Search

Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child's development. Given the rise in technology and parents' preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants., Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned., Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles-the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development., Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability., Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development., (©Shefaly Shorey, Thiam Chye Tan,   thilagamangai, Jancy Mathews, Chun Yan Yu, Siew Hoon Lim, Luming Shi, Esperanza Debby Ng, Yiong Huak Chan, Evelyn Law, Cornelia Chee, Yap Seng Chong. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.12.2021.)

Family-centered care is recognized as the gold standard in pediatric healthcare practice. However, despite the acknowledgment of its benefits and importance, inconsistent and questionable implementation persists in neonatal intensive care units (NICUs) without a consolidated understanding of healthcare professionals' experiences. Therefore, this review aims to explore and consolidate healthcare professionals' perspectives on parental participation in the NICU. A systematic review of qualitative studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven electronic databases were searched from their respective dates of inception until December 30, 2020. Twenty-eight studies were included in this review. The analysis was conducted via a framework synthesis approach using Antonovsky's Sense of Coherence theory. Three over-arching themes, guided by Antonovsky's Sense of Coherence theory emerged: (1) "Comprehensibility of parental involvement in family-centered care," (2) "Manageability of parental involvement in care and decision-making," and (3) "Meaningfulness of parental involvement in shared decision-making in neonatal care," with nine corresponding subthemes. Healthcare professionals had mixed views of parental involvement, recognizing the benefits attributed to infants and parents, but were greatly hindered by organizational, environmental, and personal obstacles that weakened their sense of coherence in coping with the situation, making them feel unconfident and unprepared to involve parents in care. To cope, more integrated and formalized support was required. Organizational, environmental, and policy changes, as well as psychological support, were strategies identified to enhance healthcare professionals' sense of coherence, and consequently, their ability to cope., (© 2021 Wiley Periodicals LLC.)

Background: The United Nations Sustainable Development Goals 2030 aim to reduce health care inequity and maternal and infant mortality rates amongst marginalized populations. To provide adequate and culturally relevant maternity care for minority ethnic groups, it is imperative to examine health care providers' views on care for migrant women. We reviewed published accounts of views and experiences of maternity health care providers providing maternity care for migrant women as a way of exploring their cultural competency., Method: A qualitative meta-synthesis was conducted. Systematic searches were conducted in five electronic databases from inception dates through February 2021. Qualitative data were analyzed using a framework thematic analysis based on Campinha-Bacote's five-component cultural competency model., Findings: Eleven studies were included. Findings were presented according to Campinha-Bacote's model: cultural awareness, cultural knowledge (personal responsibility, familial role and cultural influence, the influence of social and system factors, conflicting maternity care expectations), cultural encounter (language and communication), and cultural desire (establishing trust and going the extra mile, resources to boost culturally competent care)., Discussion: Our findings can inform the design of high-quality behavioral change, health care management, sociological, and other relevant studies, along with reviews of what matters to service users about cultural responsiveness. Our data also suggest that health system constraints can exacerbate the lack of cultural competency. Improving the quality of care for migrant communities will necessitate a joint effort between health care organizations, health care providers, policymakers, and researchers in developing and implementing more culturally relevant maternity care policies and management interventions., (© 2021 Wiley Periodicals LLC.)

Aims: To explore nurses' experiences of workplace bullying and ways to prevent such occurrences., Design: A qualitative systematic review was conducted., Data Sources: Five electronic databases were searched from each database's inception to December 2020., Review Methods: Meta-summary and meta-synthesis were conducted using Sandelowski and Barroso's approach., Results: Twenty-seven studies were included in this review. The overarching theme, 'The Vicious Cycle of Bullying in Nursing', and four themes were synthesized: (a) different 'faces' of bullying, (b) the hidden drivers of bullying, (c) impact of being bullied and (d) responses to bullying., Conclusion: The nursing code of ethics and anti-bullying policies should be consistently enforced by each organization's upper management. Nurses should be provided a safe space to voice their concerns on bullying within the organization., (© 2021 John Wiley & Sons Ltd.)

Background: There is increasing evidence that being resilient negates the deleterious impacts of stress and promote academic success. To develop an insight into how important resilience is, it is vital to explore how higher education students perceive and develop resilience., Objectives: The purpose of this review was to gather students' experiences of their resilience journey in an educational setting., Design: Systematic review and meta-ethnography of qualitative evidence REVIEW METHODS: This review was reported in accordance with the eMERGe guidelines. The data were analysed with reference to the seven steps of meta-ethnography. The Grading of Recommendations, Assessment, Development and Evaluation's Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) was used to appraise the quality of the evidence., Results: Three themes emerged: (1) resilience associates with internal resources, (2) resilience develops through meaningful relationships and (3) resilience can be instilled by educational institutions. An individual's trait, outlook and engagement within their social network can influence resilience. The presence and availability of institution-based support services can ease students transition into higher education., Conclusion: This review provides a basis for influencing further research and curriculum development in ensuring students' well-being and success in school., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: This scoping review aimed to consolidate evidence of the learning styles, preferences and needs of Generation (Gen) Z healthcare students., Background: It is essential to update the educational framework and pedagogy to meet each generation's distinct learning styles and preferences., Design: A scoping review of published and unpublished data., Methods: Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, ProQuest and Scopus) were searched for studies written in English from June 2016 to July 2021. The Arksey and O'Malley (2005) five-stage framework was adopted to guide this review: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarising and reporting the results using a thematic analysis., Results: Seventeen studies were included and based on the thematic analysis, four themes were identified: (1) attributes of Gen Z healthcare students; (2) learning styles of Gen Z healthcare students; (3) learning preferences and needs of Gen Z healthcare students; and (4) teaching the Gen Z healthcare students: future directions and recommendations for educators. The findings implied more culturally diverse studies that adopt the mixed-methods or qualitative design are needed to capture deeper insights about Gen Z and in examining the effectiveness of technology integration and digital storytelling to boost students' learning and confidence in their future careers., Conclusions: Technology, campus resources and self-care strategies must be carefully integrated and planned to ensure an optimal and a safe learning environment for the students. The specific preferences and needs of the unique healthcare disciplines and educational subjects could be examined. A theory-based framework could be considered in designing future pedagogy. These future directions could allow educators to initiate vital change agents in guiding, supporting and nurturing students across generations., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: The aim of the study is to explore available literature on nurses'/midwives' perceptions of emotional intelligence in the clinical setting., Background: Emotional intelligence is a crucial skill in nursing practice but little is known about nurses' perceptions of it., Evaluation: Eight electronic databases (CINAHL, Cochrane, Embase, ProQuest Dissertations and Theses Global, PsycInfo, PubMed, Scopus and Web of Science) were searched until November 2020. Quality appraisal was performed using the Critical Appraisal Skills Program Checklist. Data analysis was conducted using Sandelowski and Barroso's two-step approach of meta-summary and meta-synthesis., Key Issues: Five themes emerged from the 17 included studies: (1) understanding emotional intelligence in clinical nursing, (2) nurses' utilization of emotional intelligence, (3) benefits of being an emotionally intelligent nurse, (4) barriers to developing emotional intelligence and (5) recommendations to enhance emotional intelligence., Conclusions: Nurses expressed interest in enhancing their emotional intelligence, and they identified barriers and provided corresponding recommendations to support their endeavours. Future studies should be geographically distributed and include nurses from all sectors of the profession to amass a holistic and comprehensive conceptual understanding of emotional intelligence., Implications for Nursing Management: Policy makers and nursing educators should tactically and successfully integrate emotional intelligence training into the nursing profession and curricula., (© 2021 John Wiley & Sons Ltd.)

