The Malaysian Journal of Nursing (MJN)

Message from the Editor in Chief

Prof. Datuk Dr. Hjh. Bibi Florina Abdullah — 2024-11-27

In today’s healthcare circumstances, we must prioritize shared commitments to health equity, sustainable health systems, digital transformation, and preparedness for pandemics and climate change. Concerns are raised about inequitable international nurse recruitment to protect nursing workforces in fragile nations and prevent aggressive recruitment by high-income countries that undermines global health equity and access to essential services. Greater emphasis is required on establishing sustainable and ethical policies for health workforce migration. There is need for advocates to build self-sufficient nursing workforces globally and ending unsustainable recruitment practices that drain the health workforce from under-resourced areas. We must prioritize improving health workforce conditions, remuneration, education, and gender equity, alongside supporting equitable digital health transformation, vaccine access, and pandemic preparedness, and highlights the role of social inequalities in driving pandemics.

Perinatal Fathers in the Context of the COVID-19 Pandemic and Beyond: Impacts and Implications

Josephine Francis Xavier — 2024-10-25

Introduction: The COVID-19 pandemic introduced unprecedented challenges for fathers during the perinatal period, impacting family dynamics, especially among vulnerable groups such as first-time fathers, low-income fathers, and immigrant fathers. This paper explores these effects and proposes strategies for healthcare professionals and community organisations to ensure inclusive, family-centred care. The review aims to enhance fathers’ well-being and family resilience in both pandemic and post-pandemic contexts. Methods: A state-of-the-art review was conducted using MEDLINE, CINAHL, blogs, and advisory publications. A comprehensive literature search was performed, covering the period from March 2020 to March 2021, with an additional search extending to 2024. The review included 18 studies from the initial search period and 30 studies from the post-pandemic period. Results: Three specific themes emerged: fear of the virus, social isolation, and a mental health crisis. Fathers experienced significant anxiety about spreading COVID-19 to their partners and newborns, which increased stress during prenatal care and childbirth. Restrictions on hospital visits limited their involvement in the child birth process, leading to feelings of helplessness and disconnect during crucial bonding periods. Additionally, fathers faced heightened anxiety, depression, and role ambiguity due to caregiving and financial pressures exacerbated by the pandemic. These themes uniquely impacted perinatal fathers, affecting both paternal and maternal mental health and overall family well-being. Recommendations: The findings suggest several actions: customising training programs for healthcare professionals, promoting inclusive nursing practices, advocating for comprehensive parental leave policies, integrating telehealth services, and implementing father-centric interventions to enhance overall perinatal well-being. These recommendations are appropriate for the post-pandemic era as they address ongoing mental health challenges, ensure continuous support, and promote resilience in healthcare systems. These actions are essential to support perinatal fathers and their families in both current and future disruptions. Conclusion: The pandemic highlighted the need for personalised support for fathers to enhance their mental well-being and family welfare. Strategies such as customised training for healthcare professionals, inclusive nursing practices, comprehensive parental leave policies, and telehealth services are essential. These initiatives are crucial to ensure inclusive family-centred care, fostering fathers’ well-being and family resilience in both pandemic and post-pandemic contexts. Immediate and sustained efforts are needed to support perinatal fathers and improve family resilience.

Factors Affecting Quality of Life of an Elderly Person: A Systematic Review and Meta Analysis

Kuntal Mandal — 2024-10-25

Background: Elderly people have been observed to experience a highly vulnerable quality of life from every aspect. Various factors, such as diet, physical health, monetary conditions, family situation, and others, affect the quality of older people. However, it has still not been analyzed which factor affects quality of life quality in a negative direction and vice versa. The purpose of this research study is to perform a meta-analysis to identify the factors and the levels to which these factors affect QoL among elderly people. Methods: A secondary design has been followed to conduct the research study. Meta-analysis was the chosen method to conduct the research. Statistical analysis was performed to find out the factors affecting the life quality of elderly people. Authentic and open-access databases were selected for the review. Moreover, English-published recent research papers (2019-2023) were selected for the review. All other papers were excluded from the review. The study included 8 articles. Results: The results have shown that the specific factors include exercise, diet, nutrition, community, physician, and pharmacist care for elderly people, which affect the QoL. However, it has been observed that the nutrition effect on QoL was statistically significant, as the p value was found to be less than 0.05 (< 0.000001). The other factors were observed to be non-statistically significant but had biological validity. Conclusion: On a concluding note, it can be said that the research study has addressed the aim and study objectives. The nutrition factors effects have more effect on the QoL of patients.

Stroke Rehabilitation for Early Physical Activities among Patients Ongoing Rehabilitation: A Meta-Analysis

Zohaib Shahid — 2024-10-25

Background: A report from the World Health Organisation says that stroke is the second largest cause of death and the primary reason for impairment in the world. Stroke is a worldwide well-being problem with an incidence of 0.2 to 2.5 per 1000 population. Stroke patients lead to paralysis on one or both sides of the body, causing difficulty in Activities of Daily Living (ADLS) and ambulation. Methods: A search for published materials was conducted from 1990 until 2023 through online sources such as Google Scholar, PubMed, Medline, Cochrane Library, and Embase. The following keywords were combined collectively to identify appropriate study papers. A total of seven studies were included in this study. Results: Higher heterogeneity was evident in the present meta-analysis (p=0.06, I squared=0.59). Prognosis-based outcome analysis showed a substantial difference in the online management system for early physical activity of stroke patients’ continuous rehabilitation. Conclusion: Prognosis-based outcome analysis revealed that there was a significant difference in the online management system for early physical activity of stroke patients in rehabilitation.

