IeJSME 2016 10(1)
Issue: IeJSME 2016 10(1)
Editorial Board and Contents
Professionalism 2.0
Author: Muneer Gohar Babar
Citation: IeJSME 2016 10(1): 1-2
Patient autonomy – what does it mean for clinical decision-making in children and adolescents?
Author: Thor Willy Ruud Hansen
ABSTRACT
Autonomy implies the right of a competent patient to make decisions about their own health care. To exercise autonomy a patient must receive an explanation of his/her condition. True autonomy presumes intellectual understanding, the ability to translate theoretical ideas into real-life concepts, and emotional connectedness to the situation.
Children may not be able to understand or process information about treatment choices. Therefore, responsibility for decision-making is vested in the parents. In Norwegian law, this lasts until the child is 12 years old, though the child must be informed and involved commensurate with intellect and maturity. From the ages of 12 until 16, the youngster should increasingly be heard and involved, and from the age of 16 years a youngster is considered medico-legally competent.
Parents who face serious illness in a child are in a life crisis. Yet in spite of this, decision-making competence is often assumed. Decisions with life-or-death or lifetime implications will profoundly influence the life of the family. The best interest of the sick child may not necessarily be compatible with the needs of the family as a unit. As medical caregivers we should be cautious about assuming that our insight into such family realities is adequate. We must sensitively, yet critically, consider decision-making competence, while at the same time supporting the parents’ efforts to cope and make the best decisions possible. However, we must never lose sight of the fact that our primary responsibility is towards the sick child.
Keywords: Bioethics; Autonomy; Children and adolescents; Decision-making competence; Best interest; Parental authority; Emancipation of children.
Citation: IeJSME 2016 10(1): 3-9
Are nurses ready for evidence-based practice? A descriptive study of information literacy competency among clinical practicing registered nurses in a private hospital in Malaysia
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
Dietary fibre and total fluid intakes are inversely associated with risk of constipation in Malaysian adolescents, adults and the elderly
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
Leaving intention and exit destinations among the Malaysian private hospital nurses
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
Assessing clinical reasoning skills of final year medical students using the script concordance test
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
Muslims’ views on the permissibility of organ donation: The case of Malaysia
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
Malignant melanoma of the ear canal presenting as wart
Authors: Rafiqahmed Vasiwala, Ismail Burud.
ABSTRACT
Malignant melanoma is a rare malignancy of the external auditory canal. The vast majority of them occur in the areas of the body that are exposed to the sun. Early histological examination may possibly favor better prognosis. We report a case of a 38-year-old female who presented with a small mass in right ear canal, earache and minimum discharge since 4 months. Initially scraping was done in the ENT clinic. Subsequently she had a wide excision done by the end aural approach at a different hospital. A year later the patient presented with a swelling involving the ear canal which extended to the helix and supratemporal region with the histology report as malignant melanoma. A literature review of the disease, radiological findings, immunohistochemical features and treatment options are discussed.
Keywords: ear canal, malignant melanoma, wart.
Citation: IeJSME 2016 10(1): 47-48
