Student Research Posters

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  The Psychological Impact of Denied Blood Transfusions by Jehovah's Witness Parents in Pediatric Patients

  Jaelyn Capablanca Braganza

  Jehovah's Witnesses believe that it is against God's will to receive blood from someone else, or to tamper with their own blood, influencing them to deny blood transfusions for themselves and for their children. Since minors are legally not allowed to make healthcare decisions on their own until they reach 18 years of age, this decision made by the parents to deny transfusions on the pediatric patient's behalf may create significant emotional and psychological challenges, potentially influencing family dynamics, mental health, and overall well-being. Understanding these effects, especially for the pediatric patient, is crucial for healthcare providers, social workers, and support organizations in providing holistic care to families navigating such medical and religious conflicts since there is limited research on this issue.

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  Nursing Knowledge Regarding Pap smears for Transgender Men

  Caytlin Capulong

  Cervical cancer screening (CCS) is a crucial test used for preventative measures against cervical cancer, yet transgender men (TM) experience significantly lower screening rates in comparison to cisgender women due to pain, anxiety, and systemic healthcare barriers. A major factor for deterrence is pain during speculum insertion, often because of vaginal atrophy related to testosterone usage. Other factors include fear of discrimination, mistreatment, and lack of provider awareness, particularly among nurses who play a pivotal role in patient preparation and care. This research aims to assess the extent of nurses’ knowledge regarding Pap smears for female-to-male (FTM) patients through a quantitative descriptive survey. A Likert scale-based questionnaire will evaluate the knowledge of 100 nurses in California, identifying potential areas of knowledge deficits in understanding CCS for TM. The anticipated findings will highlight any potential gaps in knowledge, which could inform future educational interventions such as workshops or simulations.

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  Reassessing Pet Allergy Prevention in Children Through Early Pet Exposure in Toddlerhood

  Reynaldo A. Adalin III

  Background: Allergies are among children's most common health issues growing up, impacting them daily and into adulthood. Among these allergies, pet allergies have become increasingly common with children around the globe developing sensitization to common household pets such as cats and dogs. Several factors cause pet allergies, including proteins found in an animal's skin, saliva, urine, and dander, which are the most problematic due to their ability to remain airborne for a prolonged period. Objective: To examine the relationship between early exposure to pets during toddlerhood versus later exposure at school age and the development of pet allergies. By studying the effects of early pet exposure, we can have more precise insights into whether growing up with a pet in the household plays a crucial role in reducing the development of pet allergies. Method: To accomplish the purpose of this study, researchers will use a mixed method, quantitative and qualitative, prospective cohort study design to investigate the effectiveness of early pet exposure in toddlers in reducing the development of pet allergies. Results: The data for this study have not been collected yet, but the expected results are that children who have pets during toddlerhood will have less incidence of pet allergies and allergy symptoms than children who are introduced to pets during school age or beyond. Conclusion: Reconsidering previous studies on early pet exposure therapy can provide a modern perspective on treating allergies through exposure therapy while closing the gap in knowledge about the relationship between the immune system and pet allergens. Understanding the potential protective benefits of early pet exposure could lead to strategies that mitigate pet allergies, enhancing children's long-term health and quality of life.

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  Occupational Therapy Students’ Perspectives on Co-Curricular Resilience Programming

  Dan Kavin Agbayani, Stephen Beck, Nicole Colombo, Danielle Tirpack, and Mikayla Hilario

  Occupational Therapy (OT) students and healthcare workers face significant stress due to academic and professional demands. This stress, if prolonged, can lead to burnout and exhaustion. Resilience, the ability to adapt to challenging experiences, can mitigate the effects of stress and burnout. Resilience has been linked to mindfulness, self-compassion, social support/ connection, and physical activity. While resilience programs have shown positive effects for college students and healthcare providers, there is limited research on resilience programming tailored for OT students. This study aimed to fill this research gap by assessing OT students’ utilization of and satisfaction with a co-curricular resilience program offered by the OT department at Dominican University of California. This study also sought to assess the perceived impacts of this resilience program. To meet these objectives, this research project employed a 57-item survey developed using Qualtrics. Results showed that an Instagram page was the most utilized resilience resource and that participants were most satisfied with group hiking events. Group meditation sessions had the greatest impact on participants’ ability to focus on the present moment, while group hiking events had the greatest impact on participants’ sense of belonging, ability to cope with stress, and ability to extend kindness to themselves. This study’s results demonstrate the value of the co-curricular resilience program offered through the Dominican OT department. These results may inform future resilience programming at Dominican or the formation of new resilience programs at other higher education settings.