Clinical Handover among Nurses in an Emergency Setting: Facilitators and Barriers

Nurul’Ain Ahayalimudin — 2024-10-25

Background: Clinical handover in emergency settings is a crucial and complex process involving transferring patient care responsibilities and information. Objective: It identified the facilitators and barriers to clinical handover among nurses in an emergency setting. Methods: This descriptive qualitative study involves fourteen nurses from the emergency department of a teaching hospital in the East Coast region of Malaysia. The data was collected from one-on-one interviews using a topic guide. Results: The study acknowledged seven facilitators: learning from various approaches, the information that needs to be relayed, the accuracy and precision of the information, the clinical handover at the bedside, the documentation process of the clinical reports, having a good practice of punctuality, familiarise with the use of technology, and six barriers; a limited number of electronic devices, the handover happened away from the patients, heavy workloads occur concomitantly, a lack of self-discipline coincide with the time for handover, and illegible writing skills and inappropriate documentation. It led to themes such as communication effectiveness and commitment to patient safety, teamwork and practices leading to continuity of care, and overcoming challenges while handover reports. Conclusion: Clinical handovers are a vital component of patient care, and they require effective communication and commitment to patient safety, teamwork, and practices, leading to continuity of care and overcoming challenges while handling reports. The administrators shall address the concerns raised by these nurses, as adhering to best practices can help reduce errors and improve the overall quality of care provided.

Association of Psychological Well-being and Work-Related Quality of Life on Compassion Fatigue among Staff Nurses

Gil P. Soriano — 2024-10-25

Background: Nurses experience compassion fatigue, which can be one of the factors affecting the provision of quality care to their patients. Aim: This study aimed to determine the correlation between psychological well-being and work-related quality of life on compassion fatigue among staff nurses. Methods: This study utilized a descriptive-correlational research design. Respondents were selected through purposive sampling, and data were collected using the Compassion Fatigue Short Scale (CFS), Psychological Well-Being (PWB), and Work-Related Quality of Scale (WRQoL). The data was analyzed using mean, standard deviation, and Pearson’s r. Results: The findings revealed that there is no significant relationship between compassion fatigue and psychological well-being. However, a significant negative correlation was noted between work-related quality of life and compassion fatigue. Conclusion: Nurses need protection not only physically but also mentally and emotionally. It is also critical that hospital administrators are fully aware of threats to nurses' physical, mental, and emotional health, and that they have the capability to assess the warning signs exhibited by their staff and provide guidance to nurses to prevent the worst situations.

The Relationship between Paediatric Nurses’ Knowledge, Attitude, and Practice about Atraumatic Care of Hospitalized Children in Indonesia

Nafisatun Nisa — 2024-10-25

Background: The main stressors of the hospitalised children's are separation from family, loss of control, pain, and the unfamiliar hospital environment. Atraumatic care is therapeutic care provided through interventions that eliminate or reduce the psychological and physical distress experienced by children and families. Objective: The objective of this study was to describe the Indonesian nurses' knowledge, attitudes, and practices regarding atraumatic care for hospitalised children and to identify the factors affecting the nurses’ practice of atraumatic care. Methods: This descriptive correlation study was held in a regional general hospital. Totally, 70 of 44 nurses in paediatric wards and 26 nurses in the Paediatric Intensive Care Unit PICU completed a 20-question multiple-choice scale of knowledge about atraumatic care and a 30-item scale of attitude towards atraumatic care. The behaviours were observed using a 25-item Nurses' Practice Scale for Atraumatic Care. Results: Compared to their colleagues in other units, the nurses in the PICU (12.65±2.79) had the best knowledge, and the nurses in the paediatric wards had the best attitude (98.19±9.76) and practice (63.09±10.64) toward providing atraumatic care. Hierarchical linear regression revealed that nurses who were working in the paediatric wards (B = 7.826, SE = 3.254, p = 0.019) and females (B = 9.814, SE = 3.481, = 0.006) had better knowledge (B = 1.068, SE = 0.622, p = 0.010) and attitude (B = 0.237, SE = 0.139, p = 0.029) and significantly better practice scores in providing atraumatic care than those who were working in the PICU and male. Conclusion: Trainings regarding the provision of atraumatic care for hospitalised children should be developed for the nurses to improve their knowledge and attitude so they can provide optimal care to minimise the impact of hospitalisation on children.

Cognition and Perception of Critical Care Nurses Regarding Non-Invasive Positive Pressure Ventilation

Shanu Mehna — 2024-10-25

Background: The use of non-invasive positive pressure ventilation (NIPPV) has increased substantially in the last three decades as it moved from critical care to ward settings and became an essential tool to manage respiratory failure. To provide a good standard of care, it is crucial that nurses providing NIPPV care to patients have knowledge and a positive attitude within their area of competence. Objective: To determine the level of knowledge and attitude of nurses who provide NIPPV patient care and to associate the findings with the selected demographic variables. Methods: A descriptive cross-sectional study was carried out from May to June 2023 with 280 nurses working at various critical care units in a tertiary-level hospital, selected through convenience sampling technique. Data was collected using a questionnaire prepared by the researchers and analyzed using SPSS version 27. Descriptive and inferential statistics were employed for the analysis. Normality of the data was ensured by using the Q-Q plot and the Shapiro-Wilk test. The Fisher exact test was used to compute association with demographic variables. The level of statistical significance was set at ≤ 0.05 for all analyses. Results: The majority (68.9%) of nurses had inadequate knowledge of NIPPV with an overall knowledge mean score of 13 ± 3.45, and the majority (69.3%) maintained a neutral attitude, with 27.1% expressing negativity and a small proportion (3.6%) of nurses demonstrating a positive attitude. Notably, none of the participants had attended critical care training. There was a significant association found between knowledge levels and attitude with age (p value 0.035) and the total years of experience (p value <0.001) in nursing. There was a negative correlation found between knowledge and attitude, computing a Karl Pearson correlation coefficient of -0.248 (p<0.001). Conclusion: The study findings emphasize the necessity for targeted in-service education and interventions to ensure a comprehensive and positive approach to enhance the quality of care provided by the nurses in the context of patients receiving non-invasive positive pressure ventilation therapy.