Aim and Objective: To test the psychometric properties of the entrustable professional activity assessment tool for clinical procedures to be administered to clinical trainers and students., Background: Students' ability to perform clinical procedures professionally and safely is a key concern for healthcare educators. The assessment of professional activities, in which entrustment is a key outcome, is crucial for determining the level of training and supervision of work-based assessments. The entrustable professional activities for clinical procedures (EPA-CP) have been used among clinical trainers, but it needs more psychometric testing., Design: The psychometric study used a cross-sectional design., Methods: Students' self-assessment (n = 302) and the supervisors' ratings on the students' performance in clinical procedures (n = 266) were used to evaluate the psychometric properties of the six-item EPA-CP assessment tool. Internal consistency and test-retest reliabilities of the assessment tool were examined. Convergent, known-groups, analysis of structural validity were conducted to investigate the tool's construct and factorial structure. The STROBE checklist for cross-sectional studies was followed., Results: The EPA-CP assessment tool demonstrated good reliability, satisfactory convergent validity and significant differences in the known-group comparison. The exploratory factor and confirmatory factor analyses indicated the cogent constructs of the assessment tool when administered to students and their supervisors., Conclusion: The EPA-CP assessment tool is a valid, reliable and user-friendly tool for evaluating healthcare students' capability to perform clinical procedures. This tool makes it possible for the precise assessment of learners in performing procedures in busy and dynamic clinical settings., Relevance to Clinical Practice: Reliable instruments are needed to effectively assess healthcare students' ability to perform clinical procedures and enable trainers to entrust students with the tasks. The results indicate that the EPA-CP assessment is promising and may be used in the healthcare settings., (© 2021 John Wiley & Sons Ltd.)

Background: Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons., Design: A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235)., Methods: A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline., Results: Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up., Conclusion: The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest in this study., (Copyright © 2021. Published by Elsevier Ltd.)

Preventing smoking among adolescents is critical. This study evaluated the effectiveness of the Smoking Prevention Education Program among nonsmoking adolescents. A quasi-experimental study design was used. Data were collected from Year 5 students ( n = 140) from four government primary schools in the Kuantan and Pahang districts of Malaysia. The participating schools were randomly assigned into the intervention and control groups. Questionnaires and exhaled carbon monoxide (CO) levels were used to collect data at the baseline and at 3 months postintervention. At 3 months postintervention, the percentage of nonsmokers remained 100% in the intervention group, while 2.9% of the participants in the control group reported to have smoked in past 7 days. Comparatively, the mean scores of attitudes, subjective norms, and nonsmoking intentions of the intervention group improved significantly. The intervention was effective in preventing smoking initiations among Malaysian adolescents; however, further evaluation of this intervention is needed among varied populations.

In Singapore, many older adults suffer from subsyndromal depression and/or subsyndromal anxiety, which can negatively impact their physical and mental well-being if left untreated. Due to the general public's reluctance to seek psychological help and the low psychiatrist-to-population ratio in Singapore, this study aims to examine the preliminary efficacy, perceptions, and acceptability of a trained volunteer-led community-based intervention on community-dwelling older adults. Twenty-one participants (control: n = 11; intervention: n = 10) completed the randomized pilot study. A mixed-methods approach (questionnaires, semistructured interviews, examining blood samples, intervention fidelity) was adopted. No significant differences were found between the intervention and the control groups in depression, anxiety, life satisfaction, friendship, and quality of life. However, there was a positive change in quality-of-life scores from baseline to 6 months in the intervention group. The control group had significantly higher cortisol levels and lower annexin-A1 levels at 6 months, while the intervention group did not. Three themes emerged from the interviews: (1) impact of the intervention on older adults' well-being, (2) attitudes toward intervention, and (3) a way forward. However, intervention efficacy could not be established due to small sample size caused by the coronavirus pandemic. Future randomized controlled trials should evaluate volunteer-led, technology-based psychosocial interventions to support these older adults.

Background: Mindful parenting is the process of bringing awareness and attention intentionally in a non-reactive and non-judgemental way to a child at any present moment. Parenting mindfulness is believed to influence parenting factors and parental psychological outcomes, child's emotional and behavioural outcomes, and family relationships. However, the efficacy of such interventions on interpersonal mindfulness in parenting and parenting behaviours has received minimal empirical attention., Objective: This meta-analysis aims to quantitatively evaluate the efficacy of mindful parenting interventions on parenting mindfulness and parenting behaviours. Parenting stress, parents' psychological wellbeing, interpersonal relationships, and child behavioural outcomes were examined secondarily. When meta-analysis was not possible (due to insufficient data in the included studies), the narrative approach was taken to present the findings., Design: A systematic review, meta-analysis, and narrative summary., Methods: Six electronic databases (PubMed, Embase, PsycINFO, CINAHL, Scopus, and ProQuest Dissertations and Theses) were systematically searched for articles in the English language from their respective dates of inception to December 2020. Studies involving clinical and non-clinical samples of parents with children or youths aged 24 years and below were included. Only randomised controlled trials were included. Studies were excluded if the mindfulness intervention did not focus on parenting skills training; that is, it focused on childbirth, stress reduction or incorporated other forms of therapy (e.g. cognitive behavioural therapy). Data was synthesised using a random-effects model in RevMan 5.4. The outcomes of primary interest were parenting mindfulness and parenting behaviours. The secondary outcomes were parenting stress, parents' psychological wellbeing, interpersonal relationships, and child behavioural outcomes., Results: Eleven studies representing 1,340 parents from six countries were included in the review. No evidence of intervention effect was found for overall parenting mindfulness and overall parenting stress. However, mindful parenting interventions demonstrated a moderate effect size when examining parenting mindfulness scores (standardised mean differences (d)=0.62, 95% CI: 0.11, 1.13, p = 0.02) of parents with non-clinical samples of children. No intervention effect was found for overall parenting stress. Due to insufficient studies and data, findings on parenting behaviours, psychological wellbeing, relationships, and child behaviour were presented narratively., Conclusion: Mindful parenting interventions are associated with higher parenting mindfulness scores for parents of typically developing children when compared with a control group. The limited studies and mixed results on positive parenting behaviours, parental psychological wellbeing, parental relationship with child and partner, and child behavioural outcomes serve as an impetus for further research., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students., Design: A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials., Data Sources: Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020., Review Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I 2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots., Results: Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective., Conclusion: Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Although Indonesia's child mortality rate has decreased in tandem with the global trend, healthcare services can be further improved for children. This study aims to explore the perceptions of healthcare providers and caregivers of children aged below five years to improve child health in urban Indonesia. A mixed-methods study design was adopted. Quantitative data were collected via questionnaires from the caregivers. Qualitative data were collected via semi-structured interviews from the healthcare providers. Analysis of 540 caregiver questionnaires regarding the care provided to their child revealed that the majority of them were very satisfied (46.1%) and satisfied (52.2%) with the care received. Analysis of 12 interviews with healthcare providers derived three major themes: (1) importance of one's role as a healthcare provider; (2) factors affecting the delivery of healthcare; and (3) the way forward in caring for young children. Although caregivers were very satisfied with the care received for their children, the perception of healthcare providers regarding their responsibility in delivering care to children under five years old provides insights into improving the quality of services for children in Indonesia. Our findings suggest that mortality and morbidity of children aged below five years can be best reduced by optimizing primary and secondary preventive measures.

