Li Yoong Tang

Purpose: Stroke is a leading cause of morbidity and mortality worldwide, and rapid early detection is essential. Although screening tools such as FAST (face, arm, speech, and time) are widely used, they may miss posterior strokes, whereas BE-FAST (balance-eyes, face, arm, speech, and time) demonstrates greater sensitivity. However, its implementation in digital formats remains limited. This study aimed to develop, validate, and implement BE-ALERT (balance-eyes-arm weakness-language difficulties-extreme headache-reaction slowed or confusion-time to response) as a community-based early stroke detection application. Methods: This research and development study consisted of development, validation, diagnostic accuracy testing, and community implementation. The development and validation phase included 160 family caregivers of patients with stroke who were aged ≥18 years. The diagnostic accuracy phase included 500 family caregivers who accompanied consecutive patients with suspected stroke in the emergency department. Family caregivers completed the BE-ALERT assessment while accompanying the patients, and their assessment results were compared with neurologist-confirmed diagnoses. Results: Validation showed a content validity index of 0.95 and a Cronbach α reliability coefficient of .82. Community implementation among 160 participants was associated with higher stroke knowledge scores (82.1) and stronger intention to seek immediate treatment (4.5). Receiver operating characteristic curve analysis yielded an area under the curve of 0.836, indicating good diagnostic accuracy. BE-ALERT showed a sensitivity of 85.0%, specificity of 82.1%, negative predictive value of 94.5% and System Usability Scale score of 74. Conclusion: BE-ALERT is a practical, accurate, and well-accepted tool for community-based early stroke detection. It may support stroke screening, public education, and timely treatment-seeking behavior.

Adolescents are susceptible to HIV transmission. The incidence of HIV among teenagers and young adults in Indonesia is on the rise, underscoring the importance of comprehending factors that impact HIV prevention behavior in adolescents, with social support being a significant factor to consider. Objective. This study aimed to investigate the correlation between social support and HIV prevention behavior among adolescents. Methods. This research was a quantitative correlational analytic study using a cross-sectional design. A total of 610 students from vocational high schools in Bandung, Indonesia, participated in this study. Data were gathered utilizing both the family and friend versions of the Perceived Social Support Scale (PSSfa and PSSfr) and the Sexual Behavioral Abstinence and Avoidance of High-Risk Situations Questionnaire (SBAHAQ). Descriptive data were analyzed by descriptive statistics. Relationships between the variables were analyzed by spearman’s correlation test, followed by simple linear regression analysis. Results. Social support and HIV Prevention Behavior scores were positively and weakly associated (r = 0.288, p<0.0001). The mean value of social support from family was 11.87 (SD = 3.83); social support from peers was 11.64 (SD = 4.22). The mean value of HIV prevention behavior for the self-efficacy domain was 14.51 (SD = 3.14); behavioral intention was 11.69 (SD = 3.04); perceived benefit was 22.40 (SD = 4.69; range 0–30). Conclusion. Healthcare professionals should develop evidence-based educational interventions specifically tailored to the needs of adolescents, incorporating life skills education. This approach aims to enhance HIV prevention behaviors among adolescents, utilizing a peer support framework.

Introduction: This study aimed to evaluate the effect of Sharia-Based Nursing Care, utilizing Swanson’s Caring Model (ShariaSwanCare), on patient satisfaction in hospital settings. Methods: A quasi-experimental pretest–posttest design with a control group was employed, involving 76 hospitalized patients (38 per group) selected via purposive sampling. Participants received a structured, five-day treatment for conditions such as hypertension, diabetes mellitus, cerebrovascular accident (stroke), and pneumonia. Eligibility criteria included compos mentis status and uninterrupted completion of the five-day treatment period. Patients who were transferred to other wards were excluded. The intervention group received ShariaSwanCare, administered daily for five consecutive days, with patient satisfaction assessed every 24 hours. The control group received standard hospital care without additional interventions. Data were analyzed using both paired t-tests and independent t-tests. A significance level of p < 0.05 was used for all analyses. Results: Statistical analysis yielded a p-value of < 0.001, indicating that the implementation of ShariaSwanCare had a significant positive effect on patient satisfaction. Specifically, patients in the intervention group showed a greater increase in satisfaction scores compared to the control group. The paired t-test revealed a significant improvement from pre- to post-intervention in both groups, but the effect was more pronounced in the intervention group. Conclusions: Sharia-based nursing practices, when integrated with Swanson’s Caring Model, can effectively enhance patient satisfaction. With appropriate training and structured implementation, these practices have the potential to be adopted across Islamic hospitals.

