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ObjectivePast studies on intensive care unit (ICU) patient transfers compare the efficacy of using standardised checklists against unstructured communications. Less studied are the experiences of clinicians in enacting bidirectional (send/receive) transfers. This study reports on the differences in protocols and data elements between receiving and sending transfers in the ICU, and the elements constituting readiness for transfer.MethodsMixed-methods study of a 574-bed general hospital in Singapore with a 74-bed ICU for surgical and medical patients. Six focus group discussions (FGDs) with 34 clinicians comprising 15 residents and 19 nurses, followed by a structured questionnaire survey of 140 clinicians comprising 21 doctors and 119 nurses. FGD transcripts were analysed according to the standard qualitative research guidelines. Survey data were analysed using Student’s t-test with Bonferroni corrections.ResultsGeneral ward (GW) clinicians are more likely to receive ICU patients with complete discharge summaries while ICU clinicians receiving GW patients get significantly less data. Emergency department (ED), GW and operating theatre physicians accompany their patients to the ICU while ICU nurses accompany their patients to the GW. Not all units, such as the ED, experience bidirectional transfers.ConclusionThe protocols and supporting data elements of an ICU transfer vary by the type of transfer and transferring unit. Readiness for transfer means that sending unit protocols affirmatively consider the needs of the receiving unit’s data needs and resource constraints.

Modern educational technology (Edtech) combines technological tools with educational theories. Over the years, Edtech has been adopted in nursing education to address student needs and expectations, institutional resources, community stakeholder expectations, and healthcare trends. However, regardless of the technologies used, keeping students engaged in learning is still challenging. As intrinsic motivation is significantly related to academic achievement, ensuring student engagement and motivation for learning becomes crucial.This scoping review aims to explore the types and features of modern Edtech that have impacted on undergraduate nursing students' engagement and motivation.This scoping review is based on the five-stage approach following Arksey and O'Malley's framework, and the Engagement theory framework for technology-based teaching and learning.A systemic search was conducted across 10 electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, ProQuest, Web of Science, Cochrane, Engineering Village, and IEEE Explore). The titles, abstracts, and full texts were screened and reviewed based on the inclusion criteria of undergraduate nursing students, using innovative Edtech, and outcomes of engagement and motivation. Studies published in non-peer reviewed journals, or not in English were excluded. Study characteristics were summarized and quantified. Descriptions of educational technology characteristics from selected studies were coded and categorized as follows: "Facilitating collaboration", "Stimulating problem-solving", and "Pursuing authentic focus".Majority of the studies utilised gamification over other types of Edtech such as virtual reality or smart glasses, successfully engaging and motivating students through the features of collaboration, competition, and challenge. Despite the high technology aspect of the interventions used, the human presence as an authentic focus was perceived to be important in engaging students in learning experience. Moreover, attaining meaningful achievements also improves engagement and motivation.Edtech can promote positive engagement and motivation of undergraduate nursing students. Educators should emphasize an authentic focus in students' learning experience with Edtech.

Aim To develop a strategic model of participation in policy development for nurses in Thailand. Background Public health policies inevitably affect nursing practice, service delivery and the nursing workforce. Available evidence indicates that nurses have minimal participation in policy development. Introduction Nurses' participation in public health policy development is essential to developing and maintaining an efficient, high-quality healthcare system. Methods The Delphi method was used to develop the strategic model based on the input of fifteen nurse experts who were interviewed over three Delphi rounds. Data were analysed descriptively to identify items to be retained or dropped, and the final list of statements was verified by all participants to establish the strategic model of participation. Findings The strategic model contains twenty-five participation strategies for nurses wishing to engage with public health policy development. Within the model, the priorities as identified by clinical nurses, nurse leaders, nurse researchers and scholars, nursing educational institutions and nursing professional organizations are acknowledged. Conclusion The model represents a consensus of values related to policy participation by nurses and the results align with similar studies. The inclusion of different nursing groups in promoting and developing strategies to participate in policy development ensures that all nurses have a role to play in developing nursing capacity for effective health policy engagement. Implication for nursing policy Nursing involvement in policies that affect them and their practice is fundamental to establishing good public policy. This research provides a clear mechanism for the development of nurses' awareness and abilities to become involved in policy development and review processes.

This study aimed to determine the efficacy of mindfulness practice on emotional state and cognitive function of community-living elderly with mild cognitive impairment. A randomized controlled trial was conducted with the experimental group undergoing a Mindfulness Awareness Program (MAP) and an active control group undergoing a Health Education Program (HEP) over a nine month period. Sessions were conducted weekly for the first three months and monthly for the remaining six months. Self-reported questionnaires in English and Chinese were administered through face-to-face interviews to collect data at baseline, three months and nine months. Descriptive statistics and analysis of covariance (ANCOVA) were used to analyse data. Fifty-five elderly participants aged sixty and above, were randomized to MAP (N = 28) and HEP (N = 27) programs. Participants in both intervention arms experienced decreases in depressive and anxiety symptoms over the nine-month period. A significant improvement occurred in the HEP group in depression scores at three months and anxiety scores at both three and nine months. There were no statistically significant changes on cognitive function in both groups over the nine-month period. Both the MAP and HEP can benefit the emotional states of community-living elderly with mild cognitive impairment. Our study supports the usefulness of group-based HEP as a low cost intervention for promoting active aging and psychological health in a community setting.

