Introduction: Sexual and Reproductive Health (SRH) education in Malaysia remains a sensitive and complex issue due to the nation’s diverse religious beliefs, cultural norms, and societal stigmas. Parents are critical in shaping adolescents' SRH knowledge, yet many face challenges due to insufficient knowledge, skills, and confidence. This study aims to explore these challenges and develop a culturally sensitive SRH education framework tailored to Malaysian families. Materials and methods: A three-phase methodology was employed. Phase 1 consisted of qualitative interviews with 31 parents (9 fathers, 22 mothers) from diverse academic and socioeconomic backgrounds. Participants were recruited through non-governmental organisations (NGOs), religious institutions, parenting workshops, and snowballing methods in six states. Phase 2 involved a critical discourse analysis of two key resources: the government’s Cakna Diri module and the self-help book Berbual-bual dengan Anak Tentang Seksualiti. Phase 3 focused on developing and validating a culturally sensitive SRH framework. Thirteen experts, including religious scholars, healthcare professionals, and child advocates, evaluated the framework using the Fuzzy Delphi Method. Results: Phase 1 identified three key themes: (1) The Influence of Religion and Culture in SRH Education, (2) Parents’ Attitudes and Practices in Delivering SRH Education, and (3) Issues and Challenges in SRH Education Among Parents. Phase 2 highlighted content gaps and delivery issues in the Cakna Diri module, recommending improvements such as clearer objectives, practical adult learning principles, and coverage of topics like internet safety, masturbation, and pornography. Analysis of Berbual-bual dengan Anak Tentang Seksualiti provided additional insights for framework refinement. Phase 3 concluded in the validation of a culturally sensitive SRH framework. Of 36 proposed criteria, 34 achieved high consensus (0.831–0.967). Rejected elements included men-cantered approaches (d=0.587) and framing repentance as a primary focus (d=0.241). Conclusion: This study highlights the critical role of religion, culture, and systemic challenges in shaping SRH education in Malaysia. The validated framework empowers parents with practical, culturally appropriate strategies and promotes collaboration among schools, parents, and healthcare providers, offering a path to improve SRH education and adolescent well-being.

Background: In the Malaysian mental health setting, adolescents with psychiatric disorders (APDs) are admitted to psychiatric wards for treatment due to conditions such as suicidal behaviour, substance use, and worsening of psychiatric symptoms. These patients are particularly vulnerable to relapses and readmissions following hospital discharge. An effective and patient-tailored discharge plan is essential to ensure continuity of care, reduce readmission rates, and support long-term recovery. However, there remains a lack of qualitative research capturing the perspectives of key stakeholders—patients, caregivers, and healthcare providers - on the discharge process for APDs in Malaysia. Objectives: This study aims to (i) explore key components of previous discharge interventions for APD, (ii) examine stakeholder perspectives on discharge practices and challenges, and (iii) develop a discharge intervention framework for inpatient adolescent with psychiatric disorders. Methodology and Methods: A generic qualitative approach was employed across three phases. Phase one involved a document review of 221 patients' records to identify existing discharge-related interventions within psychiatric units. Phase two comprised of semi-structured interviews with 10 APD and 6 parents of APD (PAPD), alongside focus group discussions (FGD) with 25 mental health professionals. Phase three focused on synthesising the findings to inform the development of a discharge intervention framework. Findings: Analysis revealed two overarching themes and their sub-themes; Theme One: coordination in discharge planning and documentation of APD; 1) system and documentation process, 2) education and collaborative actions and 3) home and follow-up care. Theme Two: psychosocial support, engagement and mental health recovery. 1) family and peer support, 2) formal and informal community mental health services, 3) utilisation of technology on app, and 4) persistent stigma when support is not enough. Conclusion and Implications: The study offers to propose the framework of discharge interventions for inpatient adolescent mental health care in Malaysia based on insights from multiple stakeholders. The results highlight the need to develop adolescent-focused discharge plans, enhance clinician training, support caregiver involvement, and strengthen coordination practice to improve continuity of adolescent psychiatric care in Malaysia. Keywords: Discharge Intervention, Adolescent with Psychiatric Disorder, Adolescent, Mental Health

Background: Chronic knee pain significantly impacts the well-being of older adults, with its prevalence increasing annually. Despite numerous intervention programes for chronic knee pain, the efficacy of those that are mobile technology-supported remains under-assessed. Moreover, the opportunities and challenges of such programmes, specifically those using mobile instant messaging application (WhatsApp) as a tool, are lacking for health research and most importantly are not known for chronic knee pain. Purpose: This study aims to develop and evaluate the feasibility and potential effects of a WhatsApp-based self-management and exercise programme for older adults living with chronic knee pain. Methods: The development of the programme module was guided by the UK Medical Research Council (MRC) framework. This feasibility study involved 41 older adults with chronic knee pain recruited from selected activity centres in Kuantan, Pahang. Participants engaged in a structured five-week self-management and exercise programme delivered via WhatsApp . Outcomes: Pain intensity was measured using the Numerical Rating Scale (NRS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS-pain). Physical function was assessed via KOOS subscales: symptoms, activities of daily living (ADL), and sport/recreation. Meanwhile the psychological disabilities were measured by the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Other outcomes were health beliefs and self-efficacy scale, and the KOOS subscales quality of l ife (KOOS-QoL) for quality of life measurement. Results: Post-intervention analysis revealed a significant reduction in pain as measured by NRS (Median: pre = 4.00, post = 3.00, p < 0.001) and KOOS-pain scores (Mean diff = 6.50, p = 0.035). Physical function improved significantly across KOOS-symptoms (Mean diff = 6.62, p = 0.034), KOOS-ADL (Median diff, p = 0.007), and KOOS-sport (Mean diff = 15.60, p < 0.001).The mean SWEMWBS score increased from 29.19 (SD = 5.24) to 30.53 (SD = 3.85) post-intervention, though the change was not statistically significant (p = 0.108). Self-efficacy improved significantly from 65.70 (SD = 8.13) to 71.26 (SD = 8.57) (p = 0.001). Similarly, the KOOS-QoL subscale showed a significant increase from 56.50 (SD = 26.38) to 69.51 (SD = 30.65) (p = 0.019), indicating improved knee-related quality of life. Conclusions: This study demonstrates that a WhatsApp-based self-management and exercise programme is a feasible intervention that shows positive potential in reducing pain and improving functional outcomes, self-efficacy, and quality of life among older adults. These findings support the use of mobile messaging platforms as accessible tools for delivering self-management interventions in the older adult population. Keywords: Older Adults, Exercise, Knee pain, Self-management, WhatsApp

