Authors: Chun Wai Chan, Junyi Wang, Joanne Johnny Bouniu, Parampreet Singh, Cheong Lieng Teng.

ABSTRACT

Introduction: Poor adherence to anti-hypertensive agents may be a major contributor for suboptimal blood pressure control among patients with hypertension. This study was conducted to assess the adherence to antihypertensive agents using Morisky Medication Adherence Scale (MMAS-8) among primary care patients, and to determine whether the blood pressure control is associated with the level of adherence.

Methodol0gy: This cross-sectional study was conducted between June 2011 and August 2011. Adults with hypertension older or equal to aged 30 with or without diabetes were recruited from two public primary care clinics in Negeri Sembilan, Malaysia. Medication adherence was assessed using MMAS-8.

Results: Data from 231 patients were analysed, whereby 68% of them had good medication adherence but only 38.1% of the patients had their blood pressure under control. Statistical analysis failed to find correlation between adherence and blood pressure control. Twenty per cent of hypertensive subjects were on beta-blocker alone, and 37.1% of patients with either diabetes or proteinuria were not prescribed either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB). Above half the patients (51.5%) were on monotherapy.

Conclusion: Discordance between adherence to antihypertensive agents and hypertension control is clearly shown in this study, and the likely explanation for the discordance is therapeutic inertia.

Keywords: primary care, hypertension, therapeutic inertia, medication adherence.

Citation: IeJSME 2015 9(3): 27-32

DOI: https://doi.org/10.56026/imu.9.3.27

Authors: Sivalingam Nalliah, Joanne Pereira, Lim Shin Tom, Vyshanavi Jayasingam, Phang Gin Ga.

ABSTRACT

Introduction: In recent years, the internet has become an increasingly popular tool for people to obtain information due to the overwhelming availability of material. As internet access becomes more readily available, the newer generation of patients, medical students and doctors are starting to prefer the internet as a source of reference to acquire medical knowledge. The main objectives of this study were to determine the accuracy of using Google search in establishing a clinical diagnosis based on information provided from the New England Journal of Medicine (NEJM) and to determine the concordance rate of Google diagnosis with the actual diagnosis from NEJM.

Method: The research design was a cross sectional study of 200 NEJM cases. The research team comprised of four 3rd year medical students and one senior supervisor. Google search engine was used to obtain a diagnosis. The time allocated for a Google search for each case was 20 minutes regardless of the number of websites used. The top two diagnoses were then compared to the actual diagnoses of the NEJM case and the accuracy of Google was then assessed.

Results: The study achieved a congruence of 71.5%. This is considered acceptable and satisfactory as the cases presented in NEJM covered a wide variety of problems and encompassed rare diseases.

Conclusion: From the final results obtained, it can be concluded that with the aid of Google, medical students in their 3rd year of their Bachelor of Medicine and Bachelor of Surgery programme are able to obtain a reasonable clinical diagnosis.

Keywords: Google search, diagnosis, clinical case, congruency.

Citation: IeJSME 2015 9(3): 33-37

DOI: https://doi.org/10.56026/imu.9.3.33

Authors: Mei Foong Ng, Bee Yean Ooi, Wei Fern Siew.

ABSTRACT

Background: In Malaysia the percentage of diploma registered nurses outnumber the percentage of degree registered nurses. Internationally, most registered nurses earn associate degrees or bachelor’s degrees in nursing. Malaysia is in the pipeline of ensuring that its registered nurses are professionally qualified with nursing degree by year 2020. Registered nurses with diploma qualification are feeling the pressure to upgrade their qualification to degree. There are concerns as to why these nurses are not pursuing their post registration nursing degree.

Objective: To determine factors that are deterring the registered nurses of a private hospital in Penang from pursuing the post registered nursing degree.

Methods: This descriptive study utilised a convenient sample of 150 registered nurses from Lam Wah Ee Hospital in Penang. The instrument of this study was developed based on literature search and the conceptual framework of Force Fields Analysis developed by Kurt Lewin in 1952.

Results: The deterring factors for registered nurses not pursuing post registration nursing degree from this hospital were determined through negative mean score, which was valued at less than 2.5. The top 3 deterring factors identified were: high educational cost, with a score of 1.92; financial commitment, with a score of 2.22 and time constraints and high workload, with a score of 2.27.

