ABSTRACT In the context of this study, we postulated that individuals exposed to hands-only CPR video would exhibit a higher inclination to perform CPR in a stimulated out-of-hospital cardiac arrest scenario. Furthermore, it was anticipated that they would demonstrate improved CPR skills, potentially attributed to heighted knowledge, attitude and comprehension of the challenges associated with administering CPR in such situations. This study was conducted to assess the knowledge, attitude, and practice of CPR initiated by households in cases of out-of-hospital cardiac arrest. The study aimed to evaluate the impact of a tailored video-self-instruction CPR programme specifically designed for households with individuals at risk of cardiovascular disease. This study used a mixed methodology describing bystanders' experiences of being CPR layman rescuer. In the quantitative study, the researcher uses the survey method of research questions to respondents. This study uses descriptive analysis, chi-square correlation analysis and inferential analysis using paired sample T-test and Bivariate test. A qualitative research design using purposive sampling with multiple methods was conducted involving 13 in-depth interviews among household participants coming from high risk of cardiovascular disease. In the quantitative part, respondents were provided with video-self-instruction CPR and instructed to answer the pre and post intervention questionnaires consisting of 53 questions.This study identifies four major conceptual ideas derived from participants. The findings of the data of analysis from qualitative are presented in four key themes: (1) Knowledge, (2) Attitude, (3) Practice, and (4) Barriers. The findings suggest that several factors, including a heightened desire to help community household members, an imminent threat to the patient’s life, the perception of bystander CPR as altruistic pro-social behaviour, and an underlying desire to help others in need, may facilitate CPR delivery. Furthermore, the interviews indicated a few beliefs that may limit the ability to notice when a cardiac arrest has happened and influence the inclination of a communal household to intervene. The findings of the data of analysis from quantitative for the knowledge, attitude and practice score considerably changed from the pre-intervention to the post-intervention (p<0.001). The post- intervention knowledge, attitude and practice score was found to be considerably higher than the pre-intervention value. Knowledge, attitude and practice toward CPR showed a statistically significant difference and improvement after post-intervention (p<0.001). The result analysis from paired sample T-test analysis, found that there was a significant average association score of CPR Knowledge (p=0.02) and practice before and after the intervention (p-value below 0.05). The bivariate analysis between post knowledge and post attitude is significant (r=0.140, p=0.203). It was found that relationships on post knowledge and post attitude are positive and weak. The study found that theoretical knowledge improved following a post-test with the video-self-intervention CPR. The intervention programme utilising video-self-instruction CPR has the potential to enhance the knowledge, attitude, and practice of community members in performing CPR. However, several barriers exist that hinder their willingness to act during out- of-hospital cardiac arrests. Qualitative analysis revealed varying factors such as concerns about infection, uncertainty about the sequence of CPR steps, and lack of confidence that contribute to the reluctance. The relationship between community knowledge, attitude, and practice in CPR was found to be moderate and weak. The utilisation of video-self-instruction CPR has been associated with improvements in the retention of community knowledge, attitude, and practice concerning CPR.

Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injury (TBI) that is seen in emergency departments (ED) representing up to 90% of all TBIs. The growing burden following mTBI highlights the importance of early education and reassurance for ED patients following mTBI. However, poor understanding and recall of mTBI discharge instructions are often reported in the literature which highlight a great concern for the quality and reliability of these instructions. Hence, this study aimed to determine the role of health literacy in developing a new set of ED written discharge instruction for patients with mTBI. This study is divided into three phases. Phase 1 was the needs assessment of mTBI written discharge instructions made available from government hospitals of Ministry of Health (MOH) around the country. All 132 EDs of the government hospitals in Malaysia were contacted and requested to send a copy of the written discharge instruction that they give to their mTBI patients. These instructions were evaluated using the Patient Education Materials Assessment- Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established clinical practice guidelines. Phase 2 was the needs assessment of 62 recently discharged patients who had received mTBI written discharge instructions at one particular ED who were evaluated using the Malaysian version of the Health Literacy Skill Instrument (M- HLSI) and Montreal Cognitive Assessment (MoCA). Prior to the evaluation, cross- cultural validation of the M-HLSI, an adaptation of the short form version of HLSI (HLSI-SF) in English, was conducted among 319 Malay speakers and also in a sample of patient with mTBI that would not be participants of the main study. Phase 3 was developing a set of new mTBI written discharge instruction based on the findings of the needs assessment and previous results found in the literature. The findings from Phase 1 found 49 printed discharge instructions eligible for the study: 26 of the articles met the criteria of understandability, but only 3 met the criteria for actionability. The average readability level met the reading ability of the average adult in Malaysia. However, most of the discharge instructions focused on emergency symptoms, but none contained post- concussion features for reassurance. In Phase 2, the M-HLSI was found to be a reliable and valid instrument, according to Rasch model analysis. The study finding revealed the high prevalence of limited health literacy among participants, particularly in the mTBI group (54.8%). The needs assessment of the participants showed their health literacy level was associated with gender (p=0.022) and education attainment (p=0.011). mTBI participants in both health literacy groups (limited and sufficient) performed better in print literacy and oral literacy skill compared to numeracy skill and information-seeking skill. As for cognitive function, there were significant differences in executive functioning, attention, concentration, language, memory and orientation between patients that were mildly cognitive deficit and those with no cognitive deficit. In Phase 3, there was a significant improvement in percentage scores of understandability (97.4% to 97.8%) and actionability (49.8% to 99.1%) and readability of the newly-developed mTBI discharge instructions compared to those reviewed in Phase 1. Ultimately, this understandable, actionable and readable written discharge instruction may facilitate the ED health care providers in communicating the discharge instructions effectively and may serve as a useful guide for patient self-management regardless of their health literacy level.

