Needs of family members of critically ill patients in a Critical Care Unit at Universiti Kebangsaan Malaysia Medical Centre

Fulfillment of the family needs for the critically ill patient in Critical Care Unit should be met by healthcare providers to improve patient’s quality of life. The purpose of this study was to identify the needs of family members of critically ill patients in a Critical Care Unit. A cross-sectional study was conducted on 109 family members of patient hospitalized at the Intensive Care Unit and Coronary Care Units of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The modified Critical Care Family Needs Inventory (CCFNI) comprised of 5 domains of family member’s needs: Information, Proximity, Assurance, Comfort and Support. The findings showed that assurance and information needs were the highest with (3.77 ± 0.306); (3.62 ± 0.379), proximity need (3.60 ± 0.415), support need (3.57 ± 0.477) and comfort need (3.55 ± 0.586), respectively. There was significant relationship between respondent’s relationship with family needs of proximity (p = 0.013). This study indicated that there were significant association between respondent’s monthly income and family needs of comfort and support, (p = 0.033) and (p = 0.004). There was also significant association between the gender with comfort need (p = 0.013). In this study, it was observed that information, proximity, assurance, comfort and support were opinioned as their requirements during hospitalization. Hence, it assists in coping while being admitted to Intensive Care Unit and Coronary Care Unit of UKMMC. An educational package and updating patient’s information should be emphasized to enhance the family needs of critically ill patient in the critical care settings

A Case Study on Structural Failure of Reinforced Concrete Beam-Column Joint After the First Significant Earthquake Impact in Malaysia

This paper presents a case study regarding failures of structural buildings which occurred in Malaysia after the first significant earthquake event dated on June 5, 2015. Ranau is a locality situated in Sabah, Malaysia on the island of Borneo. The seismic activity was triggered when an earthquake with a magnitude of 5.9 afflicted Ranau, including seven other districts that also felt the tremors. Even though the impact of magnitude was undisputedly not high, the severity level of damages was found to be absolute (irreparable) in the structural RC beam-column joints and soft-storey buildings. Most of the buildings in Malaysia were built without the consideration of seismic design, and thus a major factor in structural failure. The earthquake has directed the seismic demand, while the total displacement was concentrated at the weakest floor that caused more damage to the building.  This paper shows the causes of beam-column joint damages and explains the proposed (to-date) strengthening methods. Future studies related to seismic activities are in need to analyse the performance of the existing design of structural RC members and propose a seismic design in Malaysia

Kemahiran keibubapaan, kefungsian keluarga dan kesejahteraan psikologi dalam kalangan ibubapa

Kemahiran keibubapaan, kefungsian keluarga dan kesejahteraan psikologi dalam kalangan ibubapa adalah tiga aspek yang sangat penting untuk menjamin kesejahteraan sesebuah keluarga. Kajian dalam kalangan 187 orang ibu dan bapa ini bertujuan untuk mengenalpasti tahap kemahiran keibubapaan dan kefungsian keluarga serta hubungan antara kedua pemboleh ubah ini. Selain daripada itu hubungan antara kefungsian keluarga dengan kesejahteraan psikologi juga dikaji. Perbezaan antara jantina bagi ketiga-tiga pemboleh ubah tersebut juga dikaji. Dapatan menunjukkan terdapat hubungan yang signifikan antara kemahiran keibubapaan dengan kefungsian keluarga, serta kefungsian keluarga dengan kesejahteraan psikologi. Manakala ujian t pula menunjukkan terdapat perbezaan kemahiran keibubapaan antara lelaki dengan wanita, tetapi tidak terdapat perbezaan dari aspek kefungsian keluarga dan kesejahteraan psikologi. Implikasi kajian ini menunjukkan kepentingan kemahiran keibubapaan dan kefungsian keluarga dalam mencapai kesejahteraan psikologi

Forest management for eco-tourism: understanding the community perspective of co-management

Forest management for eco-tourism needs to emphasis on the participation of the community to ensure that eco-tourism products remain sustainable. Without active involvement by the community, eco-tourism products face the risk of being destroyed by the ravages of overzealous economic development activities. Of paramount importance is the need for a balance of economic development and sustainable forest management. The forest inhabitants and the community need to be in symbiotic relations in order to survive in the forest. This study seeks to understand the community perspectives in co-managing the eco-tourism forest in RBFRSP. For that reason, three community representatives, including two Penghulu and a Tok Batin were interviewed to seek their perspectives on co-management. The results, in a nutshell, indicate that the community is not ready for co-management

Backstepping control of nonholonomic car-like mobile robot in chained form

This project is attempts to stabilize an underactuated system based on the backstepping approach. The discontinuous time-invariant state feedback controller is designed for exponential stabilization of underactuated nonho-lonomic systems in chained form. System dynamic of the car-like robot with nonholonomic constraints were employed. The validity of the proposed ap-proaches is tested through simulation on a car-like vehicle using Matlab soft-ware

