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Aims: To examine the pertinent issues discussed by endometriosis patients in Malaysia on MyEndosis Facebook group as an alternative platform for online support. Methods: Using thematic analysis based on three frameworks, 120 posted messages and comments were examined from MyEndosis Facebook group—a support group for women with endometriosis from January to July 2014. Results: Results showed the issues discussed were (a) personal struggles, (b) medication and treatment, (c) alternative medication, (d) side effects, and (e) medication recommended by doctors. While using this social medium, users found (a) emotional support, (b) esteem support, (c) information support, (d) network support, and (e) tangible assistance in their engagement with others. Conclusion: The analysis suggested that users' interactions were structured around information, emotion, and community building, which many doctors and nurses were not aware of. The group was shaped as a social network where peer users share social support, cultivate companionship, and exert social influence. SUMMARY STATEMENT: What is already known about the topic? There are no studies of Malaysian women with endometriosis seeking alternative support online and limited knowledge of their use of Facebook as an alternative platform for discussion on non‐communicable diseases.MyEndosis has created a pleasant and non‐judgemental environment that encourages well‐being and ease for patients to discuss and manage their endometriosis related issues. What this paper adds? Social media such as Facebook provide an integral platform for patients with endometriosis in Malaysia where the topic is still a taboo subject of discussion.This study provides insight into the usage of Facebook by patients as a platform for discussion and social support.Online patient interaction connects women with a similar condition and helps build a compassionate, courteous, and respectful community. The implications of this paper: There are many opportunities to improve understanding and research on how patients with endometriosis cope.Offering doctors and nurses an effective communication platform like Facebook will allow them to accurately assess patients' struggles with endometriosis, identify coping mechanisms, and develop appropriate discussion strategies. [ABSTRACT FROM AUTHOR]

Aim To examine the practical applicability of the 'hard' and 'soft' constraints associated with the 'nurse rostering problem' as defined in operations management research literature and thereby investigate the objectivity of the rostering process. Background In practice, rostering nursing staff is often unrecognized, unrewarded and undervalued; yet, despite four decades of research, operations management has little to offer in terms of faster, safer, fairer or more effective rosters. This paper contrasts the theoretical perceptions of roster 'constraints' with the subjective, often political, rules governing practical rosters. Design Using both qualitative and quantitative data, this inductive study compares the practical process of rostering with that theorized in the nurse rostering problem. Methods This research spanned 4 years examining the rosters from 28 wards in 14 hospitals. Interviews with senior nursing staff regarding staff levels and with ward managers regarding rules defining the roster were complemented by analysis of actual roster data to establish the number and type of unfilled shifts and rule breakages. Interviews were analysed using thematic content analysis and roster data were evaluated using the HealthRoster™ e-rostering system. Findings Often the rules governing how nursing staff are scheduled are undocumented, tacit and informal. Furthermore, the roster process can be highly politicized, leading to forms of 'information anarchy' or 'information feudalism' on the ward. Conclusions Hospital managers must understand that roster design has a major impact on ward performance and must develop clear roster policies that define staff levels, skill mix, shift patterns and the rules used in preparing the roster. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. Background: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi‐ethnic country. Design: A cross‐sectional study design. Methods: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE‐Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). Results: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self‐driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face‐to‐face, centre‐based cardiac rehabilitation approach. Conclusion: Several barriers were associated with non‐participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home‐based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. Relevance to clinical practice: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation. [ABSTRACT FROM AUTHOR]

