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Introduction: Pregnancy is a time of great joy and excitement for many mothers to be, however it could also be stressful. It is a time when the mother becomes more vulnerable and this reduced level of control can add to the mother's perception of stress and anxiety. Emotional response can cause physical changes that can negatively affect the pregnancy. This study aims to evaluate the prevalence of anxiety symptoms and factors associated with anxiety among out-patient antenatal mother. Design: Cross-sectional study. Materials and Method: A cross sectional survey was conducted with 320 out-patient antenatal mothers from a major teaching hospital in Malaysia. Their anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Descriptive analysis and chi-square were used to evaluate the association between anxiety symptoms with socio-demographic factors, self-esteems and social supports. Result: This study revealed 35.5 % of the pregnant women experiencing significant anxiety symptoms at their first booking. Factors associated with significant anxiety symptoms among antenatal mother are the total family monthly income, mothers' period of gestations, history of obstetric complication and mothers' self-esteem. Conclusion: Anxiety symptoms are prevalent during pregnancy. Intervention to deal with the factors that increase the prevalence of anxiety at this stage is crucial to prevent the development of further psychological problems during pregnancy, delivery and post-delivery. [ABSTRACT FROM AUTHOR]

Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses' (RNs) needs and not simply organizational requirements. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including experience of students athletes in dealing and managing psychological challenges, research of ethical issues among postgraduate students and methodological dilemma.

Introduction: Illness perceptions involve personal beliefs that patients have about their illness and may influence health behaviour considerably. This preliminary study evaluates the understanding of illness perception among cardiac patients' and correlations of each of the items. Methods: A preliminary study was conducted using the on Brief Illness Perception Questionnaire (BIPQ) in a tertiary hospital among 40 cardiac patients. Ethical approval was obtained from the institution ethical committee. There are 9 items in the BIPQ with 0-10 response scale measuring causal factors and an open-ended item. Items 1 to 5 assesses on the cognitive illness perception which comprises of consequences, timeline, personal control, treatment control and identity. Item 6 and 8 are on emotional response and item 7 is on coherence. Results: The overall mean score of the 8 items of BIPQ was 7.04 (1.07) with the highest mean for item 4 on treatment control and item 6 on personal control at 8.02 (0.92) and 7.03 (1.77) respectively while the lowest mean was item 7 on understanding at 6.63 (1.83). The causal factor for the open-ended question was mostly on consumption of fatty food intake, sedentary lifestyle and stress at work. Perceiving personal control was significantly being affected by perceiving treatment control for the cardiac disease (r=0.50) and being concerned about their cardiac symptoms was significantly related to perceiving consequences of the disease (r =0.54), perceiving identity (r=0.75) and perceiving emotional control (r=0.67). Perceiving emotional control on their symptoms was significantly related to perceived consequences on cardiac disease (r=0.51), perceived identity (r=0.53) and perceived concern on cardiac disease (r=0.67). Conclusion: The results shown significant correlations with relevant outcomes measures. It is useful in clinical practice to assess and potentially modify patient's perceptions on understanding, emotional control, personal control, consequences and perceived concerned over their cardiac disease. [ABSTRACT FROM AUTHOR]

