24^th World Nursing and Healthcare Conference September 13-15, 2018 Park Inn by Radisson, Copenhagen, Denmark

Biography:

Randi C Haugstad pursued Master’s Degree in Evidenced based Practice. She is a Specialist Nurse in Neuronursing. She is employed by The National Competence Center for multiple sclerosis (MS) of Haukeland University Hospital in Norway and has been working with patients suffering from MS for more than 25 years. She is the coauthor of several international posters about MS. She is also a coauthor on 2 papers in reputed international journals and has published several articles in Norwegian journals regarding MS. She is an Editorial Member in several boards regarding MS in Norway.

Abstract:

Multiple sclerosis (MS) is a chronic neurological disease, and the cause of MS remains unknown. There is no cure for MS, but several disease-modifying treatments (DMT) are available to prevent disease progression for patients with relapsing remitting MS (RRMS). A national guideline recommended that patients with RRMS should be offered DMT to prevent further disability due to MS. A total of 11,000 people are living with MS in Norway today, and about 50% of the MS patients are using DMT. A study performed at a University Hospital in Norway, a total of 837 patients (female 560, male 277) had RRMS. Of this population, 750 (90%) patients had been offered DMT. For not being offered DMT, reasons were stabile MS, uncertainty about fulfilling the criterion for DMT, and unknown reason. Female gender and high age at inclusion were risk factors for not being offered DMT. Reasons for not using DMT were related to adverse events, pregnancy, generally not want to use, stabile MS and unknown reasons. A high adherence to the national guideline in the department was seen, by 90% of the RRMS patients were offered DMT. It is known that patients treated with DMT early in the disease course had delayed long-term disability, but DMT initiated late in the disease course gave better prognosis compared to patients never treated, and due to this knowledge, it is important to offer DMT also for older MS-patients with RRMS.

Biography:

Maria Gouvea pursued her Nursing Degree and her Master’s Degree in Public Management from Federal University of Espírito Santo - UFES. She is a Nurse at Espaço Amar (School) and also works at Cassiano Antonio Moraes University Hospital. She studied palliative care since her college. She has published a paper about nursing care in “Cuidado é fundamental (Care is fundamental) – online Research Journal and participated at 5^th Sao Paulo Congress of Human Milk Banks, XV Maternal Breast Paulista Encounter II Regional Macro Congress of Bank of Human Milk.

Abstract:

The epidemiological and demographic transition in Brazil presents a challenge to the management of public health. Chronic noncommunicable diseases (CNCD) has the highest incidence in elderly population which demands longer hospitalizations in a system that has not increased the number of hospital beds in the past decade. In this scenario arise palliative care (PC), a therapeutic approach for patients with life threatening diseases that seeks to mitigate the pain and ease the suffering of patients and their families. The objective of this research is to identify potential patients to palliative care by creating a situational diagnosis of two months of hospitalization at HUCAM. To this end, documentary and quantitative research was conducted identifying patients who could be benefited by palliative care. Data as age, diagnosis and hospitalizations were collected. Palliative Performance Scale were used to monitor disease progression and as indicator of the functional decline of patient, was applied to define the necessary level of palliative care. Among the 198 identified patients, 57.1% were older than 60 years, 48% were suffering from cancer, 64% had more than one hospitalization. Unfortunately, 18.2% died during this research. The result shows that people maybe dying alone and suffering. Therefore, the implementation of palliative care could lead to an early discharge or to rehospitalization optimizing the use of hospital beds of medium and high complexity also respecting the dignity of the ones facing death.

Biography:

Jana Slobodnikova, MD pursued her studies from Faculty of Medicine at Charles University, Prague. She is a specialist in Radiology I and II. She pursued CSc/PhD from Institute of Experimental Oncology of Slovak Academy of Sciences. She served as an Assistant Professor at the University of Trnava; Professor Emeritus from St. Elizabeth High School. She has lectured at several universities - Prague, Trenčín, Trnava and Bratislava. She is the author of teaching script and university textbooks. She lead workshops, organize international congresses and workshops. She has published more than 90 scientific papers, from then 25 papers in renowned journals and has been serving as an Editorial Board Member of repute. She has also published 3 monography. She founded the Section of Breast Imaging in 1996; President of The Section of Breast Imaging of Slovak Radiologic Society and Vice President The Slovak Society of Ultrasound in Medicine (since 1996). She has several Membership in organizations to her credit: ECR, EUSOBI, EFSUMB, SSUM (Slovak Society of Ultrasound in Medicine) and SRS (Slovak Radiology Society). Her research interest include : oncology, nursing in oncology, radiology, preventive medicine and healthcare.