This paper examines the experiences of mothers caring for a child with Down syndrome in the Malaysian ( Sarawak) context. Qualitative interviews were conducted with 26 biological mothers of children with Down syndrome aged 18 years and below. They were accessed through selected child health clinics, community-based rehabilitation centres and schools using purposive sampling within two regions in Sarawak, one of the two Borneo States of Malaysia. Major themes emerging within the context of care demands were children's health, developmental delays, daily needs and behaviour issues. The insights obtained into the care demands experienced by mothers of children with Down syndrome have several implications for practice by care professionals. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the quality of life ( QOL) among mothers with a child with Down syndrome using The World Health Organization Quality of Life scale instrument. A convenience sample of 161 mothers was accessed through the various institutions which provide interventional or educational programmes to children with disabilities within two of the regions of the Borneo State of Malaysia ( Sarawak). Nearly half of the group of mothers perceived their QOL as neither poor nor good ( n = 73). An overall QOL score of 14.0 ± 1.84 was obtained. The highest and lowest domain scores were found for social relationship domain (Mean = 14.9 ± 2.1) and environmental support domain (Mean = 13.3 ± 2.1) respectively. Correlation analysis of selected background variables (i.e. locality, education, income and marital status) and overall QOL indicated rho (161) = 0.22-0.28 ( P < 0.01). Inverse correlation between maternal age and overall QOL score was indicated, with rho (161) = −0.17 ( P < 0.05). Linear regression analysis indicated that the combination of these few variables together accounted for 14.5% of the QOL variability in the sample. Findings point to implications for priorities of care provisions by policy-makers and care professionals in their practice. [ABSTRACT FROM AUTHOR]

Aim: To investigate semantic equivalence between two translated versions of the heart quality of life (HeartQoL) questionnaire produced by the forward‐backward and dual‐panel methods. Methods: The forward‐backward and dual‐panel versions of HeartQoL were self‐administered among 60 participants who met the inclusion criteria of being a native Bahasa Malaysia‐speaking Malay, aged 18 and older, having an indexed diagnosis of ischaemic heart disease and being cognitively fit. The administration sequence of the two versions was randomized. Additionally, three sociolinguists, who were blinded to translation processes and survey findings, rated the translated versions against the source version on three aspects of semantic equivalence. Results: Textual content in both translated versions was considerably similar (n = 9/14 items, ≈64%). The overall results from weighted kappa, raw agreement, intraclass correlations, and Wilcoxon signed‐rank as well as experts' ratings were confirmative of semantic equivalence between the forward‐backward and dual‐panel versions of the HeartQoL. However, some mixed findings were indicative of potential gaps in both translated versions against the source version. Conclusion: Both the forward‐backward and dual‐panel methods produced semantically equivalent versions of HeartQoL; but translation alone is insufficient to narrow the subtle gaps caused by differences in culture and linguistic style. SUMMARY STATEMENT: What is already known about this topic? The lack of empirical evidence and consensus creates uncertainties surrounding best practices on establishing equivalence between a translated questionnaire and its source.There is a lack of supportive evidence on the extent to which the forward‐backward and dual‐panel methods of translation produce semantically equivalent versions of the source questionnaire.What this paper adds? The forward‐backward and dual‐panel methods of translation are potentially comparable with each other as they have produced semantically equivalent versions of the heart quality of life (HeartQoL) questionnaire.Feedback from sociolinguists reveals potential gaps in both versions and offers insights to enhance translation equivalence.The implications of this paper: Translation of questionnaires for use in nursing research and practice can employ either the forward‐backward and dual‐panel methods or both.Regardless of methods used and the personnel involved in the translation process, the potential sources of equivalence gaps may persist. This warrants further examination using the quantitative and qualitative approaches of inquiry. [ABSTRACT FROM AUTHOR]

