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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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