Introduction: Hospital-at-Home (HaH) programmes are well-established in Australia, Europe, and the United States. However, there is limited experience in Asia, where the hospital is traditionally seen as a safe and trusted space for healing. This cross-sectional study aimed to explore attitudes and perceptions among patients and caregivers in Singapore toward this care model. Methods: A quantitative study design was adopted to collect data among patients and their caregivers from medical wards within two acute hospitals in Singapore. Using a series of closed-ended and open-ended questions, the investigator-administered survey aimed to explore barriers and facilitators determining patients' and caregivers' responses. The study questionnaire was pretested and validated. Data were summarised using descriptive statistics, and logistic regression was performed to determine key factors influencing patients' decisions to enrol in such programmes. Results: Survey responses were collected from 120 participants (101 patients, 19 caregivers; response rate: 76%), of which 87 respondents (72.5%) expressed willingness to try HaH if offered. Many respondents valued non-quantifiable programme benefits, including perceived gains in quality of life. Among them, reasons cited for acceptance included preference for the comfort of their home environment, presence of family members, and confidence toward remote monitoring modalities. Among respondents who were unwilling to accept HaH, a common reason indicated was stronger confidence toward hospital care. Discussion: Most patients surveyed were open to having acute care delivered in their home environment, and concerns expressed may largely be addressed by operational considerations. The findings provide useful insights toward the planning of HaH programmes in Singapore., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lai, Lim, Kuan, Goh, Soong, Shorey and Ko.)

Objective: Prolonged home isolation may lead to long-term negative consequences for both children and caregivers' psychological wellbeing, especially in families with children with neurodevelopmental disorders. Therefore, a scoping review was conducted to identify challenges faced by caregivers of children with neurodevelopmental disorders during the coronavirus disease 2019 (COVID-19) pandemic and to consolidate parenting interventions and guidelines., Methods: A systematic search was conducted on Embase, PsycInfo, PubMed, Scopus, and LitCovid. All article types published between December 2019 and November 2020 which reported on intervention guidelines and experiences of families with children with neurodevelopmental disorders during the COVID-19 pandemic were included. Qualitative themes, quantitative data, and article summaries were charted, and a thematic analysis was conducted., Results: Twenty-nine articles were included in the review. Three themes were generated: (a) behavioral issues and health concerns, (b) disruptions of lifelines and daily routines, and (c) existing programs, models, and guidelines to support families. Additionally, a list of caregiver strategies such as scheduling regular online consultations, maintaining online therapy, educating a child on COVID-19, and preventive behaviors, creating a structured daily schedule and reinforcement system, and selecting child-appropriate activities was consolidated., Conclusion: This review revealed a lack of evidence-based studies and articles on children with other neurodevelopmental disorders apart from autism and attention-deficit hyperactivity disorder. It also places emphasis on the importance of telehealth services as major lifelines to parents during this pandemic and urges healthcare organizations to provide funding to increase telehealth services to afflicted families., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients., Design: A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials., Data Sources: English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020., Review Methods: A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I 2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level., Results: Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement., Conclusions: Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Perinatal loss can occur due to miscarriages and ectopic pregnancies, among other circumstances. Psychological health of parents can deteriorate due to perinatal loss. Parent's negative psychological outcomes include depression, anxiety, and grief., Objective: To evaluate the effectiveness of psychosocial interventions in reducing depression, anxiety, and grief among parents after perinatal loss., Design: A systematic review and meta-analysis of randomized controlled trials DATA SOURCES: English language articles published from database inception to 19 November 2019 were systematically retrieved from eight electronic databases (CINAHL, Cochrane, EMBASE, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science)., Review Methods: The Cochrane Risk of Bias tool was used to conduct quality appraisal of each individual article and data was analyzed using Review Manager 5.3. A meta-analysis of randomized controlled trials was conducted using a random-effect model., Results: Among this review's 17 included studies, 15 studies' results were included in the meta-analyses. The remaining two studies were summarized narratively. Meta-analyses revealed that psychosocial interventions significantly reduced depression (95% CI: -0.64 to -0.29, Z = 5.17, p = <0.00001), anxiety (95% CI: -0.50 to -0.18, Z = 4.21, p < 0.0001) and grief (95% CI: -0.71 to -0.32, Z = 5.12, p < 0.0001)., Conclusion: Psychosocial interventions are effective in improving depression, anxiety, and grief amongst parents with perinatal loss. Psychosocial care can be provided by medical healthcare professionals and expanded with technology-assisted implementation., Study Registration Number: CRD42019145526., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: Despite palliative care being offered to paediatric cancer patients, it has limited utilisation and often excludes parental support. Therefore, this review aims to consolidate evidence regarding experiences and needs of parents of end-of-life palliative paediatric oncology patients., Methods: Six electronic databases were searched as follows: CINAHL, The Cochrane Library, Embase, PubMed, Scopus and PsycINFO. Included studies were appraised using the Critical Appraisal Skills Programme Checklist. They were then analysed using a two-step approach comprising firstly meta-summaries followed by meta-synthesis for generating fresh insights to the topic., Results: Thirteen studies were included. Three themes emerged as follows: (1) normalising the pain; (2) failure as a parent; and (3) importance of communication and social support. Parental experiences included moving on despite the pain and harbouring hopes for their children. However, parents felt immense guilt and a sense of failure in carrying out their parental roles. Effective communication with healthcare providers, availability of family support and religion were necessary to help them cope., Conclusions: Given the emotional challenges faced by parents, healthcare policies and practices should be revised to include parental support in paediatric palliative care services. Future healthcare communication trainings should consider parental need for sensitivity in communication, empathy and kindness from healthcare professionals., (© 2020 John Wiley & Sons Ltd.)