Emotional Freedom Techniques and Oxytocin Stimulation Massages that Effectively Reduce Anxiety and Increase Smooth Breast Milk Production of Nursing Mothers

Tetet Kartilah — 2024-10-25

Introduction: Maternal anxiety is potentially increased by postpartum psychological changes and the perceived inability to breastfeed effectively. The increase in adrenaline levels could further reduce the resistance and trust of mothers, inhibiting oxytocin and the ability of prolactin to secrete and create milk. Objectives: Therefore, this research aimed to determine the effectiveness of Oxytocin Stimulation Massage (OSM) and Emotional Freedom Therapy (EFT) in reducing anxiety and increasing smooth breast milk production. Methods: The quantitative method was used with a control group to assess the effects of intervention and investigate the relationship between anxiety and the smooth breast milk production of nursing mothers in Public Health Centers, Tasikmalaya. Results: The results showed a difference in average anxiety scores of the nursing mothers before and after the therapy. The intervention group had a lower score of 1.19 compared to the control group, r = 0.432 (r > 0.05). Furthermore, there was a difference in the average smooth breast milk production before and after the therapy, with the intervention group having a lower score of 8.3 compared to the control group of r = 0.129 (r> 0.05). This research showed that the intervention group had a negative and weak correlation between anxiety and smooth breast milk production after the therapy, with a Pearson correlation of -0.037, R-count, and R-count < R-table at a significance value of 0.854. Finally, EFT was effectively applied to reduce the anxiety of nursing mothers (Cohen's D value = 1.76) and increase smooth breast milk production (Cohen's D value = 1.51). Conclusion: The study highlights the effectiveness of Oxytocin Stimulation Massage (OSM) and Emotional Freedom Therapy (EFT) in reducing maternal anxiety and enhancing smooth breast milk production. Although the correlation between anxiety reduction and milk production was weak, EFT notably reduced anxiety and improved lactation. These therapies show promises for supporting postpartum mothers and could be further developed into accessible, therapeutic applications for maternal care.

Sustainable Mental Health Literacy among Nursing Students: A Cross-sectional Study in West Bengal, India

Soma Naskar Chakraborty — 2024-10-25

Background: Mental health nursing is one of the major subjects in all types of nursing curricula. Assessment of mental health literacy of nursing students is very crucial, as they will play a key role in nursing fraternities and society as well. The present study is aimed at assessing the level of mental health literacy among nursing students at selected nursing training institutes in West Bengal, India. Methods: A cross-sectional study design was adopted for the collection of data from a total of 240 female nursing students using a census or complete enumeration sampling technique from two General Nursing and Midwifery training schools and two basic bachelor nursing colleges in West Bengal. The tool consisted of six items of structured socio-demographic profile, and the “Mental Health Literacy Scale” consisted of 35 items. Results: The overall mean score of the mental health literacy of nursing students was 117.04 (SD=11.34). General Nursing and Midwifery students scored a higher mean (119.43), (SD=9.93) than Basic Bachelor Nursing students (114.84), (SD=12.12), which was statistically non-significant (Mann-Whitney U test, U=6371, p=0.128). The Chi-Square test confirmed that there was a significant association between mental health literacy and selected demographic components, ‘Whether any previous exposure to mental health awareness programme / survey’ (5.54) and ‘Whether any previous experience of observing or caring for a person with mental illness other than in the clinical area’ (4.82), of nursing students at df (1) at the 0.05 level of significance. Conclusion: The present study results reveal a comparatively lower level of “mental health literacy” among student nurses despite an effective mental health curriculum than that of the other available studies.

Factors Influencing Documentation in Nursing Care by Nurses at the Federal Medical Centre, Apir, Benue State, Nigeria

Aniekwe Louisa Ngozi — 2024-10-25

Introduction: Nursing documentation should meet specific and comprehensive standards to achieve its goals, including effective communication, education, research, monitoring, and evaluation within the healthcare system. It should also ensure the collection of essential patient information based on established principles. This study investigated the factors that influence nursing documentation practices at the Federal Medical Centre in Apir, Benue State, Nigeria. The lack of national and local guidelines on nursing documentation has resulted in substandard practices among Nigerian nurses. Methods: The study employed an analytical cross-sectional design. There were 102 participants with a 99.7% response rate. Results: The practice of nursing care documentation was found to be inadequate. The practice of nursing care documentation was significantly linked to not having enough documentation sheets (AOR = 3.271, 95% CI = 1.125–23.704), not having enough time (AOR = 2.205, 95% CI=1.101–3.413), and not meeting the operational standard of nursing documentation (AOR = 2.015, 95% CI = 1.205–3.70). The results also highlight that while nurses recognise the importance of accurate documentation, several barriers, such as workload, inadequate training, and a lack of resources, hinder effective practice. Finally, more than half of nurses did not document their nursing care. Conclusion: The study concludes that addressing these barriers through targeted interventions could significantly improve documentation quality, thereby enhancing patient care outcomes. Agencies employing nurses must ensure to train them for proper nursing care documentation to improve knowledge and foster awareness among healthcare workers about accurate and thorough documentation practices. This will enable nursing directors and chief executive officers to access adequate documenting supplies, in addition to employing more competent and qualified nurses.