Abstract:

Obesity belongs to civilization diseases and is a risk factor for the occurrence of a number of serious diseases, including colon and breast carcinoma. Clinical and epidemiological studies have identified many important breast cancer risk factors. Some of these factors are intangible or beyond our control; such as age or family history. However, several modifiable lifestyle factors have been associated with a higher risk of developing breast cancer. The aim of the minireview is summarization of the effect of endogenous estrogen on breast cancer and these clinically meaningful findings should motivate programs for obesity prevention from the view of the selected current studies. The authors whose names are listed in the title of the article certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, or other equity interest), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. All over the world, breast cancer remains a major issue for public health. Increasing numbers of new cases and deaths are observed in both developed and less developed countries, only partially attributable to the increasing population age. In the 28 member states of the European Union, there were 361,608 new breast cancer cases in 2012 and these are estimated to have increased to 373,733 in 2015 (+3.4 %); deaths were 91,585 and 95,357, respectively (+4.1 %). No major differences in this trend can be appreciated across European countries. However, in 2006-2012 the mortality for larger tumours remained greater than that for smaller tumours, significantly for the comparison of T1c and T1a stage, and was independent from nodal status. Recent data demonstrate that the age-adjusted obesity (BMI≥0.0 kg/m2) prevalence in USA is 34.9% among all adults age 20 years and older while that for overweight plus obesity (BMI≥25.0 kg/m2) is 68.5%. More recently, the 2012 annual report to the Nation on Cancer concluded that overweight and obese women have a relative risk for postmenopausal breast cancer of 1.13 and 1.25, respectively vs. normal weight women.

Biography:

Tomomi Goda holds a Doctoral Degree in education from Meisei University, Japan. She currently is an Associate Professor of the School of Nursing at Takarazuka University, Japan. She has published few papers in journals of nursing and education related magazine.

Abstract:

Purpose: We created teaching materials using virtual reality (VR; a system that uses Goggles to freely view a three-dimensional space covering 360°), which feature children and mothers during intravenous drip procedures in hospitals. Here we report our findings about the learning effect of risk prediction for nursing students by viewing these materials.

Methodology: We enrolled 9 fourth-year nursing students from a university school of nursing. Between September and November 2017, we asked students to view the VR material for 3 min and subsequently answer an anonymous, self-administered questionnaire. The questionnaire inquired about students’ sex, interest level, and experience using VR and 28 items on learning effects and identification of self-appointed tasks. This study protocol was approved by the Research Ethics Review Committee of the researcher’s affiliated institution.

Results: We enrolled 2 male and 7 female nursing students who were interested in VR but had no experience using it. The questions regarding the learning effect post viewing revealed that the VR materials featured “images that are easy to understand and that appear real (mean 4.56) and a scenario that is easy to picture and comprehend (mean 4.33).” Furthermore, the students highly rated the materials by claiming that “one can consider what kind of risks exists by viewing the scenario objectively (mean 4.44).” The students to observe their “many oversights (mean 4.44)” and realize that “caution must be paid to lack of observation power as well as knowledge (mean 4.22).”

Biography:

Sonia Cottom is the Director of Pain Association Scotland for three years – a national charity providing self-management training and support for people burdened with chronic pain. She is continuing to underpin the work of the Association through her research work with the University of Oxford (UK). She is a Member of the Institute of Directors (IoD) and recently received the IoD Emerging Director of the Year Award as well as the Sayer Vincent Charity Accounting Award for excellence and has published her work in several healthcare journals.

