Displaying publications 21 - 36 of 36 in total

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  1. Diao Y, Li M, Huang Z, Sun J, Chee YL, Liu Y
    Risk Manag Healthc Policy, 2019;12:357-367.
    PMID: 31908552 DOI: 10.2147/RMHP.S226379
    China's healthcare reform aims to provide affordable and equitable basic healthcare for all by 2020. Access to medicines is an essential part of the healthcare. The efforts of promoting access to medicines have been moving from meeting the needs of the basic healthcare, towards increasingly dedicated resources to offer breakthrough therapies. Looking at access to novel medicines from a health system perspective, and placing the changes China has made into that system context, this paper makes a comprehensive review of the progress of access to novel medicines in China. The review drew on two sources of information, which included desk review of published and grey literature, and key informant interview. Five hurdles were identified which create barriers of access to novel medicines, ranging from regulation and financing of medicines, intellectually property rights protection, and development of innovation capacity, to other health system components. Multiple policies have been implementing in China to remove the multiple access barriers gradually. Universal access to medicines has been moving from towards the basic common conditions to the world breakthrough technologies. We see cause for optimism, but recognize that there is a long way to go. Achieving broader and better access to modern medicines for Chinese patients will require multiple and coordinated government efforts, which would need to target the whole lifecycle regulation of novel medicines with a health system perspective, from balancing IP protection, strengthening R&D and public health, to appropriate regulatory approach and financing mechanism, and to supply chain management, as well as smart use.
  2. Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S
    Risk Manag Healthc Policy, 2020;13:409-426.
    PMID: 32547272 DOI: 10.2147/RMHP.S239074
    The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85-90% of premature deaths among 30-69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs.
  3. Mahmoud MA, Islam MA, Ahmed M, Bashir R, Ibrahim R, Al-Nemiri S, et al.
    Risk Manag Healthc Policy, 2021;14:4235-4241.
    PMID: 34675717 DOI: 10.2147/RMHP.S325184
    Objective: The aim of this study was to validate the Arabic version of General Medication Adherence Scale (GMAS) in Sudanese patients with type 2 diabetes mellitus (T2DM).

    Methods: A 3-month cross-sectional study was conducted among patients with T2DM at Al-Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined.

    Results: Responses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834.

    Conclusion: The Arabic version of GMAS was validated in Sudanese patients with T2DM making it a suitable scale to be used in this population.

  4. Ahmed AAA, Al-Shami AM, Jamshed S, Zawiah M, Elnaem MH, Mohamed Ibrahim MI
    Risk Manag Healthc Policy, 2020;13:3089-3102.
    PMID: 33380849 DOI: 10.2147/RMHP.S281285
    Background: Cardiovascular disease is a leading nationwide cause of morbidity and mortality. Public awareness of risk factors for heart attacks is thought to impact the burden of disease, prevention, and timely management. The objective of this study was to assess the awareness of risk factors for heart attack and to identify the factors associated with the awareness of all modifiable risk factors for heart attack in the general population.

    Methods: This is a cross-sectional study conducted among 393 adult individuals in Kuantan, Pahang, Malaysia. Data collection was conducted through face-to-face interviews among the lay public members who were 18-64 years old, excluding healthcare professionals in clinical settings and academic settings. Statistical analysis was performed using chi-square test and logistic regression analysis.

    Results: The majority of the individuals identified smoking as a risk factor for heart attack, followed by atrial fibrillation (57.7%), heart disease (54.1%), and obesity (53.8%). However, diabetes (26%) was the risk factor that was least recognized by the participants. A total of 90.6% of participants identified at least one risk factor for heart attack, while 9.8% of the participants did not identify any risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk factors. Furthermore, participants aged 46-64 years old, married respondents, and Chinese participants, those with higher educational levels, and received prior information demonstrated great awareness of eight modifiable risk factors for heart attack. Multivariable logistic regression presented that participants with aged 55-64, those with family history of heart attack and individuals with dyslipidemia were factors independently related to excellent awareness (p=0.04, OR=6.21, 95% CL= 1.081-35.641), (p=0.049, OR=2.11, 95% CL=0.721-6.230) and (p=0.009, OR= 4.08, 95% CL= 1.427-11.685), respectively.

