socially accepted, being physically comfortable, feeling safe, being close to significant people are some of the characteristics that qualify comfort. Regarding comfort in nursing, the findings analysed demonstrate numerous comforting strategies, namely, effective and empathetic presence, touch, smile, family integration in the care process, among others.

**Conclusions**

The main results, while providing data that allow us to characterize comfort and comfort in nursing, also highlight the need to investigate the focus.

**Keywords**

Caracterization of the comfort term, Comfort care, Nursing care.

P35

Rotines of life and health of institutionalized young people

Tiago Machado¹, João Serrano¹, Sergio Ibanez², Helena Mesquita¹, Pedro Pires¹

¹School of Education, Polytechnic Institute of Castelo Branco, 6000-266

Castelo Branco, Portugal; ²Faculty of Sports Science, University of Extramadura, 10003 Cáceres, Spain

**Correspondence:** Tiago Machado (tiagomachadix@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P35

**Background**

Today's society creates many limitations in the daily lives of children and young people and will have an impact on their well-being, health and quality of life. This is aggravated when we speak of institutionalized children. **Objective**

To study the leisure activities of young people institutionalized in Homes for Children and Youth and to know if these activities contribute to the development of healthy lifestyles.

**Methods**

A questionnaire was used as instrument, which was submitted to validation by specialists. The questionnaires were completed by the young people with the presence of the researcher. The sample consisted of 100 young people aged between 10 and 18 years old, belonging to 6 Homes for Children and Youth.

**Results**

In the period of free time we found that in the recreations the most accomplished activities were to talk with friends (86.4%), play in the sports fields (47.5%) and dating (23.3%). Most of the young people do not participate in school sports (76.7%). The most accomplished activities after school were: watching TV (100%), cleaning the Institution (96.2%), listening to Music (89.3%), studying (87.4%), playing on the computer and on Facebook (82.6%) and doing physical activity (table tennis, football, among others) (73.8%). Regarding the accomplishment of these activities, the young people reported doing them daily or at least 2 to 3 times a week. When asked if they would like to occupy their free time within the institutions otherwise, the young people were divided, even though the majority responded that they did not (53.4%). As young people are in an open regime, we asked them which activities were most frequently carried out, outside the institution, and they answered that it was a walk with their friends (87.4%), and that the frequency of this activity was daily or at least 2 to 3 times a week. When asked if they would like to take their free time away from institutions in a different way, most of the young people said no, given that their activities are their preference.

**Conclusions**

The results showed that the young people in the study carried out activities considered healthy, which contribute to their quality of life and well-being; however, we were able to verify that they present limitations, namely, in relation to physical activity, since most of the activities performed both inside and outside the institutions had low levels of intensity and frequency, being carried out sporadically.

**Keywords**

Life and health routines, Free Time and Leisure, Children and young people at risk.

P36

Evaluation of pain in patients intubated orotracheally: BPS and CPOT

Ana RPQ Pinheiro¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

**Correspondence:** Ana RPQ Pinheiro (queiroz.anarita@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P36

**Background**

Pain is considered as a symptom of difficult assessment and characterization by health care providers who take care of orotracheal intubated patients (EOT) unable to communicate verbally, so their assessment is critical to an effective management of care and therapy. An EOT patient is exposed to a variety of painful procedures and, if the pain is not controlled, it can lead to multiple complications: physical (cardiovascular, neurological and pulmonary) and psychological (stress, anxiety and delirium), so nurses must have credible instruments for evaluation and monitoring.

**Objective**

This systematic literature review (RSL) aimed to identify the most reliable tool for pain assessment, by analysing the validity and reliability of the BPS and CPOT scales, as well as their ease of application.

**Methods**

Using the methodology recommended by the Cochrane Centre, this RSL was guided by the following research question: "Which is the most appropriate scale, BPS or CPOT, for pain assessment in patients unable to communicate verbally?" The seven included studies resulted from a research in EBSCO, using the terms "behavioural pain scale" and "critical care pain observation tool", with Boolean operator "and", in full text, published between 2007-2017.

**Results**

With a number of participants between 23 and 117, the 7 selected studies, all with quantitative nature, concluded that both scales are reliable and valid for the assessment of pain in this population [1-5]. [4] report that although BPS is more sensitive in identifying the patient's response, CPOT is a good alternative. It was also verified that both instruments are sensitive to painful procedures, with an increase in several indicators [1, 2, 6]. There was also a significant statistically correlation between the values of arterial tension and the performance of a painful procedure, (the higher the pain value, the higher the arterial tension) [5,6].

**Conclusions**

Both scales (BPS and CPOT) are suitable for the evaluation of pain in EOT patients and according to nurses, both are easy to apply and useful for care delivery [5, 7]. However, the literature does not show the most adequate scale, suggesting that other studies must be done.

**References**

1. Rijkenberg S, Stilma W, Endeman H, Bosman RJ, Straaten HMO. Pain measurement in mechanically ventilated critically ill patients: Behavioral Pain Scale versus Critical-Care Pain Observation Tool. Journal of Critical Care.
2015;

2015;

30: p. 167-172.

2. Liu Y, Li L, Herr K. Evaluation of Two Observational Pain Assessment Tools in Chinese Critically Ill Patients. Pain Medicine. 2015; 16: p. 1622-1628.

3. Rahu MA, Grap MJ, Ferguson P, Joseph P, Sherman S, Elswick, Jr RK. Validity and Sensitivity of 6 Pain Scales in Critically Ill, Intubated Adults. American Journal of Critical Care. 2015 Nov; 24(6): p. 514-523.

4. Darwish ZQ, Hamdi R, Fallatah S. Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation. AACN Advanced Critical Care. 2016 4-6; 27(2): p. 162-172.

5. Vadelka A, Busnelli A, Bonetti L. Comparison between two behavioural scales for the evaluation of pain in critical patients, as related to the state of sedation: an observational study. SCENARIO. 2017; 34(2): p. 4-14.
6. Damström DN, Saboonchi F, Sackey PV, Björling G. A preliminary validation of the Swedish version of the critical-care pain observation tool in adults. Acta Anaesthesiol Scand. 2011; 55: p. 379-386.

7. Fothergill Bourbonnais F, Malone-Tucker S, Dalton-Kischel D. Intensive care nurses' assessment of pain in patients who are mechanically ventilated: How a pilot study helped to influence practice. Canadian Journal of Critical Care Nursing. 2016; 27(3): p. 24-29.

**Keywords**

Behavioral pain scale, Critical care pain observation tool, Pain rating scales, Nursing.

P37

Analgesic effect of the topical use of cannabidiol oil in experimental ulcers in the laboratory animal

María-del-Carmen Jiménez-Díaz<fnref n="1" />, Carla Jiménez-Rodríguez<fnref n="1" />, María-del-Pino Quintana-Montesdeoca<fnref n="2" />, Juan F Jiménez-Díaz<fnref n="3" />, Francisco J Hernández Martínez<fnref n="3" />

**Correspondence:** María-del-Carmen Jiménez-Díaz (cjimenez@ujaen.es)

BMC Health Services Research 2018, **18**(Suppl 2):P37

**Background**

Since ancient times the use of the *Cannabis sativa* L. plant has been known in topical form for the treatment of haemorrhages, inflammations, oedema, various pains, among others. In fact, tincture and cannabis extract were sold without restriction in European and American pharmacies until the beginning of the 20th century.

**Objective**

To study the analgesic effect of cannabidiol oil (CBD) applied topically to experimental ulcerative skin lesions in the laboratory animal.

**Methods**

Experimental study with control group (with physiological saline to maintain hydration conditions and group with extra virgin olive oil (EVOO) to avoid bias with the oleic excipient), to check the analgesic effect of CBD applied topically on ulcerative lesions. Experimental total skin in the adult male white rat, Sprague Dawley strain. Ten animals were used for each group under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. They were then distributed in individual cages to prevent them from licking each other and with sufficient height to prevent rubbing of the skin ulcer with the passenger compartment. 0.15 ml of the respective product was applied daily to the ulcers. The analgesic response was assessed by obtaining latency of withdrawal of the tail of the animal under thermal stimulus through the meter LE7106 Tail-flick®, Letica®, previous impregnation of the tail of the animals of the different products used by topical friction and, after waiting for 15 minutes, the tail of each of the animals is subjected to the emission of the infrared beam. Similar action was taken with the rest of the products studied, the EVOO and the CBD. The analgesic response was practiced twice, on different days. The statistical program SPSS 25.0 was used, considering a level of significance of p < 0.05.

**Results**

There was no significant difference between the products applied to the different animals. The highest average corresponded to the application of CBD in observation and measurement 1. In observation and measurement 2, no significant difference was detected and the average values were similar between EVOO and CBD.

**Conclusions**

The most favourable analgesic response was obtained under the influence of cannabidiol oil, which also presents a greater tolerance to pain as experimentation progresses.

**Keywords**

Analgesia, Cannabidiol, Skin, Ulcer, Rat.

P38

Polypharmacy in elderly patients in a community pharmacy

Sónia Lopes<fnref n="1" />, Clara Rocha<fnref n="2" />, Rui Cruz<fnref n="1" />

**Correspondence:** Sónia Lopes (soniabelina@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P38

**Background**

The definition of polypharmacy isn't consensual, but all authors refer it as the simultaneous use, and the chronic way, of several drugs by the same person. Polypharmacy affects mainly elderly and it's due to the high number of chronic diseases in this population and consequent need to take medications to control them.

**Objective**

Characterization and quantification of polypharmacy in a rural elderly population; identification of the most prescribed pharmacotherapeutic classes; evaluation of connection between polypharmacy and elderly characteristics.

**Methods**

It carried out an observational, retrospective, transversal and analytical study in a Popular Pharmacy (Pombal). 230 individuals aged 65 years old or more were surveyed and the data collection was made through a questionnaire prepared for this purpose. Major polypharmacy was defined as the chronic consumption of at least 5 different drugs.

**Results**

The elderly took, on average, 6.20 ± 2.91 drugs daily. The prevalence of Major polypharmacy was 70.4%. The most prescribed pharmacotherapeutics groups were cardiovascular and Central Nervous System. There were statistically significant differences between age and number of medicaments taken, as well between number of drugs and the way to identify the medication, the knowledge of the therapeutics indications, the occurrence of mistakes or take outside advised time, and the self-perception of health state (p ≤ 0.05).

**Conclusions**

In view of the obtained results, it's concluded that polypharmacy is very high in the Portuguese population under study. It's the persons most aged who consume a greater number of drugs. The elderly with less academic qualifications are those who have more difficulty in identifying medication and respective therapeutic indications. It's necessary to adopt strategies in order to reduce polypharmacy, having both the prescriber and the professionals of pharmacy, a preponderant role in this task.

**Keywords**

Polypharmacy, Elderly, Chronic medication.

P39

Salivary detection of the topical use of cannabidiol oil in experimental ulcers in the laboratory animal?

Bienvenida-Del-Carmen Rodríguez-De-Vera<fnref n="1" />, Carla Jiménez-Rodríguez<fnref n="1" />, María C Jiménez-Díaz<fnref n="2" />, Juan F Jiménez-Díaz<fnref n="1" />, Francisco J Hernández-Martínez<fnref n="3" />

**Correspondence:** Bienvenida-Del-Carmen Rodríguez-De-Vera (bienvenida.rodriguez@ulpgc.es)

BMC Health Services Research 2018, **18**(Suppl 2):P39

**Background**

Cannabidiol (CBD) is a phytocannabinoid that does not refer to experiences contrasted with its topical use in ulcerative lesions and skin wounds.

**Objective**

To determine if the topical application of CBD in ulcers exerts a cumulative effect in the organism of the experimental animal, with

<footnote n="1">¹Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España;</footnote>

<footnote n="2">²Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España;</footnote>

<footnote n="3">³Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas, Islas Canarias, España</footnote>

<footnote n="1">¹Pharmacy Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal; ²Complementary Sciences Department, Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal</footnote>

<footnote n="1">¹Universidad de Las Palmas de Gran Canaria, 35015 Las Palmas de Gran Canaria, España;</footnote>

<footnote n="2">²Universidad de Jaén, Universidad de Jaén, 23071 Jaén, España;</footnote>

<footnote n="3">³Cabildo de Lanzarote, 35500 Lanzarote, Las Palmas, Islas Canarias, España</footnote>
undesirable effects at the level of the Central Nervous System (CNS), in a similar way to its general use.

## Methods

Experimental study applying total skin ulcerative lesions in the adult male white rat, Sprague Dawley strain, with cannabidiol oil to check if it accumulates in the body and can be detected in salivary secretion. Ten animals were used under standard laboratory conditions. After anaesthesia with 100% isoflurane, a total skin wound was performed in the region of the back with a disposable surgical punch of 8 mm in diameter. They were then distributed in individual cages to prevent them from licking each other, with sufficient height to prevent rubbing of the skin ulcer with the passenger compartment. 0.15 ml of cannabidiol oil was applied daily to the ulcers. The study of the body accumulation of the drug object of our study, the cannabidiol oil, was done by qualitative detection of the drug and its metabolites in the saliva of the experimental animal. This type of assay provided a preliminary analytical result using monoclonal Ab to selectively detect high levels of a specific drug which, if positive, would require complementing it with other chemical methods to quantify the accumulation of the product. The test, drogotest®, is made up of spongy collectors (chupa-chups) that, after being soaked for 3 minutes in the mouth of the animal treated with cannabidiol oil, allows to pour its contents by manual compression of the same through a strainer in collecting chamber. Finally, 3 drops of the fluid of the animal's saliva, contained in said collecting chamber, are poured over a detector sample in cassette wells that will show, or not, the presence of the drug in a time period of less than 10 minutes, by observation. direct visual with colour changes of the cassette sample.

## Results

The detection by the drogotest® test of the general accumulation of cannabis in the organism of the animals studied was negative.

## Conclusions

The benefit of the topical use of cannabidiol in ulcerative lesions is confirmed without the undesirable effects that cannabis causes in the CNS.

## References

1. Grotenhermen F, Russo E, Navarrete R (eds). Cannabis y cannabinoides, farmacología, toxicología y potencial terapéutico. Sevilla: Castellarte; 2003.

2. Abanades S, Cabrero-Castel A, Fiz J, Farré M. Farmacología clínica del cannabis. Dolor 2005; 20: 187-98.

3. OMS. Serie Informes Técnicos, n° 478. El uso del Cannabis.

4. Fusar-Poli P et al. Distinct effects of (delta) 9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing. Arch Gen Psychiatry 2009; 66 (1): 95-105.

5. Pertwee RG. Cannabinoid receptors and pain. Prog Neurobiol 2001; 63: 569-611.

6. Walker JM, Huang SM. Cannabinoid analgesia. Pharmacol Ther 2002; 95: 127-35.

## Keywords

Detection, Saliva, Cannabidiol, Skin, Ulcer, Rat.

## P40

### Humour and nurses' stress: humour contributions on stress management. A literature systematic review

Maria I Santos¹, Rita Marques²

¹Health Sciences Institute, Catholic University of Portugal, 1649-023

Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha

Portuguesa, 1300-125 Lisbon, Portugal

Maria I Santos (inescamiller@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P40

### Background

Nurses experience high levels of work-related stress due to their daily contact with critical situations, suffering, negative emotions and death. This stress overload imposes negative consequences at an individual and at an organizational level, with direct and indirect costs. On the contrary, humour seems to produce benefits to health, job

satisfaction and group cohesion, when used in an adaptive way. There is scientific evidence that humour may establish an incisive coping strategy in the management of work-related stress that can be used by nurses for their own benefit.

### Objective

The aim of the present study is to build a framework of a systematic review on the relationship between humour and nurses' work-related stress.

### Methods

Using the Cochrane Centre recommended methodology, this systematic review was guided by the following research question: *What is the contribution of humour to nurses' stress management?* The research was performed through the EBSCO and Google Scholar search engines, in the bibliographic databases: CINAHL®Complete, MEDLINE Complete, Cochrane Controlled Trials Register, MedicLatina, Pubmed, Scielo and RCAAP, since 2007 to 2017, using the following conjugations of descriptors and Boolean operators: humour (OR humor) AND stress AND nurses (OR nursing) NOT children NOT patients NOT students.

### Results

A sum of four articles, that respond to our research question, was selected. The empirical studies were developed in four different countries (USA, Canada, UK and Portugal) with diverse designs using either qualitative and quantitative approaches. The sample varied from 15 to 61 nurses. All studies demonstrated that humour expressions are used by nurses to deal with stressful situations [1-4].

### Conclusions

The use of adaptive forms of humour promote detachment and reassessment of the situation contributing to stress management [3, 4]. It also strengthens interpersonal relationships, improves communication and group cohesion, and contributes to job satisfaction [1, 2]. Therefore, evidence shows that humour can be an effective tool in stress management. Moreover, one study points out that humour can also arise in response to stress, warning to an increased stress level [4]. Nevertheless, the reduced empiric evidence found suggests that this subject within Nursing Science is not yet highly established.

## References

1. Scott T. Expression of humour by emergency personnel involved in sudden deathwork. Mortality. 2007, 12 (4): 350-364.

2. Dean R, Major J. From critical care to comfort care: the sustaining value of humour. Journal of Clinical Nursing. 2008, 17: 1088-1095.

3. Harris T. Caring and Coping. Exploring How Nurses Manage Workplace Stress. Journal of Hospice & Palliative Nursing. 2013, 15 (8): 446-454.

4. Santos M, José H, Capelas M. O Humor e o Stresse dos Enfermeiros que Cuidam com Pessoas em Fim de Vida. Revista Servir. 2016, 59 (4): 69-74.

## Keywords

Humor/humour, Stress, Nurses.

## P41

### Socio-clinical relationships among nursing students in practice context

Laura Reis (laurareis@esenf.pt)

Porto Nursing School, 4200-072 Porto, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):P41

### Background

It is in clinical context that the students attribute greater meaning to their peers. This fact is related to a set of new experiences that are significant for these actors. Supported by the literature consulted, we are led to say that they last even beyond the end of the course, unlike the relations established in the classroom.

### Objective

Analyse the relationships established among students over two consecutive clinical studies.

### Methods

The study was carried out with students from a group of the 2nd year of a Nursing Degree who were experiencing their first clinical experience in a hospital context, namely 10 weeks in an internal
medicine service and 10 weeks in a surgery service. We chose an ethnographic study within the framework of the qualitative paradigm, in a longitudinal approach according to the logic of the case study. As a data collection technique, we used participant observation and semi-structured interviews.

## Results

We verified that the relation established between students differed according to whether it was a first or a second clinical teaching. The knowledge that the group acquired about themselves and about the methodologies adopted by the tutors, was different in the different contexts. In the first medical school (medicine), despite the little knowledge that the students had among themselves, the established relationship was very cooperative and cordial, based on the spirit of help. This was due to a number of factors, namely, a first clinical experience, leading to a high need to share information and knowledge related to the context and clinical practices; the lack of knowledge about tutors; and the lack of safety in the care of patients. The relationships established in this space were, therefore, strong and cohesive. In the clinical teaching of surgery, the relation established was different, highlighting more divergences/heterogeneities. According to the students' opinion, this fact was related to the work methodology/distribution of students and the request of academic work by the teachers.

## Conclusions

We verified that on the 2nd clinical teaching, the relationships established between students were influenced by interpersonal competition logics. As it is known, the need to form more restricted groups can lead to unleashing alliance dynamics and oppositions among students, giving rise to behaviours of competitiveness, or of helping others, or even to the development of individualized work. Another aspect that seems to have been strongly conditioning, were the methodological strategies adopted by the tutors of the different clinical contexts.

## Keywords

Clinical supervision, Clinical teaching, Nursing students, Socio-clinical relations.

## P42

### Stress management in under graduation nursing students

Marco Oliveira, Andreia Santos, Rafaela Barbosa, Diana Portovedo, Isabel Oliveira

Escola Superior de Enfermagem da Cruz Vermelha Portuguesa, 3720-126 Oliveira de Azeméis, Portugal

Correspondence: Isabel Oliveira (ijoliveira@sapo.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P42

### Background

Admission to higher education is seen by some students as an opportunity of growth, to explore new environments and build new relationships yet, other students, perceive it as potentially anxiogenic. Some of the stressful factors are: examinations, clinical teaching, academic results, a competitive environment and the experience of transition and adaptation to a new academic environment. Therefore, it is necessary to work on the causes of stress and promote coping strategies. Being such an important subject for under graduation students, that experiencing it so intensely, it is crucial that students are also an active part in promoting the efficient management of stress.

