Gaining insight into patients' experience of adherence to hypertensive treatment

Hypertension is one of the major risk factors for coronary heart disease and the most important factor for cerebrovascular diseases. Adherence to treatment is a fundamental pre-requisite for therapeutic benefit in hypertensive patients. Adherence is a complex behavioural process that is strongly influenced by the way in which patients live, as well as the psychological and social support system. Aim: To understand and conceptualize the experience of people on long-term antihypertensive treatment Method: Qualitative analysis using semi-structured interviews with ten hypertensive patients from the medical clinic of Kuala Lumpur General Hospital. Results: Although the participants were aware of having high blood pressure they declined receiving any treatment at the early stage of the disease. Fear of death and disease complications are reinforcements for participants to adhere to medication. They perceived the label of "hypertension" will affect their self-identity and social role. Positive thinking regarding medication assists participants to adhere to treatment. Conversely, participants who perceived medication negatively also adhere to a medication regime, as adherence behaviour satisfies the family. Participants justified modifying their regimen or taking Complementary and Alternative Medicine (CAM) as they believe know the their body best. However, participants wished to obtain more information regarding hypertension and its treatment from the doctors. Conclusion: In finding the fine balance between stepping in and holding back treatment and care, health professionals need to know their clients in context. This balance can only be achieved by establishing processes of negotiation within an ongoing therapeutic relationship

Parents perceptions of their children body fat percentage and weight

Parents’ perception of their children’s weight and fat percentage may play an important role in developing and maintaining healthy lifestyle. This study was conducted to determine the perceptions of parents of first-grade studentsin a Malaysian urban school setting regarding their children’s weight and body fat percent. A descriptive statistic was used in the study. A number of 197 first-grade students participated in this study. The students’ anthropometric data,such as weight, body mass index (BMI) and body fat were measured using TANITA TBF-410 GS Body Composition Analyzer. Also The questionnaire for parents used in the study included parents’ perception of their child body shape,body weight and eating habit. Results showed a statistically significant correlation between the parents perception and children’s real fat percentage with (r = −.46, p .05) was not significant. Results of the current study show that girls’ parents have misperceive of their children weight. In contrast to the focus of the previous studies on prevalence of overweight among children, most of the underweight children in this study were perceived as normal

Mental trauma experienced by caregivers of patients with diffuse axonal injury or severe traumatic brain injury

Context: As with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach. Evidence Acquisition: Qualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist. Results: Caregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver. Conclusions: A long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of caregivers. Unless research on TBI or DAI trauma is given its proper attention, the burden of trauma and injury on societies will continue to exacerbate globally

The influence of culture on analgesic consumption: a retrospective study among Malaysian patients after breast cancer surgery

This study was carried out to determine the relationship between ethnicity/culture and analgesic consumption among patients from three main ethnic groups in Malaysia after breast cancer surgery. A retrospective study design was adopted, using medical records of 80 patients. The findings showed that the analgesic most consumed by the patients during the 48 hour post-operative period was morphine equivalents (85%), followed by non steroidal anti-inflammatory drugs (60%) and paracetamol (38%). No relationship was found between ethnicity/culture and the type or amount of analgesic consumption

Rural primary school children body fat and their parents' physical image perceptions

Parent’s perception of their children’s physical images such as body shape or type, weight and eating habit plays an important role in determine their attitude toward their children’s development. This study was conducted to determine perceptions of rural schools’ parents or guardians regarding their children’s body shape, weight and eating habit and to investigate whether there was a correlation with the children’s body fat mass measured with bio impedance analyzer. This descriptive study was conducted in selected rural areas located in the East of Peninsular Malaysia. A total number of 145 year one school children and their parents or guardians (total 145) participated in this study. A questionnaire was developed to measure the parents’ or guardians’ perceptions, while the children’s actual body fat mass was measured separately using Tanita body composition analyzer. Body fat mass results showed that majority of the rural primary school children had less body fat mass for both gender. Correlation analysis using Chi-square indicated that there were significant association presences between the body fat mass with body shape, body weight and eating habit. The reported Chi-square values were X2 (3)=27.15, p<.01 for body shape, X2 (3)=22.68, p<.01 for body weight and X2 (3)=19.67, p<.01 for eating habit, respectively. In conclusion, early awareness pertaining their children’s physical images changes will contribute to a more successful prevention and treatment of obesity among children, and this will have an impact in term of reducing the adult incidences of cardiovascular diseases in the near future