Background: Heart failure (HF) is a major public health problem that places a significant disease burden on society. Self-care is important in the management of HF because it averts disease progression and reduces the number of hospitalizations. Effective nursing interventions promote HF self-care., Objective: This study aims to explore participants' perspectives on a nurse-led, home-based heart failure self-management program (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness of the study intervention., Methods: A descriptive, qualitative approach was used. English- or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semistructured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed verbatim, with the participant identifiers omitted to ensure confidentiality. The thematic analysis approach was used to identify, analyze, and report patterns (themes) within the data., Results: A total of six themes emerged from the process evaluation interviews and were categorized according to the Donabedian structure-process-outcome framework as intervention structure, intervention process, and intervention outcome. These six themes were manageability of the intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care., Conclusions: The findings of the process evaluation provided additional information on participants' perceptions and experiences with the HOM-HEMP intervention. Although a home visit may be perceived as resource intensive, it remains to be the preferred way of engagement for most patients. Nurses play an important role in promoting HF self-care. The process of interaction with the patient can be an important process for empowering self-care behavior changes., (©Ying Jiang, Karen Wei Ling Koh, Hadassah Joann Ramachandran, Yee Kian Tay, Vivien Xi Wu, Shefaly Shorey, Wenru Wang. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.04.2021.)

Background and Objectives: The experiences and needs of individuals with osteoporosis, especially among women, are poorly understood. This meta-synthesis aimed to examine the experiences and needs of women living with osteoporosis., Research Design and Methods: Six databases were searched for qualitative studies from each database's inception to July 18, 2019. Qualitative data were meta-summarized, then meta-synthesized., Results: A total of 2,781 studies were obtained, and 2,768 studies were screened after the removal of 13 duplicates. Two thousand seven hundred and sixty studies failed to meet the eligibility criteria, resulting in the inclusion of eight studies in this meta-synthesis. Three themes emerged: (a) physical and psychological consequences of living with osteoporosis, (b) coping strategies to "live better" with osteoporosis, and (c) sources of support and support needs., Discussion and Implications: Women living with osteoporosis experienced negative physical and psychological consequences that led to changes in their lives, particularly in their relationships. They adopted various coping strategies such as acceptance and engaging in doing things that they loved. They expressed support needs such as educational and self-help groups that may help them to cope better. As the included studies were only from the West, more studies from geographically diverse backgrounds such as the Middle East and Asia are required to explore the experiences and needs of women living with osteoporosis. Theory-based health services that incorporate active coping strategies such as self-seeking behaviors should be designed to create awareness about osteoporosis to assist such women in maintaining their independence and overall well-being to age gracefully., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Problem: Parents of children with chronic kidney disease face tremendous burdens of care, having to adopt dual roles as parents and informal healthcare providers, delivering home-based clinical care, despite lacking proper qualification and training., Eligibility Criteria: A systematic review of qualitative studies was conducted to identify sources of distress among parents caring for children with chronic kidney disease undergoing dialysis, excluding children who have had renal transplants. Guided by PRISMA guidelines, six electronic databases (PubMed, Embase, PsycINFO, Scopus, Cochrane, Google Scholar) were searched for relevant articles published in English. A three-step inductive thematic synthesis method outlined by Thomas and Harden (2018) was used to form descriptive themes and the Critical Appraisal Skill Program (CASP) qualitative checklist was utilised to appraise the quality of included articles., Sample: A total of 23,129 title and abstracts were reviewed; 161 full texts were reviewed. Thirteen papers, with the experiences of 183 parents, met the inclusion criteria. Most included studies were conducted in Western countries, which may limit the applicability of this review to other countries., Results: Five themes emerged: disease-related distress, personal struggles, family structure, lack of resources and unrealistic social expectations., Conclusion: Parents of children with chronic kidney disease undergoing dialysis experienced distress at multiple levels., Implication: Healthcare professionals caring for children with chronic kidney disease could screen parents early for distress, and refer them to relevant psychosocial and community services., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Due to technological advancements and the current generation being more tech-savvy, the use of virtual worlds in nursing education and clinical practice is increasingly popular. We performed a systematic review on randomised controlled trials and quasi-experimental studies to examine the current evidence on the use of virtual worlds as a teaching tool and to ascertain the outcomes measured., Design: Systematic review of randomised controlled trials and quasi-experimental studies., Data Sources: Six electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Web of Science, and ProQuest) were searched by title and abstract from each database's date of inception to December 2019., Review Methods: The Joanna Briggs Institute's Critical Appraisal Tool was used to conduct critical appraisal of the selected articles., Results: Eighteen studies were included in the narrative summary. Studies were mostly conducted in developed countries and focused on nursing students. Advantages of virtual worlds include higher time-cost-effectiveness as compared to mannequin-based simulations and face-to-face lectures. Two major disadvantages were technological issues and the lack of realism., Conclusions: Among the three learning outcomes (skills-based, cognitive, and affective), virtual worlds are the most effective in improving cognitive outcomes such as theoretical knowledge. This suggests that virtual worlds may be used as an alternative or complementary method to teach theoretical knowledge in nursing education., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Childhood diabetes is a rising concern as the overall annual increase in diabetes among children/adolescents is estimated to be around 3% over the past decade. Diabetes management places children/adolescents and their parents at greater risks of psychological distress. This study aims to measure the levels of diabetes-related emotional distress in children/adolescents with diabetes and their caregiving parents and to identify associations between sociodemographic characteristics and clinical variables in Singapore. A cross-sectional study was conducted using validated questionnaires. Ninety-two parent-child/adolescent dyads completed self-reported questionnaires. Elevated levels of diabetes-related distress were found in both children/adolescents with diabetes and their parents. Female children/adolescents with diabetes, low-income households, and less-educated parents of children/adolescents with diabetes were more susceptible to diabetes-related distress. It is important for healthcare professionals to educate less-educated parents in the management of their children's/adolescents' diabetes. Greater financial assistance should be provided to low-income households that may not have access to advanced diabetes treatments.