Aim To develop an education and training programme to enhance bedside nurses' knowledge, competency and compliance in accurately performing delirium screening in intensive care units. Background Delirium in intensive care units is associated with several poor patient outcomes. Delirium detection can be improved by enhancing nurses' knowledge, competency and compliance in accurately performing delirium screening. Methods A descriptive quantitative study with pretest-post-test design was adopted. There were 245 nurses from five intensive care units who participated in the study. Multiple-choice questions were used to assess nurses' knowledge change before and after the education programme. Competency was assessed before and 2 months after the programme by simulation with a standardized patient, followed by real patients at the bedside. Compliance data on screening were collected from the documentation of the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU before and 3 and 10 months after the programme. Data collection took 1 year, from June 2014 to May 2015. Results Despite nurses' improved knowledge and good competency, delirium screening documentations after 3 months were poor. However, screening documentations subsequently improved when measured at 10 months, following further emphasis by the senior nursing staff. Implications for nursing practice and policy Nursing administrators and bedside nurses need to be involved in the policy-making process and plan a training programme for the new nursing staff in the high-risk areas. A short refreshment course should be offered to the nursing staff 3 months after the initial training programme. Conclusions Improved knowledge and competency in assessment did not improve compliance and documentation of delirium screening. Therefore, it is important to reinforce nurses' compliance of delirium screening over time.

Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied.We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014. Demographics, BMI, MV, comorbidities, ICU scores (Acute Physiology And Chronic Health Evaluation (APACHE) II and sequential organ failure assessment (SOFA)), use of vasopressor, renal replacement therapy and calorie supplementation were collected from the ICU database. BMI was categorized into four groups according to the World Health Organization's Asian BMI recommendation. Post-ICU LOS (days) was calculated from ICU discharge to hospital discharge in hospital survivors. We used multivariable logistic regression to identify factors associated with 28-day mortality and post-ICU LOS of more than 7 days.In a cohort of 273 patients (male 62%, mean age 58.4 ± 17 years), the prevalence of overweight/obesity was 53%. In the bivariate analysis, 28-day mortality was lower (p = 0.014) and post-ICU LOS longer (p = 0.01) in the overweight/obese groups. In the multivariable logistic regression analysis, APACHE II (Odds ratio, OR 1.10, CI 1.05-1.16), SOFA (OR 1.17, CI 1.05-1.31), duration of MV (days, OR 1.14, CI 1.05-1.25) were associated with increased and higher BMI groups (p 0.001) with decreased 28-day mortality. Further analysis of 196 hospital survivors showed age (OR 1.04, CI 1.02-1.06), duration of MV (days, OR 1.14, CI 1.02-1.27) and higher Asian BMI (p = 0.042) were associated with longer post-ICU LOS. The odds of longer post-ICU LOS amongst overweight and obese patients were 1.27 (CI 0.59-2.73) and 1.62 (CI 0.69-3.81) times that of those with normal BMI respectively.In multiethnic critically ill Asian patients, the prevalence of overweight/obesity was high. Although higher BMI was associated with reduced risk of 28-day mortality, obese patients stayed significantly longer in the hospital following ICU discharge.

Aim The study aimed to evaluate the effectiveness of the collaborative teaching of a multi- disciplinary team on the introductory online radiology session for the Master of Nursing students. Background The teaching method for basic radiology reading for the Master of Nursing program was delivered via a 4-hour didactic face-to-face lesson and was ineffective as evidenced by the students' feedback and evaluation. Therefore, a multi-disciplinary team consisting of nursing, medical and radiology staff developed a 4-week online radiology session to enhance knowledge, attitudes and confidence of the Master of Nursing students in interpreting basic chest radiographs, abdominal radiographs and computed tomographic brain scans. Methods A quasi-experimental study design using pre-test and post-test was adopted. The effectiveness of the online radiology session was evaluated on the students' knowledge, attitudes, and confidence. Forty Master of Nursing program students completed the pre-test and post-test questionnaires (response rate 74%) and responded to the open-ended questions in the post-test. IBM-SPSS was used to analyse the quantitative data and quantifying qualitative data technique was used to analyse the qualitative data. Results The participants demonstrated an improvement in knowledge and confidence mean scores of the post-test compared to pre-test. There was improved self-rated proficiency in reading and interpreting a film radiograph but no difference in the way they perceived the importance of radiological investigations vis-a-vis the physical examination and routine laboratory testing. Quantifying quantitative data technique showed that majority of participants appreciated the learning process as it could be done at their own pace and the lectures could be replayed again. However, participants hoped for improved interaction with the tutor during learning and the use of real-life cases in the scenarios. Conclusion Collaborative teaching using an online radiology session shows promise over a traditional didactic method of teaching but requires further refinement in terms of participant interaction and the use of case examples.

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Background Care activities provided by community health practitioners for older adults primarily focused on disease prevention and management. However, healthy longevity can go beyond disease prevention and management and promote greater well-being by tapping into the accrual of resources that older adults possess using the salutogenic approach. This study explored how health resources are used among older adults who are residing in senior-only households to promote and maintain health, with the intent of providing insights into how community health practitioners can support these older adults via asset-based strategies. Methods We adopted a descriptive qualitative study design using focus group discussions. Twenty-seven older adults who either lived alone or with their spouses were purposively sampled from an elderly populated residential estate in Singapore. Six focus group discussions, conducted from December 2016 to May 2017, were audio-recorded, transcribed, and analyzed using thematic analysis. Results The themes that emerged were ‘tapping on internal self-care repository’, ‘maintaining and preserving informal social support’, and ‘enabling self by using environmental aids’, and an eco-map of aging assets was used to capture an overview of internal and external resources. With the repository of personal strengths, knowledge, and experiences, these older adults were generally resourceful in navigating around their resource-rich environments to cope with everyday life stressors and promote health. However, they were occasionally limited by individual factors that affected their comprehension, access, maintenance, and utilization of resources. Conclusion The eco-map of aging assets can be used as an assessment framework by community health practitioners to recognize, consider, and build a repertoire of resources among these older adults. It serves as a gentle reminder to adopt an ecological approach in considering and tapping into older adults’ wide-ranging personal, social, and environmental resources. Community health practitioners can support resource integration as resource facilitators via cognitive, behavioral, and motivational salutogenic pathways to overcome resource mobilization barriers faced by older adults. Such an approach helps older adults to find their internal capabilities and abilities to know who, where, what, and how to seek external resources to identify solutions, creating the intrinsic value to sustain their actions on resource utility.