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Belongingness: Malaysian nurses’ experiences in the clinical workplace

The need to belong has been proposed to be the most basic need for human psychological wellbeing. Lack of belongingness has been associated with stress, anxiety, and lack of esteem. Understanding the nature of nurses’ interconnection with others and their perceptions of belongingness has been linked to social and psychological functioning in the workplace. The purpose of this mixed-methods study was to explore factors contributing to Malaysian nurses’ sense of belonging in the workplace. Registered nurses (n = 437) from two hospitals in Kuala Lumpur, Malaysia, completed a previously validated questionnaires translated into the Malay language. Questionnaires were analysed using a variety of statistical measures for the close-ended questions, and content analysis for two open-ended questions. Subsequent to answering the survey, ten nurses participated in individual interviews which were thematically analysed. Nurses enhanced their sense of belonging through acceptance, ‘fitting in’, respect, and group harmony. There were no specific demographic factors contributing to the perceptions. The four core themes that emerged from the interview were: what it means to belong; being heard; finding a way to fit in; and the influence of Malay culture. The findings confirmed the positive effects of sense of belonging on feeling motivated, confidence level, and job satisfaction. The results also provide evidence for an effect of positive workplace culture which included supportive colleagues, the nursing manager and the other health care team members in enhancing a sense of belonging among nurses. Aspects of belongingness in Malaysian nurses reflect those of nurses elsewhere. However, there are specific cultural influences at play. Given the likely influence of Malaysian culture, development of a measurement scale based on Eastern culture would help in enhancing understanding of workplace practices among these groups of nurses

Malaysian nurses\u27 skin care practices of preterm infants: experience vs. knowledge

This study sought to explore the impact of Malaysian nurses' perceptions, knowledge and experiences in preterm infant skin care practices using a descriptive approach. Questionnaires were distributed to Neonatal Intensive Care Unit (NICU) nurses in one teaching hospital in Malaysia. A knowledge gap was revealed among nurses in both theoretical and practical knowledge of preterm infant skin. Nurses working for more than 5 years in NICU or having a Neonatal Nursing Certificate (NNC) were not predictors of having adequate knowledge of preterm infants' skin care. The results highlight the complex issue of providing effective skin care to preterm infants. However, a specific finding related to nurses' confidence provides some direction for future practice and research initiatives. Clear clinical evidence-based guidelines and Continuing Nursing Education on relevant topics of preterm infants' care may provide the required knowledge for the nurses.</p

Constant disturbance in critical care units influenced patients’ sleep quality

The critically ill patients’ experiences and sleep quality are a crucial aspect of quality care in the critical care setting. The aim of this study was to identify the perceived sleep quality and patients’ experiences during their stay in critical care units. Data was collected using validated and reliable self-reported questionnaires by patients on sleep quality in the intensive care unit and intensive care experience (ICEQ) for two months’ duration. A random sampling was used in participants’ selection and 55 patients who fulfilled the inclusion criteria participated in this study. Descriptive and Inferential analyses were used in data analysis. Mean age of the respondents was 52 with 64% male. More than half (58.2%) patients reported poor sleep quality while in critical care units. Disruption in patients’ sleep was mainly due to noises from medical devices alarms (76.36%) and constantly taking vital signs e.g. measuring blood pressure (70.90%). Even though more than half of the patients (54.5%) reported more frightening experiences while in critical care units, but overall their experience was either positive or neutral. Patients (16.36%) who stayed longer in critical care units between 8 -12 days reported better sleep quality. Reducing noise by minimizing the alarm sounds and attend to any alarm as soon as possible may help to promote better outcome for patients’ sleep quality and experience while in critical care. It is important for nurses to plan and cluster the patient’s care to avoid constant disturbance

Structured education programme on Patient Controlled Analgesia (PCA) for orthopaedic patients

Patient-controlled analgesia (PCA) via an infusion pump enables patient to administer their own analgesia. The aim of this study was to evaluate the effect of an educational programme in managing post-operative pain and satisfaction on PCA following orthopedic surgery. A pre-test and post-test interventional study design with implementation of patient education programme on PCA was provided to 54 respondents. The control group received conventional PCA briefing from the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and 24 hrs following surgery and pre-test and post-test of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There was difference in respondents’ level of pain score among the study respondents’ medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were 7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs, 6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and 1.00 (IQR=1.00) respectively. There were significant differences in median of pain score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50, p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically significant differences (p<0.05) in the median of patient’s pain severity at all pain levels i.e. least pain, worst pain, and severe pain between intervention and control group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain, U=49.0, p<0.05). In conclusion, patients who received pre-operative structured education programme showed improvement in managing post-operative pain and satisfaction on PCA after orthopedic surgery