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Fulltext A case study: wrong patient; wrong blood transfusion:is there a theory – practice – ethics gap?

Manfred Mortell

The Malaysian Journal of Nursing, 2019;10(3):22-28.
MyJurnal

This case study illustrates an ongoing therapeutic dilemma which continues to place the patient's welfare at risk. The safety predicament is associated with the transfusion of blood or their products to the correct patient. Predictably, healthcare scholars declare that when clinical practice is ineffective, a “theory-practice gap” is typically responsible. Within this paradigm there is often a gap between theoretical knowledge and its application in clinical practice. Most of the evidence relating to the non-integration of theory and practice makes the premise that environmental factors will influence learning and practice outcomes, hence the "gap". However, it is the author's belief, that to "bridge the gap" between theory and practice an additional component called “Ethics” must be appreciated. This introduces a new concept “theory-practice-ethics gap” which must be considered when reviewing some of the unacceptable appalling outcomes in health care practice

Matched MeSH terms: Professional Practice Gaps
A comparison of Malaysian and Australian speech-language pathologists' practices with children with developmental disabilities who are pre-symbolic

Joginder Singh S, Iacono T, Gray KM

Int J Speech Lang Pathol, 2011 Oct;13(5):389-98.
PMID: 21888557 DOI: 10.3109/17549507.2011.603429

The aim of this study was to explore the assessment, intervention, and family-centred practices of Malaysian and Australian speech-language pathologists (SLPs) when working with children with developmental disabilities who are pre-symbolic. A questionnaire was developed for the study, which was completed by 65 SLPs from Malaysia and 157 SLPs from Australia. Data reduction techniques were used prior to comparison of responses across questionnaire items. Results indicated that SLPs relied mostly on informal assessments. Malaysian and Australian SLPs differed significantly in terms of obtaining information from outside the clinic to inform assessment. When providing intervention, SLPs focused mostly on improving children's pre-verbal skills. A third of Australian SLPs listed the introduction of some form of symbolic communication as an early intervention goal, compared to only a small percentage of Malaysian SLPs. Regarding family involvement, SLPs most often involved mothers, with fathers and siblings being involved to a lesser extent. Overall, it appeared that practices of Malaysian SLPs had been influenced by developments in research, although there were some areas of service delivery that continued to rely on traditional models. Factors leading to similarities and differences in practice of SLPs from both countries as well as clinical and research implications of the study are discussed.

Matched MeSH terms: Professional Practice
Fulltext A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan

Hashmi FK, Hassali MA, Khalid A, Saleem F, Aljadhey H, Babar ZUD, et al.

BMC Health Serv Res, 2017 07 19;17(1):500.
PMID: 28724411 DOI: 10.1186/s12913-017-2442-6

BACKGROUND: In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan.
METHODS: A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework.
RESULTS: Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings.
CONCLUSION: Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan.

Matched MeSH terms: Professional Practice/organization & administration
Academic surgery in Asia

Yip CH

ANZ J Surg, 2008 May;78(5):345-6.
PMID: 18380727 DOI: 10.1111/j.1445-2197.2008.04471.x
Matched MeSH terms: Professional Practice
Fulltext Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work?

Cheek C, Hays R, Allen P, Walker G, Shires L

Rural Remote Health, 2017 Jul-Sep;17(3):4292.
PMID: 28846850 DOI: 10.22605/RRH4292

INTRODUCTION: Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices.

METHODS: This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences.

RESULTS: There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania but most left for specialty training. All 15 interview participants intended to remain in Australia for at least their intern year, although at enrolment only six had planned to remain. Factors influencing workplace location decisions were (1) 'professional': greater appeal of Australian medical workplaces, intention to pursue a speciality, and to complete this at an Australian metropolitan hospital; (2) 'social': proximity to family/partner or opportunity to meet a prospective partner, family obligations, positive rural experiences; and (3) 'location': direct travel access to family.

CONCLUSIONS: IFP graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for both Tasmania and the broader Australian rural and remote context. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.