Abstract:

Chronic pain is a major clinical challenge in Scotland and across Europe as a whole. It is estimated that 18% of the population are currently affected by severe chronic pain . In the UK, approximately a third of the population suffers from chronic pain, it affects individuals and their families, and comes at a significant economic cost. More recently it was estimated that people with chronic pain are responsible for almost 5 million GP appointments in the UK by people seeking help and relief from chronic pain and in many cases, they leave without answers and without effective pain relief with a related cost of almost £70 million to the NHSIII. Pain Association Scotland has continued to provide a high quality staff-led community based service for people burdened with chronic painful conditions. This is because chronic pain is multifactorial, comprising of neuropathic and nociceptive components, based on a bio-psycho-social understanding. To support patients with this condition, the Association has developed appropriate service delivery through collaborative working relationships with health care professionals and extended new joint working opportunities with the majority of Scottish health boards and some in England and North Wales. Such self-management has potential to improve health outcomes in many cases, with patients reporting increases in physical functioning.

Biography:

Linda Jensen, PhD, RN, Professor Graduate Nursing, Clarkson College, has taught and worked in nursing for over 50 years. Her research in nursing education, perinatal depression, and mental health recovery has been presented at conferences in the US, Australia, Austria, Hong Kong, Paris, Japan, and published in several nursing journals.

Lynn Frederick, PhD, LISW, MSW, Online Instructor, Walden Univ. and Our Lady of the Lake Univ. She began social work practice in 1974, is licensed at the highest level in SC and has been teaching social work and sociology since 1991. She has consulted and made presentations in several European countries and in the US since the 1980’s. She currently teaches graduate social work students online.

Abstract:

This presentation reflects on the shift from face to face teaching to online teaching at the college level, especially in colleges of Nursing and other health professions. The authors use the 10 Principles of Effective Online Teaching: Best Practices in Distance Education developed by Penn State’s World Campus1 and numerous other sources to evaluate their own practices and adjustment after over ten years of online teaching. The principles include: Show up and Teach, Practice Proactive Course Management Strategies, Establish Patterns of Activities, Plan for the Unplanned, Response Requested and Expected, Think Before You Write, Help Maintain Forward Progress, Safe and Secure, Quality Counts, and (Double) Click a Mile on My Connection. Informal data collection of comments from other higher education professors showed concerns about adaptations for online teaching. A recent change in learning management systems for one author validated and increased previous frustrations with learning new technology that seems more cumbersome and less adaptable. The presentation will close with recommendations for the authors’ own improvement in designing courses for online learning, as well as suggestions for institutions that employ online faculty to teach courses designed by someone other than the instructor. This presentation could also be given as a workshop, with additional information and hands on examples.

Biography:

Linda Jensen, PhD, RN, Professor Graduate Nursing, Clarkson College, has taught and worked in nursing for over 50 years. Her research in nursing education, perinatal depression, and mental health recovery has been presented at conferences in the US, Australia, Austria, Hong Kong, Paris, Japan, and published in several nursing journals.

Lynn Frederick, PhD, LISW, MSW, Online Instructor, Walden Univ. and Our Lady of the Lake Univ. She began social work practice in 1974, is licensed at the highest level in SC and has been teaching social work and sociology since 1991. She has consulted and made presentations in several European countries and in the US since the 1980’s. She currently teaches graduate social work students online.

Abstract:

This presentation reflects on the shift from face to face teaching to online teaching at the college level, especially in colleges of Nursing and other health professions. The authors use the 10 Principles of Effective Online Teaching: Best Practices in Distance Education developed by Penn State’s World Campus1 and numerous other sources to evaluate their own practices and adjustment after over ten years of online teaching. The principles include: Show up and Teach, Practice Proactive Course Management Strategies, Establish Patterns of Activities, Plan for the Unplanned, Response Requested and Expected, Think Before You Write, Help Maintain Forward Progress, Safe and Secure, Quality Counts, and (Double) Click a Mile on My Connection. Informal data collection of comments from other higher education professors showed concerns about adaptations for online teaching. A recent change in learning management systems for one author validated and increased previous frustrations with learning new technology that seems more cumbersome and less adaptable. The presentation will close with recommendations for the authors’ own improvement in designing courses for online learning, as well as suggestions for institutions that employ online faculty to teach courses designed by someone other than the instructor. This presentation could also be given as a workshop, with additional information and hands on examples.

Biography:

Sanusi R. Adejumoke is a registered nurse, registered midwife, registered public health nurse and finished her Bachelor of Nursing science (BNSc) from Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Oyo State, Nigeria. She has worked for some years in the hospital setting for some years before joining the university. She has published papers in reputable journals.

