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Title: The Lived Experience of Women with Breast Cancer during the Surveillance Phase of Recovery: A Liminal Process to Healing and Recovery
Patricia K. Amado, received her undergraduate nursing degree from DeSales University (BSN), her master’s degree in nursing education MS(Ed), from Florida Atlantic University and her PhD from Barry University. She is currently an Assistant Professor of Clinical at the University of Miami. Areas of expertise and teaching include undergraduate and graduate courses across the curriculum as well patient and student mentorship. Her research is focused on areas of breast cancer and creating healthy transition post treatment. Patricia K. Amado is also recognized as a speaker in the nursing profession. She has spoken at international conferences and schools of nursing regarding her creation of liminal pathways in transitioning through chronic illness utilizing a liminal pathway to healing and wholeness. Her research formed the basis of a concept analysis framework which she is developing to advance nursing practiceHer most recent project is publishing her dissertation; The Lived Experience of Women with Breast Cancer During the Surveillance Phase of Recovery: A Hermeneutic Phenomenological Inquiry. Also she has several manuscripts awaiting publication related to transition and the art of humor for healing illness and mental stress and maladies.
Purpose: The purpose of this presentation is premised upon my hermeneutical phenomenological study on breast cancer survivors. The method of hermeneutics enables all disciplines to understand the narrative inquiry approach to research; what it is from a therapeutic lens; what uniqueness it provides in dealing with coping and making- meaning out of a chronic illness such as breast cancer and the art of story-telling as a venue for communication and a method to facilitate healing body, mind, and spirit while battling a chronic illness.
Method: Through the use of narrative inquiry as a research method in nursing will introduce an innovative way to understand phenomena (illness) in order to understand the lived experiences of woman diagnosed with breast cancer and also those living in fear of the recurrence of the disease. It is important as healthcare professionals and laypersons realize the experience of what happens for women in the transition from health to facing a life- threatening disease. Narrative inquiry represents a better perspective on the story of illness that at times may be difficult to voice. A cognitive engagement of discourse in an open semi- structured format may give voice to the person within the context of their own journey through illness. With semi-structured interviews, the investigator will have a set of questions on an interview schedule, but the interview will be guided by the participants rather than be dictated hence the advantages of this method is as follows:
Objectives: Differentiate how the phenomenon of breast cancer and transition can be viewed from various paradigms: for education, practice, and research
Understand the phenomenon of surveillance
Provide all practitioners an innovative method to address long term survivor needs
To introduce the concept of a liminal pathway which will contribute to the development and the body of knowledge in nursing
• There is an attempt to establish rapport with the patient which allows a richer relationship to gather personal experiences of illness
• The ordering of questions is less important as in gathering information in a history and physical (less empirical approach)
• The interviewer is freer to probe interesting areas that arise.
• The interview can follow the respondent’s interests or concerns. It is a creative method of healing as someone is faced with a chronic and sometimes terminal journey.
Quality of life is a multi- dimensional facet of one’s social, spiritual, and physical, emotional well- being. Breast cancer survivors face many fears, whether it is fear of recurrence, loss of health, and fear of dying. In order to treat each person holistically the healthcare provider needs to acknowledge alternative ways of healing for the breast cancer patient. Through introducing narrative therapy as a therapeutic way to express feelings one can make sense of this malady through the art of dialogue and may introduce new ways of learning how one builds resiliency in this specific population. It is an innovative method to help people transition to a better quality of life. A Liminal pathway through transilience, transition, and acceptance with authentic reflection on illness was discovered. This has been an important tool in moving forward in life and accepting a higher quality of being.
Lisa Leote is currently a Chief Executive Officer at BAMC, USA from 2018, Professor at UEC University, Queenstown, and Georgetown, Guyana. She was a President at CURE, Center for Ultrasound Research and Education from 2015 – 2018.