Matched MeSH terms: Professional Practice Location/statistics & numerical data*
Challenge to clinical pharmacy practice in Malaysia

Hassan Y

Ann Pharmacother, 1993 Sep;27(9):1134-8.
PMID: 8219450 DOI: 10.1177/106002809302700920

OBJECTIVE: To report on the current status and future trends of clinical pharmacy practice in Malaysia.
DATA SOURCES: Published conference reports and journal articles.
DATA EXTRACTION: Data on areas related to clinical pharmacy practice in Malaysian hospitals were gleaned from various publications.
DATA SYNTHESIS: Malaysia is capable of implementing clinical pharmacy services in hospitals and perhaps also in the community setting. The important factors in clinically oriented pharmacy practice include improvement of the drug-control process, development of physical and human resources, clinical pharmacy skills, and the training of practicing pharmacists. A number of Malaysian pharmacists have already developed a unit-dose drug distribution system, patient counseling, therapeutic drug monitoring, drug information, and total parenteral nutrition services.
CONCLUSIONS: The pharmacy profession in Malaysia has many challenges ahead and it is hoped that every practicing pharmacist will be highly committed to future professional needs so that clinical pharmacy practice in Malaysia becomes a reality.

Matched MeSH terms: Professional Practice/trends*
Counseling for prenatal diagnosis and termination of pregnancy due to thalassemia major: a survey of health care workers' practices in Malaysia

Ngim CF, Lai NM, Ibrahim H

Prenat Diagn, 2013 Dec;33(13):1226-32.
PMID: 24014379 DOI: 10.1002/pd.4233

OBJECTIVE: Genetic counseling for thalassemia carriers is conducted by nongeneticist health care workers (HCWs) in many countries. The aim of the study was to assess Malaysian HCWs' genetic counseling practices with regards to discussing prenatal diagnosis (PND) and termination of pregnancy (TOP) when counseling thalassemia carriers.
METHOD: A total of 118 Malaysian HCWs (52 doctors and 66 nurses) completed a structured questionnaire that enquired if they would discuss PND and TOP when counseling couples with thalassemia traits, and reasons for their responses were explored.
RESULTS: All the nurses and 50 (96.1%) doctors were in favor of discussing PND. Only 29 (58%) doctors and 33 (50%) nurses were agreeable to discuss about the option of TOP. Main reasons given for declining to discuss TOP were views that "the condition was not serious enough" (54.9%), TOP is not permissible by their religion (17.6%) and abortion for this indication was illegal (13.7%).
CONCLUSION: The results showed that HCWs in Malaysia lacked the comprehensive information and necessary skills required when counseling thalassemia carriers. When nongeneticist HCWs are tasked with such responsibilities, their practices and attitudes should be regularly evaluated so that areas of deficiencies could be identified and addressed.

Matched MeSH terms: Professional Practice/statistics & numerical data*
Fulltext Cross-sectional Study on the Impact of Discount Pricing and Price Competition on Community Pharmacy Practice

Mathews A, Ming LC, Che Rose FZ, Abbas SA

Cureus, 2020 Aug 20;12(8):e9903.
PMID: 32839684 DOI: 10.7759/cureus.9903

Background Without stipulated legislation, a free pricing policy can lead to a disparity in prices among private healthcare setups. Competition is especially rampant among community pharmacies, especially in the Sabah state of Malaysia, where the recent years have witnessed the steady growth of pharmacy players from Peninsular Malaysia. Thus, this study aimed to examine the impact of price competition and discount pricing on the practice of community pharmacy in Sabah, Malaysia. Methods This was a cross-sectional study using an online questionnaire. Survey participants included community pharmacists practicing in Sabah. The validated and pilot-tested questionnaire consisted of three parts: background information of the pharmacy, attitudes and perception toward medicine prices, and practice of discount pricing. All required data were collected from community pharmacists practicing only in Sabah. Data were then analyzed by using descriptive, Chi-Square, and Kendall's tau-b tests. Results Of the 150 community pharmacists contacted, only 70 responded, providing a response rate of 47%. In terms of pharmacy type, 71% of the respondents were pharmacist-owned independent pharmacies, while 19% were pharmacy chains owned by community pharmacists. The remaining were pharmacies owned by non-pharmacists (10%). Sixty percent of the community pharmacies had been in existence for more than 10 years, with 12% in existence for less than two years, and 28% in existence for three to 10 years. More than 80% of the respondents stated that the business aspect of community pharmacy had overwhelmed the professional practice aspects and that community pharmacists have become providers of products instead of providers of care. In terms of professionalism, 87% also noted that they are being perceived as profiteering in the medicine business at the expense of patients. Conclusions The free market situation in Malaysia for medicine pricing has brought a detrimental consequence for community pharmacists with each one trying to undercut prices. Differing pricing mechanisms of medicines based on the quantity ordered contribute to the problem of discount pricing and price competition. Most community pharmacists, as indicated by this study, want the problem to be addressed.

