Search

Objective: There is a pressing need for public health practitioners to understand cultural values influencing parents on the uptake of human papillomavirus (HPV) vaccination for their daughters, which is presenting a growing challenge to close the immunization gap worldwide. Parental decisions were predominantly shaped by cultural norms and values. This systematic review encompasses parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters., Method: This systematic review was registered on PROSPERO CRD42020211324. Eligible articles were selected from CINAHL, PsycINFO, EMBASE, PubMed and Science Direct. Original qualitative studies exploring parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters under the age of 18, published in the English language with no restriction dates were reviewed. Two authors independently screened abstracts, conducted the fill-text review, extracted information using a standardized form, and assessed study quality. A third author is needed to resolve the disagreements if necessary., Results: Of the 1552 citations, 22 were included, with information on 639 parents. Five themes emerged from the data: sexuality-related concerns; upbringing and moral values; obligation to protect; external influences; and vaccine-related concerns., Conclusion: This systematic review is beneficial to identify and understand the culturally related facilitators and barriers to HPV vaccination among young women for the development of strategies to optimize HPV vaccine coverage among this population group by the policymakers., Competing Interests: Conflicts of interest None., (Copyright © 2024 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Despite increasing interest in quality end-of-life care (EOLC), critically ill patients often receive suboptimal care. Critical care nurses play a crucial role in EOLC, but face numerous barriers that hinder their ability to provide compassionate and effective care., Methods: An integrative literature review was conducted to investigate barriers impacting the quality of end-of-life care. This review process involved searching database like MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, and ScienceDirect up to November 2023. Search strategies focused on keywords related to barriers in end-of-life care and critical care nurses from October 30th to November 10th, 2023. The inclusion criteria specified full-text English articles published between 2010 and 2023 that addressed barriers perceived by critical care nurses. This integrative review employs an integrated thematic analysis approach, which combines elements of deductive and inductive analysis, to explore the identified barriers, with coding and theme development overseen by the primary and secondary authors., Results: Out of 103 articles published, 11 articles were included in the review. There were eight cross-sectional descriptive studies and three qualitative studies, which demonstrated barriers affecting end-of-life care quality. Quality appraisal using the Mixed Method Appraisal Tool was completed by two authors confirmed the high credibility of the selected studies, indicating the presence of high-quality evidence across the reviewed articles. Thematic analysis led to the three main themes (1) barriers related to patients and their families, (2) barriers related to nurses and their demographic characteristics, and (3) barriers related to health care environment and institutions., Conclusion: This review highlights barriers influencing the quality of end of life care perceived by critical care nurses and the gaps that need attention to improve the quality of care provided for patients in their final stages and their fsmilies within the context of critical care. This review also notes the need for additional research to investigate the uncover patterns and insights that have not been fully explored in the existing literature to enhance understanding of these barriers. This can help to inform future research, care provision, and policy-making. Specifically, this review examines how these barriers interact, their cumulative impact on care quality, and potential strategies to overcome., (© 2024. The Author(s).)

Background: Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited., Objective: This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps., Methods: We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records., Results: Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection., Conclusions: Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities., (©Michael Gnant, Khatijah Lim Abdullah, Frances Boyle, Chiun-Sheng Huang, Katie Bickford, Sola Neunie, Alexander Noble, Anne Nunn, Caroline Sproat, Nadia Harbeck, Carlos Barrios. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.03.2024.)

Background: Patients' death caused the intensive care unit (ICU) nurses to grieve, which led to their burnout. Intensive care unit nurses use various coping mechanisms and need support to overcome grief., Objective: The aim of this study was to identify the mediation effects of coping mechanisms and grief support on the impact of grief on burnout., Method: This cross-sectional study among 660 ICU nurses from 9 hospitals used 4 self-reported instruments to collect data, apart from the sociodemographic and employment-related variables. A final model was developed through structural equation modeling after establishing the construct validities of the measures through confirmatory factor analysis., Results: The representation of ICU nurses from each hospital was greater than 50%, with the majority being female (90.8%) with a mean age of 27.27 years. Most nurses perceived the absence of grief, low burnout, and moderate to low grief support. The nurses use various coping mechanisms. Grief support significantly mediated the relationship between grief and burnout using a bootstrapping method with a mediation strength using the variance counted for (VAF) of 34.95%. The final model fit indices with acceptable values validated the direct and indirect relationships of grief, grief support, and coping mechanisms on burnout., Discussion: The significant influence of grief support in mediating the effect of grief on burnout is an important finding. The nursing and hospital management can use this finding to provide grief support to ICU nurses, enhance the grief support resources, and promote future studies to test the model's validity and applicability to health care professionals who frequently face patients' death., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Emotional and Behavioral Problems (EBPs) are prevalent among adolescents, and adolescents' capacity for adaptation can be influenced by their interactions with their parents, environment, and self-esteem. This link has not been systematically examined among adolescents in West Sumatra, Indonesia. This study aimed to assess the association of parental attachment and self-esteem with EBPs in adolescents., Methods: A cross-sectional study was conducted from July to November 2022 in Padang West Sumatra, Indonesia. In total, 854 students from public senior high school 4 Padang were involved in this study and completed questionnaires on demographics, EBPs, parental attachment, and self-esteem. There was a total of five subscales for EBPs, which included emotional problems, conduct problems, hyperactivity, peer problems and prosocial. Additionally, there were three subscales for parental attachment, which included the mother's attachment, father's attachment, and peer attachment. Spearman's correlation, independent-sample t-tests, ANOVA and multiple linear regression analysis were employed to examine factors associated with EBPs., Results: This study showed that father's attachment (r = -0.191, p < 0.001), mother's attachment (r = -0.241, p < 0.001), and self-esteem (r = -0.437, p < 0.001) were negatively correlated with EBPs. The linear regression analysis showed EBPs was associated with father's education, father's communication, father's alienation, mother's alienation, and self-esteem. All predictors of overall EBPs among adolescents were able to explain 31 % of the variance in EBPs., Conclusion: High self-esteem and a strong parental attachment have positive outcomes in terms of mental health in adolescents. Thus, increasing adolescent self-esteem and establishing a warm parent attachment can be the main target in providing interventions for Indonesian adolescents with EBPs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Purpose: Kangaroo care is a complementary humanistic intervention based on a family-centered care model. This study investigated the effects of a locally contextualized, structured kangaroo care education program on weight gain, breastfeeding rate and length of hospitalization for premature infants., Patients and Methods: This longitudinal quasi-experimental study with pre- and post-intervention design involved 96 infants born between 28 and 37 weeks of gestation for three months, and was carried out at a neonatal intensive care unit in Malaysia. The experimental group received a structured education program and careful monitoring of their kangaroo care practices, while the control group received routine care without a structured education program. The institutional review board approved the study design and registered at ClinicalTrials.gov (NCT04926402)., Results: The kangaroo care hours performed by mothers at baseline in the experimental and control group was 4.12 and 0.55 hours per week, respectively. At three months post-discharge, the experimental group had significantly higher weight gain, higher breastfeeding rates and shorter lengths of hospitalization than the control group., Conclusion: A locally contextualized and structured kangaroo care education program is effective in the performance of kangaroo care. One hour per day of kangaroo care is positively associated with an extended period of breastfeeding, improved weight gain and shorter hospitalization of premature infants., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Samsudin et al.)