Conclusions: High educational cost, financial commitment, time constraint and high workload were the main factors deterring the registered nurses from this hospital from pursuing their post registration nursing degree. Thus it is timely for the organisational management to consider workable measures to assist and motivate their nurses to upgrade themselves with nursing degree in line with Malaysia’s vision to meet the increasing challenges and complex needs in the care of clients in health services.

Keywords: bachelor degree in nursing; continuing education; nursing education; Malaysian nurses.

Citation: IeJSME 2015 9(3): 38-46

DOI: https://doi.org/10.56026/imu.9.3.38

Authors: Chun Hoe Leng, Suk Yin Lim, Wei Fern Siew.

ABSTRACT

Background: Nurses are the highest numbered healthcare professionals who work in a knowledge-driven environment, where accurate and updated information is needed when delivering care to clients. Information literacy has therefore become one of the criteria in determining nurses’ readiness for evidence-based practice in recent years. In the actual day-to-day care practice, are nurses ready for this?

Objective: To determine the information literacy competency in readiness for evidence-based practice among clinical practicing registered nurses in a private hospital in Penang, Malaysia.

Methods: This cross sectional descriptive study was conducted in the selected private hospital. Universal sampling method was used. At the time of study, there were 443 registered nurses who met the eligibility criteria of this study. The registered nurses were asked to complete a self-reporting questionnaire about information literacy for evidence-based practice.

Results: The response rate was 86.2%, with a total of 382 returned questionnaires. Less than half of the participants (47%) stated that they frequently sourced information to support nursing practice. Poor research experiences among these participants were identified where 56% of the registered nurses never identified researchable problems, 59% have not evaluated a research report and 54% have never utilised research into practice. Registered nurses frequently sought information sources from colleagues or peers (65%) rather than from printed resources, where only 43% and 33% respectively make use of CINAHL and MEDLINE bibliography databases as the electronic resources for their practice.

Conclusions: Results demonstrated that information literacy among registered nurses from this hospital was lacking. Organisation efforts are needed to create awareness of information for evidence-based practice as well as to encourage more research activities and the search of bibliography database among its registered nurses.

Keywords: evidence-based practice; information literacy; information literacy competency; information search; registered nurses.

Citation: IeJSME 2016 10(1): 10-16

DOI: https://doi.org/10.56026/imu.10.1.10

Authors: Tony Kock Wai Ng, Yu Tang Jia, Yip Onn Low, Loo Zheng Wei Yeoh, Cai Li Gan.

ABSTRACT

Introduction: Dietary fibre (DF) and fluid intakes have been reported elsewhere to reduce the risk of constipation. The association of these dietary components on Agachand’s Constipation Score (CS) was investigated in the present study.

Methods: A total of 202 Malaysian participants comprising 50 adolescents (aged 12.4 ± 5.3 yrs), 50 adults (aged 46.3 ± 11.3 yrs), 52 women of child-bearing age (aged 29.1 ± 9.3 yrs) and 50 elderly persons (aged 70.0 ± 7.4 yrs) were recruited by convenience sampling from five venues – two communities in Cheras, one community in Klang, the IMU campus, Bukit Jalil and a private secondary school in Klang. All participants were interviewed with a previously-evaluated food frequency questionnaire (FFQ) and an Agachand’s Constipation Score (CS) Questionnaire.

Results: Mean daily DF intakes were low across all age groups with means ranging from 10.0 – 15.6g. The percentage of subjects with daily DF intakes below the “deficient” cut-off of 20g was alarmingly high; 80% in adolescents, 45% in adults, 85% in women of child-bearing age and 70% in the elderly. About one-fifth or 20% of subjects in all age groups had CS values ≥15 which indicated a problem of constipation. Mean daily total fluid consumption (TFC) ranged from 2128 – 5490 ml in the four categories of subjects. Overall, both daily DF intakes and TFC were negatively associated with CS values. This inverse association was significant for DF vs CS scores in adolescents (r = -0.500, p = 0.001), adults (r = -0.351, p = 0.013), the elderly (r = -0.392, p = 0.005) and all subjects combined (r = -0.366, p=0.001). For TFC vs CS scores, the inverse association was only significant for the elderly (r = -0.312, p = 0.027) and all subjects combined (r = -0.245, p = 0.001).