### Methods

Thus, in order to contribute to the adoption of coping strategies and promote the efficient management of stress, a participatory action research in health was developed in a nursing school. The strategies were: the implementation of a student support line (peer support); monthly meetings, addressed to the student population, on topics related to stress and its management; tutorials for 1st year undergraduate students by 3rd and 4th year students, through a structured program of integration to the nursing school. The follow-up of the effectiveness of the activities was carried out through a questionnaire measuring stress levels. This research foresees an initial

evaluation (before implementation), intermediate evaluations and a final one, to measure the achievement of the objectives initially stated.

## Results

The preliminary findings show a mean of 8.52 and a standard deviation of 2.73 in the score of the domain Sleep/Stress of the Portuguese version of the Fantastic Lifestyle Assessment.

## Conclusions

With the implementation of this participatory action research it is expected a reduction of stress levels, as well as enabling students to adopt coping strategies in order to manage their stress. On the other hand, it will allow a better integration of students, as well as a better academic development, both in theoretical evaluations and in clinical teaching, consolidating the relational skills, which are so important during the course of clinical teaching and later on in their professional life.

## Keywords

Nursing students, Stress, Coping skills, Action research, Participatory.

## P43

### A contribution to the validation of the volume - viscosity swallow test (V-VST) - Portuguese version

Catarina Camões¹, Marília Dourado¹, Maria A Matos²

¹Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;

²School of Health, University of Aveiro, 3810-193 Aveiro, Portugal

Correspondence: Marília Dourado (mdourado@fmed.uc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P43

### Background

The prevalence of swallowing disorders after stroke is well described in the literature [1,2]. The early identification of these alterations resorting to non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality among these patients [1,4]. The V-VST exhibits good psychometric properties, allowing the early identification of patients at risk of developing respiratory and nutritional complications. Its use also allows dietary preventive recommendations to patients until diagnosis confirmation, by instrumental examinations [2].

### Objective

The goal of this study is to contribute to the validation of the V-VST -Portuguese version, in patients with subacute stroke.

### Methods

In phase I, the V-VST- Portuguese version [3], as well as its instructions, was presented to a panel of experts constituted by six speech and language therapists, in order to assess its content validity. In phase II, after ethical approval, it was applied to thirty-three patients with subacute stroke, to analyse its psychometric properties, namely its internal consistency and reliability (inter and intra raters). Criterion validity was assessed through the simultaneous application of the 3Oz wst. Collected data were analysed with IBM SPSS version 24.0. Intraclass Correlation, Cronbach's Alfa and Cohen's Kappa values were calculated.

## Results

Results of phase I demonstrate a very good agreement between all members of the panel of experts as for constituent items of the V-VST (I-CVI/Ave = 0.95) as well as to its instructions (I-CVI = 0.83). Preliminary results of phase II, showed that the V-VST presents very good intraclass (ICC=0.816) and interclass correlation coefficients (ICC = 0.837). Values obtained from the comparison between the V-VST and 3Oz wst have given similar results (I- CVI = 0.83).

## Conclusions

The V-VST - Portuguese version seems to be a valid, reliable and practical tool for assessing dysphagia in patients with subacute stroke. Further studies need to be done in the future.

## Acknowledgements

We would like to thank to the Nutricia Portugal, to the Faculty of Pharmacy of the University of Coimbra as well as to all patients and members of the
neurology C service of the Hospitalar and University Center of Coimbra by
all the support and availability showed during this study.

## References

1. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Toll (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919-924.

2. Clavé P, Arreola V, Romea M, Medina L, Palomera E, Prat MS. Accuracy of the volume - viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 2008 Dec;27(6):806-815.

3. Nogueira DS, Ferreira PS, Reis EA, Lopes IS. Measuring Outcomes for Dysphagia: Validity and Reliability of the European Portuguese Eating Assessment Tool (P-EAT-10). Dysphagia. 2015;30(5):511-520.

## Keywords

Deglutition disorders, Bedside examination, Dysphagia, Aspiration.

## P44

### Strategies to improve hand hygiene practices: an integrative literature review

Ana C Mestre, Filipa Veludo, Susana Freitas
School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

**Correspondence:** Ana C Mestre (catarina-mestre@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P44

### Background

Healthcare-associated infections (HAIs) are a global concern and pose a real threat to patient safety. Many of them preventable [1]. Knowing that hands of healthcare professionals are one of the main vehicles in the transmission of microorganisms, hand hygiene (HH) is recognized as the easier and most effective measure to prevent and reduce HAIs [2]. However, despite all evidence available and although 98% of healthcare professionals consider HH as the most important basic precaution in preventing HAIs, compliance is poor, remaining less than 40% [3,4].

### Objective

To identify, in Literature, the most effective strategies to promote HH compliance.

### Methods

An integrative review between September and October 2017 was fulfilled with the Boolean strategy: [(TI Title) hand hygiene AND (AB Abstract) nurse AND (AB Abstract) infection AND (AB Abstract) strategy OR compliance OR adherence] in CINAHL®, Science Direct and Academic Search Complete. A total of 396 articles were identified, initially. After applying the inclusion criteria: primary and secondary studies with a qualitative and quantitative approach available in full text in Portuguese, English, French and Spanish; and exclusion criteria: studies published before 2016, a sample of 12 articles was included for analysis.

### Results

From a total of 12 articles analysed, 10 showed the importance of a multimodal approach to the improvement of HH practices with consequent increase in compliance to this behaviour. It stands out the combination of interventions addressing knowledge (education), awareness, context of action (reminders in the workplace) as well as the involvement and support of leaders and managers in building an institutional safety culture (social influence) as the most effective to ensure greater compliance to HH.

### Conclusions

In order to improve HH practices and, consequently, adherence to this behaviour, the adoption of a multimodal strategy proved to be more successful when compared to single interventions. At an early stage, it is essential to understand the reasons that lead to non-adherence to HH and after that design interventions based on identified barriers. The approach should be global, including not only healthcare professionals but also leaders and managers.

## References

1. WORLD HEALTH ORGANIZATION. WHO Guidelines on Hand Hygiene in Health Care. 2009. Accessed 20-11-2017. Available in http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf

2. DIREÇÃO-GERAL DA SAÚDE- Circular Normativa nº 13/DQS/DSD de 14/06/2010 (2010). Orientação de Boa Prática para a Higiene das Mãos nas Unidades de Saúde. Lisboa: Direção Geral de Saúde. Acceded 20-11-2017. Available in: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/circular-normativa-n-13dqsdsd-de-14062010.aspx

3. Piras SE, Lauderdale J, Minnick A. An elicitation study of critical care nurses' salient hand hygiene beliefs. Intensive and Critical Care Nursing. 2017;42:10-16.

4. Farhoudi F, Sanaei Dashti A, Hoshangi Davani M, Ghalebi N, Sajadi G, Taghizadeh R. Impact of WHO Hand Hygiene Improvement Program Implementation: A Quasi-Experimental Trial. Biomed Res Int. 2016;2016:7026169.

## Keywords

Hand hygiene, Healthcare-associated infections, Multimodal strategy, Integrative literature review.

## P45

### Conception and implementation of a nursing intervention program for family caregivers

Ricardo Melo<fnref n="1" />,², Marília Rua², Célia Santos<fnref n="3" />

**Correspondence:** Ricardo Melo (rmcmelo@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P45

### Background

The increase of longevity of people and prevalence of diseases resulting in situations of dependency [1], emerge a greater need for supportive care to meet the needs expressed [2]. Family caregivers are very important elements in caring for the family member with self-care dependency, at the home context [3, 4]. This is an exhausting process with serious consequences for the general state of health perceived by the caregiver, as well as for the manifested burden [3, 5, 6]. A structured and contextualized intervention program [7] aimed at the qualification and support of family caregivers is essential for the transition and adequate performance of the functions inherent in this role.

### Objective

To develop and implement a Nursing Intervention Program with family caregivers of dependent persons, in a home context.

### Methods

This process began with an integrative review of the literature, in order to discover the main needs evidenced by family caregivers. Electronic databases were used, namely EBSCO and B-on, with the following descriptors: Caregiver; Family Caregivers; Needs; Dependent. The second stage corresponded to the adaptation of the Intervention Program, with the use of the Delphi technique on a group of experts. The last phase corresponded to a quasi-experimental study, with pre- and post-intervention evaluation, with the implementation of the program on 70 family caregivers, using home visits.

### Results

With the review of the literature were obtained 21 articles (ten quantitative studies, five qualitative studies, four systematic reviews of the literature, a review of the literature and a mixed study). The evidenced needs were organized by the Transition Theory: community and social resources; knowledge and preparation; personal meaning, beliefs and attitudes; and socioeconomic condition. The consensus technique allowed the structuring of a Nursing Intervention Program, with 93 interventions, divided in emotional and instrumental support. The implementation of the Intervention Program implied, on average, 6 home visits to the caregivers, emotional support provision and caregiver training.

<footnote n="1">¹Centro Hospitalar de Gaia/Espinho, 4400-129 Gaia, Portugal; ²Escola</footnote>

<footnote>Superior de Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal;</footnote>

<footnote n="3">³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal</footnote>
## Conclusions

A Nursing Intervention Program, with structured and contextualized interventions in the home context, with family caregivers of dependent persons, is a facilitator for the transition experienced by caregivers, but also an important instrument of the work developed by nurses. Thus, it provides the necessary emotional support and skills that enable caregivers to optimize care delivery.

## References

1. INE - Instituto Nacional de Estatística IP. Censos 2011 Resultados Definitivos - Portugal. XV recenseamento geral da população; V recenseamento geral da habitação. Lisboa: Instituto Nacional de Estatística; 2012.

2. Figueiredo D. Cuidados Familiares ao Idoso Dependente. Lisboa: Climepsi Editores; 2007.

3. Imaginário C. O Idoso Dependente em Contexto Familiar: Uma Análise da Visão da Familia e do Cuidador Principal. 2ª ed. Coimbra: Formasau; 2008.

4. Marques SCL. Os Cuidadores Indormais de Doentes com AVC Coimbra: Formasau - Formação e Saúde Lda.; 2007 Janeiro de 2007.

5. Martins T. Acidente Vascular Cerebral: Qualidade de Vida e bem-estar dos doentes e familiares cuidadores. Coimbra: Formasau - Formação e Saúde Lda.; 2006.

6. Sequeira C. Cuidar de Idosos com Dependência Física e Mental. Lisboa: Lidel; 2010.

7. ICN. CIPE Versão 2 - Classificação Internacional para Prática de Enfermagem Lisboa: International Council of Nurses; 2011.

## Keywords

Family caregivers, Intervention program, Transition, Needs, Dependency.

## P46

### Antimicrobial activity of natural extracts and commercial elixirs in oral pathogens

Maria J Alves, Marta Pereira, Sara Fraga, Isabel Ferreira, Maria I Dias
Centro de Investigação de Montanha, Instituto Politécnico de Bragança,
5300-253 Bragança, Portugal

**Correspondence:** Maria J Alves (maria.alves@ipb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P46

### Background

Although *Streptococcus mutans* has been responsible for decades as the etiological agent of dental caries, recent evidence indicates a high prevalence for *S. mutans* in dental biofilms where *Candida albicans* resides; which suggests that the interaction between these two species may mediate cariogenic development [1].

### Objective

To evaluate the antimicrobial activity of three chemical elixirs of different commercial brands and two aqueous extracts obtained from plants (*Chamomilla recutita* L. and *Foeniculum vulgare* Mill.) in *C. albicans* and *S. mutans*.

### Methods

Percent growth inhibition was quantified by measurement of optical density (OD) at 600 nm in a microplate reader.

### Results

Both the extracts and the elixirs presented antimicrobial activity for the two microorganisms previously mentioned. Among the elixirs tested, the one with the highest antimicrobial activity for *S. mutans* was Colgate (100%), followed by Eludril and a white brand (≥ 99%). For *C. albicans*, the Eludril (100%) gave the highest activity, followed by Colgate (99%). A *Chamomilla recutita* extract (10 mg/ml) showed an inhibition percentage of growth of 96% for *S. mutans* very similar to that of the antibiotic (97%). The inhibition percentage of growth decreased for *C. albicans* (87%), although was higher than the antifungal fluconazole (84%).

### Conclusions

The two extracts showed less antimicrobial activity compared to the elixirs, however, they had higher percentages of inhibition growth than the drugs tested for both microorganisms. The extract of

*Chamomilla recutita* was the one that presented the highest antimicrobial activity for the two microorganisms tested comparatively with *Foeniculum vulgare*.

## References

1. Metwalli KH, Khan SA, Krom BP, Jabra-Rizk MA. Streptococcus mutans, Candida albicans, and the Human Mouth: A Sticky Situation. PLOS Pathogens. 2013;9(10):1-5.

## Keywords

Oral biofilm, Antimicrobial activity, Elixir, *Foeniculum vulgare* mill, *Chamomilla recutita* L.

## P47

### The effects of water walking on body composition - a study with children between 6 and 12 years old

Samuel Honório¹,², João Oliveira³, Marco Batista¹,², João Serrano¹,⁴, Jorge Santos³, Rui Paulo¹,², Pedro Duarte-Mendes¹,²

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Arcozelo, Vila Nova de Gaia, Portugal;

³Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ⁴Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

**Correspondence:** Samuel Honório (samuelhonorio@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P47

### Background

Aquatic activities have been recommended as frequent practice, due to the physical properties of water, especially because fluctuation and reduction of joint impact, with improvements in the body composition of children.

### Objective

The present research aims to verify if there are differences in body composition in children aged between 6 and 12 years who practice swimming, complemented with water walking at the end of each session and those who only practice swimming.

### Methods

The sample consisted of 28 individuals aged 6 to 12 years and was divided into two groups: swimming group (SG) with 9 children and a swimming complemented with water walking group (SWWG) of 19 children. In this study, of twelve weeks with three moments of evaluation, with two sessions per week of 45 minutes each, we wanted to identify the benefits in body composition (weight, muscle mass, fat mass, body water, BMI, waist circumference and body percentiles). For that purpose, we used a bio-impedance scale Targa Z29777A, and an anthropometric tape to measure the waist circumference. The water walking activity occurred at the end of each session for 6 minutes, performed in straight line with the water level at the children's chest. In terms of statistical procedures, we used the program Statistical Package for the Social Sciences version number 20 (SPSS 20.0). We used descriptive statistics (minimum, maximum, means and standard deviations), the Shapiro Wilk test for testing the normality of the sample, inferential statistics (non-parametric Mann-Whitney tests, Friedman's ANOVA, and for the calculation of the magnitude of the effect, the d-Cohen test).

### Results

After data treatment, regarding the inter-group analysis (comparison between the swimming group and the swimming group with water walking) we observed that there were significant differences in the weight variable, that is, at the end of the 3 moments. Concerning intra-group differences (improvements in the swimming group and in the swimming with water walking group, in the three moments evaluated), the SWWG showed significant improvements in the variables of weight as well, muscle mass, fat mass, body water, body mass index (BMI) and body percentiles.

### Conclusions

We have concluded that the practice of activities such as swimming and water walking has benefits in the analysed variables and that there are differences in the groups analysed; however, the two
activities complemented (swimming and water walking) present much more significant improvements.

## Trial Registration

NCT03519620

## Acknowledgements

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest - OE/CED/UI4016/2016).

## Keywords

Children, Water Walking, Swimming, Body composition, Bio-impedance.

## P48

### Health literacy level of students at the time of enrolment to health courses in higher education

Luis S Luis¹,², Victor Assunção³, Henrique Luis⁴, Helena Melo⁵

¹School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Escola Superior de Saúde, Instituto Politécnico de Portalegre, 7300-074 Portalegre, Portugal; ⁴Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-003 Lisboa, Portugal; ⁵Escola Superior de Saúde Ribeiro Sanches, 1950-396 Lisboa, Portugal

**Correspondence:** Luis S Luis (luis.luis@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P48

### Background

A good level of Health literacy is essential for effective communication between health professionals and patients. Health professionals training should provide them with a set of skills in this area that would allow them to communicate successfully with other health professionals and patients.

### Objective

The goal of this study was to identify what level of health literacy students have when enrolled at the Universities and Polytechnic Institutes. Students from Nursing Degree courses (Portalegre School of Health Sciences and Ribeiro Sanches Health School) and from the Dental Hygiene Degree (Faculty of Dental Medicine of Lisbon and Portalegre School of Health Sciences), had their health literacy level assessed at enrolment, in the year of 2013/2014.

### Methods

To evaluate the level of health literacy, the Portuguese version of the NVS (New Vital Sign) was administered to 42 dental hygiene students (6 males and 36 females) and 53 nursing students (14 males and 39 females).

### Results

The total sample, composed of 95 students, was analysed for provenance to higher education level degree, it was verified that 83.5% came from high school, 6.6% entered by the process of "Maiores de 23", and 9.9% through other enrolment processes. When analysing these data, by degree, most of the students at the Dental Hygiene degree (92.9%), accessed higher education through high school completion. This value was of 75.5% for Nursing students. Regarding the level of health literacy, it was observed that 72.63% of the students had high level of health literacy, 24.21% moderate health literacy level and 3.16% low health literacy level. There was a statistically significant difference between Nursing and Dental Hygiene students, with the former having a better health literacy (p = 0.007). At the time of entry to the University and Polytechnic, and when considering courses, collected data shows that, for the Degree in Dental Hygiene, 4.8% of the students had a low level of health literacy, 21.4% present a moderate level and 73.8% a high level of health literacy. When considering the Nursing Degree, these values were, respectively, 1.9%, 26.4% and 71.7%.

### Conclusions

Students access higher education with a level of health literacy appropriate to the courses they intend to attend. The presented results are preliminary and part of a longitudinal study lasting three

academic years, evaluating the evolution of health literacy levels of students throughout their training.

**Keywords:** Health literacy, Nursing School, Dental Hygiene School, Students.

## P49

### Nursing caring of vulnerable patients in emergency situations: what does the evidence say?

Marta Pacheco, Maria T Leal

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

**Correspondence:** Marta Pacheco (mpacheco@campus.esel.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P49

### Background

Critically ill patient's (CIP) nursing care quality has improved significantly in the last years because of important technological improvements. In pre-hospital, emergency and intensive care settings, they contribute to the valuation of technical competencies over relational aspects. The emergent need to stabilize the CIP diverts the attention away from the psychological and emotional support, increasing anxiety and diminishing the patient's cooperation, making the care experience increasingly hostile. Vulnerability arises in these settings [1] as a condition to be appreciated in a "harmonious conciliation between the technological expertise and the art of caring" [2], because it improves expectations and experiences, and increases the positive outcomes of the resuscitation process, giving greater visibility to the nurses' work. To understand the experiences of patients who lived emergency situations, as well as nursing interventions that reduce vulnerability, will allow for better care of the CIP [3].

### Objective

Our goal is to review the available evidence regarding nursing interventions that reduce vulnerability at emergency and resuscitation settings.

### Methods

We performed an integrative review of the literature available from MEDLINE and CINAHL databases and grey literature, to answer the question: "Which nursing interventions promote the reduction of the CIP's vulnerability in emergency setting?" [4].

### Results

Nine qualitative and quantitative studies satisfied the search criteria and were included. These studies are from different countries and cultures and their analysis identified both the emergency setting and nursing interventions as elements that influence the CIP's subjective experience of vulnerability. Vulnerability is a permanently present condition in the human being and the recognition of the mutual vulnerability by nurses is a way of preserving the value of caring.

### Conclusions

The experience of CIP in emergency and resuscitation settings is influenced by organizational, environmental and caring factors. Being cared by competent professionals [5,6], using a therapeutic relationship and responding to the patient main needs are the most valued aspects that convey safety and a significant decrease in vulnerability. Communication and empathy [6], with explanation of clinical procedures, allows the development of trust and reduces vulnerability, facilitating patient collaboration in the care provided. Recognizing the vulnerability of CIP and its influence on collaboration, recovery and satisfaction in care, allows developing strategies and abolishing mechanized and merely technical behaviours. Vulnerability is a continually present condition in humans and the recognition of vulnerability of the professionals themselves [7] is a way to socially preserve the value of caring in an emergency context.

### References

1. Mitchell M. General anaesthesia and day-case patient anxiety. J Adv Nurs. 2010;66(5):1059-1071.

2. Sá F, Botelho M, Henriques M. Cuidar da Família da Pessoa em Situação Crítica: A Experiência do Enfermeiro. Pensar Enferm. 2015;19(1):31-46.

