Displaying all 10 publications

  1. Saddki N, Mohamad Sani FE, Tin-Oo MM
    Nurs Crit Care, 2017 Mar;22(2):89-98.
    PMID: 25349099 DOI: 10.1111/nicc.12119
    AIMS: This study aimed to determine attitudes and practices of intensive care unit (ICU) nurses towards provision of oral care for intubated patients.

    BACKGROUND: Oral care is as an essential nursing intervention for intubated patients to maintain patient comfort and prevent colonization of dental plaque by respiratory pathogens.

    DESIGN: This was a cross-sectional study.

    METHODS: Data were collected from 93 ICU nurses of a teaching hospital in the East Coast of Peninsular Malaysia using a self-administered questionnaire.

    RESULTS: Some nurses agreed that oral cavity of intubated patients was difficult (40·8%) and unpleasant (16·2%) to clean, but all of them realized the importance of oral care and the majority (97·9%) would like to learn more about it. Most nurses reported providing oral care at least two times daily using various methods and products such as suction toothbrush (90·4%), manual toothbrush (49·5%), cotton swab (91·5%) and foam swab (65·7%). Chlorhexidine gluconate oral rinse was the preferred mouthwash (97·8%) and swabs (93·5%) solution although few used non-optimal products such as sodium bicarbonate (14·0%), tap water (4·3%) and hydrogen peroxide (3·2%) to wash their patients' mouths. While the majority of nurses agreed that oral care supplies and equipments were available (93·6%) and suitable (88·2%), most of them also thought they need better hospital support (88·2%).

    CONCLUSIONS: The nurses' attitudes towards oral care were generally positive and most oral care methods were appropriate. However, some methods and products used were inconsistent with the current recommendations and they have mixed views about the suitability of oral care supplies and equipment provided by the hospital.

    RELEVANCE TO CLINICAL PRACTICE: Recommendations were made for providing standard oral care protocols for intubated patients and oral care training programs for ICU nurses to support delivery of quality patient care.

  2. Ramoo V, Abdullah KL, Tan PS, Wong LP, Chua PY
    Nurs Crit Care, 2016 Sep;21(5):287-94.
    PMID: 25271143 DOI: 10.1111/nicc.12105
    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.

  3. Atefi N, Abdullah KL, Wong LP
    Nurs Crit Care, 2016 Jan;21(1):8-17.
    PMID: 25270664 DOI: 10.1111/nicc.12100
    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.

  4. Darsin Singh SK, Ahmad A, Rahmat N, Hmwe NTT
    Nurs Crit Care, 2018 Jul;23(4):186-191.
    PMID: 27071369 DOI: 10.1111/nicc.12240
    BACKGROUND: Coronary heart disease has emerged as a number one killer in Malaysia and globally. Much of the morbidity and mortality in acute coronary syndrome patients is because of patients not recognizing their symptoms which contributes to delay in seeking early treatment.

    AIM: The aim of this study is to evaluate the effectiveness of a nurse-led health education programme on knowledge, attitude and beliefs of coronary patients towards the responses to acute coronary syndrome and the association with patients' characteristics.

    METHODS: A single-group quasi-experimental design took place in a tertiary hospital. A total of 60 coronary patients were recruited to this study. The knowledge, attitude and beliefs towards acute coronary syndrome (ACS) were evaluated at baseline and after 1 month of giving education intervention.

    RESULTS: Knowledge, attitude and beliefs about ACS increased significantly from baseline to 1 month after intervention. Level of attitude was associated with gender, educational level and employment status.

    CONCLUSIONS: The findings of this study suggest that an education program conducted by a nurse improved patients' level of knowledge, attitudes and beliefs in response to ACS symptoms at 1 month compared to baseline, but whether they are sustained for a longer period is unclear. Improving the responses towards ACS might reduce decision delay in symptom interpretation and seeking early treatment.

