1. careers
2. nursing

King Saud University Medical City
(KSUMC)
In collaboration with
College of Nursing
2015
NURSING
MAY
Conference and Seminars
Creating a Culture of Excellence in Care
THE NURSING CONTRIBUTION
Riyadh, Marriott Hotel (Makarim Halls)
Scientific Programme
Booklet
Diamond Sponsor:
Bronze Sponsors:
1
Table of Contents
Scientific Chairperson’s Message…………………………….................…….......… 4
Organising Chairperson’s Message…………………….......…....................….….….. 5
Introduction…………………………………………………..…………........….… 6
Objectives…………………………………………………….…………….........…. 6
Themes...............................................................................................................................................6
Target Audience…………………………………………......……………......….… 7
CME Hours………………………………………………..……………….….....…. 7
Venue ……………………………………………………………………….......… 7
Scientific Committee…………………………………….......……………….….... 8
Organising Committee………………………..…………..........…....………........... 11
Support Staff................................................................................................................................. 12
Speakers (International) ……………………….….................……………………. 13
Speakers (National and Local)............................................................................................... 15
Scientific Programme……..…….…………………….....…………………..…… 20
Information For Seminar Selections.....................................................................................23
Seminar Presentations…………………..................………….......................…....…. 25
Poster Presentations …….…………………………….......……………...………. 31
Social Programme…….……………………………………………....….…..…… 51
Badge Codes ……………………………………….…………………….….…….52
3
Scientific Chairperson’s Message
I would like to personally welcome you to the first Nursing Conference for King Saud
University Medical City in collaboration with the College of Nursing “Creating a
Culture of Excellence in Care: The Nursing Contribution”.
High quality care places quality at the heart of healthcare delivery, with nurses playing
a significant role. Nurses are in a powerful position to improve the quality of care, the
experience and health outcomes across health services for our patients.
This conference aims to bring experts and nurses together to demonstrate and share the
contribution nurses make in the delivery of patient care, focusing on building a transcultural
relationship to deliver quality improvements, explore the advances in nursing practice
and education, and the opportunity to enhance professional and clinical practice.
The Scientific Programme has been planned to enable international, national and local
speakers to share their experience of the contribution nurses make to excellence in care.
The first day of the conference provides an opportunity to debate the challenges for the
professional nurse in Saudi Arabia and to hear from some of the many international speakers.
The morning of the second day continues with the conference theme and widens the
opportunity for delegates to hear from other international, national and local speakers.
The afternoon session invites delegates to participate in a range of concurrent seminars
delivered by the international, national and local speakers.
I would like to make a special mention, and to give my personal thanks, to all members
of the Scientific Committee and Organising Committee without whom this Nursing
Conference would not be possible. Finally a special thanks goes to Dr. Ahmad
Aboshaiqah and Ergie Pepito Inocian for their guidance.
On behalf of the Scientific Committee, we wish you an enjoyable conference.
Ms. Lorraine Elizabeth Bell
Chairperson, Scientific Committee
Acting Director of Nursing
Executive Nursing Services
King Saud University Medical City
4
Organising Chairperson’s Message
On behalf of the Organising Committee, it is my great honor to welcome you to the
Nursing Conference and Seminars on “Creating a Culture of Excellence in
Care: The Nursing Contribution”. This Conference is held in collaboration with
the College of Nursing, with full support and wise leadership of H.E. Prof. Badran Al
Omar, the Rector of King Saud University and Dr. Abdulrahman Al Muammar, Chief
Executive Officer, KSUMC, which we believe without their support this event will not
be fruitful.
Under the theme of Leadership, Education, Evidenced-Based Practice & Research,
Patient Centered Care, Quality Improvement and Information Management and
Technology, the Organising Committee is preparing for the event in order to
successfully provide delegates the opportunities for not only learning practical and
relevant knowledge and skills, but also deepening mutual understanding between
colleagues working under diverse medico- social conditions so that everyone can
establish excellence in care together. The conference will offer various seminars where
delegates can experience small interactive discussion sessions. Invited International,
National and Local speakers from all over the world will ensure that the Conference
filled with rich and insightful sessions. They will share their knowledge and medical
experiences from renowned professionals.
Conference of such nature provide a great opportunity to Health Care society, not
only to update knowledge and keep learning with the latest developmental scenario in
the respective medical field, but also an occasion for the resource persons, delegates,
observers to exchange ideas and interact with each other. There is always room for
improvement in academic world; no stage of attainment is the final stage.
The Committee will put its utmost effort to provide the high- quality experience of
large – scale exhibition and enjoyable social event where you can establish a culture
of excellence in care. We sincerely hope that you find new perspectives of patients care
and the scientific programs presented at the conference interesting and valuable.
I look forward to your distinguished presence at the 1st Nursing Conference and
Seminars on “Creating a Culture of Excellence in Care: The Nursing
Contribution” and your enjoyment of the educational experience.
Ms. Rola M. Al Ghussein
Chairperson, Organising Committee
Director, Event Management
Academic Affairs Department
King Saud University Medical City
5
Introduction
King Saud University Medical City presents their 1st Nursing Conference on “Creating a
Culture of Excellence in Care: The Nursing Contribution” organised in partnership with
King Saud University, College of Nursing.
Objectives
• Focus on building the right cultures and relationships to deliver quality improvements
in patient care effectively and consistently
• Explore advances in nursing practice، management and education in relation to clinical
excellence in the delivery of healthcare
• Examine the role of the Nurse in the changing healthcare delivery system
• Promote the nursing contribution in care delivery and improved patient outcomes
• Enhance professional and clinical practice knowledge and skills
• Identify the challenges of the nursing profession in Saudi Arabia
Themes
• Leadership
• Education
• Evidence-based Practice and Research
• Patient Centered Care
• Quality Improvement
• Information Management and Technology
6
Target Audience
• Nurses/ Managers/Educators
• Instructors/Professors
• Lecturers
• Nursing Students
• Nursing Interns
Accredited: 16 CME Hours by Saudi Commission for Health Specialties
Venue: Marriott Hotel (Makarim Halls ), Riyadh, Kingdom of Saudi Arabia
7
Scientific Committee
Chairperson, Scientific Committee
Ms. Lorraine Elizabeth Bell
Acting Director of Nursing
Executive Nursing Services
King Saud University Medical City
Co-Chairperson, Scientific Committee
Dr. Ahmad Aboshaiqah
Chairman of Saudi Nursing Scientific Board
Dean, College of Nursing
King Saud University
8
Members
Dr. Nazik Zakari
Vice Dean
College of Nursing
King Saud University
Dr. Mahaman Moussa
Associate Professor
College of Nursing
King Saud University
Dr. Omar G. Baker, Ph.D., MSN, BSN, RN (BC)
Associate Professor
Head, Unit of e-Learning & Information Technology
College of Nursing
King Saud University
Ms. Clara Altavano
Assistant Director of Nursing
King Abdulaziz University Hospital
King Saud University Medical City
9
Samah Sayed El Zakazeky
Clinical Instructor
King Abdulaziz University Hospital
King Saud University Medical City
Ergie P. Inocian, RN, MSN
Nurse Educator
King Khalid University Hospital, KSUMC
King Saud University Medical City
Kathy Dayao
Secretary, Scientific Committee
King Saud University Medical City
Maan Ciocson, RN, MN
Nurse Educator
King Khalid University Hospital
King Saud University Medical City
10
Organising Committee
Chairperson, Organising Committee
Ms. Rola M. Al Ghussein
Director, Event Management
Academic Affairs Department
King Saud University Medical City
Members:
Ms. Anna Beth A. Basco
Researcher
Event Management
Academic Affairs Department
King Saud University
Ms. Wafa Al Bogami
Medical Records Technician
Event Management
Academic Affairs Department
King Saud University Medical City
Ms. Rasha Al Mubarak
Administrative Assistant
Event Management
Academic Affairs Department
King Saud University Medical City
Mr. Bader Al Nwijm
Secretary
Event Management
Academic Affairs Department
King Saud University Medical City
Mr.Mishal Al Musallam
Administrative Coordinator
Event Management
Academic Affairs Department
King Saud University Medical City
Ms. Sahar Al Nuwaiser
Administrative Coordinator
Event Management
Academic Affairs Department
King Saud University Medical City
Ms. Mashael Al Mandeel
Administrative Assistant
Event Management
