Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training.

Cardiothoracic intensive care unit (CICU) nurses have shared the role and responsibility for ventilator-weaning to expedite decision-making in patient care. However, the actions taken are based on individual's unstructured training experience as there is no clinical practice guideline (CPG) for nurses in Malaysia. Hence, this study aims to design a CPG for the process of weaning from mechanical ventilation (MV) for a structured nursing training in a CICU at the National Heart Institute (Institut Jantung Negara, IJN) Malaysia. The Fuzzy Delphi Method (FDM) was employed to seek consensus among a panel of 30 experts in cardiac clinical practice on the guidelines. First, five experts were interviewed and their responses were transcribed and analyzed to develop the items for a FDM questionnaire. The questionnaire, comprising of 73 items, was distributed to the panel and their responses were analyzed for consensus on the design of the CPG. The findings suggested that the requirements expected for the nurses include: (a) the ability to interpret arterial blood gases, (b) knowledge and skills on the basics of mechanical ventilation, and (c) having a minimum 1-year working experience in the ICU. On the other hand, the CPG should mainly focus on developing an ability to identify criteria of patient eligible for weaning from MV. The learning content should focus on: (a) developing the understanding and reasoning for weaning and extubating and (b) technique/algorithm for extubating and weaning. Also, the experts agreed that the log book/competency book should be used for evaluation of the program. The CPG for structured nursing training at IJN in the context of the study is important for developing the professionalism of CICU nurses in IJN and could be used for training nurses in other CICUs, so that decision for ventilator-weaning from postcardiac surgery could be expedited.

The Effectiveness and Challenges of Online Learning for Secondary School Students -- A Case Study

The COVID-19 pandemic has forced an immediate implementation of online learning. However, little is known about its effectiveness and challenges faced by the students. Thus, this study is aimed at examining the effectiveness of online learning and the challenges that it presents to pupils' abilities to learn. This study employed a case study design using a survey questionnaire, administered to 99 students from a secondary school in Jasin, Melaka. Data were analysed descriptively (calculation of percentage and frequency). Generally, the findings indicated that the students have computers or smartphones and an internet connection at home. Besides, it was found that that the ability and comfortability to use computers was high (>93%). However, their motivation in online learning was low (41.5%) and ability to work in a group was at a moderate level (66.7%). They also agreed that conventional teaching (face-to-face) was important for their learning (98%). These findings are valuable for the government, school administrators, teachers and parents to acknowledge the importance of well-equipped facilities and a stable internet connection for effective learning. However, it is recommended for future researchers to utilize a larger sample size and students from various backgrounds to better understand this issue.

The Impact of Unplanned School Closures on Adolescent Behavioral Health During the Covid-19 Pandemic in Malaysia.

School closures were implemented as a public health intervention to reduce the risk of infection from COVID-19. However, prolonged school closure is likely to impact adolescents' behavioral health due to the extreme change in routine. The current study aimed to explore adolescents' behavioral health experiences during the beginning of the outbreak of the COVID-19 pandemic. This study was done using qualitative methods to interview 15 adolescent participants (n =15) from low-income households in Malaysia. The study lasted for 2 months amidst the outbreak and data were collected via online based on focus group discussions. The results revealed that adolescents faced four main themes of experience during the COVID-19 pandemic: Alteration of sleep patterns, stress-related fatigue, dysfunctional eating patterns and lack of physical activity. This first-hand experience shows that knowledge and skills of adolescents' behavioral practices during outbreak deserves attention. This research stresses the role of family, schools, and media in addressing the health communication gap among adolescents to help them adapt in these new norms.