The aim of the current study was to examine the effect of a psychoeducation intervention on knowledge, insight, and internalized stigma among people with schizophrenia in a long-term care (LTC) facility in Jordan. This study was conducted based on cluster randomization using a pre- and post-test design. The intervention group ( n = 66) received seven sessions about schizophrenia over a 3-week period along with usual treatment. The control group ( n = 56) received usual treatment only. The psychoeducation intervention significantly improved knowledge (15.5%) and insight (22.5%) and reduced stigma (18%) among participants in the intervention group compared to the control group (2.6%, 4.7%, and 3.6%, respectively). This study shows the importance of integrating psychoeducation interventions in routine care for people with schizophrenia in LTC. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (2), 9-18.].

Purpose: To determine if listening to verses of the Qur'an during the immediate postoperative period has an effect on patients' anxiety levels, the number of opioids used to control pain, and the length of stay (LOS) in the Post Anesthesia Care Unit (PACU)., Design: Randomized Control Trial. Adult Muslim patients who had undergone a laparoscopic cholecystectomy through the Day Surgery Unit were randomly selected using computer-generated sequence into two groups, interventional and control groups., Methods: The control group listened to the natural environment and received Fentanyl for pain relief, and the interventional group listened to the Qur'an recitation and received Fentanyl for pain relief. A total of 112 (79.4%) participants completed the study. The level of the pain and anxiety was measured using the Wong-Baker Faces pain scale and Spielberger State-Trait Anxiety Inventory, respectively. Statistical analysis was conducted using SAS version 9.3 (Statistical Analysis System, SAS Institute Inc, Cary, North Carolina)., Findings: This study compared the effects of Qur'an audio therapy on patients' anxiety levels, opioid consumption, pain, and LOS in the PACU. The findings showed that by listening to chosen verses from the Qur'an in the recovery period post-anaesthesia, anxiety scores were significantly reduced (P = .0001), opiate use was reduced (P = .0081), and overall PACU LOS was also reduced (P = .0083)., Conclusions: Adding the use of listening to the Qur'an as a complementary therapy is a simple and cost-effective measure to reduce the need for narcotics in the PACU, and reduce the overall PACU length of stay. This intervention benefits the patient, the PACU, and reduces health care organization costs., (Copyright © 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objectives: To identify and analyse the determinants of emergency department length of stay., Methods: The cross-sectional study was conducted from December 20 to 31, 2017, at the Centre of Referral Hospital after approval from the ethics review committee of Dr Soetomo General Hospital, Surabaya, Indonesia, and comprised patients of either gender aged 18 years or above who visited the emergency department who required follow-up after triage, such as diagnostics or hospitalisation. Emergency department length of stay, assessment time, review and consultation, and disposition or decision were the variables noted. Data was analysed using SPSS 18., Results: Of the 172 patients, 95(57%) were men and 74(43%) were women. The largest age group was of those aged 45-59 years 61(34.4%). There were 48(27%) cases of surgery and 124(73%) of medicine. Mean emergency department length of stay was 575.94±306.402 minutes (range: 100-2215 minutes), and it was significantly associated with assessment time (p=0.001), review and consultation time (p=0.001) and disposition or decision time (p=0.002)., Conclusions: The emergency department length of stay was found to be rather prolonged and needed to be improved.

Little is known about the changes in perception of illness among patients with the acute coronary syndrome (ACS) during cardiac rehabilitation programme (CRP). The purpose of this study is to determine changes in perception of illness with ACS patients during CRP to evaluate the association of patients' characteristics with the perception of illness at the end of Phase II of CRP. A descriptive longitudinal study was conducted among 450 patients who attended 8-weeks of Phase II CRP at 2 public hospitals in Malaysia and perception of illness was assessed using Brief Illness Perception Questionnaire (BIPQ). The assessment was conducted before Phase II (T0), during the 4th session (T1), and at the end of right after the 8th session (T2). One-way repeated measures of ANOVA analysed the changes of perception at T1 and T2 while logistic regression analysis evaluated the association of patients' characteristics with the perception of illness at T2. Perception of illness changed during and after CRP from T0 to T1, and T1 to T2 ( p < 0.001). The patient viewed ACS as an illness that changed from being more acute to a chronic condition as the sessions progressed. Previous history of acute myocardial infarction (OR = 2.380, 95% CI 1.46, 5.49) and angioplasty intervention were both found to be associated with the perception of illness (OR = 3.857, 95% CI 1.55, 9.61). Perception of illness changed during CRP and these changes are associated with patients' previous history of cardiac events. Phase II can be viewed as the second window of opportunity for healthcare professionals to intervene early in modifying the perception of illness., Competing Interests: The authors declare no conflict of interest.