In this study, an improved dansyl‐chloride derivatization technique using a microwave synthesizer was used for the qualitative and quantitative analyses of biogenic amine in the fresh meat samples. The derivatization technique was optimized in terms of temperature, reaction time, and spinning speed. The derivatization method together with a validated reversed‐phase HPLC‐DAD method was used for the determination of biogenic amines in chicken, beef, and mutton sold in the wet market. The results of the analyses showed that tryptamine, putrescine, and histamine were generally detected in all the three types of meat. Higher levels of histamine were found in chicken and beef. However, low levels of histamine were observed in mutton. Tyramine was either detected low or moderate in all the three types of meat. The biogenic amines of the fresh meat sold in the wet market is generally higher than the reported values. The mechanisms of biogenic amines‐dansyl‐chloride formation were investigated and proposed. Practical Application: The biogenic amine derivatization method was improved. The improved derivatization method can be potentially used for various food products beside meats for routine biogenic amine analyses due to its fast analysis time and simplicity. High levels of biogenic amines were generally found in the meat sold in the wet markets. However, proper handling of the raw meat can reduce the risk of infection. [ABSTRACT FROM AUTHOR]

Chan KG, Upi H, Gani R, Chang KH. International Journal of Nursing Practice 2011; : 181-186 This survey study investigated the paediatric ward nurses for their action intentions and attitudes towards quit smoking-related interventions (QSRI), and knowledge related to effects of children's exposure to second-hand smoke (SHS) ( n = 267). Results indicate that less than 2% of the nurses smoked, and a majority had a positive attitude towards QSRI. A majority also indicated that they would only assess children's parents' smoking status depending on the child's diagnosis on admission. The total mean scores for two knowledge items are relatively lower than the others. More than half of the participants (66%) indicated 'no' to 'documenting smoking status'. Differences in responses of the participants across the hospitals were statistically significant, χ (2, n = 267) = 11.190, P < 0.05. About half of the participants did not know of any existing quit smoking clinics. The variation in the nurses' action intention towards various QSRI may be attributed to their busy workload and varying perceptions towards QSRI as a nursing priority. Results indicate the needs for knowledge related to impacts of children's exposure to SHS to be integrated into the basic nursing curriculum, support and affirmation from ward managers in the clinical settings to promote the initiatives to integrate QSRI in paediatric nursing settings. [ABSTRACT FROM AUTHOR]

Background: Healthcare‐associated infection (HAI) is one of the major threats to patients' safety besides being among the principal causes of patient morbidity and mortality. Catheter‐associated urinary tract infection (CAUTI) is reported to be the most common HAI worldwide. CAUTI can be prevented with appropriate practice and care by healthcare personnel, especially nurses, who play the main role in urinary catheter care. Nurses' knowledge and attitude are considered to be important factors that influence their practice. Objectives: To assess nurses' level of knowledge, attitude and perceived practice regarding CAUTI and its preventive measures. Methods: A cross‐sectional design was adopted, and a self‐administered questionnaire was used to collect data. Nurses from the medical and surgical inpatient wards of a tertiary teaching hospital in Malaysia were recruited in two stages using the stratified and simple random sampling methods. A total of 301 nurses participated. Descriptive analysis, an independent t test, ANOVA and hierarchical multiple regression were employed to analyse the data using SPSS software version 25. In addition, a STROBE checklist was used to report the results of this study. Results: Nurses were found to have good knowledge, a positive attitude and good perceived practice regarding CAUTI prevention. Nurses aged above 30 and who had more than ten years of experience reported higher knowledge levels. Knowledge was found to be positively correlated with attitude and perceived practice; however, attitude explained a higher variance in perceived practice of CAUTI prevention compared with knowledge. Conclusion: Attitude was found to have a higher significant influence on perceived practice in this study. Educators need to emphasise the inculcation of a positive attitude among nurses rather than just knowledge for CAUTI prevention. Since this study assessed perceived practice, examining nurses' actual practice and its impact on patient outcomes is recommended in future studies. [ABSTRACT FROM AUTHOR]