BACKGROUND Providing pregnant women in the world accessibility to healthcare by educating their community to provide it, I trained three (3) nurses in Haiti to perform prenatal ultrasounds. The goal was to is to ensure the safe passage of women from pregnancy through birth to motherhood. Approximately 800 mothers die around the world daily because of complications of pregnancy and childbirth, resulting in hundreds of babies dying as well. Having a healthy pregnancy is one of the best ways to promote a healthy birth and to prevent a mother from dying. Getting early and regular prenatal care improves the outcomes of a healthy pregnancy, reduce the risk of pregnancy complications and free the infant's risk from lifelong complications. 98% of pregnancy challenges are completely preventable with adequate, reliable and repeated prenatal care visits. In Haiti there are wide disparities between the rural and urban areas, with the rural areas being worse off in terms of both economic and health condition. Approximately 80% of the rural population lives below the poverty line. The inequitable distribution of government resources has contributed greatly to maternal mortality in rural Haiti. 47% of pregnant women in urban areas can reach a health care facility in less than 30 minutes, only 1/3 of women in rural areas can do the same, frequently needing two hours or more. As a result, women in rural areas depend primarily on poorly- trained healthcare agents and traditional birth attendants that provide the bulk of health care to pregnant and delivering women.
OBJECTIVE Access to education is a basic human right, and nothing has proven this more powerfully and effectively than the education of our community nurse volunteers who are the backbone of the mobile prenatal care efforts in rural Haiti. We pour our knowledge into the students and encourage them to share with their neighbors what they have learned. As a result, now armed with knowledge and skill, our graduates go out and educate women in their communities about the importance of prenatal care—they, in fact, go on and deliver this care. This transforms the culture from the inside out.
METHODS The curriculum has been created and modified to be applied in developing countries only as the accessibility to ultrasound alone as a line of diagnostic assessment has proven to be a key modality in identifying pathology and/or complications, which otherwise would have gone unnoticed. The need for a more detailed specificity and sensitivity is not warranted at this time. For nurses, the program covers: Medical History; Infection Control; Medical Equipment; Medical Terminology; Principles of Scanning; Ultrasound Physics; Anatomy/Physiology; Pathology; Female Pelvis; Obstetrics; Ultrasound Technology and Imaging; Examination Protocols; Impressions and Recommendations.
RESULTS The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere of 1 in 83, with rates similar to those found in Afghanistan and several African countries. According to UNICEF, Haiti has the highest mortality rates for infants, children under age 5 years, and pregnant women in the Western Hemisphere. Over the past 40 months, in our served population, we have drastically reduced that to 1 in 1200. Our data included that out of our 8,000 patients, we’ve identified:
PRE-ECLAMPSIA – 30% of patients: High blood pressures in pregnancy. The condition progresses until the mother has seizures or strokes, or the baby stops growing inside her. Left untreated, the mother and/or baby will die. HIV – 2% of patients: Two percent of women in Haiti are living with HIV and don’t even know it. Without pregnancy care, the health of many women with HIV will deteriorate during pregnancy. No medications means a high likelihood of her baby becoming infected with the virus. STIs – 50% of patients: These little spiral terrors are transmitted primarily through sex. Untreated, it can lead to neurological deterioration of the mother and for the pregnancy means miscarriage or stillbirth. Babies born with syphilis have severe neurological problems and learning delays PLACENTA PREVIA – 25-30% of patients: A condition where the placenta lies low in the uterus and partially or completely covers the cervix. The placenta may separate from the uterine wall as the cervix begins to dilate (open) during labor and cause hemorrhaging and/or shock.
CONCLUSION The formalized training of nurses in developing countries to use ultrasound as an imaging modality demonstrated successful findings. These nurses were able to exponentially identify risks and conditions which otherwise may have resulted in mortality of the mother and/or baby. The introduction of ultrasound has allowed for trained nurses to triage and monitor patient conditions, to proactively prepare for any complications, or refer a stable patient to a hospital prior to the patient becoming symptomatic or distressed which leads to favorable pregnancy and birthoutcomes.