Primary care nurses play a vital role in preventing adults’ obesity by delivering effective obesity-related health education. An effective health education related to obesity requires knowledgeable and skilful primary care nurses. Obesity training has traditionally been provided to primary care nurses through continuing nursing education activities such as conferences, seminars, and workshops. Despite such trainings, the prevalence of obesity in the Malaysian community is still rising, indicating that obesity-related training for primary care nurses may be insufficient. As a result, it is crucial to examine the obesity training needs of primary care nurses to prepare for them to play an effective role in obesity management. This study aims to develop a obesity management training model for primary care nurses to help address the increasing numbers of obese patients in Malaysia. A descriptive cross-sectional survey was conducted, and random sampling method was applied. Two hundred and thirty-four nurses were recruited from a variety of primary health clinics throughout Pahang. After obtaining informed consent, the questionnaires were distributed to the participants. Based on the findings of the training needs assessment, a training model was designed using Partial Least Square-Structure Equation Modelling and revealed a significant positive association between knowledge and practice in managing obesity among primary care nurses. This suggests that having a solid knowledge base is crucial for effective obesity management. However, the relationships between attitude and practice, as well as belief and practice, are not statistically significant, indicating that attitudes and beliefs may not be the sole determinants of actual practice. On the other hand, the relationship between opportunity and practice is statistically significant, highlighting the importance of creating more opportunities for nurses to actively engage in obesity management practices. Overall, these findings emphasise the significance of knowledge and opportunities in influencing the practice of managing obesity among primary care nurses and suggest areas for intervention and improvement in healthcare settings. Policymakers can develop policies and guidelines for nurses’ training that support evidence-based obesity management practices in primary care settings. By addressing knowledge gaps, promoting positive attitudes, strengthening beliefs in the efficacy of obesity management strategies, and creating more opportunities for nurses, healthcare systems can improve the quality of care for patients with obesity and contribute to better public health outcomes.

Introduction: In December 2019, the outbreak of the novel coronavirus began in Wuhan, China, marking the onset of a global health crisis that would challenge healthcare systems and professionals, particularly nurses, across the world. This study focuses on the intensive care unit (ICU) nurses in Malaysia, who have faced heightened workloads and increased mental and physical strain amidst the COVID-19 pandemic. The study aims to explore the ICU nurses' experience and challenges in providing nursing care to the patient with viral infection during the outbreaks – the COVID-19 pandemic cases, to explain the role of the healthcare center’s management towards the job of the ICU nurses in caring for patients with viral infection during the pandemic and to develop the Islamic approach to the challenges of providing nursing care to the patient with viral infection during the pandemic. Therefore, addressing the gap in current research regarding spiritual coping mechanisms and Islamic adaptations in healthcare. Material and methods: This study utilizes systematic literature review, employs a descriptive qualitative study design and conducted a semi structured face-to-face interviews with ICU nurses and key personnel in ICU Sultan Ahmad Shah Medical Centre SASMEC. Besides, document and textual analysis were performed in the process of developing Islamic approach. Results: The thematic analysis from this study reveals the challenges encountered and emotional response by ICU nurses in the care of COVID-19 patients, the coping strategies in the ICU environment, impact of COVID-19 on ICU nurses, spiritual dimensions in the context of nursing care and healthcare center management's role in supporting ICU nurses during COVID-19. This study has developed Islamic approach rooted in twelve Islamic principles. Conclusion: The study underscores the importance of integrating Islamic principles into nursing practices, especially in critical situations like the COVID-19 pandemic. By developing an Islamic approach, it offers a holistic framework that not only addresses the immediate challenges faced by nurses but also aligns with their spiritual beliefs, thereby enhancing their resilience and quality of care provided to patients. This research contributes to the body of knowledge by bridging the gap between conventional nursing practices and Islamic ethical considerations, offering insights for policymakers and healthcare administrators to support the nursing workforce effectively.