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Aim and objectives: To determine the prevalence of psychological distress and its association with job satisfaction among nurses in a teaching hospital in Malaysia. Background: Nurses constitute the majority of health care workers, and, compared with other professions, nursing profession is highly stressful and, hence, a cause of anxiety and depression. This may affect nurses' job satisfaction. Method: Using self‐administered questionnaires, Depression Anxiety and Stress Scale (DASS‐21) and Job Satisfaction Scale for Nurses (JSS), a cross‐sectional study of 932 nurses from the inpatient departments of a teaching hospital was conducted in December 2017. Descriptive analyses and multiple logistic regressions were used for the analysis. The STROBE guideline was used in this study. Results: The overall prevalence of psychological distress was 41%. The prevalence of stress, anxiety and depression were 14.4%, 39.3% and 18.8%, respectively. It was found that single and widowed nurses had a higher level of stress, anxiety and depression compared with married nurses. In addition, nurses in the age of 26–30 years had a higher level of depression than nurses in other age groups. Also, nurses who worked in the paediatric departments had a higher level of depression compared with nurses in other departments. The majority of the nurses were satisfied with their job at 92.0%. Those nurses who were not satisfied were found to be significantly associated with a high level of stress and depression. Conclusion: This study revealed that the level of stress, anxiety and depression is high. Stress and depression were found to be associated with nurses' low job satisfaction. Relevance to clinical practice: Stress and depression can affect nurses' job satisfaction, it is important for nursing managers to institute strategies to address this issue. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the studies that used interventions based on the Mindfulness‐Based Stress Reduction (MBSR) for decreasing psychological distress among nurses. Background: Because of the demanding nature of their work, nurses often have significantly high levels of stress, anxiety and depression. MBSR has been reported to be an effective intervention to decrease psychological distress. Design: Systematic review. Methods: The databases included were Science Direct, PubMed, EBSCO host, Springer Link and Web of Science from 2002 to 2018. Interventional studies published in English that used MBSR among nurses to reduce their psychological distress were retrieved for review. The PRISMA guideline was used in this systematic review. The included studies were assessed for quality using "The Quality Assessment Tool For Quantitative Studies (QATFQS)." Results: Nine studies were found to be eligible and included in this review. Many benefits, including reduced stress, anxiety, depression, burnout and better job satisfaction, were reported in these studies. Conclusion: The adapted/brief versions of MBSR seem promising for reducing psychological distress in nurses. Future research should include randomised controlled trials with a larger sample size and follow‐up studies. There should also be a focus on creative and effective ways of delivering MBSR to nurses. Relevance to clinical practice: The results of this review are substantial for supporting the use of MBSR for nurses' psychological well‐being. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the effectiveness of a structured nursing intervention program on maternal stress and NICU‐related maternal ability after the admission of premature infants to a neonatal intensive care unit (NICU). Background: Mothers of premature infants may face stress having premature infants, and their infants may be admitted to the NICU for a few weeks or months. The mothers' experience of stress would be worse if they have low knowledge and poor NICU‐related maternal ability. Mothers of infants admitted to the NICU require well‐planned interventions to cope with psychological matters arising after an infant hospitalisation. Design: Quasi‐experimental design. Methods: A total of 216 mothers were consecutively assigned to control and intervention groups. Each group consisted of 108 mothers. The mothers in both groups received questionnaire concerning maternal stress and NICU‐related ability during their first visit to NICU (within 48 hr of admission). A structured nursing intervention was implemented for 10 days on mothers in the intervention group. The control group continued to receive existing practice nursing care. Mothers of both groups were again given the questionnaire on maternal stress and NICU‐related ability after 14 days of admission. Results: In the intervention group, the difference between the mean total score of maternal stress and parental role and relationship subscale decreased significantly, compared to the control group (p = 0.04; p = 0.01) respectively. Maternal ability improved significantly in mothers in the intervention group 2 weeks postintervention, p < 0.001. Conclusion: A structured nursing intervention for mothers could significantly reduce maternal stress and promote maternal NICU‐related abilities. Relevance to clinical practice: The results of the study could help neonatal nurses to develop an appropriate nursing intervention for parents with premature infants in the NICU. [ABSTRACT FROM AUTHOR]