Reflection is a core competency in geriatric nursing, and reflective learning is an effective approach in nursing education and pracice. An internship program is a transition course that enhances the knowledge, skills, and attitudes of aspiring nursing students in real clinical work. In geriatric clinical setting, nursing internship students require a broad understanding of professional competency that integrates reflective learning with clinical practice to deal with geriatric patient problems and equip them with the knowledge, attitudes, and skills needed to provide quality of care. However, there is a lack of studies examining the effect of holistic reflective learning on professional competency development among nursing internship students in geriatric settings. This study aimed to investigate the effect of professional holistic reflective learning on professional competency development among nursing internship students caring for hospitalized older adults in medical-surgica wards. This study employed a quasi-experimental pretest–posttest design, where 160 participants were grouped into control and intervention groups. This study was conducted at two nursing schools under the Mashhad University of Medical Sciences in Iran in 2020. Baseline information was collected from both groups, followed by a pretest and follow-up assessment. The intervention group received a Blended Professional Holistic Reflective learning program, while the control group received conventional learning(undertaking professional clinical practice as a usual treatment and submitted reflective logbooks),, which included standard lectures and group discussions. Participants were selected based on specific inclusion and exclusion criteria. The selection process was non-randomized and unblinded. The participants were equally divided, with 80 in the control group and 80 in the intervention group. Baseline data, including demographic characteristics, were collected. Pretest data were collected for both groups using the Geriatric Nursing-Specific Mini-CEX (GN-Specific Mini-Clinical Evaluation Exercise), an instrument designed to assess nursing students' professional competency in geriatric nursing practice. The intervention was delivered through a combination of in-person and online sessions over four mounts. Posttest data and follow-up, were collected similarly to the pretest. Data were analyzed using SPSS version 22, and potential confounding variables were controlled for in the analysis. The study included a total of 160 nursing internship students, with no exclusions. At baseline, no significant differences were observed between the intervention and control groups in terms of professional competency (PC) and its dimensions, except for age, which was adjusted as a covariate in the analyses. The intervention group showed a significant improvement in PC and its various domains (communication skills, physical examination, clinical judgment, health education, professionalism, and organizational efficacy) over time. The Generalized Estimating Equation (GEE) analysis confirmed significant interaction effects between time and group for all PC dimensions (p < 0.05). Post-test comparisons revealed that the intervention group scored 2.4 points higher than the control group in overall PC (p < 0.001), with sustained improvements in the follow-up phase. Significant within-group improvements were also found across all PC dimensions for both groups from pre-test to follow-up (p < 0.05). The study found that the professional holistic reflective learning program was effective in developing professional competency among nursing internship students. The blended teaching–learning approach (face-to-face and online) during workshops and geriatric clinical practice is a practical, cost-effective, and time-efficient learning program during students' clinical practice in geriatric settings. Nurse educators are recommended to implement holistic reflective learning during clinical education.