Aim: To assess the effectiveness of the maternal kangaroo care education programme over 1 month and 3 months on the mother's perception, knowledge, perceived barriers and stress., Design: A quasi-experimental and longitudinal study was conducted among mothers with premature infants., Methods: Forty-eight mother-infant dyads were enrolled per arm in the control and experimental groups. The control group received standard routine care, while the experimental group received a maternal kangaroo care education program. Data were collected through self-administered Kangaroo Care Questionnaires. Chi-square, the general linear model and repeated measures ANOVA were used to analyse data., Results: The demographics are a majority of Malay mothers with multipara, a caesarean delivery with prematurity. At 3 months post-intervention, the experimental group reported a significant reduction in stress, a positive perception and good knowledge towards kangaroo care implementation. The mothers' perceived barriers towards kangaroo care significantly decreased after 3 months in the experimental group., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Primary healthcare workers (PHCWs) are at the frontline of dealing with viral pandemics. They may experience significant psychological stresses, which have hitherto not been examined in depth. We aimed to explore the impact of the COVID-19 pandemic on the psychological health and wellbeing of frontline PHCWs in Malaysia., Method: We purposively recruited PHCWs with diverse backgrounds in Klang Valley, Malaysia. Using longitudinal qualitative methods, we conducted two sequential semi-structured telephone interviews, 3 to 4 weeks apart, to capture different stages of the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically., Result: Twenty-one PHCWs participated yielding a total of forty-two interviews. Themes clustered around stressors associated with work, home, and leisure activities, emotional changes, and modifying factors. In the first interviews, COVID-19 had just started in Malaysia. Participants expressed fear about the actual and perceived personal risk of COVID-19 infection. Most were worried about transmitting COVID-19 to their family members. Some felt stigmatized because of this perceived risk of infection. By the second interviews, participants felt safer, but instead focused on the need to keep other people safe. Participants' emotions were influenced by their perceived risk of contracting COVID-19 infection. Internal factors such as religion enabled them to manage their concerns and develop personal coping strategies. Support from family members, colleagues, and employers promoted wellbeing during the pandemic. Training sessions, daily roll calls, and psychological support services were important in maintaining their psychological health and wellbeing. Many participants were hopeful and believed normalcy would return by the end of 2020., Conclusion: PHCW's psychological health and wellbeing evolved throughout the early stages of the pandemic and were influenced by their perceived risk of contracting the disease and personal belief structures. Clear updates on the disease and strategies for keeping safe at work and socially are essential to maintaining PHCWs' psychological health and wellbeing., (© 2022. The Author(s).)

Aim: This study aimed to establish the validity and reliability of the measurement model of the Grief Support Healthcare Scale sub-constructs among the intensive care unit (ICU) nurses., Method: This methodological study in January 2015 uses the TRIPOD checklist for model validation. A two-order confirmatory factor analysis involving 655 nurses from the adult ICUs of nine hospitals confirmed the validity and reliability of the sub-constructs of grief support. The evaluation of the measurement model was based on the multi-category model fit indices., Results: The convergent and discriminant validities and reliability of the grief support sub-constructs, recognition of the relationship, acknowledgment of the loss, and inclusion of the griever were confirmed, with eight indicators. The measurement model of the revised Grief Support Healthcare Scale had a good model-fit (chi-square (df) = 67.586(17); p = .000; relative chi-square = 3.976; AGFI = 0.947; GFI = 0.975; CFI = 0.990; IFI = 0.990; TLI = 0.984; RMSEA = 0.067; SRMR = 0.020)., Conclusion: The validated grief support measurement model allows measurement of grief support for future intensive care unit nurses and the structural model analysis. Nurse managers and co-workers provide support to the grieving intensive care unit nurses based on the essential components of grief support.

Objective: Female sex is a major barrier to completing a programme of cardiac rehabilitation (CR) after acute coronary syndrome (ACS). Women require significant social support to promote compliance and the ability to cope with CR programme attendance. The aim of this systematic review of qualitative studies was to explore social support among women coping with CR programme attendance at phase II CRP is 3 months after their cardiac event., Methods: Articles were searched through CINAHL (Cumulative Index and Allied Health Literature), Science Direct and PubMed databases using the following terms: "women", "acute coronary syndrome", "coping", "social support" and "cardiac rehabilitation"., Results: A total of 6 articles were selected based on eligibility criteria. Thematic analysis was used to analyse the data using line to line coding into descriptive themes, interpreting further to generate new insights. The 3 most common themes regarding social support for women attending the CR programme were: family support, female as the primary caregiver in the family, and peer support. For most women who perceived themselves as the primary caregiver in the family there was a negative impact on their ability to cope fully with CR programme attendance. On the other hand, encouraging support from family and peers positively improved their coping mechanism for attending the CR programme, leading to improved compliance., Conclusion: Women with ACS consider that support from their family plays a vital role as a coping mechanism in their attendance at a CR programme. Healthcare providers should teach the importance of social support among women after discharge to help them cope with CR programme attendance.

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

Self-care education can direct patients to manage their side effects during treatment, reduce psychological distress, and improve self-care information. In this study, the effectiveness of the Self-Care Education Intervention Program (SCEIP) on patient activation levels, psychological distress, and treatment-related concerns in women with breast cancer was assessed by adopting a longitudinal quasi-experimental pre-test and post-test design. The data for 246 women with breast cancer undergoing adjuvant chemotherapy were collected. Pre- and post-interventional assessments were conducted at baseline (T1) and the second (T2), fourth (T3), and sixth (T4) cycles using the 13-item Patient Activation Measure, 14-item Hospital Anxiety and Depression Scale, and 25-item Cancer Treatment Survey. It was found that the SCEIP significantly improved the activation level ( p ≤ 0.001), psychological distress (anxiety level ( p ≤ 0.001), the depression level ( p ≤ 0.001)), and treatment-related concerns (sensory/psychological concerns ( p = 0.05); procedural concerns ( p ≤ 0.001)). Therefore, the SCEIP could potentially improve patients' activation level, psychological distress, and treatment-related concerns regarding symptom management during chemotherapy, specifically for Malaysian women with breast cancer., Competing Interests: The authors declare no conflict of interest.