The aim of this study was to explore patients' perceptions toward the nursing uniforms used in a hospital in Singapore and how different uniforms impact nurse-patient interactions.Nursing uniforms act as a form of nonverbal communication. However, implications of the increasing variety of nursing uniforms on patients' perceptions of nurses and nurse-patient interactions are unexplored.An exploratory qualitative study design using semistructured interviews was adopted for the study. Twenty-one patients agreed to be interviewed. An audio recorder was used during data collection. The thematic analysis method was used for data analysis.Four major themes were identified: identity, subjectivity, suitability, and inconsequential. Nurses' uniform was regarded as a representation of identity. Suitability of the uniform for nurses was a main concern for patients. However, nurses' uniforms were inconsequential to nurse-patient interactions.Patients' perceptions of nurses' uniforms were highly subjective and have no substantial impact on nurse-patient interactions.

Aim The aims of this study were to explore year two nursing students' perceptions toward critical thinking and clinical reasoning and to identify the barriers faced by the students in developing critical thinking and clinical reasoning. Background Critical thinking and clinical reasoning are core competencies emphasized in nursing practices. Nursing students are required to develop and practice these skills throughout their nursing programs to graduate as competent nurses. However, recent studies still report a lack of critical thinking and clinical reasoning in nursing students and fresh graduates. Hence, it is important to recognize the perceptions of nursing students and the barriers that they face in developing critical thinking and clinical reasoning skills. Methods An exploratory descriptive qualitative study design was adopted. Twenty nursing students were recruited from a university in Singapore. Individual face-to-face interviews, using semi-structured questions and an interview guide, were conducted in the academic year 2018/2019. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Results Seven themes were emerged, namely: 1) essentials for nursing practices, 2) linking theory to practice, 3) individual thought process, 4) stimulating strategies, 5) classroom environment, 6) clinical environment, and 7) students' attributes. Nursing students perceived critical thinking and clinical reasoning as essential for nursing practices and described these skills as linking theory to practice. Strategies such as simulation, case studies, real clinical experiences, and guidance from clinical instructors/preceptors were found to stimulate critical thinking and clinical reasoning for the students. Barriers to developing critical thinking included classroom environments, such teaching methods and student-to-tutor ratios, ward environments/cultures, and students' attributes/attitudes toward learning. Conclusion The findings provided areas for improvement in the current nursing education and practices to better support nursing students in developing critical thinking and clinical reasoning skills.

Aim To explore the different levels of nurses' perspectives in the delivery of patient education in postoperative care. Background Patient education is a frequently reported missed nursing care and can lead to postoperative complications and hospital readmissions. Methods Descriptive exploratory qualitative study involving eight focus groups with 35 nurses was conducted in an acute hospital. Interviews were audio-recorded and transcribed verbatim. Data were thematically analysed. Results The analysis yielded three themes: 'Role ambiguity' between the levels of nurses concerning their roles in patient education; 'Not a priority nursing care' for patient education due to competing work demands and the missing workplace culture to teach; and 'Informal teaching' carried out conversationally during nursing care activities. Conclusion This study augments the need to develop strategies, including informal teaching, to strengthen the delivery of patient education to avert missed nursing care. Implications for nursing management Nurse managers and educators are instrumental in establishing role clarity between ward nurses and specialty care nurses for patient education, recognizing patient education as the next nurse-sensitive indicator in reflecting quality of care, fostering positive workplace cultures to teach and providing ward nurses with trainings on communication strategies to provide effective informal teaching at bedside.

Background Psychosocial care is the culturally sensitive provision of psychological, social, and spiritual care through therapeutic communication. Current evidence suggests that effective psychosocial care improves patients' health outcomes and quality of life. Purpose The aim of this study was to explore nurses' perceptions and experiences in providing psychosocial care to patients and to identify the related barriers and challenges. Methods An exploratory qualitative design using semistructured, individual, face-to-face interviews was adopted. A purposive sample of 18 registered nurses was recruited from the geriatric, medical, and surgical wards in an acute general hospital in Singapore. Interviews were audio-recorded, transcribed, and analyzed thematically. Results Four major themes emerged: patient-centered care, communication, interprofessional care, and barriers to psychosocial care. Nurses perceived that psychosocial care consists of providing holistic care, spiritual care, support to the patient and family members, and showing empathy. Furthermore, psychosocial care is composed of communication between nurses and the patient and family members as well as communication among nurses. In addition, psychosocial care involves collaboration between healthcare professionals as well as multidisciplinary care. Barriers that are perceived by nurses include lack of time, language barriers, being task-oriented, excessive documentation, lack of family involvement, and fear of complaints. Conclusions This study highlighted the perceptions of nurses regarding psychosocial care and the challenges in providing this care. Future studies are needed to explore ways to overcome these barriers and to enhance nurses' competencies in providing psychosocial care. The findings indicate a need to plan future interventions to provide nurses with both skill development and support to improve their ability to integrate psychosocial care, which will improve patient outcomes.