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  Breaking the Mold: Exploring the Influence of Gender Roles on Men's Choice of Nursing Specialties and Its Implications for Patient Care

  Cid Rowel Agustin

  Gender roles and stereotypes continue to shape societal perceptions and expectations within the nursing profession. While strides have been made towards gender equality, male nurses remain underrepresented in certain nursing specialties. Understanding the influence of gender roles and stereotypes on male nurses' specialty selection is essential for promoting diversity and enhancing patient care outcomes. This study aims to explore how perceptions of gender roles and stereotypes impact the career decisions of male nurses and the subsequent implications for future patient care. By examining this complex interplay, we seek to uncover insights that can inform strategies for fostering inclusivity and improving healthcare delivery within the nursing profession.

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  Evaluating the Mental Health of Newly Graduated Nurses in Transition from Undergraduate Training to Professional Practice

  Victor Louis C. Alinas IV

  Background: There is an increasing demand for nurses worldwide as healthcare systems slowly recover from the COVID-19 pandemic. Simultaneously, there is a high turnover of registered nurses and an even higher turnover in the demographic of newly graduated nurses. Newly graduated nurses (NGNs) are constantly faced with high levels of stress upon starting out in the professional environment and as a result of mental burnout and inadequate preparation, there is a notably high turnover of newly graduated nurses within their first year of employment. Purpose: This research aims to use existing information on the transition from undergraduate training to professional practice to evaluate the mental health of newly graduated nurses and to help develop a greater understanding of the importance of well-being. The implementation of this understanding into clinical orientation has the potential to significantly reduce the turnover rate and promote job satisfaction for newly graduated nurses. Method: To accomplish this research, a mixed-methods approach combining both quantitative and qualitative data will be applied to explore the experiences of newly graduated nurses transitioning from undergraduate training to professional practice. The quantitative component will use a validated scale to measure specific emotions experienced during the transition, while the qualitative component will provide a fully captured understanding of the perceptions and perceived mental health status of newly graduated nurses during this period. Results: The data for this study has yet to be collected, but the expected results will prove the hypothesis that the transition from undergraduate training to professional practice can significantly impact the mental health of newly graduated nurses during their first year of employment.

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  Developmental Effects of Child Abuse: The Relevance of Timing

  Laura Luz Alvarez Pineda and Karla Susana Saldaña

  Background: Early physical, sexual, and emotional child abuse has been associated with long-life cognitive, emotional, and physical health repercussions. Purpose: The current paper, in addition to a literature review, proposes a research design to examine the emotional outcomes of physical, emotional, and sexual child abuse on Hispanics when a psychosocial therapy program is implemented. Methods: Participants will be recruited from children’s hospitals, daycares, and preschools around the Bay Area. Parental-informed consent will be obtained prior to participation. This longitudinal quantitative quasi-experimental study will be comprised of three phases to measure posttraumatic stress and depression symptoms, and suicidal ideation. Results: Multivariate analysis of variance (MANOVA) procedure, descriptive statistics, and a t-test will be used to interpret the data and identify a correlation between participation in psychosocial therapy and the improvement of posttraumatic stress symptoms, depression symptoms, and suicidal ideation in young Hispanic adults who have been victims of child abuse. Conclusion: Determining emotional outcomes of the implementation of a psychosocial therapy program on children with a history of child abuse into young adulthood is related to nursing as nurses are often the first to recognize and initiate treatment for this vulnerable population. This proposal will help healthcare professionals understand the importance of treatment in the development and mental health of child maltreatment victims.

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  Tackling Fall Risk in Geriatric Dementia Patients: The Impact of Medication Reconciliation Relating to Polypharmacy & Falls

  Jenl Khristen Ang

  Over half of the elderly population are taking three or more prescription drugs daily. For those aged 65 and older, polypharmacy, taking five or more medications, is common due to conditions like hypertension, heart disease, arthritis, and diabetes (CDC, 2019). Managing these medications can be challenging, especially for those with dementia, who may also take drugs for conditions such as diabetes or depression, which can worsen cognitive impairment (Chippa & Roy, 2023). The complex regimens and increased sensitivity to medications heighten the risk of adverse events, particularly falls, a major cause of injury, hospitalizations, and loss of independence in older adults (Mueller et al., 2018). Studies suggest that medication reconciliation, or regularly reviewing a patient’s medications, could help reduce falls and improve safety for elderly individuals with dementia.