Abstract:

Cancer is becoming ubiquitous in developing countries at the moment. The etiology of cancer, though unknown, lifestyle habits including food consumption of the people have been implicated in its origin. The type of food consumed, mode of preparation as well as methods of packaging have lots of implications on human health. To sensitize people in the community on the dangers inherent in packaging foods in plastic and styrofoam containers, the study was conducted among food vendors in Kano state, Nigeria. Rice were purchased from two food vendors and these were taken to the laboratory for analysis. Through experimental design method, leaching of carcinogens into foods packaged in PVC containers were assessed. Two food vendors were selected and twenty four (24) food samples were bought from each of them. From each food vendor, twelve (12) food samples were fatty foods (Jollof rice), while twelve (12) were non-fatty (white rice). Styrofoam, plastic and ceramic plates were used for the study. Two carcinogens (phthalate and nonylphenol) that are used as additives in plastic production were assessed for possible leaching into foods that are packaged in plastic containers. The experiment was carried out through the use of gas chromatophy mass spectrometer (GC-MS). Data were analyzed by descriptive statistics using frequency tables. The results showed that all food samples served in ceramic plates from both food vendors do not contain the carcinogens. Phthalates were present in all the food samples obtained from both food vendors served in both styrofoam and plastic plates. However, the quantities of these phthalates found in fatty food samples were more than non-fatty food samples. Nonylphenols were not found in non-fatty food samples served in both styrofoam and plastic plates. Considerable quantities of nonylphenols were found in fatty food samples served in both styrofoam and plastic plates. Also, the quantities of both phthalates and nonylphenols found in styrofoam plates were discovered to be more in quantity than the ones found in plastic plates. Based on the findings of the study, it was concluded that phthalates do leach into foods served in styrofoam and plastic food containers whether they contain oil or not. Nonylphenol also do leach into styrofoam and plastic food containers when used to package fatty foods.

Biography:

Ayla Yavuz Karamanoglu pursued her PhD at Ege University, Turkey. She is currently working as an Assistant Professor in the Surgical Nursing Department, Faculty of Health Sciences at Pamukkale University. She worked as a Nurse at Dokuz Eylül University Medical Faculty Hospital from 1988 to 1998. She has published articles in various journals.

Abstract:

In places such as war, nuclear and biological crisis, protection places built to meet the needs of individuals and to ensure their security are called shelters. It is required for the provision of housing support to those affected by war and/or natural catastrophe, to prevent disease and death, to be protected from climate, to ensure security and rehabilitation. The care at this domain is provided from shelter nurses. Nurses have important roles in war, disaster and crisis management. Shelter nursing is composed of identification and meeting of individuals' health and emotional needs with professional nursing knowledge, skills and attitudes and nursing services offered to individuals affected by traumas caused by disasters in cooperation with other areas. Nursing process consisting of assessment, diagnosis, outcomes/planning, implementation, evaluation stages determines the roles and responsibilities of shelter nurses in all stages of care. In the case of disasters, nurses have roles such as team member, coordinator, educator, caregiver and researcher. Adequate water, food, supplies, medical support, environmental health and control of waste should be provided to meet the needs of the victims of disaster and to increase the quality of life. Nurses' responsibilities include providing triage, first aid and care, supplies and psychological support to the victims of disaster who need medical support. The responsibilities of shelter nurses were examined in this study.

Biography:

Pitsini Mongkhonsiri is an expert Registered Nurse Acting in Chief of Research Development Group in Research Division at Praboromarajchanok Institute for Health Workforce Development, Permanent Secretary Office, Ministry of Public Health, Thailand. She has completed her Master’s degree in Medical Physiology in Faculty of Medicine at Khon Kaen University, and her PhD in Nursing at Massey University, New Zealand. She had been part of curriculum development team for nursing education and a Nurse Instructor at Boromarajonani College of Nursing, Udonthani for 27 years. She is experienced as a Special Lecturer in Human Resources For Health Development (HRHD) in the areas of health promotion, nursing education, medical and surgical nursing, and research development for health sciences. She works together with Dr Jureerat Kijsomporn to conduct research on cost effectiveness of HRHD in Thailand.