Impact of Shot Blocker on Alleviating Peripheral Intravenous Cannulation Associated Pain among School-Aged Children: A Randomized Controlled Trial

Salsabeel A. Naser — 2024-10-25

Background: The aim of this research is to examine the effectiveness of ShotBlocker in reducing pain to enhance school-age patients' experience with intravenous cannulation. Nurses need to explore non-pharmacological approaches during intravenous cannulation to pain management while adhering to ethical and legal principles. Objective: To investigate effectiveness of ShotBlocker and ShotBlocker placebo in reducing pain during intravenous cannulation in school age children’s patients. Methods: A Randomized Controlled Trial (RCT) that is comparative and prospective, was used. The study was conducted on 228 school age children’s patients (6-12 years) who undergo intravenous cannulation in Emergency Departments (EDs). Three groups of patients were randomly assigned: ShotBlocker group (n=79), ShotBlocker placebo group (n=75), and control group (n=74). The patients were requested to evaluate the level of pain immediately following Peripheral Intravenous Line (PIV) procedure using the Wong–Baker Faces Pain Scale. Results: This study showed P-value=0.000 indicated that there are statistically significant differences in pain intensity among the ShotBlocker, ShotBlocker placebo, and control groups. In comparison to both the ShotBlocker placebo and control group, the ShotBlocker group’s pain intensity was significantly reduced (mean difference 1.74684). Furthermore, there were higher pain levels noted in the ShotBlocker placebo (mean difference 8.50667) and control group (mean difference 8.757). Conclusions: When compared the ShotBlocker group with ShotBlocker placebo and control groups, the study discovered that the ShotBlocker use was effective in minimizing the levels of pain associated with the intravenous cannulation.

A Cross-Sectional Study on Nursing Errors and Prevention Strategies among Nursing Students

Mai Ba Hai — 2024-10-25

Background: In healthcare, nursing errors are a serious problem that frequently arise from a lack of experience, insufficient information, or difficult clinical settings. Developing successful preventative tactics and improving patient safety require an understanding of the types and prevalence of these errors among nursing students. Objective: This study aimed to determine the incidence of nursing errors among nursing students and explore the strategies of clinical instructors in controlling nursing errors. Methods: A cross-sectional exploratory sequential design was used, with 332 students recruited from the third and fourth years of nursing school to investigate the incidence of nursing errors. Five clinical instructors who taught these students were interviewed to explore their strategies for decreasing students' nursing errors. Data were examined quantitatively using descriptive statistics and qualitatively using content analysis. Results: The most common nursing errors noted by students were not cleaning the thermometer while measuring body temperature (2.38 + 1.41) and providing care without the proper equipment (2.31 + 1.25). In contrast, the least common nursing error was giving oxygen to a patient with the incorrect equipment (1.20 + 0.61) and giving oxygen regardless of the patient's illness (1.10 + 0.43). The study demonstrated significant differences between gender, year of education, career interest, and nursing errors (p<0.05). The primary reasons for these errors were a lack of clinical skills and pharmacological knowledge. The results from qualitative analysis suggested that the clinical instructors' strategies for dealing with these errors among students can be explained from different perspectives, including theoretical, practical, and clinical teaching environments. Conclusion: According to study findings, nursing errors can be caused by various factors. During clinical courses, all students committed at least one nursing error, most of which derived from a lack of clinical skills and pharmacological knowledge. In addition, clinical instructors must change their teaching approaches and integrate nursing error information into the curriculum. Technology in education is one of the innovative approaches to minimize nursing errors.

Burnout among Nurses in Critical Care Units: Addressing a Persistent Challenge

Sahar Yaqoob Yousif — 2024-10-25

Background: Burnout is a highly prevalent occupational disease among nurses, especially those working in complex critical care settings. Objective: To determine the level of burnout among nurses practicing in critical care units. Methods: This study employed a descriptive cross-sectional design, involving 377 nurses working in critical care units across 13 hospitals in Iraq. Data were collected using sociodemographic, professional characteristics of the nursing competency and performance, and the Burnout Assessment Tool. The data was analysed using descriptive statistics. Results: The study showed a high prevalence of overall burnout among nurses, with a mean score of 2.53. The study also revealed medium levels of mental detachment, cognitive impairment, emotional impairment, and psychological distress, with mean scores of 2.18, 1.85, 2.17, and 2.71, respectively. The exhaustion and psychosomatic complaints scored highly, with mean scores of 3.07 and 2.87, respectively. Conclusion: Nurses in critical care units experienced a high level of burnout. Within the dimensions of burnout, high levels of exhaustion and psychosomatic complaints were found, as were medium levels for each of the dimensions of mental distance, cognitive impairment, emotional impairment, and psychological distress.

The Caregivers’ Knowledge on Epilepsy and Its Relationship with Stress Levels

Lee Khuan — 2024-10-25

Background: Eighty percent of 50 million people who live in economically underdeveloped and developing countries tend to have epilepsy, and more than 50 million people worldwide suffer from this condition. Objective: To determine the levels of knowledge about epilepsy among carers and the relationship this has with their stress levels. Methods: A cross-sectional study design was employed using probability systematic sampling. All the data obtained were analysed using the Statistical Package for Social Sciences (SPSS) version 22. Results: In total, 308 respondents participated in this study. A significant association was found between carers’ knowledge levels and stress levels. A significant association was identified between educational level, monthly income, and level of knowledge. However, the results reveal no significant association between carer knowledge and the socio-demographic characteristics of age, gender, and religion. Similarly, no significant association was identified between socio-demographic characteristics and stress levels. Conclusion: This study revealed that most carers who have family members with epilepsy experience moderate levels of stress, even though they have high levels of knowledge. Therefore, stress levels among carers can be reduced by implementing health education related to stress management. Therefore, having good knowledge on epilepsy and good social support will reduce stress levels among carers.