3. Paavilainen E, Salminen-Tuomaala M, Kurikka S, Paussu P. Experiences of counselling in the emergency department during the waiting period: importance of family participation. J Clin Nurs. 2009;18(15):2217-2224.
4. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers' Manual: 2014 Edition [Internet]. Adelaide: The Joanna Briggs Institute; 2014. 197 p.

5. Baldursdottir G, Jonsdottir H. The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department. Hear Lung. 2002;31(1):67-75.

6. Wiman E, Wikblad K, Idvall E. Trauma patients' encounters with the team in the emergency department: a qualitative study. Int J Nurs Stud. 2007;44(5):714-22.

7. Malone RE. Dimensions of vulnerability in emergency nurses' narratives. Adv Nurs Sci. 2000;23(1):1-11.

### Keywords

Vulnerability, Critically ill patient, Nursing care, Emergency department.

## P50

### Sedentary behavior of older people above 75: where, when and with whom

Marta Gameiro, Madalena G Silva

Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, 2910-761 Setúbal, Portugal

**Correspondence:** Marta Gameiro (marta gameiro93@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P50

### Background

Sedentary behaviours are understood as activities with a low energy expenditure (<1.5 metabolic equivalent - METs) [1]. Even for those who comply with physical activity recommendations, prolonged time in sedentary behaviours is associated with an increased risk of chronic and cardiovascular diseases; decreased muscle mass, strength and power; decreased functional capacity and premature death in elderly people [2]. Older people spend long periods of time in sedentary behaviour [3]. A deeper understanding of what activities represent these behaviours, when and with whom they take place, becomes extremely relevant for health professionals who need to promote a reduction in sedentary time, among very older people in order to enhance health benefits.

### Objective

To characterize the time spent in sedentary behaviour of older people in three urban day-care centres, as to the duration, type of activities, with whom and where they take place.

### Methods

A cross sectional study was conducted with 54 participants, average age of 84.53 ± 5.35. An Activity Diary was used to characterize sedentary activity. Each activity noted in the diary was classified in METs, per the Compendium of Physical Activities: Classification of Energy Costs of Human Physical Activities. They were then clustered in four groups: sedentary activities; light intensity; moderate intensity and vigorous intensity activities. Time spent in activities within each group was summed, resulting in the total sum of sedentary, light, moderate, and vigorous intensity activities (min.week⁻¹). Relative and absolute frequencies, as well as mean/standard deviation, were used, to characterize sedentary behaviour.

### Results

Our sample was mainly female (88.9%), widowers (70.4%), living alone (64.8%) and with a low educational background (61.1%). On a regular week, they spent an average of 6h20 min (2608.15 ± 930.67 min.week⁻¹) in sedentary behaviour. Half of this time is spent watching TV (50.2%), alone, in the afternoon and evening. Other activities are talking (11.73%), reading (6.7%), resting (6.4%) and playing board games (4.7%).

### Conclusions

We conclude that our sample spent an average of 6h20min per day in sedentary activity, mainly in the afternoon and evening, watching television alone. In order to break sedentary patterns, clinical interventions need to tackle this particular period of the day, finding alternative strategies for a greater energy expenditure for very old people.

### References

1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz ANNM, Strath SJ, et al. Compendium of Physical Activities: an MET intensities. Med Sci Sport Exerc. 2000;32(9):498-504.

2. Dunlop DD, Song J, Arntson EK, Semanik PA, Lee J, Chang RW, et al. Sedentary time in U.S. older adults associated with disability in activities of daily living independent of physical activity Dorothy. J Phys Act Heal. 2015;12(1):93-101.

3. Leask CF, Harvey JA, Skelton DA, Chastin SF. Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom). Eur Rev Aging Phys Act. 2015;12(1):4.

### Keywords

Sedentary behavior, Context, Very old people.

## P51

### Women's perception on the role of family nurse in the transition to motherhood

Andreia Ferreira, João Simões, Helena Loureiro

Escola Superior Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Andreia Ferreira (aloferreira84@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P51

### Background

The study carried out has as its title "Women's perception on the role of family nurse in the transition to motherhood" and aims to understand the experiences of puerperal women in relation to the role of the family nurse, in promoting the transition to maternity, in the year 2016/2017, at USF Rainha Tereza.

### Methods

The accomplishment of the empirical study was authorized by the ARS Centro Ethics Committee. It is part of a paradigm of qualitative nature, based on a descriptive phenomenological methodology, that intends to answer the research question: *What is the perception of puerperal women regarding the interventions of the family nurse in the transition to motherhood?* Eleven mothers for the first time, who were selected in a non-probabilistic manner and for convenience, according to previously established inclusion and exclusion criteria, participated in this study. Once the informed consent of all the participants was obtained, the information collection was obtained through the filling of a questionnaire of sociodemographic characterization and the conduction of a semi-structured interview, recorded in an audiographic record, was later transcribed and analysed by the webQDA program, through the Bardin content analysis technique.

### Results

Evidence has led to the conclusion that motherhood, as a life cycle transition, is approached by the family nurse in a fragmented way. Women perceive that this health professional has an intervening role in the processes of "Being Woman" and "Being Mother", but as far as "Being Wife", the intervention still remains little exiguous. Nevertheless, it became clear that family nurses assume a primordial function in this transition and that this is
essentially related to the role of health promoter attributed to it, by mothers for the first time.

### Conclusions

In conclusion, the traineeship report sensitized the importance of relational skills in the delivery of care and the need to provide care in a holistic way, integrating the family as a partner in the perinatal follow-up.

### Keywords

Women's Health, Maternal Health, Motherhood, Transition, Nursing.

## P52

### Self-perception of health status and physical condition of elderly people practitioners of hydrogymnastics

Carlos Farinha¹, João Serrano², José P Ferreira¹, João Petrica², Rui Paulo³, Pedro Duarte-Mendes², Marco Batista²

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-256 Coimbra, Portugal; ²Higher School of Education, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ³Sport, Health and Exercise Research Unit, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal

**Correspondence:** Carlos Farinha (cajo596@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P52

### Background

The researcher interest in self-perception of health status and physical condition of the elderly is determinant in an increasingly aging society and where one should seek to improve their quality of life.

### Objective

To study the self-perception of health status and the impact of a physical activity program oriented during 4 months among an elderly population of practitioners of hydrogymnastics.

### Methods

As instruments were used the questionnaire "mos short health survey – 36 items version 2 (SF-36)" translated and validated for the Portuguese version by Ferreira (2000), and the battery of Functional Tests Fitness Test. Questionnaires were filled by the elderly with the presence of the investigator and the physical fitness was evaluated following the protocol of proof. The sample was constituted by 83 elderly individuals over 55 years of age. In statistical terms we used a percentage analysis in the questionnaire and in the evaluation of the physical condition after application of the Kolmogorov-Smirnov test, we used the non-parametric test for two paired variables, Wilcoxon.

### Results

According to the different dimensions studied (physical function, physical performance, pain, general health, vitality, social function and emotional performance), we found that the majority of the elderly presents limitations mainly in the most demanding tasks (lift weights, running, walk fast, more intense housework, among others); and that their state of health interfered in the performance of some daily activities, but not in the time spend in performing these same activities. The pains have not been strong in the last times and so, they consider their general health moderate and stable, interfering little in the development of their relationship and social activities. The elderly also said that they feel most of the time calm and tranquil and therefore they feel happy. As for physical fitness, there were improvements in the results in practically all the tests, between the 1st and 2nd evaluation, which showed a positive impact of the work developed during the 4 months.

### Conclusions

Based on the results, we can conclude that the elderly of the study evidenced a perception of their health condition considered positive and that fits in the normal parameters for their age. The results of the physical activity program revealed improvements in physical fitness levels, between the beginning and the end of the program, aspect that is determinant for the health and autonomy of the elderly, as the investigation reveals.

### Keywords

Gerontomotricity, Physical activity and health, Physical condition, Hydrogymnastics.

## P53

### Impact of dual-task on older adults' gait spatiotemporal parameters

Nádia Augusto¹, Rodrigo Martins², Madalena G Silva¹, Ricardo Matias¹,³

¹Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, 2910-761 Setubal, Portugal; ²Red Cross School of Health, 1300-125 Lisbon, Portugal; ³Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal

**Correspondence:** Nádia Augusto (naa.fisio.augusto@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P53

### Background

The ageing process induces changes in gait, particularly in its automatic features [1]. Early detection of gait changes can be a key to ensure timely clinical intervention to prevent falls [2], since most of these occur while walking in dual-task situations [3]. Several studies using 3D kinematic analysis systems have suggested that changes in spatiotemporal parameters can be measured before these changes are noticeable [4,5]. However, their use has been confined to laboratories [6], which is difficult to transfer into clinical practice [7].

### Objective

To study the effects of the introduction of a dual task, in spatial/temporal parameters, on the gait of older adults, with an ambulatory 3D kinematic analysis system.

### Methods

An exploratory observational study was performed. Fifteen healthy older adults (age = 75.73 ± 6.03 years old) were recruited from a day centre. All participants were instructed to walk 10 meters in a single self-selected pace, and in a dual task (a verbal fluency task and an arithmetic task) condition. Seven spatiotemporal gait parameters were assessed with the Xsens MVN ambulatory system, based on 17 inertial sensors: stride velocity, stride length, stride width, cadence, stance time, swing time and double support time.

### Results

The results of the Friedman test revealed statistically significant differences between the temporal parameters of single gait (stride velocity: $\chi^2$=11.200, p = 0.004; cadence: $\chi^2$=24.102, p = 0.000; stance time: $\chi^2$=20.133, p = 0.000; swing time: $\chi^2$=17.733, p = 0.000 and double support time: $\chi^2$=19.733, p = 0.000) and each of the two dual task conditions. No statistically significant differences were observed between the cognitive verbal fluency and the arithmetic conditions.

### Conclusions

Our results suggest that spatiotemporal parameters of gait significantly change under both cognitive dual task conditions, and that these changes are detectable with the ambulatory 3D kinematic analysis system used. These findings strongly support the use of body-worn sensors, to early detect changes in gait patterns, promoting timely interventions to prevent falls.

### References

1. Bridenbaugh SA. Kressing RW. Motor cognitive dual tasking: early detection of gait impairment, fall risk and cognitive decline. Z Gerontol Geriatr. 2015;48(1):15-21.

2. Bridenbaugh SA, Kressing RW. Quantitative gait disturbances in older adults with cognitive impairments. Curr Pharm Des. 2014;20(19):3165-3172.

3. Beauchet O, Annweiler C, Dubost V, Allali G, Kressig RW, Bridenbaugh S, Berut G, Assal F, Herrmann FR. Stops walking while talking: a predictor of falls in older adults?. European Journal of Neurology. 2009;16(7):786-795.

4. Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait Posture. 2007;26(1):113-119.
5. Bridenbaugh SA, Kressing RW. Laboratory Review: The Role of Gait Analysis in Seniors' Mobility and Falls Prevention. Gerontology. 2011;57(3):256-264.

6. Aminian K, Najafi B, Búla C, Leyvraz PF, Robert P. Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. J Biomech. 2002;35(5):689-699.

7. Najafi B, Helbostad JL, Moe-Nilssen R, Zijlstra W, Aminian K. Does walking strategy in older people change as function of walking distance?. Gait Posture. 2009;29(2):261-266.

## Keywords

Dual task, Spatiotemporal parameters, Gait, Older adults.

## P54

### Portuguese workers: perception of wellbeing at work in an industrial company

Marina Cordeiro¹,², José C Gomes¹,², Paulo Granjo³

¹School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ²Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal

**Correspondence:** Marina Cordeiro (marina.cordeiro@ipleiria.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P54

### Background

People spend a long time working, but work can have a negative impact on wellbeing, especially in situations of poor working conditions and dissatisfaction [1, 2]. This may lead to negative consequences for the worker, company and society [2, 3], therefore, it's important to recognize the wellbeing perception at work of Portuguese workers and which variables may influence it.

### Objective

To determine worker's perception of wellbeing at work and its relationship with sociodemographic and occupational characteristics.

### Methods

A cross-sectional study, descriptive and correlational, was performed in a Portuguese industrial company. The non-probabilistic convenience sample was composed by 134 workers. Data was collected by a self-administered questionnaire including sociodemographic and occupational questions and the Perception of Wellbeing at Work Questionnaire (PWW). The study was approved by an ethical commission.

### Results

The sample mean age was 38.58 years (SD=9.52; min=21; max=62), mainly composed by female workers (77.6%), 44% concluded high school, 61.2% are married/living under common law, and 31.3% has 2 children. Workers worked in the company for about 107.15 months (SD=51.10), 88.1% had a Permanent Employment Contract (PEC), 87.3% works ≤ 40 hours a week, 40.3% had as working schedule from 07h00 to 16h00 and 41% were production operators. PWW had a mean of 67.2 (SD=7.8), Adaptation and Adequacy to Work (AAW) dimension of 27.2 (SD=3.2), Organizational Characteristics (OC) of 19.2 (SD=3.9), Interpersonal Relationship (IR) of 11.2 (SD=1.7), Structure of work (SW) of 5.4 (SD=1.3) and Bound with the Institution (BI) of 4.2 (SD=1.6). There were no statistically significant differences (p > 0.05) between PWW and sociodemographic or occupational variables. However, statistically significant differences (p < 0.05) were found in IR according to gender (men with higher average) and the type of contractual affiliation (workers with Term Employment Contract [TEC]) had better PWW in IR than those with PEC) and SW according to the workload (workers working ≤ 40 hours have higher PWW in SW). It was also found that IR was negatively correlated with age and with working time for the same function.

### Conclusions

The sample presents moderate PWW, which assumes higher values in AAW and lower in BI. Older workers and those who

have been working longer at the same function have a lower PWW in IR. Male workers and those with a TEC had a better PWW in the IR, and those who worked ≤ 40 hours per week had higher PWW in SW. These results may be useful for designing interventions to promote wellness at work.

## References

1. International Labour Office. Psychosocial risks, stress and violence in the world of work. International Journal of Labour Research. 2016;8:1-131.

2. Harvey SB, Modini M, Joyce S, Milligan-Saville JS, Tan L, Mykletun A, Bryant RA, Christensen H, Mitchell PB. Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occupational & Environmental Medicine. 2017; 74(4): 301-310.

3. Cottini E, Lucifora C. Mental Health and Working Conditions in Europe. ILRReview. 2013; 66(4): 958-988.

## Keywords

Workplace, Mental health, Occupational health, Workers wellbeing.

## P55

### Informal caregivers of oldest old people

Sara Alves¹, ², Constança Paúl¹,², Oscar Ribeiro²,³

¹Unidade de Investigação e Formação sobre Adultos e Idosos, Centro de Investigação em Tecnologias e Serviços de Saúde, Instituto de Ciências Biomédicas Abel Salazar, 4050-313 Porto, Portugal; ²Centro de Investigação em Tecnologias e Serviços de Saúde, Universidade do Porto, 4200-450 Porto, Portugal; ³Departamento de Educação e Psicologia, Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Sara Alves (ssafalves@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P55

### Background

Living longer may lead to a long period of disability and frailty with increasing care demands. Informal caregivers, namely family members, play a very important role in the provision of care to very old individuals. Informal care represents crucial support but the available knowledge on this topic is still scarce in the Portuguese context.

### Objective

To provide an overview of caregiving characteristics in a sample of dyads of informal caregivers and oldest old people (80+) from Porto.

### Methods

A sample of 72 caregiving dyads was considered. Sociodemographic data, information on the caregiving experience (e.g. length of care, relationship with the person cared) and the disability level of care receiver (Activities of Daily Living – ADL’s and IADL’s, and comorbidities) were obtained.

### Results

Informal caregivers had a mean age of 63.9 years (SD=9.95), were mostly women (76.4%), with children (70.8%), married (63.9%) and retired (50.0%). Time spent on caregiving was on average 9.73 hrs/day (SD=7.61) and the length of care was around 7 years (SD=6.15). Most of the sample had formal social support to help in the care provision: 54.2% receives support from home care services and 34.7% from day centres. Care receivers mean age was 92.0 years (SD=5.28), were mostly women (73.6%) and widowed (65.3%). Half of the care receivers (n=36; 50.0%) were completely dependent in ADL’s, 30.6% were moderately dependent, 16.7% severely dependent, and 2.8% were independent. Most of the sample was severely dependent in IADL’s (95.8%). The mean number of comorbidities was 6.94 (SD=1.95), and the mean of medicines intake was 6.17 (SD=3.41).

### Conclusions

This is an ongoing project but current data already shows that the amount of time spent on caring activities by women who are themselves in advanced age is very high, and probably exhausting due to
the high level of functional dependency of the care recipients. A clear picture of tasks and probable exhaustion of the group of people taking care of very old people is crucial in order to plan which and how to deliver formal care to these dyads. Such planning is important for preventing/alloviating burden situations and raising the quality of life of care recipients and their families.

**Acknowledgements**

Project was approved by Ethical Commission of ICBAS UP, approval number 188/2017 and by Portuguese Data Protection Authority (CNPD), approval number 1338/2017.

**Keywords**

Informal caregiving, Oldest old people, Disability.

P56

Comparison of antioxidant activity for Ginkgo biloba L. and Rosmarinus officinalis L

Diana Silva¹, Ana França², Cláudia Pinho³, Ana I Oliveira³, Rita F Oliveira³,⁴, Agostinho Cruz²

¹Farmácia Holon, Baguim do Monte, Gondomar, Portugal; ²Farmácia Higiénica, Fão, Esposende, Portugal; ³Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ⁴Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Cláudia Pinho (clp@eu.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P56

**Background**

Natural antioxidant products have gained popularity worldwide and are increasingly being used to treat various diseases [1]. Leaves of *Rosmarinus officinalis* L. and *Ginkgo biloba* L. possess a variety of bioactivities, including antioxidant [2].

**Objective**

Therefore the present study aims to evaluate *in vitro* antioxidant properties of aqueous and hydroalcoholic extracts of three different commercial brands of *R. officinalis* and *G. biloba*.

**Methods**

*R. officinalis* and *G. biloba* leaves from three different commercial brands were extracted with two solvents (water and 80% ethanol), and antioxidant activity of the extracts were screened using the superoxide anion and 1,1-diphenyl-2-picryl hydrazyl (DPPH+) radical scavenging, and metal ion chelating capacity.

**Results**

A comparison of both plant extracts in the DPPH assay and Fe²⁺ chelating activity indicated that *R. officinalis* showed lower IC₅₀ values comparing to G. biloba, ranging from 44.1-61.8 µg/mL (aqueous extracts) and 20.8-23.3 µg/ml (hydroalcoholic extracts) in the DPPH assay, and 93.1-329.0 µg/mL (aqueous extracts) and 33.4-71.0 µg/mL (hydroalcoholic extracts) in the Fe²⁺ chelating activity. For the superoxide radical scavenging activity, the hydroalcoholic extracts of *R. officinalis* showed the best IC₅₀ values, ranging from 5.1-15.5 µg/mL, with one brand showing and IC₅₀ value lower (5.1 µg/mL) than positive control (5.8 µg/mL - ascorbic acid). Results also showed that in both plants and brands, the highest antioxidant activity was found mainly in the hydroalcoholic extracts, for all the assays tested.

**Conclusions**

The findings of this study support the view that some medicinal plants are promising sources of potential antioxidants. The different brands and solvent types used in the present study may influence the chemical composition of the rosemary and ginkgo extracts obtained and therefore their antioxidant capacity.

**References**

1. Zhang A, Sun H, Wang X. Recent advances in natural products from plants for treatment of liver diseases. Eur J Med Chem. 2013;63:570-577.

2. El-Beltagi HS, Badawi MH. Comparison of Antioxidant and Antimicrobial Properties for Ginkgo biloba and Rosemary (Rosmarinus officinalis L.) from Egypt. Not Bot Horti Agrobo. 2013;41(1):126-135.

**Keywords**

Antioxidant activity, *Ginkgo biloba*, *Rosmarinus officinalis*, Solvent extraction.

P57

The skills of the wound navigator in the health care team

Raquel Silva, Filipa Veludo
School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal

**Correspondence:** Raquel Silva (raklitasol@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P57

**Background**

Aging co-morbidities are the main reason for skin changes, requiring qualified professionals to assist the person with this problem [1,2]. In this sense, it emerges in the literature even the tenuous concept – wound navigator, which may enhance the approach to the person with wounds, often described as the tissue viability nurse.

**Objective**

Define the wound navigator and identify his skills.