The ageing population is expected to experience mental health challenges, as shown by the increasing trends in the prevalence of these ailments. Older people are vulnerable to depression due to a number of factors, but it is often undertreated. The aim of this study is to determine the prevalence and associated factors of depression among community-dwelling older people in Terengganu. A quantitative cross sectional study was conducted in several areas of Terengganu using a multi-layered, stratified sampling technique. A total of 240 participants were randomly selected. Several instruments were used, namely the Geriatric Depression Scale (GDS), the Elderly Cognitive Assessment Questionnaire (ECAQ), the University of California Los Angeles (UCLA) Loneliness Scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the Barthel Modified Index, the Instrumental Activities of Daily Living Scale, the Pittsburgh Sleep Quality Index, and the Duke University Religion Index (DUREL). The prevalence of depression symptoms among community-dwelling older people in Kuala Terengganu was 24.6%. In addition, the multivariable logistic regression model revealed that single older people, regardless of whether they were unmarried, widowed or divorced (aOR =42.42; CI = 1.22, 15.96), poor social support (aOR = 3.06; CI = 1.18, 7.93), loneliness (aOR =1.11; CI = 9.87, 45.18), impaired functional status (aOR = 3.39; CI =1.22, 9.39), impaired instrumental function (aOR = 6.09; CI = 1.95, 19.0), and older people with asthma (aOR 14.14; CI = 2.83, 70.5) were associated with depression symptoms in older people. Therefore, screening of older people in primary care for early detection of depression symptoms and initiation of community-based intervention for psychological aspects is needed to address the problem.

Nurse educators are critical in developing students’ reflective practice in clinical nursing education. This study aimed to develop a reflective practice training module to educate and motivate nurse educators on their role as facilitators in students’ reflective practices. It was conducted in two phases: Phase one composed of a need analysis with a mixed method study design survey to assess the need for implementing reflective practice in clinical nursing education among nurse educators (n = 221) and propose possible solutions. Phase two was the module's design and Phase three was module development, which looked into the validity and improvement of the module. Seven (7) experts from various related fields were involved in reviewing the developed module. The need analysis indicates that the content required includes the importance of reflective practice, the concept of reflective practice, the appropriate reflective model (John's Model of Structured Reflection), and reflective practice methods in clinical nursing education. The module is offered as a single module to serve as guidance for running a 2-day workshop. It comprises eight interconnected activities that must be completed in the order: “Making sense of imagination”; “Getting to know”, “Starting your engine”, “Ten Cs of reflection”, “Journey to success”, “Writing your mind”, “Let’s do the talking”, and “Guided reflection”. The module was found to have good content validity (CVI=85.143%) based on the review by the experts. They also provided valuable suggestions, which were then incorporated into the module accordingly. It can be concluded that the module has good content validity and can be used to enhance reflective practices among nurse educators and develop their abilities to guide students’ reflective practices. By utilising reflective practices, the nursing education system can produce nurses who can recognise individual patient needs and provide safe and quality patient care.

