Malaysian Journal of Medical Research (MJMR)

Late Antenatal Booking in Advanced Maternal Age Pregnancy with Suspected Fetal Abnormality and Medico-Legal Considerations

Hazwani Hanum Binti Hashim — 2026-10-29

Advanced maternal age is associated with increased maternal and fetal risks and warrants timely antenatal assessment. A 37-year-old gravida 7 para 4+2 woman first booked for antenatal care at 22 weeks and 3 days of gestation, after the optimal first-trimester screening period. Prenatal screening and diagnostic options for fetal chromosomal abnormality were discussed and offered at booking, but the patient declined because she considered that the result would not change her decision to continue the pregnancy at that gestation. Specialist assessment subsequently showed a small-for-gestational-age fetus with polyhydramnios, followed by persistent fetal growth restriction with normal doppler findings. At 34 weeks, she developed hypertension with 2+ proteinuria and was managed as pre-eclampsia; concern regarding an underlying chromosomal abnormality was also documented. At 36 weeks and 6 days, emergency caesarean delivery was performed for breech presentation in labour. The 1.47-kg neonate had dysmorphic features suggestive of a severe congenital or chromosomal disorder and died on day 7 without cytogenetic confirmation. The case highlights how early prenatal assessment may provide a wider timeframe for diagnostic clarification, counselling, and consideration of pregnancy-management options, including lawful termination where Malaysian statutory criteria are fulfilled.

Short Communication: Improving Timeliness of Analgesia for Acute Trauma-Related Pain in the Emergency Department Green Zone — A Quality Improvement Initiative

Gurjeet Singh a/l Harvendhar Singh — 2026-10-01

Background: Emergency Department (ER) overcrowding is a perennial issue in Malaysia. Non-critical, lower-acuity patients in the Green Zone often face long wait times, which frequently leads to institutional oligoanalgesia (delayed or inadequate pain relief). Objective: This short communication outlines a Quality Improvement (QI) work flow proposed by the author to clear departmental bottlenecks. The main target is to bump up the percentage of Green Zone patients with acute trauma-related pain who get their pain relief within 90 minutes of registration. This framework serves as a suggested model for other public hospitals looking to improve their ED throughput. Methodology: Using the Nominal Group Technique (NGT) and SMART prioritization criteria, the author evaluated key departmental issues and selected delayed pain management as the priority target. A strict Model of Good Care (MOGC) was designed to run through a rapid implementation timeline from July 2026 to August 2026. Data collection plans include pulling timestamps from the Electronic Health Record (EHR) system and handing out targeted questionnaires to frontline staff. Expected Outcomes: By sorting out the fragmented department layout, introducing decentralized analgesia sub-stores/carts directly inside the Green Zone, and conducting proper staff briefings, this model establishes a practical, sustainable work flow to hit our national KKM QA benchmark of ≥ 70% compliance.

Analysis of Factors Influencing the Adoption of Electronic Nursing Documentation: A SEM-PLS Approach

Siska Mayang Sari — 2026-10-15

Background: The Indonesian Ministry of Health mandates the use of electronic medical records (EMRs) across all healthcare facilities, impacting hospitals nationwide, including those in Pekanbaru. In response, hospitals in Pekanbaru have integrated digital applications into healthcare services, including nursing care. Nursing documentation is now conducted using Electronic Nursing Documentation (END). Despite its implementation, no formal evaluation of END usage has been conducted, even though service effectiveness remains a key performance indicator. Objectives: This study aims to analyze factors influencing the adoption of END using a Structural Equation Modelling–Partial Least Squares (SEM-PLS) approach. Methods: This quantitative study employed a cross-sectional design and utilized a structured questionnaire. A total of 287 inpatient nurses from three hospitals in Pekanbaru were selected through purposive sampling. Data were analyzed using SEM-PLS techniques. Result: The structural model showed that perceived usefulness (POU) significantly influenced attitude toward using (ATU) (β = 0.749, p < 0.001) and behavioral intention to use (BITU) (β = 0.415, p < 0.001). Perceived ease of use (PEOU) significantly influenced ATU (β = 0.168, p = 0.010) and POU (β = 0.831, p < 0.001). ATU significantly influenced BITU (β = 0.490, p < 0.001) and actual usage behavior (AUB) (β = 0.464, p < 0.001), while BITU significantly influenced AUB (β = 0.479, p < 0.001). The model explained 82.7% of the variance in AUB. IPMA showed that POU had the highest importance for AUB (0.722), whereas PEOU had the highest performance (72.115). These results suggest that enhancing system usability and demonstrating its practical benefits can strengthen adoption intentions. Conclusion: The TAM creates significantly influenced END adoption, with POU being the strongest predictor of AUB and PEOU showing the highest performance. Future longitudinal studies applying objective usage measures are needed to authenticate these associations and explore additional determinants of adoption.

