Stigma towards Mental Illness among Healthcare Students: A Comparative Study of Nursing and Medical Programs in a Public University in Malaysia

Background: Stigma towards mental illness among healthcare students is a pressing issue, as their attitudes shape future patient care and influence societal perceptions. Despite the rising prevalence of mental health problems, evidence from Malaysia remains limited. This study aimed to compare stigma levels between undergraduate nursing and medical students. Methods: Using a convenient sampling approach, this cross-sectional study surveyed 240 nursing and medical students at a public university in the East Coast of Malaysia via the OMS-HC scale. The researchers applied descriptive statistics to summarize the data and utilized t-tests and Mann-Whitney U tests to perform inferential comparisons. Results: Nursing students reported significantly higher stigma scores (M = 35.6) compared to medical students (M = 32.1, p < 0.05). Across subscales, nursing students also showed more negative attitudes (Median = 17.0 vs. 15.0), greater social distance (Median = 8.5 vs. 8.0), and higher reluctance to disclose personal mental health issues (M = 10.1 vs. 9.2; all subscale differences were statistically significant at p < 0.05). Conclusion: Generally, nursing students demonstrated higher stigma than medical students. These findings highlight the need for curriculum reform, including structured anti-stigma education, reflective sessions, and mentorship, to foster more positive attitudes and reduce stigma among future healthcare professionals in Malaysia

Adherence to the Dialysis Regimen, Diet, and Fluid Restrictions among Hemodialysis Patients in Northern Region Malaysia

Background: Non-adherence to comprehensive management of chronic kidney disease (CKD) especially renal diet and fluid restrictions will hinder the effective management of the overall dialysis population. Long-term effects of indulging and overloading on food and drinks which are not suitable for the dialysis patient brings on a lifetime of suffering from a multitude of diseases such as cardiovascular and bone disease which eventually leads to death. The aim of this research project is to identify the dialysis regime, renal diet and fluid restriction among dialysis patients. Methods: This research is a quantitative descriptive cross-sectional design. The sample was distributed using convenience sampling method with inclusion and exclusion criteria. 80 participants were recruited. The study tool was adopted from Standard for Private Hemodialysis Centre from the Malaysian Ministry of Health for Private Dialysis Centers. Results: Of the 80 participants, most were female (62.5%) and aged 18–25 years (41.3%). Although almost all (98.8%) adhered to the prescribed thrice-weekly hemodialysis (HD) schedule, a notable proportion skipped sessions (31.3%) or ended treatments early (67.5%). Mean adherence scores indicated moderate compliance for fluid (4.123 ± 1.524) and diet (3.988 ± 1.563) management, and low compliance for the dialysis regime (1.44 ± 0.524). Overall, 38.75% had poor, 60% moderate, and only 1.75% good adherence, with no significant association between demographic variables and compliance, highlighting the need for targeted behavioural and educational interventions. Conclusion: Adherence to dialysis, fluid, and diet regimes was generally moderate to low, underscoring the urgent need for patient-centred education and behavioural interventions to improve compliance regardless of demographic background

Education-Based Nursing Management of Vascular Access Complications in End-Stage Renal Disease: A Case Study

Background: End-stage renal disease (ESRD) requires lifelong haemodialysis (HD) therapy. Functional vascular access is a key determinant of the success and adequacy of HD therapy and patient safety. Despites advance in vascular access management, catheter-related complications, such as luminal obstruction, continue to present significant challenges in clinical practice. This study aims to describe the education-based nursing management in addressing vascular access complications, particularly catheter obstruction in ESRD patient undergoing HD. Case Presentation: Mrs. AN, a 58-year-old woman with ESRD experienced complete obstruction of both lumens of her right subclavian catheter during HD therapy. The procedure was interrupted for 2 hours and 25 minutes despite a 45-minute heparin flush without success. Previously, a similar incident occurred, which was a month earlier. Conclusion: Nursing management of ESRD patients with catheter obstruction requires an integrated approach combining nursing education for patients and nurses with appropriate clinical interventions. This education encompasses vascular access care, early detection of obstruction, hygiene practices, and adherence to haemodialysis schedules. This case study highlights that effective nursing education has the potential to improve patients’ knowledge, skills, and adherence, thereby contributing to the prevention of recurrent complications, enhanced patient safety, and long-term therapeutic success

Professional Boundaries in Nurse-Patient Relationships: Perspectives of Undergraduate Nursing Students in Brunei Darussalam