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  The Impact of Workplace Stressors on Anxiety Levels and Mental Health Among Pediatric Intensive Care Nurses

  Kelsey Ericah Ang

  Background: Pediatric Intensive Care Unit (PICU) nurses work in a high-stress environment where they are exposed daily to traumatic situations. The demanding emotional and physical challenges contribute to significant psychological burdens, including increased stress and anxiety. Purpose: The current paper proposes a research design to examine the outcomes of stress, anxiety levels, and mental well-being on PICU nurses when workplace support and structured debriefing sessions take place following a traumatic event. Methods: Participants will be recruited from PICU hospitals in Northern California. Participation will be voluntary, and informed consent will be obtained prior to the study. The selection criteria will include registered nurses with a minimum of three years of experience in the PICU setting. Results: Standardized mental health assessment scales, such the Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS), and the Depression, Anxiety, and Stress Scale will be used to gather quantitative data as well as descriptive statistics which will provide an overview of baseline psychological variables. Afterwards, inferential statistics such as the t-test will be used to compare the averages between the control group and the intervention group, utilizing pre- and post-test measures. The analysis will then examine correlations between the participation in structured debriefing following a critical incident and the improvements in psychological outcomes, including reduced anxiety levels, decreased stress, and improved psychological well-being among PICU nurses. Conclusion: Workplace stressors significantly impact the emotional health of PICU nurses and can result in heightened levels of stress and anxiety. By addressing the foundation of these challenges, this study recognizes the importance of mental health interventions as it supports the development of strategies to strengthen overall well-being of pediatric nurses working in critical care settings.

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  Effectiveness of Early Intervention Programs for Children with Autism Spectrum Disorder

  Milan Grace Mendoza Baccay

  Background: Autism spectrum disorder is one of the most common developmental disorders, which affects the way a child learns and gains certain skills. Intervention programs aid in the development of these skills and allow children with autism to reach their full potential. Purpose: The following paper examines the effectiveness of early intervention programs on the social, behavior, and cognitive skills for children with autism spectrum disorder. Methods: Participants will be recruited from local schools and community based organizations and their parents will be highly encouraged to participate. They will be separated into two groups: experimental and control. This mixed-methods study will consist of four phases to assess the efficacy of early intervention programs for children with autism. Results: Independent sample t-test, repeated measures ANOVA, and descriptive statistics will be used to interpret the data found and establish any significant differences in the development of the two groups. Conclusion: Determining the effectiveness of early intervention programs for children with autism is a key factor in helping these children reach their full potential developmentally.

  Keywords: early intervention for children with autism, programs for autism spectrum disorder, children with autism, efficacy or effectiveness, and early intervention or intervention programs

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  Nurse Suicide: Examining Depression and Anxiety in Critical Care Settings

  Arianna Bernardine Barata

  Nurses play a critical role in healthcare, yet the demanding work environment often exposes them to stressors, leading to the development of depression and anxiety. According to the National Library of Medicine (NLM) (2021), 50.8% of nurses have stress, 74% have anxiety, 70.8% have depression, and 79.1% have at least one of them. Burnout, understaffing, COVID fatigue, alarm fatigue, patient ratios, and disrupted sleep patterns are some of the stressors nurses contend with in every shift. While some nurses may cope and overcome these challenges, many face more severe issues, such as suicide. Nurse suicide is an issue that has begun to grow exponentially across the United States. Howard (2023) reported an annual suicide rate of 14 per 100,000 nurses. Compared with other U.S. workers, nurses are at higher risk for suicidal ideation, and nurses with such ideation are more reluctant to seek help than those without it (Elizabeth et al., 2021). In this paper, critical nurses are defined as nurses who work in intensive care and oncology units. There is limited research on the efficacy of resources used to decrease anxiety and depression in the workplace. Some interventions can be implemented to decrease the prevalence of depression and anxiety in the critical care nurse setting. The purpose of this Research proposal is to identify the factors causing depression and anxiety in nurses working in the Intensive Care Unit versus the oncology department and determine if meditation and visualization are effective in decreasing the rates of depression and anxiety. How does the practice of meditation reduce the incidence of depression and anxiety in nurses, specifically analyzing ICU and Oncology nurses? The hypothesis is that meditation and visualization will decrease the amount of depression and anxiety in ICU and oncology nurses.

