Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study.

People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18−23) and 19 (IQR; 13−22) at baseline and 6 months, respectively. Having elevated stress (ß = 0.65, p ≤ 0.005) and illness perception (ß = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R2 = 0.664). Stress (ß = 0.28, p = 0.003), illness perception (ß = 0.2, p = 0.03), poor social support (ß = −0.22, p = 0.01) and low body weight (ß = −0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R2 = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.

Barriers deterring patient advocacy in a Saudi Arabian critical care setting.

AIM: To explore the perceptions of patient advocacy among Saudi Arabian intensive care unit (ICU) nurses. BACKGROUND: Despite advocacy being a crucial role for nurses, its scope is often limited in clinical practice. Although numerous studies have identified barriers to patient advocacy, their recommendations for resolution were unclear. METHOD: The study employed a constructivist grounded theory methodology, with 13 Saudi Arabian registered nurses, working in critical care, in a tertiary academic teaching hospital. Semi-structured interviews, with broad open-ended questions, and reflective participant journals were used to collect data. All interviews were concurrently analysed and transcribed verbatim. RESULTS: Gender, culture, education, subjugation, communal patronage, organisational support and repercussions, and role-associated risks were all revealed as factors affecting their ability to act as advocates for critically ill patients. CONCLUSION: Saudi Arabian ICU nurses in the study believed that advocacy is problematic. Despite attempting to advocate for their patients, they are unable to act to an optimal level, instead choosing avoidance of the potential risks associated with the role, or confrontation, which often had undesirable outcomes. Patient advocacy from a Saudi Arabian nursing perspective is contextually complex, controversial and remains uncertain. Further research is needed to ensure patient safety is supported by nurses as effective advocates.

Job satisfaction of Malaysian registered nurses: a qualitative study.

BACKGROUND: Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses. AIM: The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia. METHOD: A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach. FINDING: The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction. CONCLUSION: It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction. RELEVANCE TO CLINICAL PRACTICE: Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover.

Intervention to improve intensive care nurses' knowledge of sedation assessment and management.

BACKGROUND: Sedation management is an integral component of critical care practice. It requires the greatest attention of critical care practitioners because it carries significant risks to patients. Therefore, it is imperative that nurses are aware of potential adverse consequences of sedation therapy and current sedation practice recommendations. AIMS AND OBJECTIVES: To evaluate the impact of an educational intervention on nurses' knowledge of sedation assessment and management. DESIGNS AND METHODS: A quasi-experimental design with a pre- and post-test method was used. The educational intervention included theoretical sessions on assessing and managing sedation and hands-on sedation assessment practice using the Richmond Agitation Sedation Scale. Its effect was measured using self-administered questionnaire, completed at the baseline level and 3 months following the intervention. RESULTS: Participants were 68 registered nurses from an intensive care unit of a teaching hospital in Malaysia. Significant increases in overall mean knowledge scores were observed from pre- to post-intervention phases (mean of 79·00 versus 102·00, p < 0·001). Nurses with fewer than 5 years of work experience, less than 26 years old, and with a only basic nursing education had significantly greater level of knowledge improvement at the post-intervention phase compared to other colleagues, with mean differences of 24·64 (p = 0·001), 23·81 (p = 0·027) and 27·25 (p = 0·0001), respectively. A repeated-measures analysis of variance revealed a statistically significant effect of educational intervention on knowledge score after controlling for age, years of work and level of nursing education (p = 0·0001, ηp (2) = 0·431). CONCLUSION: An educational intervention consisting of theoretical sessions and hands-on sedation assessment practice was found effective in improving nurses' knowledge and understanding of sedation management. RELEVANCE TO CLINICAL PRACTICE: This study highlighted the importance of continuing education to increase nurses' understanding of intensive care practices, which is vital for improving the quality of patient care.

Effect of turning vs. supine position under phototherapy on neonates with hyperbilirubinemia: a systematic review.

AIMS AND OBJECTIVES: To determine the most effective position jaundiced neonates should assume during phototherapy from appraised randomised controlled trials. BACKGROUND: Many local hospitals still alternate positions of jaundiced neonates receiving phototherapy despite the safe infant sleeping protocol of placing them supine. DESIGN: A systematic review was conducted. METHODS: Databases that included Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase and The Cochrane Library were used. Randomized controlled trials published in English language that evaluate the best position for healthy jaundiced neonates aged day 1 to 14 under phototherapy were searched. In addition, any positioning done every 2-3 hours during phototherapy with the outcome measures being bilirubin reduction and duration of phototherapy were also searched and included (n = 5). Physiotherapy Evidence Database scale was adopted for quality assessment. All processes were conducted by both reviewers independently. Discrepancies were resolved by a third reviewer. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guideline were utilised. Out of 20 papers, five were included for qualitative synthesis. Data extraction was based on the template (participants, study designs etcetera) agreed by both authors. RESULTS: All five studies possessed external validity. One paper scored 7, three scored 5 while one scored 3. Four of these studies reported no difference in bilirubin reduction and duration of phototherapy. Only one study reported a significant drop in serum bilirubin and shorter duration of phototherapy in the supine group. CONCLUSION: It has been proved that keeping the jaundiced newborns in the supine position throughout phototherapy is as effective as turning them periodically based on the appraised studies. RELEVANCE TO CLINICAL PRACTICE: It is unnecessary to alternate positions of the jaundiced neonates when conventional phototherapy is delivered to lighten nurses' workload.

The relationship between job satisfaction and intention to leave current employment among registered nurses in a teaching hospital.

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.