Aims: This review aimed to evaluate the effectiveness of healthy eating interventions among normal-weight children., Design: A systematic review of randomized controlled trials., Data Sources: Seven databases were searched from the inception of each database until September 2019., Review Methods: A systematic review of quantitative studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA extension for reporting a synthesis without a meta-analysis., Results: Fifteen studies were included in this review. A meta-analysis could not be conducted because of the observed heterogeneity across studies. There were mixed effects of the included interventions on healthy eating habits, ranging from effective to not effective. Only a few studies found behavioural determinants effective in enhancing healthy eating., Conclusion: Because of the observed heterogeneity and varied outcome variables, a meta-analysis could not be conducted, and the overall effectiveness of the included interventions could not be verified. Interventions that were theory based, parent focused, and delivered through the multimodal interactive approach were found to be effective in enhancing healthy eating habits among children. More studies involving peers that are institution based need to be conducted., (© 2020 John Wiley & Sons Ltd.)

Aims: To explore and describe the experiences, challenges and coping strategies of new nurses dealing with paediatric death in a clinical setting., Design: A descriptive qualitative study design was used., Methods: Semi-structured interviews were conducted to explore the experiences of 12 new paediatric nurses from a tertiary public hospital in Singapore. Data were collected from September 2019-December 2019. A thematic analysis was performed for data analysis., Results: Four themes were generated: (a) a spectrum of emotions; (b) the 'blame' game; (c) getting through the grief; and (d) new nurses' wish list. The new nurses tended to be emotionally affected by their first death experience. They felt anxious and personally responsible for the death but eventually controlled their emotions. Colleagues, religion and self-actualization were key in overcoming grief., Conclusion: The experiences nurses go through at the early stages of their profession shape future workplace attitudes. Additional training and support should be provided to new nurses to build their confidence in managing end-of-life care. Training should include cultural awareness and communication skills to equip nurses with the necessary skills., Impact: This research will have an impact on institutions, which develop culturally congruent training and support platforms that prepare new nurses for nursing practice. This research will drive future investigations on the long-term effects of paediatric death on new nurses., (© 2020 John Wiley & Sons Ltd.)

Purpose: To examine the experiences and needs of Asian older adults who are socially isolated and lonely living in Asian and western countries., Materials and Methods: Six databases were searched for qualitative studies from each database's inception to December 2019. Qualitative data were meta-summarized and then meta-synthesized., Results: Fourteen studies were included in this review. Five themes emerged: (1) association with older adults' well-being, (2) loss of social support, (3) dealing with social isolation and loneliness (4) unique experiences of Asian older adults in western countries, and (5) wish list of older adults. The older adults felt psychologically down and experienced a lack of social support from their family members. They coped using strategies such as religious reliance and social engagement with peers. Asian older adults in western countries faced cultural barriers and tried to form ethnic communities. The older adults wished for more community resources and care., Conclusion: There were multiple associations of social isolation and loneliness on the Asian older adults' well-being and social support. Coping mechanisms such as acceptance and social engagement were adopted. They expressed support needs such as social programs and healthcare services. More geographically distributed studies are needed to gather a more comprehensive and causality-related perspectives of socially isolated and lonely older adults. Lay-led programs, technology, and active coping strategies are proposed and can be incorporated in healthcare services and social programs to assist these older adults., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Problem: A pathogenic medical orientation focusing on disease management relies heavily on the skills of healthcare professionals. In contrast, a salutogenic approach focuses on health promotion by encouraging resource strengthening among patients to maintain and support recovery, which could help alleviate healthcare burden and enhance healthcare quality. Considering the increased life expectancies of chronically ill children, this review aimed to consolidate evidence on the use of salutogenesis among children and adolescents with chronic illnesses., Eligibility Criteria: A scoping review guided by Arksey and O'Malley's five-stage framework was conducted. Studies with samples of children or adolescents aged 19 years and below with chronic disease were included in the review., Sample: A library search was performed across six electronic databases (PubMed, Embase, CINAHL, PsycInfo, and Web of Science) from each database's inception to March 2020. Twelve studies were included., Results: Current evidence only highlighted the trend and advantages of high sense of coherence and identify factors that enhance sense of coherence. Boys, younger age, higher cognitive functioning, non-migrants, non-smokers, and available peer and family support contribute to higher levels of sense of coherence, which lead to better perceived health, quality of life, and more positive coping strategies., Conclusions: Healthcare professionals should adopt a salutogenic approach to encourage patient involvement, independence, and responsibility in maintaining their own health., Implications: Further research is needed to provide a holistic view of the sense of coherence and application of salutogenesis (especially other salutogenic concepts) among this sample group, which can also inform future salutogenic intervention studies., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To consolidate existing qualitative studies which examined the experiences and needs of adults living with IBS, and to gather a holistic insight for future directions and avenues to support these adults., Methods: A qualitative systematic review was conducted and six databases were searched for qualitative studies, beginning from each database's inception to July 2020. The qualitative data were meta-synthesised and thematic analysis was adopted. Any discrepancies that arose were discussed between the reviewers until a consensus was reached throughout the process of data screening, selection, critical appraisal and synthesis., Results: Seventeen studies with a total of 299 adults diagnosed with IBS were included. Four themes were identified: (1) physical, psychological, and social consequences; (2) impact of IBS on working adults; (3) dealing with IBS; and (4) sources of support and support needs., Conclusion: Future research across geographically diverse locations are needed to gather a thorough perspective of the experiences and needs of adults living with IBS. The development and evaluation of technology-based, trained peer-led volunteers, and interventions that adopt mindfulness, active coping strategies, cognitive behavioural therapy and acceptance, and commitment therapy are needed. Ultimately, the collaboration between the relevant stakeholders is essential for standardised instruments and materials for accurate testing, diagnosis, assessment, treatment and management of IBS., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Caregiver burden of parents of children with disabilities is negatively associated with parental quality of life and psychosocial well-being and has been identified as a public health concern. Reviews have consolidated the experiences of these parents, but little is understood about the unique challenges faced by parents of children with cerebral palsy (CP). We aim to conduct an in-depth synthesis of the experiences and needs of parents of children with CP to better support them., Methods: Six electronic databases were searched systematically for qualitative research, and a thematic synthesis was performed., Results: Seventeen studies from 1988 to 2019 encapsulating the experiences of 226 parents were included in this review. Four themes and 11 subthemes were identified: (1) self: the caregiver-parent trajectory (coming to terms with the fact, physical and emotional demands, and a nice outlet), (2) family: maintaining the family unit (juggling multiple children and parenting as a co-occupation), (3) society: social repercussions (facing public discrimination, rejection by extended family, and loss of freedom), and (4) parents' wish list (open communication and caring attitudes, funding and health care accessibility, social integration, and inclusivity). Apart from emotional adaptation and physical childcare difficulty, parents indicated a need for more information on health care services, funding, better attitudes and empathy from health care providers, properly trained educators, disability-friendly fixtures, and more public awareness., Conclusion: The findings in this review provide insight into the true experiences and needs of parents caring for children with CP and will aid clinicians in the development of family-centered care pathways for these patients.

