Nurses’ Knowledge and Practice in Relation to Peripheral Intravenous Catheter Care

Peripheral Intravenous Catheters (PIC) are widely used. Nurses are required to possess appropriate knowledge and practice. The present study aimed to determine nurses' knowledge and practice towards care of PIC. A cross-sectional descriptive study was conducted and 84 respondents participated in the study. A 26-item questionnaire comprising 11 items on knowledge and 15 items related to nursing practice was adapted and modified. The findings reported higher mean score from specialty unit respondents, with knowledge (M = 49.19, SD = 3.44) and practice (M = 66.38, SD = 5.15), compared to medical surgical wards with knowledge (M = 46.25, SD = 4.68) and practice (M = 63.17, SD = 4.63) towards the care of PIC, which was significant (p value = 0.010 and p value = 0.009, respectively). The study indicated a higher mean score of charge nurse respondents as compared with registered nurse with knowledge (M = 49.68, SD = 3.23); (M = 46.20, SD = 4.62) and practice (M = 67.11, SD = 4.84); (M = 63.06, SD = 4.61), which was significant (p value = 0.003 and p value = 0.001, respectively). There were no significant differences between respondents’ education qualification towards care of PIC with p > 0.05. However, the findings reported that respondents who possessed Bachelor of Nursing were deemed to score slightly higher in their knowledge and practice towards the care of PIC. In conclusion, the specialty unit and charge nurse respondents were deemed to possess better knowledge and practice towards the care of PIC in the hospital.

Structured Education Programme on Patient Controlled Analgesia (PCA) for Orthopaedic Patients

Patient-controlled analgesia (PCA) via an infusion pump enables patient to administer their own analgesia. The aim of this study was to evaluate the effect of an educational programme in managing post-operative pain and satisfaction on PCA following orthopedic surgery. A pre-test and post-test interventional study design with implementation of patient education programme on PCA was provided to 54 respondents. The control group received conventional PCA briefing from the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and 24 hrs following surgery and pre-test and post-test of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There was difference in respondents’ level of pain score among the study respondents’ medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were 7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs, 6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and 1.00 (IQR=1.00) respectively. There were significant differences in median of pain score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50, p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically significant differences (p<0.05) in the median of patient’s pain severity at all pain levels i.e. least pain, worst pain, and severe pain between intervention and control group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain, U=49.0, p<0.05). In conclusion, patients who received pre-operative structured education programme showed improvement in managing post-operative pain and satisfaction on PCA after orthopedic surgery.

The Impact of Dry Needling on Patients with Neck Pain in a Tertiary Hospital

Neck pain presents as a symptom of dull pain or discomfort mainly along the trapezius muscle. Dry needling is an invasive procedure which uses acupuncture needle directed at myofascial trigger points. The aim of the study was to evaluate the effectiveness of dry needling in managing patients with neck pain. A pre-test-post-test interventional study design was used. Patient education package was provided to 32 respondents who fulfilled the inclusion criteria. A 13-item Pain Catastrophizing Scale (PCS) questionnaire was used to assess Rumination, Magnification and Helplessness. Subjective pain intensity was measured by Visual Analogue Scale (VAS). These questionnaires were given before and after the dry needling intervention. The findings reported that respondents scored high in pre-test total PCS score (27.41±13.652). Post-test result revealed a significant improvement in total PCS score (23.06±13.938) (p = 0.000). Post-test VAS score (4.78±1.237) was also significantly better than pre-test (6.47±1.414) (p = 0.000). There was no significant difference in pre-test PCS in terms of marital status (p > 0.05) whereas there was significant difference between marital status and rumination in post-test (Z = -2.303, p = 0.021). There was significant difference between pre-test magnification in terms of respondents’ occupation (p = 0.008) and race (p = 0.035) but no significant difference in post-test. Respondents’ age group showed no significant differences between pre-test and post-test PCS and VAS (p > 0.05). In conclusion, patients who received dry needling showed improvement in pain intensity and catastrophizing towards neck pain.