Background and Objectives: A care pathway is a structured care plan based on best clinical practice for a particular patient group. It reorganizes a complex process by providing structured, standardized care and supportive multidisciplinary teamwork. Although care pathways are used worldwide, the impact and benefit of a care pathway for coronary care practices have been minimally debated. This preliminary study aimed to examine the effect of a care pathway on the autonomy, teamwork, and burnout levels among coronary care nurses in a tertiary hospital., Methods: A preliminary study was conducted using a pre/posttest one-group quasi-experimental design. A self-administered questionnaire was provided to 37 registered nurses from the cardiac ward of a tertiary hospital. The care pathway was developed on the basis of the current literature, local guidelines, and expert panel advice. The autonomy, teamwork, and burnout levels at the beginning and 4 months after disseminating the care pathway were measured. Implementing the care pathway included educational sessions, training in using the care pathway, and site visits to monitor nursing practices., Results: Most of the respondents were female (94.6%; n = 35), the median age of the respondents was 26.5 years (interquartile range [IQR] = 23-31), and the median length of the clinical experience was 4 years (IQR = 2-8). A statistically significant reduction in the mean burnout score was observed (mean of 58.12 vs 52.69, P < .05). A slight improvement in autonomy level was found, although it was not statistically significant. No statistically significant improvement was found in the teamwork levels., Conclusion: The care pathway was associated with reduced nurse burnout. The results showed a slight improvement in autonomy level among coronary care nurses after implementing the care pathway. From a practical viewpoint, the current study can help policy makers and managers reduce burnout. This study highlights the importance of using care pathways as a tool to reorganize the care process and improve the working environment. Managers must support nursing decisions and provide continuous education to enhance nurses' autonomy, which may increase understanding of respective roles, leading to higher levels of teamwork. However, with a small sample size, caution must be applied, as the findings might not be generalizable., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This paper describes the development and validation of an educational information web page designed for family members who have relatives in the Intensive Care Unit (ICU)., Background: Family members with relatives in the ICU always encounter a stressful experience. Hence, healthcare providers play a crucial in educating and alleviating the psychological distress experienced by family members with relatives in the ICU., Design and Methods: This study was a methodology research design. The educational information material was conducted in three stages: 1. Bibliographic survey; 2. Design and development of educational material; and 3. Validation of those materials by experts in the subject and representatives of the target audience and evaluation. The validation was performed by nine experts and 30 representatives of the target audience. A minimum value of 0.78 was recommended for Content Validation Index while a standard usability score value of 0.68 indicates good app usability., Result: The educational information material achieved acceptable CVI values (0.83) and the usability score of the web material was higher than 0.68. Meanwhile, the experts proposed changes to the educational information, which were accepted and updated for the final edition of the content., Conclusion: The educational information material was validated in terms of content and relevance and should be used by nurses to fulfil the needed information. Based on the knowledge given, healthcare providers can support, provide comfort, assurance and proximity to family members or relatives in the ICU. Future studies with this application are necessary to assess educational information effectiveness to reduce the psychological distress experienced by family members in the ICU., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Aims and Objectives: To map research-based psychological distress among the family members with patients in the intensive care unit (ICU)., Background: Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery., Design: The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist., Methods: A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL ® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed., Results: From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress., Conclusions: Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members., Relevance to Clinical Practice: The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery., (© 2021 John Wiley & Sons Ltd.)

The Coronavirus disease 2019 (COVID-19) global pandemic since its onset has had a dramatic and often devastating impact, both physical and psychological, on all healthcare workers. This study aimed to assess the impact of psychological distress that COVID-19 has on nurses, as well as the coping strategies that they employed. This is a cross-sectional national online survey. A total of 859 nurses actively involved in caring for patients with suspected or confirmed COVID-19 in Malaysia participated in the study. More than three-quarters of the nurses experienced stress (77.2%). A total of 88.7% and 7.2% of nurses revealed a moderate and high stress level, respectively. Approximately one in eight (12.1%) nurses reported feeling depressed. Nurses working in the outpatient departments reported significantly higher stress levels than nurses working in inpatient care departments. Nurses having chronic health problems reported significantly higher depression levels than nurses with no chronic health problem. Highly stressed or depressed nurses tend to adopt avoidance coping strategies while religion and emotional support were used regardless of the stress or depression levels experienced. The findings of the study provide insight into the mental health and coping strategies of nurses actively involved in caring for patients with suspected or confirmed COVID-19 in Malaysia. This would be of tremendous help to nursing administrators in implementing mental health services for nurses during and following the COVID-19 global pandemic.

Purpose: Malaysian disaster relief volunteers have a long and proud history of participating in relief missions within and outside the country. Despite of a plethora of researches into the various areas of disaster relief, there has been a little scholarly activity looking into the experiences of the medical volunteers worldwide and even less research on the experiences of the relief volunteers in Malaysia. Therefore, the purpose of this study is to identify the effect of disaster relief works on volunteers in Malaysia., Methods: This is a non-experimental cross-sectional design study, which was conducted using survey questionnaire to examine the incidence of burnout, posttraumatic stress disorder (PTSD) symptoms and the quality of life (QOL) among the disaster relief volunteers. And the study also examined the socio-demographic variables of the participants. In addition, the association between the sociodemographic variable and the preferred coping strategies was also investigated through self-reporting checklist., Results: The findings of this study revealed that 90.9% volunteers (n = 312) experienced some levels of recurring stress throughout their lives, which led to burnout. Also, 96.8% (n = 332) of the participants were categorized as having at least some symptoms of PTSD. However, self-reporting QOL measurements indicated that the participants are, in general, satisfied with their lives. Significant associations between the incidence of burnout, incidence of PTSD and QOL were identified. Both positive coping measures and behavioral or avoidant coping measures were also identified. Furthermore, a number of socio-demographic factors were also seen to interact significantly with burnout, PTSD and QOL., Conclusion: This study provides some insights into the psychological challenges of disaster relief volunteers in Malaysia, and this impact can last a long time after the volunteers return to their hometowns. Several recommendations including practice development, policy and research were discussed in the study., Competing Interests: Declaration of competing interest All the authors agree that there is no conflict of interest associated with this manuscript., (Copyright © 2021 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Aim: This study aimed to investigate the moderating effect of demographic variables (sex, age, marital status, years of experience, level of education, and income) on the relationship between quality of work life and turnover intention in Malaysian nurses., Method: A descriptive, and cross-sectional design using Brook's quality of nursing work life questionnaire (self-reported) and Porter's anticipated turnover scale was implemented to collect data from 430 randomly selected Malaysian nurses in a teaching hospital's medical, surgical, and special units. The data were analyzed using the structural equation model smart partial least squares and Statistical Package for Social Sciences software services., Results: The nurses had a moderate level of quality of work life and high level of turnover intention. Sex, number of children, and work wards/units had a moderating effect on turnover intention, after its interaction with quality of work life ( p < .05)., Conclusion: The study findings highlighted the factors having a moderating effect on turnover intention after its interaction with quality of work life . This knowledge is beneficial for providing guidance to nursing leaders or healthcare departments in hospitals to improve nurses' quality of work life and decrease their turnover intention. Addressing and understanding the demands and needs of nurses in the work environment and the family structure within a quality of work life could affect nurse's retention, leading to a decrease in their turnover intention., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright © 2021 Florence Nightingale Journal of Nursing.)

Purpose: This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan., Design and Methods: A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan., Findings: The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge., Practice Implications: This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia., (© 2020 Wiley Periodicals LLC.)