**Methods**

Integrative literature review using electronic research (CINAHL®, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE®) and manual research in 12 specialty associations in tissue viability, with the following descriptors (wound OR tissue viability OR ulcer) AND (nurs®) AND (care OR role OR skills OR patient care team OR navigator OR manager OR multidisciplinary OR interdisciplinary OR tissue viability service OR interven* OR pratic*). Inclusion criteria were articles in Portuguese, English, Spanish or French, without temporal limitation, full texts and free access. Exclusion criteria were articles that do not address the study phenomenon. The research was conducted on 08/25/2017, where we obtained 601 articles from the databases and 145 from associations. The titles and abstracts of the publications were read, followed by reading the full text of the selected publications. The sample was defined by 19 articles (15 from databases and 4 from associations).

**Results**

Only one article defines wound navigator, as the health professional with knowledge in the specialty, who acts as a defender of the interests of the clients, which combines the needs felt by them; the objectives of the treatment and the health care treatment plan by referral [3]. It collects the results achieved from the practice and dissemination of research, in order to highlight their actions before the policy of health care [3]. The competences found in the remaining 18 articles were divided into 4 categories: quality (training, auditing, research and elaboration of norms and protocols) management (involvement in product choice, articulation with suppliers, promotion of change and ability to work in multi and interdisciplinary team), care (postgraduate knowledge, experience in the area of tissue viability, prescription of specialized care and treatments with advanced therapies) and leadership (communication, supervision and consulting).

**Conclusions**

There is little literature that precisely defines the wound navigator and his skills, therefore more research is needed to describe in detail. When the term is defined and its competences are known, it may through them formally develop teams with nurses specialized in the area, holders of the general and specific attributes identified.

**References**

1. Bianchi, J. Preventing, assessing and managing skin tears. Nurs Times. 2012;108(13):12,14, 16
2. Dutton, M; Chiarella, M. e Curtis, K. The role of the wound care nurse: an integrative review. Community Wound Care. 2014; Vol. Supplement: S39-40, S42-7.

3. Moore, Z.; Butcher, G.; Corbet, L.P. et al. AAWC, AWMA, EWMA, Position Paper: Managing Wounds as a Team. J Wound Care. 2014;23(5): S1-S38.

**Keywords**

Tissue viability nurse, Skills, Role.

P58

Nursing interventions in the prevention and management of
aggressive behaviors in psychiatric context

Aida Bessa¹, Isabel Marques², Amorim Rosa²

¹Centro Hospital e Universitário de Coimbra, 3000-075 Coimbra, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-051 Coimbra, Portugal

**Correspondence:** Aida Bessa (bessaaida@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P58

Background

Aggressive behaviour emerges in social interaction and is therefore consid-
ered as a process arising from the relationship between the person and
the person's physical, social and cultural environment over time. In these
situations, where the person is experiencing transition processes that gen-
erate misaligned human responses, inducing processes of mental suffering
as the manifestation of aggressive behaviours, the need to provide special-
ized nursing care emerges.

Objective

The aim of this study was to analyse the most relevant data from the
studies about Nursing Interventions in the prevention and manage-
ment of aggressive behaviours in the psychiatric context, according to
the risk profile of the patients.

Methods

An integrative review of the literature was carried out, in libraries of
national and international organizations, using the B-On search en-
gine, PubMed database - from the question "What Nursing interven-
tions in the prevention and management of aggressive behaviours in
psychiatric context, according to the risk profile of the patients?" The
following keywords were used: Nursing Interventions, Violence, Ag-
gression, and Risk Psychiat*. 343 articles were considered, published
in the period 2004-2016, in Portuguese, Spanish, French or English
and with full text. After applying the inclusion and exclusion criteria,
we obtained 10 articles that were analysed according to the previ-
ously defined protocol.

Results

Five articles addressed the prevention and management measures im-
plemented to deal with the incidents of aggression, while all the others
emphasize the implementation of interventions to prevent aggressive
behaviour. Award-winning nursing interventions are non-restrictive
(communicational and de-escalation techniques). Observation emerges
as the first intervention, including risk assessment. Environmental and
chemical containment arise among the containment measures.

Conclusions

It was concluded that the risk assessment of aggressive behaviours,
upon stratification, followed by the implementation of preventive/
management measures, adapted to the risk level, can be easily im-
plemented in the routines of the services. It therefore contributes
both to reducing the incidence and severity of these behaviours and
to improving the management/reduction of coercive measures.

Keywords

Aggressive behaviors, Psychiatry Context, Prevention, Nursing Interventions.

P59

An advanced nursing practice model proposal to improve heart failure under mechanical circulatory support patients' outcomes

Teresa Pessoa¹,², Maria T Leal²

¹Departamento de Cardiologia, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, 1649-035 Lisboa, Portugal; ²Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

**Correspondence:** Teresa Pessoa (teresapessoa@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P59

Background

The use of left ventricular assist devices has grown rapidly in recent
years for patients with end-stage heart failure (HF) [1]. HF under
Mechanical Circulatory Support (MCS) patient-centred care assumes
that nurses have professional competence, knowledge and ability to
make decisions and prioritize care [2]. The ability of decision-making,
and prioritization of multiple nursing interventions depends on clin-
ical judgement and professional and personal experience [3].

Objective

To identify evidence-based nursing interventions that improve the
outcomes of patients with HF under MCS and organize them in the
form of an Advanced Nursing Practice Model.

Methods

Integrative literature review based on a systematic search of original articles and literature reviews published between January 1st, 2010 and August 31st, 2016, in MEDLINE, CINAHL and Cochrane databases and manual search on Google and ResearchGate. Studies related to adult HF patients with formal indication or under MCS in which the first author was a nurse, have been included. Studies related to patients under MCS devices such as intra-aortic balloon counterpulsation or venovenous extracorporeal membrane oxygenation have been excluded.

Results

From the 41 articles included, 43 categories emerged through con-
tent analysis. Those were grouped in four areas of care where nurses
should intervene. The 15 nursing interventions included in the Model
were not mutually exclusive, which makes that the same intervention
can be applied to more than one area of care. There are no validated
protocols to each intervention. The model was constructed based on
the review results and on The Strong Model of Advanced Nursing
Practice [4], Clinical Judgement [5] and Patient Centred Care [2]
frameworks.

Conclusions

HF under MCS patients centred-care is complex and requires team-
work and relational skills. It depends on the best available evidence-
based scientific knowledge, on stakeholders' life experience and on
context and environment specificity. Patient-related outcomes can
be improved through the application of the proposed model. To
make it operational, there is a need to standardize practices and to
develop protocols, guidelines and training programs to improve ad-
vanced nursing practice.

References

1. Creaser JW, Rourke D, Vandenbogaart E, Chaker T, Nsair A, Cheng R, et al. Outcomes of biventricular mechanical support patients discharged to home to await heart transplantation. J Cardiovasc Nurs. 2015;30(4):E13-20.

2. McCormack B, McCance TV. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56(5):472-9.

3. Benner P, Tanner CA, Chesla CA. Expertise in nursing practice: caring, clinical judgment and ethics. 2nd ed. Springer Publishing Company. New York: Springer Publishing Company; 2009.
4. Ackerman MH, Norsen L, Martin B, Wiedrich J, Kitzman HJ. Development of a model of advanced practice. Am J Crit Care. 1996;5(1):68–73.

5. Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006;45(6):204–11.

**Keywords**

Heart failure, Mechanical circulatory support, Nursing interventions, Patient-related outcomes, Advanced nursing practice.

P60

**Acute effects of aerobic exercise on motor memory consolidation in older people**

André Ramalho¹, Pedro Duarte-Mendes¹, Rui Paulo¹, João Serrano¹,²,
António Rosado³, João Petrica¹,²

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-266 Castelo Branco, Portugal; ²Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; ³Faculty of Human Kinetics, University of Lisbon, 1499-002 Lisbon, Portugal

**Correspondence:** André Ramalho (andre.ramalho@ipcb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P60

**Background**

Scientific evidence suggests that an aerobic exercise session promotes improvements in the consolidation of motor memory in adults.

**Objective**

In this sense, the main purpose of this study was to investigate if an aerobic training session could improve motor memory consolidation in older people.

**Methods**

The participants of this study were 33 subjects of both genders (M = 68 years old; SD = 4.2 years old) divided in two groups: a control group and an experimental group. The participants performed a Soda Pop test before the aerobic training session (Baseline). The training session lasted 45 minutes and was composed of running exercises. After the training session, the motor memory consolidation was held in three different stages: Training; 1 hour after training; 24 hours after training. The Shapiro-Wilk test was applied to the normality distribution of data and One-way ANOVA test for parametric statistics.

**Results**

The results indicated that although the experimental group presented a better performance in motor memory consolidation, 1 hour after training and 24 hours after training, the differences were not significant (p ≥ 0.05).

**Conclusions**

Thus, it seems that an aerobic training session does not significantly improve motor memory consolidation in older people.

**Acknowledgements**

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest – OE/CED/UI4016/2016).

Trial Registration

NCT03506490

**Keywords**

Aerobic exercise, Motor memory consolidation, Learning, Aging.

P61

**Fundamentals of care in the critically ill person in ICU: an integrative literature review**

Maria J Pires¹, Helga R Henriques², Maria C Durão³

¹Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal;

²Departamento de Fundamentos de Enfermagem, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal; ³Departamento de Enfermagem Médico-Cirúrgica, Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

**Correspondence:** Maria J Pires (m.jiao.pires08@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P61

**Background**

In the critically ill person, the priority of nursing interventions is, in most cases, exclusively directed to the management of the clinical situation, not valuing the fundamentals of care [1,2]. These universal activities are essential to the maintenance of life. They are present in each person, regardless of their health condition, whenever there is the necessary strength, will or knowledge [3,4]. In acute or chronic illness, injury or in the healthy person, the fundamentals of care may be disturbed, which motivate the nurses' intervention [3,5].

**Objective**

To know the evidence related to the fundamentals of care in the recovery of the critically ill person.

**Methods**

Integrative Literature Review, using a PICO model clinical question and carried out through the search of articles in MEDLINE, CINAHL and grey literature databases.

**Results**

We identified 1,268 results, of which 11 documents were selected to compose the final sample. The analysis of the documents showed that there is an invisibility of the fundamentals of care in ICU, caused by the predominance of biomedical model and technological care. Some studies, however, highlight the importance of nurses' intervention in patient recovery in areas of fundamentals of care, such as sleep [6], breathing, skin, nutrition, communication, patient and family education, mobilization, positioning and hygiene [7,8].

**Conclusions**

Fundamentals of care contribute to reducing complications during hospitalization of patients in the ICU, such as malnutrition, development of pressure ulcers or infection. The fundamentals of care are neglected in this context of care to the detriment of the technological care, reason why it is necessary to investigate this issue.

**References**

1. Feo R, Kitson A. Promoting patient-centred fundamental care in acute healthcare systems. Int J Nurs Stud. 2016;57:1–11.

2. Henneman EA. Patient Safety and Technology. AACN Advanced Critical Care, 2009;20(2):128–132.

3. Henderson V. Principios Básicos dos Cuidados de Enfermagem do CIE. Lusodida, Ed. Loures; 2007.

4. Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. Defining the fundamentals of care. Int J Nurs Pract. 2010;16(4):423–434.

5. Clares JWB, Freitas MC, Galiza FT, Almeida PC. Necessidades relacionadas ao sono/repouso de idosos: estudo fundamentado em Henderson. Acta Paul Enferm. 2012;25(Número Especial 1):54–59.

6. Eliassen K, Hopstock L. Sleep promotion in the intensive care unit-A survey of nurses' interventions. Intensive and Critical Care Nursing. 2011;27(3):138–142.

7. Shahin E, Dassen T, Halfens R. Pressure ulcer prevention in intensive care patients: Guidelines and practice. J Eval Clin Pract. 2009;15(2):370–374.

8. Curtis K, Wiseman T. Back to basics-Essential nursing care in the ED, Part 2. Australasian Emergency Nursing Journal. 2008;11(2):95–99.

**Keywords**

Critical patient, Fundamentals of care, Recovery, Safety.

P62

**Adaptation and validation for the Portuguese population of the Quality of the Carer-Patient Relationship (QCPR) scale: preliminary results**

Rosa Silva¹, Paulo Costa², Isabel Gil³, Hugo Neves⁴,⁵, Nele Spruytte, João Apóstolo²,⁵

¹Universidade Católica Portuguesa, Institute of Health Sciences, 4200-374 Porto, Portugal; ²The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, 3046-851 Coimbra, Portugal; ³Nursing School of Coimbra, Coimbra, 3046-851, Portugal; ⁴School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁵Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁶Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, 3000-232 Coimbra, Portugal

**Correspondence:** Rosa Silva (rcgsilva@porto.ucp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P62
**Background**

The number of elderly with dementia is hastily increasing. The informal (family) carer are urged to perform more activities in order to maintain the elderly health needs. Assessing the quality of the relationship between the dyad (a family carer and a patient with dementia) is necessary to assure that care plans are well adjusted. The Quality of The Carer-Patient Relationship (QCPR), [1] emerges as a specific scale for assessing the quality of the bidirectional relation of the dyad.

**Objective**

To adapt the QCPR scale to Portuguese and determine its psychometric properties.

**Methods**

Phase (I), transcultural adaptation according to the international recommendations of the American Association of Orthopedic Surgeons [2], composed by four steps; Phase (II), a pilot study was conducted to assess the preliminary psychometric properties in the new cultural context, with a convenience sample composed by patients with dementia (n=30) and their caregivers (n=30). The factorial structure of the QCPR in this sample was evaluated through a confirmatory factorial analysis (CFA) with the AMOS software (v.24, SPSS Inc, Chicago, IL).

**Results**

Phase (I), the initial translations proved to be close to the original content (first step). Less consensual terminology was critically analysed and synthesized by the translators and elements of the research team (second step), resulting in the first version. The versions obtained in the back-translation process (third step) presented good semantic and idiomatic equivalence. After expert consensus (fourth step), the scale was revised in its entirety and punctually reformulated. This resulted in a second translated version, which maintained the original structure (an individualized questionnaire for each element of the dyad, with 14 items of the 5-point Likert-type scale response).

Phase (II), the CFA shows no violation of normality in all variables, with the presence of factorial weights below 0.5 in items 10 and 11 in the caregiver's version, and in items 13 and 14 in the patient's version. Regarding the quality of the adjustment of the model, both the caregiver's version ($\chi^2/df=1.304; CFI=0.922; GFI=0.731; RMSEA=0.097 P[RMSEA\le0.05]> 0.05; MECVI=6.739)$, as well as the patient's version ($\chi^2/df=1.152; CFI=0.955; GFI=0.760; RMSEA=0.069 P[RMSEA\le0.05]> 0.05; MECVI=6.475$) present a model with questionable to good adjustment.

**Conclusions**

A strong and positive relation between both latent variables were contrary to what was expected to observe. The fact that only two observations evidenced conflict may indicate that there is a need to strengthen the number and diversity of participants sampled, in order to clarify these preliminary results.

**Acknowledgements**

This study is part of the project "Cognitive stimulation in the elderly: intervention in cognitive fragility and promotion of self-care", funded by the Nursing School of Coimbra.

**References**

1. Spruytte N, Audenhove C, Lammertyn F, Storms G. The quality of the caregiving relationship in informal care for older adults with dementia and chronic psychiatric patients. Psychology and Psychotherapy: Theory, Research and Practice. 2002;75(3):295-311.

2. Beaton D, Bombardier C, Guillemin F, Ferraz M. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine. 2000;25(24):3186-3191.

**Keywords**

Patient-carer relationship, Quality of the relationship, Dementia.

P63

**Association between Mediterranean diet and mood in young volunteers**

Rafael Bravo¹, Nuria Perera¹, Lierni Ugartemendia¹, Javier Cubero², Ana B Rodríguez¹, Maria A Gómez-Zubeldia¹

¹Department of Physiology, Faculty of Science, University of Extremadura, 06071 Badajoz, Spain; ²Health Education Laboratory, Experimental Science Education Area, University of Extremadura, 06071 Badajoz, Spain; ³Department of Physiology, Faculty of Medicine, University of Extremadura, 06071 Badajoz, Spain

**Correspondence:** Rafael Bravo (rbravo@unex.es)

BMC Health Services Research 2018, **18**(Suppl 2):P63

**Background**

Mediterranean diet (MD) is characterized by a high intake of vegetables, a moderate intake of fish and poultry and a low intake of meat and alcohol. MD is considered as a healthy dietary pattern in terms of morbidity and mortality. These benefits have been associated with the ingested levels of olive oil, fibber, non-simple carbohydrates and proteins obtained from vegetables.

**Objective**

In the last years, it has been reported that dietary patterns may influence on several psychological aspects like mood, anxiety or depression. Therefore, our aim was to elucidate whether MD may have a positive effect on the mood of young volunteers.

**Methods**

In this assay participated 52 male volunteers and 80 female volunteers. Participants filled the following scales: Mediterranean Diet Adherence Questionnaire (MDAQ), Beck's Anxiety Inventory, Beck's Depression Inventory, Ruminative Response Scale and the Well-Being Index (WHO-5). After data collection, every psychological variable was correlated with the score obtained in the MD Adherence Questionnaire.

**Results**

Related to male participants our results showed a negative correlation between MDAQ and Personal Dysfunction (p < 0.05). On the other hand, related to women, anxiety showed a negative correlation (p < 0.05) and well-being showed a positive correlation (p < 0.05), when correlated with MDAQ.

**Conclusions**

In our sample, we observed that MD may have positive effects on the mood of both young men and women.

**Acknowledgements**

Authors are grateful to Junta de Extremadura (Fondos FEDER - GR 15051).

**Keywords**

Nutrition, Mediterranean diet, Mood.

P64

**Health education, interprofessional collaboration and infection control in a house of support in southern Brazil**

Andressa T Hoffmann, Adriele Timmen, Alzira MB Lewgoy, Nadia M Kuplich, Ester D Schwarz
Hospital de Clínicas de Porto Alegre, Porto Alegre, 90035903, Rio Grande do Sul, Brasil

**Correspondence:** Andressa T Hoffmann (athoffmann@hcpa.edu.br)

BMC Health Services Research 2018, **18**(Suppl 2):P64

**Background**

Interprofessional collaboration can be understood as the interaction of professionals from different fields of knowledge aiming at a whole and broad health care. In this sense, health education constitutes a means-activity for the promotion of health, with a transforming role of individual practices [1,2]. The emergence of multidrug resistant
(MDR) bacteria is a public health problem, and measures to prevent their spread are essential, together with awareness actions on infectious diseases and basic measures of personal and environmental hygiene.

**Objective**

To describe the interprofessional collaboration carried out by a group of professionals, in the areas of social work, nursing and pharmacy of the hospital infection control commission (HICC), with the staff and the children and relatives housed in a house of support from a university hospital, in Brazil.

**Methods**

Experiences reported from July 2016 to December 2017. After identifying the need for a theoretical deepening in prevention and control of infections, especially in the management of children and adolescents with MDR bacteria and their relationships, in the daily routine of the home, a joint planning of actions was started between the infection control team and the support house staff, focusing on health education. Initially, monthly meetings were made among professionals for reflection and problematization of learning and participatory observation, making feasible the situational diagnosis of the house. In these meetings, subjects such as hand hygiene, bacterial transmission, management of individuals with MDR bacteria, matrix-based strategies, hospital and house of support concepts were discussed, enabling a better understanding of the difference of care inside and outside the hospital. After the development and consolidation of concepts, house staff was encouraged to produce health education actions for their public.

**Results**

The performance of a theatrical play was carried out by both teams in June 2017, where it was identified the consolidation of contents by the professionals in the period of theoretical deepening. After this action, monthly workshops were started with the hosted public, carried out with the participation of both teams, in which issues related to the prevention and control of infections were discussed.

**Conclusions**

Health education and interprofessional collaboration enabled the development of the identity of the house of support, the strengthening of the team in topics of infection control, as well as the planning and carrying out of activities with the house's public. Such health promotion actions enabled employees and family members to become multipliers of good practices in infection prevention and control.

**References**

1. Matuda CG, Pinto NRS, Martins CL, Fazão P. Colaboração interprofissional na Estratégia Saúde da Família: implicações para a produção do cuidado e a gestão do trabalho. Ciência & Saúde Coletiva. 2015; 20(8):2511-2521.

2. Candeias NMF. Conceitos de educação e de promoção em saúde: mudanças individuais e mudanças organizacionais. Rev. Saúde Pública. 1997; 31(2):209-213.