    Conclusion: Awareness of risk factors for heart attack appears to be poor, where most of the respondents recognized only one modifiable risk factor. According to these findings, programs and strategies to raise awareness of modifiable risk factors for HA are urgently needed to protect the lay public from HA.

  5. Samad N, Sodunke TE, Banna HA, Sapkota A, Fatema AN, Iskandar K, et al.
    Risk Manag Healthc Policy, 2020;13:2707-2728.
    PMID: 33262668 DOI: 10.2147/RMHP.S281388
    The world is striving against the severe crisis of the COVID-19 pandemic. Healthcare professionals are struggling to treat their patients based on nonspecific therapies. Amidst this uncertainty, convalescent plasma therapy (CPT) has appeared to be an interim adjuvant therapy for severely ill patients of COVID-19 until long-term clinical trial treatment options are available. Considering the transfusion-related hazards, especially lung injuries and microbial transmission, where sensitivity is not ensured, rigorous trials should be conducted to determine this therapy's efficacy. Moreover, the ratio of recovered cases to plasma donors is not satisfying, which questioning this therapy's availability and accessibility. Although some countries are making the treatment free, the attributable cost mandates a justification for its suitability and sustainability. Our article aimed to review the published facts and findings of CPT's effectiveness in lowering the mortality rate of COVID-19. This pandemic showed that healthcare systems worldwide need core reform. A unified global collaboration must align and coordinate to face the current pandemic and enhance world readiness for future outbreaks based on health equity and equality.
  6. Mohd Hatta FH, Samsudin EZ, Aimran N, Ismail Z
    Risk Manag Healthc Policy, 2023;16:1229-1240.
    PMID: 37431510 DOI: 10.2147/RMHP.S411335
    INTRODUCTION: Workplace violence (WPV) incidences are prevalent in healthcare, and existing WPV interventions have only moderate evidence for effectiveness. This study aimed to develop and validate an instrument to assess worksite-specific WPV risk factors in healthcare settings based on a tripartite perspective of key stakeholders to facilitate improved interventions.

    METHODS: Three questionnaires were developed to get the responses from healthcare administrators, workers, and clients, representing the three components of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF). The domains of the questionnaires were developed based on The Chappell and Di Martino's Interactive Model of Workplace Violence, and the items were generated from 28 studies identified from a systematic review of the literature. Six experts, 36 raters, and 90 respondents were recruited to assess the content validity, face validity, and usability and reliability of the QAWRF respectively. Item and Scale Level Content Validity Index, Item and Scale Level Face Validity Index, and Cronbach's alpha values were determined for QAWRF-administrator, QAWRF-worker, and QAWRF-client.

    RESULTS: The psychometric indices for QAWRF are satisfactory.

    CONCLUSION: QAWRF holds good content validity, face validity, and reliability, and findings from QAWRF can contribute towards worksite-specific interventions that are expected to be resource efficient and more effective than general WPV interventions.

  7. Juliasih NN, Dhamanti I, Semita IN, Wartiningsih M, Mahmudah M, Yakub F
    Risk Manag Healthc Policy, 2023;16:1731-1738.
    PMID: 37692768 DOI: 10.2147/RMHP.S425760
    INTRODUCTION: A hospital's patient safety culture affects surgical outcomes. Operating room safety culture has been overlooked despite the importance of patient safety. The AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC) has been used worldwide to assess and enhance patient safety culture. This study examined how patient safety culture and infection prevention effect patient safety in the Operating Room (OR).

    METHODS: This observational study used an online survey and included 143 OR workers. Descriptive statistics and multilinear regression were used to examine how patient safety culture and infection prevention affects level of patient safety.