Abstract:

Despite the fact that excellent knowledge and skills are vital, humanized healthcare behaviors (HHBs) have been acknowledged to be essential among healthcare professionals. The purposes of this study were to explore HHBs and to compare HHBs between student nurses who had engaged in nursing practicum and those who had not. 236 1st and 4th year student nurses were obtained by purposive sampling. The research instruments were self-rating questionnaire asking about the participants’ HHBs and an opened-end questionnaire about their opinions regarding HHBs. Results showed that HHBs in 14 dimensions were found in high levels in both 1st and 4th year student nurses. Total HHBs scores of 4th year student nurses were significantly higher than that of 1st year student nurses in morality and ethics dimension regarding duty responsibility. It was interesting to find that 1st year student nurses reached a significantly higher score regarding pride of nursing professional. Sub-scores comparison revealed that 4th year student nurses reached significantly higher scores than that of the 1st year student nurses in the dimensions of service-minded; creation of relationship and trust; establishing relationship in learning processes; supporting and improving physical, social and spiritual environment; and helping in clients’ personal needs. Humanized healthcare mindset and behaviors are vital for cultivating a development of caring in healthcare environment. Appraisal of the gap and attainment of the development of HHBs in a concrete ways in health-related curriculum is significant. However, HHBs assessment including more points of view informed from all stakeholders may imply more precise and useful knowledge for nursing education in the future.

Biography:

Adile Tümer pursued her PhD in the Department of Public Health Nursing of Ege University, Turkey, in 2007. She is currently an Assistant Professor Faculty of Health Sciences at Mugla Sitki Kocman University in Turkey. Her main research interests are healthy lifestyle, health promotion behaviours, behavior of physical activity, women's health, adolescent health.

Abstract:

This descriptive study was conducted with the purpose of examining the research utilization barriers that nurses who work in a training and research hospital confront and the influencing factors. The data were collected in the hospital environment from 224 nurses via “Descriptive Characteristics Survey” and “The Barriers to Research Utilization Scale”. It was determined that the age average of the nurses who participated to the study is 37.31±6.71. It was also found out that 37.5% of the nurses attend scientific activities related to nursing, 46.9% of them follow publications related to nursing and 48.7% of them want to join research projects. In this study, it was identified that the point average of the Barriers to Research Utilization Scale is 2.82±0.64, the highest point average was received from the sub-dimension of “institution/working environment” (3.05±0.75), and it was followed by “research values, skills and awareness of nurses” (2.79±0.77), “research characteristics” (2.69±0.76) and “presentation of research results” (2.69±0.88). It was determined that the perception of barriers is low for the nurses who want to join research projects and this difference is statically significant (p<0.05). According to the other independent variables, it was identified that there is no statistically significant difference in the point average of the Barriers to Research Utilization Scale (p>0.05). As a consequence, the findings of the study emphasize that the nurses who participated in the study have a medium level of a barrier perception and the institution support is not sufficient in terms of research utilization.

Biography:

Faten Fathi Ahmed Mahfoz pursued his PhD from Suez Canal University, Egypt and Postdoctoral studies and is a Lecturer Faculty of Nursing at the same university. a premier Bio-Soft service organization. She has published more than 10 papers in reputed journals and has been serving as an Editorial Board Member of repute and Supervisor on more than 10 thesis for Master and 5 Doctoral Degree students.

Abstract:

Nephrotic syndrome is the most common presentation of glomerular injury in children. It is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. This study aims to assess effect of an educational program on knowledge and practice of nurses who are caring for nephrotic children. Empirical study was conducted to (57 nurses) working at all available setting providing care to children suffering from nephrotic syndrome in Ismailia city. A structured interview questionnaire sheet included general characteristics of the studied nurses, nurse's knowledge regarding nephrotic syndrome, and observational check list before, immediate after and 3 months' post program regarding nursing care of children with nephrotic syndrome. The results shows that majority of the studied nurse had inadequate practice and unsatisfactory knowledge about nephrotic syndrome. The study recommended that the nurses’ knowledge and practices about nephrotic syndrome could be improved by following existing guidelines on the organization of continuing education programs that could help upgrade the level of knowledge and practice, hence, the quality of care provided to children with nephrotic syndrome.