**Keywords**

Health education, Infection control, Interprofessional collaboration.

P65

**Promotion of patient safety in nursing practice: what strategies?**

Tânia Ferreira¹, Rita Marques²

¹Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisboa, Portugal

**Correspondence:** Tânia Ferreira (tania.vaf@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P65

**Background**

Patient safety is a priority for World Health Organization (WHO). The organization considers it fundamental to develop a safety culture among health professionals in general and among nurses in particular, ensuring the safety and quality of the health care.

**Objective**

The purpose of this literature review (LR) was to identify nursing strategies for promoting patient safety.

**Methods**

Using the methodology recommended by the Cochrane Centre, this LR was guided by the research question: "What are the strategies that promote patient safety associated with nursing practice?" A research was carried out in scientific databases, in EBSCOhost (CINAHL® MEDLINE®) and SciELO, with publication dates between January of 2012 and December of 2017, with descriptors "patient safety", "safety culture" and "nursing care", having emerged 47 articles. After reading the title and abstract, 8 articles were selected to answer the research question.

**Results**

The identification of risks for people during nursing care and the incorporation of good practices and trust in teamwork, contribute to the improvement and development of a safety culture in health care [1,2]. The guarantee of satisfaction of the professional, the communication between professionals and institution, and the support to the team given by the administrations, are strategic factors for the assurance of patient safety [3, 4]. Nurses' perceptions about the safety culture of the patient and the intention to report adverse events are significant in promoting patient safety [5-7]. Coaching behaviour showed a significant and positive correlation with safety culture and coaching behaviours of team leaders were associated with higher degrees of perceived safety culture and stronger intentions to report adverse events [2,8]. Openness of communication and non-punitive responses to mistakes, as well as teamwork influence the patient's safety culture [5, 7].

**Conclusions**

Through this LR it was possible to perceive that the safety culture is an issue still underdeveloped in health organizations, where nurses have an essential role. Nursing practice is related to the professionals' perception of patient safety, which is related to a set of strategies that minimize the risks of adverse events.

**References**

1. Oliveira R, Leitão I, Silva L, Figueiredo S, Sampaio R, Gondim M. Estratégias para promover segurança do paciente: da identificação dos riscos às práticas baseadas em evidências. Esc. Anna Nery. 2014; 18(1): 122-129.

2. Hwang J. What are hospital nurses' strengths and weaknesses in patient safety competence? Findings from three Korean hospitals. International Journal for Quality in Health Care. 2015; 27(3): 232-238.

3. Rigobello MCG, Carvalho REFL, Cassiani SHDB, Galon T, Capucho HC, Deus NN. Clima de segurança do paciente: percepção dos profissionais de enfermagem. Acta Paul Enferm. 2012; 25(5): 728-35.

4. Mayeng LM, Wolvaardt JE. Patient safety culture in a district hospital in South Africa: Na issue of quality. Curationis. 2015; 38 (1).

5. Ammouri AA, Tailakh AK, Multiira JK, Geethakrishnan R, Al Kindi SN. Patient safety culture among nurses. International Nursing Review. 2015; 62: 102-110.

6. Costa TD, Salvador PTCO, Rodrigues CCFM, Alves KYA, Tourinho FSV, Santos VEP. Percepção de profissionais de enfermagem acerca de segurança do paciente em unidades de terapia intensiva. Rev Gaúcha Enferm. 2016; 37 (3).
7. Khater WA, Akhu-Zaheya LM, AL-Mahasneh SI, Khater R. Nurses' perceptions of patient safety culture in Jordanian hospitals. International Nursing Review. 2015; 62: 82-91.

8. Ko Y, Yu S. The Relationships Among Perceived Patients' Safety Culture, Intention to Report Errors, and Leader Coaching Behavior of Nurses in Korea: A Pilot Study. J Patient Saf. 2015; 00.

### Keywords

Patient safety, Safety culture, Strategies, Nursing.

## P66

### End of life person's evaluation criteria in the decision making regarding artificial nutrition

Tânia Afonso¹, Filipa Veludo¹, Patrícia P Sousa¹, Sónia Santos²

¹Instituto de Ciências da Saúde, Escola de Enfermagem, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal; ²Unidade de Cuidados Intensivos Polivalente, Hospital Prof Doutor Fernando Fonseca, 2720-276 Amadora, Portugal

**Correspondence:** Tânia Afonso (tafonso3@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P66

### Background

Artificial nutrition at the end of life is assumed as a medical intervention, however for a large percentage of person's and families is considered as basic care [1]. Thinking about artificial nutrition and the end of life person, such as the person with advanced, incurable and progressive disease, with a survival expectancy between 3 to 6 months [2] is often reflected on a set of issues. This is a controversial discussion, about the quality of life resulting of one of these means and ethical questioning [3]. It's relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support.

### Objective

Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses' decision-making about artificial nutrition.

### Methods

Literature Review (15-06-2017) with PRISMA guidelines for reviews [4] in Academic Search Complete, Complementary Index, CINAHL Plus with Full Text®, Psychology and Behavioural Sciences Collection, ScieELO, MEDLINE®, Directory of Open Access Journals, Supplemental Index, ScienceDirect, Education Source, Business Source Complete and MedicLatina. Inclusion/exclusion criteria: nurses who care for adult/elderly persons at the end of life, excluding nurses who care for children; articles about nurses' intervention in nutrition care to the person at the end of life and the person's evaluation criteria; full text; in French/Spanish/English/Portuguese; peer-reviewed; published between 2000-2017. A sample of 11 articles was selected.

### Results

The evaluation criteria to be considered when making decisions on artificial nutrition are: the evaluation of symptoms/problems; emotional value of food; the meaning of the diet for the person at the end of life and definition of prognosis [3,5-6]. In every decision-making, it should be considered the existence of a clinical indication/treatment, a therapeutic objective and the informed consent of a user or legal guardian.

### Conclusions

It is concluded that the decision on artificial nutrition should integrate the person at the end of life and family, be taken by an interdisciplinary team, considering the definition of the prognosis and the effectiveness of the treatment applied [3]. The intervention of the nurse is understood as a primordial one, based on the best evidence, in relation of proximity [5] considered, simultaneously, the principle of autonomy, beneficence, non-maleficence and justice. There is little evidence of end-of-life nutrition and new studies on the role of nurses within the interdisciplinary team are suggested.

### References

1. Stiles E. Providing artificial nutrition and hydration in palliative care. Nursing Standard. 2013, 27: 35-42.

2. Barbosa A [et al.], Manual de Cuidados Paliativos. Lisboa: Núcleo de Cuidados Paliativos, Centro de Bioética da Faculdade de Medicina da Universidade de Lisboa. 2010, 2ª edição;

3. Alves P. Intervenção do Enfermeiro que Cuida da Pessoa em Fim de Vida com Alterações do Comer e Beber. Pensar Enfermagem. 2013, 17(1): 17-30;

4. Moher D [et al.], Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. 2009, 151(4): 264-269;

5. Bryon E [et al.], Decision-making about artificial feeding in end-of-life care: literature review. Journal of Advanced Nursing. 2008, 63(1): 2-14;

6. Holmes S. Withholding or withdrawing nutrition at the end of life. Nursing Standard. 2010, 25(14): 43-46.

### Keywords

Nursing, Artificial nutrition, Therapeutic obstinacy, Integrative review.

## P67

### Psychometric properties of the Portuguese version of personal outcomes scale for children and adolescents: an initial research

Cristina Simões¹,², Célia Ribeiro¹

¹Economics and Social Sciences Department, Portuguese Catholic University, 3504-505 Viseu, Portugal; ²Research Centre on Special Education, Faculdade de Motricidade Humana, 1495-687 Cruz Quebrada, Portugal

**Correspondence:** Cristina Simões (cristina-ferreira@iol.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P67

### Background

The quality of life (QOL) assessment of children and adolescents has been particularly important in the field of intellectual disability (ID) during the past years. Special Education needs to use a systematic approach to the assessment of the QOL domains, in order to implement a social-ecological model and to promote full inclusion in all contexts of life. It is important to develop a scale that provides simultaneously self-report and report-of-others measures to gather information based on a multiperception strategy and to encourage person-centred planning.

### Objective

This research aims to analyse the validity and reliability of the Portuguese version of the Personal Outcomes Scale for Children and Adolescents (POS-C).

### Methods

Data were collected from 54 children and adolescents with ID (M<sub>age</sub> = 12.48, SD = 2.93) and respective proxies (M<sub>age</sub> = 46.59, SD = 5.68). After the cross-cultural adaptation stage, the validity (content, construct) and the reliability (test-retest, Cronbach's alpha, inter-rater) properties of the POS-C were examined.

### Results

All items of the POS-C were considered relevant by 10 experts, who agreed on a Portuguese version of the scale. The scores of the content validity index (CVI) of each item (≥ .80), the scale CVI-universal agreement (≥ .84), the scale CVI-average (≥ .99) and the Cohen's kappa (≥ .44) showed suitable content validity of the scale. The total score from self-report and domains ranged from moderate (r = .42 in emotional well-being) to high (r = .82 in social inclusion). Regarding the report-of-others, the Pearson's coefficients ranged from moderate (r = .49 in emotional well-being) to high (r = .85 in interpersonal relations). The test-retest scores were high in practitioners (r = .95) and in family members (r = .90). The internal consistency reliability of the self-report domains ranged from .41 (interpersonal relations) to .70 (self-determination), and in report-of-others ranged from .54 (physical well-being) to .79 (emotional well-being). The overall scale demonstrated good Cronbach's alpha scores (α = .81 in self-report and α =
.87 in report-of-others). The inter-rater of domains ranged from .47 (interpersonal relations) to .81 (personal development).

**Conclusions**

This initial research on the psychometric properties of the scale, introduces the POS-C as a useful measure of personal outcome scales for Portuguese children and adolescents with ID. POS-C is an important tool to improve personalized support plans, based on self-report and report-of-others measures.

**Keywords**

Quality of life, Intellectual disability, Cross-cultural adaptation, Validity, Reliability.

P68

Development and validation of a multi-domain digital cognitive stimulation program for older adults with mild to moderate cognitive decline

Filipa C Couto¹, Maria A Dixe¹,²,³, Jaime Ribeiro²,³,⁴, Mónica Braúna²,³, Luís Marcelino⁵, João Apóstolo⁶

¹The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, 3000-232, Portugal; ²School of Health Science, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ⁴Research Centre on Didactics and Technology in the Education of Trainers, Department of Education and Psychology, University of Aveiro, Campus Universitário, Aveiro 3810-193, Portugal;

⁵Informatics Engineering Department, School of Technology and Management, Polytechnic of Leiria, Leiria, 2411-901, Portugal; ⁶The Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Nursing School of Coimbra, Coimbra, 3000-232, Portugal

**Correspondence:** Filipa C Couto (filipadccouto@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P68

**Background**

Frail older adults present a decline on their cognitive function. Cognitive interventions are related to the maintenance of cognitive function and are associated with independence and well-being [1, 2]. A cognitive intervention could be considered as a complex intervention once it contains several interacting components [3]. The MIND&GAIT project expects the development of a structured digital cognitive stimulation program to be used with older adults with mild to moderate cognitive decline.

**Objective**

To develop and validate an elderly-friendly multi-domain digital cognitive stimulation program.

**Methods**

To develop the program, the research team followed Guidelines for complex interventions from The Medical Research Council. The development process comprises four phases [3]. The first phase corresponds to a Preliminary Phase (I), the second to a Modelling Phase (II), the third to a Field Test Phase (III) and the last to a Consensus Conference Phase (IV).

**Results**

The digital stimulation cognitive program has 8 individual sessions and 1 group session. The program has already passed for Phase I, which corresponds to an initial conceptualization of the program design and its support materials. At the moment, it is on Phase II, being presented to an experts' panel to gather different opinions and evaluations from specialists in the area of cognitive interventions. Each session of the program will later be evaluated at Phase III. All the contributions and analysis resulted from the previous phases will be synthesized in phase IV. It is expected that the critical evaluation, provided by specialists

in the area of cognitive interventions, will result in a well-founded and structured intervention to be applied in older adults with mild to moderate cognitive decline. The program's construction, supported by guidelines and based in elderly-friendly digital components, intends to give a response to the challenge of an increasing aged population allying e-health. The program is to be used by health professionals and informal caregivers, in order to work as a possible way to prevent or minimize cognitive decline.

**Conclusions**

Cognitive interventions have impact on cognitive decline, a condition that assumes more importance once it is related with frailty in older adults. Although being a multidomain program, it also potentiates people for activities of daily living. As a complex intervention, this program allows health professionals and other people to apply nonpharmacological interventions which can represent the implementation of best practice towards the needs of an ageing population.

**Acknowledgements**

The current abstract is being presented on behalf of a research group. It is also part of the MIND&GAIT project Promoting independent living in frail older adults by improving cognition and gait ability and using assistive products, which is a Portuguese project with the support of COMPETE 2020 under the Scientific and Technological Research Support System, in the copromotion phase. We acknowledge The Health Sciences Research Unit: Nursing (UICISA:E) of the Nursing School of Coimbra, the Polytechnic of Leiria and also to other members, institutions and students involved in the project.

**References**

1. Apóstolo J, Holland C, O'Connell MD, Feeney J, Tabares-Seisdedos R, Tadros G et al. Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA). Maturitas. 2016;83:83-93.

2. Mewborn CM, Lindbergh CA, Miller LS. Cognitive interventions for cognitively healthy, midly impaired and mixed samples of older adults: a systematic review and meta-analysis of randomized-controlled trials. Neuropsychol Rev. 2017;27(4):403-439.

3. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.

**Keywords**

Aged, Cognitive decline, Cognitive stimulation, Frailty, Complex intervention.

P69

Tele-enfermeiro evolution

Telmo Sousa¹, Pedro Brandão¹,⁴, Paulino Sousa²,³, João Rodrigues⁴,⁵

¹Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal;

²Centro de Investigação em Tecnologias e Serviços de Saúde, 4200-450 Porto, Portugal;

³Escola Superior de Enfermagem do Porto, 4200-072 Porto, Portugal;

⁴Instituto de Telecomunicações, 1049-001 Lisboa, Portugal; ⁵Administração Regional de Saúde do Norte, 4000-099 Porto, Portugal

**Correspondence:** Telmo Sousa (telmocatarina17@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P69

**Background**

Despite the high technological growth envisaged in the health area, the use of technologies is still scarce when we refer to the Primary Healthcare (PHC). PHC care is very important because it
allows for the implementation of proximity interventions, such as nursing home care, resulting in an improvement of the health of individuals, families, and communities. The system mentioned above is the one implemented in health centres called S-Clinic and developed by the Serviços Partilhados do Ministério da Saúde (SPMS). However, this process presents some problems, such as the time spent collecting patient data; the introduction of the intervention data into the system, and the lack of a support structure for the data records extracted from the patient by the nurse.

**Objective**

Combining technological evolution, the importance of PHC and the difficulty of the nursing process at home, we propose the development of an application for mobile devices, with the objective of allowing nurses to import patient data through information, data records of the interventions carried out in an electronic format, which are then exported to the system.

**Methods**

In this way, the application will facilitate the work of the nurse because it replaces the records on paper, thus allowing a better collection and structuring of the data, as well as the increase of the efficiency of the work activity, and reduction of the time spent for the collection and introduction of data in S-Clinic. We had to study the essential contents of the nursing process at home and implemented in the system, in order to create a data structure with the closest resemblance to S-Clinic. Then, to obtain this information a meeting was held with nursing experts to provide their knowledge in this area.

**Results**

In this meeting, the contents considered essential for a domicile were addressed, and the key points were: nursing focus or diagnosis and nursing intervention. The data model was implemented in order to cover all the contents. Some security measures that could be implemented have also been discussed, in order to protect data. After the application development was complete, a meeting was held with some of the nursing experts present at the first meeting to gather requirements, in order to evaluate the system.

**Conclusions**

The feedback was very positive, encouraging the research team to continue this development because they see a good solution for the future of the PHC at the home environment.

**Acknowledgements**

This article is a result of the project NanoSTIMA Macro-to-Nano Human Sensing: Towards Integrated Multimodal Health Monitoring and Analytics, Norte-01-0145-FEDER-000016, supported by Norte Portugal Regional Operational Programme (NORTE 2020), through Portugal 2020 and the European Development Fund.

**Keywords**

Nursing, Health information system, Digital health, Innovation, Development.

P70

**Construction of parenthood - role of the family nurse**

Andreia MJS Azevedo, Elsa MOP Melo, Assunção DL Almeida
School of Health Sciences, University of Aveiro, 3810-193 Aveiro,
Portugal

**Correspondence:** Andreia MJS Azevedo (jarmelo.andreia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P70

**Background**

The birth of the first child is presented as the most challenging responsibility facing the family, requiring the adaptation of their

interactions with singular and holistic impact. The first six months emerge as a transient, predictable and irreversible milestone. The transition to parenting is marked by the changes and repercussions that drive the child's growth and development, predating and precipitating others in the family life cycle. Supporting families in transition is the competence of nurses, namely, their intervention in the field of family health nursing, in the training for the construction of parenting.

**Objective**

Understand how parents build their parenting model during the first semester of life of the first child. Analyse parents' expectations and constraints/difficulties in the transition to paternity. Explore identity figures and resources mobilized by parents in the transition to parenthood.

**Methods**

We developed a phenomenological study of qualitative nature, with a non-probabilistic sampling of convenience that includes 11 subjects, parents with the first child to complete six months of life between October and December 2016, enrolled in USF Rainha D. Tereza. We conducted semi-structured interviews, obtaining the narratives of the experiences and their deepest understanding of them. We complied with ethical procedures and submitted the information collected to analysis using WEBQDA Software.

**Results**

We highlight the experience of parenting in the desire to be a parent, and in the expectations created in pregnancy, contributing to the parental model. This is determined by factors such as the characteristics of the child, the characteristics and previous experiences of the parents, and the family dynamics. Parents face difficulties in providing care for the child and reconciling parental, marital and familial and social roles. Faced with these difficulties, parents use human, community and monetary resources. We highlight the community resource in support of health care, which is valued by parents. The family nurse, when identified and recognized, is described as an effective and accessible resource in adapting to parenting.

**Conclusions**

The results obtained by the research carried out allowed us to acknowledge the experience of the transition to parenthood of the parents interviewed and to affirm the role of the family nurse, in their capacity to build their own model of parenting, as well as contributing with knowledge to be valued in nursing interventions.

**Keywords**

Nursing, Family, Transition, Parenthood.

P71

**Antioxidant activity of the garlic (Allium sativum L.) submitted to different technological processes**

Carla Sousa¹, Catarina Novo², Ana F Vinha¹,³

¹Unidade de Investigação em Energia, Ambiente e Saúde, Centro de Estudos em Biomedicina, Fundação Fernando Pessoa, 4249-004 Porto,

Portugal; ²Universidade Fernando Pessoa, 4249-004 Porto, Portugal;

³REQUIMTE/LAQV, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto 4051-401 Porto, Portugal

**Correspondence:** Ana F Vinha (acvinha@ufp.edu.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P71

**Background**

Garlic has become extensively investigated by its benefits for health. Some therapeutic activities are attributed to the garlic, namely, antioxidant, hepatoprotective, anticancer and antitumor properties, among others [1-3].

**Methods**

Therefore, the total phenolic content (TPC) and the total flavonoid content (TFC) have been determined, as well as the antioxidant
properties of extracts of the different forms of presentation/parts of the garlic existing in the market (bulb, in powder and in tablets/capsules), by the radical 2,2-diphenyl-1-picrylhydrazyl (DPPH+) method and by evaluation of the ferric reducing antioxidant power (FRAP). The scavenging capacity of the same extracts against reactive species (O₂•, H₂O₂, NO•) was also evaluated. Finally, the biological activity of the presentation forms of garlic existing in the market was compared with the one of the garlic peel, considered food waste, taking also into account some variables that can influence the properties of the bulb, that is, boiling and freezing.

## Results

TPC was superior in the frozen chopped garlic sample, having the garlic tablets the lowest content. The cooked garlic presented an inferior value of TPC when comparing with the raw chopped bulb. These results indicate that cooking and freezing methods intervene directly with the total phenolic content, but in an opposite way. The extract of cooked garlic had the higher value of TFC, belonging the lowest tenor to garlic tablets. Radical DPPH+ and FRAP methods allowed to verify that the cooked garlic extract evidenced a superior antioxidant activity. This result can be explained by cell wall rupture derived from heating, provoking antioxidant substance release, new and/or stronger antioxidant substance formation or oxidant enzymes inhibition [4]. The frozen chopped garlic extract presented the highest scavenging capacity of the three studied reactive species. In general, the higher the total phenolic content, the greater the capacity of inhibition of reactive species NO•, O₂• and H₂O₂.