Exploring Knowledge, Attitude, and Learning Experiences of Nursing Students towards Sustainable Patient Safety Following Online Nursing Education: A Mixed Method of Study

Jharna Ghosh — 2024-10-25

Background: Nursing students find it challenging to manage patient safety when attending online classes, both theoretical and practical, for extended periods. Objective: To assess and explore nursing students’ knowledge, attitude, and learning experiences toward sustainable patient safety following online education. Methods: A mixed-method study among 3^rd and 4^th year level nursing students following online education. In the first phase of the quantitative study, 383 students participated using a self-reported questionnaire, while in the second phase, 20 focused groups of students participated using the purposive sampling technique. Results: In the first phase, most of the participants, 151 (39.43%), were in their 3rd year of B.Sc. nursing. Of these, 250 (65.27%) attended more than 6 months of online classes using smartphones, 374 (97.65%). The participants encountered issues with educational storage in 229 cases (59.79%) and internet connectivity in 183 cases (47.78%). According to their learning experiences, most of them—196 (51.17%) and 187 (48.83%)—had attended scenario-based and simulation-based practical classes, among which 238 (62.14%) students shared theoretical confidence but 294 (76.76%) lacked clinical confidence. In terms of knowledge and attitude, 228 (59.53%) students demonstrated strong knowledge, with a mean, median, and SD of 27.09, 17.51, 06.64, while 173 (45.17%) students demonstrated a positive attitude, with a mean, median, and SD of 131.97, 117.19, and 13.37, respectively. In the second phase, a maximum of 16 (80%) students expressed a lack of confidence in the management of patient safety. Conclusion: The study showed that it is important to maintain patient safety is a healthcare discipline. In this study, nursing students demonstrated strong theoretical knowledge and a positive attitude, but they lacked clinical confidence.

The Nurses’ Knowledge Regarding Endotracheal Suctioning at Critical Care Unit of Kirkuk Teaching Hospital, Iraq

Ali Abbas Raoof — 2024-10-25

Background: Endotracheal suctioning is one of the most frequently performed invasive procedures by intensive care nurses. Nurses should have adequate knowledge and skills to perform endotracheal suctioning based on the best evidence. The purpose of this study was to investigate critical care nurses’ knowledge regarding endotracheal suctioning. Methods: A descriptive cross-sectional research design was adopted for this study, which was conducted in Kirkuk Teaching Hospital. The study extended from October 2023 to March 2024. The study population consisted of all the nurses working in the critical care unit of the hospital. A non-probability purposive sampling technique was used to select 46 nurses. A structured self-administered questionnaire was used to collect data. The collected data were entered, coded, and edited into the Statistical Package for Social Science (SPSS) version 26. Data were analysed by employing both descriptive and inferential statistical methods. Results: Among this group, 84.8% had attained a college education. It is worth noting that a significant portion of the sample (82.6%) had not undergone any training courses in endotracheal suctioning. The knowledge levels of 82.6% of nurses regarding endotracheal suctioning were inadequate, while 17.4% were adequate. There was a relationship between nurses’ knowledge regarding endotracheal suctioning and both nurses’ experience in the critical care unit at a p-value of 0.049 and nurses participating in training courses about endotracheal suctioning at a p-value of 0.022. Conclusion: The study concludes that only a few nurses had adequate knowledge and that the majority of them had inadequate knowledge of endotracheal suctioning. Therefore, it is necessary to upgrade nurses’ knowledge on endotracheal suctioning through in-service education programs.

Medication Calculations Competency among Nurses: A Cross-sectional Study

Kholood E. Al-Nbabteh — 2024-10-25

Background: Medication calculation, dispensing, and administration are one of the major tasks of nurses, and medication errors (MEs) are one of the most common errors in the medical field, where some of these errors are fatal. ME can be attributed to many causes, such as medication dosage calculation errors. Accordingly, this study aims to assess Jordanian nurses` competency regarding medication calculation and its associated factors. Methods: A descriptive cross-sectional study design was used to assess the medication calculation skills of 126 registered nurses in Jordan, representing different departments of three governmental hospitals. Nurses’ dosage calculation skills were evaluated using a self-administered Nursing Medication Calculation Competency Tool (NMCCT) prepared by eXperts in nursing practice assessing nurses’ medication calculation competency in oral, parenteral, and intravenous flow rate. Data was collected; data entry was done on a Microsoft Office EXcel sheet and analysed using SPSS 25.0. Results: The study found that 95% of nurses (n = 120) did not receive mathematical education during their nursing program, and 84.9% (n = 107) reported no medication calculation competency programs at their hospitals. Additionally, 79.7% (n = 113) had not attended any such courses post-graduation, and 90.5% reported a lack of medication administration guidelines at their hospitals. Competency was highest for oral medication calculations (65.1%), followed by intravenous flow rates (57.9%) and parenteral/intravenous medications (48.9%). Only 27.8% (n = 35) were competent in all three areas. Significant factors affecting competency were nurse age, availability of programs, and post-graduation courses (p = 0.045, <0.001). Conclusion: Nursing curricula and continuing education programs should recognize pharmaceutical education, including drug calculation skills, as an essential part of their content. Also, the researchers encourage the adoption of a national-wide learning/competency program that is able to assess the level of competency, track gaps in medication calculation skills, and provide a supportive learning program in this aspect as needed.