Background: Singapore is among the several countries affected by the COVID-19 outbreak. The outbreak has elicited panic and unease among Singapore's public. This study aimed to analyze the comments left on local media news outlets to find common concerns and discuss potential new measures that can be developed to reduce panic and support for Singapore's public during and beyond COVID-19., Methods: A qualitative content analysis on the comments on relevant news articles from the Facebook pages of six online local news publications dated from 23 January 2020 to the 3 April 2020 was carried out., Results: Five common themes were derived 1: fear and concern (35.42%), 2 panic buying and hoarding (21.21%), 3 reality and expectations about the situation (20.24%), 4 staying positive amid the 'storm' (10.07%) and 5 worries about the future (5.01%). The analysis revealed that fear and concern were the main reasons behind the public's responses., Conclusion: Clear communication between the government and the public is one of the best ways to maintain calm among the public and to contribute to greater social cooperation. Timely updates and support measures from the government further help to maintain social peace and cohesion., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Modern medical pedagogical strategies are shifting toward the use of virtual patient simulations., Objective: This study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training., Design: A descriptive qualitative study design was used., Setting: Nursing faculty at a local university in Singapore., Participants: 24 nursing undergraduates and six clinical facilitators., Methods: This study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis., Results: Two overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled 'value of technology in teaching communication' comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills., Conclusion: The mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To consolidate qualitative research studies that examined the experiences and needs of pregnant women, midwives, and nurses of maternity units to provide a way forward for future research and practices during the current pandemic and future epidemics and pandemics., Design: Qualitative systematic review and meta-synthesis., Data Source: Four electronic databases-PubMed, Scopus, PsycINFO, and Cumulative Index to Nursing and Allied Health (CINAHL)., Review Methods: Qualitative studies with samples of pregnant women, midwives, and/or nurses of maternity units who experienced epidemics and/or pandemics were searched from 1 January 2000 to 4 April 2020. The included studies were critically appraised using the ten-item Critical Appraisal Skills Programme (CASP) tool., Findings: Eight studies were included in this review. Four themes emerged from the synthesis: (1) psychological responses, (2) challenges faced, (3) coping strategies, and (4) sources of support and support needs., Key Conclusions: Pregnant women, midwives, and nurses experienced negative psychological responses during epidemics and pandemics. Challenges, such as limited available information and public stigma, were faced. Various coping strategies, such as actively looking for more information and seeking solace in religions, were practiced by pregnant women, midwives, and nurses. Families were both sources of support and stress and they expressed needs for more informational, emotional, and financial support during pandemics., Implications for Practice: More culturally diverse research in the future that includes the development of technology-based programs, trained community volunteer-led programs, psychosocial interventions, and anti-stigma and awareness initiatives are needed to combat the current pandemic and future public health crises., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The diagnosis of childhood cancer not only affects the life of the child but also impacts the lives of the caregivers as well. This study aims to explore the caregiving stress, coping strategies, and support needs of mothers caring for children/adolescents with cancer during the active treatment phase. Individual semi-structured interviews were conducted, and two authors independently and thematically analyzed data. Caregiving mothers went through a process of emotional changes and a change in lifestyles when their children were diagnosed with cancer and undergoing treatments. It is important to ensure that caregiving mothers of children/adolescents with cancer are well supported by family, friends, and healthcare professionals. Healthcare professionals can develop informational booklets on cancer treatment protocols and work together with mothers. Parent support groups and plans for psychoeducational and spiritual care programs for mothers as forms of informational and emotional support may also be established.

Introduction: Diabetes self-management education is a key aspect in the long-term management of type 2 diabetes. The patient and healthcare professional (HCP) perspective on the use of technology-assisted DSME has yet to be studied. Hence, the objective of this study was to better understand the factors that facilitate or hinder the adoptions of such education by adults with type 2 diabetes and their HCPs., Methods: We systematically searched five databases (Medline, Embase, CINAHL, Web of Science Core Collection, and PsycINFO) until August 2019. The search included qualitative and mixed-method studies that reported the views of patients and HCPs regarding features, uses, and implementations of technology-assisted DSME. Data were synthesized through an inductive thematic analysis., Results: A total of 13 articles were included, involving 242 patients, ranging from 18 to 81 years and included web-based, mobile application, digital versatile disc (DVD), virtual reality or telehealth interventions. Patients and HCPs had mixed views towards features of the technology-assisted interventions, with patients' personal qualities and HCPs' concerns affecting uses of the interventions. Patients generally preferred technologies that were easy to access, use, and apply and that had reliable information. Patients' ambitions motivated them, and personal attributes such as poor competence with technology, poor literacy, and language barriers acted as barriers. Patients especially liked the peer support that they received but did not like it when there was no regulation of advice on these platforms. HCPs believed that while the interventions were useful to patients, they faced difficulties with integration into their clinical workflows., Conclusion: This review explored the features of technology-assisted diabetes self-management education interventions that enhanced positive patient engagements and the negative aspects of both the platforms and the target groups. Technical support and training will be effective in managing these concerns and ensuring meaningful use of these platforms., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Women in the perimenopause stage may face climacteric symptoms where physical and mental challenges are experienced. The purpose of this study was to increase the understanding of the experiences and needs of perimenopausal women with climacteric symptoms in Singapore. Method: This is a descriptive qualitative study. Purposive sampling was used to recruit 20 perimenopausal women with climacteric symptoms from a tertiary public hospital in Singapore. Semistructured face-to-face interviews and thematic analysis were used for data collection and analysis, respectively. Results: Participants lacked knowledge resulting in misconceptions of the condition. Experiencing climacteric symptoms led to mixed feelings. The availability of support varied in different sources and forms. Participants seek for more information, understanding, compassion, and empathy from family members and health care professionals. Discussion: Health care professionals should provide adequate support to cater to the diverse experiences and needs of multiracial perimenopausal women with climacteric symptoms. Future research should include the perspectives of health care professionals and family members.