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  Male Caregiver Strain: The Mental Effects of Being an Informal Caregiver for a Family Member with Dementia and Alzheimer's Disease

  Alessandra M. Barillas and Elijah Rammel B. Borja

  Background: Caregivers are vital in fulfilling patients' primary care needs, and families prefer them over sending their loved ones to skilled nursing facilities (SNFs). Alzheimer's Disease and Dementia are prevalent conditions necessitating continuous assistance due to memory and cognition impairments. As a result, support is essential for tasks like mobility, feeding, bathing, and perineal care, as well as emotional and physical challenges inherent in caregiving. Purpose: Upon diving into the mental health impacts of serving as an informal caregiver for individuals with Alzheimer's Disease and Dementia, a notable research gap becomes evident, especially concerning male caregivers. This lack of information may stem from a potential reluctance among male caregivers to openly share their experiences and emotions due to fears of societal judgment. Additionally, they might avoid seeking support, feeling obligated by a sense of duty and loyalty to care for their loved ones unconditionally. This thesis proposal intends to shed light on the physical and mental well-being of male caregivers in their roles as informal caregivers for individuals with Dementia and Alzheimer's Disease. The thesis will examine differences in caregiving responsibilities, the impact on health, experiences of burnout and strain, and the coping strategies used by male caregivers compared to their female counterparts. Method: The assessment will comprise 10 multiple-choice questions and three written response questions focusing on caregivers' responsibilities and the perceived impact of these duties on their lives. Results: Data collection for this qualitative study is pending; however, the survey anticipates illuminating the experiences of the male caregivers interviewed.

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  Pediatric Hemorrhagic Stroke: Family Perspectives

  Louis Barnett, Sabrina Montano, Deana Vander Meulen, Charissa Thompson, and Alma Martinez Pamatz

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  Reducing Paternal Stress in the NICU: The Role of Supportive Nursing Interventions

  Kylie Bennett

  The neonatal intensive care unit, also known as the NICU, is a special unit for newborn babies who require intensive medical care (Stanford Medicine Children's Health, 2019). As of February 2024, 1 in 10 infants born in the United States is admitted to the NICU (Goodman et al., 2024). An infant’s NICU hospitalization generates significant stress for parents. Fathers of NICU infants often face unique stressors, and are commonly overlooked in the NICU environment (Rajabzadeh et al, 2020). With limited research on nursing interventions to address this stress specifically for fathers, this emphasizes the importance of exploring the stressors and support needs of fathers with infants in the NICU, as well as understanding what nursing interventions are being implemented to support fathers and reduce their stress during this difficult period.

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  Effectiveness of Harm Reduction and Narcan Education for Young Adults

  Jason Bolfango

  Education on the Harm Reduction Model is an upstream preventative approach to addressing the opioid crisis and a strategic method to promote safety among young adults.

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  Unleashing Wellness: Exploring the Impact of Pet Therapy on Anxiety Reduction, Quality of Life, and Treatment Adherence in Pediatric Oncology Patients

  Karina Brouwer

  Pet therapy is a complementary type of therapeutics in which a person and animal have a guided interaction with the purpose of helping someone cope with physical and/or mental illness. Animal-assisted therapy is used in numerous settings and has been shown to reduce stress, lower blood pressure and heart rate, and decrease anxiety and depression (Husson University, 2022). In particular, pediatric oncology patients have enormous amounts of stress in their lives, which leads to increased anxiety and decreased quality of life (Children's Cancer Cause, 2023). While evidence shows that integrating pet therapy in pediatric oncology patients produces significant benefits on anxiety levels and perception of quality of life, there is a lack of substantial research regarding how these benefits lead to increased treatment adherence. It is pivotal for nurses and other healthcare professionals to understand the impact of pet therapy on pediatric oncology patients in order to implement a holistic approach to treatment that aims to address both the physical and psychological needs of the patient.