Application of Lean Six Sigma to Improve Turnaround Time for Orthopedic Patients in Emergency Room of a Public Hospital in Southern Philippines

Gretzel Mae V. Deang — 2024-10-25

Background: The Lean Six Sigma Methodology (LSS) is acknowledged for its potential in optimising emergency room (ER) efficiency, particularly turnaround time. Objective: This study explores the impact of LSS on ER turnaround time at Gregorio T. Lluch Memorial Hospital (GTLMH) in Iligan City, Philippines, using a mixed-methods approach. The aim is to fill the research gap by empirically investigating the effects of LSS implementation on the turnaround time for orthopaedic patients in the ER. Methods: Analysing data from 50 orthopaedic patients admitted to the ER from September to November 2023, the study employed descriptive statistics, chi-square, and three-way ANOVA. Qualitative interviews with six GTLMH personnel provided nuanced insights. Results: The findings revealed a higher prevalence of trauma-related injuries among orthopaedic patients, emphasizing the need for injury prevention. A significant association between lower family income and longer turnaround times suggests socio-economic factors influence timely care. The study underscores the importance of addressing healthcare disparities and improving registration efficiency. Challenges include patients not meeting admission criteria and those with political connections bypassing ER protocols. Strict adherence to admission criteria and protocol enforcement can address these issues. Conclusion: Despite challenges, the medical staff perceives the current system as efficient, indicating efforts to provide quality care. In conclusion, LSS is highly applicable for enhancing patient outcomes in GTLMH's ER. Utilising a data-driven approach, LSS can eliminate waste, reduce variation, and optimise processes, addressing inefficiencies in registration, streamlining workflows, and improving resource allocation. It also proves instrumental in addressing root causes of staff scarcity and bed capacity issues, leading to improved patient flow and more timely, efficient care.

A Qualitative Study on the Lived Experiences of Patients Post-Coronary Artery Bypass Grafting

Saranya Rajendran — 2024-10-25

Background: In India, cardiovascular disease is the leading cause of mortality and a frequent health issue. Coronary Artery Bypass Grafting (CABG) is one of the major surgeries; survival is not always the primary outcome of the surgery, and it will affect the patients’ mental and psychological wellbeing. Understanding the lived reviews of sufferers will assist fitness experts in providing tremendous care. Objective: To explore the lived experiences of patients who have undergone coronary artery bypass graft. Methods: The study exploited a generic qualitative descriptive approach that aimed to explore the lived experiences of patients who have undergone coronary artery bypass grafts. The study was conducted using Van Manen's method. A comprehensive, semi-structured, in-person interview method was utilised to investigate the patients' post-operative experiences. Between the ages of 30 and 70, seven males and four women were interviewed. Results: One main theme was constructed, namely the desire to live; this theme constitutes three sub-themes: obtaining family attention, cherishing hope, and having a spiritual perspective. Conclusion: Hence the outcomes suggested that the individuals experienced the desire to live following their operations. The overall result shows that after surgery, individuals frequently perceive their lives and health from a different perspective.

Effect of Health Educational Package on Reducing Postpartum Discomforts

Mona Al-Deeb Mahmoud — 2024-10-25

Background: One of the most important maternal health care services to prevent impairment and incapacity after childbirth is postnatal care. The aim of this study was to assess the effect of health educational packages on reducing postpartum discomforts. Methods: This study used a quasi-experimental pre- and post-test one-group design. A convenient sample of a total of 110 postpartum mothers were attending the postpartum ward at Sohag University Hospital. Three tools were used to collect the data: a structured interviewing schedule, a pre- and post-test on maternal knowledge regarding minor discomforts, and a follow-up tool for postpartum minor discomforts. Results: The postpartum women's mean age was 22.97±2.856 years. The study revealed that 86.4% of postpartum women were housewives, 72.7% lived in rural areas, and 43.6% had completed secondary education. Sixty-six-point four percent of the postpartum women stated that prior to receiving health education, they had an unsatisfactory level of knowledge regarding postpartum minor discomforts. After the teaching, only 0.9% of postpartum women were unaware of these minor discomforts. Conclusion: The health education package improved the women's knowledge of postpartum discomforts. There was also partial relief from afterpain, episiotomy pain, breast engorgement, constipation, and urinary retention. Recommendations: Before discharge from the hospital, postpartum primiparous mothers should receive health education materials that clearly and comprehensively explain postpartum minor discomforts.

A Quantitative and Cross-sectional Study on Knowledge of Breast Cancer in Nursing Interns at a University in Lima, Peru 2024

Vania Yulisa Abanto Castro — 2024-10-25

Background: Breast cancer is one of the most common cancers in the world, improving outcomes requires early identification and awareness. Since nursing interns are essential in educating patients and promoting early screening initiatives, it is critical to evaluate their understanding of breast cancer. Objective: Determine the level of knowledge about breast cancer in final-year nursing students at a private university in Lima, 2023. Methods: This study has a non-experimental quantitative approach, descriptive and cross-sectional. The population consisted of all IX and X cycle nursing students, totaling 120 students. Sampling was non-probabilistic for convenience. A level of knowledge questionnaire about breast cancer, prepared by the authors, was used, consisting of 26 items. Results: Out of the sample, 110 students participated in the study. Of 100% of the students (N=110), 31.8% (N=35) had a low level of knowledge about breast cancer, 39.1% (N=43) had a regular level, and 29.1% (N=32) had a high level of knowledge about breast cancer. Conclusions: Nursing students in the IX and X cycles generally have a regular level of knowledge about breast cancer.