Title: Healthcare Champions Role in Preventing and Controlling Healthcare associated infections and complications
Muhammad Wasif Rashid Chaudhary has 15 years of experience in Healthcare Executive management and Leadership in the UAE. His role at Via Medica International Healthcare LLC, is Medical Director with additional assignment as Director Quality. VMIH is American owned Healthcare facility and head office is in DC Washington. Muhammad Wasif has occupied many diverse roles in hierarchy Healthcare management in the past. Under his Leadership, Organizations has achieved JCI, CARF Accreditation, ISO, Sheikh Khalifa Excellence award. UAE licensed General Physician and practicing medicine. He has worked in different capacities of JCI accredited hospitals as ER Doctor, Casualty Medical Officer, Administrator of Corporate Service Division, Director of Continuous Quality Improvement. Proactive and strong role in strategic Leadership. Certified Six Sigma Green Belt and Total Quality management. He is also holding a Prestigious credentials i.e., Certified Professional in Healthcare Quality (CPHQ). Achieved MBA degree from Delaware University USA.
His passion in Healthcare is to improve existing/current processes and systems by utilizing Quality Improvement tools which lead to Safe, Timely and high quality, effective care of the patients. He is key note speaker of many International Conferences, including USA and Canada.
Major role of Healthcare providers is to prevent and control infections in healthcare facilities by using advance strategies and to decrease transmission of infectious diseases from healthcare workers to patients and vice versa, is very crucial. We will understand why Hand Hygiene, Respiratory Hygiene, Cough etiquette, Use of PPE (face mask, gown, gloves, face shield, goggles), Environmental disinfection, Safe work practices including injections, Infectious patient placement, Medical Waste management
to reduce healthcare associated infections and Occupational health hazards. Isolation or barrier precautions for patients who are having diseases like chicken pox, MERS, influenza, scabies etc. We shall share Quality improvement methodologies (FOCUS-PDCA & FMEA) and importance of implementations in healthcare facilities.
We shall discuss about post exposure Interventions to infectious disease in healthcare field and how to prevent and treat employee and also share guidelines for work restrictions to employees suffering from infectious diseases like Meningococcal Meningitidis, HAV, HBV, HCV, HIV, MDRO, RSV, Varicella, TB and Influenza.
According to Centres for disease control and prevention (CDC), results of a project known as the HAI Prevalence Survey (2014 Data) were published in 2016. The Survey described the burden of HAIs in U.S. hospitals, and reported that, in 2011, there were an estimated 722,000 HAIs in U.S. acute care hospitals. Additionally, about 75,000 patients with HAIs died during their hospitalizations.
Title: Best Practice Guidelines for Short- Term Medical Missions (STMMs): Perspectives From Host Countries
Short-term medical missions (STMM) have become increasingly popular among healthcare professionals of all disciplines and experience levels. It is estimated that volunteer teams travelling from the U.S. to low and middle-income countries (LMICs) spend upwards of $3.7 billion in annual expenses (Caldron, 2016). While these missions can provide significant benefits to patients and invaluable experiences to practitioners, the relatively uncoordinated and unregulated nature of such practices has raised questions about their overall effectiveness, longer-term impact, and potential consequences.
The Partnership for Quality Medical Donations (PQMD) launched the Healthcare System Strengthening/Medical Missions Initiative (HSS-MM), a 3 -year project, which aims to improve the practice of STMMs to better support and strengthen local healthcare systems. With well-researched and an improved framework for best practice medical missions can better help address longer-term needs and contribute to improved health outcomes in host communities, in LMICs. High quality, inclusive and reciprocal partnerships with local healthcare providers and ministry of health officials are critical for open dialogue, trust and improved coordination.
Developing an in-country framework required the involvement of many different stakeholder participants including: the Ministry of Health; local and International Health Care Providers; Professional Associations; International and National Non- Governmental Organizations (NGOs); Medical and Nursing Schools; and Community leaders. To date, assessments have been conducted in Honduras, Malawi and the Philippines. Full REB approval (file #25339) from Trent University, Peterborough, ON, along with organizational letters of support from PQMD and Americares.
There was an overall acceptance and positive response to the best practice guidelines. Naturally, licensing and country based tools will be required for implementation. Examples of benefits, challenges and lessons learned will be shared. Guideline development for Medical Missions representative of both sending and host organizations from Honduras, Malawi and Philippines are now available.