Aims: To examine fathers' experiences and needs associated with mental health during the perinatal period., Design: Qualitative studies were meta-synthesized using the steps outlined by Sandelowski and Barroso., Data Sources: Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database's inception to 24 June 2019., Review Methods: Studies were critically appraised using the Critical Appraisal Skills Program tool. Qualitative data were extracted, meta-summarized, then meta-synthesized., Results: Fourteen studies were included and four themes were identified: (a) negative feelings and psychological difficulties, (b) role strain and role conflict with multiple sources, (c) coping strategies that buffered negative feelings and psychological difficulties and (d) support needs to enhance mental health., Conclusion: Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory-guided, family inclusive, technology-based healthcare services are needed to manage mental health. Healthcare providers can promote positive mental health to prepare fathers, increasing their awareness to manage their mental health and to seek timely help., Impact: Problem-focused coping (i.e. support and problem-solving with partners and childcare involvement) helped fathers to buffer their negative feelings and psychological difficulties. Future studies should focus on paternal mental health rather than on general fathering experiences. Healthcare providers should focus on promoting positive mental health and well-being. Policymakers should create awareness on paternal mental health across the perinatal period., (© 2020 John Wiley & Sons Ltd.)

Background: Increasingly, children are at risk of developing eating disorders. A systematic review and a meta-analysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old., Methods: Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I 2 statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots., Results: A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective., Conclusions: The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research., (© 2019 Association for Child and Adolescent Mental Health.)

Aims: To evaluate the efficacy of exercise-based interventions and mind-body therapies on quality of life, menopausal symptoms, and depression among Asian perimenopausal women., Design: A systematic review, meta-analysis, and synthesis without meta-analysis (SWiM)., Data Sources: Six electronic databases were systematically searched: PubMed, CINAHL, Embase, PsycINFO, Scopus, and ProQuest., Review Methods: The point of inception of each database to 15 November 2018 were systematically searched. A meta-analysis and SWiM were used to present the results. Review Manager 5.3 and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively., Results: In all, 23 studies were reviewed. Significant effects in exercise-based interventions and mind-body therapies were found for quality of life, menopausal symptoms, and depression but not for hot flashes. Limitations of this review include insufficient blinding of participants and/or researchers found in most of the included studies and high levels of heterogeneity in the meta-analyses. Evidence found in this review is to be interpreted with caution., Conclusion: Healthcare professionals can consider exercise-based interventions or mind-body therapies to manage menopausal symptoms. Future trials of good quality can examine the cost-effectiveness and optimal intervention duration. Intervention effects on specific menopausal symptoms such as sleeplessness in Asia can be examined in future., Impact: Exercise-based interventions and mind-body therapies suggest effectiveness on quality of life, menopausal symptoms, and depression among Asian perimenopausal women. Exercise-based interventions and mind-body therapies improve quality of life, menopausal symptoms, and depression but not hot flashes. Long-term exercise-based interventions is effective in managing depression. Due to varied limitations in the review and included studies, firm conclusions cannot be reached. Healthcare professionals in Asia can consider implementing exercise-based interventions and mind-body therapies for symptomatic perimenopausal Asian women., (© 2020 John Wiley & Sons Ltd.)

Parents of children with autism are faced with higher risks of unemployment, divorce, and poorer mental health than parents of children with other disorders. Such parenting stress can be further exacerbated by cultural and environmental factors such as the more conservative and collectivistic Asian values. Therefore, this review identifies and synthesizes literature on the parenting experiences and needs of Asian primary caregivers of children with autism using a critical interpretive method. A qualitative meta-summary was conducted. Seven electronic databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science) were searched from each database's date of inception to November 2018. In total, 44 studies were included in this review. Thirteen studies examined Asian immigrant parents' experiences, and 31 studies were done among Asia-based parents. Six domains were identified: "personal parenting journey"; "adaptation and coping strategies"; "family, community, and social support"; "experiences with healthcare, education, and social services"; "future hopes and recommendations"; and "unique experiences of immigrants." The distinctive influence of religious beliefs, cultural values, and environmental factors on Asian parenting experiences were discussed, and recommendations were proposed to better meet the needs of parents with autistic children.

Background: Entrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework., Objectives: To explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors., Design: An exploratory qualitative study using focus group interviews., Participants: Seven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study., Methods: The students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data., Results: Despite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences., Conclusions: The use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Nursing education adopts a time-based approach to assess the multifaceted competencies of student nurses. The competency-based approach is preferred historically as it is practical and ensures that individuals deliver effective healthcare practice. However, there remains a gap on how these competencies are actually applied in nursing practice. To facilitate the connection between competencies, competency-based education, and nursing practice, entrustable professional activities (EPAs) can be utilized to translate competencies into clinical practice. EPAs have shown promising results across multiple healthcare specialties and have become the current driving force to facilitate nursing care and practice. Given the limited information of EPAs in nursing education, it is an opportune time to develop EPAs specific to nursing care and practice., Objectives: To provide a detailed breakdown on the development of EPAs in nursing education to inform clinical care and practice., Methods: The development stages of EPAs included: i) the formation of a team, ii) the development of the conceptual framework, and iii) the pooling, reviewing, and revising of core EPAs., Results: A total of ten core EPAs were developed, with sub-EPAs nested within these core EPAs. The EPAs include: 1) patient engagement, 2) patient care and practice, 3) care management, 4) common procedures, 5) safety, 6) urgent care, 7) transition care, 8) patient education, 9) interprofessional collaboration, and 10) palliative care., Conclusion: The development of EPAs specific to nursing care and practice may offer nursing programs a guide to assist with curricula planning and a basis for developing entrustment assessment tools. The unfamiliarity of EPAs in nursing education may pose as implementation challenges to EPAs. Future research is warranted to evaluate and improve the developed EPAs., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one's movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky's original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal's work to strengthen salutogenesis as a theory base for health promotion., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Falls pose substantial challenges to health care institutions. This review aims to provide a synthesis and critique of studies that investigated fall injury risk factors and to identify significant risk factors that predispose patients to injurious falls. A comprehensive literature search was conducted in PubMed, COCHRANE, Embase, Cumulative Index to Nursing and Allied Heath Literature, and Scopus. Additional records were searched through Google Scholar and bibliographies of the retrieved articles. Twenty-three primary research studies were included. Demographic, intrinsic, and extrinsic factors have been identified. Demographics include age, gender, and marital status. Intrinsic factors include body mass index, medication, and preexisting conditions, and extrinsic factors include environmental factors. Several factors were found to be inconclusive. These factors should be considered and examined further. Future research may evaluate interventions focusing on targeted risk factors of injurious falls. Clinical guidelines addressing the factors in this review may be considered after further testing and research.