Matched MeSH terms: Professional Practice
Fulltext Dietary inquiries in public health practice

Wadsworth GR

Med J Malaysia, 1996 Mar;51(1):18-22.
PMID: 10967974

Public health administrations are responsible for monitoring the availability and use of foods. The information required can be obtained cheaply and easily by asking schoolchildren about the foods they have consumed. When the mean weights of adults is low and the number of kinds of food in use is small, nutritional problems probably exist and must be investigated. The same indicators may also be useful in the identification of families affected by poverty.

Matched MeSH terms: Professional Practice*
Good clinical practice

Merican I

Med J Malaysia, 2000 Aug;55 Suppl B:35-7.
PMID: 11125519
Matched MeSH terms: Professional Practice*
Fulltext Is it my fault? contemplative reactions among nurses toward the existence of blamingculture in relation to their documentation: a Malaysian context

Rekaya Vincent Balang, Robert L. Burton, Nichola A. Barlow

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):19-0.
MyJurnal

Introduction: Nursing documentation is the key to nursing care in hospitals. Nursing documentation contains ev- idences which demonstrate a significant association between the comprehensive level of nursing care and nurses’ professional practice. Therefore, nurses in Malaysia are trained to abide with the code of professional practice (1998) which required them to contrive a complete and comprehensive nursing documentation. Despite the importance of nursing documentation in the nursing professional practice, such study almost non-existent in Malaysia. Hence, there is a need to explore nurses understanding about existence of professionalism within their documentation, from a Malaysian context. Methods: The study utilized a qualitative approach which aimed to explore the perceptions among nurses in Malaysia on their documentation with relation to professionalism in nursing. Forty semi structured interviews were conducted in order to obtain an understanding of nurses’ views on their documentation and its influ- ence on their ways of preparing and completing their documentation. Thematic analysis was used to identify catego- ries and themes in nurses’ accounts of their documentation with relation to professionalism in nursing. Results: One of many profound findings from the study is the fear among nurses of “blaming culture” in that occurs their clinical setting. The nurses perceive “blaming culture” do not tolerate mistakes and they are more likely to be blamed for poor patient safety and insufficient quality of care. This is because nurses are directly involved in delivering care to patient or client in the hospital. “Blaming culture” however motivates nurses to ensure their documentation is com- plete, comprehensive and contemporaneous. Conclusion: Interestingly, the nurses perceive their documentation as an important evidence if there are possible future medical legal issues that they might have to involve with.

Matched MeSH terms: Professional Practice
Fulltext Knowledge and practice among nurses on management of tuberculosis in a teaching hospital

Hng, S.H., Siti Nabihah, S., Siti Nabilah, S.

Medicine & Health, 2018;13(1):153-164.
MyJurnal

Tuberculosis (TB) has become a worldwide public concern with 10.4 million new cases reported in 2015 and 1.4 million deaths. More importantly, an increase in trend in TB incidence among healthcare workers has become a major concern. Therefore, the present study was conducted to explore the knowledge and practice towards TB and the factors associated with it among nurses in a teaching hospital. The present study used cross-sectional design and stratified sampling method. A total of 275 nurses in a teaching hospital participated in this study. The knowledge and practice on management of TB was measured using a structured questionnaire. Majority of the respondents had good knowledge and practice on management of TB represented by 70.2% and 63.3%, respectively. However, knowledge gap (1.8%) and practice gap (0.4%) were identified in method of sputum collection. Work place setting was the only demographic factor found significantly associated with level of knowledge and practice (p=0.028). Level of knowledge and practice on management of TB identified among nurses was not associated with many socio-demographic factors. Nurses as frontline healthcare workers are at high risk of being exposed due to frequent contact with various patients especially those who are undiagnosed and TB suspect patients. Hence, implementation of TB Infection Control (TBIC) measures is important to minimize the risk of infection and cross-infection within hospital.

Matched MeSH terms: Professional Practice Gaps
Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training

Azraii AB, Ramli AS, Ismail Z, Abdul-Razak S, Mohd-Kasim NA, Ali N, et al.