The Impact of a Patient Education Package on Outcomes of Pain Management Following Orthopaedic Surgery in a Tertiary Hospital in Malaysia

Patient’s belief towards pain management may affect pain management outcomes and quality of life. The main aim of the present study was to determine the impact of a pre-operative pain education package towards pain belief among patients undergoing orthopaedic surgery in a tertiary hospital. A one-group pre-test post-test design study was conducted on orthopaedic surgery patients. Thirty respondents were recruited and pre-operative pain education was administered individually before surgery. Pre-operative and post-operative pain belief, management scores and side effects were measured using the Barrier Questionnaire (BQ-13). The results reported significant differences between pre-test scores (Mean = 41.87, Standard Deviation = 11.467) and post-test scores (Mean=34.80, Standard Deviation=13.026) of pain belief (t = 2.84, p = 0.004). There were also significant differences between pre-test scores (Mean = 37.10, Standard Deviation = 10.610) and post-test scores (Mean=30.80, Standard Deviation = 11.424) of pain management (t = 3.856, p = 0.0005). Respondent’s gender (t = -2.403, p = 0.023) and ethnicity (F = 5.038, p=0.014) reported significant differences with p value 0.05). There was positive impact of the pain education package towards pain belief and painmanagement among respondents who underwent orthopaedics surgery in a tertiary hospital. Reinforcement of pain educational program is pivotal in order to achieve optimal post-operative pain management.

Postnatal Urinary Incontinence: Prevalence and Factors Associated with It in a Malaysian Population

The aim of this study was to investigate the prevalence of postnatal urinary incontinence (PNUI), the risk factors associated with it and postnatal women’s (PN) level of engagement in practicing traditional Malay confinement care (TMCC) in Kelantan, Malaysia. A cross-sectional survey was conducted among 362 postnatal women aged between 18 – 45 years and who were between three to five months post-delivery. Participants were selected through convenience sampling at six Maternal and Child Health Clinics located in comparatively similar districts. Descriptive and inferential analyses including, factor analysis, Pearson chi-square, Mann-Whitney U test and logistic regressions analysis were used for data analysis. Overall, PNUI was reported by 80 women (22.1%). Vaginal delivery was associated with PNUI. All PN women within the study context practiced TMCC. The findings revealed that women who had PNUI were more likely to engage in a higher level of the ‘Body care’ component of TMCC. UI is prevalent among PN women in Kelantan, Malaysia. Further research into the impact of the ‘body care’ component of TMCC on PNUI is required.

Clinical Decision Making Ability of Nursing Students in a Tertiary Hospital

Decision making in nursing is one of the most important skills nurses must apply and utilize in their nursing practice. The aim of this study was to determine the perception of clinical decision making ability among nursing students. A descriptive crosssectional study was conducted in a tertiary hospital. A total of 54 nursing students were recruited using a modified version of Clinical Decision Making in Nursing Scale (CDMNS) adapted from Jenkins (1985). The findings showed good CDMNS score with mean and standard deviation of (124.24±12.713). The four sub-scales of CDMNS were: searching for alternative (33.24±4.821), canvassing (28.74±3.514), evaluation and re-evaluation (31.43±3.922), searching for information(30.83±4.765). Nineteen (35%) of the participants chose nursing as their first choice, whereas 35 participants (65%) did not. Thirthy seven (69%) participants were satisfied with their nursing competency, 17 (31%) were unsatisfied. There were significant differences between searching for alternatives, evaluation and re-evaluation, and nursing as their first choice (p=<0.05). There were also significant differences between searching for alternatives and satisfaction with nursing competency (p=<0.05). There was significant difference between education level and searching for alternatives and information (p=<0.05). The nursing students possessed adequate clinical decision making ability. Although most of the nursing students did not choose nursing as their first choice, they sought for alternatives and evaluated-reevaluated during their decision making process. Nursing students’ satisfaction also contributed to appropriate clinical decision making in the critical care setting.

Case Study on the Effect of Epidural Analgesia on Pain Management During Labour

Child birth is associated with severely painful experience for the parturient, and often exceeds one’s expectations. Even though, severe pain is non life-threatening condition in healthy parturient women, it may lead to undesired neuropsychological consequences. When no analgesia was used, postnatal depression may be more common, and this labour pain leads to the development of post-traumatic stress disorder. Epidural analgesia is now considered gold standard for effective pain relief during labour. We here report a case of a 37-year-old G1 P0 patient at term gestation who successfully used epidural analgesia for labour pain management.