Aims: To determine the effect mobile messaging apps on coronary artery disease patient knowledge of and adherence to a healthy lifestyle. Background: Due to the increasing incidence of coronary artery disease in recent years, interventions targeting coronary artery disease risk factors are urgent public priorities. The use of mobile technology in healthcare services and medical education is relatively new with promising future prospects. Design: This study used a quasiexperimental design that included pre‐ and posttest for intervention and control groups. Methods: The study was conducted from January–April 2017 with both intervention and control groups, in a teaching hospital in Klang Valley. Convenience sampling was used with inclusive criteria in choosing the 94 patients with coronary artery disease (intervention group: 47 patients; control group: 47 patients). The pretest was conducted as a baseline measurement for both groups before they were given standard care from a hospital. However, only the intervention group was given a daily information update via WhatsApp for 1 month. After 1 month, both groups were assessed with a posttest. Results: The split‐plot ANOVA analysis indicates that there is a significant and positive effect of the intervention on coronary artery disease patients' knowledge on coronary artery disease risk factors [F(1, 92) = 168.15, p < 0.001] with a large effect size (ηp2 = 0.65). The mobile messaging apps also significantly improve the patients' adherence to a healthy lifestyle [F(1, 92) = 83.75, p < 0.001] with a large effect size (ηp2 = 0.48). Conclusion: This study concluded that WhatsApp was an effective health intervention in increasing coronary artery disease patient's knowledge and subsequently increasing their adherence to healthy lifestyles. Relevance to clinical practice: In clinical setting, mobile messaging apps are useful in information delivery and efficient patient monitory. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To assess intensive care unit nurses’ knowledge of intensive care unit delirium and delirium assessment before and after an educational intervention. In addition, nurses’ perception on the usefulness of a delirium assessment tool and barriers against delirium assessment were assessed as secondary objectives. Background: Early identification of delirium in intensive care units is crucial for patient care. Hence, nurses require adequate knowledge to enable appropriate evaluation of delirium using standardised practice and assessment tools. Design: This study, performed in Malaysia, used a single‐group pretest–posttest study design to assess the effect of educational interventions and hands‐on practices on nurses’ knowledge of intensive care unit delirium and delirium assessment. Methods: Sixty‐one nurses participated in educational intervention sessions, including classroom learning, demonstrations and hands‐on practices on the Confusion Assessment Method‐Intensive Care Unit. Data were collected using self‐administered questionnaires for the pre‐ and postintervention assessments. Analysis to determine the effect of the educational intervention consisted of the repeated‐measures analysis of covariance. Results: There were significant differences in the knowledge scores pre‐ and postintervention, after controlling for demographic characteristics. The two most common perceived barriers to the adoption of the intensive care unit delirium assessment tool were “physicians did not use nurses’ delirium assessment in decision‐making” and “difficult to interpret delirium in intubated patients”. Conclusions: Educational intervention and hands‐on practices increased nurses’ knowledge of delirium assessment. Teaching and interprofessional involvements are essential for a successful implementation of intensive care unit delirium assessment practice. Relevance to Clinical Practice: This study supports existing evidences, indicating that education and training could increase nurses’ knowledge of delirium and delirium assessment. Improving nurses’ knowledge could potentially lead to better delirium management practice and improve ICU patient care. Thus, continuous efforts to improve and sustain nurses’ knowledge become relevant in ICU settings. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore self‐care and self‐care support in patients with Type 2 diabetes in urban Malaysia. Background: The prevalence of Type 2 diabetes in Malaysia and associated long‐term and life‐changing complications is increasing. With effective self‐care and self‐care support, severe complications of the condition can be avoided or reduced. Prior to this study, no evidence existed about Malaysian patients’ management of the condition or support for self‐care from the healthcare system. Design: A single embedded qualitative case study. Methods: Semistructured interviews with 18 patients with Type 2 diabetes aged 28–69 years, healthcare professionals (n = 19), observations (n = 13) of clinic appointments from two urban settings in Malaysia and a documentary analysis. Recordings were transcribed verbatim, field notes were made during observations and the data analysed and synthesised within and across case using Framework analysis. Findings: Three main themes explained self‐care and self‐care support in Malaysia: fatalism, faith and fear. Patients were fatalistic about developing diabetes—they perceived it as inevitable because it is so common in Malaysia. However, faith in God, coupled with fear of the consequences of diabetes, motivated them to engage in self‐care practices. The fear was largely induced by diabetes healthcare professionals working in overcrowded clinics, and stretched thinly across the service, who used a direct and uncompromising approach to instil the importance of self‐care to avoid severe long‐term complications. Conclusion: This study provided important insight on how people in Malaysia developed diabetes, their responses to the disease and the approach of healthcare professionals in supporting them to engage with self‐care. Relevance to clinical practice: Any future development of self‐care programmes in Malaysia needs to recognise the factors that motivate patients to self‐care and include components that build self‐efficacy. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables. Background A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals. Design A cross-sectional study was used. Methods A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses ( n = 309) in twelve wards of a teaching hospital in Kuala Lumpur. Results Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint . Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint. Conclusion This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint. Relevance to clinical practice Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals. [ABSTRACT FROM AUTHOR]

Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires ( APS- POQ- R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race ( P = 0.038), education level ( P ≤ 0.001), previous operation status ( P = 0.032) and operation status ( P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery. [ABSTRACT FROM AUTHOR]

Aim To describe the enablers and barriers working women experience in continuing breast milk feeding after they return to work postpartum in urban Malaysia. Background In Malaysia, urban working women have low rates of breastfeeding and struggle to achieve the recommended 6 months exclusive breastfeeding. Design A qualitative enquiry based on a phenomenological framework and multiple methods were used to explore women's experiences in depth. Methods Multiple qualitative methods using face-to-face interview and participant diary were used. Data collection took place in urban suburbs around Penang and Klang Valley, Malaysia from March-September 2011. Participants were 40 employed women with infants less than 24 months. Findings Only 11 of the participants worked from home. Based on the women's experiences, we categorized them into three groups: 'Passionate' women with a strong determination and exclusively breastfed for 6 months, 'Ambivalent' women who initiated breastfeeding, but were unable to sustain exclusive breastfeeding after returning to work and 'Equivalent' women who introduced infant formula prior to returning to work. Conclusion Passion and to a lesser extent intention, influenced women's choice. Women's characteristics played a greater role in their infant feeding outcomes than their work environment. [ABSTRACT FROM AUTHOR]

Patient decision-making role preference ( DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28-67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP. [ABSTRACT FROM AUTHOR]