Biography:

Maria Luíza Bernardo Vidal is a qualified nurse in gynecology, obstetrics and obtained her bachelor's degree from Universidade Gama Filho 1983; She has specialization in Oncology Nursing from UFRJ / Inca 1998; Master's degree in health sciences / Oncology by Inca - "Late effects of radiotherapy on sexual function, bladder and rectum" 2008; and PhD by IFF / FIOCRUZ - "Access to treatment of malignant cervical neoplasia in SUS / RJ" 2017. She is 33 years old, and serving assistance activities in hospital and ambulatory, administrative, permanent education, research, teaching for technical and higher education, as well as participation of examining bank for selection of residents and orientation of TCC.

Abstract:

The attention to women with cancer in the pelvic region requires care and interdisciplinary interventions, which are sometimes not enough to meet the legacy of adverse effects caused by the treatment and coping of the disease. Survival has increased attention to the process of reintegrating survivors into the daily life of their life histories after successful treatments or not. The experience with systematization of nursing assistance practiced in consultations with patients who underwent radiotherapy indicated as most prevalent nursing diagnoses the image disorders and body movements, anxiety, altered self-esteem, social isolation, lack of knowledge of the health disease process, dysfunction sexual and fear. The need for the creation of specific care spaces for intervention in these diagnoses was then perceived, with the aim of increasing the availability of alternatives for patients with or without sexual dysfunction, but with the diagnoses described as prevalent. In order to intervene in this framework, a workshop for the recovery of self-esteem based on the Dorothea Orem theory was implemented at INCA/ HCII, which emphasizes the recovery of self-care. The workshop is playful, interactive and listening to professionals. It consists of a talk wheel on controversial subjects such as women's rights and generally predefined affection directed by interdisciplinary team or patient and light subjects like beauty, art and poetry. Body exercises are performed in a playful way, "belly dancing" with a volunteer teacher with relaxation, safety, revitalization of women's movements and counseling for social reintegration.

Biography:

Grace Daniel is a qualified Nurse and Midwife from Nigeria She has about 14 years’ experience in the profession. She holds a degree in Nursing and has completed her masters in Maternal and Child Health. She is a Lecturer at the Department of Nursing Science, University of Jos. She has published about 13 papers in reputed journals and has been serving as a reviewer for some of the journal.

Abstract:

The high burden of both HIV and cervical cancer in countries like Nigeria necessitates the need for early detection. Pap smear is an effective screening tool for the early detection of precancerous cervical lesions and other cervical abnormalities. Women with HIV have a higher incidence of abnormal cervical cytology as such screening guidelines recommends yearly screening rather than 3 yearly. The study aimed at determining the outcome of cervical cancer screening among HIV positive women in Jos. A descriptive cross-sectional design was employed for the study. 326 HIV positive (18 years and above) women participated in the study. A multivariate logistic regression analysis was used to determine predictors of precancerous cervical lesions. Majority 263(80.6%) of the women had never done a pap smear before. 33(10.1%) had acute inflammation on the cervix; 3(0.9%) had acute inflammation with changes; fungus was seen in 1(0.3%) and acute inflammation and fungus was seen in 1(0.3%). Precancerous cervical lesions was present in 40(12.2%) women. 19(5.8%) had low grade squamous intraepithelial lesions (LSIL); 13(4.0%) had high grade squamous intraepithelial lesions (HSIL); 3(0.9%) had high grade squamous intraepithelial lesions suspect for invasion (HSIL Susp for Inv); 4(1.2%) had atypical squamous cells of undetermined significance (ASCUS) while 1(0.3%) had ASCUS-H. Age (OR: 1.7, 95% CI: 0.3-9.5, p<0.004) and parity (OR: 3.4, 95%CI: 1.3- 9.5, 0.043) were independent predictors of precancerous cervical lesions among HIV positive women. Cervical abnormalities were prevalent among HIV positive women in Jos, Nigeria; strict adherence to the existing protocol of routine Pap smear screening and strengthening family planning services is strongly recommended.

Acknowledgement: Research reported in this publication was supported by the Fogarty International Center (FIC); Office of the Director (OD/NIH); National Institute of Neurological Disorders and Stroke (NINDS/NIH); and the National Institute of Nursing Research (NINR/NIH) of the National Institutes of Health under Award Number ID43 TW010130-02. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.