    RESULTS: Most responders worked in excellent-accredited general hospitals. Most responders were male, aged between 26 to 40 years old, and had bachelor's degrees. Most were hospital-experienced nurses. Less than half had worked in units for over ten years. Organizational Learning - Continuous Improvement; Teamwork and Handoffs; and Information Exchange had the most positive responses in the OR. However, Staffing, Work Pace, and Patient Safety ranked lowest. Organizational Learning - Continuous Improvement and Hospital Management Support for Infection Prevention Efforts were found to affect OR patient safety level perceptions.

    CONCLUSION: According to the findings of our study, the overall patient safety culture in the operating room remains weak which highlights the importance of continuing efforts to improve patient safety in the OR. Further study could be directed to identify organizational learning in infection prevention to enhance the patient safety in the OR.

  8. Paudel S, Palaian S, Shankar PR, Subedi N
    Risk Manag Healthc Policy, 2021;14:2253-2261.
    PMID: 34104016 DOI: 10.2147/RMHP.S310289
    PURPOSE: The study was conducted to explore the perception of healthcare workers and staff towards the risk of COVID-19 vaccination and to study vaccine hesitancy amongst them.

    METHODS: A total of 266 healthcare workers working in a medical college in Nepal were studied using a questionnaire consisting of three sections: demographics, experiences and perception of COVID-19, and COVID-19 vaccine safety. Data were analyzed using IBM SPSS version 26. The total perception score was calculated by noting respondent's agreement with a set of eleven statements using a Likert-type scale. Non-parametric tests (Mann-Whitney U and Kruskal-Wallis) were used for analysis (p<0.05).

    RESULTS: Altogether, 13.9% of respondents had been diagnosed COVID-19 positive prior to the survey. Many considered themselves to be at increased risk of contracting COVID-19. Only over one third (38.3%) were willing to be vaccinated. The most common reason for refusal/hesitancy was concern about vaccine safety. The median (interquartile range) total perception score was 36 (4) (maximum possible score=55). The score was significantly higher among those who had been diagnosed COVID positive, those who perceived the pandemic as being moderate or severe and among those willing to be vaccinated.

    CONCLUSION: Addressing doubts related to vaccine safety and providing more data on the safety of vaccine may be helpful in overcoming hesitancy.

  9. Ng DL, Bin Jamalludin MA, Gan XY, Ng SY, Bin Mohamad Rasidin MZ, Felix BA, et al.
    Risk Manag Healthc Policy, 2023;16:2505-2519.
    PMID: 38024502 DOI: 10.2147/RMHP.S439530
    INTRODUCTION: Malaysia entered the transition to the endemic phase of Coronavirus 2019 (COVID-19) on 1st April 2022. This study aims to determine the public's willingness to perform COVID-19 self-testing. Factors that influenced their willingness were also assessed.

    METHODS: A nationwide, cross-sectional, and population-based study was conducted online in Malaysia from 28th April 2023 to 4th June 2023. Individuals aged 18 years and above were enrolled through the snowball sampling method. Data were analyzed by using the Chi-Square test, independent t-test, and binary logistic regression.

    RESULTS: One thousand four hundred fifty-three responses were included in the analysis. Of these respondents, 89.3% were willing, 4.1% were reluctant, and 6.6% remained hesitant to perform COVID-19 self-testing, The common reasons given by those willing to perform COVID-19 self-testing included being able to self-isolate (99.0%) and seek treatment (96.3%) earlier if tested positive. The common reasons against COVID-19 self-testing included the belief that COVID-19 is equivalent to the common flu (91.7%) and having received the COVID-19 vaccine (78.3%). The isolation policy for COVID-19 was the most significant consideration for those who were still hesitant (85.4%). Women [adjusted odds ratios (OR): 2.1, 95% confidence intervals (95% CI): 1.44-3.00, p < 0.001], individuals with tertiary education (OR: 2.1, 95% CI: 1.32-3.26, p = 0.002), those vaccinated against COVID-19 (OR: 8.1, 95% CI: 2.63-24.82, p < 0.001), and individuals with prior experience of COVID-19 self-testing (OR: 4.2, 95% CI: 2.84-6.12, p < 0.001) showed a significantly higher willingness to engage in COVID-19 self-testing.