Background: Peer learning has enabled undergraduate nursing students to develop competence and clinical skills. It is rare to find quantitative studies examining the effect of peer learning on professional competence development among undergraduate nursing students comprehensively., Objective: To examine the effect of peer learning on professional competence development among Indonesian undergraduate nursing students., Design: A quasi-experimental study with non-equivalent control group pre-test post-test design., Participants: Convenience sampling was used to recruit participants. Seventy-five students completed the study (37 in the intervention group and 38 in the control group)., Methods: The intervention group received the peer learning program, while the control group received conventional learning during clinical practice. The Nurse Professional Competence (NPC) was used to collect data at pre-test and post-test measurement. Data were analysed using descriptive and inferential statistics., Results: Professional competence had significantly increased in the intervention group. A significant interaction effect of time (pre-test and post-test) and group on professional competence development was also found. The effect of peer learning on professional competence development was significantly greater than the conventional method., Conclusion: Peer learning was demonstrated as an innovative learning method to develop professional competence during clinical practice among Indonesian undergraduate nursing students. It is recommended for nurse educators to consider implementing peer learning during clinical education., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

Problem: Stigma affects not only children diagnosed with autism spectrum disorder (ASD) themselves, but also people connected with them (i.e., parents, siblings). The capacity of parents to provide care is affected by the stigma they perceive. This meta-synthesis encompasses the experiences of affiliate stigma among parents of children with ASD., Eligibility Criteria: Articles were limited to the English language, those reported on stigma experienced by parents of children with ASD aged 2-18 years, published between 1940 and 2019., Sample: PubMed, CINAHL, PsycINFO, EMBASE, Scopus and The Cochrane Library databases were searched for eligible studies. Titles and abstracts were reviewed, and twelve articles fitted the selection criteria. The texts of the selected research papers were reviewed by two independent reviewers., Results: Four common themes across parental experiences included felt stigma, enacted stigma, variations in stigma, and contributors to stigmatizing experiences., Conclusions: Highlighting the differences in parents' views on affiliate stigma is necessary to create awareness about ASD and the stigma linked with this disorder., Implications: The findings asserted that healthcare professionals, especially those in pediatric settings, and society need to have a greater awareness of the stigma and challenges that these parents encounter as this has implications on their mental and physical health. This awareness will lead to more compassionate health care delivery which will support them and create a better environment for families and children with ASD., Competing Interests: Declaration of Competing Interest The authors declare no actual or potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Understanding the factors influencing nurses' turnover intention, particularly the work life quality and commitment to organization, is important to all countries suffering from nursing shortage. The study aims to determine the mediating role of commitment to organization on work life quality and its relationship with turnover intention among Malaysian nurses., Methods: A descriptive cross-sectional design, using a self-report survey was conducted on 430 nurses from a teaching hospital from February to April 2019. A structural equation model version 3 was used for testing study hypotheses., Results: The mediating effect (indirect effect) of organizational commitment on the relationship between work life quality and turnover intention (QWL→OC→IT) was negative with path coefficient - 0.234, whereas the direct effect of work life quality on turnover intention (QWL→IT) was negative with smaller path coefficient - 0.228. This means that the relationship between work life quality and turnover intention was partially mediated by the organizational commitment (P < 0.001)., Conclusion: Organizational commitment has a negative partial mediating effect between work life quality of nurses and intention of turnover in teaching hospitals where the organizational commitment significantly reduced the nurses' intention to leave. The study findings can guide nursing managers to be carefully attended to the levels of nurses' commitment to their organization.

Introduction: Patients who visit emergency departments need to undergo a precise assessment to determine their priority and accurate triage category to ensure they receive the right treatment., Aim: To identify the effect of triage training on the skills and accuracy of triage decisions for adult trauma patients., Method: A randomized controlled trial design was conducted in ten emergency department of public hospitals. A total of 143 registered nurses and medical officer assistants who performed triage roles were recruited for the control group (n = 74) and the intervention group (n = 69). The skill and accuracy of triage decisions were measured two weeks and four weeks after the intervention group were exposed to the intervention., Results: There was a significant effect on the skill of triage decision-making between the control and the intervention group p < 0.001, η 2 partial  = 0.31. Concerning the accuracy of triage decisions, the effect was significantly different between the control group and the intervention group p < 0.001, η 2 partial  = 0.66 across time., Conclusion: The triage training improved the skills of the participants and the accuracy of triage decision-making across time., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Previous studies of nurses' critical thinking skills that included demographic characteristics as determinants have been inconclusive. This study explored demographic determinants of critical thinking skills among nurses from public hospitals in Peninsular Malaysia., Method: This cross-sectional study included 549 nurses recruited via multistage cluster sampling. Nurses completed the demographic questionnaire and Health Sciences Reasoning Test (HSRT)., Results: The majority of respondents failed to demonstrate critical thinking skills with a mean overall HSRT score of 13.8 (SD = 3.4). Educational qualifications (p = .003) and clinical specialties (p = .022) were significantly related to nurses' critical thinking skills. Years of clinical experience, age, and job ranking were not significant CONCLUSION: The findings indicate a need to address the present curriculum in nursing education and to reinforce critical thinking skills in the nursing workforce. Future research on how nurses in Malaysia acquire critical thinking skills is needed. [J Contin Educ Nurs. 2020;51(3):109-117.]., (Copyright 2020, SLACK Incorporated.)

Aims and Objectives: To explore the studies that used interventions based on the Mindfulness-Based Stress Reduction (MBSR) for decreasing psychological distress among nurses., Background: Because of the demanding nature of their work, nurses often have significantly high levels of stress, anxiety and depression. MBSR has been reported to be an effective intervention to decrease psychological distress., Design: Systematic review., Methods: The databases included were Science Direct, PubMed, EBSCO host, Springer Link and Web of Science from 2002 to 2018. Interventional studies published in English that used MBSR among nurses to reduce their psychological distress were retrieved for review. The PRISMA guideline was used in this systematic review. The included studies were assessed for quality using "The Quality Assessment Tool For Quantitative Studies (QATFQS).", Results: Nine studies were found to be eligible and included in this review. Many benefits, including reduced stress, anxiety, depression, burnout and better job satisfaction, were reported in these studies., Conclusion: The adapted/brief versions of MBSR seem promising for reducing psychological distress in nurses. Future research should include randomised controlled trials with a larger sample size and follow-up studies. There should also be a focus on creative and effective ways of delivering MBSR to nurses., Relevance to Clinical Practice: The results of this review are substantial for supporting the use of MBSR for nurses' psychological well-being., (© 2019 John Wiley & Sons Ltd.)