Academic Affairs, KSUMC
Ms. Nena B. Gamueda
Medical Administrative Coordinator III
Event Management
Academic Affairs Department
King Saud University Medical City
11
Support Staff
• Public Relation and Communication of Medical City
• Finance Department of Medical City
• Support Services Department
• Logistics & Contracts Management
• Government Affairs Human Resources
• Safety & Security Department
• Volunteers
12
Speakers:
International:
Prof. Dennis Ray Sherrod
Professor and the inaugural Forsyth Medical Center
Endowed Chair of Recruitment & Retention in the
Division of Nursing at Winston-Salem State University
United State of America
Prof. Anahid Kulwicki
Dean & Professor at College of Nursing and Health Sciences
University of Massachusetts Boston
United State of America
Prof. Basanti Majumdar
Professor
Faculty of Health Science, School of Nursing
McMaster University
Canada
Prof. Ayman M. Hamdan-Mansour
Professor
Faculty of Nursing
The University of Jordan
Jordan
13
Ms. Melaine Coward
Director of Health Sciences Education
School of Health Sciences, Faculty of Health and Medical Sciences
University of Surrey
United Kingdom
Ms. Joanne Welch
Senior Lecturer
School of Health and Social Work
University of Hertfordshire
United Kingdom
14
National:
Dr. Thurayya Eid
Director of Clinical Practice and Nursing Research Unit
Department of Nursing
King Abdulaziz University
Jeddah, Kingdom of Saudi Arabia
Dr. Wael Al-Zayyer
Executive Consultant
CEO Office
King Fahad Specialist Hospital
Dammam, Kingdom of Saudi Arabia
Dr. Tagwa Yousif Omer
Dean, College of Nursing
King Saud Bin Abdul Aziz University For Health Sciences
National Guard Health Affairs
Jeddah, Kingdom of Saudi Arabia
15
Local:
Dr. Joel Gonzales Patalagsa
Assistant Professor , Community Health Nursing
College of Nursing
King Saud University
Riyadh, Kingdom of Saudi Arabia
Mr. Osama Nazek Zamel
Nurse Educator
King Khalid University Hospital
King Saud University Medical City
Riyadh, Kingdom of Saudi Arabia
Dr. Juliana D’Sa
FAIMER Fellow
Professor, Maternal & Child Health Nursing Department
College of Nursing,
King Saud University
Ms. Maryam Omar Alshanqiti
Consultant
Assistant Deputy for Assistant Medical Services
Ministry of Health
Riyadh, Kingdom of Saudi Arabia
16
Mohammad Abdulrahman Al Derwish
Diabetic Foot Specialist / Foot Care Department Head
University Diabetes Center
King Abdulaziz University
Riyadh, Kingdom of Saudi Arabia
Naif Hamdi Alanazi
Intern Student
King Saud University, College of Nursing
King Faisal Specialist Hospital and Research Center
Riyadh, Kingdom of Saudi Arabia
Dr. Ramon Perley Mercado Pandaan
Lecturer
Shaqra University
Shaqra Ar Riyadh, Kingdom of Saudi Arabia
Mr. John Mark Montoya Gutierrez
Lecturer
Nursing Department
Shaqra University
Shaqra Ar Riyadh, Kingdom of Saudi Arabia
17
18
19
Scientific Programme
Day 1: (Wednesday 6th May 2015)
Time
07:00 – 08:00
Topics
Speaker
Registration
Welcome & Introduction
08:00 – 08:30
Ms. Lorraine Bell, Acting Director of Nursing
Executive Nursing Services
King Saud University Medical City
Session 1, 2 & 3
Makarim Hall
Moderator: Dr. Mahaman Moussa College of Nursing KSU
Education through Innovation
Session 1
Jo Welch, Senior Lecturer & Research Lead
8.30 - 9.00
School of Health and Social Work
Makarim Hall
The Centre for Learning Disability Studies
University of Hertfordshire, UK
Session 2
9.00 – 9.30
Makarim Hall
Has evidenced based practice shadowed humanistic approach of nursing?​
Professor Basanti Majumdar, Professor
McMaster Univeristy, Canada
Preceptorship models in Clinical Training
Session 3
Dr. Tagwa Omer
9.30 – 10.00
Dean, College of Nursing
King Saud Bin Abdul Aziz University For Health Sciences
National Guard Health Affairs
Makarim Hall
10.00 – 10.15
10.15 – 10.45
Question Time
Coffee break
Opening Ceremony
10.45 – 11.15
Dr. Ahmad Aboshaiqah, Dean, College Of Nursing, KSU
Makarim Hall
Dr. Abdulrahman Al-Muammar, CEO, KSUMC
Professor Badran Alomar, Rector KSU
20
11.15 – 11.30
11.30 – 12.00
Session 4, 5 & 6
Opening of the Nursing Poster Exhibition
Professor Badran Alomar, Rector KSU
Nursing Poster Exhibition open to Participants
Moderator: Dr. Nazik M.A. Zakari , Associate Professor
KSU College of Nursing
Session 4
Identify the Challenges of the Nursing Profession in KSA
12.00 – 13.00
Moderator: Dr. Abdulrahman Al-Muammar, CEO, KSUMC
13.00 – 13.45
Prayer & Lunch
Session 5
Developing Healthy Workplaces
13.45 – 14.15
Professor Dennis Sherrod
Forsyth Medical Centre, USA
Session 6
14.15 – 14.45
Engineering the Operating Room to Improve the Quality of Patient Care: An
Evidence Based Approach
Dr. Wael Alzayyer, King Fahad Specialist Hospital, Dammam
14.45 – 15.00
Question Time
15.00– 15.30
Coffee break
Session 7 & 8
Moderator: Dr. Omar Baker, Associate Professor College of Nursing KSU
Session 7
15.30 – 16.00
Evidence-based Practice and Research
Dr Thurayya Abdulwahid Eid, Faculty of Medicine King Abdulaziz University Hospital, Jeddah
Public Can Lead Health Issues
16.00 – 16.30
Ms. Maryam O. AlShanqiti, MSN-RN
Consultant, Assistant Medical Deputy for Medical Assistant Services
Senior-Specialist Community Health Nursing
Senior Regional Nursing Director
16.30 – 16.45
Question Time
16.45
End of Day 1
Session 8
21
Day 2: (Thursday 7th May 2015), (18/7/1436)
Time
Session 9 &
10
Session 9
8.30 – 9.00
Topics
Speaker
Moderator: Clara Altavano, Acting Assistant Director of Nursing
King Abdulaziz University Hospital
Managing Stress in the Workplace
Professor Ayman Hamdan Mansour, Professor, Mental Health Nursing
Faculty of Nursing, University of Jordan
Education being linked to Quality Improvement
Session 10
Jo Welch, Senior Lecturer & Research Lead
9-00 – 9.30
School of Health and Social Work
The Centre for Learning Disability Studies
University of Hertfordshire, UK
9.30 – 9.45
Question Time
9.45 – 10.15
Coffee break
Session 11, 12
& 13
Moderator: Dr. Omar Baker, Associate Professor College of Nursing
Session 11
Professional Knowledge Acquisition through Reflection for Student Nurses
10.15 – 10.45
Ms. Melaine Coward Director of Health Sciences Education
King Saud University
School of Health Sciences
University of Surrey, UK
Session 12
10.45 – 11.15
Inter-Professional Education and Practice
Professor Anahid Kulwicki, Dean & Professor at College of Nursing and Health Sciences
University of Massachusetts, USA
Session 13
Biopsychosocial Characteristics and Functional status among the Elderly in Riyadh
11.15 – 11.45
Naif Hamdi Alanazi
Intern Student
College of Nursing, KSU
22
11.45 – 12.00
Question Time
12.00 – 12.45
Prayer & Lunch
12.45– 13.15
Nursing Poster Exhibition
Information for Seminar Selections
Seminar(s) 1 – 3
Seminar 1
Nursing Care Plan: Evidence Based Framework
Makarim Hall 1
Dr. Joel Gonzales Patalagsa, Assistant Professor King Saud University
13.15 – 14.15
Moderator: Samah Elzakazeky, Nursing Clinical Instructor, KAUH
Seminar 2
Global Perspectives in Nursing Education, Research and Practice
Makarim Hall 2
Professor Anahid Kulwicki, Dean & Professor at College of Nursing and Health Sciences
13.15 – 14.15
University of Massachusetts, USA
Moderator: Maan Rasonabe Ciocson, Nursing Clinical Educator, KKUH
Seminar 3
The role of the Nurse in Diabetic Limb Salvage
Makarim Hall 3
Mr. Mohammad Abdulrahman Al Derwish, Registered Nurse/Diabetic Educator
13.15 – 14.15
Moderator: Joel Granido, Nursing Clinical Instructor, KAUH
Seminar(s) 4 – 6
Seminar 4
Assessment Of HIV/AIDS Educational Intervention On Stigma Reduction Among
Nurses: A Quasi-Experimental Study
Makarim Hall 1
John Mark M. Gutierrez
14.15 – 15.15
Nursing Department, College of Applied Medical Sciences, Shaqra Male Campus, Shaqra University
Moderator: Samah Elzakazeky, Nursing Clinical Instructor, KAUH
Seminar 5
Midwives: for a Better Tomorrow
Makarim Hall 2
Dr. Juliana D’Sa
14.15 – 15.15
FAIMER Fellow
Maternal & Child Health Nursing Department
College of Nursing, KSU
Moderator: Maan Rasonabe Ciocson, Nursing Clinical Educator, KKUH
Seminar 6
Makarim Hall 3
14.15 – 15.15
The role of the Mentor in Supporting Learners and Newly Qualified Practitioners to
attain Excellence in Practice
Ms. Melaine Coward Director of Health Sciences Education
School of Health Sciences
University of Surrey, UK
Moderator: Joel Granido, Nursing Clinical Instructor, KAUH
15.15 – 15.45
Coffee break
23
Seminar(s) 7 – 9
Seminar 7
Makarim Hall 1
15.45 – 16.45
Seminar 8
Makarim Hall 2
Management Styles and Organizational Challenges of Nurse Supervisors
Dr. Ramon Perley Mercado Pandaan
Nursing Department, College of Applied Medical Sciences, Shaqra Male Campus, Shaqra University
Moderator: Samah Elzakazeky, Nursing Clinical Instructor, KAUH
Nurse Retention: Strategy for Improving Patient Care
Professor Dennis Sherrod, USA
15.45 – 16.45
Moderator: Maan Rasonabe Ciocson, Nursing Clinical Educator, KKUH
Seminar 9
Adaptation Of Evidenced-Based Clinical Practice Guideline On Chemotherapy
Extravasation: Prevention, Assessment and Management
Makarim Hall 3
15.45 – 16.45
Mr. Osama N. Zamel, Nurse Educator Oncology/Hematology
Moderator: Joel Granido, Nursing Clinical Instructor, KAUH
16.45
24
Conference Closes
Seminar Presentations
25
Seminar Series A Thursday 13.15 – 14.15
A1
Nursing Care Plan: Evidence-Based Framework
Dr. Joel Gonzales Patalagsa
Assistant Professor , Community Health Nursing
College of Nursing
King Saud University
Riyadh, Kingdom of Saudi Arabia
Nurses Are Expected To Provide Safe, High Quality And Compassionate Care Be It Promotive, Preventive, Curative,
Or Rehabilitative. Health Care Clients Are Human Beings Endowed By Biological, Psychological, Social, And Spiritual
Characteristics. Therefore A Holistic Approach In Providing Care Is Needed.