Recalling ICU experiences: patients' perspectives

Patients in ICU are commonly in a critical condition and they need several types of support such as mechanical ventilation to sustain their life. However, the supports provided can also create an unpleasant experience even after they have been discharged from ICU. This study aims to determine the types of unpleasant experiences suffered by post ICU patients during their ICU stay. Approximately 65.4% of the post ICU patients were able to recall the physical and psychological effects of their ICU experience, with the five most stressful experiences being endotratracheal suctioning, pain, confinement to bed, general discomfort, ventilator dependence and needle punctures. This study provides a set of baseline information to the health care providers especially nurses to improve patient care in the ICU

Depression, anxiety and quality of life in stroke survivors and their family caregivers: a pilot study using an actor/partner interdependence model

Background:Depression and anxiety are common in stroke survivors as well as their family caregivers. However, it is not known whether each person's emotional distress contributes to their partner's quality of life (QOL). Objective:This study aimed to examine the effect of depression and anxiety on QOL in stroke survivor-caregiver dyads using dyadic analysis technique - the Actor-Partner Interdependence Model (APIM).Methods:This was a cross-sectional pilot study with a total of 30 participating dyads (30 stroke survivors and 30 family caregivers) from Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia. This pilot study was conducted over a period of 3 months, between December 2014 and February 2015. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). QOL was assessed using the Short Form-12 Health Survey (SF-12). All analyses were carried out using IBM SPSS version 22. Dyadic data were analysed using multilevel modelling (MLM).Results:Depression was uniquely associated with an individual's own QOL. Survivors and caregivers with higher depression had poorer physical component summary (PCS) scores and mental component summary (MCS) scores. Stroke survivor's depression exerted a significant actor effect on their PCS (b=-1.42, p=0.001) and MCS (b=-1.52, p<0.001). Caregiver's depression exerted a significant actor effect on their PCS (b=-2.53, p<0.001) and MCS (b=-1.51, p=0.004). Caregivers' anxiety negatively influenced their own MCS (b=-0.58, p=0.031). Furthermore, depression exerted a significant partner effect on PCS in stroke survivors (b=-1.19, p=0.003). Caregivers' depression was also related to their stroke survivors' poorer QOL, particularly PCS. Conclusion:The findings suggest that depression affects the QOL of both stroke survivors and caregivers, not only emotionally but also physically. This dyadic study also has evidence pointing to depression in caregivers and its association with stroke survivors' physical QOL

Pain management knowledge among medical ward nurses in Malaysia

Pain, a common symptom for patients in medical wards, can be relieved by effective pain management, with nurses playing a vital role in this regard. A study was undertaken to determine the knowledge of nurses on pain management and to examine the factors that influence their acquisition of such knowledge. A total of 143 medical ward nurses (representing 60% response) in a government referral hospital in Malaysia participated in the study. Data from this study derived from a set of questionnaires were analysed using 2 x 2 contingency tables and the chi squared test with Yate’s correction. Approximately two thirds of the nurses were deficit in knowledge regarding pain management, registering a mean knowledge score of 40.5 out of a possible 100 points. There was no significant association between the level of knowledge on pain management and demographic characteristics such as age and work experience. There was also no significant relationship between the level of knowledge on pain management and the pain courses attended. A better understanding of the factors that affect the acquisition of such knowledge could provide useful information that can be incorporated in an improved educational program on pain management for nurses

raumatic brain injury : caregivers' problems and needs.

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders

Perception of intensive care unit stressors by patients in Malaysian federal territory hospitals.

The Intensive Care Unit (ICU) is a therapeutic place for monitoring critically ill patients. However, it is a stressful area for the patients and it is causing them great anxiety. Previous studies have identified three groups of stressors in ICU namely; physical, psychological and environmental.The aims of this study were to determine the ICU stressors as experienced by patients and to determine the level of stressors felt by patients in ICU. A cross sectional study was done on 70 patients from two tertiary hospitals in Malaysia. A face-to-face interview with structured questionnaire was used for patients. Data collection occurred from 15 December 2006 to 31 January 2007.The five major ICU stressors perceived by patients were pain, being stuck with needles, boredom, missing their spouses and being too hot/cold.The ICU physical stressors were the major items ranked by post ICU patients.The findings from this study provided a set of baseline information to the health care providers, particularly ICU nurses in Malaysia, with which to provide better care for the patients in ICU