Panic attacks (PAs) are intense episodes of anxiety with severe physical symptoms that can impair an individual's social and occupational functions. Psychoeducation, a structured educational intervention, aims to improve various health aspects, including mental disorders. Delivering psychoeducation via the Internet can overcome barriers to accessing mental health treatment. This study examined the effectiveness of online psychoeducation on panic symptoms, anxiety, and quality of life (QOL) among people experiencing PAs. In this quasi-experimental design, 157 participants with PAs were recruited, and 136 eligible participants were allocated to treatment and control groups. The treatment group received an eight-session online psychoeducational program over 8 weeks, while the control group received reading materials. Outcome variables, including panic symptoms, anxiety, and QOL, were measured at baseline, 1-week post-intervention, and at 8-week follow-up using the Panic Disorder Dimensional (PD-D) scale, the Generalized Anxiety Disorder (GAD-7) scale, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. In the treatment group, the split-plot ANOVA showed a significant reduction in panic symptoms [F(1, 98) = 18.86, p < 0.01] and anxiety [F(1, 98) = 18.241, p < 0.01] compared to the control group. However, the intervention did not significantly affect QOL [F(1, 98) = 0.278, MSE = 153.007, p > 0.05]. The online psychoeducational program effectively reduced panic symptoms and anxiety levels but did not significantly impact QOL. Internet-based interventions, including psychoeducation, can improve access to mental health treatment, potentially reducing the treatment gap and enhancing overall mental health outcomes.

(1) Background: Antibiotic resistance is a serious health issue, and raising public awareness of it is crucial to combating it. This study aimed to assess the socio-demographic factors associated with knowledge of antibiotics and antibiotic resistance in Malaysia. (2) Methods: A cross-sectional study was carried out between April 2022 and March 2023. Malaysian adults aged ≥18 years old and able to understand English or Malay were recruited. During data collection, the WHO questionnaire “Antibiotic Resistance, Multi-Country Public Awareness Survey” was used. Data were collected across 14 states in Malaysia. (3) Results: A total of 517 participants completed the questionnaire. Most participants were females (67.9%), aged 30–49 (46%), and from central Malaysia (69.8%). Most participants (98.5%) reported taking antibiotics. A misconception presented was that sore throats, fevers, colds, and flu can be treated with antibiotics. A total of 58.8% of participants had high knowledge of antibiotic usage (scores 12–15), while 64% had high knowledge of antibiotic resistance (scores 9–14). Findings indicate that increasing age, income, and education were associated with higher knowledge. (4) Conclusions: This study highlights the knowledge deficiency of antibiotic resistance among Malaysians. Educational programs should engage a younger and lower socio-economic population to increase awareness.

Background: Professional self-concept is one of the important outcomes of nursing professionalism. There is a lack of adequately planned curriculum may limit nursing students’ practical knowledge, skills and professional self-concept in providing comprehensive geriatric-adult care and promoting nursing professionalism. Professional portfolio learning strategy has allowed nursing students to continue professional development and enhance nursing professionalism in professional clinical practice. However, there is little empirical evidence in nursing education to support the use of professional portfolios in blended learning modality among internship nursing students. Therefore, this study aims to examine the effect of the blended professional portfolio learning on professional self-concept among undergraduate nursing students during Geriatric-Adult internship.Methods: A quasi-experimental study two-group pre-test post-test design. A total of 153 eligible senior undergraduate students completed the study (76 in the intervention group and 77 in the control group). They were recruited from two Bachelor of Sciences in Nursing (BSN) cohorts from nursing schools at Mashhad University of Medical Sciences (MUMS), in Iran, in January 2020. Randomization was undertaken at the level of school via a simple lottery method. The intervention group received the professional portfolio learning program as a holistic blended learning modality, though the control group received conventional learning during professional clinical practice. A demographic questionnaire and the Nurse Professional Self-concept questionnaire were used for data collection.Results: The findings imply the effectiveness of the blended PPL program. Results of Generalized Estimating Equation (GEE) analysis was indicated significantly improved professional self-concept development and its dimensions (self-esteem, caring, staff relation, communication, knowledge, leadership) with high effect size. The results of the between-group comparison for professional self-concept and its dimensions at different time points (pre, post and follow up test) showed a significant difference between groups at post-test and follow up test (p < 0.05),while at pre-test there was no important dissimilarity between two groups (p > 0.05).The results of within-group comparison for both control and intervention showed that there were significant differences in professional self-concept and for all its dimensions across the time from pre-test to post-test and follow-up (p < 0.05), and also from post-test to follow-up it was significant (p < 0.05) for both groups.Conclusion: This professional portfolio learning program demonstrates as an innovative and holistic blended teaching-learning approach to improve professional self-concept during professional clinical practice among undergraduate nursing students. It appears that the use of a blended designed of professional portfolio can promote a link between theory and the advancement of geriatric adult nursing internship practice. The data obtained from the present study can be useful for nursing education to evaluate and redesign a curriculum for development of nursing professionalism as a quality improvement process and groundwork to develop new models of teaching-learning and assessment.