## Conclusions

This study has showed that the diverse forms of presentation/parts of the garlic possess high bioactive compounds content, and consequently antioxidant activity, presenting health benefits.

## References

1. Banerjee SK, Mukherjee MK, Paulik SK. Garlic as an antioxidant: the good, the bad and the ugly. Phytother Res. 2003, 17(2): 97-106.

2. Naji KM, Al-Shaibani ES, Alhadi FA, Al-Soudi SA, D'souza MR. Hepatoprotective and antioxidant effects of single clove garlic against CCl4-induced hepatic damage in rabbits. BMC Complement Altern Med. 2017, 17: 411.

3. Oommen S, Anto RJ, Srinivas G, Karunagaran D. Allicin (from garlic) induces caspase-mediated apoptosis in cancer cells. Eur J Pharmacol. 2004, 485(1-3): 97-103.

4. Ali M, Mahsa M, Barmak MJ. Effect of boiling cooking on antioxidant activities and phenolic content of selected iranian vegetables. Res J Pharm Biol Chem Sci 2015, 6(3): 663-641.

## Keywords

*Allium sativum* L., Bioactive compounds, Antioxidant activity, Reactive species.

## P72

### Influence of gamma irradiation in the antioxidant potential of pumpkin seeds and mung beans

Anabela Macedo<fnref n="1" />, Carla Sousa², Ana F Vinha²,<fnref n="3" />

**Correspondence:** Ana F Vinha (acvinha@ufp.edu.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P72

Food conservation is a challenge for the food industry. The high respiration rate, the lack of physical protection to avoid water loss and the changes due to microbial attack are often associated with loss of food quality, contributing to deterioration through browning, weight loss and texture changes [1]. Furthermore, bacteria, moulds, enzymatic activity (mainly polyphenol oxidase) and biochemical changes can cause spoilage during storage [2]. The use of ionizing energy for preservation has been widely studied by the food industry. However, studies evaluating the effects of ionizing radiation are mostly available in cultivated species, being scarce the reports on wild species

and food waste, considered add-value foods. In this regard, food technology is making progress towards increasing food preservation and contributing to a reduction of the incidence of food-related diseases. Previous studies assessing the potential of gamma irradiation as a suitable technique to increase natural products shelf-life were focused in nutritional and chemical parameters, including bioactive compounds and their antioxidant activity [3]. Many natural compounds found in edible food wastes (seeds) or grains (beans) present antioxidant activity. Among the most important natural antioxidants are phenolic compounds (flavonoids, phenolic acids and tannins), nitrogenous compounds (alkaloids, amino acids, peptides, amines and chlorophyll byproducts), carotenoids, tocopherols and ascorbic acid. In the present work, the effects of gamma radiation dose (0, 0.5, 1.0, 1.5 and 5.0 kGy) on the chemical composition (total phenolics and total flavonoids) of pumpkin seeds and mung beans were evaluated. The antioxidant activity was studied using DPPH+ and FRAP assays. It was observed a slight increase in the content of bioactive compounds, as well as in antioxidant activity, with irradiation doses below 1.5 kGy. Final results showed that irradiation may be a viable technique to guarantee the content of bioactive compounds, as well as their biological properties, including antioxidant activity.

## References

1. Singh P, Langowski HC, Wanib AA, Saengerlaub S. Recent advances in extending the shelf life of fresh Agaricus mushrooms: a review. J Sci Food Agric. 2010, 90: 1393-1402.

2. Fernandes Â, Barreira JCM, Antonio AL, Bento A, Botelho ML, Ferreira ICFR. Assessing the effects of gamma irradiation and storage time in energetic value and in major individual nutrients of chestnuts. Food Chem Toxicol. 2011, 49: 2429-2432

3. Antonio AL, Fernandes Â, Barreira JCM, Bento A, Botelho ML, Ferreira ICFR. (Influence of gamma irradiation in the antioxidant potential of chestnuts (Castanea sativa Mill.) fruits and skins. Food Chem Toxicol. 2011, 49: 1918-1923.

## Keywords

Food conservation, Gamma irradiation, Pumpkin seeds, Mung beans, Antioxidants.

## P73

### The effects of swimming and swimming complemented with water walking on spirometry values

Pedro Duarte-Mendes<fnref n="1" />,², Samuel Honório<fnref n="1" />,², João Oliveira<fnref n="1" />, João Petrica<fnref n="1" />,<fnref n="3" />, André Ramalho<fnref n="1" />,², António Faustino<fnref n="1" />, Rui Paulo<fnref n="1" />,²

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention, 4411-801 Arcozelo, Vila Nova de Gaia, Portugal;

³Centre for the Study of Education, Technologies and Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal

**Correspondence:** Pedro Duarte-Mendes (Pedromendes@ipcb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P73

### Background

Spirometry is a standard pulmonary function test that measures how an individual inhales or exhales volumes of air as a function of time. It is the most important and most frequently performed pulmonary function testing procedure, having become indispensable for the prevention, diagnosis and evaluation of various respiratory impairments. However, there have been only a few studies addressing the effect of physical activity on pulmonary function test results and investigating the association between body composition and respiratory parameters in sports activities [1-3].

### Objective

The objective of this study was to verify if there are differences in spirometry values in children aged between 6 and 12 years who practice swimming complemented with water walking at the end of each session and those who only practice swimming.

### Methods

In this study 28 subjects (mean age, 7.68 ± 1.16 years) participated and were divided into two groups: swimming group (SG) (N=9) and

<footnote n="1">¹Universidade Fernando Pessoa, 4249-004 Porto, Portugal; ²Unidade de Investigação em Energia, Ambiente e Saúde, Centro de Estudos em Biomedicina, Fundação Fernando Pessoa, 4249-004 Porto, Portugal;</footnote>

<footnote n="3">³REQUIMTE/LAQV, Departamento de Ciências Químicas, Faculdade de Farmácia da Universidade do Porto 4051-401 Porto, Portugal</footnote>
swimming complemented with water walking group (SWWG) (N=19). The study was performed in 12 weeks with 3 moments of evaluation (M1, M2 and M3), with two sessions per week of 45 minutes each, we wanted to identify the benefits in pulmonary function - Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and Peak Expiratory Flow (PEF). The water walking activity occurred at the end of each session for 6 minutes, performed in straight line with the water level at the children's chest. The spirometry tests were realized with the microQuark Spirometer®. For the analysis of the results, we used descriptive statistics, the Shapiro Wilk test for testing the normality of the sample and for inferential statistics the Mann-Whitney tests, Friedman's Anova, and d-Cohen for the magnitude of effect.

**Results**

The results show, that from the inter-group analysis (comparison between the SG and the SWWG) we observe that there were significant differences in the FVC (M2 - p=0.025), VEF1 (M2 - p=0.01; M3 - p=0.008) and PEF (M1 - p=0.033; M2 - p=0.012; M3 - p=0.037) values. Concerning intra-group differences (improvement in the SG and the SWWG in the three moments evaluated), the SWWG showed significant differences in FVC (p= 0.003) and FEV₁ (p=0.008), and the SG showed significant differences in VEF₁ (p=0.034) and PEF (p=0.013).

**Conclusions**

These results show that "swimming" and "swimming complemented with water walking" show improvements in spirometry values in children. The swimming complemented with water walking group showed better results.

**Acknowledgements**

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest - OE/CED/UI4016/2016).

**Trial Registration**

NCT03506100

**References**

1. Durmic T, Lazovic B, Djelic M, Lazic J, Zikic D, Zugic V, Dekleva M, Mazic S. Sport-specific influences on respiratory patterns in elite athletes. J Bras Pneumol. 2015, 41: 516-522.

2. Vaithiyanadane V, Sugapriya G, Saravanan A, Ramachandran C. Pulmonary function test in swimmers and non-swimmers- a comparative study. Int J Biol Med Res. 2012, 3, 1735-1738.

3. Lopes, M. d., Bento, P. C., Lazzaroto, L., Rodacki, A. F., & Leite, N. (2015). The effects of water walking on the anthropometrics and metabolic aspects in young obese. Rev Bras Cineantropom Desempenho Hum. 2015, 17, 235-237.

**Keywords**

Spirometry, Swimming, Water walking.

## P74

**Preliminary translation and validation of Movement Imagery Questionnaire - Children (MIQ-C) to Portuguese**

Pedro Duarte-Mendes¹,², Daniel Silva¹, João Petrica¹,³, Daniel Marinho⁴,⁵, Bruno Travassos⁴,⁵, João Serrano¹,³

¹Department of Sports and Well-being, Polytechnic Institute of Castelo Branco, 6000-084 Castelo Branco, Portugal; ²Research on Education and Community Intervention 4411-801 Arcozelo - Vila Nova de Gaia, Portugal; ³Centro de Estudos em Educação, Tecnologias e Saúde, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal; ⁴Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal;

⁵Research Center in Sports Sciences, Health Sciences and Human Development, University of Tras-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal

**Correspondence:** Pedro Duarte-Mendes (Pedromendes@ipcb.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P74

**Background**

The ability to perform movement imagery has been shown to influence motor performance and learning in sports and rehabilitation.

Imagery is a cognitive process that can play an important role in planning and execution of movements or actions. Several instruments have been developed in order to evaluate the ability of Imagery in adults such as the MIQ-3, with Portuguese Athletes [1]. However, none focused on imagery ability questionnaire for children with the three modalities (kinesthetic, visual internal and visual external imagery) for Portuguese children's.

**Objective**

The objective of this study was to translate and validate preliminary, for the Portuguese children's population, the Movement Imagery Questionnaire for Children [2], determining its initial psychometric qualities through an exploratory factor analysis model that supports it.

**Methods**

In this study 162 subjects of both genders (124 male, 38 female) with a mean age of 10.1 years (SD = 16) participated. For the development of the Portuguese adaptation of the evaluation instrument, a methodology was developed in two phases: (1) the translation phase and cultural adaptation of the questionnaire and (2) the application of the Exploratory Factor Analysis method of the instrument. In the statistical analysis of data, we used the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, to evaluate the quality of the correlations, and an exploratory factorial analysis (EFA) to determine the number of factors to be retained, the number of items associated with them and their internal consistency. The type of rotation adopted was the oblique rotation Promax.

**Results**

Initially it was found that the procedures of translation and adaptation originated a Portuguese version of MIQ - C similar to the original version. Secondly, we found that the psychometric qualities proved their suitability of adaptation performed (KMO=0.822, Bartlett test p=0.000), demonstrating that its factor structure is the same as the original version (12 items grouped into 3 factors, with 4 items each factor), with quite acceptable levels of validity and reliability (Cronbach's alpha: 0.85 to MIQ - C, 0.79 for the kinesthetic imagery, 0.74 for the visual internal imagery and 0.76 for the visual external imagery).

**Conclusions**

The results showed that the Portuguese version of the Movement Imagery Questionnaire for Children, with the aim to assess the imagery ability in three modalities (kinesthetic, visual internal and visual external imagery) has quite acceptable indexes for its validation.

**Acknowledgements**

This work was supported by the Portuguese Foundation for Science and Technology (FCT; Grant Pest - OE/CED/UI4016/2016).

**References**

1. Mendes P, Marinho D, Petrica J, Silveira P, Monteriro D, Cid L. Translation and Validation of the Movement Imagery Questionnaire - 3 (MIQ - 3) with Portuguese Athletes. Motricidade. 2016, 12, 149-158.

2. Martini R, Carter M, Yoxon E, Cumming J, Ste-Marie M. Development and validation of the Movement Imagery Questionnaire for Children (MIQ-C). Psychology of Sport and Exercise. 2016, 22: 190-201.

**Keywords**

Imagery, Translation and validation, Children, Exploratory factor analysis.

## P75

**New emerging point-of-care platforms for Clostridium difficile testing**

Isabel Andrade¹, Chantal Fernandes²,³, Teresa Gonçalves²,³

¹Coimbra Health School, Polytechnic Institute of Coimbra, 3046-854

Coimbra, Portugal; ²Institute of Microbiology, Faculty of Medicine,

University of Coimbra, 3004-504 Coimbra, Portugal; ³Center for

Neuroscience and Cell Biology, University of Coimbra, 3004-504
Coimbra, Portugal

**Correspondence:** Isabel Andrade (imandrade@estescoimbra.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P75
**Background**

Since 2000, the incidence and severity of *Clostridium difficile* (C. difficile) infections have increased, justifying the need for expedite, sensitive and specific methods of diagnosis. The existing rapid diagnostic tests vary widely in terms of clinical usefulness, which is evaluated on its sensitivity, specificity, turnaround time (TAT), cost, and availability. Besides that, there is no generally accepted gold standard or single optimal approach for C. difficile testing. This has challenged various stakeholders to develop point-of-care (POC) platforms with the best test performance characteristics, easy to use, and with rapid TAT, a critical element of POC testing to improve the clinical management of this infectious disease. POC testing can be done at home, at the primary care level, by hospital staff in emergency or operating rooms, intensive care units, as well as in extreme environments, such as remote or low-resource settings, or in conditions following emergency crises or natural disasters.

**Objective**

To review current evidence regarding emerging POC platforms for C. difficile testing.

**Methods**

PubMed database was searched using keywords relevant to POC testing of C. difficile, since 2000, yielding a total of 10 articles included out of 17 initially identified/selected for full review.

**Results**

The findings show that during the last decade extensive research efforts were underway to develop stand-alone platforms suitable for POC testing of C. difficile infections. Multistep algorithms using the polymerase chain reaction test for C. difficile toxin gene(s) have the best test performance characteristics, and a trend seems to exist in favour of molecular tests in detriment of immunoassays, in POC platforms. A common feature to all POC devices is the rapid TAT, within seconds-minutes to a few hours, which is crucial for C. difficile infection management. Some of these POC devices enable to run either multiplex tests on a single sample, or multiple samples. Although the majority of these stand-alone POC platforms for C. difficile testing are still prototypes, they may be looked at as a step towards more rapid, miniaturized, portable and easier to use test devices with the potential to affect healthcare decisions at its earliest stage.

**Conclusions**

In conclusion, research efforts show an increasing number of technologies evolving for the development of POC platforms for C. difficile testing.

**Keywords**

Clostridium difficile, Point-of-care testing, Turnaround time, Stand-alone platform.

P76

**Contributions for the validation of the Portuguese version of the Cohen-Mansfield Agitation Inventory (CMAI)**

Rafael Alves¹, Daniela Figueiredo²,³, Alda Marques²,⁴

¹Psychiatric Hospital Centre of Lisbon, 1749-002 Lisbon, Portugal;

²School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal; ³Institute of Biomedicine, University of Aveiro, 3810-193 Aveiro, Portugal; ⁴Center for Health Technology and Services Research, University of Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Rafael Alves (susanapupocorreia@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P76

**Background**

Dementia represents one of the greatest health challenges due to its incidence and frequency, costs and impacts on the individual, family and society. The Diagnostic and Statistical Manual of Mental Disorders – V (DSMV) considers that the behavioural changes, i.e., the non-cognitive aspects of dementia, should be diagnosed, however, this is often not common practice. The identification and quantification of Behavioural and Psychological Symptoms of Dementia (BPSD) can be objectively assessed using the Cohen-Mansfield Agitation Inventory (CMAI). CMAI is a reliable and valid instrument used in clinical and research practice [3], however, it has never been validated for European Portuguese.

**Objective**

To contribute for the adaptation and validation of the CMAI for the European Portuguese population.

**Methods**

The study was conducted in two phases. The first phase consisted of the translation and cultural and linguistic validation of the CMAI according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The following methodology was used a) Translation, b) Reconciliation, c) Retroversion, d) Harmonization, e) Cognitive testimony/analysis and e) Spelling review. In phase 2, the internal consistency was calculated using the Cronbach's alpha. The intra- and inter-rater reliability was determined using the Intraclass Correlation Coefficient (ICC), using the intra-rater (1,1) and the inter-rater (2,1) equations. A factorial exploratory analysis of the construct validity was conducted with 101 people with dementia (83.3 ± 8.0 years; n=83; 82.2% female). Statistical analysis was performed with the Kaiser-Meyer-Olkin (KMO) test, on the behaviours manifested by more than 10% of the sample and only items weighing more than 0.4 were included in the extracted factors.

**Results**

The Portuguese version of CMAI revealed good reliability inter-rater (ICC> 0.4 for 22/29 items) and excellent intra-rater (ICC> 0.75 for 21/29 items) reliability and good internal consistency (α = 0.694). The factorial exploratory analysis was applied to 21 items that meet the criterion. An association in three factors "non-aggressive physical behaviour" (67.3%), "aggressive behaviour" (66.3%) and "verbal agitation behaviour" (63.4%) was found with a reasonable quality (KMO = 0.664) and reasonable internal consistency values (0.754; 0.633; 0.714).

**Conclusions**

This study contributed to the availability of a measurement instrument for the European Portuguese, that can be used in clinical or research contexts, with people with dementia. As a future study it is suggested to analyse the remaining validation processes (criterion and confirmatory factor analysis).

**Keywords**

Dementia, Instrument, BPSD, Agitation.

P77

**Analysis of the activations of the Intra-Hospital Emergency Team**

Marisa J Cardo¹, Pedro Sousa²,³

¹Centro Hospitalar de Leiria, 2410-197 Leiria, Portugal; ²School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; ³Center for Innovative Care and Health Technology, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

**Correspondence:** Marisa J Cardo (marisacardo@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P77

**Background**

The safety of patients is extremely important, therefore the Intra-Hospital Emergency Team (IHET) has emerged to respond to situations of clinical deterioration of hospitalized patients. When the patient presents deterioration of his clinical condition, it requires being examined in a timely manner by a team that provides the highest level of care. That seems to be the better way to avoid the occurrence of critical events, such as mortality, cardiovascular arrest and unplanned admission in intensive care units.

**Objectives**

This study aims to determine the characteristics of the IHET activations of Centro Hospitalar de Leiria (CHL).

**Methods**

This exploratory study analysed the registrations of the activations occurred in the last half of 2011, totalling 325 records. Sociodemographic and clinical characteristics of the patients, and the characteristics of the activations were analysed using the chi-square test and ANOVA.

**Results**

This study showed IHET activations mainly for male patients (56%), with a mean age of 74.48 ± 13.34 years, with an admission diagnosis related to respiratory diseases (34%) and with the main activation
criterion of worried professional (33%). Despite the lack of records on the presence of previous signs of clinical deterioration, it was found that only 27% of patients presented them. The relationship between the presence of previous signs of deterioration and the result of the activation stands out ($\chi^2 = 18.695$; $p \le 0.001$).

### Conclusions

It was found that the IHET was activated in a timely manner by nurses who were knowledgeable of their patients and with the capacity to predict critical events, which enabled the best possible outcomes.

### Keywords

Hospital rapid response team, Nursing, Emergency situation, Clinical deterioration.

## P78

### Virtual assistant to facilitate self-care of older people with type 2 diabetes: preliminary study protocol

Mara P Guerreiro<fnref n="1" />, Adriana Henriques<fnref n="1" />, Isabel CE Silva<fnref n="1" />, Anabela Mendes<fnref n="1" />, Ana P Cláudio<fnref n="2" />, Maria B Carmo<fnref n="2" />, João Balsa<fnref n="2" />, Susana Buinhas³, Nuno Pimenta<fnref n="4" />, Afonso M Cavaco⁵

**Correspondence:** Mara P Guerreiro (mara.guerreiro@esel.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P78

### Background

More than a quarter of people aged 60-79 years is diabetic [1]. The management of type 2 diabetes (T2D) includes diet, physical activity and, often, medicines; it requires daily self-care and constant lifestyle-related choices [2]. It has been estimated that glycaemic control is achieved in less than 50% of T2D patients due to low self-care behaviour [2]. Sustained hyperglycaemia causes complications and premature death, as well as significant costs [1]. Improving self-care and T2D management is therefore crucial.

Technology-based interventions, such as text messages, have successfully been used in T2D management; nevertheless, challenges remain, such as acceptability to users and attrition [3,4]. Relational agents, which are computational artefacts designed to establish rapport and trust by simulating face-to-face counselling in long-term interactions, may overcome such challenges. In particular, they have shown acceptability to older and low literacy patients in other contexts [5,6]. There is a paucity of research on the use of relational agents in older people with T2D.