Summary Background & aims For patients in the intensive care unit (ICU), nutritional risk assessment is often difficult. Traditional scoring systems cannot be used for patients who are sedated or unconscious since they are unable to provide information on their history of food intake and weight loss. We aim to validate the NUTRIC (NUTrition RIsk in Critically ill) score, an ICU-specific nutrition risk assessment tool in Asian patients. Methods This was an observational study in the medical ICU of a university-affiliated tertiary hospital. We included all adult patients (≥18years) admitted between October 2013 and September 2014 who stayed for more than 24 hours in the ICU. Components of the modified NUTRIC (mNUTRIC) score, demographic details, body mass index (BMI), use of mechanical ventilation (MV), vasopressor drugs, and renal replacement therapy (RRT) were obtained from the ICU database. For patients on MV (maximum 12 days), we calculated the energy intake and nutritional adequacy (energy received ÷ energy recommended) from enteral or parenteral feeding data. Multivariable logistic regression analysis was used with 28-day mortality as the outcome of interest. Results 401 patients (62% male, mean age 60.0 ± 16.3 years, mean BMI 23.9 ± 6.2 kg/m 2 ) were included. In the univariate analysis, BMI, mNUTRIC score, MV, vasopressor drug, and RRT were associated with 28-day mortality. In the multivariable logistic regression analysis, mNUTRIC score (Odds ratio, OR 1.48, Confidence Interval, CI 1.25–1.74, p Nutritional adequacy was assessed in a subgroup of 273 (68%) patients who received MV for at least 48 hours. Median (IQR) nutritional adequacy was 0.44 (0.15–0.70). In patients with high mNUTRIC score (5–9), higher nutritional adequacy was associated with a lower predicted 28-day mortality; this was not observed in patients with low mNUTRIC (0–4) score (effect modification, p interaction Conclusion In a mixed Asian ICU population, mNUTRIC score is independently associated with 28-day mortality. Increased nutritional adequacy may reduce the 28-day mortality in patients with a high mNUTRIC score.

Students nowadays feel more comfortable with new technologies, which increase their motivation and, as a result, improve their academic performance. In the last two decades, the use of information communication technology has been increasing in many disciplines in higher education. Online learning or e-learning has been used and integrated into the curriculum around the world. A team of nursing faculty and educational technology specialists have developed an e-learning research module and integrate it into the nursing curriculum. The aim was to assist master of nursing and postgraduate nursing students in developing their research knowledge before and throughout their enrollment in the research course. This e-learning module includes interactive multimedia such as audiovisual presentation, graphical theme, animation, case-based learning, and pretest and posttest for each topic area. The module focuses on three main topic areas: (1) basic research principles (for review), (2) quantitative method, and (3) qualitative method. The e-learning module is an innovative use of the information and communication technology to enhance student engagement and learning outcomes in a local context. This article discusses the development journey, piloting process, including the variety of evaluation perspectives, and the ways in which the results influenced the e-learning resource before its wider distribution.

Nursing students have experienced stress because they need to focus on academic performance while being exposed to a clinical environment. The study aimed to identify the contributing factors of stress and the clinical environment expectations of undergraduate nursing students during their clinical practice at a university in Singapore. A cross-sectional descriptive study design using validated surveys was adopted. The Stressors in Nursing Students and the Clinical Learning Environment Inventory questionnaires were used to collect the data in January 2014. A total of 285 nursing students participated in this study. The results showed that third year nursing students had higher stress levels than first year and second year students. Satisfaction in terms of fulfilment among nursing students during clinical practice was found to be the most influential factor in predicting stress. The study suggests that the nursing faculty needs to be more concerned about nursing students' stress level and provide more support to third year students. In addition, students' satisfaction should be considered when developing a clinical curriculum.

The aim of this study was to investigate factors influencing nursing students' intention to use a simulated web-application 'Integrated Nursing Education System' for practicing electronic health documentation. The cross-sectional study was conducted at a Malaysian University that provides undergraduate nursing degree program. A total of 133 undergraduate nursing students in their year 2 to year 4 of the program were recruited. They had accessed the simulated web-application as part of the teaching-learning activities during the academic year 2016/2017. Technology Acceptance Model was used to guide the study. Validated questionnaires were used to measure the students' perceived ease of use, perceived usefulness, attitudes and intention to use the application. Data collection was done at the end of the semester. Data analysis was done using SPSS (19.0) and AMOS (23.0). Perceived usefulness was the most influential factor of the students' intention to use the simulated web-application. Perceived ease of use influenced their perceived usefulness significantly. Nurse educators should explain the usefulness of the simulated web-application before assigning students to access it to practice electronic health documentation. The availability of a stable internet access and IT support is important to influence students' perceived ease of use and intention to use the application.

The prevalence of patients with diabetes mellitus has increased in recent years. This has resulted in increased demand for face-to-face diabetes education by diabetes nurse clinicians. The use of mobile-health technologies in diabetes education is an innovative way of learning and has the potential to engage patients and influence positive health behaviors, including meeting desired goals and diabetes-related outcomes. The aim of the study was to develop and test the usability and feasibility of an empirical diabetes application for patients with type 2 diabetes mellitus. The mobile-based, gamified Diabetes Application was developed based on a full systems development life-cycle framework. Eight patients with poorly controlled type 2 diabetes mellitus completed a pilot study that consisted of a postapplication survey to assess the usability and feasibility of the diabetes application. The findings affirmed the usefulness and feasibility of the diabetes application for patients with diabetes mellitus. It increased awareness, enriched knowledge, promoted user engagement, motivated positive behaviors, and affirmed patient belief in diabetes self-management. This article discusses the development and evaluation of the diabetes application, including modifications made based on the results of the pilot study.