    CONCLUSION: The public exhibited a high willingness to perform COVID-19 self-testing during the transition to the endemic phase in Malaysia. Future strategies to promote COVID-19 self-testing uptake in Malaysia should focus on vulnerable groups, address the common concerns among those hesitant and reluctant, and highlight the advantages of COVID-19 self-testing.

  10. Jairoun AA, Al-Hemyari SS, Shahwan M, Jairoun O, Zyoud SH
    Risk Manag Healthc Policy, 2024;17:663-675.
    PMID: 38528943 DOI: 10.2147/RMHP.S440482
    BACKGROUND: p-Phenylenediamine (PPD) has been used over the past five decades as a primary precursor in the production of oxidative hair dyes. Numerous health dangers are associated with the short- and long-term use of PPD, raising concerns about its safety. For instance, mounting data suggests that PPD is linked to dermatitis and allergy cases.

    OBJECTIVE: To quantify the PPD content in hair dyes by measuring the PPD concentration after mixing the ingredients of commercial hair dyes.

    METHODS: A total of 290 permanent hair dyes were tested. RP-HPLC-DAD analysis was performed to determine and quantify the PPD content.

    RESULTS: The estimated mean of the PPD limit was 0.89 (95% CI [0.81-0.96]). Of the 290 tested hair dyes, 7.2% (n = 21) exceeded the recommended PPD concentration after mixing. Significantly more hair dyes manufactured in India and China had a PPD content exceeding 2% after mixing compared to dyes from other regions (P = 0.001). Moreover, hair dyes manufactured in India and the UAE were more likely to have incomplete descriptions of the conditions of use and warnings on the label (P = 0.002).

    CONCLUSION: The effectiveness of the current regulations relevant to these products should be reevaluated. Moreover, through the use of good manufacturing procedures (GMPs), research, and the reporting of adverse reactions, hair dyes should be subjected to better control and monitoring in terms of their safety and quality.

  11. Mubarak N, Raja SA, Khan AS, Kanwal S, Saif-Ur-Rehman N, Aziz MM, et al.
    Risk Manag Healthc Policy, 2021;14:1615-1627.
    PMID: 33907479 DOI: 10.2147/RMHP.S296113
    BACKGROUND: There is a growing global interest in formulating such policies and strategic plans that help devise collaborative working models for community pharmacists (CPs) and general practitioners (GPs) in primary care settings.

    OBJECTIVE: To conceptualize a stakeholder-driven framework to improve collaboration between CPs and GPs in Malaysian primary care to effectively manage medicines in chronic diseases.

    DESIGN AND SETTING: A qualitative study that involved individual semi-structured interviews of the leadership of various associations, guilds, and societies representing CPs, GPs, and Nurses in Malaysia.

    METHODS: This study collected and reported data in accordance with the guidelines of the Consolidated Criteria for Reporting of Qualitative Studies. Key informants were recruited based on purposive (expert) sampling. Interviews were transcribed verbatim and data were coded based on the principles of thematic analysis in NVivo.

    RESULTS: A total of 12 interviews (5 CPs, 5 GPs, and 2 nurses) were conducted. Five themes emerged: Theme 1 highlighted a comparison of community pharmacy practice in Malaysia and developed countries; Theme 2 involved current practices in Malaysian primary care; Theme 3 encompassed the advantages of CP-GP collaboration in chronic diseases; Theme 4 highlighted the barriers which impede collaboration in Malaysian primary care; and Theme 5 delineated the way forward for CP-GP collaboration in Malaysia.

