ABSTRACT
@#Introduction: The Ministry of Health (MOH) implemented the MalaysianDRG casemix system in 2010, and two national target indicators on the accuracy and completeness of clinical documentation were introduced to measure its performance. This study aims to show the trend of casemix performance in MOH hospitals and to explore the challenges in meeting these targets. Methods: The study design was sequential explanatory mixed-method design. First, a cross-sectional study described the trend of casemix performance in five MOH hospitals in Malaysia. Second, a single holistic case study of the hospital with the lowest casemix system performance was conducted to explore the perceptions of clinicians regarding the MalaysianDRG casemix and the challenges pertaining to clinical documentation. Purposive sampling was employed, and the case study data collection was carried out using in-depth-interviews, observation, and document reviews. Results: Two hospitals achieved the target in the accuracy of clinical documentation for the main condition (≥90%). For completeness in clinical documentation, four out of five MOH hospitals performed below the target (≤ 60%). Thematic analysis of the data found poor commitment of clinicians towards casemix and a multitude of obstacles in performing clinical documentations. Conclusion: After a decade of its implementation, the performance of the MalaysianDRG casemix system in MOH hospitals is still moderate due to inaccurate and incomplete clinical documentations. The study findings may be used to spread awareness and devise tailored solutions to assist clinicians in paving the way towards future excellence in MalaysianDRG casemix system.
ABSTRACT
@#Introduction: The USM Pre-clinical medical students’ guidance and counselling needs questionnaire (USM-MSGCN-Q) is an English-language guidance and counselling needs questionnaire which was developed specifically for pre-clinical medical students. The aim of this study is to highlight the construct validity of USM-MSGCN-Q among pre-clinical medical students. Methods: In June 2017, a cross-sectional study on 208 pre-clinical medical students was conducted in Universiti Sains Malaysia (USM). This self-administered USM-MSGNC-Q consisted of four constructs and 20 items with a 5-point Likert scale within each item. A confirmatory factor analysis was employed to test the hypothesized measurement model. Results: The final measurement model fitted the data well. The four-factor model initially consisted of 20 items however, it was reduced to 18 items with the goodness of fit indices suggesting good model fit (RMSEA 0.89, GFI .915 and ChiSq/df 2.642). Internal consistency reliability (Cronbach’s alpha) was 0.879 for self-leadership skills, 0.929 for communication skills, 0.871 for learning skills, and 0.870 for psychological coping skills. The overall Cronbach’s value was 0.922. Respective composite reliability values were 0.879,0.952,0.879 and 0.835 while the Average Variance Extracted values were 0.729, 0.911, 0.595 and 0.630. Conclusion: This study has confirmed that self-leadership, communication, learning and psychological coping skills were the components of guidance and counselling needs which influences the effectiveness of guidance and counselling sessions with pre-clinical medical students.
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@#Introduction: Consistent with the significant of the stress issue in education, this study aimed to survey type of stressors and identifies the coping strategies used by diploma nursing students during clinical practices. Methods: A descriptive cross-sectional study was carried out at the Kubang Kerian Nursing College, Kelantan which involved 346 respondents using simple random sampling method. The inclusion criteria were year one, two and three of nursing students who have clinical posting and voluntarily joining the study. Perceived Stress Scale (PSS) and Brief COPE inventory were utilised in the data collection. Higher mean score indicates higher degree of stress. Results: Clinical assignments and workload were the main stressor (mean = 3.19, SD = 1.09). Religion approach was the most coping strategy applied (mean = 3.30, SD = 0.71). Pearson’s correlation coefficient test found that six domains of stressors during clinical practices (taking care of patients; clinical educators/instructors and ward staff; clinical assignments and workload; peers and nursing students from other college; lack of professional knowledge and skills and clinical environment) were statistically significant correlation with coping strategies, where P-value < 0.05. Conclusion: Clinical assignment was the main stressor among nursing students; therefore, successful activities should be promoted to help them in managing clinical assignment and enhancing knowledge in religion.