Improving health outcomes by preventing intensive care related infection in Malaysia Intensive Care Unit (INVEST study)

Ventilator-associated pneumonia (VAP), catheter-related blood stream infection (CRBSI) and pressure ulcers (PU) are well recognized complications in intensive care units (ICUs). Many of these are preventable but can also complicate patient recovery, prolong length of stay, increase costs, morbidity and mortality. In Malaysia, the majority of studies investigating VAP and CRBSI in Malaysia have focussed on identifying risk factors, diagnostic criteria and treatment of ICU-related complications. Further, in spite of the burden of PU there are limited studies undertaken in Malaysia and few of these have been nurse-led. Importantly, to date there has been limited investigation of the efficacy and effectiveness of quality improvement initiatives and the contextual issues impacting on clinical practice improvement in Malaysia.In spite of the increasing emphasis on quality assurance in Malaysian ICUs there has been a limited focus on nurse-specific interventions and the majority of projects have been initiated by physicians. This study has evaluated the utility of a nurse-led action research project to drive clinical practice improvement in the ICU and is significant in demonstrating the capacity of nurses to critique and control their practice. The project conducted for this thesis was called the Improving health outcomes by preveNting intensiVe care related infEction in Malaysia intenSive care uniT - INVEST study. The INVEST Study as reported in this thesis has been undertaken using an action research approach to improve the uptake of evidence-based strategies to prevent infection in the ICU in the Malaysian cultural context.The aims of this thesis were to identify best practices, evaluate the current nursing practice in prevention of VAP, CRBSI and PU in ICU patients in a single Malaysian ICU, and evaluate the impact of the evidence-based interventions to improve patient outcomes. The specific and research objectives of this study were to:1. Identify best practice interventions for preventing VAP, CRBSI and PU in the ICU. 2. Document the current rates of VAP, CRBSI and PU in an ICU in Malaysia. 3. Implement an action research intervention to collaboratively develop and implement strategies for improvement 4. Assess the impact of the intervention on clinical outcomes, staff dynamics, work place culture and sustainability of practice change An action research approach was used in this study to involve and empower nurses and drive practice change. A literature review identified that many action research studies conducted in the ICU were mainly most focused on process measures and not outcomes. In this study the data were collected in three phases following the action research cycles which comprised of a period of planning, acting, observation, reflecting and re-planningIn Phase I of the thesis current best practice interventions for the prevention of VAP, CRBSI and PU in ICU are described. A literature search was conducted to identify evidence-based practices (EBP) that were recommended by bodies to improve the prevention of VAP, CRBSI and PU. A core set of nursing activities was identified in preventing the complications of VAP, CRBSI and PU. These were hand washing, hygiene care, positioning of patient, elevation of the head of bed and providing adequate nutrition.Pre- intervention data collection consisted of an environmental scan, including interview with the key stakeholders, patient profiling and a nurse survey. Twenty-one cases of ICU complications were identified in 18 of the 91 patients (19.8%) admitted in December 2009. Of the patients, three developed two complications - PU and VAP (two patients) or CRBSI (one patient). The findings indicated that this ICU had a high case load due to the high ICU bed demand. Patients needing ICU care were being nursed in general wards due to the unavailability of ICU beds.Nurses reported a good knowledge of prevention strategies with a mean score of 124.84 ±SD14.66 and reported a high level of positive regard for their professional practice environment based on the results of Revised Professional Practice Environment (RPPE). Three components had mean scores of ≥3 and five 55%. The nurses reported a positive regard for their practice environment in the pre- and post-intervention groups. The mean scores for each component were comparable for both the pre- and post-intervention groups except for Internal Work Motivation, Control Over Practice and Staff Relationship With Physician. The highest mean scores within the eight components for the post-intervention group were for Internal Work Motivation (M 3.13; SD 0.27), Relationship With Physician (M 3.04; SD 0.33) and Cultural Sensitivity (M 3.01; SD 0.23). The three lowest were for Handling Disagreement and Conflict (2.80; SD 0.20), Control Over Practice (2.71; SD 0.34) and Teamwork (2.48; SD 0.31).There was a reduction in overall complications from 19.8% to 8.7%. Few nurses in the focus group were optimistic that at least some changes had taken place, and positively improving their knowledge on assessment of patients and some of their common practices in the ICU. The challenge, which they were presently facing was the implementation of hospital information system because most of them were not knowledgeable in information technology.The main outcome of this study was that there was a reduction in number of patients with PU from 16 to 6 in pre and post intervention groups. This reduction of PU was statistically significant (χ[superscript]2=8.14, df=1, p=0.04).In conclusion whether there was a real improvement in patient care provided due to the interventions given was not able to be determined due to methodological considerations and inability to control for confounders. These data underscore the importance of considering cultural factors, both organisational and societal in quality improvement initiatives and empowering nurses for practice change. A risk management system which acknowledges competing demands in dynamic, real world environments is important to consider in future quality improvement studies. The series of studies presented in this thesis have contributed to understanding of factors influencing implementation and sustainability of quality improvement initiatives in a Malaysia ICU. Information acquired from the thesis will be useful information for further improvement targeting education, services, research, policy and future quality improvement project plans in Malaysia