An Enhanced Nursing Intervention Model Is Presented To Guide Nurses—Students And Practitioners Alike—In Making
Sure That Safe, High Quality Holistic Care Is Provided At All Times. The Amethodist Model Is An Enhancement On
What Nurses Should Think And Do When Providing Care To Their Clients.
A2
Global Perspectives in Nursing Education, Research and Practice
Professor Anahid Kulwicki
Dean & Professor At College Of Nursing And Health Sciences
University Of Massachusetts, USA
More Countries Are Now Adopting And Implementing Similar Nursing Curricula Which Promotes An Increase In
Standardized Testing In The Nursing World On A Global Level. There Is Currently A Global Shortage Of Nursing
Faculty With Numerous Factors Involved In Creating The Shortage. In Developed And Industrialized Countries There
Are Numerous Resources Available To Nurses That Are Focused On Graduate Education, Advanced Practice Nurses
And Research. However, In Low Resource Countries, Funding For Nursing Higher Education, Advanced Practice And
Research Is Limited.
It Is Important For Nurses To Gain Global Perspectives On Nursing Education, Research And Practice That Will
Advance The Role Of Nurses And Nursing Care For Their Respective Populations. It Is Imperative That Nurses From
High Resource Countries Collaborate With Nurses From Low Resource Countries In The Areas Of Higher Education,
Advance Nursing Practice And Research That Meets The Needs Of Their Respective Populations. Advancement In
Technology And The Ease Of Worldwide Travel Has Been Instrumental In Connecting The Nursing World Into A
Global Community Rich With Opportunities For Advancement And Cost Effectiveness. Establishing Local, Regional
And Global Partnerships Through Advanced Technology Can Assist Nurses From Any Country To Benefit From The
Opportunities Made Available To Them From The Global Nursing Community.
26
Learning Objectives:
• The Learner Will Identify Challenges Facing Nurses In Their Own Countries In Advancing Nursing Education,
Practice And Research.
• The Learner Will Examine Opportunities In Collaboration With Nurses From The Global Community.
• The Learner Will Establish Strategies In Collaborating With Nurses In The Global Nursing Community With Similar
Needs And Challenges In Advancing Nursing Education, Research And Practice.
A3
The Role Of The Nurse In Diabetic Limb Salvage
Mr. Mohammad Al Derwish
Diabetic Foot Specialist / Foot Care Department Head
University Diabetes Center
King Abdulaziz University
Riyadh, Kingdom of Saudi Arabia
The Prevalence Of Diabetes Among Saudi Population Is Almost 24%, And Mainly Type 2 Due To Life Style
Changes And Some Genetic Background. It Is Generally Assumed That Regular Foot Exam May Reduce
The Burden Of Diabetic Foot Ulceration. So, Appropriate Patient Foot Exam In The Pre-Clinic Setting Will
Enhance Lower Limb Salvage. King Saud University Diabetes Centre Is A Referral Centre Dealing With
More Than 15, 000 Diabetic Patients Yearly.
Aim: We Sought To Implement A Mandatory Foot Exam Policy Referral In Our Pre-Clinic Setting For Foot
Screening And Follow Up.
Seminar Series B Thursday 14.15 – 15.15
B1
Assessment Of HIV/AIDS Educational Intervention On Stigma Reduction Among Nurses: A
Quasi-Experimental Study
Mr. John Mark Montoya Gutierrez
Lecturer ,Nursing Department
Shaqra University
Shaqra Ar Riyadh, Kingdom of Saudi Arabia In A Setting Where HIV/AIDS Is A Pressing Concern, Nurses May Respond To Patients With Increase Fear Of Being
At Risk Of Acquiring Hiv Infection, Decrease Willingness To Care, Or Both.
This Presentation Aimed To Increase Nurses’ Knowledge On HIV/AIDS And Reduce HIV/AIDS-Related Stigma And
27
Discrimination In Healthcare Through HIV/AIDS Educational Intervention. A Quasi-Experimental Design Was Carried
Out In A Secondary-Level Hospital In Riyadh From February To April 2014. Nurses (N = 58), Meeting The Eligibility
Criteria, Were Included In The Sample And Were Assigned In One-Group Pre-Test And Post-Test. The Results Of The PreAnd Post-Intervention Phases Were Compared Using Paired-Sample T-Test. Significant Increase In Nurses’ Knowledge
Was Demonstrated Following HIV/AIDS Educational Intervention (P = 0.000). HIV/AIDS Educational Intervention
Was Significantly Associated With Less Stigmatization For Attitudes Towards Imposed Measures (P = 0.002). In PreIntervention Phase, The Greatest Stigmatizing Attitude Was Observed In Statement Concerning The Need For Screening
All Inpatients For HIV/AIDS. The Assessment At Pre- And Post-Intervention For ‘Comfortableness Dealing With HIV/
AIDS Patients Did Not Differ Significantly, Indicating Least Stigmatizing Attitude. However, A Statistical Significant
Difference (P = 0.044) On Nurses’ Overall Attitude Towards Patients With Hiv/Aids Was Detected Between Pre- And
Post-Intervention Assessment. Pooled Mean Revealed No Observed Discriminatory Act Among Nurses At Pre- And PostIntervention Assessment. The Utilization Of HIV/AIDS Educational Intervention Improved Nurses Knowledge About
HIV/AIDS. The Effectiveness Of Hiv/Aids Educational Intervention In Reducing HIV/AIDS-Related Discrimination As
Well As Its Impact On Nurses’ Attitudes Towards Patients With HIV/AIDS Warrants Further Investigation.
B2
Midwives: For A Better Tomorrow
Dr. Juliana D’Sa
FAIMER Fellow
Professor, Maternal & Child Health Nursing Department
College of Nursing , King Saud University
Aim: The Health Professionals Will Appreciate The Significant Role Played By The Midwives In Contributing To
Quality Reproductive, Maternal And Newborn Health, Thereby Contributing To A Better Future.
Objective
By The End Of The Session, The Participants Will Be Able To:
• Understand The Crucial Role Of Midwives In Reducing Maternal And Neonatal Mortality.
• Appreciate The Contributions Of Midwives In Creating A Better Tomorrow Through Effective Midwifery Care.
B3
The Role Of The Mentor In Supporting Learners And Newly Qualified Practitioners To Attain
Excellence In Practice
Ms. Melaine Coward
Director of Health Sciences Education
School of Health Sciences, Faculty of Health and Medical Sciences
University of Surrey
United Kingdom
28
This Presentation Will Address Historical And Current Theories Regarding Reflection In Nursing. Uk Policy Such As
The Francis Inquiry (2013) Will Be Highlighted To Illuminate The Importance Of Reflection In Professional Practice
In Developing Awareness, Use Of The Evidence-Base And Contemporaneousness. Consideration Of The Role Of The
Nurse Educator And Practice Mentor Will Be Addressed In Terms Of Developing The Future Practitioners Who Will
Direct And Lead Quality Patient Care.
Learning Objectives
• To Discuss The Global Differences In Supporting Students In The Clinical Setting
• To Review Excellence In Theory And Practice Support For Students In Health Care Settings
• To Review The Role Of Educators And Clinicians In Supporting Learning
• Discussion Regarding The Provision For Mechanisms To Support Newly Qualified Nurses To Enter The
Workforce
• To Develop An Action Plan Drawing Upon Shared Good Practices To Take Away And Implement On Your Home
Site.
Seminar Series C Thursday 15.45 – 16.45
C1
Management Styles And Organizational Challenges Of Nurse Supervisors
Dr. Ramon Perley Mercado Pandaan
Lecturer
Shaqra University
Shaqra Ar Riyadh, Kingdom of Saudi Arabia
Content And Scope
This Is A Descriptive Correlational Study Utilizing A Quantitative-Qualitative Approach To Determine The
Management Styles Of Nurse Leaders.
Findings
Majority Of The Nurse Leaders (35%) Are Ages 52 To 57 Years Old. The Males Predominates The
Population Of Nurse Leaders In This Study. Most Of The Respondents Are Bsn Degree Holders With
Masters Units. In Terms Of Length Of Service, 9 (45%) Out Of 20 Have Been Employed For 26 To 30
Years. With Reference To The Number Of Trainings, Majority (85%) Have Participated/Attended Trainings
For 20 Hours And Below. The Management Style Of The Nurse Leaders As Perceived By The Staff Nurses
Are High (3.05). Finally, There Is No Significant Relationship In The Correlates Of Age, Gender, Civil
Status, Highest Educational Attainment, Length Of Service And Number In Hours Of Trainings And The
Management Styles Of The Nurse Leaders.