### Objective

To develop a viable prototype of a relational agent software to assist older T2D patients in self-care and to test its use in this patient group.

### Methods

This is a mixed-method study, grounded in the Medical Research Council framework to develop and evaluate complex interventions [7]. The first stage - development of the optimal intervention - will comprise the definition of pre-requisites, content production (e.g. analog creation guided by behaviour-change theories) and empowering existing virtual humans [8] with artificial intelligence. Users and health care professionals will be involved iteratively. The software is expected to run in a tablet, independently from internet connections, targeting adherence to physical activity, diet and medication-use, without assistance from health care professionals. The second stage will be a non-randomised, non-controlled feasibility trial. Eligible subjects enrolled in diabetes nursing consultations in primary care will be invited to participate. Main outcome measures include software use (timing and frequency, usability, patient satisfaction), reported self-care and reported medication adherence. Acceptability will be researched through focus groups. In both stages data will be

analysed with the aid of SPSS; qualitative data will be transcribed verbatim and thematically analysed with NVIVO software.

### Results

Data collection will start once ethical approval is obtained.

### Conclusions

The study is expected to yield a software prototype to facilitate self-care of older T2D patients, with potential to become an effective, scalable and sustainable intervention.

### Acknowledgements

The study is funded by Compete 2020 and FCT (024250, 02/SAICT/2016).

### References

1. Sociedade Portuguesa de Diabetologia. Diabetes: Factos e Números - o ano de 2015.2016.

2. García-Pérez L-E, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013;4:175-94.

3. Arambepola C, Ricci-Cabello I, Manikavasagam P, Roberts N, French DP, Farmer A. The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials. J. Med. Internet Res. 2016;18.

4. Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, et al. Web 2.0 chronic disease self-management for older adults: A systematic review. J. Med. Internet Res. 2013;15:e35.

5. Bickmore T, Caruso L, Clough-Gorr K, Heeren T. "It"s just like you talk to a friend' relational agents for older adults. Interact. Comput. 2005;17:711-35.

6. Bickmore TW, Pfeifer LM, Paasche-Orlow MK. Health Document Explanation by Virtual Agents. In: Pelachaud C, Martin J-C, André E, Chollet G, Karpouzis K, Pelé D, editors. Intell. virtual agents. Springer; 2007:183-96.

7. Möhler R, Köpke S, Meyer G. Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). Trials; 2015;16:1-9.

8. Cláudio AP, Carmo MB, Pinto V, Guerreiro MP. Virtual Humans for Training and Assessment of Self- medication Consultation Skills in Pharmacy Students. Proc. IEEE ICCSE 2015- 10th Int. Conf. Comput. Sci. Educ. 2015:175-80.

### Keywords

Diabetes, Self-care, Relational agents, Technology, Elderly

## P79

### Use of maggot therapy in a hard-to-heal wound care unit: application and home follow-up protocol

Rodrigo C Ferrera<fnref n="1" />, María AF Fernández<fnref n="1" />, Pablo G Molina<fnref n="2" />, Evelin B Lopez<fnref n="2" />, Alberto P Paredes³, Adán A Ordiales<fnref n="4" />,⁵

**Correspondence:** Alberto P Paredes (alpe1591@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P79

### Background

Larval debridement therapy or "maggot" therapy or biosurgery is described as the use of worms for the removal of non-viable tissue. Debridement is achieved thanks to the action of proteolytic enzymes, which are secreted by these larvae, liquefying the protein material on the surface of the wound, which is subsequently used by the larvae as a nutritive material. Healthy tissues are not affected, making this method the most selective among those available. In addition, this therapy helps to fight infection and helps normalization and closure of injuries. Larval debridement has been successfully used in a large range of chronic hard-to-heal wounds with presence of non-viable tissue of many

<footnote n="1">¹Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal;</footnote>

<footnote n="2">²Instituto de Biossistemas e Ciências Integrativas, Universidade de Lisboa, 1749-016 Lisboa, Portugal; ³Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal; ⁴Escola Superior de Desporto de Rio Maior, Instituto Politécnico de Santarém, 2040-413 Rio Maior, Portugal; ⁵Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal</footnote>

<footnote n="1">¹Nursing Department, University of Las Palmas de Gran Canaria, 35015</footnote>

<footnote>Canary Islands, Spain; ²Nursing Department, University of Valencia, 46010</footnote>

<footnote>Valencia, Spain; ³Hospital Clínico Universitario, 46010 Valencia, Spain;</footnote>

<footnote n="4">⁴Hard-to-heal Nursing Care Unit, Hospital Clínico Universitario, 46010</footnote>

<footnote>Valencia, Spain; ⁵Nursing Department, University of Valencia, 46010 Valencia, Spain</footnote>
aetiologies such as pressure ulcers, venous or ischemic wounds or diabetic foot ulcers [1-5]

**Objective**

To ensure continuity in care in the aim of obtaining the best results from the use of larval debridement therapy, while allowing the administration of treatment in any healthcare context, especially at the patient's own home.

**Methods**

The procedure for the use of Maggot therapy has been elaborated and coordinated by the Nursing Unit of Ulcers and Complex Wounds of the Hospital Clínico de Valencia. This protocol includes the administrative process, selection of the size of the dressings and the procedure of application and care of the therapy itself. At the same time, an information brochure was prepared for family members, patients and care professionals with information about daily surveillance and application of the therapy.

**Results**

This protocol is in the process of being implemented, having been applied in several patients with different aetiology of hard-to-heal wounds within home follow-up care with successfully results.

**Conclusions**

The implementation of a protocol for the use of Maggots debridement therapy seems to be effective in ensuring continuity in the treatment and follow-up of patients with difficult healing wounds in a home care context.

**References**

1. Ballester Martínez L, Martínez Monleón E, Serra Perucho N, Palomar Llatas F. Utilización de la Terapia Larval en Heridas Desvitalizadas: Revisión Bibliográfica [Use of Maggots Therapy in Necrotic Wounds: Literature Review]. Enf Derm. 2016, 10: 27-33.

2. McCaughan D, Cullum N, Durnville J, VenUS II Team. Patient2s perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study. Health Expect. 2015, 18(4): 527-541.

3. Mudge E, Price P, Walkley N, Harding KG. A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Wound Repair Regen. 2014, 22(1): 43-51.

4. EWMA Document. Larvae debridement therapy. J Wound Care. 2013, 22(1): 522-525.

5. Whitaker IS, Twine C, Whitaker MJ, Welck M, Brown CS, Shandall A. Larval trerapy from antiquity to the present day: mechanisms of actions, clinical applications and future potential. Postgrad Med J. 2007, 83(980): 409-413.

**Keywords**

Maggot therapy, Wound care, Debridement, Home-care settings, Protocole.

P80

**Adverse reactions and dietary supplements**

Andreia Barros¹, Cláudia Pinho², Ana I Oliveira², Rita F Oliveira²,³,
Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Rita F Oliveira (rfo@ess.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P80

**Background**

Over the last years, the use of dietary supplements has increased substantially [1]. Although these products are considered as safe and can be beneficial, there are risks associated with some. Manufacturers are not required to demonstrate their safety and efficacy, so it is essential that consumers have good knowledge about dietary supplements [2]. The attribution of injury to a

specific supplement can be challenging, especially because of the multiple ingredients, the variability in quality and content, as well as the vast underreporting of adverse reactions [3].

**Objective**

This study aims to identify the main adverse reactions and knowledge on reporting adverse events associated to the use of dietary supplements, by the population of Porto (Portugal).

**Methods**

A descriptive, cross-sectional study was performed through an anonymous, confidential and voluntary questionnaire to 404 adult participants from the municipality of Porto (Portugal). Data were analysed quantitatively using SPSS version 24.0.

**Results**

Of the 404 participants, 54.7% (221) were females and 45.3% (183) were males. Results revealed that 55.9% (226) of the participants were users of dietary supplements and the common reasons for consuming supplements were to improve memory, concentration and reduce fatigue. Of the 226 consumers of supplements, only 1.3% (3) identified adverse reactions after taking supplements with multivitamins and used for insomnia and anxiety. Of the 404 participants, 21.5% (87) referred to know that is possible to report an adverse reaction associated to dietary supplements, in Portugal, since 2014. Also, only 8.9% (36) referred to know which entity is responsible for the adverse reactions associated to supplements, and of these 36 participants only 5.6% (2) had correctly answered the name of the entity - Direção Geral da Alimentação e Veterinária (DGAV).

**Conclusions**

The findings of this survey indicate the need to provide knowledge on reporting adverse events associated with dietary supplements use. It is essential to provide adequate information to facilitate better understanding of the risks associated with the use of these products.

**References**

1. Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999–2012. JAMA. 2016, 316:1464–1474.

2. Axon DR, Vanova J, Edel C, Slack M. Dietary Supplement Use, Knowledge, and Perceptions Among Student Pharmacists. Am J Pharm Educ. 2017, 81(5): 92.

3. Felix TM, Karpa KD, Lewis PR. Adverse Effects of Common Drugs: Dietary Supplements. FP Essent. 2015, 436:31-40.

**Keywords**

Dietary supplements, Risks, Adverse reactions reporting, DGAV.

P81

**Urinary tract infections and dietary supplements: counselling in pharmacy**

Marta Novais¹, Cláudia Pinho², Ana I Oliveira², Rita F Oliveira²,³,
Agostinho Cruz²

¹Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ²Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, 4200-072 Porto, Portugal; ³Secção Autónoma de Ciências da Saúde, Universidade de Aveiro, 3810-193 Aveiro, Portugal

**Correspondence:** Rita F Oliveira (rfo@ess.ipp.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P81

**Background**

Urinary tract infections (UTIs) are some of the most common bacterial infections [1]. Treatment usually involves antibiotics, and recurrence is a major concern [2]. Therefore, identifying new and effective strategies, like the use of botanical dietary supplements, to control UTIs is a high priority. It is also important to provide health professionals with adequate knowledge related to the use
of dietary supplements and other complementary and/or alternative medicines.

**Objective**

This study aims to evaluate the counselling practices by pharmacy professionals, working in Barcelos (Portugal), related to the use of botanical dietary supplements, in the prevention and/or treatment of urinary infections.

**Methods**

A descriptive, cross-sectional study was performed through an anonymous, confidential and voluntary questionnaire to a convenience sample of 108 pharmacy professionals from Barcelos (Portugal). Data were analysed using SPSS version 24.0.

**Results**

Of the 108 participants, 67.6% were females and 32.4% were males. The results showed that 96.3% of the professionals usually advise the use of dietary supplements for the prevention and/or treatment of lower urinary tract infections. The common reasons to recommend supplements include the efficacy and safety of these products, and the lower price. It was also observed that 64.8% of pharmacy professionals consider their knowledge sufficient to recommend dietary supplements for the prevention and/or treatment of urinary infections. Regarding the recommendations by professionals for the prevention of urinary tract infections, the products containing Vaccinium macrocarpon L. were the most recommended. On the other hand, products containing Arctostaphylos uva ursi L were the most recommended for the treatment of urinary tract infections. In general, the main plants sold by pharmacy professionals for the control of urinary tract infections included Vaccinium macrocarpon L., Arctostaphylos uva ursi L., Vaccinium myrtillus L., Equisetum arvense L. and Hibiscus sabdariffa L..

**Conclusions**

The findings of this study revealed that pharmacy professionals recommend dietary supplements for control of urinary tract infections and consider their knowledge sufficient to properly advise these products. Because evidence on the efficacy of dietary supplements is often scarce or controversial, providing consistent recommendations about these products to their patients can be challenging for healthcare professionals.

**References**

1. Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis. 2001, 183 (Suppl 1):S1-S4.

2. Guay DR. Contemporary management of uncomplicated urinary tract infections. Drugs. 2008, 68(9):1169-205.

**Keywords**

Urinary Tract Infections, Botanical Dietary supplements, Counseling, Pharmacy Professionals.

P82

**Nurse's intervention – end of life nutrition approach protocol**

Tânia S Afonso¹, Filipa Veludo¹, Patrícia P Sousa¹, Dulce Oliveira²

¹Instituto de Ciências da Saúde, Escola de Enfermagem, Universidade Católica Portuguesal, 1649-023 Lisboa, Portugal; ²Unidade de Medicina Paliativa, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, Portugal

**Correspondence:** Tânia S Afonso (tafonso3@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P82

**Background**

To know that nutrition in the present society is increasingly associated with life maintenance and comfort, helps us to understand the complexity of this subject when approached the end of life. Artificial nutrition remains controversial in a palliative context, given the questioning

about the quality of life that offers [1]. Protocols help nurses in the decision-making process and increasing their competences.

**Objective**

To present an end-of-life nutrition approach protocol for palliative care.

**Methods**

This study is the result of three integrative literature reviews that intended to measure: which nursing interventions promote end of life nutrition in people without artificial nutrition criteria?; what are the evaluation criteria for the end-of-life person for the nurse's decision-making of start, don't start or suspending artificial nutrition?; does the nurse's interventions towards the end-of-life reduce the risk of therapeutic obstinacy associated with artificial nutrition? Based in Buckman & Spikes Communication Protocol [2], the results were integrated in a protocol form and submitted to the opinion of 13 experts, from 18th October to 6th November 2017, and the respective changes were made. Inclusion criteria of experts were: being health professionals; palliative care experience and/or work development in nutrition subjects.

**Results**

Our experts have on average 37 years old; 10 carry out their activity in Palliative settings, 8 of these have advanced training in Palliative Care. Our protocol considers: I) setting - preparing the environment; II) perception - prior knowledge of the person/family information about nutrition, preferences and considerations regarding the future commitment of feeding and active listening, understanding what the person/family wants to know, especially as to the meaning of nutrition, what that moment represents and invite them to address the subject; III) knowledge - provide adequate information in phases, contextualizing the present symptoms in the disease process (prognosis) and discuss the evaluation criteria before starting artificial nutrition; IV) emotions - attend to the emotions and provide realistic hope; V) strategy - interventions from the patient's needs are presented in an algorithm form, promoting oral feeding as long as possible. In all process, the person and family autonomy in decision making is preserved. At each step, we identified an element to avoid in the communication process [1,2].

**Conclusions**

The set of nurse's interventions in end-of-life nutrition approach systematizes the elements to be considered in decision-making and guarantees the importance of nurses' contribution in risk reduction of therapeutic obstinacy.

**References**

1. Alves P. Intervenção do Enfermeiro que Cuida da Pessoa em Fim de Vida com Alterações do Comer e Beber. Pensar Enfermagem. 2013, 17(1): 17-30;

2. Baile W [et al.], SPIKES — A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist. 2000, 5(4):302-311.

**Keywords**

Nursing, Nutrition, Spikes protocol, Communication, Palliative care.

P83

**Associated factors with polymedication in elderly accompanied in the health strategy of the family of the city of Palhoça, Santa Catarina, Brazil**

Fabrícia M Almeida¹, Mônica R Moraes¹, Giovanna G Vietta¹, Roberta TS Shirasaki², Isísa M Sousa², Pedro F Simão¹, Bárbara O Gama¹, Fabiana O Gama¹, Paulo F Freitas¹, Márcia Kretzer¹

¹Universidade do Sul de Santa Catarina, 88704-900, Tubarão, Santa Catarina, Brasil; ²Unidade Básica de Saúde Ponte do Imaruim, Palhoça, Santa Catarina, 88130-300, Brasil

**Correspondence:** Fabrícia M Almeida (fabricia_dani@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P83
**Background**

Aging implies in an increase in the number of morbidities, which requires medical treatment and may result in the use of multiple medications. Polymedication is associated with a risk of loss of quality of life, negative health outcomes and a risk of dependent mortality.

**Objective**

To evaluate the factors associated to polymedication in the elderly followed up in the Family Health Strategy of the city of Palhoça, Santa Catarina, Brazil.

**Methods**

A cross-sectional study carried out in the elderly accompanied by two Basic Health Units in Palhoça. Data collected between august and November 2017, using a questionnaire with sociodemographic and clinical data and the Geriatric Depression Scale (GDS). Polymedication was defined as the use of 5 or more drugs on an ongoing basis. Analysis by SPSS 20.0, with chi-square and Fisher's exact test, Prevalence Ratio (PR), Confidence Interval (CI) 95%, p < 0.005. The project was approved by the Research Ethics Committee of the Southern University of Santa Catarina.

**Results**

135 individuals were interviewed, with a mean age of 69.9 years and a standard deviation of 8 years, ranging from 60 to 97 years. The highest frequency was female (70.0%), white (81.3%), married (50.4%), and widowed (28.1%). About the occupation, 80.7% were retired and 54.6% received up to 250 Euros monthly. The schooling was predominantly until elementary school (74.6%), with 9.7% being illiterate, 4.5% with higher education and 0.7% with post-graduation. The majority (63.7%) did not practice physical exercise, 6.8% were smokers. The frequency of depression was 39.6%, with 5.2% categorized as severe depression. The use of drugs among the interviewees ranged from none (4.4%) to 25 different medications per day (0.7%), with 42.7% using 5 or more medications. Among those who reported the use of medication, 63% used antihypertensives, 32.6%, antidepressants, 37.8%, anti-diabetics and 14.8% analgesics. Self-medication was identified in 23.9%. Polymedication had a significant association (p < 0.001) with the presence of arterial hypertension (RP = 2.85, CI 1.59-5.09), Diabetes Mellitus (RP = 2.31, CI 1.58-3.36), arthritis (RP = 1.60, CI 1.10-2.33), depression (RP = 1.87, CI 1.30-2.69), and cardiovascular diseases (RP = 2.29, CI 1.61 -3.26).

**Conclusions**

Polymedication in the elderly presented high prevalence and was associated with the presence of cardiovascular, endocrine, joint and depression diseases. A presence of symptoms of depression was present in 39.6% of the elderly.

**Keywords**

Polymedication, Associated factors, Comorbidity, Elderly.

P84

**Lack of Vitamin D in elderly individuals: case study – Figueira da Foz**

Ana Azul¹, Cristina Santos¹, António Gabriel², João P Figueiredo³, Ana Ferreira¹

¹Department of Environmental Health, Coimbra Health School, 3046-854 Coimbra, Portugal; ²Department of Laboratory Biomedical Sciences, Coimbra Health School, 3046-854 Coimbra, Portugal; ³Department of Complementary Sciences, Coimbra Health School, 3046-854 Coimbra, Portugal

**Correspondence:** Ana Azul (ana.sofia.azul@hotmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P84

**Background**

Nowadays, the increase of aging among world's population is becoming a reality, due to the decrease of the fertility and mortality rates and to the consequent increase of the average life expectancy [1]. This population aging brings different health, economic and social needs, turning elderly dependent and making them living in an institutionalized way [2]. In turn, the institutionalization favours the decline of their physical and cognitive functions, which consequently, weakens the old-aged. For all this, it is very likely that this age group will have D vitamin lack,

being considered a serious public health problem at a worldwide level. Therefore, its supplementation must be considered, since this age group has the tendency of staying shortly exposed to solar radiation, has little mobility and their bodies manifest a reduction of the ability of synthesis of this hormone [3-5].

**Objective**

This investigation intends to evaluate de existence of the lack of D vitamin in old-aged people who may be institutionalized and old-aged people in ambulatory from the region of Figueira da Foz.

**Methods**

Application of a questionnaire and collection of blood samples.

**Results**

With the purpose of evaluating the concentrations of 25(OH)D for each one of the studied groups, it was verified that the non-institutionalized group showed higher 25(OH)D values, when to compared to the institutionalized group. This result has shown to be statistically significant, with a p-value of 0.003. On the other hand, other variables were compared, as for example, feeding, sun exposure, chronic diseases and intake of vitamin supplements, to try to understand if they had any influence on the 25(OH)D levels. Nevertheless, concerning these parameters, no great differences were verified, because p-values were always higher than 0.005.

**Conclusions**

With this study, we conclude that the geriatric population presents a high lack of vitamin D, both the institutionalized group (although with higher values of 25(OH)D) and the ambulatory group.

**References**

1. Nogueira P, Afonso D, Alves MI, Vicêncio PO, Silva Jd, Rosa MV, et al. Portugal Idade Maior em números, 2014: A Saúde da População Portuguesa com 65 ou mais anos de idade. 2014. p. 223

2. Bárrios MJ, Fernandes AA. A promoção do envelhecimento ativo ao nível local: análise de programas de intervenção autárquica. Revista Portuguesa de Saúde Pública. 2014;32(2):188-96.