Purpose: Children diagnosed with ASD usually have impaired social functions, exhibit repetitive, stereotyped and self-stimulatory behaviors, which make them prone to be stigmatized by the public. However, stigma not only affects those with stigmatization characteristics such as children with ASD but also tends to include other people related to them including parents. This is called affiliate stigma. However, affiliate stigma is unlikely to occur if public awareness is high. Considering that awareness of ASD is still comparatively low in this region and that, as a review of the literature showed, there have been limited studies on stigma and ASD conducted in South-East Asia, particularly in Malaysia, this study is of great significance, especially in the context of the East and other developing countries. The aim of this study was to explore parents’ experiences of caring and perceptions of affiliate stigma, resilience and quality of life (QoL) when caring for a child with ASD. Methods: This paper is part of the sequential explanatory mixed-methods study in which, after a cross-sectional study of 144 parents, a qualitative approach was used to explore parents’ experiences of caring and their perceptions of affiliate stigma, resilience, and QoL. Participants were recruited when they were accompanying their children to therapy at two tertiary public hospitals in one of the north-eastern states of Malaysia. Eleven parents of children with ASD aged 2– 12 years participated. Qualitative data analysis followed Braun and Clarke’s methodology of thematic analysis. Results: Four themes were identified: the meaning of QoL, ASD and life adjustment, perceived stigma, and resilience. Conclusion: This is the first Southeast Asian study on parent-perceived affiliate stigma, resilience, and QoL in the context of ASD. These findings can inform healthcare personnel and policymakers into day-to-day parenting realities and therefore an effort to coordinate support services across all disciplines could be made to improve outcomes for both parents and children.

Bronchial asthma among children is a common chronic disease that may impact quality of life. Health education is one of the strategies to improve knowledge and quality of life. This study aims to assess the effect of health education via a mobile application in promoting the quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (an intervention group and a control group). The control group received face-to-face health education, whereas the experimental group received health education via a mobile application. The findings showed that the total score of quality of life improved from a mean total score at pre-intervention of 5.31 ± 1.27 to post-intervention of 5.66 ± 1.28 for the control group, compared with the experimental group with a mean total score of quality of life at pre-intervention of 5.01 ± 1.36 and post-intervention of 5.85 ± 1.29. A comparison between the experimental and control groups using an independent t test showed statistically significant differences in their mean quality of life scores. The effect of health education via a mobile application showed a statistically significant improvement in the mean quality of life score from pre- to post-intervention (F _1,288 = 57.46, P < .01). As recommended, the use of mobile technology in health education improved the quality of life of schoolchildren with asthma as compared with the traditional methods of a face-to-face lecture and/or a handbook. Thus, educational modules using mobile applications do improve quality of life.

People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18–23) and 19 (IQR; 13–22) at baseline and 6 months, respectively. Having elevated stress (β = 0.65, p ≤ 0.005) and illness perception (β = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R² = 0.664). Stress (β = 0.28, p = 0.003), illness perception (β = 0.2, p = 0.03), poor social support (β = −0.22, p = 0.01) and low body weight (β = −0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R² = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.