Complementary And Alternative Medicine Use Among Breast Cancer Patients In A Tertiary Hospital In Malaysia

The Use of Complementary and alternative medicine (CAM) is a common phenomenon among women with breast cancer in Malaysia. This study examines the prevalence, types, influencing factors and source of information regarding CAM among women with breast cancer, using a cross sectional research design. A purposive sampling was used to recruit 103 women with breast cancer who were attending follow up care at the Radiotherapy and Oncology unit of Universiti Kebangsaan Malaysia Medical Centre. Data was gathered through the use of self–administered questionnaires. Ninety one women identified themselves as CAM users while twelve were non users. Among the CAM users, 57(62.6%) were Malays, 27(29.7%) Chinese and 7(7.7%) Indians. The common types of CAM used were vitamins, nutritional supplements and traditional medicines (TM). CAM was used more frequently upon diagnosis (63.7%) and after completion of conventional treatment (97.8%). With regard to decision-making, most of the women (62.6%) did not make the decision to use CAM and were mostly influenced by their husband and mother (67%). Mother (71.4%), husband (67%), and relatives (56%) were the main sources of information and all values showed significant association with CAM use (p<0.05). Prevalence of CAM use, especially TM, was high among the Malay and Chinese ethnic groups. The lack of autonomy in decision-making by the women was the major reason for the use of CAM. The effectiveness and safety of using TM upon diagnosis and in combination with conventional cancer treatment are of concern to the breast surgeons, oncologist and the health care team.

Quality Of Life amongst Post Coronary Artery Bypass Patients at the National Heart Institute, Malaysia

Coronary Artery Bypass Grafting (CABG) surgery has increased the survival rate for individuals suffering from myocardial infarction or coronary ischemia. The present study aimed to examine the perception of quality of life amongst post CABG patients at the National Heart Institute Malaysia. A total of 69 post CABG patients, were studied using the Medical Outcomes Short Form 36 (SF-36). The findings showed that post CABG respondents possessed good level of quality of life (SF-36) physically and mentally. There were significant differences between the role physical in the physical functioning domains of quality of life with gender (t=0.286, p<0.05). Duration of physical exercises of more than 20 minutes have positive effects on both physical (t=2.738, p<0.05) and mental components (t=7.326, p<0.05). The level of income influenced both the physical component (F=3.100, p<0.05), and mental component (F=4.272, p<0.05). Post CABG patients were found to have high quality of life post operatively. They were able to make comprehensive lifestyle changes through frequent physical exercises to accommodate their needs.

Survey of Nurses’ Knowledge and Attitude Regarding Post Operative Pain Management at a Teaching Hospital in Malaysia

Post operative pain is an expected adverse outcome following surgery and it often delays mobilization and overall recovery. Acute post operative pain is subjective and cannot be measured directly. The objective of this study was to determine nurses’ knowledge and attitude towards post operative pain management. A cross sectional study was conducted in surgical wards and the Intensive Care Unit of Universiti Kebangsaan Malaysia Medical Centre from February to April 2008. A 28 item questionnaire which comprised of two domains: knowledge and attitude towards post operative pain management was used. Eighty four respondents successfully responded to the study. Twenty respondents (25%) possessed high level, 58 respondents (69%) possessed moderate level and 5 respondents (6%) had low knowledge level of post operative pain management. Positive attitude towards post operative pain management was reported by 66 respondents (78.5%). There was a significant relationship between nurses’ academic qualifications and attitude towards post operative pain management (χ² =29.96, p <0.05). In conclusion, nurses in UKMMC possessed moderate level of knowledge and positive attitude towards post operative management. Results of this study show the need to enforce continuing medical education in pain management amongst UKMMC nurses in enhancing the quality of post operative care.