3. Jalal S, Khan NU. Frequency of Vitamin D Deficiency in Elderly Patients Visiting Tertiary Care Hospital in a Low Income Country. 2014;40:44-53.

4. Lanske B, Razzaque MS. Vitamin D and aging: old concepts and new insights. The Journal of nutritional biochemistry. 2007;18(12):771-7.

5. Zumaraga MP, Medina PJ, Rectoa JM, Abrahanc L, Azurinc E, Tanchoco CC, et al. Targeted next generation sequencing of the entire vitamin D receptor gene reveals polymorphisms correlated with vitamin D deficiency among older Filipino women with and without fragility fracture. 2017:98-108.

**Keywords**

Aging, Vitamin D, Vitamin supplementation, Public health.

P85

**Error prevention in nursing: strategies for a safety culture**

Teresa Vinagre¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

**Correspondence:** Rita Marques (ritamdmarques@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P85

**Background**

The Safety culture is becoming more and more linked to quality and excellence of care, being a crucial factor for health error prevention. Nursing assumes a crucial role in patient safety, being at forefront of patient care, and should protect patient interests and assure consolidation of strategies that guarantee safety.

**Objective**

Identify what are the strategies for an effective safety culture and to prevent errors in nursing.

**Methods**

Literature Review, following the recommended methodology of the Cochrane Centre, guided by the investigation question: *What are the*
strategies for an effective safety culture and to prevent errors in nursing?

The study includes the analysis of articles found in EBSCO (CINAHL, MEDLINE, Nursing & Allied Health Collection, Cochrane Database of Systematic Reviews), in B-ON and in SCIELO, with the following descriptors: Nursing; Patient Safety; Errors, with the timeframe between 2012 and 2017. The sample resulted in 12 articles.

## Results

The Team Work [1-5,8-12] and communication [1-6,8-11] where referenced in 75.0% of the studies as vital measures in an effective safety culture and error preventing in nursing, 66.7% reinforce the importance of error notification [1,2,4,7-11], 58.3% defend that continuous improvement/training is essential [1,2,4,5,9,11,12], 33.3% consider global safety perception [4,10-12] and the importance of trust in superiors and their compromise with their subordinates [4,10-12] as effective methods, 25.0% stand out the importance of error feedback to health professionals [5,10,11]. As an ending, less than 10% of the analysed studies refer work conditions [4], critical reflexion [6], supervision and existence of standards [3], conflict management [3], and assume the person as the centre of health care [3] as important strategies.

## Conclusions

Many are the strategies used for an effective safety culture and error prevention in nursing, being the most significant, team work and communication, followed by error notification and continuous improvement/training. Besides the aspects mentioned above, in every article analysed two crucial factors where identified: the direct relation between the existence of a safety culture and the decrease of advert events in health and the need to make the system safer, instead of trying to change human conditions, as a mean to ensure safety and quality care provision.

## References

1. Marinho M, Radünz V, Tourinho F, Rosa L, Misiak M. Intervenções Educativas e seu Impacto na Cultura de Segurança: Uma Revisão Integrativa. Enferm Foco. 2016. 7 (2): 72-77.

2. Mendes C, Barroso, F. Promover uma cultura de segurança em cuidados de saúde primários. Rev Port Saúde Pública. 2014. 32 (2): 197-205.

3. Silva E, Rodrigues F. Segurança do processo de processos sociais na relação com enfermeiros em contexto de bloco operatório. Cultura de los Cuidados. 2016. 45: 134-145.

4. Paese F, Sasso G. Cultura de segurança do paciente na atenção primária à saúde. Texto e Contexto Enferm. 2013. 22 (2): 302-310.

5. Minuzza, SalumN, Locks, M. Avaliação da cultura de segurança do paciente em terapia intensiva na perspectiva da equipe de saúde. Texto e Contexto Enferm. 2016. 25 (2): 1-9.

6. Araújo M, Filho W, Silveira R, Souza J, Barlem E, Teixeira N. Segurança do paciente na visão de enfermeiros: uma questão multiprofissional. Enferm Foco. 2017. 8 (1): 52-56.

7. Correia T, Martins M, Forte E. Processes developed by managers regarding the errors. Rev Enferm Referência. 2017. IV (12): 75-84.

8. Cavalcante A, Cavalcante F, Pires D, Batista E, Nogueira L. Cultura de segurança na percepção da enfermagem: Revisão integrativa. Rev Enferm UFPE On Line. 2016. 10 (10): 3890-3897.

9. Wang X, Liu K, You L, Xiang J, Hu H, Zhang L, Zheng J, Zhu X. The relationship between patient safety culture and adverse events: A questionnaire survey. Int J Nurs Stud. 2014. 51: 1114-1122.

10. Noord I, Wagner C, Dyck C, Twisk J, Bruijne M. Is culture associated with patient safety in the emergency department? A study of staff perspectives. Int J Qual Health Care. 2013. 26 (1): 64-70.

11. Ballangrud R, Hedelin B, Hall-Lord M. Nurses' perceptions of patient safety climate in intensive care units: A cross-sectional study. Intensive Crit Care Nurs. 2012. 28: 344-354.

12. Feng X, Bobay K, Krejci J, McCormick B. Factors associated with nurses' perceptions of patient safety culture in China: a cross-sectional survey study. J Evid Based Med. 2012. 50-56.

## Keywords

Nursing, Patient Safety, Errors.

## P86

### Error notification: a strategy for a safety culture

Teresa Vinagre¹, Rita Marques²

¹Instituto de Ciências da Saúde, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola Superior de Saúde da Cruz Vermelha Portuguesa, 1300-906 Lisbon, Portugal

Correspondence: Teresa Vinagre (tererasousasoares@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P86

### Background

Errors are an inevitable condition of the human being, and one of the biggest contributors to morbidity and mortality around the world. Error notification is a scientifically proved strategy as being one of the most effective of a safety culture [1-8], being essential for the prevention and detection of factors that contribute for the error. The Operation Room (OR) is one of the most prone health services for the occurrence of adverse events/errors [3], hence being vital the fulfilment of studies regarding this issue, to contribute to an improvement in health care and assure patient safety.

### Objective

To determine the error notification frequency in the OR; and to characterise the safety culture of the OR.

### Methods

Exploratory study, with a quantitatively approach. A survey was conducted with 9 closed questions to 33 nurse professionals that work in a OR in a Lisbon Hospital.

### Results

54.6% of the adverse events that caused damage to the patient were always notified by the nurses, nevertheless, none of the participants pointed this regular notification for adverse events, that could have resulted in damage for the patient, but that did not. Of the several adverse events, 55.6% of the occurred cases were not notified, being the more frequent justification for not notifying them, the lack of time to notify. A negative correlation was obtained between professional experience and the error notification frequency, being this difference statistically significant (p < 0.05). Regarding the factors that contribute the most for error occurrence in OR, all of the participants mentioned the pressure for working fast, 87.0% referred the lack of human resources, 85.2% absence of motivation, 82.6% professional inexperience and workload overcharge and 65.2% of the participants considered fails in communication, as a factor preponderant to error. Patient safety perception by the nurse professionals of the OR was evaluated as "acceptable" by the majority of the participants.

### Conclusions

It was evident the low notification frequency of adverse events/errors, and it was found that professional experience is inversely proportional to error notification. Error notification is a central aspect of health care, particularly in the OR, hence it is fundamental to educate teams for the setting of strategies that promote a safety culture. It is important to continuously train professionals as well as work on the errors, making them a learning opportunity to prevent new errors associated to the same causes, to achieve a quality safety culture.

### References

1. Marinho M, Radünz V, Tourinho F, Rosa L, Misiak M. Intervenções Educativas e seu Impacto na Cultura de Segurança: Uma Revisão Integrativa. Enferm Foco. 2016. 7 (2): 72-77.

2. Mendes C, Barroso, F. Promover uma cultura de segurança em cuidados de saúde primários. Rev Port Saúde Pública. 2014. 32 (2): 197-205.

3. Paese F, Sasso G. Cultura de segurança do paciente na atenção primária à saúde. Texto e Contexto Enferm. 2013. 22 (2): 302-310.

4. Correia T, Martins M, Forte E. Processes developed by managers regarding the errors. Rev Enferm Referência. 2017. IV (12): 75-84.

5. Cavalcante A, Cavalcante F, Pires D, Batista E, Nogueira L. Cultura de segurança na percepção da enfermagem: Revisão integrativa. Rev Enferm UFPE On Line. 2016. 10 (10): 3890-3897.

6. Wang X, Liu K, You L, Xiang J, Hu H, Zhang L, Zheng J, Zhu X. The relationship between patient safety culture and adverse events: A questionnaire survey. Int J Nurs Stud. 2014. 51: 1114-1122.
7. Noord I, Wagner C, Dyck C, Twisk J, Bruijne M. Is culture associated with patient safety in the emergency department? A study of staff perspectives. Int J Qual Health Care. 2013. 26 (I): 64-70.

8. Ballangrud R, Hedelin B, Hall-Lord M. Nurses' perceptions of patient safety climate in intensive care units: A cross-sectional study. Intensive Crit Care Nurs. 2012. 28: 344-354.

## Keywords

Nursing, Safety Culture, Error Notification.

## P87

### The use of ultrasound in peripheral venous catheterization

Bruno Santos¹, José Pinho², Rogério Figueiredo², Pedro Parreira², Luciene Braga³, Anabela Salgueiro-Oliveira²

¹Hospital Privado do Algarve, 8500-322 Alvor, Portugal; ²Escola Superior de Enfermagem de Coimbra, 3046-851 Coimbra, Portugal; ³Universidade Federal de Viçosa, 36570-900 Viçosa, Minas Gerais, Brasil

**Correspondence:** Anabela Salgueiro-Oliveira (anabela@esenfc.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P87

### Background

The insertion of peripheral vascular catheters (PVCs) is the most common procedure performed in clinical settings [1]. The traditional method for detection and selection of a venous access includes the use of a tourniquet, palpation, and observation. However, when veins are not visible or palpable, this may lead to successive puncture attempts, causing pain to the patient and discomfort to the nurse, which results in increased costs [2]. In this regard, nurses should consider using vascular visualization technologies that aid in vein identification and selection for difficult intravenous access [3]. However, these technological resources available today, are still underutilized in Portugal.

### Objective

This study aims to explore an alternative method (ultrasound) for assistance of the traditional venous cannulation, in order to ensure the satisfaction of the patients and of the health professionals.

### Methods

The search method used was the integrative literature review, which analysed relevant research that supports decision-making and the improvement of clinical practice [4]. The investigation question was formulated based on the PICO strategy: *How important is the use of ultrasound technology by the nurses in patients with PVCs insertion needs?* The search was conducted between 4 and 10 January, 2017, using the timeframe between 01-01-2011 and 31-12-2016, with the purpose of finding only primary scientific studies developed over the past 5 years, in English, Portuguese or Spanish. The search was conducted in the following databases: Medline, Cinahl, Psychology and Behavioural Sciences Collection, MedicLatina, ERIC, Business Source Complete, Library, Information Science & Technology Abstracts e Academic Search. We used two search strategies P1 and P2 with the following descriptors, respectively: Ultrasound AND Peripheral catheterization AND Cannulation; Ultrasound AND Peripheral catheterization AND ultrasound guided NOT Paediatric NOT PICC NOT Artery. We found 146 scientific articles and after reading the title, abstract and full text we retained 8 studies for analysis.

### Results

The results found confirm the venous cannulation with assistance of ultrasonography has a higher success rate, when compared to the traditional venous cannulation. It was also possible to observe a decrease in: the numbers of attempts to puncture the vein; the time used in the procedure; the incidence of central venous catheter placement; and as a consequence, the reduction of possible complications. The patient also presented lower levels of pain and higher degrees of satisfaction.

### Conclusions

The implementation of ultrasound in clinical settings, such as in nurses training programs, are important to perform ultrasound-guided PVCs placement and quality care.

## References

1. Webster J, Osborne S, Rickard C, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2015;8. Art. No.: CD007798.

2. Aponte H, Acosta S, Rigamonti D, Sylvia B, Austin P, Samolitis T. The use of ultrasound for placement of intravenous catheters. AANA Journal. 2007;75(3):212-216.

3. Gorski L, Hadaway L, Hagle M, McGoldrick M, Orr M, Doellman, D. Infusion Nursing Standards of Practice. Journal of Infusion Nursing. 2016; 39(15): 1-159.

4. Mendes K S, Silveira R C, Galvão C M. Revisão integrativa: Método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto e Contexto Enfermagem. 2008;17(4):758-764.

## Keywords

Peripheral venous cannulation, Ultrasound, Nurses.

## P88

### Nursing care in the person with intestinal elimination ostomy

Igor Pinto¹, Silvia Queirós¹, Célia Santos², Alice Brito²

¹Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; ²Escola

Superior de Enfermagem do Porto, 4200-072 Porto, Portugal

**Correspondence:** Igor Pinto (isp.igor@gmail.com)

BMC Health Services Research 2018, **18**(Suppl 2):P88

### Background

Performing an intestinal elimination stoma triggers changes in the physical, psychological, social, self-care and lifestyle of the person. The way this event is experienced is influenced by several factors. The literature suggests that a systematized nursing care, started in the preoperative period, which includes the postoperative period and continues after hospital discharge, is associated with a better level of adaptation and a higher quality of life of the person with intestinal elimination ostomy.

### Objective

To identify the existing literature on nursing care programs and to map the respective interventions performed in the person proposed for the construction of a stoma or with an intestinal elimination stoma.

### Methods

A literature review was performed in the Web of Science, CINAHL Plus with Full Text, CINAHL Complete and Scopus databases, based on the Joanna Briggs Institute for Scoping Reviews model, from inception to April 2017. Two independent reviewers performed the analysis of article relevance, extraction and synthesis of the data.

### Results

A total of 1,728 articles was identified and only 17 were included for content analysis. It was not possible to find a program that contemplates all phases of perioperative and post-discharge intervention, with the studies focused essentially on one or two specific moments. Considering the interventions mentioned in the literature, the most stated were: stoma site marking; preoperative education; post-operative education; and nursing follow-up after hospital discharge. However, there is still no evidence to suggest timings, methodology and contents to guide the implementation of each of the interventions.

### Conclusions

A systematized nursing care in the person with intestinal elimination ostomy, covering the perioperative period and follow-up after discharge, has a significant impact on the adaptation to the stoma, reduces complications, increases the perception of self-efficacy and also the quality of life. It is imperative to create and test an intervention program that contemplates all these phases and all the interventions mentioned in the literature. On the other hand, further studies should be carried out to determine the defining characteristics of these interventions, which help in the decision-making process and the nurses' performance.

## Keywords

Ostomy, Nursing Care, Cecostomy, Colostomy, Ileostomy.
P89

Nurses competencies in catastrophes and disaster nursing

Patrícia MG Godinho, Maria T Leal

Escola Superior de Enfermagem de Lisboa, 1600-190 Lisboa, Portugal

**Correspondence:** Patrícia MG Godinho (p.guerra@campus.esel.pt)

BMC Health Services Research 2018, **18**(Suppl 2):P89

Background

Disasters and catastrophes are unpredictable multi-victim events, leading to a sudden demand for emergency health care. An adequate response requires multidisciplinary professionals that must be experienced and specialized in the field. There is evidence that nurses are important in a catastrophic situation as key-elements that can contribute positively in these situations, because of their broad care-giving skills, that can be applied in a variety of disaster settings, with high levels of creativity, adaptability, and leadership [1]. Nevertheless, nurses need to be competent in disaster nursing, in order to make the difference [2].

Objective

To review the available evidence regarding nursing competencies/interventions that improve victims' outcomes in the context of catastrophe or multi-victim emergencies.

Methods

We completed an integrative review of the literature available from MEDLINE and CINAHL databases and grey literature, to answer the question: "Which nursing competencies/interventions contribute to improve victims' outcomes in the context of catastrophes or multi-victim emergencies?" [3].

Results

Eight articles, published between 2012 and 2016, satisfied the search criteria and were analysed. The number of participants varied between 16 and 620 nurses. Most of the articles demonstrate that nurses' competencies have gaps in this field, due to lack of knowledge, training, and simulation, both in nursing education as in working contexts. One of the studies emphasized that nurses from military hospitals have a superior knowledge and preparation in catastrophes, when compared with nurses from civil hospitals, given their military training [4]. The academic training, and the implementation of catastrophe training in the nursing curriculum is also addressed in three of the analysed articles [4-6]. The fact that hospital administrations and nursing leadership fail as promoters of training and promotion of regular exercises and simulations of disasters, is also evidenced in three articles [5,7,8].

Conclusions

Globally, the results of this integrative review show that most nurses don't have enough training in disaster nursing. They are not prepared to respond adequately in a mass-causality event. The recommendations are that both, in academic fields or at work contexts, regular training and simulations should be part of disaster preparedness.

References

1. World Health Organization, International Council of Nurses, editors. ICN Framework of Disaster Nursing Competencies. Geneva: ICN & WHO; 2009.

2. Loke AY, Fung OWM. Nurses' Competencies in Disaster Nursing: Implications for Curriculum Development and Public Health. In: Kapur GB, Baéz AA, editors. International disaster health care: preparedness, response, resource management, and education. Oakville: Apple Academic Press; 2017. p. 185-203.

3. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers' Manual: 2014 Edition [Internet]. Adelaide: The Joanna Briggs Institute; 2014. 197 p. Available from: http://joannabriggs.org/assets/docs/sumari/ReviewersManual-2014.pdf

4. Thobaity A, Plummer V, Innes K, Copnell B. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J. 2015 Aug;18(3):156-64.

5. Labrague LJ, Yboa BC, McEnroe-Petitte DM, Lobrino LR, Brennan MGB. Disaster Preparedness in Philippine Nurses. J Nurs Scholarsh. 2016 Jan;48(1):98-105.

6. Khalaileh MA, Bond E, Alasad JA. Jordanian nurses' perceptions of their preparedness for disaster management. Int Emerg Nurs. 2012 Jan;20(1):14-23.

7. Baack S, Alfred D. Nurses' preparedness and perceived competence in managing disasters. J Nurs Scholarsh. 2013 Sep;45(3):281-7.

8. Li YH, Li SJ, Chen SH, Xie XP, Song YQ, Jin ZH, et al. Disaster nursing experiences of Chinese nurses responding to the Sichuan Ya'an earthquake. Int Nurs Rev. 2017 Jun;64(2):309-17.

Keywords

Disaster nursing, Nursing competencies, Catastrophe, Multi-victims emergencies, Mass causality events.

P90

Patient safety culture: the same functional typology, distinct cultures

Vanda Pedrosa (terapeutavandapedrosa@gmail.com)

School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal

BMC Health Services Research 2018, **18**(Suppl 2):P90

Background

Fostering a culture of safety in health organizations should begin by evaluating the current culture. In Primary Health Care, patient safety becomes more important because a considerable proportion of safety incidents, detected in hospitals, originate from earlier levels of the system, from most of the interactions and from the largest volume of appointments of the functional units. At this level of health care, in family health units that provide accessible care, global and longitudinal follow-ups on the health process in a lifetime, enables greater health gains, and greater proximity to the patient. These are elementary health care units, based on multi-professional teams, composed by doctors, nurses and administrative staff. Still, many are on very different levels in terms of safety culture of the patient, although in all, the patient wants to have security.

Objective

Describe the patient's safety culture of health professionals from two family health units (USF), belonging to the same Health Centre, to understand the similarities and/or differences between them.

Methods

Qualitative study, with a semi-structured interview (to GPs and nurses), at two USFs, models A and B, of one Health Centre in the Lisbon area. Content analysis was supported by maturity levels of a patient safety culture, five maturity levels ranging from 1 (worst culture) to 5 (best culture).

Results

By adjusting the responses within a maturity level for the patient safety culture of the 2 functional units, it was observed that the culture oscillated between 1.8 values in the USF model A, close to a reactive culture, in which the organization only cares about safety when problems occur, and 4 values for USF B, close to a proactive culture, with patient safety measures, even without adverse events, close to the ideal, with an informed and worried team.

Conclusions

The functional units have the same typology, belong to the same Health Centre, but align the patient's safety culture with its greater and lesser complexity, respectively, model B and A. In other words, patient safety is not observed from the same perspective, although it operates in the same geographical area. There is a need for more and a better evaluation, information and training so that the safety culture develops.