29
Recommendations
The Nursing Administration Should Emphasize On The Significant Importance Of Applying An Effective
Management Style Especially In Decision Making. Nurse Leaders Should Evaluate And Identify Areas
Potential For Improvement In The Aspect Of Leadership. A Similar Study Be Conducted But To A Different
Pool Of Respondent And A Larger Group.
C2
Nurse Retention – A Strategy For Improving Patient Care
Professor Dennis Ray Sherrod
Professor and the inaugural Forsyth Medical Center Endowed Chair of Recruitment & Retention in the
Division of Nursing at Winston-Salem State University
United State of America
Nurse Retention Decreases Costs, Increases Morale, And Improves Patient Care Outcomes. This Session
Will Identify Reasons For Nurses Leave An Organization And Will Discuss Generational Issues That Can
Influence Job Satisfaction. Specific Retention Strategies Will Be Identified For New Graduates, Nurse
Managers, And Mature Nurses.
Learning Outcome: To Enhance Nurses’ Skills In Retaining Colleagues In The Workplace.
C3
Adaptation Of Evidence Based Clinical Practice Guideline On Chemotherapy Extravasation:
Prevention, Assessment And Management
Mr. Osama Zamel
Nurse Educator
King Khalid University Hospital
King Saud University Medical City
Extravasation Is A Serious Condition That Warrants Significant Intervention From Healthcare Professionals Involved
In Administering Intravenous Medications. The Aim Of This Study Was To Adapt Existing Evidence-Based Clinical
Practice Guidelines On Chemotherapy Extravasation Developed By International Experts.
Implication To Nursing Practice
Evidence-Based Clinical Practice Guideline Is An Important Tool To Unify Practice And Improve Patient’s Outcomes.
It Provides An Outline Of The Pivotal Role That Nurse’s Play In The Management Process For Patient’s Experiencing
Chemotherapy Extravasation.
30
POSTER PRESENTATION
ABSTRACTS
31
1
Prevalence of Depression among Saudi Pregnant Women
Essmat M. Gemaey*, Salma A. Moawed **, Hessa A. Al-Mutairi***
*Community Psychiatric Department, King Saud University, College Of Nursing
** Maternity Department, King Saud University, College Of Nursing
*** Health educator, Ministry Of Health, KSA
Depression affects about 20% of women during their lifetime, with pregnancy being a period of high
susceptibility. Prevalence of depression during pregnancy ranges from 4% to 20%. Depression during
pregnancy is not only the sturdiest risk factor for post-natal depression but also precursor to adverse obstetric
outcomes.
Aim: To identify the prevalence of depression among Saudi pregnant women & correlate between sociodemographic, medical and psychological history and depression. Methods: the study was conducted at two
primary health care units at two hospitals (Al-Yammama & King Saud Medical Complex) at Riyadh city. A
convenient subjects of 316 pregnant women from the 2nd month of pregnancy till 9th. A structured interview
questionnaire was developed. It consisted of questions related to socio-demographic aspects & a validated
Beck’s Depression inventory was used to screen for antenatal depressive symptoms. (December 2013 –
March 2014) were screened and approached individually by the researcher. Result: The current study reveal
that the prevalence rates of antenatal depression were mild to severe and extreme depression were 18.6%,
11.7% and 6.6% respectively. Spearman’s rho test showed a significant correlation between depression and
marital status of mother, status of the pregnancy, health complications of previous pregnancies, number of
previous abortions, number of dead newborn, and number of children with low birth weight (less than 2.5
kg). Recommendation: Early detection of depression during pregnancy is awful because depression can
unfavorably affect birth outcomes and neonatal health and, if left untreated, can persist after the birth can
impair mother-infant attachments and have cognitive, emotional, and behavioral impact for children.
2
Perception of Primary Schools Saudi Female Teachers Regarding Child Abuse
Author: Mastoura Fahad AlOtaibi
Thesis supervisor: Dr. Faten Ez El-Din Helmy
Associated Prof. Community Health Nursing
Background: Child abuse and neglect is endemic throughout the world with serious life-long consequences
impairing the health and welfare of children and adolescents.
Aim: This study was done to assess governmental primary school female teachers’ perception regarding
child abuse, their recognition of maltreatment, and their varying responses toward reporting concerns about
suspected abuse and examining the relationship between teachers› perception and their socio demographics
variables.
32
Design: A Quantitative descriptive with a cross sectional design was adopted in this study.
Method: The study was conducted in 32 representative governmental primary schools for females in Riyadh
city after dividing it into 5 sectors; each sector has school guidance offices which is responsible for particular
schools distributed geographically. The total numbers of the studied subjects were around 300 teachers who
participate in a self-administered questionnaire by using cluster sampling technique.
Result: the majority of the teachers’ perception were satisfactory toward child abuse but the majority of
them with (63%) felt that they are not prepared and not qualified by training to deal professionally with all
cases of child abuse as (90.3%) of the studied sample, didn’t receive any training courses regarding child
abuse in their career. A statistically significant association was found between teachers’ perception and their
sociodemographic variables.
Conclusion: School health nurses and teachers are expected to play a key role by leading and facilitating the
process of comprehensive strategy for the prevention and interventions of child maltreatment.
3
Central Vascular Access Device: An Adapted Evidence-Based Clinical Practice
Guideline
Maria Ana Flor R. Ciocson, MN, RN
Maranda G. Hernandez, MN, RN, RM
Mohammad Atallah, PhD, MSN
Yasser S. Amer, MBBCh, MSc Ped, MSc
King Saud University Medical City, Riyadh, Saudi Arabia
Background
Our aim was to adapt recommendations from high-quality, evidence-based clinical practice guidelines (CPGs)
for central vascular access device (CVAD) insertion, management, and removal in King Saud University
Medical City. Currently, the hospital has a policy and procedure for CVAD insertion; however, the methodology
of creating the policy document was not evidence-based, and the clinical content was not up to date. A new
CPG will guide the revision of CVAD policies and procedures and eliminate variation in clinician practices.
Methods
The King Saud University Medical City CPG Committee introduced the modified ADAPTE process
methodology for adaptation and implementation of CPGs originally developed by the ADAPTE Collaboration.
Results
The final decision of the panel after full assessment of 2 selected source CPGs was to adopt all Centers for
Disease Control and Prevention CPG recommendations and some essential sections from the Infusion Nurses
Society CPG recommendations. In addition, the team developed new implementation tools.
Conclusions
The ADAPTE process is an excellent scientific and rigorous process for CPG adaptation and clinical
performance improvement. It can be further adapted according to the local context and resources to promote a
sense of ownership of the adapted CPG. Furthermore, new CPGs will have a positive effect on hospital-wide
accreditation processes and local benchmarking of health care quality outcomes.
33
4
Saudi Nurses Perception of Their Occupational Nursing Stress and Their Coping
Strategies in Abha Public Hospitals
Reham Hamad Falah AlSaqrah
Jazan University
Demostrate in College of Nursing and Allied Health Science
The study seeks to evaluate the Saudi nurse’s perception of their occupational nursing stress and their coping
strategies in Abha hospital, a descriptive design was employed. The sample included 260 female and male
nurse working in medical, surgical, ICU and emergency department at Aseer and Abha general hospitals
.Three instruments were used for data collection. A designed questionnaire by the researcher to assess sociodemographic data, perceived nurses stress scale and Coping strategies scales for nurses. Results of the study
revealed that most nurses were never felt confident about their abilities to handle the work problem and to
control their irritating situations, and cope with their work stress in the form of Escape-avoidance the problem.
So, the study recommended that In-service training, workshops and seminars should be organized for nurses
to update their knowledge and skills for coping with their occupational stress. And an educational program
should be designed to enhance the nurses human behavior, resource management, interpersonal relation, stress
management, crisis interventions and coping strategies to help them to be less aggressive or hostile to the
patients or their families and to accept the work responsibilities.
5
Developing Research Capability Building Program For The Faculty Of Applied
Medical Sciences-Department Of Nursing, University Of Tabuk
Vanessa Varona, MAN; Luis Claro Belocura, Hamza Abunab, MAN
The increasing demand for highly competent and qualified nursing faculty is one of the many challenges
that higher educational institutions (HEI’s) face. The tripartite responsibilities of higher educational institution
are instruction, community extension, and research. Nurse educators are expected to carry excellence in
delivering the teaching-learning process, hence, these educators play a significant role in preparing and
strengthening the nursing workforce with the ultimate goal of providing quality nursing care to patients.
Furthermore, as members of the academic arena, it is a pivotal role to produce quality researches guided by
systematic inquiry which will further contribute to existing body of knowledge.
The study aimed to determine the training needs of the faculty staff of University of Tabuk – Department
of Nursing as a basis for developing research capability program for the department. This specifically sought
to answer the research capability of the respondents in terms of research process and research management
and as correlated with their gender and educational attainment. This study utilized a descriptive - correlational
research. The target population of the study is the Faculty Staff of Applied Medical Sciences - Department of
Nursing both in male and female sections in University of Tabuk. This study utilized universal sampling, with
retrieval rate of 78.57% specifically with total of 33 respondents, 15 female staff and 18 male staff.