Effectiveness of Hybrid Nurse-Led Self-Management Education with a Digital Pocketbook on Medication Adherence and Blood Pressure Control among Patients with Hypertension: A Quasi-Experimental Study

Prima Trisna Aji — 2026-10-26

Background: Sustained medication adherence and effective self-management are essential for hypertension control. This study examined the association between hybrid nurse-led self-management education incorporating a Digital Pocketbook and medication adherence and blood pressure outcomes among adults with hypertension. Methods: A non-randomized quasi-experimental study with a pretest–posttest control-group design involved 62 adults with hypertension at a primary healthcare facility in Central Java, Indonesia. Participants were allocated to an intervention group (n = 31) or control group (n = 31). The eight-week intervention combined individualized nurse-led education, a Digital Pocketbook, and weekly WhatsApp follow-up, while controls received routine care. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), and blood pressure was measured using standardized automated procedures. Analysis of covariance (ANCOVA) adjusted for baseline outcome values. Results: Compared with controls, the intervention group demonstrated higher medication adherence (adjusted mean difference = 2.18; 95% CI: 1.56–2.80), lower systolic blood pressure (−17.84 mmHg; 95% CI: −22.77 to −12.91), and lower diastolic blood pressure (−11.05 mmHg; 95% CI: −14.34 to −7.76). All comparisons were statistically significant (p < 0.001), including after Bonferroni correction. Conclusions: Hybrid nurse-led education incorporating a Digital Pocketbook was associated with improved self-reported medication adherence and reduced blood pressure over eight weeks. Larger randomized trials with objective adherence measures and longer follow-up are needed to establish effectiveness and sustainability.

The Relationship between Burnout Levels and the Quality of Therapeutic Communication among Nurses

Raja Fitrina Lastari — 2026-10-28

Abstract

Background: Burnout is a state of severe physical, mental, and emotional exhaustion that can decrease individual performance. Therapeutic communication plays an important role in enhancing nurses’ interpersonal skills, while unmanaged burnout may adversely affect the quality of nursing care. Objectives: This study aimed to examine the relationship between burnout levels and the quality of therapeutic communication among nurses. Methods: A quantitative study with a descriptive correlational design and cross-sectional approach was conducted. A total of 43 nurses were recruited using total sampling. Data were analysed using frequency distributions and the Spearman rank correlation test. Results: The findings indicated that most respondents were between 31 and 40 years old, with a mean age of 38.09 years and a standard deviation of 7.217. The majority of respondents were female (41 nurses; 95.3%), had a Diploma in Nursing (D3) as their highest educational qualification (23 nurses; 53.5%), were married (37 nurses; 86.0%), and had more than 10 years of work experience (25 nurses; 58.1%). Based on the dimensions of burnout, 46.5% of respondents experienced a low level of emotional exhaustion, 53.5% experienced a low level of depersonalization, and 83.7% demonstrated a high level of personal accomplishment. Statistical analysis revealed a significant negative relationship between burnout levels and the quality of therapeutic communication among nurses (p=0.012, p<0.05). The Spearman rank correlation coefficients were −0.379 for emotional exhaustion, −0.303 for depersonalization, and −0.333 for personal accomplishment. Conclusion: The findings indicate a significant relationship between burnout and therapeutic communication among nurses. Recreational programmes and other workplace activities promoting nurses’ physical and psychological well-being may help manage burnout.