    CONCLUSION: The actionable insights obtained from the Malaysian stakeholders offered an outline of a framework to enhance collaboration between CPs and GPs in primary care. Generally, stakeholders were interested in CP-GP collaboration in primary care and identified many positive roles performed by CPs, including prescription review, adherence support, and patient education. The framework of the way forward includes: separation of CP and GP roles through a holistic revision of relevant legislation to grant an active role to CPs in chronic care; definition of protocols for collaborative practices; incentivization of both stakeholders (CPs and GPs); and design and implementation of an effective regulatory mechanism whereby the Malaysian Ministry of Health may take a leading role.

  12. Pang KL, Ekeuku SO, Chin KY
    Risk Manag Healthc Policy, 2021;14:2715-2732.
    PMID: 34194253 DOI: 10.2147/RMHP.S316429
    Air pollution is associated with inflammation and oxidative stress, which predispose to several chronic diseases in human. Emerging evidence suggests that the severity and progression of osteoporosis are directly associated with inflammation induced by air pollutants like particulate matter (PM). This systematic review examined the relationship between PM and bone health or fractures. A comprehensive literature search was conducted from January until February 2021 using the PubMed, Scopus, Web of Science, Google Scholar and Cochrane Library databases. Human cross-sectional, cohort and case-control studies were considered. Of the 1500 papers identified, 14 articles were included based on the inclusion and exclusion criteria. The air pollution index investigated by most studies were PM2.5 and PM10. Current studies demonstrated inconsistent associations between PM and osteoporosis risk or fractures, which may partly due to the heterogeneity in subjects' characteristics, study design and analysis. In conclusion, there is an inconclusive relationship between osteoporosis risk and fracture and PM exposures which require further validation.
  13. Lugova H, Samad N, Haque M
    Risk Manag Healthc Policy, 2020;13:2937-2948.
    PMID: 33328772 DOI: 10.2147/RMHP.S283698
    The ongoing humanitarian crisis in the Democratic Republic of the Congo has triggered sexual and gender-based violence, including rape, sexual slavery, trafficking, intimate partner violence, and sexual exploitation. Gender inequalities and abuse of power experienced by women and young girls at refugee settings further exacerbate their vulnerability to different forms of violence. This study aimed to offer an evidence-based approach to developing strategies in tackling the complex problem of sexual and gender-based violence among refugees and internally displaced persons in the Congo. We conducted a narrative review of all the relevant papers known to the authors to explore the origins of the problem, its implications on public health, and its impact on equity. The study revealed that sexual assault survivors face physical and psychological sufferings, excruciating emotions, and profound disruption of their social well-being since they are often stigmatized and ostracized by society. The analysis of current government policies revealed a lack of programs to address survivors' specific concerns and policy enforcement problems. This study suggested strategic objectives and policy implementation steps. The proposed strategies address women empowerment and gender stigma, provision of effective health services, and adequate response action.
  14. Haque M, McKimm J, Sartelli M, Dhingra S, Labricciosa FM, Islam S, et al.
    Risk Manag Healthc Policy, 2020;13:1765-1780.
    PMID: 33061710 DOI: 10.2147/RMHP.S269315
    Healthcare-associated infections (HCAIs) are a major source of morbidity and mortality and are the second most prevalent cause of death. Furthermore, it has been reported that for every one-hundred patients admitted to hospital, seven patients in high-income economies and ten in emerging and low-income economies acquire at least one type of HCAI. Currently, almost all pathogenic microorganisms have developed antimicrobial resistance, and few new antimicrobials are being developed and brought to market. The literature search for this narrative review was performed by searching bibliographic databases (including Google Scholar and PubMed) using the search terms: "Strategies," "Prevention," and "Healthcare-Associated Infections," followed by snowballing references cited by critical articles. We found that although hand hygiene is a centuries-old concept, it is still the primary strategy used around the world to prevent HCAIs. It forms one of a bundle of approaches used to clean and maintain a safe hospital environment and to stop the transmission of contagious and infectious microorganisms, including multidrug-resistant microbes. Finally, antibiotic stewardship also has a crucial role in reducing the impact of HCAIs through conserving currently available antimicrobials.
  15. Mohd Hatta FH, Samsudin EZ, Aimran N, Ismail Z, Sapian NAM
    Risk Manag Healthc Policy, 2024;17:455-471.
    PMID: 38481392 DOI: 10.2147/RMHP.S439914
    INTRODUCTION: Among available workplace violence (WPV) interventions, only data-driven, worksite-based, and risk-based approach WPV interventions had moderate evidence for effectiveness in decreasing the risk of WPV. The Questionnaires to Assess Workplace Violence Risk Factors (QAWRF) had been previously developed to determine the level of WPV risk factors in each healthcare setting based on the tripartite perspective of key stakeholders to enable effective WPV interventions. This study aimed to determine the construct validity and test-retest validity of QAWRF.