Results have shown that there is almost equal distribution of male and female faculty staff while there
34
is higher percentage of faculty staff with masters’ degree. Qualitative research ranked as number one as the
respondents preferred topic for future seminars. Findings have also shown that there is significant difference
in terms of research process when grouped according to gender, while there is no significant difference in
terms of research management when grouped according to gender. On the other hand, there is no significant
difference in terms of research process and research management when grouped according to educational
attainment. Further, this study also shows that there is significant relationship between gender and research
process while there is no significant relationship between educational attainment and research process and
research management.
The researchers recommend that there should be a continuous research capability-building program
for the faculty staff, to keep them abreast of the latest trends in research.
6
Feto-Maternal Outcomes Of Hospitalized Hypertensive0 Gravida In Shaqra
General Hospital: A Retrospective Study
Rosanta O. Ellasus
Nursing Department, College of Applied Medical Sciences, Shaqra Female Campus, Shaqra University
Elevation of blood pressure during pregnancy can adversely affect both fetal and maternal outcomes. Other
maternal and fetal complications may also arise which may result to maternal and fetal mortality. This study
aimed to determine the fetal and maternal outcomes of hospitalized pregnant clients with hypertension.A
6-year retrospective research design was carried out in Shaqra General Hospital between January 2008 and
November 2013. Following approval by the hospital research ethics committee and hospital administrators,
hospital records were reviewed and examined using guide checklist. Universal sampling was applied totaling
to 56 evaluable cases of pregnant women with hypertension. Of 56 cases studied, year 2008 to 2013 had the
most frequency of hypertensive mothers. Most women are in middle adulthood stage with age 25 years old
and above, had more than one pregnancy (multigravida) and more than one viable pregnancy (multipara).
Fetal outcome resulted to high number of babies who were term, appropriate for gestational age, with good
Apgar score, no birth defect but high frequency of neonatal intensive care unit (NICU) admissions. Maternal
outcome recorded no maternal deaths; however, 4% maternal complications (i.e., post-partum hemorrhage
and HELLP syndrome) and more caesarean section deliveries were observed. Good Apgar score and absence
of birth defects is associated with higher frequency of roomed-in babies and less NICU admissions. There
were lesser complications to mothers who had more than one pregnancy. There were more NICU admissions
from caesarean section deliveries.
35
7
Effects Of Blood Glucose Level On Cognitive Performance Of Male Nursing Student:
Randomized, Single-Blinded, Placebo-Controlled Pilot Trial
Allan L. Dueño
Nursing Department, College of Applied Medical Sciences, Shaqra Male Campus, Shaqra University
Targeted activities that enhance nursing students’ cognitive performance are vital component of nursing education.
This study utilized a randomized, single-blinded, placebo-controlled pilot trial design to determine the transient effects
of blood glucose level on cognitive performance of male nursing students enrolled in a Saudi university. The research
protocol was reviewed and approved by university research ethics committee. A total of 22 participants, who met the
inclusion criteria, were included for analysis. Using systematic random sampling technique, 10 eligible participants
were assigned in experimental group while the remaining 12 were assigned in control group. In pre-intervention phase,
baseline blood glucose levels and test scores were obtained. Both groups watched a 5-minute video presentation regarding
effects of cigarette smoking. Twenty-item multiple-choice questions were administered following video presentation. In
intervention phase, the experimental group received glucose-prepared solution while the control group received placebo
solution. The post-intervention phase was similarly to pre-intervention phase. Results revealed that the blood sugar levels
(p = 0.045) and test scores (p = 0.025) for experimental group improved significantly; no change in blood glucose levels
(p = 0.732) and test scores (p = 0.987) was observed in the control group. Blood glucose levels have significant transient
effect on cognitive functioning, primarily on memory tasks. The experimental group, with improved blood glucose levels,
demonstrated improved cognitive performance compared to control group. Results show that nursing students’ cognitive
performance can be enhanced by targeted activities. Further investigation is recommended with a larger sample size.
8
The Delivery of Nursing Care To Pneumonia Patients
Jerry Acosta Abriam, MAN
College of Applied Medical Sciences,
Nursing Department, Shaqra University
This study determined the delivery of nursing care to pneumonia patients among (5) selected hospitals of
La Union, Philippines. This study utilized the qualitative method with questionnaire accompanied by interview.
A sample size of staff nurses (N=61) were chosen through a purposive sampling, and patients (N=118) who were
confined at the period on which the researcher conducted the research were also included as respondents. Tools
utilized to analyze and interpret data study gathered were frequency, percentages and ranking. Findings of the
study revealed that the there is low prevalence and incidence of pneumonia in the five selected hospitals of La
Union. The delivery of nursing care as to Independent Nursing Care, Dependent Nursing Care ad Collaborative
nursing Care was highly implemented. The most common problems encountered by staff nurses in the delivery
of nursing care are the availability of equipment, too much workload, lack competence and lack of policy.
Pneumonia patient encountered problems in receiving care from the nurses. This study will enable the nurses
to focus on the most common management and delivery of best possible care rendered by nurses to pneumonia
patients. Revealing our strengths and weaknesses in management of pneumonia will improve our services to
our patients. Moreover, inclusion of patients in their disease management will improve the patients’ outcome for
early recovery and hospital discharge. Therefore, measures were proposed to enhance the delivery if nursing care
along Independent, dependent and collaborative nursing interventions to improve the patients’ outcome.
36
9
Efficacy Of Counseling For Cervical Cancer Screening And Protective Procedures On
Saudi Women’s Health Beliefs And Practice”
*Soliman, Aziza;1 ** Amany S. Badawy;1,2 ***Fouad, Abeer1
*Professor of Obstetrics & Gynecological Nursing, ** Assistant Professor of Obstetrics & Gynecological
Nursing, *** Lecturer of Community and Mental Health Nursing,
1-College of Nursing, King Saud University, Riyadh, Saudi Arabia- 2College of Nursing, Zagazig University,
Zagazig, Egypt
Background: Cervical cancer is the second most common cancer of women in the world, and it becomes a major
cause of cancer mortality in low-income countries due to inadequate use of the screening services. Currently,
little is known regarding cervical cancer incidence in Arab countries. In the Kingdom of Saudi Arabia, cervical
cancer occurs in 4.1/100,000 females in the population. It accounts for 7% of all newly diagnosed cancers in
females, and is the eighth leading cause of cancer death in Saudi females. An intensive screening program for
cervical cancer is not well established, and despite the availability of the Pap smear test among different health
sectors, it was noted that the number of cases of cervical cancer has been increasing over the past 2 decades.
Objective: To evaluate efficacy of counseling about cervical cancer in Changing Saudi Women’s beliefs
and Practices toward Screening and Protective procedures. Methods: A Quiz- experimental study carried
on100 Saudi women were counseled after being administered a structured interview questionnaire with the
Health Belief Model Scale for Cervical Cancer and Pap Smear Test. The study was performed in two Holy
Quran teaching centers in Riyadh City between September 2014 and December 2014. Data were collected
by means of an form Results: Lack of subjective symptoms was the main reason for women to refrain from
gynecological examinations. Women were found to have poor knowledge, inadequate health behavior and
false beliefs regarding cervical cancer symptoms and screening. There was relation between health beliefs and
characteristics of women and particularly education (F = 10.80, p = 0.01). Conclusions: Primarily beliefs and
practices of women in the target group should be evaluated to increase their participation in cervical cancer
screening and to prepare effective education strategies. There is a need to educate the general community
about the disease and its prevention.
10
Infertility Related Stressors in Saudi Women Initiating In Vitro Fertilization (IVF)
Essmat M. Gemeay*, Salma Moawed**, Essmat A.Mansour***, Mona El Nady*
*Community Psychiatric Department , King Saud University, College Of Nursing
** Maternity Department , King Saud University, College Of Nursing
*** Medical surgical Department , King Saud University, College Of Nursing
Infertility is a stressful experience, yet little is known about the specific issues confronting infertile women.
37
In the present study, therefore, the objective of this study is to identify prevalence of anxiety, stress and
depression of women going to infertility clinic in Riyadh. descriptive cross-section design was used, Methods
.A convenient subject 150 women , the study conducted at king Fahd Medical City(KFMC) - Riyadh, in
vitro fertilization clinic(IVF), Tools clients were interviewed individually using interview questionnaire sheet
which formed by the researchers & composed of 2 parts ; The first one : is about the sociodemographic data as
(age, Living Area, Accommodation, Job, Education, Family income, ..etc.). In the second part, DASS scale is
a 42-item self-report instrument designed to measure the three related negative emotional states of depression,
anxiety and tension/stress. Results The findings of the present study revealed that infertile women have a
little pit association between the anxiety, stress and depression among women and infertility. The researchers
recommended that Psychological support should be a part of the medical treatment process, to improve mental
health and quality of life among IVF women.
11
Cultural Competency Among Expatriate Nurses in Saudi Arabia
Mohammad Atallah1, Ergie P. Inocian1*, Mohammed Moufleh1, Maha Faden1, and Sami Eid1
Department of Nursing, King Khalid University Hospital, Riyadh, Saudi Arabia
Background: The culture of Saudi Arabia is dominated by the values and virtues of Islam. Methods: This
descriptive study served as a baseline assessment survey to determine the level of competence among expatriate
nurses in providing culturally competent nursing care. The Individual Assessment of Cultural Competence, with
approval from the Institution Review Board (IRB), was administered to 584 expatriate nurses of a University
Hospital in Kingdom of Saudi Arabia. Results: The findings of the study showed that majority of the respondents
were Indians and Filipinos, with a frequency percentage of 53% and 39%, respectively. The respondents were
culturally competent in providing nursing care however there were significant differences in their cultural
competency when grouped according to their age, gender, educational status, nationality and length of service.
