42.9% respectively. Predominant conditions neuro-ischemic form of DFS were >87%. The main group consisted of 57 (35.6%) patients that underwent corrective surgery on major vessels of lower limbs and treated daily with APC and OT. All procedures were carried out qualified nurse. The wound then was dressed with water-soluble ointment. The first control group consisted of 75 (46.9%) patients that did not undergo corrective surgery on major vessels of lower limbs; the second group consisted of 28 (17.5%) patients with corrective vascular measures. Treatment in these groups involved daily changes of wound dressings and application of water-soluble ointment. Results: Proliferation activity of fibroblastic cells, collagenogenesis and mitotic activity of epithelial cells in the main group exceeded the same indexes in the first control group more than two times and more than 1.5 times in the second control group. Microbiological contamination of wound in the main group on the 4-5 day declined down to 103-105 CFM/cm2, however in both control groups this score remained >105 for up to 12 days. Conclusion: Sequenced application of APC and OT in treatment of patients with DFS is characterized with pronounced bactericidal effect and boosts epithelialization process, making it two times faster.
Felip Burgos
Hospital Clinic Barcelona, Spain
Title: High Quality Spirometry across the Healthcare System
Biography:
Felip Burgos is a register nurse in the Respiratory Diagnostic Center in Hospital Clinic, University of Barcelona, Spain. He received a master’s degree in respiratory medicine and the PhD degree from University of Barcelona. During the last 30 years, he has been involved in Lung Function in several topics, specially related to reference values and standardization of lung function methodology. He was a Research Fellow at Harbor-UCLA (USA). He is a regular member of the ERS-ATS Pulmonary Function Standards Committee. He has published over 60 original manuscripts, editorials and reviews (36 internationals & 24 national) and 28 book chapters.
Abstract:
Extensive deployment of eHealth services is showing enormous potential to generate efficiencies in healthcare. In a previous research, we demonstrated enhanced quality of forced spirometry (FS) in Primary Care (PC). Recently, the Master Plan for Respiratory Diseases in Catalonia has consolidated further developments including different services supported by Information and Communication Technologies aiming at ensuring high quality spirometry (HQS) and interoperability at regional level, namely: i) generation of standards to transfer FS data (HL7-XML) across the system; ii) deployment of web-based support to PC and Community Pharmacists (CPh); and, iii) assessment of an algorithm for automatic Quality Control (QC) of the tests. We explored 1894 subjects from 15 PC and 1456 subjects from 100 CPh. The percentage of HQS in PC increased from 58% to 78% during a follow-up period. Similarly, the CPh study showed on average 70% HQS. Validation of the algorithm for automatic QC was carried out with 778 curves from 291 patients. The score produced by an expert professional and that automatically generated through the algorithm (Sensitivity 96%; Specificity 95%). We conclude that our results foster extensive adoption of strategies to facilitate interoperability of HQS tests at regional level facilitating information sharing across the system that reduce testing duplicities and generate healthcare efficiencies. Currently, the scheme is being generalized to other diagnostic/therapeutic procedures such as management of obstructive sleep apnoea. The study facilitates future strategies addressing early diagnosis, enhanced management and long-term follow-up of chronic respiratory patients.
Daniel Doherty
Christiana Care Health Systems, USA
Title: Vicarious Trauma: Beyond Burnout and Compassion Fatigue
Biography:
Daniel Doherty has been a Staff Development Specialist in the Emergency Department at a large teaching hospital for 14 years. He serves as adjunct faculty at a college in Delaware and as in service to over 100 nurses within Christiana Care Health System and Wilmington Delaware Police Department.
Abstract:
Healthcare providers are socially recognized and required by society to care and their job involves personal investment to fulfill their role. There are significant effects associated with the providing patient care; including burnout and compassion fatigue which we are all very familiar with. However, there is another less familiar yet more profound effect called vicarious trauma. Vicarious trauma is an internal transformation caused by repeated exposure to experiences in dealing with pain, suffering, and death daily. The result may be lingering intrusive images, avoidance behaviors, isolating physically, anxiety, detachment, and feelings of isolation. It is important to examine the challenge of separating work from one’s personal life. Organization’s suffer with higher absenteeism, changes in co-workers’ relationships, and possible outbreaks of aggressive behaviors among staff. Stress related to intense working environments and high patient acuity are some of the main reasons newer nurses leave the profession. Review of the literature, while showing the prevalence of burnout and compassion fatigue and vicarious trauma does not provide information on useful, effective interventions to prevent these complications of the healthcare work. Proactive coping is more future-oriented, with having in place general resources to overcome challenging experiences and allow the nurse to cope more effectively. The inservice will provide very specific strategies for health promotion behaviors and resiliency; how to put these very specific acquired insights into practice to decrease or minimize the effect of working with the sick, dying, and/or critically ill patients and families.