Investigating the Dynamics of Women's Health Information on Social Media: Nursing Perspective

Hadeel Daham Habow — 2024-10-25

Background: The digital era has revolutionised health information dissemination, with social media emerging as a pivotal resource. This study explores how female university staff in Mosul, Iraq, utilise social media for health information seeking, emphasizing their engagement patterns, preferred platforms, and perceived benefits and challenges. Methods: A cross-sectional descriptive survey was conducted among 500 female University of Mosul and Nineveh University staff members. Data were collected using a validated questionnaire addressing demographic characteristics, social media usage patterns, and health information-seeking behaviours, and the study period, chosen to capture a comprehensive snapshot of social media usage, spanned from November 2 to December 10, 2023. Descriptive and inferential statistics were applied using SPSS software. Results: Most participants (68.0%) had been using social media for over five years, with Facebook (40.8%) and YouTube (14.4%) being the most popular platforms for health information. Most participants (93.6%) actively sought health information on social media, spending 3-6 hours daily. Video clips (47.0%) were the preferred content format. Significant sources included well-known medical professionals (31.8%) and health influencers (14.8%). Trust in the source (39.2%) was the primary factor influencing the sharing of health information. A notable 56% of participants made health-related decisions based on information obtained from social media. The benefits were perceived as good by 47.8% of participants, highlighting the positive impact of social media on health information-seeking behaviour. Conclusion: This study's findings underscore the crucial role of social media as a platform for health information among female university staff. The significant engagement and reliance on trusted sources highlight social media's potential to shape future health information dissemination strategies. However, the potential for misinformation necessitates urgent and improved digital health literacy and critical evaluation skills, a key area for future research and intervention. Recommendations: Nurses should develop tailored communication strategies that consider individual preferences and promote digital health literacy. Policymakers should establish guidelines to ensure the credibility of health information on social media. Future research should explore longitudinal impacts and intervention strategies to enhance health outcomes through social media.

The Use of Foetal Movement Cards and Happy Tummy Applications against Anxiety among Pregnant Mothers in Trimester III at the Cisoka Health Center, Tangerang, Indonesia

Novita Regina Vidya Trias — 2024-10-25

Introduction: Foetal well-being refers to the condition of the foetus being in a good and healthy state, as measured by heart rate and foetal movement. Regularly counting foetal movements, a subjective measure, can reduce anxiety among expectant mothers. The purpose of this study is to analyse the effectiveness of using the Foetal Movement Card (FMC) and the Happy Tummy Application (HTA) in reducing anxiety among mothers in their third trimester. Methods: This study uses a quasi-experimental design without a control group. The sample consisted of 60 respondents, divided into the FMC and HTA groups, using accidental sampling in July 2023 at the Cisoka Health Centre. Data collection tools included HAR's anxiety questionnaires, FMC, and the HTA. A paired t-test was used to measure anxiety levels before and after using the tools, and the Mann-Whitney Test was used to compare the two groups. Results: The study showed that 24 participants (80%) were adherent, while 6 participants (20%) did not comply with using the FMC. In the HTA group, 26 participants (86.7%) complied, while 4 participants (13.3%) did not. The mean anxiety level before using the FMC was 9.77, and after using it, the anxiety level decreased to 6.37. For the HTA, the mean anxiety level was 10.50 before use and 7.40 after use. The paired t-test results were 0.000 (<0.05), indicating a significant reduction in anxiety levels before and after using the FMC and HTA among third-trimester pregnant women at the Cisoka Health Centre. However, the Mann-Whitney test results showed an insignificant value of 0.492 (>0.05), suggesting no significant difference in compliance between the two groups. Conclusion: The use of the FMC and HTA effectively reduced anxiety in third-trimester pregnant women and can serve as an alternative method for monitoring foetal well-being. Consistency and attention in using these tools are essential, and the support of healthcare workers plays a crucial role in promoting health and preventing complications during pregnancy.

Barriers to Healthcare Access among Visually Impaired in Iligan City, Philippines: A Qualitative Study

Roselyn M. Butalid — 2024-10-25

Background: The visually impaired population continues to experience disparities in healthcare access, reducing their capacity to meet physical and mental needs. This study delved into the barriers visually impaired individuals face when accessing healthcare to determine how nurses, as front-line healthcare providers, might help this underserved population. Methods: This study employed a qualitative descriptive research design utilizing in-depth one-on-one interviews with fifteen visually impaired massage therapists in Iligan City, Philippines recruited through a purposive sampling technique. The researchers developed an interview guide with open-ended questions for the unstructured interview sessions. The interviews underwent a process of recording, transcription, and thematic analysis. Results: Several barriers discouraged visually impaired individuals from seeking medical care, including challenges related to accessing healthcare facilities due to a lack of support and transportation difficulties. Other issues include inadequate knowledge of healthcare access, fear of discrimination, negative experiences with health services, and financial constraints. Conclusion: Visually impaired individuals encounter complex barriers to healthcare, including the need for reliable assistance, inadequate transportation, limited support systems, and financial constraints. Additional challenges like insufficient social interactions, low health literacy, and discrimination further hinder their access to care. Financial issues often lead them to prioritize other needs, worsening their health. A comprehensive approach is needed to address these barriers, including enhancing support networks, improving accessibility, providing better assistive devices, and training healthcare personnel. Increasing health literacy and making healthcare more affordable are also crucial for creating a more inclusive system that effectively serves visually impaired individuals.