Nursing Implications: The university hospital recognizes the importance of cultural competence in the caring
professions with the presence of diverse workforce. Hence, professional development programs are necessary to
continually provide the nursing staff with the needed information primarily about Saudi culture.
38
12
Post-Anesthesia Recovery Score For Ambulatory Patients (PARSAP):
Addressing Millennium Nursing Care
Ratnasree Chindada, Teocele O. Ebarat, Mohammed Atallah, Mohammed Moufleh, And Veronika Jones
Department Of Nursing, King Khalid University Hospital
Background:
The use of discharge criteria in the ambulatory surgery setting has been the topic of many research studies
and reviews because this will affect the total recovery time of same day surgery clients. This evidence–
based practice provides a discussion of a research utilization project regarding the use of an Expanded Postanesthesia Recovery Score for Ambulatory Patients or PARSAP.
Methods:
This is a Pilot Study, a sort of test-running to adopt the Aldrete’s Expanded Post-Anesthesia Recovery Score
for Ambulatory Patients (PARSAP) scale. For this purpose, the OB-GYNE Unit was selected as a convenient
sample population to implement the PARSAP discharge criteria for their post-operative clients for five- month
period starting October 2103 up to February 2014. Mainly, PARSAP scoring scale was tested on one major
claim: Is there any decrease in the length of stay in phase II recovery of post-anesthesia patients?
Results:
The implementation of the PARSAP discharge scoring scale was accomplished with minimum difficulty primarily
because of the unit staff nurses commitment to work for the project and the excellent relationship with the anesthetists.
In the IVF Unit, staff nurses catered 139 post-anesthesia patients and they were able to fast track the discharge time
to an average length of stay for 45.9 minutes as compared to the 1 hour traditional practice. The quality of care
rendered was evaluated on the basis of reported complications after 2 weeks of discharge including pain, nausea
and vomiting. Results revealed 2 call backs (0.014%) of the total population served. In the Antenatal, Post-Natal and
Gyne Units, the use of PARSAP scoring scale has reduced the monitoring time of the staff nurses by an average of
30 minutes. The average length of stay in the unit has also decreased to 15% of the time as compared to the previous
practice. In the Labor and Delivery Unit, the PARSAP scoring system was found to have comprehensive and
consistent criteria which is more applicable during the Phase I close monitoring period. Of the 10-item scale, items
9 & 10 scoring was modified accordingly because at this Phase I, patient is still on NPO and has Foley’s catheter.
Overall observation revealed that the length of stay has been reduced by an average of 68.56 minutes, decreased the
monitoring workload of the staff nurses and fast-tracking the transfer of patients to the post-natal unit.
Conclusion and Recommendation:
The Post-Anesthesia Recovery Score for Ambulatory Patients (PARSAP) is an Expanded Aldrete’s scoring system which can be
used as an effective tool for assessing discharge readiness both in Phase I and Phase II post-anesthesia patients. Its implementation
is the easiest way of streamlining the recovery of patients, have been able to meet the standards of care without adversely
affecting the quality of care utilizing the eSIHI of the Cerner’s system. The timely discharge of patients using PARSAP is one
method of reducing healthcare cost for both the institution and the patient’s family. Hence, a proposed Protocol for its usage and
implementation was forwarded to the top management for review and approval.
39
13
Progressive Mobility Protocol: Reducing Icu-Adult Complications
and Injury-Free For Carers
Ruhaina Ladja, Mohammed Atallah, Zakaria Al Masri, Mohammed Moufleh
Department of Nursing, King Khalid University Hospital
INTRODUCTION:
A review of the literature reveals recent studies that discuss the benefits of early mobility in intensive care
patients. Early progressive mobility programs use a systematic progression of activity to prevent deconditioning
and its complications in critically ill patients.
The expected patient outcomes of the innovative progressive mobility protocol can also improve the workload
condition of the nurses.
METHODS:
Assessment of the ICU nurses’ theoretical understanding on the effects of immobility was conducted, as well
as the statistical data on the patient –handling related injuries of nurses were collected.
FINDINGS:
Results of the staff nurses’ manual handling survey and knowledge on the effects of immobility indicated
that staff nurses have inadequate knowledge on the effects of immobility. Having low back pain was the most
common problem experienced by the staff related to manual handling. There is no available guidelines on
manual handling. Mostly, they do not receive annual training on manual handling and back care and only upon
orientation during arrival.
CONCLUSION:
With the emphasis on frontline caregiver empowerment to drive mobility using an evidence-based guide, the
team will be able to integrate safe mobilization practices. A recommendation to formulate a project design
in Integrating a Multidisciplinary Progressive Mobility Programme into Intensive Care Practice is necessary.
14
Self-Efficacy among Staff Nurses on Patient-Controlled Analgesia Administration
Wilfreda Moran1, Mohammad Atallah1, Ergie P. Inocian1, And Mohammed Moufleh1,
Department Of Nursing, King Khalid University Hospital, Riyadh, Saudi Arabia
Background: Patient-Controlled Analgesia (PCA) has become a common method to manage postoperative
pain. This study aims to determine the self-efficacy of staff nurses in using PCA.
Methods: A survey questionnaire was administered to 143 staff nurses in the perioperative setting of a
university hospital. Self-efficacy regarding the use of PCA is measured based on the perceived clinical skills
of PCA administration.
40
Results: The study found out that majority of the respondents are confident in terms of programming the PCA
pump, providing patient education, patient monitoring, independent double check, documentation and the
overall use of PCA.
Implication to Nursing: Perceived Self-efficacy is central to the understanding of individuals’ transactions
with their environments and a core construct that mediates between knowledge and behavior. Assessing the
self-efficacy of the staff nurses will contribute significantly in the formulation of educational programme
aimed at improving the knowledge and skills of the staff nurses with PCA administration.
15
Ensuring Patient Safety Through Effective Implementation Of Surgical Safety
Checklist
Trinidad
J. Salcedo, Associate Director Nursing-Operating Room
Mohammed Atallah, Associate Director Of Nursing-Education
Ergie P. Inocian, Nurse Educator
Wisam Almomani, Nurse Educator
Mohammed Moufleh, Director Nursing
King Khalid University Hospital
Background
Patient safety as a fundamental principle of health care emphasizes the reporting, analysis, and
prevention of medical error that leads to adverse healthcare events. The implementation of evidence-based
practice in perioperative nursing holds promise of improving quality of care and client outcomes.
Methods
The study utilized a descriptive research design to determine the compliance rate on surgical safety checklist
in the operating room of a university hospital in Riyadh, Saudi Arabia. The study used the Surgical Safety
Checklist implemented in the Operating Room. This form is patterned from the WHO surgical safety Checklist.
Findings
It was noted since the time of surgical safety checklist implementation that there was a fluctuating increase
and decrease level of compliance to the surgical safety checklist during the three phases of the surgical
procedure. This indicates a need to consistently monitor the implementation of the checklist to achieve full
100% compliance.
Implication to Nursing Practice
In many respects, checklists are instruments which facilitate communication amongst members of the clinical
team and to help avoid error. Instituting a surgical safety checklist is a very important step toward improving
surgical safety and team collaboration. The utilization of surgical safety checklist can also have a positive
impact on patient outcomes.
41
16
Impact Of Initial Glycemic Control On The Healing Rate Of The Diabetic Foot Lesions
Mohammad Derwish, RN
Background: The prevalence of diabetes among Saudi population is almost 24%, and mainly type 2, due to
life style changes and some genetic background. It is generally assumed that poor glycemic control may delay
wound healing. So, the impact of glycemic control on healing of diabetic foot ulcers remains to be explored.
Aim: To identify the impact of glycemic control on diabetic foot ulcer healing outcome.
Methods: Medical podiatric records of 335 diabetic patients with diabetic foot wounds from the Foot Unit
at University Diabetes center between September 2011 - November 2013 were collected. Diabetes control
was based on the HbA1c values, podiatric exam includes sensory testing performed by using a VPT, and
vascular status evaluation was based on pedal pulses palpation and/or ankle brachial pressure index (ABPI).
Wound care was done up on the standard of the IWGDF (debridement, infection control, vascular control,
and offloading). Wound assessment was done up on PEDIS classification and Healed wound was defined as
complete closure without discharge.
Results: Mean age, diabetes duration, and HbA1c were 58±0.6 years, 17±0.4years, and 9.4 ±0.1% respectively.
Diabetic peripheral neuropathy and peripheral vascular disease was 94.92% and 35% respectively. 47.46% of
the total ulcers were infected and 70% were located at the plantar aspect of the foot, the mean wound size was
5,25cm² and the wound severity type was grade III classification (9.8%). Foot Deformity and Charcot foot
was 65% and 15.22% respectively. History of ulceration and amputation was 33.5% while all wounds healed
within a mean of 13.31 weeks.
Conclusion: Better Diabetic foot ulcers outcome rely on well-organized diabetic foot team rather than better
glycemic control.
17
Nurse’s Perception Toward Medication Errors In Pediatric Emergency Departments At
Riyadh Hospitals
Prof. Dr. Salma Moawed & Haifa Fahad
Human error is an innate behavior, process experts tell us that if a person performs a process enough times, a
mistake will eventually be made by that person performing that process and error rates increase as the number
of steps in a process increase. There is no consistent policy or procedure in place in health care to help nurses
deal with their reactions generated upon the realization that a medication error has been made.