Su-Fen Cheng
National Taipei University of Nursing and Health Sciences, Taiwan
Title: Flipping the classroom to improve self-directed learning for RN to BSN students in Taiwan
Biography:
Su-Fen Cheng has completed her PhD from University of Colorado Health Sciences Center in the USA. She is an Associate Professor of National Taipei University of Nursing and Health Sciences and teaches pediatric nursing. Her research focus is on nursing education and pediatric nursing. She has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Background: Literature found that Taiwanese nursing students had lower self-directed learning ability. O'Neil, Kelly and Bone (2012) maintained that flipped classroom teaching strategy (FCTS) can effectively improve self-directed learning for nursing students. Aims: The purposes of this study were (1) to design a pediatric nursing course for nursing students in a RN-BSN program using FCTS and (2) to examine the effectiveness of the FCTS. Methods: A series of teaching strategies for flipped classroom in a pediatric nursing course of a RN-BSN program were developed. A total of 46 students were asked to complete a survey of learning satisfaction in the pediatric nursing course. Ten students who experienced flipped classroom were invited to interview in order to understand their learning experiences. Results: Forty three students (93.5%) completed the survey. They all agreed that the flipped classroom teaching strategies were effective in improving their abilities of clinical reasoning and problem-solving. Forty students (93%) reported that the scenario based learning augmented their self-directed learning; 88% students had increased their interesting in pediatric nursing and motivated learning. The qualitative data revealed that flipped classroom can (1) bridge the knowledge-practice gap; (2) improve the self-directed learning ability and expand the depth and breadth of learning and (3) increase reflective learning, community skills and team competency using strategy of collaboration. Conclusion: The FCTS improves self-directed learning and increase student satisfaction toward learning. The findings of this study may serve as a guide for faculty to develop and implement flipped classroom model in nursing education.
Gabriela Rique
Federal University of Paraiba, Brazil
Title: Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil
Biography:
Gabriela Lemos Negri Rique completed her medicine course in 2012 at the Federal University of Paraíba, Brazil. Currently she is a psychiatry resident physician at Famene (Faculdade de Medicina Nova Esperança).
Abstract:
The aim of this study was to identify chronotypes of medical students at the Federal University of Paraíba (UFPB) and its relationship to quality of sleep, daytime sleepiness, age, sex and season of birth. The sample consisted of 221 students, assessed by four questionnaires: Demographic questionnaire, Morningness–Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality lndex (PSQI) and Epworth Sleepiness Scale (ESS). There was a statistically significant difference between groups with respect to chronotypes and PSQI score (po0.0005), but not with excessive daytime sleepiness. A significant negative correlation was found between the scores of MEQ and PSQI (rho¼ 0.3, po0.0005), demonstrating that the greater the eveningness, the worse the sleep quality. It was observed that 51.6% of students were classified as indifferent chronotype, 61.5% had poor quality of sleep, while 42.1% had excessive daytime sleepiness. Sex and season at birth did not differ between chronotypes. These findings demonstrate that the evening chronotype was associated with poor quality of sleep in medical students, but not with increased daytime sleepiness, with potential impairment to their academic performance and quality of life.
Thurayya Eid
King Abdulaziz University, Saudi Arabia
Title: Patients’ and nurses’ differences in postoperative pain scores in Saudi Arabia
Biography:
Thurayya Eid has completed her PhD from the University of Melbourne. She is the Director of Nursing Clinical Practice and Research Unit at King Abdulaziz University hospital since 2012. Her research interests are in decision-making, pain management and communication. She has undertaken various clinical positions, published in reputed journals and served as reviewer for abstracts of medical decision-making conferences and manuscripts for various journals.
Abstract:
Introduction: More than 50% of hospitalized patients experienced moderate to severe pain following surgery. Patients’ self-reporting of pain is considered the most reliable form of pain assessment. While past research has shown nurses often underestimate or overestimate patients’ pain score, there has been a lack of work in this area conducted in Saudi Arabia. Aim: To determine nurses’ judgments about patients’ postoperative pain intensities. Method: The study was conducted in surgical wards at a tertiary teaching hospital in Saudi Arabia. A 10 cm Visual Analogue Scale was used to rate the patient’s pain on two occasions: at 4 hours pre-observation and 4 hours post-observation. Data were analyzed using Bland-Altman measurements of agreement. Results: Participants were 137 nurse-patients pairs; adult patients had undergone various surgical procedures. Nurses’ first language was different from the patients, and nurses tended to not be Arabic-speaking. At pre- and post-observation, the mean differences were 2.05 cm (SD=2.0, SE=0.17) and 1.96 cm (SD=2.41, SE=0.2) consequently; indicated a significant disagreement between patients’ and nurses’ ratings of patients’ post-operative pain. More than 85.0% patients experienced from mild to severe post-operative pain. Nurses’ judgment about assessing patients’ postoperative pain often involved the use of simple questioning. Communication difficulties between Arabic speaking patients and non-Arabic speaking nurses were prominent. Conclusion: Communication problem need to be addressed for accurately determining patients’ pain intensity following surgery in Saudi Arabia.