Conclusion: The results of this study support the role of dietary fibre intake and TFC in reducing the risk of constipation, as well as reinforcing previous data for low DF intakes among the Malaysian population.

Keywords: Dietary fibre, fluid consumption, constipation score.

Citation: IeJSME 2016 10(1): 17-23

DOI: https://doi.org/10.56026/imu.10.1.17

Authors: Wai Mun Tang, Abdul Rahman Idris.

ABSTRACT

Background: Many nurses are leaving for various destinations and leaving intention was found to be the immediate precursor for actual turnover, but studies examining the different forms of leaving intention (unit, hospital, country, and profession) and exit destinations are scarce.

Objectives: To determine the different forms of nurses’ leaving intention (i.e., leaving the unit, hospital, country, and profession), exit destinations and associations of demographic variables on the different forms of leaving intention and exit destinations.

Methods: The study design was a cross-sectional survey. Private hospital nurses in the Peninsular Malaysia were the study population and a total of 942 (73% response rate) nurses participated in the study. A self-reported questionnaire was used for data collection.

Results: The results revealed that intention of leaving the organisation (M = 2.81, SD = 1.33) was the highest and followed by intention of leaving the unit (M = 2.54, SD = 1.31). In terms of exit destinations, advancing nursing qualification (M = 2.95, SD = 1.31) and practising nursing in another country (M = 2.55, SD = 1.31) were the most preferred exit destinations among the nurses.

Conclusions: Nursing managers play a significant role in retaining nurses within the units and organisations. The findings on nurses’ exit destinations are crucial because they serve as the direction for nurses’ retention strategies which include professional development opportunities through training, education and staff mobility.

Keywords: leaving, intention, exit, destinations, nurses.

Citation: IeJSME 2016 10(1): 24-35

DOI: https://doi.org/10.56026/imu.10.1.24

Authors: Velayudhan Menon, Rifdy Mohideen.

ABSTRACT

Background: Clinical reasoning is the name given to the cognitive processes by which doctors evaluate and analyse information from patients. It is a skill developed by experiential learning and is difficult to assess objectively. The script concordance test, an assessment tool introduced into the health sciences about 15 years ago, is a way of assessing clinical reasoning ability in an objective manner and allows comparisons of the decisions made by medical students and experts in situations of uncertainty.

Methods: Twenty-six final year medical students from the International Medical University, Kuala Lumpur, were tested on their decision making skills regarding a young febrile patient. The students evaluated different pieces of information in five different scenarios and made decisions on a five-point Likert scale in the standard format of the script concordance test. Their decisions were compared to the decisions of a panel of experienced clinicians in Internal Medicine.

Results: The script concordance test scores for the different scenarios were calculated with higher scores being indicative of greater concordance between the reasoning of students and doctors. The students showed poor concordance with doctors in evaluating clinical information. Overall, only 20 percent of the choices made by students were the same as the choices made by the majority of doctors.

Conclusion: Medical students vary in their ability to interpret the significance of clinical information. Using the script concordance test, this preliminary study looked at the ability of final year medical students to interpret information about a patient with a febrile illness. The results showed poor concordance between students and doctors in the way they interpreted clinical information. The script concordance test has the potential to be a tool for teaching and assessing clinical reasoning.

Keywords: Assessment in medical education, clinical reasoning, script concordance test.

Citation: IeJSME 2016 10(1): 36-40

DOI: https://doi.org/10.56026/imu.10.1.36

Authors: Makmor Tumin, Abdillah Noh, NurulHuda Mohd Satar, Khaled Tafran, Nawi Abdullah, Wan Ahmad Hafiz Wan Md Adnan, Mohamad Yusoff Sanusi.

ABSTRACT

Background: Some argue that Malaysia’s extremely low organ donation rate is attributed to religion, specifically Islam. Testing this argument, this study asked Malaysian Muslims their views regarding various issues on organ donation and examined whether their decisions to donate organs are framed by religious beliefs.