The purpose of this study was to explore the relationship between nurse characteristics and medication errors
in pediatric emergency department on Riyadh.
A study questionnaire was sent to convenience subjects of 200 registered nurses (RN) from across the Riyadh
area who was working in pediatric emergency departments. The primary causes of medication errors identified
were interruptions during medication pass, short RN staffing, nurses caring for high acuity patients, nurses
42
working more than 12 hours in one shift, and nurses’ knowledge of medications dispensed.
Rank ordering identified three major barriers to reporting medication errors; fear of consequences that may
result if a medication error is reported, fear of blame if something happens to the patient due to a medication
error, and fear of reprimand if they reported a medication error had been made. Nurses perceived that medication
administration technologies would decrease medication errors in their hospitals.
Results of this study have serious implications for individual staff nurses, nurse administrators, as well as
hospital administration and hospital systems in terms of error reduction and patient safety.
18
Clinical Learning Environment As Perceived By Bachelor Degree Nursing Students
Latifah Alenazi
Supervised By: Dr.Fatmah Baddar, Dr. Hanan Alkorashy
Background and Aim: The clinical learning environment is the interactive network of forces within the
clinical setting that influence the students’ clinical learning outcomes. The identification of factors that
characterize clinical learning environment could lead to strategies that foster the factors most predictive
of desirable student learning outcomes and ameliorate those which may have a negative impact on student
outcomes .the aim of this study focused on Assessment of the clinical learning environment from the bachelor
degree nursing students‟ perception at College of Nursing , King Saud University and find out whether there
is a difference between the actual and the preferred clinical learning environment .
Materials and Methods: A cross-sectional descriptive comparative design was used in this study. The selected
setting was is the oldest programs for education of baccalaureate and master degrees in nursing at Kingdom of
Saudi Arabia, accessible population included all undergraduate bachelor of nursing students (males & females)
from level 4 up to 8. Total No. of male students were (144), total No. of female students were (147). In this study
a self-administered questionnaire was used. The questionnaire developed by chan (2002) used in the currently
study consisted of two main parts as well as a demographic data sheet. The parts were namely: clinical learning
environment inventory – Actual (CLEI-A) and clinical learning environment inventory – Preferred (CLEI-P).
Results: The study results revealed that, the majority of the nursing students at King Saud University had
high perception than preferred clinical learning environment. In comparing between male and female sections,
the results showed the mean scores of actually perception to clinical learning environment lower in female
comparing to male nursing students referred to culture.
Recommendations: The current study highlights the need for a supportive clinical learning environment which
is of importance in obtain the required teaching and learning process for students on clinical practice.
43
19
Surgical Site Infection Prevention: Bundle Of Care
Mohammed Atallah1, Ergie Inocian1, Tariq Al Tokhais2, Yasser Amer3
1
Department Of Nursing, King Khalid University Hospital
2
Surgery Department, King Khalid University Hospital
3
Quality Management Department, King Khalid University Hospital
INTRODUCTION
The issue of Surgical Site Infection Prevention (SSI) is one of the high priority health topics for Clinical
Practice Guideline production in the hospital due to the following reasons: Prevalence of the condition in
KKUH; The burden associated with SSI (e.g. an economic, financial, or patient burden); Concerns about
practice variation; The likelihood that the CPG will be effective in influencing practice; The potential for improving
quality of care and/or patient outcomes (e.g. pain, disability, quality of life, etc.); and The existence of relevant
good-quality evidence-based CPGs in the international context. Since, a rigorous development process of
clinical practice guidelines is costly and time consuming, the hospital has prompted to rely on adaptation of
guidelines developed internationally by experts.
METHODS
The description of the methodology for the production Clinical Practice Guideline (CPG) in the hospital
utilized the sequential process for trans-contextual adaptation of CPGs proposed by the ADAPTE Working
group of the Guidelines International Network (G-I-N). The researchers utilized the five items PIPOH model
(Population – Intervention – Professionals – Outcome – Healthcare settings) to cover relevant aspects.
RESULT
The panel retrieved 27 source CPGs; 24 CPGs were excluded based on the identified PIPOH and
selection criteria and 3 were considered for further assessment. The National Guidelines Clearinghouse (NGC)
“Compare Guidelines” tool was used to compare the 3 selected CPGs. The Appraisal of Guidelines Research
& Evaluation II (AGREE II) Instrument was used to assess the quality of the CPG. The Overall Assessment
and decision of the panel was to adapt the Clinical Practice Guideline from The National Collaborating Centre
for Women’s and Children’s Health Surgical site infection: prevention and treatment of surgical site infection.
London (UK): National Institute for Health and Clinical Excellence (NICE); (2008 Oct. reaffirmed 2011).
IIMPLICATION TO NURSING PRACTICE
The ADAPTE process for CPG adaptation (version 1.0 and 2.0) is an excellent scientific and rigorous process
for clinical performance improvement and is a valid and scientific alternative to de novo CPG development.
Implementation of the adopted CPG on SSI prevention is recommended to decrease the incidence rate of SSI.
44
20
Cognitive Impairment Among Community-Dwelling Elderly
Joel Gonzales Patalagsa1 And Ergie Pepito Inocian2
1
King Saud University, College Of Nursing
2
King Khalid University Hospital, Nursing Department
Aim: We determined the cognitive function and modeled the odds of having mild, moderate, or severe cognitive
impairment among 65 years and older persons in Cebu City, Philippines.
Methods: The mini mental state examination was used in assessing the cognitive function of 120 communitydwelling 65 years and older persons. Pearson χ2-Monte Carlo Method with CI 99% and multinomial logistic
regression were used to analyze data.
Results: Collectively, the participants have mild cognitive impairment (M=22.53; SD=5.08). Significant
differences in cognitive function were observed when grouped according to sex, age, and education level
(p<.05, CI .016-.023; p<.001, CI 0.000-0.000; and p<.001, CI 0.000-0.000 respectively). Increase in age
increased the odds of having mild, moderate, or severe cognitive impairment (p<.05, OR 1.11, CI 1.001-1.23;
p<.001, OR 1.40, CI 1.20, 1.63; and p<.01, OR 1.56, CI 1.17-2.09 respectively). Being male had decreased
odds of having mild cognitive impairment (p<.05, OR .104, CI .01-.89). Having elementary education only
increased the odds of having mild or moderate cognitive impairment (p<.01, OR 23.49, CI 2.45-224.77;
p<.05, OR 19.23, CI 1.92-192.15 respectively).
Nursing Implications: The results support the growing global concern on the increasing threats to health
caused by cognitive decline and/or cognitive impairment to the quality of life of older persons. Advancing age
was the strongest predictor for having mild, moderate, or severe cognitive impairment among older persons.
Implementation of primary health care-based cost-effective early detection and interventions are needed to
prevent possible debilitating effects of cognitive impairment among older persons.
21
Effectiveness Of Organizational Stressors And Leadership Behavior On Level Of
Emotional Exhaustion
Mona Talat El-Nady
College of Nursing, King Saud University
The aim of this study was to investigate the effect of organizational stressors and leadership behavior on level
of emotional exhaustion among nurses. Descriptive correlation design was utilized in this study. The present
study was conducted in selected departments affiliated to El-Kser El-Aini general hospital. A convenient
sample of seventy staff nurses was included in this study. Data was collected through utilizing the following
tools: a) Demographic data sheet; b) The Supervisory behavior questionnaire; work stressors were measured
through utilizing two instruments: nursing stress scale and role conflict and role ambiguity scale; emotional
45
exhaustion was measured using scale of Maslach Burnout Inventory. Results of the present study concluded
that stresses from physical and social environment and role conflict were significantly correlated with increased
level of emotional exhaustion among staff nurses. Results also revealed that there was a relationship between
leadership behavior of head nurses and subordinate level of emotional exhaustion. It was recommended that
there is a need for training for head nurses and supervisors in order to develop consideration oriented leadership
style emphasizing mutual respect open communication rather than controlling behavior to decrease level of
emotional exhaustion among nurses.
22
Sources Of Stress As Perceived By Nursing Students At King Saud University
Mofida Younis Al Barrak DNSc, Elham Abdelkader DNSc and Mona Talat El-Nady DNSc
The Department of Psychiatric Mental Health Nursing, College of Nursing, King Saud University
Nursing students suffer higher levels of stress during their college years than college students in other disciplines.
Nursing students and persons employed in the nursing profession have been identified as a population with
an elevated stress level. Stressors for student nurses included adjusting to a rigorous program of theory, long
hours of study and pressures of student clinical practice requiring emotional and personal maturity. So the
aim of the present study was to identify sources of stress as perceived by undergraduate nursing students at
King Saud University. A descriptive, correlation design was utilized in this study. The study was conducted
at Female College of Nursing, King Saud University at Al-Riyadh City. The total proposed subjects included
in this study were 300 students covering all levels of the nursing college, using convenience data. The tools
included two parts: Part 1 included socio-demographic data for students such as age, marital status, and health
related data, part 2 was the Student Stress Survey Sheet (SSSS) which used to study the major sources of
stressors among college students; it included items addressed academic, intrapersonal, interpersonal, and
environmental sources of stress. The present study results concluded that there were a variety of stressors
placed on the studied subjects. The major sources of stress as perceived by King Saud University College
of Nursing students were the academic followed by intrapersonal, then environmental and the last was
interpersonal. The results of the current study recommended that it is important for the university to maintain
well balanced academic environment conducive for better learning, with the focus on the students’ personal
needs. The university should be affording adequate resources such as books, computers to do assignments;
also nursing college should do an effort to narrow the gap between students’ expectations, goals, and values to
be integrated with that of the university.