Marisa Krairiksh
Khon Kaen University, Thailand
Title: Implementation of Nursing Service Strategies Supporting ASEAN Economic Community in the Year 2015 of Nursing Organizations in Thailand
Biography:
Marisa Krairiksh has completed her Ph.D. at Frances Payne Bolton School of Nursing, Case Western Reserve University, USA. She is working at Nursing Administration Department, Faculty of Nursing, Khon Kaen University, Thailand as an Associate Professor. The subjects teaching in Master Program of Nursing Administration are nursing leadership, nursing management, nursing human resource management, nursing project management, and practicum in nursing management. Her research papers focused on nursing leadership which were published in Thai journals and were presented in international conferences.
Abstract:
This descriptive research aimed to study the implementation of nursing service strategies to support nursing during changes in the ASEAN Economic Community (AEC) in 2015 of nursing organizations in hospitals being under The Ministry of Public Health, Thailand. Five hundred and eighteen nursing directors, who were working in hospitals in north, central, northeast, and south part of Thailand, responded to a questionnaire developed by the researchers. The questionnaire was comprised of five dimensions based on the Nursing Service Strategies Supporting the ASEAN Economic Community (AEC) Year 2013-2015 which were 1) Establishment of understandings about the AEC to nursing personnel; 2) Competency development of nursing personnel supporting nursing changes in the AEC; 3) Development of manpower management system; 4) Development of emergency and disaster nursing system and emerging and re-emerging diseases nursing system; and 5) Elevation of nursing care quality. The reliability of the questionnaire tested by using the data derived from the nursing directors of hospitals in northeastern part was 0.97. Frequency, percentage, mean and standard deviation were used for data analysis. The finding underlined that nursing organizations in north, central, northeast, and south part of Thailand were implementing the strategies of competency development of nursing personnel supporting nursing changes in the AEC, development of manpower management system, development of emergency and disaster nursing system and emerging and reemerging diseases nursing system, and elevation of nursing care quality in moderate levels (mean=2.11 to 2.82). While, the implementation of the establishment of understandings about the AEC to nursing personnel strategy was in low levels (mean=1.68 to 1.74).
Hwey-Fang Liang
Chang Gung University of Science and Technology, Taiwan
Title: Equipping nursing students for cultural care
Biography:
Hwey-Fang Liang has completed her PhD from Duquesne University School of Nursing in USA. She is an Associate Professor in the Department of Nursing in Chang Gung University of Science and Technology in Taiwan. She has published more than 40 papers in reputed journals with English and Chinese.
Abstract:
Insufficient cultural care perception may obstruct student nurses to provide care for patients and families in clinical practice. The purpose of this study was to establish a culture care embedded in a nursing course and to explore its effectiveness as related to student nurses’ culture care perception. This study employed a one-group pre- and post-quasi-experimental research design and used proposed sampling to recruit nursing students in a university. A total of 150 nursing students took an 18-week, totally 36 hours, cultural care competence embedded in a Child and Adolescent Nursing course, which including variety teaching strategies including lectures, team based learning (TBL) and workshop discussions. Cultural care perception questionnaires with a 5-point Likert-type scale administered before and after the course to evaluate the effectiveness of the culture care perception. Results showed that the average post-course score (28.13±3.11) was significantly higher than the pre-course score (24.22±2.18) in cultural care knowledge, the average post-course score (26.05±2.36) was significantly higher than the pre-course score (24.14±3.12) in cultural care action, and the average post-course score (86.14±6.27) was significantly higher than the pre-course score (80.36±3.12) in cultural care perception. There was significant improvement noted after the intervention (p<0.01). Results of the study showed that a thorough nursing education program improve nursing students’ culture care knowledge, action, and perception. The research outcomes support the value of cultural care competence embedded in the nursing course programs, incorporating a multidisciplinary teaching strategies to help nursing students perceive adequate culture care for patients in clinical practice.
Nieves Cedenilla
Universidad de Castilla- La Mancha, Spain
Title: News strategies for the promotion and health care for the empowerment of citizenship: ´Health Ambassadors´Network´ and creating´ health apps´.
Biography:
Nieves Cedenilla is degree in clinical psychology and is preparing for the defense of doctoral thesis at the UCLM. She works as an Associate Professor at the University, in the area of PETRA, and she´s technique innovative projects and teaching in Red Ebersalud, a company that currently holds awards for its innovations as Bancaja young entrepreneurs, or innovation by Center for Minimally Invasive Surgery Jesus Usón. Julián O Salgado is diploma in nursing, mental health specialist. Currently he is working on mental health team Cáceres. He´s teacher in Red Ebersalud, and school Health sciences Extremadura, and community manager´s Red Ebersalud innovative health services.
Abstract:
One of the major emerging global challenges is the promotion and health care with reasonable efficiency, and sustainability of the actions initiated. It is time to promote new working methods, and move people the ability to know, the confidence and motivation to care. To "explore the possibilities to better health" propose boosting the community towards this goal shared work, through two strategies that have demonstrated good levels of efficiency to date: first, the formation of community volunteerism, a network Ambassadors of health, as essential to promote the empowerment of care, process tool by which people strengthen their skills, confidence, vision and leadership, to promote positive change in their communities and the realities in which they live. On the other hand, the development of new applications, both for health professionals that are enabling not only access to more patients but also to help nurses to assess, diagnose, trained and informed