Introduction: The numbers of male lower urinary tract symptoms (LUTS) and sexual dysfunction (SD) are increasing worldwide including Malaysia. Both disorders caused significant effects on quality of life. Most men assume both disorders as age-related problem and opt to go untreated. Exploring the prevalence of both disorders and their effects on males' quality of life in Sarawak by nurses is highly relevant. There has to be a significant change in the way these two health problems are assessed and managed by the nurses often with little or no medical participation. This study was aimed to determine the occurrence of LUTS and SD in men, and their effects on quality of life in Sarawak. Methods: A cross-sectional, survey-based study was used involving 162 male outpatients of age =40 years, recruited at outpatient clinics in Sarawak General Hospital. Questionnaires on International Prostate Symptoms Score; Danish Prostatic Symptoms Score-Sex and International Index for Erectile Function; and quality of life - Short Form-36 were given to eligible participants. Results: Results revealed that the occurrence of moderate to severe LUTS among male respondents attending non-urological clinics were14.8% and most common in 60-69 years old males. 84.6% of them experienced nocturia. 47.83% had severe erectile dysfunction and most common in 70-79 years old males. LUTS were also positively associated with erectile dysfunction. However, the findings on quality of life showed that both diseases were negatively associated with physical and mental composite summaries in Short Form-36. Conclusions: The results implied that prevalence of both disorders and their effects on men's quality of life is significant and have impacts on clinical practice. Contributing factors to male LUTS and SD were identified and need to be addressed accordingly to minimise the occurrence and complications of both disorders to men. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac rehabilitation is one of the secondary prevention programme to reduce morbidity and mortality in cardiac patients. However, adherence towards this programme is still sub optimal. The objective of this study isto determine the perceived barriers on cardiac rehabilitation programme among cardiac patients and its association with the sociodemographiccharacteristics. Methods: A preliminary study using the Cardiac Rehabilitation Barrier Scale (CRBS) was conducted in a tertiary hospital among 40 patients. The CRBS tool was validated and tested for reliability. Convenience sampling method was used among those who have attended the cardiac rehabilitation programme. Ethical approval was obtained from the institution ethical committee. There were total of 22 items in the CRBS except for the last item (22nd) being an open-ended item to enable the patients to share their opinion on any other barriers towards attendance to cardiac rehabilitation programme. The 21 items assessed on patients' opinion on the perceived barriers during their attendance to the cardiac rehabilitation programme in a form of Likert scale. Results: The overall mean (SD) score for the 21 items was 60.70 (8.77) showed that the patients were able to understand gave their best options on the opinions towards CRBS. The highest mean on item 11 on 'time constraints' at 3.58 (0.75). Thus, the majority of the patients scored the item "time constraints' as the highest perceived barrier during attendance in the cardiac rehabilitation programme. The association of the sociodemographic status had significance difference (p<0.05) for gender with item 4 on 'family responsibilities' and item 13 on 'I don't have energy' with (p=0.035) and (p=0.020) respectively. Level of education too showed significant difference to item 9 on I find 'exercise tiring and painful' and item 12 on 'work responsibilities' with (p=0.034) and(p=0.048). Conclusion: Thus, measures should be taken for other barriers to ensure patients' adherence to the cardiac rehabilitation programme. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various articles published within the issue on topics like qualitative research, health care services, and nursing education.

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. [ABSTRACT FROM AUTHOR]

The Internet has opened pathways for youth to find sexual health information which was not easily available to them in the past. Studies have shown that seeking sexual health information online may potentially influence an individuals' decision-making to change their sexual health behaviours. However, there is a gap in research on the associations of seeking online sexually transmitted infection (STI) information with STI prevention among young people, particularly in Malaysia. This study investigated the associations of seeking STI information online with the intentions of condom use among young adult online users in Malaysia. A cross-sectional online survey was conducted among Malaysian youth aged 18–25 years old who were recruited through Facebook. In total, 1530 respondents completed the survey, identifying 874 respondents who had sought STI information online. The majority of respondents had intentions to use condoms as protection against STI. Respondents who sought online STI information were significantly more likely to have the intention to use condoms compared to respondents who did not seek online STI information (OR = 1.33, 95% CI = 1.01–1.76, p = 0.040). Online STI information has the potential to increase access to STI information among young online users in Malaysia amid the stigma surrounding sex-related issues. Providing accurate STI information online from reliable sources may equip young people who have Internet access with awareness of sexual health protective behaviours such as condom use. It is recommended to facilitate Internet access to reach sectors of the population that currently do not have access, as the Internet is useful in STI prevention. [ABSTRACT FROM AUTHOR]