Background: Professional boundaries in nurse-patient relationships are central to ethical practice, yet often difficult to define and maintain in day?to?day care. Undergraduate nursing students, who are still developing their professional identity, may be particularly vulnerable to boundary confusion. This study explored nursing students’ perceptions of the challenges and opportunities involved in navigating nurse-patient relationship boundaries. Methods: A descriptive qualitative study using conventional content analysis was conducted. Forty?two essays written by undergraduate nursing students enrolled in a nursing ethics course at a university in Brunei Darussalam were analysed. The essays responded to four structured questions about professional limits in care delivery, challenges and benefits of setting work boundaries, and the role of the Code of Ethics in boundary maintenance. Meaning units were identified, condensed, coded, and grouped into categories and themes. Credibility was enhanced through double coding of a subset of essays, peer debriefing with experienced qualitative researchers, and maintenance of an audit trail and reflexive notes. Results: Three overarching themes were identified: (1) Having professional relationships, describing students’ views of professionalism, trust, and power in the nurse–patient relationship; (2) Setting limits, highlighting students’ uncertainty about where and how to draw boundaries in situations such as self?disclosure, gift?giving, and caring for relatives; and (3) Taking responsibility, capturing students’ emphasis on self?reflection, seeking guidance, and clarifying expectations with patients. Conclusion: The findings suggest that these nursing students conceptualise professional boundaries primarily through the lens of professionalism and personal responsibility, while dealing with ambiguity in clinical situations. Educational strategies that openly address boundary dilemmas, such as gifts, social media use, and emotional attachment, using case?based discussion, guided reflection, and clear institutional policies, may strengthen ethical sensitivity and support students in developing safe, compassionate, and professionally accountable nurse-patient relationships

Nurses’ Knowledge and Perceptions in Initiating Cardiopulmonary Resuscitation (CPR): A Mixed Method Systematic Review

Background: Cardiopulmonary resuscitation (CPR) is a critical intervention that nurses are often the first to initiate in hospital settings. Resuscitation quality depends on nurses’ knowledge, and perceived capability or self-efficacy in executing the CPR. Despite standardised training programmes, global evidence highlights persistent gaps in knowledge and CPR competence, with implications for patient outcomes. This review aimed to synthesise evidence on nurses’ knowledge, and perceptions regarding CPR initiation in hospital settings. Methods: A mixed- method systematic review was conducted. Four major electronic databases were search from 2015 to 2025 for relevant studies. The databases were searched using Medical Subject Headings (MeSH) such as ‘CPR’, ‘resuscitation’, ‘knowledge’, ‘nurses’ perceptions and ‘cardiac arrest’. The included studies methodological quality was assessed using following Joanna Briggs Institute checklists and a narrative synthesis framework. Results: Twenty-five articles were appraised with the majority classified as moderate quality. A significant and widespread deficit in nurses' CPR knowledge and a critical gap between theoretical knowledge and practical application across diverse global settings while qualitative data highlighted the emotional strain and psychological burden experienced by nurses during resuscitation events. Additional barriers included limited institutional resources and insufficient organizational support. Triangulation of the evidence confirmed four consistent themes: persistent knowledge-practice gaps, the emotional and psychological impact on nurses, the efficacy of specific training models, and the influence of systemic and environmental barriers. Conclusion: Improving resuscitation effectiveness and sustainability demands continuous, evidence-based education to prevent skill decay while addressing systemic issues through strong organizational support and integrated psychological care

A Study Protocol to Explore Dementia Care Needs and Preferences from the Perspectives of Persons with Dementia and Family Caregivers in Malaysia

Background: Dementia is a growing public health issue in Malaysia, largely due to rapid population ageing. Despite this, the care needs and preferences of persons with dementia (PwD) and their family caregivers remain poorly documented. Existing care frameworks are often fragmented and lack coordination, limiting their effectiveness in supporting this population. This study protocol is to explore the needs and preferences of PwD and their family caregivers regarding dementia care, and develop the dementia care needs and preferences framework based on the perspectives of PwD and family caregivers. Methods: This study employs a qualitative research design. A total of 40 participants, comprising 20 PwD and 20 family caregivers, will be selected through purposive sampling from tertiary hospitals and community clinics in Kuantan, Pahang. Data will be collected through semi-structured interviews and supplemented with field notes. All interviews will be audio-recorded, transcribed verbatim, and analysed thematically using NVivo software. Results: The study will generate in-depth insights into the care needs and preferences of PwD and caregivers. The final findings are also intended to facilitate the development of a dementia care framework aligned with Malaysia’s Dementia Action Plan, which emphasises early diagnosis, risk reduction, and support for family caregivers. Conclusion: This research addresses a critical gap in dementia care in Malaysia. By incorporating the perspectives of both PwD and caregivers, the study aims to improve care delivery, and contribute to a more comprehensive dementia care framework

Self-Management of Hypertension in a Patient with Ischemic Heart Disease: A Case Report