The aim of this study was to develop and examine the effectiveness of a 4-week Mobile Health (mHealth) programme using the smartphone app Care4Heart on awareness, knowledge, perceived stress, and a heart-related lifestyle among working population in Singapore.A quasi-experimental single group pretest and repeated post-test design.A total of 160 nonhealth-related working adults were recruited from February 2016-April 2016. The Care4Heart app was installed on the participants' phones. Outcome measures, including the Heart Disease Fact Questionnaire-2, the Behavioral Risk Factor Surveillance System, and the Perceived Stress Scale were collected online at baseline, 4th week, and 6th month from baseline.Compared with the baseline, the participants had significantly higher total mean scores for awareness and knowledge of coronary heart disease (CHD) after study intervention at 4 weeks and 6 months from baseline. However, there were no significant differences in perceived stress levels and heart-related lifestyle behaviours before and after the intervention.The study contributed some evidence that the mHealth app helped to improve awareness and knowledge of CHD.Coronary heart disease remains one of the major causes of death and disability. It imposes a heavy financial burden on working adults. However, working adults were less able to identify the risk factors and adopt healthy lifestyles due to gaps in knowledge and awareness. This study demonstrated some effects of a mHealth programme in improving awareness and knowledge of CHD among the working population. mHealth provides a potential avenue for primary prevention of CHD.目的: 本研究的目的是利用智能手机应用程序Care4Heart开发和检验为期4周的移动健康(mhealth)计划对新加坡工作人口的认知、知识、感知压力和与心脏相关的生活方式的有效性。 设计: 准实验单组试验前和重复试验后设计。 方法: 从2016年2月至2016年4月共招募了160名非健康相关工作人员。Care4Heart应用程序安装在参与者的手机上。在基线、第4周和自基线起第6个月在线收集结果测量,包括心脏病事实问卷-2、行为风险因素监测系统和感知压力量表。 结果: 与基线相比,在研究干预4周和自基线起6个月后,受试者对冠心病(CHD)的认知和知识的总平均分显著高于基线。然而,干预前后感知到的压力水平和与心脏相关的生活方式行为没有显著差异。 结论: 该研究提供了一些证据,证明mHealth应用程序有助于提高对冠心病的认识和知识。 影响: 冠心病仍然是导致死亡和残疾的主要原因之一。这给成年人工作者带来了沉重的经济负担。然而,由于知识和意识上的差距,成年人工作者无法识别危险因素并采取健康的生活方式。.

The study aimed to compare nurses' quality of life and investigate key determinants among Asian countries with different economic status. A cross-sectional survey was conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data were assessed. Stepwise multivariate linear regression analysis was performed to identify the key determinants of quality of life. Participants were 3,829 nurses (response rate: 82%) with a mean age of 33 ± 10 yr and majority were women (92%). Regarding quality of life, Bhutan yielded the highest scores, followed by Malaysia, Thailand, Singapore, and Japan, and these results were statistically significant. The key determinants that were significantly related to quality of life were "stress coping ability," "life satisfaction," "Japan," "social support," "job stress," and "Singapore" (adjusted R2=0.46). In conclusion, nurses' quality of life differs across Asian countries and is not linked to the country's economic development. To maintain a good quality of life for nurses, an international exchange program like international nursing conferences for work environment and staff coping strategies is recommended to broaden institution' minds and share experiences and exchange views to be able to realize their own problems and discover global solutions to them.

Objectives To compare the reliability, validity and resource utilization of the Emergency Severity Index (ESI) and Patient Acuity Category Scale (PACS) triage scales. Methods A descriptive, correlational, and cross-sectional design was used. Twenty-seven triage nurses were recruited to test interrater reliability for 20 patient case scenarios. Subsequently, interrater reliability was tested on 300 actual patients. Construct validity was analyzed using patients’ hospital dispositions and resources utilized. Results For patient case scenarios, interrater reliability for both were very good, at 0.87 (95% CI: 0.86–0.88) for ESI and 0.88 (95% CI: 0.87–0.89) for PACS. For actual patients, interrater reliability for both were moderate, at 0.59 (95% CI: 0.50–0.68) for ESI and 0.49 (95% CI: 0.40–0.60) for PACS. Both ESI and PACS demonstrated construct validity with moderate correlations for hospital admissions and the number of resources used. PACS was unable to discriminate between patients that required more or less resources, whereas the ESI can. Patients that required two or more resources had higher rates of admission. Conclusions Both triage systems demonstrated moderate interrater reliability and construct validity in triaging actual patients. The ESI has better resource discrimination ability than the PACS and can improve resource management in the ED.

Advances in video technology enables medical educators to self-produce videos, but many videos fail to achieve preset instructional goals. We speculate that they were not designed by following best practices in educational video design. Three authors shared their experience in producing educational videos by applying best practices in video design. Their paths varied, but certain strategies were commonly used. For example, key stakeholders should be consulted and needs assessment should be conducted to identify gaps; video design depends on learning objectives; and educators should be equipped with best practices in video design and take lead if a professional videographer is used.

The Institute of Medicine (IOM) and the Health Information Technology Act (2009) in America had recommended that electronic health records (EHRs) should be fully adopted by 2014. This has urged educational institutions to prepare healthcare professionals to be competent in using electronic health records (EHRs) while they are in schools. To equip nursing students with competency in using EHRs, an electronic health record for nursing education (EHRNE) has been developed and integrated it into nursing curricula. The purposes of the study were to investigate the factors influencing nursing students' acceptance of the EHRs in nursing education using the extended Technology Acceptance Model with self-efficacy as a conceptual framework. The study is a descriptive study design using self-reported questionnaires with 212 student participants. The IBM SPSS and AMOS 22.0 were used to analyze the data. The results showed that attitude toward using the EHRNE was the most influential factor on students' acceptance. The preliminary findings suggested that to enhance the students' acceptance of the EHRNE, cultivation of a positive attitude toward using this EHR as well as increasing the perceived usefulness is very important. Also, the study's framework could be used in guiding learning health informatics and be applied to nursing students.