Aim and Objectives: To determine the prevalence of psychological distress and its association with job satisfaction among nurses in a teaching hospital in Malaysia., Background: Nurses constitute the majority of health care workers, and, compared with other professions, nursing profession is highly stressful and, hence, a cause of anxiety and depression. This may affect nurses' job satisfaction., Method: Using self-administered questionnaires, Depression Anxiety and Stress Scale (DASS-21) and Job Satisfaction Scale for Nurses (JSS), a cross-sectional study of 932 nurses from the inpatient departments of a teaching hospital was conducted in December 2017. Descriptive analyses and multiple logistic regressions were used for the analysis. The STROBE guideline was used in this study., Results: The overall prevalence of psychological distress was 41%. The prevalence of stress, anxiety and depression were 14.4%, 39.3% and 18.8%, respectively. It was found that single and widowed nurses had a higher level of stress, anxiety and depression compared with married nurses. In addition, nurses in the age of 26-30 years had a higher level of depression than nurses in other age groups. Also, nurses who worked in the paediatric departments had a higher level of depression compared with nurses in other departments. The majority of the nurses were satisfied with their job at 92.0%. Those nurses who were not satisfied were found to be significantly associated with a high level of stress and depression., Conclusion: This study revealed that the level of stress, anxiety and depression is high. Stress and depression were found to be associated with nurses' low job satisfaction., Relevance to Clinical Practice: Stress and depression can affect nurses' job satisfaction, it is important for nursing managers to institute strategies to address this issue., (© 2019 John Wiley & Sons Ltd.)

Background: Undergraduate nursing students are required to acquire professional values during professional nurse education to provide safe and high quality patient care. However, there was no documentation in professional values among Indonesian undergraduate nursing students and the factors influencing its development., Purpose: The purpose of this study was to determine professional values among Indonesian undergraduate nursing students and examine the relationship between students' demographic factors and professional values., Design: A cross-sectional study using convenience sampling was applied to recruit 391 Indonesian undergraduate nursing students. The 26 items of Nurses Professional Values Scale Revision (NPVS-R) with five dimensions was employed to collect data. Descriptive and inferential statistics, independent samples t-test were applied to analyse and interpret data., Results: The result showed that the total score of nurse professional values was high (95.80 ± 12.93). The most important professional value dimension was caring, while activism was the least important values. The NPVS-R total score had a significant association with length of professional clinical practice of the students (p < .05)., Conclusion: Nurse educators need to consider the integration of professional values when developing nursing curriculum, in order to ensure that the students develop their own understanding of these values and their importance in practice., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective. To explore and compare the influences of individual-level cultural values and personal attitudinal values on the desire for medical information and self-involvement in decision making in Australia and China. Methods. A total of 288 and 291 middle-aged adults from Australia and China, respectively, completed an online survey examining cultural and personal values, and their desired level of self-influence on medical decision making. Structural equation modeling was used to test 15 hypotheses relating to the effects of cultural and personal antecedents on the individual desire for influence over medical decision making. Results. Similar factors in both Australia and China (total variance explained: Australia 29%; China 35%) predicted desire for medical information, with interdependence (unstandardized path coefficient β Australia = 0.102, P = 0.014; β China = 0.215, P = 0.001), independence (β Australia = 0.244, P < 0.001; β China = 0.123, P = 0.037), and health locus of control (β Australia = -0.140, P = 0.018; β China = -0.138, P = 0.007) being significant and positive predictors. A desire for involvement in decisions was only predicted by power distance, which had an opposite effect of being negative for Australia and positive for China (total variance explained: Australia 11%; China 5%; β Australia = 0.294, P < 0.001; China: β China = -0.190, P = 0.043). National culture moderated the effect of independence on desire for medical information, which was stronger in Australia than China ( Z score = 1.687, P < 0.05). Conclusions. Study results demonstrate that in both countries, desire for medical information can be influenced by individual-level cultural and personal values, suggesting potential benefits of tailoring health communication to personal mindsets to foster informed decision making. The desired level of self-involvement in decision making was relatively independent of other cultural and personal values in both countries, suggesting caution against cultural stereotypes. Study findings also suggest that involvement preferences in decision making should be considered separately from information needs at the clinical encounter., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

Objective: The aim of this study was to analyse the factors associated with the intention of Indonesian nursing students to work in rural areas., Design: This was a cross-sectional study. The instrument used was a self-developed questionnaire consisting of 13 questions. The data were analysed using the χ2 statistics test and binary logistic regression with a level of significance <0.05., Setting: The study was conducted at a public nursing school located in urban Surabaya, East Java, Indonesia, in December 2017., Participants: A total of 714 nursing students from four different programmes were involved., Results: This study found that almost 60% of nursing students were reluctant to work in rural areas. Of the three variables which were significant in the χ2 analysis, only two were significant following the logistic regression test, namely the class programmes of undergraduate regulars (OR=2.274; 95% CI 1.326 to 3.900), profession regulars (OR=2.262; 95% CI 1.110 to 4.607) and rural place of origin (OR=1.405; 95% CI 1.036 to 1.906)., Conclusion: The education programme and place of origin were associated with the intention of nursing students to work in rural areas. Therefore, the recruitment of prospective nurses should consider these factors by considering the local context., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background The Internet is an important resource of information about sexually transmissible infections (STIs) among young people. Little is known of the facilitators of online STI information seeking. This study aimed to identify the factors associated with online STI information seeking among youth in Malaysia., Methods: A cross-sectional online survey was conducted among Malaysian youth aged 18-25 years who were recruited through social media., Results: Among 1530 respondents who completed the survey, 57.1% sought online STI information in the past 12 months mostly from general Internet websites, health websites, and Facebook. Respondents' overall STI knowledge was low. Young people who had higher STI knowledge (OR = 2.47, 95% CI = 1.87-3.25, P = 0.000), had intention-to-seek online STI information (OR = 2.02, 95% CI = 1.23-3.30, P = 0.000), identified as homosexual or bisexual (OR = 1.67, 95% CI = 1.08-2.57, P = 0.020), experienced STI symptoms (OR = 1.51, 95%CI = 1.02-2.22, P = 0.040), were in a relationship (OR = 1.42, 95% CI = 1.08-1.86, P = 0.012) and had high perceived quality of online STI information (OR = 1.41, 95%CI = 1.09-1.83, P = 0.009) were more likely to seek online STI information., Conclusions: Findings suggest the need to increase STI knowledge and perceived quality of online STI information among Malaysian youth. Young people with low STI knowledge, who are heterosexual, sexually active without STI symptoms and single would benefit from reliable sources of online STI information for STI prevention.