Atherosclerosis, 2018 10;277:508-516.
PMID: 30270092 DOI: 10.1016/j.atherosclerosis.2018.08.018

BACKGROUND AND AIMS: This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual).
METHODS: This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP.
RESULTS: A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p 

Matched MeSH terms: Professional Practice Gaps
Mediation--the Malaysian Dental Association experience

Purmal K, Nambiar P

Int Dent J, 2009 Jun;59(3):155-60.
PMID: 19637524

To study the success and failures of the mediation process of complaints from 2004-2007 by the Complaints Bureau Steering Committee and the Public Complaints Bureau Committee of the Malaysian Dental Association (MDA).

Matched MeSH terms: Professional Practice Location
Fulltext Medical standards

Thuraisingham V

Med J Malaysia, 1982 Dec;37(4):296-7.
PMID: 7167077
Matched MeSH terms: Professional Practice/standards*
Medicine in Malaysia: haematology

Cheong SK, Lopez CG

Med J Malaysia, 1995 May;50 Suppl A:S46-50.
PMID: 10968015
Matched MeSH terms: Professional Practice/trends
Fulltext Multicentre study of preoxygenation practices by anaesthesia providers

Wong AK, Sushila S, Thomas H, Tong JMG

Med J Malaysia, 1999 Mar;54(1):102-9.
PMID: 10972012

A total of 155 consecutive anaesthetics in three public Malaysian hospitals were prospectively studied to assess preoxygenation practices by their anaesthesia providers. Preoxygenation was practised in 96.1% of patients. Specialist and non-specialist anaesthesiologist did not preoxygenate 8.8% and 2.3% of their patients, respectively. Overall incidence of arterial oxygen desaturation during induction was 15.5%. Arterial oxygen desaturation occurred more frequently with emergency surgery (30.2%) in comparison to elective surgery (9.8%). Arterial oxygen desaturation occurred more frequently with non-specialist (18.9%) than specialist anaesthesia providers (3.0%).

Matched MeSH terms: Professional Practice*
Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

Romli MH, Wan Yunus F, Mackenzie L

Aust Occup Ther J, 2019 08;66(4):428-445.
PMID: 30821362 DOI: 10.1111/1440-1630.12572

INTRODUCTION: Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.
METHODS: An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).
RESULTS: A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.
DISCUSSION: Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

Matched MeSH terms: Professional Practice
Patient education and preventive care in Malaysian dental practice

Abdul Razak I, Lind OP

J Clin Pediatr Dent, 1994;18(4):313-22.
PMID: 7811664

A questionnaire survey was conducted to examine the attitudes of Malaysian dentists toward patient education and preventive dentistry and the level of preventive care adopted in Malaysian dental practice. An adjusted response rate of 73.1% was obtained. Generally the Malaysian dentists had positive attitudes towards patient education and preventive dentistry including fluoridation. However, a sizable proportion of them considered that preventive measures were no challenge for the dentist. The common preventive measures given to patients were scaling, dental health education, prophylaxis and instruction in correct brushing and flossing in as much as 40 to 50 percent of the queried dentist claimed that these preventive items were provided to most or all of their new patients. In spite of the fact that the majority of the dentists had good knowledge about the application and effects of sealants only about 41 percent of the dentists claimed to have used sealants. More dentists in the private sector reportedly having done so. Also many Malaysian dentists (18.5%) did not use leaded protection for any of their new patients when taking radiographs.

Matched MeSH terms: Professional Practice/statistics & numerical data*
Fulltext Practical Learning and Theory-Practice as Perceived by Student Nurses in Universiti Malaysia Sabah

Hairie Aiery, Nur Izzati M. T, Ivyta D., Farah Ezora Shafine A. B., Sukhbeer K. Darsin Singh, R. Segaran

Borneo Journal of Medical Sciences, 2018;12(101):75-76.
MyJurnal

The theory-practice gap is arguably the most important issue in nursing today, given that it challenges the concept of research-based practice, which is the basis of nursing as a profession. Majority of the student nurses shared their views that some of the practical procedures that they learned during their theory sessions were different from what was practised in the wards which caused some worries among the students that it may affect their performance during their Obstructive Structured Clinical Examination.

Matched MeSH terms: Professional Practice Gaps

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