    RELEVANCE TO CLINICAL PRACTICE: Nurse-led interventions have imparted positive outcomes in response to ACS symptoms among coronary patients. Therefore, nurses should take the initiative in educating patients to minimize delay in symptom interpretation and seeking early treatment.

  5. Ramoo V, Abdullah KL, Tan PS, Wong LP, Chua YP, Tang LY
    Nurs Crit Care, 2017 May;22(3):141-149.
    PMID: 25913373 DOI: 10.1111/nicc.12180
    BACKGROUND: Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients.

    AIMS AND OBJECTIVES: This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes.

    DESIGN: A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention.

    METHODS: A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention.

    RESULTS: Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low (M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions (M = 3·68, SD = 1·13) and nurses' workload (M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities.

    CONCLUSIONS: Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills.

    RELEVANCE TO CLINICAL PRACTICE: Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses.

  6. Alkhawaldeh JMA, Soh KL, Mukhtar FBM, Peng OC, Anshasi HA
    Nurs Crit Care, 2020 03;25(2):84-92.
    PMID: 31840391 DOI: 10.1111/nicc.12489
    BACKGROUND: The level of occupational stress of nurses working in intensive and critical care units is high. Although many studies have assessed the effectiveness of stress management interventions among intensive and critical care nurses, the methodological quality of these studies remains unclear.

    PURPOSE: The purpose of this review was to summarize and appraise the methodological quality of primary studies on interventions for management of occupational stress among intensive and critical care nurses.

    METHODS: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify primary studies that assessed the effectiveness of interventions in managing occupational stress among intensive and critical care nurses using multiple databases from January 2009 to June 2019.

    RESULTS: Twelve studies published between 2011 and 2019 were eligible for inclusion. These included studies were classified as being of good or fair quality. The consensus across the included studies was that, compared with control condition, cognitive-behavioural skills training and mindfulness-based intervention were more effective in reducing occupational stress among intensive and critical care unit nurses.

    CONCLUSION: Further research should focus on methodologically strong studies by blinding the outcome assessors, using Randomized Controlled Trial (RCT) design with an active control group, using standardized assessment tools, and reporting enough details about the stress management intervention-related adverse events.

    RELEVANCE TO CLINICAL PRACTICE: This review demonstrates the need for high methodological quality studies to rigorously evaluate the effectiveness of stress management interventions before it can be recommended for use in clinical practice to reduce stress in intensive and critical care unit nurses. In addition, attention should be given to developing research protocols that place more emphasis on interventions aimed at the organization level to address the growing problem of occupational stress among intensive and critical care nurses.

  7. Chi SY, Soh KL, Raman RA, Ong SL, Soh KG
    Nurs Crit Care, 2022 Feb 02.
    PMID: 35108749 DOI: 10.1111/nicc.12758
    BACKGROUND: The prevalence of heart failure is increasing, associated with high mortality and rehospitalization rate. The complexity and progressive clinical syndromes of heart failure have massively affected patients' quality of life. Heart failure self-care education provided by nurses seems to improve patients' knowledge and the clinical outcomes despite being in critical care or community settings. Nurses often gained heart failure self-care knowledge from formal and informal educational resources. However, the extent of knowledge acquired by nurses needs to be investigated before patient education could be successfully carried out.

    AIMS: This systematic review identified the nurses' knowledge of heart failure self-care education according to the topics and factors that would be substantial to increase their knowledge.

    METHODS: Literature resources from Medline, CINAHL, Ovid, Science Direct, Scopus and Google Scholar from 2002 to 2020 were studied and reviewed. This systematic review included nurses that take care of heart failure patients and studies that measured their knowledge score. The quality of all studies was determined using the JBI SUMARI Critical Appraisal tool, and a narrative approach was used to analyse the results.

    RESULTS: 15 studies were selected, involving 1644 nurses that had experience in taking care of heart failure patients. The overall mean ± SD score of nurses' knowledges was unsatisfactory with 12.1 ± 2.7 to 17.3 ± 1.4, respectively, and it showed a significant increase in the level of knowledge after attending a heart failure speciality course or educational intervention. The majority of the nurses were uncertain about the deteriorating symptoms and fluid management for heart failure patients.