Muscle loss in critically ill patients may be related to nutrition. We study the association between modified NUTrition RIsk in the Critically ill (mNUTRIC) score obtained at admission to intensive care unit (ICU) and subsequent muscle loss. We measured rectus femoris cross-sectional area (RFCSA) by ultrasound on days 1, 3, 7, and 10 of ICU admission. We used linear mixed effects model following natural logarithmic transformation of the data. Forty-eight patients (median (IQR) age 66 (55-72.5) years, 71% male, APACHE II score 31 (25-34), BMI 24.2 (21.5-27.1) kg/m2) were analyzed. The high mNUTRIC score (>5) cohort (n = 35) lost significantly more muscle as compared to the low (≤5) group (n = 13); the adjusted ratio (high versus low group) of the geometric mean RFCSA were (0.58, 95% CI 0.46-0.75) for right and (0.61, 95% CI 0.49-0.77) for left, both p

Aims To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore. Background In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people. Design A stratified randomized control trial with process evaluation is proposed. Methodology The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme. Discussion The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senior-only households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life.

Background The effectiveness of educational interventions for osteoarthritic patients undergoing total joint arthroplasty remains inconclusive. It is essential to understand the educational needs of these patients from their perspectives. Aim The aim of this study was to systematically summarize and synthesize osteoarthritic patients' expectations and experiences in undergoing total joint arthroplasty to identify their educational needs. Design An integrative review was conducted. Methods Twenty studies (13 qualitative and 7 quantitative), published between 2006 and 2016, were independently appraised by 2 reviewers using the Critical Appraisal Skills Programme checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Tools for quantitative studies. Data were analysed using thematic analysis, and the findings were synthesized in a narrative summary. Results Six themes describing patients' preoperative and post-operative educational needs were identified: (1) preoperative anxiety, (2) unrealistic expectations of recovery, (3) post-operative pain, (4) regaining functional abilities, (5) physical and psychological sense of loss, and (6) lack of continuity of care. Conclusion This review is the first to capture the osteoarthritic patients' educational needs from their perspectives. The biopsychosocial model can address the multidimensionality (biological, psychological, and social) of patients' educational needs. A robust infrastructure supporting interprofessional collaborative practice and continuity of care should be adopted to enhance current educational efforts.

Sedative and analgesic practices in intensive care units (ICUs) are frequently based on anesthesia regimes but do not take account of the important patient related factors. Pharmacologic properties of sedatives and analgesics change when used as continuous infusions in ICU compared to bolus or short-term infusions during anesthesia. In a prospective observational cohort study, we investigated the association between patient related factors and sedatives/analgesics doses in patients on mechanical ventilation (MV) and their association with cessation of sedation/analgesia. We included patients expected to receive MV for at least 24 hours and excluded those with difficulty in assessing the depth of sedation. We collected data for the first 72 hours or until extubation, whichever occurred first. Multivariate analysis of variance, multivariate regression as well as logistic regression were used. The final cohort (N = 576) was predominantly male (64%) with mean (SD) age 61.7 (15.6) years, weight 63.4 (18.2) Kg, Acute Physiology and Chronic Health Evaluation II score 28.2 (8) and 30% hospital mortality. Increasing age was associated with reduced propofol and fentanyl doses requirements, adjusted to the weight (p

Background: Hospital-based nurses’ quality of life is affected by stress coping ability, job satisfaction, job stress, and social support. These relationships appear to be identical, even among different countries. Nevertheless, dynamic comparisons of quality of life in Asia are very limited. The Asian Nurse Quality of Life Study was designed to compare nurses’ quality of life across Asian countries and identify variables that are related to quality of life. Research design: A cross-sectional questionnaire survey design. Subject: Hospital based nurses are recruited from Japan, Singapore, Malaysia, Thailand, and Bhutan (Five Asian countries). The inclusion criteria for the research are: 1) being from an Asian country, 2) working at a teaching hospital, and 3) obtaining the nursing director’s agreement. Co-researchers from each country independently select particular research fields. Method: A cross-sectional survey is conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data are assessed. Quality of life is directly compared among the countries. Stepwise multivariate linear regression analysis is performed to identify variables related to quality of life. Survey duration: Survey duration is between October 2013 and August 2014.

BackgroundThe use of electronic health records in nursing education is rapidly increasing worldwide. The successful implementation of electronic health records for nursing education software program relies on students as well as nursing faculty members.AimsThis study aimed to explore the experiences and perceptions of nursing faculty members using electronic health records for nursing education software program, and to identify the influential factors for successful implementation of this technology.MethodsThis exploratory qualitative study was conducted using in-depth individual interviews at a university in Singapore. Seven faculty members participated in the study. The data were gathered and analysed at the end of the semester in the 2012/2013 academic year.ResultsThe participants' perceptions of the software program were organized into three main categories: innovation, transition and integration. The participants perceived this technology as innovative, with both values and challenges for the users. In addition, using the new software program was perceived as transitional process. The integration of this technology required time from faculty members and students, as well as support from administrators.LimitationsThe software program had only been implemented for 2-3 months at the time of the interviews. Consequently, the participants might have lacked the necessary skill and competence and confidence to implement it successfully. In addition, the unequal exposure to the software program might have had an impact on participants' perceptions.ConclusionThe findings show that the integration of electronic health records into nursing education curricula is dependent on the faculty members' experiences with the new technology, as well as their perceptions of it. Hence, cultivating a positive attitude towards the use of new technologies is important.Implications for nursing and health policyElectronic health records are significant applications of health information technology. Health informatics competency should be included as a required competency component in faculty professional development policy and programmes.