Aims and Objectives To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants. Background Preterm neonates are exposed to a myriad of invasive, often painful, procedures throughout their stay in the neonatal intensive care unit. A growing volume of evidence shows that pain in preterm infants has both short- and long-term deleterious effects. It is within the power and ethical responsibility of neonatal nurses to help premature babies cope with procedural pain. Design A quasi-experimental study with two groups: control and treatment group. Methods A study was conducted on a cohort of preterm infants (n = 42), divided into control ( n = 21) and treatment ( n = 21) groups, to determine the effect of facilitated tucking on pain relief during venepuncture on preterm infants in the neonatal intensive care unit. The severity of pain was measured using the Premature Infant Pain Profile score. The primary outcome measure was reduction in the Premature Infant Pain Profile scores. Results The Premature Infant Pain Profile score for the treatment group was significantly lower ( M = 6·62, SD 2·598) than for the control group (6·62 ± 2·60 vs. 8·52 ± 2·99, respectively, t = −2·202, p < 0·05). Conclusions Facilitated tucking reduced the Premature Infant Pain Profile scores in preterm infants. Relevance to clinical practice The findings of this study suggest that facilitated tucking is able to alleviate pain; therefore, nurses must be able to carry out facilitated tucking when necessary. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the process that nurses experienced in engaging with families in Malaysian palliative care settings and the challenges they faced. Background In palliative care settings, nurses and the terminally ill person's family members interact very closely with each other. It is important for nurses to work with families to ensure that the care of the terminally ill person is optimised. Research design A qualitative design using grounded theory methods was used to describe how nurses engaged with families and the challenges they faced. Methods Twenty-two nurses from home care and inpatient palliative care settings across Malaysia participated in this study. Data were collected through seven interviews and eight focus group discussions conducted between 2007-2009. Results The main problem identified by nurses was the different expectations to patient care with families. The participants used the core process of Engaging with families to resolve these differences and implemented strategies described as Preparing families for palliative care, Modifying care and Staying engaged to promote greater consistency and quality of care. When participants were able to resolve their different expectations with families, these resulted in positive outcomes, described as Harmony. However, negative outcomes of participants not being able to resolve their different expectations with families were Disharmony. Conclusions This study highlights the importance of engaging and supporting families of the terminally ill as well as providing a guide that may be used by nurses and carers to better respond to families' needs and concerns. Relevance to clinical practice The study draws attention to the need for formal palliative care education, inclusive of family care, to enable nurses to provide the terminally ill person and their family effective and appropriate care. [ABSTRACT FROM AUTHOR]

Aims and objectives To propose a model of prediction of caring behaviour among nurses that includes spiritual intelligence, emotional intelligence, psychological ownership and burnout. Background Caring behaviour of nurses contributes to the patients' satisfaction, well-being and subsequently to the performance of the healthcare organisations. This behaviour is influenced by physiological, psychological, sociocultural, developmental and spiritual factors. Design A cross-sectional survey was used, and data were analysed using descriptive statistics and structural equation modelling. Methods Data were collected between July-August 2011. A sample of 550 nurses in practice from seven public hospitals in and around Kuala Lumpur (Malaysia) completed the questionnaire that captured five constructs. Besides nurses, 348 patients from seven hospitals participated in the study and recorded their overall satisfaction with the hospital and the services provided by the nurses. Data were analysed using structural equation modelling ( SEM). Results The key findings are: (1) spiritual intelligence influences emotional intelligence and psychological ownership, (2) emotional intelligence influences psychological ownership, burnout and caring behaviour of nurses, (3) psychological ownership influences burnout and caring behaviour of nurses, (4) burnout influences caring behaviour of nurses, (5) psychological ownership mediates the relationship between spiritual intelligence and caring behaviour and between emotional intelligence and caring behaviour of nurses and (6) burnout mediates the relationship between spiritual intelligence and caring behaviour and between psychological ownership and caring behaviour of nurses. Conclusions Identifying the factors that affect caring behaviour of nurses is critical to improving the quality of patient care. Spiritual intelligence, emotional intelligence, psychological ownership and burnout of nurses play a significant role in effecting caring behaviour of nurses. Relevance to clinical practice Healthcare providers must consider the relationships between these factors in their continuing care and incorporation of these in the nursing curricula and training. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess Malaysian nurses' perceived job satisfaction and to determine whether any association exists between job satisfaction and intention to leave current employment. Background There is currently a shortage of qualified nurses, and healthcare organisations often face challenges in retaining trained nurses. Job satisfaction has been identified as a factor that influences nurse turnover. However, this has not been widely explored in Malaysia. Design Cross-sectional survey. Methods Registered nurses in a teaching hospital in Malaysia completed a self-administered questionnaire. Of the 150 questionnaires distributed, 141 were returned (response rate = 94%). Results Overall, nurses had a moderate level of job satisfaction, with higher satisfaction for motivational factors. Significant effects were observed between job satisfaction and demographic variables. About 40% of the nurses intended to leave their current employment. Furthermore, age, work experience and nursing education had significant associations with intention to leave. Logistic regression analysis revealed that job satisfaction was a significant and independent predictor of nurses' intention to leave after controlling for demographic variables. Conclusion The results suggest that there is a significant association between job satisfaction and nurses' intention to leave their current employment. It adds to the existing literature on the relationship between nurses' job satisfaction and intention to leave. Relevance to clinical practice Methods for enhancing nurses' job satisfaction are vital to promote the long-term retention of nurses within organisations. Attention must be paid to the needs of younger nurses, as they represent the majority of the nursing workforce and often have lower satisfaction and greater intention to leave than older nurses do. Strategies to nurture younger nurses, such as providing opportunities for further education, greater management decision-making capabilities and flexible working environment, are essential. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Background Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. Design A qualitative focus group study. Methods Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Results Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Conclusion Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. Relevance to clinical practice These findings provide valuable information for implementing clinical practice improvement interventions. [ABSTRACT FROM AUTHOR]