Methods of Applying Breast Milk for Umbilical Cord Care and Its Impact on the Speed of Umbilical Cord Detachment in Newborns

Nurhamida Fithri — 2024-10-25

Background: In Indonesia, the infant mortality rate due to tetanus is still high; generally, more than 50% of babies affected by tetanus will end up dying. To reduce infant mortality due to tetanus attacks, umbilical cord care is needed. Effective umbilical cord care methods speed up umbilical cord spreading and reduce the frequency of infections. There are different methods of umbilical cord care. One of them is the traditional method of applying breast milk to the umbilical cord of the newborn. The aim of this study is to evaluate the effect of umbilical cord care using the breast milk application method on umbilical cord acceleration in newborns. Methods: The research method used was a single non-equivalent post-test control group with a sample size of 38 children. Results: Based on the results of this study, it was found that in the intervention group for rapid umbilical cord release there were 16 babies (84.2%) and there were 3 normal babies (15.8%); in the control group for rapid umbilical cord release there were 7 babies (36.8%) and normal as many as 12 babies (63.2%). The results of the Chi-square test analysis show that there is an effect of umbilical cord care using the method of applying breast milk to the acceleration of umbilical cord detachment with a value of p = 0.027. Conclusion: Umbilical cord care using breast milk application is safe, effective and efficient and can protect the baby from infection because breast milk contains immunoglobulins A, G, and M, and breast milk also contains lactoferrin and lysozyme as anti-bacterial, anti-viral and anti-microbial.

Analysing the Concept of Self-Efficacy in Mothers of Children Aged 0-24 Months, Undergoing Nutritional Care Practices

Uswatul Khasanah — 2024-10-25

Background: Children aged 0-24 months have several risk factors for experiencing nutritional problems, including rapid growth and development of children, high dietary needs, an immature digestive system, and being very dependent on others, especially mothers. Mothers with children aged 0-24 months have different perceptions of risk factors, so they also have different perceptions of actions to fulfil nutritional intake for children aged 0-24 months. This causes mothers' self-confidence in their ability to fulfil nutritional intake for children aged 0–24 months to be different. This condition will result in inadequate dietary intake, namely an imbalance between nutritional needs and intake provided by parents, especially mothers, which can lead to dietary problems such as malnutrition, stunting, and even malnutrition, which have an impact on inhibiting the growth and development of children. Therefore, it is necessary to build the ability of mothers who have children aged 0-24 months to provide adequate nutrition for children aged 0-24, namely self-efficacy. Objective: The purpose of this study is to explain the concept of self-efficacy of mothers who have children aged 0-24 months in fulfilling adequate nutritional intake. Methods: Used in this concept analysis is the Walker and Avant concept approach with eight steps, namely 1) choosing a concept, 2) determining the purpose of the analysis, 3) identifying all uses of the concept, 4) identifying attribute definitions, 5) identifying case models, 6) identifying borderline, related, conflicting, false and invalid cases, 7) recognising antecedents and consequences, and 8) determining empirical references. Results: Five definitions of self-efficacy attributes include self-confidence, maternal beliefs to fulfil nutritional intake in children aged 0-24 months, resilience, commitment and motivation, and the ability to prevent risk factors that cause nutritional problems. The antecedents of the concept of self-efficacy of mothers who have children aged 0-24 months are sociodemographics (mother’s education), experience, verbal persuasion, physical and emotional conditions, and performance achievements. The consequences of increasing self-efficacy in improving maternal behaviour are providing adequate nutritional intake and increasing weight and height or optimising the nutritional status of children. Conclusion: The process of analysing the concept of self-efficacy with a conceptual approach produces important components at the attribute, antecedent, and consequence stages. Nurses need to understand this when developing promotive and preventive interventions through practice, research, and community service, especially for mothers who have children aged 0-24 months based on the evidence base, particularly nursing interventions related to self-efficacy.

Case Study on Exploration of Paediatric Cardiopulmonary Resuscitation among Involved Team Members in Paediatric Intensive Care Unit Institute Jantung Negara, Malaysia

Farah Syazwani Hilmy Zaki — 2024-10-25

Background: Paediatric in-hospital resuscitations also occur frequently and are associated with high morbidity and mortality. Objectives: To explore the Paediatric Intensive Care Unit (PICU) CPR current practices in PICU of Institute Jantung Negara (IJN) Malaysia. Methods: The research employed a qualitative approach, utilising case study research design. The data collection process involved in-depth interviews and reviewing the Resuscitation Feedback Form. Purposive sampling was used to select two cases consisting of 14 participants. The study participants comprised a cardiologist, one anaesthetist, and twelve nurses. The data collected were transcribed and entered into NVivo software to facilitate theme development. Subsequently, thematic analysis was conducted to analyse the data. Results: The research yielded significant findings for improving practices related to Cardiopulmonary Resuscitation (CPR) in the Paediatric Intensive Care Unit (PICU). These findings are organised into four main themes: routine procedures, resuscitation techniques, team dynamics, and individual contributions. Participants emphasised the importance of establishing a cohesive team to enhance the efficiency of resuscitation efforts. They identified challenges of lack of confidence, skills, and knowledge as significant barriers to effective CPR in the PICU. Conclusion: The findings of this study indicate that the participants expressed satisfaction with the current practices of PICU CPR. However, the research also highlights the need for enhancements in various areas, including routine procedures, resuscitation techniques, and team and individual factors. Furthermore, it was suggested that additional training be conducted on the resuscitation process to enhance the preparedness of the medical team.