Objective: This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety., Background: Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers., Methods: A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI)., Results: 56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics., Conclusion: Mothers in this setting revealed high levels of stress and anxiety during their premature infants' NICU admission. An immediate interventional programme focusing on relieving mothers' anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.

Aims and Objectives: To investigate the effectiveness of a structured nursing intervention program on maternal stress and NICU-related maternal ability after the admission of premature infants to a neonatal intensive care unit (NICU)., Background: Mothers of premature infants may face stress having premature infants, and their infants may be admitted to the NICU for a few weeks or months. The mothers' experience of stress would be worse if they have low knowledge and poor NICU-related maternal ability. Mothers of infants admitted to the NICU require well-planned interventions to cope with psychological matters arising after an infant hospitalisation., Design: Quasi-experimental design., Methods: A total of 216 mothers were consecutively assigned to control and intervention groups. Each group consisted of 108 mothers. The mothers in both groups received questionnaire concerning maternal stress and NICU-related ability during their first visit to NICU (within 48 hr of admission). A structured nursing intervention was implemented for 10 days on mothers in the intervention group. The control group continued to receive existing practice nursing care. Mothers of both groups were again given the questionnaire on maternal stress and NICU-related ability after 14 days of admission., Results: In the intervention group, the difference between the mean total score of maternal stress and parental role and relationship subscale decreased significantly, compared to the control group (p = 0.04; p = 0.01) respectively. Maternal ability improved significantly in mothers in the intervention group 2 weeks postintervention, p < 0.001., Conclusion: A structured nursing intervention for mothers could significantly reduce maternal stress and promote maternal NICU-related abilities., Relevance to Clinical Practice: The results of the study could help neonatal nurses to develop an appropriate nursing intervention for parents with premature infants in the NICU., (© 2018 John Wiley & Sons Ltd.)

Background: Peer learning experiences have been reported in previous qualitative studies, however individual findings could limit practical leverage due to small sample size. Thus it is necessary to integrate invaluable findings from various qualitative studies to consider appropriateness and acceptability of peer learning in professional nurse education., Objective: To identify and synthesize qualitative evidence of peer learning experiences of undergraduate nursing students so as to understand their perceptions on peer learning experiences., Design: A qualitative systematic review was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement., Data Sources: Database searching was conducted on electronic databases such as Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and MEDLINE that published from 2007 to 2017., Review Methods: Qualitative studies were appraised using the Critical Appraisal Skills Programme (CASP). Thematic analysis was used to analyse the data using line by line coding, organising coding into descriptive themes, and interpreting further to generate new insights., Results: Six studies were included in this review. The most common themes identified were integrated into two new insights including personal development and professional development., Conclusion: This review has revealed that peer learning experiences contribute to the learning process of undergraduate nursing students in preparing them to become professional nurses through personal development and professional development., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To identify the efficacy and safety of the use of various cost-effective reflective materials around phototherapy units to reduce the duration of phototherapy and hasten the reduction of bilirubin among neonates with physiologic jaundice., Data Sources: A systematic review of randomized controlled trials identified from searches in the Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase, and the Cochrane Library with the use of keywords, MeSH terms, operators, and the review of reference lists of retrieved articles., Study Selection: From a total of 186 studies initially screened, five were eventually included in this analysis., Data Extraction: Two authors independently reviewed each study with a standard template. Review parameters included the quality of each study based on the Physiotherapy Evidence Database scale and the Consolidated Standards of Reporting Trials guidelines., Data Synthesis: All studies were generalizable and were rated as high quality on the Physiotherapy Evidence Database scale; one study scored 8 points, and the other four scored 6 points each. The reflective materials used in these studies included the following: white 100% cotton cloths (one study), white plastic covers (two studies), underpads (one study), and silver fabric cloth (one study). Pooled analysis of three studies indicated that reflective materials significantly reduced the duration of phototherapy with a large effect size of 0.82 (p = .04). Pooled analysis of another three studies indicated that the mean decrease of the total serum bilirubin 4 hours after the initiation of phototherapy was significantly greater when reflective materials were added (mean difference of 11.39 μmol/L, 95% confidence interval [2.26, 20.52 μmol/L], p = .01)., Conclusion: The addition of reflective materials to phototherapy units may be therapeutic for neonates with physiologic jaundice., (Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

The use of physical restraint exposes patients and staff to negative effects, including death. Therefore, teaching nursing staff to develop the improve knowledge, skills, and attitudes regarding physical restraint has become necessary. A quasi-experimental pre-post design was used to evaluate the effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint in 12 wards of a hospital using a self-reported questionnaire and a restraint order form in Malaysia. The educational intervention, which included a one-day session on minimising physical restraint use in hospital, was presented to 245 nurses. The results showed a significant increase in the mean knowledge, attitude sand practice score and a significant decrease in the mean intention score of nurses to use physical restraint after intervention. There was a statistically significant decrease in the incidence rate of physical restraint use in the wards of the hospital except geriatric-rehabilitation wards after intervention., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Evidence-Based Medicine (EBM) integrates best available evidence from literature and patients' values, which then informs clinical decision making. However, there is a lack of validated instruments to assess the knowledge, practice and barriers of primary care physicians in the implementation of EBM. This study aimed to develop and validate an Evidence-Based Medicine Questionnaire (EBMQ) in Malaysia., Methods: The EBMQ was developed based on a qualitative study, literature review and an expert panel. Face and content validity was verified by the expert panel and piloted among 10 participants. Primary care physicians with or without EBM training who could understand English were recruited from December 2015 to January 2016. The EBMQ was administered at baseline and two weeks later. A higher score indicates better knowledge, better practice of EBM and less barriers towards the implementation of EBM. We hypothesized that the EBMQ would have three domains: knowledge, practice and barriers., Results: The final version of the EBMQ consists of 80 items: 62 items were measured on a nominal scale, 22 items were measured on a 5 point Likert-scale. Flesch reading ease was 61.2. A total of 343 participants were approached; of whom 320 agreed to participate (response rate = 93.2%). Factor analysis revealed that the EBMQ had eight domains after 13 items were removed: "EBM websites", "evidence-based journals", "types of studies", "terms related to EBM", "practice", "access", "patient preferences" and "support". Cronbach alpha for the overall EBMQ was 0.909, whilst the Cronbach alpha for the individual domain ranged from 0.657-0.940. The EBMQ was able to discriminate between doctors with and without EBM training for 24 out of 42 items. At test-retest, kappa values ranged from 0.155 to 0.620., Conclusions: The EBMQ was found to be a valid and reliable instrument to assess the knowledge, practice and barriers towards the implementation of EBM among primary care physicians in Malaysia.