    METHODS: QAWRF, a three-component instrument consisting of QAWRF-Administrators, QAWRF-Workers, and QAWRF-Clients, had previously undergone content validation, face validation, and internal consistency reliability testing. 965 respondents were recruited to examine the construct validity of QAWRF, and a subset of these (n = 90) were retested again at an interval of three weeks to assess its test-retest reliability. Confirmatory factor analysis (CFA) was performed, and fitness indices, average variance extracted, correlation coefficient, composite reliability, and intraclass correlation coefficient were determined.

    RESULTS: QAWRF-Administrator, QAWRF-Worker, and QAWRF-Client had acceptable factor loadings (≥0.6), absolute fit (Root Mean Square Error of Approximation > 0.1), incremental fit (Confirmatory Fit Index and Tucker Lewis Index > 0.9), parsimonious fit (Chi-square/degree of freedom < 5), correlation coefficient between construct (≤0.85), discriminant validity index, and construct reliability (≥0.6). CFA supported a four-factor model for QAWRF-Administrator and QAWRF-Worker, and a two-factor model for QAWRF-Client.

    CONCLUSION: QAWRF holds good construct validity and test-retest reliability. By using QAWRF, healthcare managers can identify specific WPV risk factors that are perceived by stakeholders as prevalent at a particular workplace, and these findings can contribute towards data-driven, worksite-specific, and targeted WPV interventions in healthcare settings that are expected to be resource-efficient and more effective than general WPV interventions.

  16. Cheng SL, Yusuf A, He YY, Tang WZ, Sulaiman NABS
    Risk Manag Healthc Policy, 2024;17:843-853.
    PMID: 38617594 DOI: 10.2147/RMHP.S453184
    PURPOSE: The purpose of the study was to determine the status of spiritual needs and influencing factors of postoperative breast cancer (BC) women undergoing chemotherapy.

    PARTICIPANTS AND METHODS: This study is a cross-sectional study. A total of 173 participants completed a general information questionnaire and a Chinese version of the Spiritual Needs Scale at the Guangxi Medical University Cancer Hospital. Data were collected by purposive sampling from December 2022 to April 2023. Data were analyzed by descriptive statistics, independent t-test, ANOVA, non-parametric test, and logistic regression analysis.

    RESULTS: The spiritual needs of postoperative BC women undergoing chemotherapy were at a high level (84.20 ± 12.86). The need for "hope and peace" was considered paramount and the need for a "relationship with transcendence" was considered the least important. Significant differences were found in the following: spiritual needs total score (P=0.040) and "hope and peace" (P=0.021) in education level; "love and connection" in disease stage (P=0.021); "meaning and purpose" in education level (P=0.013), household income (P=0.012), and payment method (P=0.015); "relationship with transcendence" in religion (P<0.001); and "acceptance of dying" in marital status (P=0.023). The level of education was the influencing factor of spiritual needs (OR=1.50, P=0.005), especially for "hope and peace" (OR=1.50, P=0.012).

    CONCLUSION: The spiritual need of postoperative BC Chinese women undergoing chemotherapy is at a high level and should receive more attention. In clinical work, nurses should fully assess the spiritual needs of patients and meet their specific needs. Results may help nurses to develop targeted and comprehensive spiritual intervention strategies according to the characteristics of patients.

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