    CONCLUSIONS: The nurses' level of knowledge was unsatisfactory, and therefore they need more in-depth learning and understanding of the heart failure topic through educational interventional.

    RELEVANCE TO CLINICAL PRACTICE: Critical care nurses needed to have in-depth knowledge to recognize symptoms of deterioration in heart failure patients, especially during the decompensated stage.

  8. Ying LY, Ramoo V, Ling LW, Nahasaram ST, Lei CP, Leong LK, et al.
    Nurs Crit Care, 2021 11;26(6):432-440.
    PMID: 32929840 DOI: 10.1111/nicc.12551
    BACKGROUND: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia.

    AIMS AND OBJECTIVES: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables.

    DESIGN: This was a cross-sectional survey.

    METHODS: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ2 and hierarchical logistic regression tests were used to analyse the data.

    RESULTS: A total of 229 CCNs completed the self-administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave.

    CONCLUSION: This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases.

    RELEVANCE TO CLINICAL PRACTICE: Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses.

  9. Murugiah UR, Ramoo V, Jamaluddin MFH, Yahya A, Baharudin AA, Abu H, et al.
    Nurs Crit Care, 2021 09;26(5):363-371.
    PMID: 33569880 DOI: 10.1111/nicc.12600
    BACKGROUND: Nurses play a key role in the proper management of endotracheal tube (ETT) cuff pressure, which is important for patients' safety, so it is vital to improve nurses' knowledge on safe cuff management practices.

    AIMS AND OBJECTIVES: This study aimed to evaluate the effectiveness of an educational intervention related to ETT cuff pressure management on improving and retaining critical care nurses' knowledge.

    DESIGN: A single group pre-post interventional study was conducted involving 112 registered nurses (RNs) from a 24-bed adult general intensive care unit at a teaching hospital in Malaysia.

    METHODS: The educational intervention included a theoretical session on endotracheal cuff pressure management and demonstration plus hands-on practice with the conventional cuff pressure monitoring method. Nurses' knowledge was measured using a self-administered questionnaire pre- and post-intervention. Data were analysed using repeated measure analysis of variance and bivariate analysis.

    RESULTS: In this study, 92% of the total number of RNs in the unit participated. A significant difference in mean knowledge score was noted between the pre- (mean = 8.13; SD = 1.53) and post-intervention phases (3 months [mean = 8.97; SD = 1.57) and 9 months post-intervention [mean = 10.34; SD = 1.08), P 

  10. Rosli SN, Soh KL, Ong SL, Halain AA, Abdul Raman R, Soh KG
    Nurs Crit Care, 2023 Jan;28(1):109-119.
    PMID: 35023244 DOI: 10.1111/nicc.12748
    BACKGROUND: Physical assessment skills are essential to clinical decision-making in nursing as they help nurses to identify and respond to patients' deterioration. Nurses develop confidence and can detect any out-of-range parameters in diagnosing and treating patients. Prior studies surveyed 120 skills but did not explicitly assess critical care.

    AIM: To determine the range of physical assessment skills practised by critical care nurses and their adoption factors.

    STUDY DESIGN: This study uses a cross-sectional survey design. A self-administered questionnaire evaluating 40 physical assessment skills was conducted with 133 staff nurses (response rate: 96.4%) in three critical care units at a Malaysian government hospital between November 2019 and January 2020.

    RESULTS: Most nurses applied 32 (80%) skills during every working shift, involving the vital signs and all body systems except the gastrointestinal system. Five skills (12.5%) were occasionally applied, while three skills (7.5%) were rarely applied or not part of most nurses' clinical practice. About 20% of the nurses did not routinely check the respiration rate. Medical and surgical intensive care unit nurses (U = 1129, p 

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