Background: Complementary and alternative medicine (CAM) is commonly used for cancer- and chemotherapy-related symptoms. Nurses are likely to encounter many CAM users in their practice., Objective: The aims of this study were to assess CAM use and examine the symptom burden of CAM and non-CAM users among patients with breast cancer who are undergoing chemotherapy., Methods: A CAM use questionnaire and the Side-Effect Burden Scale were administered to 546 patients. Complementary and alternative medicine use was categorized as mind-body practices (MBPs), natural products (NPs), or traditional medicine (TM)., Results: We identified 386 CAM users (70.7%) in this study. The CAM users reported a higher marginal mean total symptom burden score (40.39 ± 2.6) than non-CAM users (36.93 ± 3.21), although this difference was not statistically significant (P = .09). Triple-modality (MBP-NP-TM) CAM users had a significantly higher marginal mean total symptom burden score (47.44 ± 4.12) than single-modality (MBP) users (34.09 ± 4.43). The risk of having a high total symptom burden score was 12.9-fold higher among the MBP-NP-TM users than among the MBP users., Conclusions: Complementary and alternative medicine use is common among Malaysian patients who are undergoing chemotherapy for breast cancer. However, CAM and non-CAM users reported similar symptom burdens, although single-modality use of MBP is likely associated with a lower symptom burden., Implications for Practice: Nurses should keep abreast of current developments and trends in CAM use. Understanding CAM use and the related symptom burden will allow nurses to initiate open discussion and guide their patients in seeking additional information or referrals for a particular therapy.

Background: Population ageing has become a public health issue as it is associated with increased morbidity, institutionalization and death. These may directly affect health-related quality of life (HRQOL) of older people., Purpose: The aim of the study was to investigate HRQOL and its associated factors among community-dwelling older people in Kandy district, Sri Lanka., Method: This cross-sectional survey involved 1300 older people. The Euro 5D-3L, International Physical Activity Questionnaire, body mass index, handgrip strength were used to measure HRQOL, physical activity and nutritional status of older people respectively. Factors associated with health-related quality of life were identified through complex sample logistic regression analysis., Results: Majority of older people (81.9%) reported poor health-related quality of life. Middle old (aOR: 12.06, 95% CI: 5.76, 25.23), very old (aOR: 174.74, 95% CI: 39.74, 768.38), vegetarian diets (aOR: 2.13, 95% CI: 1.14, 3.96), under-nutrition (aOR: 3.41, 95% CI: 1.65, 7.04) and over-nutrition (aOR: 1.85, 95% CI: 1.04, 3.28) were significantly associated with poor HRQOL. Using dentures (aOR: 0.05, 95% CI: 0.28, 0.90) was found as a protective factor for poor HRQOL., Conclusions: HRQOL was poor among community-dwelling older people in Kandy district. Nutrition-related factors need to be further investigated to improve HRQOL among older people., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Incidence rate and patterns of physical restraint use were examined based on a cross-sectional study in 22 wards of a large teaching hospital in Malaysia. Results indicated that the highest rate of physical restraint (19.7%) was reported from neurology-neurosurgery wards. "Un-cooperative for electroconvulsive therapy" and "trying to pull out catheters" were the most commonly reported reasons to use restraint in psychiatric and non-psychiatric wards, respectively. There were some relationships between patterns of physical restraint in this study. Exploring the incidence rate and patterns of physical restraint is important so that effective strategies can be formulated to minimize using restraint in hospitals.

This study aimed to evaluate the usability (ease of use) and utility (impact on user's decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.

Aims and Objectives: To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses., Background: Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care., Design: Integrated literature review., Methods: The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review., Results: Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results., Conclusions: Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors., Relevance to Clinical Practice: This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making is still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables., Background: A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals., Design: A cross-sectional study was used., Methods: A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur., Results: Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint., Conclusion: This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint., Relevance to Clinical Practice: Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals., (© 2017 John Wiley & Sons Ltd.)

Purpose: To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance., Design and Methods: A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS., Results: Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43)., Conclusions: The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance., Practical Implications: The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients., Aims and Objectives: This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes., Design: A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention., Methods: A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention., Results: Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities., Conclusions: Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills., Relevance to Clinical Practice: Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses., (© 2015 British Association of Critical Care Nurses.)

Aims and Objectives: To determine the feasibility and utility of a thematic analysis approach to synthesising qualitative evidence about parental experiences in the neonatal intensive care unit., Background: Admission of infants to the neonatal intensive care unit is usually an unexpected event for parents who can cause them to experience psychosocial difficulties. A qualitative systematic review is the best method for exploring these parents' experiences regarding this type of admission., Design: Systematic review., Methods: Qualitative studies in peer-reviewed journals aimed at understanding parental experiences regarding infant neonatal intensive care unit admission were identified in six electronic databases. Three reviewers selected relevant articles and assessed the quality of the methodological studies using the Critical Appraisal Skills Programme. A thematic analysis approach was used to identify the most common themes in the studies describing parental experiences in the neonatal intensive care unit., Results: A total of eighty articles were identified; nine studies were included in this review. Four studies used semistructured interviews, three used interviews, one used self-reporting and one used both focus group and interview methodologies. Common themes across parents' experiences were the stress of hospitalisation, alteration in parenting roles and the impact of infant hospitalisation on psychological health., Conclusion: Having an infant hospitalised in the neonatal intensive care unit is a stressful experience for parents. This experience is the result of exposure to different stressors related to the infant's condition, an alteration in parenting roles or the neonatal intensive care unit environment and staffing. These parents suffered negative psychological effects, experienced an interrupted development of a healthy parent-infant attachment and/or felt parental role alteration., Relevance to Clinical Practice: The study's findings are crucial for neonatal intensive care unit nurses to develop intervention strategies and programmes that help parents to decrease the stress of their experience and to support them in facing this stressful situation., (© 2016 John Wiley & Sons Ltd.)

Background: Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown., Aim: We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM)., Design: We used a qualitative design and thematic approach., Setting: Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices., Method: We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes., Results: We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand., Conclusion: It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid., (© 2015 John Wiley & Sons Ltd.)