This cross-sectional correlational study aimed to examine health-related quality of life (HRQoL) and its predictors among patients with myocardial infarction (MI). One hundred and twenty-eight outpatients with MI were recruited from a university hospital. The 12-item Short-Form Health Survey version 2, Myocardial Infarction Dimensional Assessment Scale (MIDAS), and Hospital Anxiety and Depression Scale (HADS) were used to measure the study variables. Compared with the findings of similar studies of patients with MI, this sample, despite having significant coronary risk factors, reported generally better HRQoL. Predictors of physical HRQoL included low monthly household income, whereas predictors of mental HRQoL included ex-smoker, alcohol use, hypertension, anxiety, and depression. Special attention may need to be given to those people with a low income level, who are ex-smokers, use alcohol, or have hypertension, anxiety, or depression.

This paper summarizes the empirical evidence concerning health-related quality of life (HRQoL) of patients with coronary heart disease (CHD) and attempts to identify its significant predictors. A systematic search of the literature from 2002 to 2012 was conducted using seven electronic databases (CINAHL, ScienceDirect, Medline, Scopus, PsycINFO, PubMed and Web of Science) using the search terms 'HRQoL'. 'CHD', 'social support', 'depression', 'anxiety', 'psychosocial factors', 'sociodemographic factors', 'clinical factors' and 'predictors'. A total of 1052 studies were retrieved, of which 24 articles were included in this review. Previous studies have consistently demonstrated the negative impact of CHD on HRQoL, citing three major types of predictive factors: sociodemographic, clinical and psychosocial factors. Studies have also highlighted the advantageous use of HRQoL as a gauge for treatment satisfaction and efficacy. There are, however, few studies that collectively investigate the relationship among concepts such as HRQoL, anxiety and depression, social support, and sociodemographic and clinical factors in relation to CHD. This review highlights the need to conduct further study on HRQoL of patients with CHD in the Asian context. Such research will promote patient-centric care and improved patient satisfaction through incorporation of the concept of HRQoL into clinical practice.

BackgroundHospital and home-based cardiac rehabilitation programmes improve the health outcomes of cardiac patients. Both types of programmes include patient education as a core component. However, many patients do not attend cardiac rehabilitation programmes for a variety of reasons. In Singapore, where cardiac rehabilitation is comparatively uncommon, patient education is usually delivered face-to-face by healthcare professionals because educational materials designed specifically for cardiac patients recovering at home are not available.AimThis paper describes the development of a patient education booklet designed to aid recovery at home after a myocardial infarction in Singapore.MethodsThe conception and development of this evidence-based Heart Recovery Education Booklet was based on patient need and current clinical guidelines pertaining to cardiac rehabilitation and planned in consultation with specialists such as cardiologists, psychiatrists and physiotherapists.ResultsThe booklet is a patient resource to aid recovery at home after an myocardial infarction. It is interactive, based on identified need and aims to guide and assist the patient in performing their usual activities of daily living and adhering to treatment regimens, including exercise.ConclusionThis booklet is a resource for patients with myocardial infarction and healthcare professionals and its effectiveness in improving health-related quality of life, psychological status and coronary risk profile is to be tested in a randomized controlled trial.Implications for nursing and health policyPolicy makers in health and nursing must find ways of developing and implementing cardiac rehabilitation programmes that aid recovery from myocardial infarction. This education booklet offers one way to do this.

This paper outlines preliminary research of an innovative software program that enables the use of an electronic health record in a nursing education curriculum. The software application program is called EHRNE, which stands for Electronic Heath Record for Nursing Education. The aim of EHRNE is to enhance student's learning of health informatics when they are working in the simulation laboratory. Integrating EHRNE into the nursing curriculum exposes students to electronic health records before they go into the workplace. A qualitative study was conducted using focus group interviews of nine nursing students. Nursing students' perceptions of using the EHRNE application were explored. The interviews were audio-taped and transcribed verbatim. The data was analyzed following the Colaizzi (1978) guideline. Four main categories that related to the EHRNE application were identified from the interviews: functionality, data management, timing and complexity, and accessibility. The analysis of the data revealed advantages and limitations of using EHRNE in the classroom setting. Integrating the EHRNE program into the curriculum will promote students' awareness of electronic documentation and enhance students' learning in the simulation laboratory. Preliminary findings suggested that before integrating the EHRNE program into the nursing curriculum, educational sessions for both students and faculty outlining the software's purpose, advantages, and limitations were needed. Following the educational sessions, further investigation of students' perceptions and learning using the EHRNE program is recommended.

Second-degree Bachelor of Science in Nursing (BSN) programmes have grown rapidly in the past 5 years to respond to the nursing shortage in many countries. The purposes of this study are to describe the relationships among age, prerequisite grades, previous degree grade point averages (GPAs), admissions test scores and first semester test scores, and to investigate the most influential predictor for success in the first semester in the nursing program. Pre-existing data from academic records were used. There were 60 participants and SPSS version 15.0 was used to analyze the data. The results show that age has no relationship with the first semester performance. Fifty-four per cent of variance in the first semester GPAs (R(2) =0.54) was explained by previous degree GPAs, prerequisite GPAs and admissions test scores in the second-degree nursing student population. The most influential predictor for success for the first semester of the second-degree BSN program is admissions tests scores.