Background: Ischemic heart disease (IHD) remains the leading cause of mortality worldwide, accounting for approximately 16% of global deaths. with hypertension as a major modifiable risk factor. While self-management strategies are widely recommended for blood pressure control, evidence from individual clinical contexts remains limited, particularly in illustrating how patient education supports day-to-day management alongside medical treatment. This case report aims to describe self-management practices and short-term blood pressure outcomes in a patient with uncontrolled hypertension and ischemic heart disease following structured self-management education. Case Presentation: A 65-year-old patient was diagnosed with ischemic heart disease and uncontrolled hypertension. Data was collected through patient interviews, clinical records, and blood pressure monitoring. The self-management intervention included education on lifestyle modification, dietary practices, physical activity, home blood pressure monitoring, and medication adherence.Following the self-management education, the patient demonstrated improved engagement in self-management behaviors, including regular blood pressure monitoring, dietary modification, increased physical activity, and improved medication adherence. A reduction in blood pressure readings was observed over the short follow-up period. However, the patient continued concurrent pharmacological treatment, which may have influenced the observed outcomes. Conclusion: This case report highlights the potential role of self-management education in supporting blood pressure control among patients with ischemic heart disease. While improvements were observed, the findings should be interpreted cautiously due to confounding effects of medication and the short follow-up period

A Bibliometric Analysis of Nurse Workforce Shortages in the Western Pacific Region

Background: The nursing workforce crisis has emerged as a critical challenge across the Western Pacific Region (WPRO), impacting both healthcare quality and access. This study presents a comprehensive bibliometric analysis of the workforce trends and key themes related to nursing shortages in the WPRO. Methods: A systematic language search was conducted using the Scopus database. Drawing on 319 articles indexed in Scopus between 2016 and 2025, the analysis employed VOS viewer and the Bibliometrix R-package to identify the key research trends, influential authors, and intellectual and conceptual structures in the literature. Results: Themes emerged: current trends, nursing shortages, factors contributing to workforce shortages, ensuing challenges, and strategies to remediate nursing shortages. Keyword analysis revealed system-level issues, including inadequate workforce planning, suboptimal working conditions, and limited nursing education capacity. Policy interventions, such as workforce redistribution, investment in education, and improvements in working conditions, are discussed as viable strategies. Conclusion: This study provides a comprehensive knowledge base for researchers and policymakers developing sustainable solutions to nursing workforce challenges in the Western Pacific Region

Nurses’ Experiences and Challenges in Handing Over 24-Hour Ward Reports: A Qualitative Study

Background: Effective nurse?to?nurse handover is critical for continuity of care and patient safety. This qualitative study explored nurses’ perspectives and experiences with the 24?hour ward report used during handover at a large tertiary hospital in Brunei. Methods:   Four focus groups were conducted with 28 nurses from medical and surgical wards. Sessions were audio?recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Results: Three themes emerged: (1) lack of standardised guidelines (2) frequent disturbances and workflow barriers; and (3) perceived effects of the report. Participant quotations illustrate each theme. Conclusion: Nurses identified organisational and procedural barriers to effective use of the 24?hour ward report and perceived both benefits and limitations for communication and continuity. Findings can inform targeted guidance, education, and intervention development. Further research should include observational assessment and evaluation of interventions linking handover practices to patient outcomes

The Impact of Electronic Cigarette on Mental Health Among Adolescents and Young Adults: A Systematic Review

ABSTRACT   Background: The use of electronic cigarettes (e-cigarettes) has risen significantly among adolescents and young adults globally. While the physical health risks are increasingly documented, the impact of vaping on mental health in this demographic requires further synthesis of the available evidence. This literature review aims to consolidate scientific evidence about the impact of e-cigarette use on the mental health of adolescents and young adults. Methods: A systematic literature review was conducted following the PRISMA protocol. Searches were performed in Scopus, PubMed, ProQuest, and Cochrane databases for publications from 2021 to 2025. The search strategy used keywords related to electronic cigarette, mental health, and young populations. After screening, 23 articles met the inclusion criteria for full-text analysis. Results: E-cigarette use and mental health were found to be significantly correlated negatively in the great majority of the previous studies. The most consistently identified impacts included increased symptoms of depression, anxiety, and psychological stress. Furthermore, e-cigarette was associated with more severe outcomes, including non-suicidal self-injury, suicidal ideation, poor sleep quality, and psychological distress. Longitudinal studies indicated that persistent e-cigarette could predict the future onset of depressive symptoms. These findings were consistent across diverse geographical and cultural contexts. Conclusion: E-cigarette use is associated with a range of adverse mental health outcomes among adolescents and young adults, from common disorders like depression and anxiety to severe risks such as suicidality. These findings point out the need for targeted public health interventions and international strategies to address the mental health risks of e-cigarette in younger populations.