Background: Often, the indirect impact of autism spectrum disorder (ASD) presents the family with significant challenges. One of these challenges is affiliate stigma due to parental affiliation with their child. This study aimed to explore affiliate stigma, resilience and quality of life (QoL) among parents of children with ASD. Methods: Cross-sectional study of 144 parents of children with ASD were recruited from two main tertiary hospitals in Kelantan, Malaysia, a developing country in Southeast Asia. Pearson correlation was used to examine the relationship between parental affiliate stigma, resilience and QoL. Simple and multiple linear regression analyses were used to identify the significant associated factors of affiliate stigma, resilience and QoL. Results: Correlational analyses revealed that perceived affiliate stigma demonstrated an inverse relationship with resilience and QoL. Additionally, resilience had a positive relationship with QoL. Regression analyses revealed that the father's employment status, the mother's level of education, having a disability card, the child's age at ASD diagnosis, comorbidities of the child and ASD severity perceived by parents were associated with parental affiliate stigma, resilience and QoL. Conclusion: Study findings highlight the contribution of socio-demographic characteristics of children with ASD and their families in the determination of affiliate stigma, resilience and QoL. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to analyze the relationship between the knowledge and attitudes of medical-surgical nurses and preparedness in providing nursing care for COVID-19 patients. The long COVID-19 pandemic has exhausted nurses serving patients, resulting in a lack of preparedness for health workers. Nurse preparedness is strongly influenced by the knowledge and attitudes of nurses in dealing with problems that arise. The preparedness, knowledge, and attitudes of nurses in providing nursing care for COVID-19 patients are not yet known in detail. Methods: The research design that has been used is cross-sectional. The population that has been used in this study is nurses in the Emergency Department. The sample that has been recruited is 34 people using the purposive sampling technique. The independent variables that have been determined are nurses' knowledge and attitudes about COVID-19. The dependent variable that has been used is the readiness of nurses in providing care about COVID-19. The instrument to collect data that has been used is a modified knowledge, attitude, and preparedness questionnaire. The data analysis that has been used is Spearman's rho correlation test. Results: The results showed that the knowledge and attitudes of medical-surgical nurses were related to nursing preparedness in providing nursing care to COVID-19 patients (p = 0.022 and p = 0.018). Conclusion: Nurses' knowledge and attitudes in providing nursing care to COVID-19 patients can maintain nurse preparedness properly. Training and seminars about COVID-19 are highly recommended to be carried out frequently so that nurse preparedness remains good. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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: 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: 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: 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.

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.

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.)

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.)

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.)

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: Patients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies., Objective: This study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin., Methods: Semi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach., Results: FIVE THEMES WERE IDENTIFIED AS BARRIERS: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments., Conclusion: This study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.

Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs' design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.

Background: Cancer and chemotherapy are sources of anxiety and worry for cancer patients. Information provision is therefore very important to empower them to overcome and adjust to the stressful experience. Thus, nurses should be aware of the informational needs of the patients throughout the course of their care., Purpose: The purpose of the study was to identify the important information required by breast cancer patients during the first and fourth cycles of chemotherapy from both the patients' and nurses' perceptions., Methodology: This is a longitudinal study used a questionnaire adapted from the Toronto Informational Needs Questionnaires-Breast Cancer (TINQ-BC). Some modifications were made to meet the specific objectives of the study. The study was conducted in the Chemotherapy Day Care at the University of Malaya Medical Centre (UMMC), Malaysia. A total of 169 breast cancer patients who met the inclusion criteria, and 39 nurses who were involved in their care were recruited into the study., Results: The overall mean scores at first and fourth cycle of chemotherapy were 3.91 and 3.85 respectively: i.e., between 3 (or important) and 4 (or very important), which indicated a high level of informational needs. There was no significant difference in information needed by the breast cancer patients between the two cycles of chemotherapy (p=0.402). The most important information was from the subscale of disease, followed closely by treatment, physical care, investigative tests and psychosocial needs. Nurses had different views on the important information needed by breast cancer patients at both time points (p = 0.023)., Conclusions: Breast cancer patients on chemotherapy have high levels of informational needs with no significant differences in information needed at first cycle as opposed to fourth cycle. There were differences between the perceptions of the breast cancer patients and the nurses on important information needed. A paradigm shift, with an emphasis on patients as the central focus, is needed to enhance the information giving sessions conducted by nurses based on the perceptions of the patients themselves.