The impact of an eight-week aerobic and strength-training programme on agility and leg power of Malaysian netball players

The purposes of the study were: (1) to determine the agility and leg power among Malaysian national junior netball players and (2) to determine the impact of eight-week aerobic and strength-training programme on these two variables. A total of 21 netball players from Bukit Jalil Sport School were selected as the subjects in this study. The SEMO Agility Run test was used to determine the agility level while leg power was measured using the Vertical Jump test. Pre-test and post-test results showed no significant differences in the agility and leg power level among the netball players. The mean values for the agility and leg power post-test were 12.59 (SD = 0.56) seconds and 50.24 (SD = 4.90) cm respectively. The pre-test and post-test results for different playing positions recorded the highest improvement in agility and leg power among attacker, followed by centre, and defender. Thus, the training conducted in this study was found to have improved agility and leg power marginally, especially among attacker and centre netball players

The role of culture in quality improvement in the intensive care unit: a literature review

Improving the quality of patient care and patient outcomes is a major concern internationally. In a developing health care system, implementing quality improvement is challenging due not only to resource and workforce issues but also cultural factors. Using the method of a focussed literature review, this paper discusses the importance of assessing a societal view of culture, social mores and customs, and power relationships in quality improvement activities using the intensive care unit as an exemplar. We conclude that implementing quality improvement strategies in a developing health care system needs to address the broader perspectives of social and cultural systems particularly hierarchical relationships and issues of non-disclosure

Physical activity and health promoting lifestyle among bachelor of nursing students in Malaysia

Promoting healthy lifestyle among nurses is important because they play a crucial role in health promotion. The aims of this study are to assess the physical activity level and health-promoting lifestyle among Bachelor of nursing students in Malaysia. This study involved 66 student nurses who are currently pursuing a Bachelor degree in the local government universities. The YAMAX Digi-Walker pedometer was used to measure physical activity level, while the Health-promoting Lifestyle Profile II questionnaire was used to measure the nursing student’s health-promoting lifestyle. The HPLP II consists of six sub-scales which include health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Results showed that majority of the Bachelor of nursing students were categorised as “somewhat active” and lower with the mean of 7487.88±SD1900.75 step taken per day. Results of Health-Promoting Lifestyle Profile II showed that the Bachelor of nursing students are reported to have a positive health-promoting lifestyle with an overall mean score of 2.61±SD0.36. The highest mean score was reported in the spiritual growth with a score of 3.07±SD0.40, followed by interpersonal relations with a score of 2.93±SD0.40, and stress management with mean a score of 2.67±SD0.41. This study has discovered worrying signs of low physical activities level among the Bachelor of nursing students in two universities in Malaysia which may need immediate attention by the health care authorities. Immediate remedial is recommended to overcome the current status of physical activities level among the nursing students which may have an impact on the future health of the Malaysian general populations

Kolobrasi bersama John Hopkins School of Nursing, A.Syarikat

BALTIMORE (Amerika Syarikat), 30 Ogos – Pensyarah Jabatan Kejururawatan dan Rehabilitasi, Fakulti Perubatan dan Sains Kesihatan (FPSK), Universiti Putra Malaysia (UPM), Prof. Madya Dr Soh Kim Lam menjalani sangkutan penyelidikan sebagai Visiting Scholar di John Hopkins School of Nursing di Baltimore, Amerika Syarikat melalui Program Nobel Laurette oleh Pusat Pengurusan Penyelidikan, UPM

Nurses’ perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study

Background: Quality improvement projects have been widely adopted to prevent complications in the ICU. Objective: This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. Design: A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. Results: The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Discussion: Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU

Physical profile comparison between basketball and netball players in Malaysia based on performance and playing position

The aim of the research is to compare the physical profile between Malaysian women basketball players and netball players. The physical profile measures were height, body mass, and body fat. The subjects were divided into two groups based on their playing performance and positions. The playing performance consisted of elite/senior, junior, and reserve players. Meanwhile, the playing positions consisted of forward/attack, centre, and guard/defence. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results showed that there were significant differences in body fat percentage between basketball player and netball players (p < 0.01). The elite/senior basketball players were reported to have the lowest body fat percentage as compared to other basketball or netball players. While for the playing position, guard/defence position basketball players were reported to be the shortest and have the lowest body fat percentage as compared to other playing positions. In conclusion, Malaysian basketball players were found to have better physical or bodily advantaged in terms of playing contact sports as compared to the Malaysian netball players

Comparison between two methods of variable resistance training on body composition, muscular strength and functional capacity among untrained males