Enhanced awareness by professional affiliations, colleges and universities from High Income Countries (HIC), thought leadership forums and networking are key to future change activities. There is a need for a more robustly developed community of practice (COP) platform for the sharing of documents, knowledge and promoting dialogue between sending and host STMM communities. A newly developed COP infrastructure will include both domestic and international mission stakeholders.
Title: Postpartum Hemorrhage
Carlotta Gabriele has a master’s degree in nursing education and is enrolled in a Doctoral program. She is currently the Advance Clinical Nurse Educator for the Perinatal Department at Grady Memorial Hospital, the leading trauma hospital in the state of Georgia in the US. Two years into her career, at Dekalb Medical of Atlanta, Carlotta Gabriele became vice-chair, then chairperson for her units Partnership Council, and became a key member of the hospitals Shared Governance, a committee that evaluated needs for changes in clinical practices for the entire hospital. Mrs. Gabriele eventually became part of a Clinical Research Project at Grady whose objectives were to identify processes and system issues that caused delays in care, then evaluate clinical outcomes, and implemented risk reduction strategies to prevent patient harm. Mrs. Gabriele is also an adjunct clinical instructor at Georgia State University’s nursing program. Her specialty in women’s health and continued efforts toward improving quality patient care, positive outcomes, and advocacy for nurse engagement and nurse leadership has earned her the invitation and membership into the Sigma Theta Tau International: The Honor Society of Nursing.
Postpartum Hemorrhage has become the leading cause of maternal related deaths globally. It is a crisis of epic proportions. This research involves examinations of multiple studies addressing the challenges of management and prevention of postpartum hemorrhage. Health institutions, research universities, medical professionals collaboratively and independently through multiple mediums are working to abate this issue. Emphasis has been placed on quantifying blood loss, therapeutic, pharmaceutical, surgical remedies, and risk assessment for prevention interventions. Many studies that have been conducted are quite expansive while some are very specific referring to premorbid and peri morbid conditions, and gestational related complications. The approach to solving this problem is multidisciplinary, involving obstetricians and gynecologists, nurse educators, nurse researchers, varying technicians, and clinician specialist, from developed and less developed regions of the world. The nursing approach offers equal perspectives from prenatal, intrapartum, and postpartum primary care. Heavy involvement, and often, first-hand and first observations can be key to mitigating postpartum hemorrhage. This is the premise of the research herein to aid in the global initiative to end this crisis.
Oral Session 1:
- Registered Nurse & Advanced Practice Registered Nurse (APRN), Emergency Nursing & Critical Care, Oncology Nursing and Pediatric Nursing, Cancer Nursing, Nursing Education and Research, Women Healthcare & Midwifery Nursing, Family Nursing & Healthcare
Nonye Aghanya is an author and a nurse practitioner. She co-owned and operated a private medical clinic and currently works in a retail clinic setting in Virginia. She obtained a Master of Science degree from Pace University, New York and has worked in various outpatient/inpatient/home care health settings in New York and New Jersey. Nonye presently serves as a Family Nurse Practitioner at a Retail clinic in Virginia. She worked as a Registered Nurse for 10years before becoming a Family Nurse Practitioner, a role she currently holds for over 18 years. She is fluent in English and Ibo. She is the author of 2 books. Her first book “Simple Tips to Developing a Productive Clinician-Patient Relationship” is based on many clinical experiences in diverse health care settings and interactions with patients; and other clinicians for close to 30 years. She is also a speaker and entrepreneur.
In 2019, she published an online educational course, COMMUNICATION ACADEMY that gives access to lectures on the best interaction styles to for improving the soft skill of communication in the healthcare settings.
Statement of the Problem: Poor communication skills greatly contribute to the mistrust that is often experienced between Patients and clinicians.
It’s important to note that patients often experience high levels of apprehension during their clinical/hospital visits. Sometimes, such high anxiety levels manifest as various patient attitudes that could become a deterrent to the development of productive clinician-patient relationship. It is vital for nurses/clinicians to refrain from using a one-size-fits-all communication approach for all patient encounters because people have different personalities and backgrounds and thus perceive and react differently to the same information presented to them. The key for trust development is in the delivery method of information. To attain trust development through effective communication, the clinician’s communication style must be tailored to each patient’s personality, attitude and back ground.