Malaysian population widely consumes the cereal-based foods, oilseeds, nuts, and spices in their daily diet. Mycotoxigenic fungi are well known to invade food products under storage conditions and produce mycotoxins that have threat to human and animal health. Therefore, determining toxigenic fungi and aflatoxin B (AFB1) in foods used for human consumption is of prime importance to develop suitable management strategies and to minimize risk. Ninety-five food products marketed in Penang, Malaysia were randomly collected from different supermarkets and were analyzed for presence of Aspergillus spp. by agar plate assay and AFB1 by enzyme-linked immunosorbent assay (ELISA). A. flavus was the dominant fungi in all foods followed by A. niger. Fifty-five A. flavus strains were tested for their ability to produce aflatoxins on rice grain substrate. Thirty-six (65.4%) strains out of 55 produced AFB1 ranging from 1700 to 4400 μg/kg and 17 strains (31%) produced AFB2 ranging from 620 to 1670 μg/kg. Natural occurrence of AFB1 could be detected in 72.6% food products ranging from 0.54 to 15.33 μg/kg with a mean of 1.95 μg/kg. Maximum AFB1 levels were detected in peanut products ranging from 1.47 to 15.33 μg/kg. AFB1 levels detected in all food products were below the Malaysian permissible limits (<35 μg/kg). Aspergillus spp. and AFB1 was not detected in any cookies tested. Although this survey was not comprehensive, it provides valuable information on aflatoxin levels in foods marketed in Malaysia. [ABSTRACT FROM AUTHOR]

This study sought to determine the strategies, methods and frequency of oral care provided for mechanically ventilated patients in Malaysian intensive care units. The study also described nurses' attitudes to providing oral care and their knowledge of the mode of transmission of ventilator-associated pneumonia. Oral care is an important nursing intervention in the intensive care unit to reduce dental plaque. Dental plaque provides a repository for respiratory pathogens contributing to ventilator-associated pneumonia in the critically ill. Cross-sectional study. This study used both survey and observational methods. The observational study was conducted by a nurse, trained in the study protocol. The observation period a selected shift over three weeks in 2007. Intensive care unit nurses ( n = 284) participated in the survey. Respondents had a positive attitude towards providing oral care. On a 10-point Likert scale, aspiration of contaminated secretions from the oropharynx was identified by nurses as the highest risk factor for ventilator-associated pneumonia (mean response 6·8, SD 2·0). The majority of nurses used cotton and forceps for oral care. Toothbrushes were not used in any of the study sites. Although nurses had a positive attitude to oral hygiene, this study found no intensive care units incorporated a soft toothbrush in oral care protocols which is recommended in best practice guidelines. A review of strategies to implement evidence-based practice in the intensive care unit is warranted. This study has identified a failure to adhere with evidence-based practice. Implementing and evaluating protocols for oral hygiene in the intensive care unit has the potential to improve patient outcomes. [ABSTRACT FROM AUTHOR]