Several studies have shown a positive association between variable resistance training (VRT) and improvements in muscular performance. However, the effects of VRT on body composition among untrained individuals remain unclear. The objective of this study was to examine the comparison between of methods of VRT on body composition, muscular strength and functional capacity among untrained male adults. Fifty healthy untrained males (age: 21.5 ± 1.95 years) were selected randomly and assigned into three groups: combined weight and chain (WC), combined weight and elastic band (WE), and free-weight (CG). All three groups completed 12 weeks of high intensity resistance training (70-80% of one-repetition maximum) with three sets of 8-12 repetitions two times per week. Approximately 65% of the whole resistance was provided by free-weights, while the other 35% of the resistance was provided by chains and elastic bands for the WC and WE groups, respectively. Dependent variables including body composition, muscular strength and functional capacity using bioelectrical impedance analyzer, one-repetition maximum and maximum repetitions to muscular fatigue were measured, respectively in pre-test, post-test 1 (week 6) and post-test 2. Significance level was set at P 0.05), all groups showed a significant reduction in fat mass and significant increase in fat-free mass during and after the intervention (P = 0.0001), and these differences were insignificantly greater in WE and WC groups compared with CG group. Furthermore, all three groups showed significant improvements in muscular strength and functional capacity during and after intervention (P = 0.0001), and muscular strength and functional capacity were greater in WE and WC groups compared with the CG group, but there were not significant differences in muscular strength and functional capacity between WE and WC groups. However, the WE group showed insignificantly more improvement in muscular strength and functional capacity compared with the WC group during and after the intervention. The results of this study show that VRT has a slightly better effect than free-weight to improve body composition during and after 12 weeks intervention. Also, WE training had a slightly better effect than WC training in improving muscular strength and functional capacity during and after 12 weeks of VRT among untrained male adults

Body fat comparison between basketball and netball players in Malaysia

The aim of the study was to compare the body fat percentages between Malaysian national women basketball players and netball players. Both basketball and netball players were elite players who represented Malaysia in the 1997 Southeast Asia Games in Jakarta, Indonesia and the 1998 Commonwealth Games in Kuala Lumpur. The percentage of body fat was determined by means of skinfold measurement at seven different locations. Results of the findings showed that overall, the basketball players had higher percentages of body fat than netball players. The average percentages of body fat of basketball and netball players were 19.68 ± 4.93% and 18.93 ± 4.41%, respectively. Both Malaysian national basketball and netball players' average percentage of body fat were found to be higher than the ideal average percentage of body fat range between 10-16% for female athletes in elite team sports. The players in the defence position in basketball were found to have the highest percentage of body fat (23.00%), followed by centre position players (21.62%) and attack position players (15.10%). These results differed from netball players' in similar playing positions. Among the netball players, the defence position players had the highest percentage of body fat (21.00%), followed by attack position players (18.63%), and centre position players (16.57%)

Effects of 12 weeks combined weight and chain versus combined weight and elastic band variable resistance training on upper and lower body muscular strength and endurance among untrained males in Iran

Several studies have shown a positive association between variable resistance training (VRT) and the improvement of muscular performance. However, the most effective method of VRT to improve muscular performance in untrained individuals remains unclear. The objective of this study was to examine the effects of two methods of VRT on maximal muscular strength and endurance among untrained male adults. Fifty apparently healthy untrained males (age: 21.5 ± 1.95 years) were selected randomly and assigned into three groups: combined weight and chain (WC), combined weight and elastic band (WE), and freeweight (CG). All three groups completed 12 weeks of high intensity resistance training (70-80% of one-repetition maximum) with three sets of 8-12 repetitions, two times per week. Approximately 65% of the whole resistance was provided by free-weights and the other 35% of the resistance was provided by chains and elastic bands for WC and WE groups, respectively. Dependent variables including maximal muscular strength and endurance using one-repetition maximum and maximum repetitions to muscular fatigue were measured, respectively, in the pre-test, post-test 1 (week 6) and post-test 2. The significance level was set at P < 0.05. No differences existed among all groups at baseline for dependent variables. A mixed model ANOVA with repeated measurements analysis revealed that all groups showed significant improvements in maximal muscular strength and endurance during and after the intervention (P = 0.0001). In WE and WC groups, maximal muscular strength and endurance were significantly greater than CG group during and after the intervention, and there were no significant differences between WE and WC groups in the maximal muscular strength and endurance during and after the intervention. However, the WE group showed an insignificant more improvement in maximal muscular strength and endurance compared with WC group after the intervention (chest press strength: 47.94 ± 4.2 vs. 46.76 ± 4.4 kg, squat strength: 85.29 ± 6.5 vs. 80.73 ± 6.4 kg, chest press endurance: 16.94 ± 1.24 vs. 15.47 ± 1.58 repetitions, and squat endurance: 17.94 ± 0.74 vs. 16.58 ± 1.66 repetitions). The results of this study show that VRT has a significant better effect than freeweight resistance training to improve upper and lower body muscular strength and endurance during and after 12 weeks intervention, in particular, WE training has a slightly better effect than WC training to improve upper and lower body muscular strength and endurance after 12 weeks of VRT among untrained male adults in Iran