Introduction: The elderly population in the world is increasing, not excluding Malaysia. This phenomenon is a significant concern as the rise of dementia cases is anticipated in the subsequent decades. Undoubtedly, the disease will have a detrimental effect on economics, society, and individuals. Physical exercise and cognitive interventions have been proven as potential risk reduction strategies in targeting high-risk groups known as mild cognitive impairment (MCI). Nevertheless, movement limitations among elderly have highlighted the necessity of remote delivery interventions, particularly in rural areas. This study aims to measure the effect of Aerobic exercise and Cognitive activities for Elderly (ACE) programme on the cognitive performance of elderly with MCI. Material and methods: A total of 87 participants completed the study, consisting of an experimental group (n = 43) and a control (n = 44) group. Participants in the experimental group received the ACE programme three times weekly over 12 weeks, whereas the control group received no intervention. The validated Mini-Cog instrument assessed the participants’ cognitive performance at three intervals: baseline, week 4, and week 12 post-intervention. Chi-square and independent t-tests were performed for univariate analysis, whereas generalised estimating equations were used for multivariate analysis to measure the score changes between baseline and post intervention within and between the two study groups. Results: The results demonstrated that the memory and clock drawing test scores were not significantly different between the experimental and control groups after four weeks (p > 0.05 for both groups). Interestingly, after 12 weeks, a significant difference in memory scores and clock drawing test scores between the experimental and control groups were observed (p = 0.003) and (p = 0.045), respectively. After adjusting the confounders, multivariate analyses showed that the experimental group was significantly improved in both memory (p = 0.036) and clock drawing test (p = 0.041) scores compared to the control group, with 2.322 and 2.360 times more likely to improve the scores, respectively. A significant association between assessment time and cognitive performance was also observed, showing that 12 weeks of intervention significantly improved memory (p < 0.001) and clock drawing test (p = 0.035) scores compared to four weeks. Conclusion: The ACE programme had improved cognitive performance among the elderly with MCI, showing that implementation of physical and cognitive leisure activities at the community level may help to delay the progression of dementia among the FELDA elderly. Simultaneously, the selection of activities that can be performed at home may be a practical, inexpensive, safe, and convenient option for the elderly population in rural areas.

Burnout has been getting a lot of national and global interest recently as it is a condition that affects workers in a wide variety of professions, including nurses in the healthcare sector. Critical care nurses are considered vulnerable to burnout compared to nurses in other areas. Burnout is a threat to them and can be related to many factors. Therefore, this study aims to determine the burnout level and the predictors of burnout among critical care nurses. A quantitative, cross-sectional study was conducted among 152 critical care nurses in a tertiary hospital in Johor Bahru. A set of questionnaires containing biopsychosocial characteristics, spiritual characteristics, occupational characteristics, and the Maslach Burnout Inventory was used to identify the level of burnout and the associated factors. Data analysis was done through the Chi-square test for bivariate analysis to identify the associated factors and it was further extended to multiple logistic regression to determine the factors that could predict the burnout level. The findings showed that 25.7% of the critical care nurses had a high level of emotional exhaustion, 16.4% had a high level of depersonalization, and 34.9% had a low level of personal accomplishment. The biopsychosocial characteristics, which consisted of the amount of stress in life, anxiety disorder, supervisor support, sense of belonging to the workplace, and the number of children, were significantly associated with the level of burnout. For spiritual characteristics, it was found that attending religious activity and incorporating religion into other dealings in life were associated with the level of burnout. Occupational characteristics of nurse-to-patient ratio, frequency of overtime per week, and self-rated job satisfaction were associated with the level of burnout. The predictors contributing to emotional exhaustion of burnout among critical care nurses were determined as follows: experiencing a stressful life (OR=4.231, 95% CI=0.702-2.182; p<0.001), working in ED (OR=0.001; 95% CI=18.185-15.616; p<0.001), nurse-to-patient ratio of 1:1 (OR=0.001; 95% CI=20.075-13.849; p<0.001) and nurse-to-patient ratio1:2 1 (OR=0.001; 95% CI=19.866-14.041; p<0.001), and unsatisfied with the job (OR=11.372; 95% CI=0.974-3.889; p<0.001). Meanwhile, the predictor factor of personal accomplishment is having a strong sense of belonging in the workplace (OR=0.244; 95% CI=2.563-0.257; p<0.017) and the predictor factors for depersonalization are working less than 5 hours of overtime per week (OR=0.046; 95% CI=5.251-0.913; p<0.005) and unsatisfied with the job (OR=3.226; 95% CI=2.230-0.113; p<0.030). The critical care nurses experienced average to high levels of burnout. Unlike biopsychosocial and occupational characteristics, this study demonstrated that no spiritual characteristics were found to be a predictor. Promoting a healthy workplace requires preventive measures and intervention programs by the administrator to continually improve the nurses’ health, safety, and well-being, ultimately leading to patients’ safety. Keywords: burnout, emotional exhaustion, depersonalization, personal accomplishment, critical care nurse.