46
23
Perception Of Saudi Elderly People Toward Alzheimer’s Disease” Assessment And Care
Ahlam Rashid Khalf Al-Enazi
Generally, there is an urgent need to assess AD knowledge and perception among Saudi elderly population. Studying
elderly group of the Saudi population is meaningful because this population has diversity in socioeconomic status,
health status, as well as diverse exposure to AD and other neurologic diseases. This will have a great impact on
extending the literature of AD in this country and Arab countries as well and in finding the proper means of managing
AD. The aim of this study was to examine Saudi elderly›s perception of Alzheimer›s disease (AD). Additionally, this
study examined both the unique and collective variance of socio-demographic variables among Saudi elderly people
in regards to their knowledge of Alzheimer›s disease. A descriptive research design was utilized. A convenience
sample was utilized with a size of 300 Saudi elderly people aging 60 years and more. Setting was in Prince Salman
social center in Riyadh city. Data collection was executed by using the structured self- administered questionnaire
sheet, it covered three measures: a) Socio-demographic data questionnaire, b) Saudi elderly people›s knowledge of
Alzheimer›s disease concerning «its early identification» , and c) Saudi elderly people›s perception of Alzheimer›s
disease. This study revealed that generally perception of saudi elderly people toward care of Alzheimer›s disease
was good and ranked as first one. The second rank in the perception was assessment of Alzheimer›s disease as
it slightly less than the care . The last rank was perception about the disease in general related to symptoms and
stigma then causes and risk factors . In conclusion, knowledge of saudi elderly people was good toward Alzheimer›s
disease, however most of them stigmatized the disease. Developing nursing research and increasing networking of
nurse researchers within Saudi Arabia to overcome the lack of nursing literature about AD could be achieved. By
adding to the earlier requirement of nurses in promoting nursing research the needs of groups most at risk were to be
considered, evaluating programs there is a need to support maximum participation in health care planning; to teach
people about self-care emphasize the uniqueness of nursing to integrate knowledge, experience and the ability to
reflect on and research. Recommendations include: (1) development and execution of educational programs should
be executed to expand knowledge and decrease undesired perceptions. (2) Professional workers in the community
should be approached and educated to assume more responsibility in increasing knowledge of AD and in altering
adverse perceptions and underlining desired ones.
47
24
A Cross-Sectional Study Of Postoperative Pain And Perceived Pain Care Quality
Among Surgical Patients
*Regie Buenafe Tumala and Gerlynn Cabulong-Tumala
*Assistant Professor, College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia
Background
Postoperatively, hospitalized patients experience significant pain from surgery, treatments and their side
effects, and procedures. In this situation, nurses play a vital role in the assessment and relief of pain of surgical
patients. Pain is a common and distressing problem for hospitalized patients in the setting of the current study.
In a survey, twenty-eight percent (28%) of patients were reported having severe pain postoperatively. The aim
of this study was to determine the relationship between the postoperative pain experienced by the surgical
patients and their perception of the pain care quality they received from their nurses.
Methods
This cross-sectional study was participated by 125 adult surgical patients. All of the participants were
interviewed using a questionnaire that tested the relationship of their postoperative pain and the perceived
pain care quality they received from their nurses.
Results
Majority of the participants were between 41 - 60 years old, males, married, and college graduates. Nearly
two-thirds from them were confined in the hospital for 11 – 20 days. In addition, many among them had
general type of surgery. Majority of the participants had severe pain eight (8) hours after surgery and reported
moderate pain twenty four (24) hours after surgery. Furthermore, their perceived pain care quality was very
satisfactory. Lastly, a significant association between the postoperative pain score and perceived pain care
quality of surgical patients was established.
Conclusion
Appropriate assessment of the severity of pain experienced by surgical patients postoperatively translated into
a very satisfactory perception of the pain care quality they received from their nurses. However, during each
shift, the nurse caring for a patient may have different knowledge and skill in pain management, ultimately
providing a different level of care. Gaining in depth knowledge about postoperative pain score of patients
using the Numeric Rating Scale of Pain (NRS) by the American Pain Society (2010) can help decrease or
alleviate it through nurses’ pain care quality management.
48
25
Groin Dressing Post Cardiac Catheterization:
Traditional Pressure Vs. Transparent Film
Rokaia Al Shualah, RN, MSN
Coordinator Of Nursing Education
Royal Commission Hospital, Jubail
Introduction:
Post cardiac catheterization puncture site care is usually done with a tight pressure dressing in many
institutions due to the belief that it should prevent the bleeding. This practice is uncomfortable to the patients.
Nurses have also described difficulty in assessing the sheath insertion site in the groin when pressure dressing
is in place. A new way of dressing using transparent film dressing (TFD) has approved and rated better with
regard to: comfort, less pain, decrease hematoma formation and facilitates nurse’s assessment of puncture
wound site after femoral sheath removal.
Purpose of the study:
To determine the efficacy of using a small transparent non pressure dressing compared with the traditional
controlled pressure dressing applied to the femoral artery puncture wound site to maintain hemostasis following
cardiac catheterization procedures.
Methods:
Design: An experimental design randomized Controlled clinical trial.
Setting: King Fahd University Hospital in Khober, Saudi Arabia.
Patients: 80 post cardiac catheterization patients were randomized to have their groins dressed either with
pressure dressing (N = 40) or Transparent Film Dressing (N = 40). Patients ambulated 8 hours after the
procedures. Outcome variables were hematoma formation or bleeding, patient discomfort, and nurse-reported
ease of observation of the groin puncture site after the procedure. Five instruments were used for data collection:
1) Demographic and medical data sheet, 2) Hematoma Formation and Bleeding Scale, 3)Skin Integrity Scale,
4)Patient Discomfort and Pain Scale & 5)Nurses Ease of Assessment Scale.
Results:
Results of the study showed that 100% in TFD group vs. 55% in pressure dressing group reported feeling very
comfortable (p value of 0.003). Hematoma formation was equal in the two dressing groups with no incidence
of bleeding complications. Nurses rated the ease of assessing the groin significantly higher for TFD than for
pressure dressings (p value of 0.000).
Conclusion:
Dressing of the puncture site after cardiac catheterization with TFD was more comfortable than the conventional
pressure dressing without any difference in hematoma or bleeding complications. So TFD can be used safely
and comfortably after achieving hemostasis.
49
26
Exploring The Factors, Challenges And Obstacles Impacting Saudi Female Students
In Australian Universities: Implications For International Students Of Nursing And
Midwifery
Hanan Alzharani
Specialist At Nursing College, KSU
Introduction
The educational nursing segment in Saudi Arabia has been experiencing fast and significant change. Several
students are opting to go abroad and study in foreign universities to get higher education fit for putting resources
into and changing the nation. The current research work focused on the Saudi female students in the nursing
profession, which is also one of the main motivations for this study as well as identifying learning experience
of these students in foreign universities. From the study, several factors have been identified that behave as
obstacles for the Saudi students while studying outside their home country
Objective
To investigate the factors that impact on Saudi female nursing and midwifery students and to describe their
education experiences in Australia. It is evident that the challenges of international students still exists in
particular in nursing field of females. The encouragement from the Saudi government for nursing, the view of
nursing among Saudi society is not highly as a profession for Saudi woman because of the preference for the
genders separation as well as family demands.
Method
This study utilized a qualitative research methodology utilizing semi-structured, one-to-one interviews and
thematic analysis. The researcher selected a sample a group of Saudi females of nursing/midwifery students
in a major university in Melbourne, Australia.
Results & findings
The findings have clarified that the participants had several challenges faced by the students, in relation to their
adjustments in foreign country including language difficulties, lack of identity of Saudi female students, lack
of communication with the medical staff and patients during clinical practices, loneliness, as well as the lack
of critical thinking skills.
Conclusion & implication
Saudi females are encouraged to undertake study at an Australian nursing university in order to learn new
methods and practices to improve health nursing care in Saudi Arabia. Future research should investigate
specific interview questions that focus on the experiences of a more homogenous Saudi Muslim student sample,
the host institution’s ethnic and racial composition and country of origin. The findings indicate the need to
create whole-systems and an infrastructure approach for scaffolding the international students’ learning with
the nursing programs suggesting additional guidance from the wider nursing college was needed. It is essential
that the host institutions should develop the needs in nursing programs aiming to equally benefit the lecturers,
international students.
50
Social Day Programme
King Abdulaziz Historical Center, Riyadh , Kingdom of Saudi Arabia
Old Souq « Al Zall «, Riyadh , Kingdom of Saudi Arabia
Al Musmak, Riyadh , Kingdom of Saudi Arabia
51
Badge Codes
Badges Code:
Speaker
ORGANIZER
Organizing Committee
Speaker
Scientific
ORGANIZER
Committee
Scientific Committee
Participant
52
Moderators
Participant
Speaker
ORGANIZER
Committee
Scientific
Moderator
Participant
Speaker
Scientific
ORGANIZER
Committee
Moderator
Participant
Speaker
Scientific
ORGANIZER
Exhibitor
Committee
Moderator
Moderator
Participant
Speaker
Scientific
Support
ORGANIZER
Committee
Staff
Moderator
Moderator
Participant
Speaker
Scientific
ORGANIZER
Guest
Committee
Moderator
Note:
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
53
Note:
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
...................................................................................................................................................................................................................................................................
54
55
56