Naturally, many, if not all nurses and clinicians put their best foot forward during each patient’s consultation with the expectation to make a connection with the patient and have a productive conversation. It’s important to note that realistically, however hard a clinician may try to make a great impression, due to various reasons, there are still many patients who would not achieve a decent level of comfort with the clinician. As a result, an honest and productive conversation is not achieved which hinders the development of a successful clinician-patient relationship. Often, effective communication between two individuals does not happen naturally at first, it must take a conscious effort on the clinician’s part to be realized.
Do you know that there is a strategic approach to experience a stress-free, successful consultation with each patient for improved trust development and productivity? My online educational school COMMUNICATION ACADEMY and book, Simple Tips To Developing a Productive Clinician-Patient Relationship are resources that provide effective interaction styles for improving the soft skill of communication between healthcare providers and patients with various attitudes and attributes for better trust development.
Navita Rahim has completed her PostRNBScN in 2012 from Aga khan University School of Nursing and Midwifery (AKUSONAM) Karachi, Pakistan. Beside this, she has completed Diploma in Midwifery from Aga khan Maternal and Child Health center in 2004. She is the Clinical Trainer at Jhpiego Pakistan. She has worked more than five years in reputed organization and has been serving for Maternal and Child health. She has worked for 4 years with international Non-Government Organizations (NGOs) to improve Family Planning quality services in Low socio economic areas of Pakistan for the betterment of maternal life and decrease Maternal Mortality rate (MMR).
Holistic care is a comprehensive model of caring and proper guidance. Use of Family Planning (FP) services is still a question mark nowadays. One MWRA (Married women of reproductive age) in four (4) has an unmet need for contraception, which is the highest such rate in the region. Meeting unmet need for limiting can be accomplish by increasing the holistic approach, for family planning, three major components can be highlighted: Supply, the enabling environment and demand. Up take of Family planning services can be enhance, more successful and sustainable if multifaceted determinates included in interventions.
Availability and quality of services and other supply-related issues is a major factor for not availing FP services. Improvement in family planning cannot be achieve without quality services. Quality is consider good when adequate infrastructure, supplies, and equipment are in place, and when well- trained, skilled, motivated, and supported staff are available.
Besides that, an enabling environment for health-seeking behavior is another factor for increasing services. An enabling environment requires adequate resources; effective leadership, management, and accountability. Engagement of governments, communities, and other members of civil society is critical to fostering an enabling environment.
Furthermore, Improve knowledge of Family planning and cultivate a demand for services. The demand for FP exists in different forms: actual use and latent demand. The latter exists among those who wish to avoid pregnancy but are not currently using FP (those with an unmet need for FP) and those who might wish to avoid pregnancy. Holistic, client-centered approaches is the only way to make FP programming effective and successful ultimately support health system.
Muhammad Ibrar Khan Afridi is currently working Near East University, Turkey. He has published many papers in reputed journals.
Adipogenesis refers to the differentiation of pre-adipocytes into mature fat cells, i.e. the development of adipose tissue, which varies according to sex and age. Adipocytes differentiate from stellate or fusiform precursor cells of mesenchyme origin. Adiponectin has been postulated to act an important role in the modulation of glucose and lipd metabolism in insulin-sensitive tissue in both humans and animals. The transition from pre to post menopause is associated with the emergency of many features of metabolic state. The intraabdominal body fat increases, low density lipoprotein and triglyceride levels increase while high density lipoprotein decreases. As the results to date are conflicting. In our study we aimed to study the changes in adiponectin and anthropometric parameters after menopause. For this purpose, the ELISA methods was used in the study to evaluate the values of adiponectin. A total of 70 female in menopause and 90 control subjects were included in this study. The results showed that adiponectin, BMI and blood pressure increased with menopause and in order to investigate the effect of menopause on these parameters, further work must be carried out in the near future.
Keywords: Menopause, Adiponectin and Adipose tissue.