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  Advancing School Nursing Practice: A Novel Approach to Screening for Gastrointestinal Disorders in Children

  Ashley Bunting and Isabella Cavlan

  California schools currently only screen for vision and hearing, leaving many other health concerns unaddressed. Among these, gastrointestinal (GI) health is particularly significant, as digestive disorders can lead to severe consequences, like malnutrition and stunted growth. By incorporating routine GI screenings, school nurses can promote the early detection of disease, allowing for timely intervention and improved health outcomes in children.
  
  Based on existing literature, we have developed a novel pediatric GI screening tool for school nurses to use in routine screenings, presented below.

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  Incorporation of Nutrition Education with Medication Inject to sustain Weight Loss

  Julia Calvelo

  Nationwide prevalence of obesity is related to comorbidities including heart disease, type 2 diabetes, and stroke. The United States spends nearly $173 billion annually for the medical cost of obesity, and obese adults have a difference of $1,861 of medical costs than those with healthy weight (CDC, 2022). Overweight individuals experience chronic health issues, resuling in a significant financial burden due to increased costs associated with medical treatment. Ozempic is a newly approved drug accepted by the FDA in 2017 to treat diabetes but is now gradually being implemented as a weight loss medication. It is used in conjunction with exercise and diet in adults with type 2 diabetes mellitus to improve glycemic control; however, continuous nutrition treatment is necessary in order to prevent rebound weight gain. Obesity is a significant public health challenge in the United States resulting from lack of access to education and networks to health and nutrition. Ethnicity and a community’s socio-economic factors play a role in proper access to education of healthy management of weight loss. Further problems arise when young adults discontinue weight loss medication without the proper support of nutrition education and an exercise regime. In order to sustain clinical weight loss and decrease the susceptibility of comorbid risks, lifestyle interventions are advised (Amaro, 2022). There is limited research on interventions to help with preventing weight gain after discontinuing medication.

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  The Critical Role of External Involvement in Supporting Adolescent Mothers Facing Postpartum Depression

  Samantha Campopiano

  Postpartum depression (PPD) can occur in mothers after birth. PPD affects one in seven women during their first year of postpartum. PPD does not have a definitive cause, but underlying contributions include hormonal changes, metabolic pathway changes, and a new onset of stressors. After birth, the drop in estrogen and progesterone levels can trigger or worsen the depressive episodes seen in PPD. PPD risk factors encompass the following determinants: psychological, obstetric, social, lifestyle, and family history (Carlson et al., 2024). Postpartum depression is more common in adolescents than adult mothers (Phipps et al., 2013). Research shows adolescents who don’t have family support or approval struggle immensely when trying to cope with postpartum depression (Obichili et al., 2023). Typically, adolescents struggle to adjust to parenthood more than their adult counterparts (Oladeji et al., 2019).

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  Nursing Students’ Attitudes and Preparedness for MAiD

  Kristal Candray

  As the aging population grows, terminal illness diagnoses are increasing, which has increased global interest in Medical Assistance in Dying (MAiD), Physician-Assisted Suicide (PAS), and euthanasia. However, there hasn’t been much research on how nursing students in California feel about MAiD or how well their education prepares them for these practices. Studies show that religious beliefs and prior knowledge or clinical experience with MAiD can influence students’ attitudes and sense of preparedness. Qualitative research has also identified common challenges, like role confusion, conflicts between ethics and religion, and the need for better education on the topic. Despite this, there’s no research exploring whether nursing students’ attitudes match their stage of moral development or how Mezirow’s Transformative Learning Theory might shape this development. This study aims to explore how nursing students feel about MAiD and how prepared they think they are to support patients, which is especially important as chronic illnesses and end-of-life care needs continue to grow.