Background: Chronic heart failure (CHF) is one of the most common causes of hospital admissions and readmissions. Managing CHF requires a comprehensive treatment plan that consists of medication treatment and behavioural change. However, patients often feel unprepared for their self-management role in the community, especially during the period of transition after discharge from hospital. Therefore, an effective intervention to promote CHF self-management is needed., Aims: This paper describes the development and pilot testing of a multicomponent nursing intervention (i.e. the HOM-HEMP) for a randomised controlled trial to assess its effectiveness in improving self-care behaviour among CHF patients in Singapore. A description of the study intervention is also delineated in detail., Methods: The HOM-HEMP was developed based on the UK Medical Research Council framework for developing and evaluating complex interventions. After the development of the study intervention, a single group pre- and post-repeated measure pilot test was conducted to evaluate the study intervention package for its acceptability and the feasibility of the data collection procedure. Ten participants were recruited through consecutive sampling. All of the participants received the full intervention package with the supplementary mobile application. The data were collected at baseline and immediately after the study intervention (i.e. 6 weeks from baseline). The outcome measures included the Self-Care Heart Failure Index, Cardiac Self-Efficacy Scale, Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale and Short Form of the Social Support Questionnaire., Results: The results from the pilot testing showed that the programme was feasible and potentially effective in improving patient's self-care management, psychological outcomes and health-related quality of life., Conclusion: A self-management psychosocial education approach is the preferred choice for many patients with chronic diseases. The effectiveness of the HOM-HEMP will next be tested in a full scale randomised control trial.

Problem: Children and adolescents with non-communicable disease face more difficulties in achieving developmental milestones than their healthy peers, which affect their life and overall wellbeing. A non-disease-specific approach is important in identifying common challenges faced by children and adolescents across multiple non-communicable diseases., Eligibility Criteria: Qualitative studies reporting first-hand accounts of children and adolescents aged 4 to19 years with non-communicable disease., Sample: A library search was conducted in five electronic databases (CINAHL, Embase, PsycINFO, PubMed, Scopus, and ProQuest Dissertations and Theses) for original qualitative English language papers. Fifty-five articles met the inclusion criteria and were subjected to a two-step meta-synthesis., Results: Initial reports of negative emotional experiences and disease perceptions were mixed with gradual acceptances of their diseases and positive coping strategies. Children and adolescents with non-communicable disease all desired a normal life, but physical limitations often led to social exclusions and self-imposed restrictions. Although most were highly appreciative of the support received from family, friends, and healthcare providers, they still struggled with disease management, the need for autonomy, and the fear of illness disclosure., Conclusions: The impacts of non-communicable disease on children and adolescent's lives suggest a need for joint efforts between parents, clinicians, and educators to ensure children and adolescents' positive development of the self, acceptance and positive coping., Implications: This review is able to inform the development of future educational and psychosocial intervention programs in the school and healthcare setting, and also encourages a revision of education policies to be more flexible and accommodating., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: As more animal studies start to disentangle pathways linking the gut microbial ecosystem and neurobehavioral traits, human studies have grown rapidly. Many have since investigated the bidirectional communication between the gastrointestinal tract and the central nervous system, specifically on the effects of microbial composition on the brain and development., Methods: Our review at the initial stage aimed to evaluate literature on gut microbial alterations in pediatric neurobehavioral conditions. We searched five literature databases (Embase, PubMed, PsychInfo, Scopus, and Medline) and found 4489 published work. As the mechanisms linking gut microbiota to these conditions are divergent, the scope of this review was narrowed to focus on describing gut dysbiosis in children with autism spectrum disorder (ASD)., Results: Among the final 26 articles, there was a lack of consistency in the reported gut microbiome changes across ASD studies, except for distinguishable patterns, within limits, for Prevotella , Firmicutes at the phylum level, Clostridiales clusters including Clostridium perfringens , and Bifidobacterium species., Conclusions: These results were inadequate to confirm a global microbiome change in children with ASD and causality could not be inferred to explain the etiology of the behaviors associated with ASD. Mechanistic studies are needed to elucidate the specific role of the gut microbiome in the pathogenesis of ASD., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: The pregnancy process has always been medicalized with a focus on the prevention of adverse pregnancy outcomes and a lesser emphasis on enhancing women's wellbeing during the perinatal period. This trend urges healthcare professionals to consider the use of a salutogenic approach throughout the perinatal period., Objective: To consolidate and appraise evidence on the use of the salutogenic theory across the perinatal period., Design: A systematic mixed studies review., Methods: Four electronic databases (CINAHL, ScienceDirect, PsycINFO, and PubMed) were searched for English studies from each database's inception to November 2018. Thirty-four studies met the inclusion criteria and were appraised for quality by two researchers independently. A narrative synthesis was conducted to consolidate and synthesize results from mixed methodology studies., Results: Four themes emerged from the synthesis: (1) factors affecting sense of coherence (generalized resistance resources), (2) influences of sense of coherence, (3) ways to promote sense of coherence among mothers, and (4) use of salutogenic framework across perinatal healthcare. Sociodemographic background, psychological and birth-related factors, and availability of social support affect sense of coherence among parents, which are positively correlated to quality of relationship, satisfaction of perceived support, psychological wellbeing, and overall birth experience. Sense of coherence also determines mothering orientation and choice of delivery method. Ways to enhance maternal sense of coherence include ensuring continuity of care in the postpartum period, increasing parental involvement, focusing on wellness topics, and having balanced relationships between parents and healthcare providers., Conclusion: Despite consolidating evidence on positive relationships of generalized resistance resources, sense of coherence, and parental outcomes during the perinatal period, the scarcity of literature highlights a need for more in-depth research on the underlying mechanisms of salutogenesis and its components as these insights may underpin future maternal health promotion efforts., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.

Aims: To evaluate the effectiveness of psychological interventions in reducing stress, depression and anxiety among parents of children and adolescents with developmental disabilities., Design: A systematic review and a meta-analysis., Data Sources: Seven electronic databases (CINAHL, CENTRAL, EMBASE, ProQuest Dissertation and Theses, PsycINFO, PubMed and Scopus) were searched from each database's point of inception to December 2018., Review Methods: Quality appraisal was conducted using the Cochrane Risk of Bias Tool. Data were analysed using Review Manager 5.3. The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system., Results: A total of 18 studies were included in this review. Eleven studies were involved in a meta-analysis and the remaining seven studies were summarized narratively. The meta-analysis found that psychological interventions significantly reduced parental stress at postintervention but not at 3-6 months' postintervention. Inconclusive evidence was found for the effectiveness of psychological interventions in reducing parental depression and anxiety., Conclusion: Psychological interventions appeared to reduce parental stress temporarily. Healthcare professionals can offer varied psychological interventions for parents to choose from. Policymakers can ease accessibility and affordability for parents to attend interventions., Impact: Psychological interventions were found to have short-term effects in reducing parental stress. Inconclusive evidence was found for the effectiveness of psychological interventions in reducing parental depression and anxiety. Healthcare professionals should ensure that knowledge is transmitted to parents when delivering their interventions. Policymakers worldwide should ensure that parents of children and adolescents with developmental disabilities can attend interventions by making them accessible and affordable., (© 2019 John Wiley & Sons Ltd.)