Materials and Methods: This study investigated the perspectives of Malaysian Muslims between October and December 2013 in Kuala Lumpur. Self-administered questionnaires were distributed to 900 people, with 829 responses collected (92% response rate). Respondents’ verbal consent was taken before proceeding with the survey.

Results: The survey found that more than half of respondents felt that organ donation is permitted in Islam and that it is a communal responsibility. However, the same proportions were unsure on the issues of rewards for organs or on whether Islam permits the procuring of organs from brain dead patients.

Conclusions: Malaysian Muslims are not against organ donation; however, encouraging organ donation requires the state to address public concerns on Islam’s views on this sensitive issue through effective policy tools to help address these gaps in Malaysian Muslims’ understanding of organ donation. The organ donation rate could improve by using Islamic scholars as ambassadors for an organ donation drive to convey the message of Malaysia’s urgent need for organ donation.

Keywords: Islam; Malaysia; Muslims; organ donation; organ transplantation; perception on organ donation.

Citation: IeJSME 2016 10(1): 41-46

DOI: https://doi.org/10.56026/imu.10.1.41

Authors: Swee Geok Lim, Muhamad Asyraf Bin Muhtar.

ABSTRACT

Background: Nurses are the “front line” staff in most health systems and their contribution is recognised as essential in meeting development goals and delivering safe and effective care (ICN, 2007). Nurses are in high demand not only in developed countries but also in developing countries like Malaysia. However, more than 70% of Malaysian hospitals currently do not have adequate nursing staff. At least 174,000 nurses need to be trained by 2020 to meet WHO’s nurse-to-patient ratio of 1:200. The purpose of this study is to identify the main factors that influence the nursing students’ decision to choose nursing as their career.

Method: A descriptive study guided by Self Determination Theory was used for this study. A 29-item questionnaire adapted from McCabe, Nowak and Mullen (2005) was distributed to all students in a nursing college (n=117).

Results: The five main reasons for choosing nursing as a career were “ability to help others”, “training was provided on the job”, “ability to work closely with people”, “parental advice”, and “accommodation was provided while training”. The top three main domains that influenced the nursing students’ decision to choose nursing as their career include “travel opportunities of nursing”, “intrinsic attraction of nursing” and “immediacy of support on entry to nursing”. A total of 19 (0.2%) will not choose nursing if given a chance. The main reasons were “want to take another course”, “no time to spend with family” and “nursing is a stressful job”.

Conclusion: The findings of this study provided valuable information regarding motivating factors which attract the current generation to join nursing. It is of concern that items representing nurses’ image were not rated highly.

Keywords: career, extrinsic factors, intrinsic factors, nursing, student nurse.

Citation: IeJSME 2016 10(2): 3-10

DOI: https://doi.org/10.56026/imu.10.2.3

Authors: Wai Mun Tang, Abdul Rahman Idris.

ABSTRACT

Background: The escalating rate of private hospital nurses leaving their workplace raised serious concern among the stakeholders. Past studies had found that nursing practice environment was the key influence on nurses’ leaving intention, but studies examining the quality of nursing practice environment of private hospital settings was scarce and therefore warrant investigation to provide direction for interventions in addressing nursing turnover.

Objectives: To determine nurses’ perceptions towards nursing practice environment and whether there is any significant associations with nurses’ demographic variables.

Methods: Cross-sectional inferential survey study was conducted at four private hospitals in the Peninsular Malaysia using the Practice Environment Scale of the Nursing Work Index (PES-NWI) and 885 nurses participated in the study.

Results: Nurses rated their practice environment as favourable. However, items stated in “staffing and resource adequacy” subscale warrant serious attention because nurses rated poorly on item related to “enough staff to get the work done” (M = 2.37, SD = .81) and “enough registered nurses to provide quality patient care” (M = 2.41, SD = .82). Furthermore, t-test analyses found that nurses with educational sponsorship bond (p < .001), higher educational qualifications (p < .05), and have been working in the hospital since graduation (p < .001) were more likely to rate their practice environment lower.

Conclusion: Hospital administrators play significant role in sustaining and creating positive nursing practice environment in order to ensure steady supply of nurses to meet the challenging healthcare needs.

Keywords: nursing, practice, working, environment.

Citation: IeJSME 2016 10(2): 11-20

DOI: https://doi.org/10.56026/imu.10.2.11