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  How to Save a Life: the Impact of CPR and Bleeding Control Education on Adolescents

  Emily Charlton

  Background: Out of hospital cardiac arrest (OHCA) and uncontrolled traumatic bleeding are two of the leading causes of death globally. Death due to OHCA and bleeding is largely preventable. With appropriate bystander intervention, positive outcomes in cases of OHCA and traumatic bleeding would greatly increase. Purpose: Bystander ability and intent to provide emergency cardiopulmonary resuscitation (CPR) and bleeding control is dependent on educational programs including death prevention first aid. Upon review of research, a gap was identified in adolescent death prevention training. The purpose of this proposed prospective study is to determine the effect of a high school education curriculum on adolescent technical knowledge and intention to act in a situation involving cardiac arrest or uncontrolled bleeding. Design: This proposal outlines a longitudinal study with two phases conducted in a six month duration. Phase one and phase two will each be a quasi-experimental mixed methods study design. Sample: This study will include faculty and students at public high schools located in Marin County and San Francisco, California chosen by random selection. Methodology: Phase one will include a demographic data collection, pre test questionnaire with multiple choice knowledge content to assess technical knowledge and Likert scale statements to assess attitude, educational intervention, initial post test questionnaire, and initial focus groups. Phase two will include a post test questionnaire six months following the initial pre test and repetition of focus groups. Analysis: Quantitative data will be analyzed using a sequence of matched pair t-tests and a repeated measures ANOVA test to determine significant changes in attitude and knowledge before, immediately after, and six months after education.

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  Effects of California’s Mandated Staffing Ratios

  Connie Cheng

  California passed Mandated Staffing Ratio legislation (A.B. 394) in 2002 to regulate nurse-to-patient ratios in acute care hospitals to address nursing burnout, adverse patient outcomes, and errors. Ratios were determined by the California Health Department.

  The study aims to understand if California's Mandated Staffing Ratio legislation effectively reduced nursing satisfaction, medication errors, and hospital-acquired infections since its implementation in 2004 by focusing on Medical-Surgical units (Med-Surg).

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  The Effects of Music Therapy on Pediatric Patients with Congenital Heart Defects in the Pre and Postoperative Setting

  Janelle Marie Choy

  Congenital heart defects is a prominent medical occurrence especially in pediatrics. These defects often require surgeries and extensive treatment plans. These treatment plans often include invasive surgeries and extensive treatment plans which can require long recovery times along with potential surgical complications. This study aims to evaluate the effectiveness of music therapy on pediatric patients with congenital heart defects in the pre and postoperative setting and how music therapy can be implemented in treatment plans to yield effective recovery results for these patients. This research is significant as elevated vital signs and preoperative anxiety are associated with an increased need for anesthesia and analgesia requirements which can correlate to a risk for surgical complications. Elevated postoperative pain can result in an increased need for analgesic medications which can contribute to medication toxicity in a pediatric patient which can cause further complications. This study would consist of 80 pediatric patients on a cardiac unit aged 1 day to 10 years old diagnosed with a congenital heart defect who is undergoing cardiac surgery. A quasi-experimental randomized control trial will be conducted to compare the results of these cardiac patients in both preoperative and postoperative procedures. In these settings nurses would be responsible for gathering pre and postoperative vital signs, assessing preoperative anxiety, and assessing postoperative pain levels. With this study it is expected that patients who received music therapy during both pre and post operative procedures experienced a stabilization of vital signs, reduced preoperative anxiety, and lower postoperative pain levels.

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  Domestic Violence and Mental Health in Pregnant Women

  Arabella M. Co

  Background: Domestic violence can include verbal, emotional, and physical abuse, which can lead to long-term mental health disorders such as stress, anxiety, or post-traumatic stress disorder. Purpose: This research includes a literature review, as well as a proposed research design to examine the significance of intimate partner violence in relation to mental health by implementing screening methods and interventions. Method: Participants will be recruited from prenatal clinics around the Bay Area. A quantitative, randomized, controlled-trial cohort study will investigate the effectiveness of the Pregnancy Risk Assessment Monitoring Systems (PRAMS). A screening tool used in determining intimate partner violence within the expecting mother’s household. The effectiveness of the tool will be analyzed after the experimental group attends the necessary mental health counseling sessions. Results: Multivariate analysis of variance (MANOVA) procedure, t-test, and descriptive statistics will be applied to interpret the data and detect any correlation between psychosocial therapy and possible improvements from symptoms of any mental health disorders. The data for this study has yet to be collected, but the expected findings will prove the effectiveness of PRAMS and psychosocial therapy to those who experienced domestic violence. Conclusion: The exposure to domestic violence is associated with increased symptoms of anxiety, depression, or post-traumatic stress disorder during pregnancy (National Library of Medicine 2023). The inclusion of mental health support services can mitigate these effects. This proposed study will help healthcare professionals understand the significance of screening tools and the following treatments for all of the mother’s wellbeing.