Background: Traditional nutrition scoring cannot be applied in Intensive care units (ICU).NUTRIC (NUTrition RIsk in Critically ill) score is an ICU-specific nutrition risk assessment which has not been validated in Asian patients. Setting: Observational study in a university-affiliated tertiary hospital during October913-September914 with adult patients staying more than 24hours in medical ICU. Methods: Demographics, body mass index (BMI), mechanical ventilation (MV), vasopressor use, renal replacement therapy (RRT) and components of NUTRIC score (except interleukin 6) were obtained from ICU database. We calculated nutritional adequacy (calorie received/calorie recommended) during MV (maximum 12days) from nasogastric tube or parenteral feeding data. Results: 401 patients (male 62%, mean age 60±16.3years, mean BMI 23.9±6.2kg/m 2 ) were included. In univariate analysis BMI, modified NUTRIC (mNUTRIC) score, MV, vasopressor use and RRT were associated with 28day mortality. Patients on MV (273,68%) had median nutritional adequacy of 0.44(IQR 0.15-0.70). Effect modification between low vs high mNUTRIC score is shown. Conclusion: In an Asian ICU population, mNUTRIC score is independently associated with 28day mortality. Increased nutritional adequacy may improve predicted 28day mortality in high mNUTRIC group.

Nursing students have experienced stress because they need to focus on academic performance while being exposed to a clinical environment. The study aimed to identify the contributing factors of stress and the clinical environment expectations of undergraduate nursing students during their clinical practice at a university in Singapore. A cross-sectional descriptive study design using validated surveys was adopted. The Stressors in Nursing Students and the Clinical Learning Environment Inventory questionnaires were used to collect the data in January 2014. A total of 285 nursing students participated in this study. The results showed that third year nursing students had higher stress levels than first year and second year students. Satisfaction in terms of fulfilment among nursing students during clinical practice was found to be the most influential factor in predicting stress. The study suggests that the nursing faculty needs to be more concerned about nursing students' stress level and provide more support to third year students. In addition, students' satisfaction should be considered when developing a clinical curriculum.

Background.Patients’ and family’s satisfaction data from the Asian intensive care units (ICUs) is lacking.Objective.Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied.Method.Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires.Results.Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family’s involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (βcoefficient = 0.44) and characteristics of doctors and nurses domain for family (βcoefficient = 0.45).Discussion.In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.

No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world.在新加坡，尚未有針對加護病房病人量身打造的營養評估工具被發展或驗 證。巴西族群研究，建議內收拇肌（TAPM）的厚度可用於評估重症疾病病人 的營養狀況，及預測死亡風險。本研究目的為評估TAPM 是否可作為新加坡 加護病房病人的死亡預測指標。使用皮脂測量儀，收集229 名在醫療加護病 房的病人其TAPM。雙手的TAPM 測量值與主要結果（28 天死亡率），或次 要結果（住院結果及住院天數）均未達顯著相關。本研究證實TAPM 無法預 測新加坡加護病房病人的28 天死亡率及住院結果，與住院天數也無關。需要 更多研究，才能驗證TAPM 是否可在世界的其他區域當作加護病房結果的體 位測量指標。.

This article presents findings from a simulation-based interprofessional education (IPE) program involving trainee advanced practice nurses (APNs) and internal medicine residents (IMRs) based in Singapore. Trainee APNs and IMRs participated in a semester-long series of high-fidelity simulations of medical emergencies. Learners' attitudes toward the IPE intervention were assessed using validated Likert scaled surveys and written comments. Overall satisfaction was high among learners, with strongly positive attitudes toward teamwork, collaboration and patient centredness. Of most interest, written comments highlight the utility of IPE in defining the professional scope and boundaries of APNs. Comments from both professions observed that participation in the IPE scenarios greatly aided their understanding of the scope and role of APN's practice within the health care team. This aspect of IPE may find further application in other similarly novel roles in healthcare.

In the mid 1980s, a professional nursing education program was initiated between the Kingdom of Saudi Arabia and the United States. Based on a perceived and documented need, a collaborative education and research program was established with George Mason University in Fairfax, Virginia, to begin building a community of new scholars to assist in the advancement of professional nursing in the Kingdom of Saudi Arabia. Four cohorts of Saudi citizens from three institutions (King Faisal Specialist Hospital and Research Center, Saudi Arabia National Guard Hospital, and Ministry of Aviation and Defense Hospital), who held a degree in science or a related field, were enrolled in an accelerated baccalaureate program leading to a bachelor of science in nursing degree. This project was funded by Saudi Arabian sources. A descriptive research study was conducted to identify predictors of success in the program. Results indicated a rate of program completion that was higher than expected. Some of the first graduates went on for a doctor of philosophy degree, but not all enrolled completed the program. Many countries around the world are seeking ways to upgrade and increase the supply of qualified nurses within their own borders. This study identified those factors that were predictors of success for Saudi Arabian students who completed a baccalaureate degree in nursing program in the United States.

The purpose of this review is to examine recent literature on the awareness, knowledge, and healthy lifestyle behaviors related to Coronary Heart Disease (CHD) among women. Literature published in the English language from 2004 to 2015 was reviewed. Of the 684 articles retrieved, 21 were deemed relevant. Being aware that CHD is the leading cause of death in women and knowledge of the risk factors of CHD were found to be generally suboptimal in the women studied. Awareness was seen to be positively associated with healthy lifestyle behaviors, though findings on the predictive relationship of knowledge of risk factors on healthy lifestyle behaviors in women seem to be divided. Diabetes was the prominent risk factor that most women did not associate with CHD. Translating these findings into clinical practice can help health care providers be more attuned when discussing CHD with their female patients so as to provide targeted education on CHD prevention.