Information Needs of Post Myocardial Infarction (MI) Patients: Nurse’s Perception in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Patient education has been considered as an integral component of care for patient after myocardial infarction. Post myocardial infarction patients require information and knowledge related to their conditions to reduce anxiety and aid recovery. The objective of this study was to identify nurses’ perception on information needs of post MI patients of UKMMC. A cross sectional study using Cardiac Patient Learning Needs Inventory (CPLNI) adopted from Timmins and Kalizer (2002) was used. It comprises seven cate-gories: related to anatomy and physiology, psychological factor, life style factor, medi-cation information, dietary information, physical activity, and symptom management. This study was conducted in coronary care unit (CCU), coronary rehabilitation ward (CRW), medical ward 1 and medical ward 2 from January 2007 to March 2007. 56 res-pondents (96%) who fulfilled the inclusion criteria were recruited in this study. Results showed that CCU and CRW respondents ranked symptom management as their first ranking followed by medication, life style factor, anatomy and physiology, dietary in-formation, physical activity and psychological factor. However, respondents in Medical Ward 1 and 2 reported and ranked medication information as their top priorities fol-lowed by symptom management, psychological factors, dietary information, physical activity, anatomy and physiology and life style factor. There were significant differ-ences between ward nurses’ responses with their perception related to anatomy and physiology, psychology factor, life style factor, physical activity, and symptom man-agement with p value<0.05. This study concluded that the information needs are not always perceived in unison by nursing personnel as the CCU and CRW nurses ranked symptoms management as the cardinal factor whilst Medical Ward 1 and 2 nurses give paramount importance to medication. In order to improve this situation for post MI pa-tient, information need has to be tailored, individualized and prioritized based upon their needs.

Sharps Injury in Hospital Universiti Kebangsaan Malaysia (HUKM): Experiences of Health Care Workers and Students

Sharps injury among health care workers in HUKM has received serious attention lately due to the possible transmission of diseases like HIV, Hepatits B and Hepatitis C, which can cause serious consequences for the victim. The aim of the study was to gain a deeper understanding of the emotional problems experienced by health care workers who had incurred a sharps injury and the coping strategies adopted by them to overcome the problem. A 28 item semi-structured questionnaire was designed by the supervisors and the researcher as there was no existing questionnaire to be adopted, as no research had been carried out in this area prior to this. The target group consisted of 64 health care workers of different categories working in HUKM. Data was collected over a period of five months from November 2000 to March 2001. The results of the study revealed that the most frequently injured were the staff nurses, nearly 90% of whom were emotionally upset and were worried that they might contract a disease. There was no significant difference in the emotional stress experienced by the different categories of the health care workers, all were equally upset about the injury but each category of staff adopted different methods to overcome the tragedy. Open comments and opinions about prevention and the management of the sharps injury in HUKM as given by the respondents here are taken into account. Several views given by the participants were explored and discussed. Finally, several implications for nursing and recommendations have been presented.

A study on anxiety and depression level among high risk inpatient pregnant women in an obstetric ward

Pregnancy is perceived by many pregnant mothers as a period of happiness in anticipation of motherhood. Not all pregnant mothers experience cheerfulness as some may experience a high anxiety and depression level for unknown reasons. The purpose of this study was to determine the level of anxiety and depression among high risk pregnant women and the factors that contribute to their level of anxiety and depression. A descriptive cross-sectional study was conducted on 38 high risk mothers whose stay in hospital exceeded more than three days in the obstetric ward of Hospital Universiti Kebangsaan Malaysia. A self assessment questionaire "Hospital Anxiety Depression Scale"was used to measure the level of anxiety and depression among high risk pregnant women. Of the 38 participants, 16 (42.1%) women experienced a mild level of anxiety and 22 (57.9%) experienced a severe level of anxiety. Seventeen (44.7%) women was classified as having mild depression and 21 (55.3%) severe depression. The factors contributing to the level of anxiety and depression, include those related with "lack of information on disease", "family matters" and "finance". High risk pregnant women in this study experienced a significant level of anxiety and depression during their stay in hospital. It is therefore important for nurses and doctors to be aware and sensitive to the influencing factors that cause anxiety and depression as to enable high risk pregnant mothers to enjoy their pregnancy and childbirth.

Clinical observation on resectable cases after preoperative radiation therapy in initially unresectable rectal cancer

No abstract available.