AN EXPLORATION OF EXPERIENCES AND NEEDS OF NOVICE CRITICAL CARE NURSES TO EMBARK IN THE CRITICAL CARE AREAS Introduction: The readiness of novice critical care nurses (NCCN) to perform efficiently has been doubted globally. Studies have reported that novice nurses have issues with their confidence and competence in handling critical patients in ICU. Their lack of confidence and competence may promote more harm to the patient’s condition study aims is to explore the experience of novice critical care nurses while working and to explore the needs that would help to support them to work in critical care areas. Method: This study was carried out using a general qualitative design. Data were collected through an in-depth interview in exploring NCCN experiences, challenges and needs while working in the critical care setting. Additionally, managers of critical care areas and nursing educators were also interviewed to get information on how these nurses were prepared and expectation towards them when they were assigned to work in critical care areas. They were recruited from a teaching hospital and nursing schools located in East Coast Malaysia. Data were organised and analysed manually using the thematic analysis approach. Finding: A total of 29 participants was recruited in the study. The majority of the participants are Malay, female, and graduated with Diploma in Nursing from Malaysia. The study reported three main themes; (1) Experiences of the NCCN (2) Expectation and perception of the administrator, and (3) Needs of the NCCN before embarking on the critical care area. Themes revealed in the study have proposed that NCCN have minimal exposure thus leading to a lack of confidence to embark in the critical care area. Conclusion: The empowerment of the NCCN should be taken seriously. Improvement measures in the support programme may be considered to enhance the process. But, the preparations such as the entry requirements of the potential nursing student also need to be reflected. Certainly, that the current support program helps the NCCN to survive, however, improvisation and additional elements may be needed to minimise the negative situation faced by the NCCN. Simulation and improvisation towards the reference sources could be considered to enhance the support program prepared for the NCCN. . Keywords: junior nurse, needs, support, readiness, critical care area

Background: In the global effort to enhance the provision of high-quality healthcare in paediatric settings, healthcare providers (HCPs) have developed a range of strategies. One approach that has been employed is the utilisation of shared decision-making (SDM), which places a strong emphasis on children actively participating in their healthcare, particularly during the decision-making process. Despite the abundance of evidence supporting the positive effects of SDM on children, its implementation in paediatric settings remains underrated. In Malaysia, research regarding SDM in paediatric settings is still lacking. This study aims to explore children’s participation in the shared decision-making process related to healthcare in paediatric hospital settings in Malaysia. Methods: This study used a generic qualitative approach. Data was obtained through a combination of participant observation and semi-structured interviews. Participant observation was carried out with 100 participants (26 hospitalised children ranging in age from 7 to 12 years old, their parents, and 48 HCPs from three university hospitals in Malaysia). Semi-structured interviews were conducted with 35 participants (nine children, 12 parents, and 14 HCPs). Data was analysed using framework analysis. Results: Children were seen to participate to varying degrees. Five themes emerged from the children’s participation in the SDM process during their hospitalisation: i) children being ignored, ii) children being informed, iii) children being listened to, iv) children being recognised, and v) children serving as decision-makers. Children occupied one of two roles in the SDM process, being either passive or active participants. The roles of children fluctuated throughout their hospitalisation depending on the circumstances they encountered during the communication and decision-making process. The involvement of parents and HCPs appeared to be the most significant factor influencing the degree of children's participation in the SDM process. The roles of the adults either facilitated or hindered the children’s participation in this process. Conclusion: The children’s preferences and levels of participation consistently exhibited variability. To effectively address the needs and well-being of children, it is imperative for adults to comprehend their thoughts. By doing so, adults can establish meaningful communication with children, optimising their overall health outcomes. HCPs have an especially critical role in facilitating children’s participation by providing information and simultaneously empowering the children’s active involvement. The findings of this study are of vital importance for the field of paediatric healthcare, particularly in relation to enhancing the treatment quality and improving the delivery of healthcare services for children within hospital settings. Keywords: shared decision-making, participation, involvement, children, healthcare, Malaysia

An intestinal stoma is a life-saving surgical procedure for patients with gastrointestinal disorders. However, living with a stoma presents significant physical and psychosocial challenges, making effective self-care essential for improving patients’ quality of life. Given the complex nature of stoma care, the involvement of Healthcare Providers (HCPs) is pivotal in fostering patient empowerment and supporting meaningful engagement in self-care activities. This study aimed to explore the self-care experiences of patients living with an intestinal stoma and the support provided by healthcare providers in the Malaysian healthcare context. A qualitative research design underpinned by pragmatism paradigm was employed. Data were collected through semi-structured interviews, supported by observation and document analysis. The study was conducted at the Surgical Outpatient Department of Hospital Kuala Lumpur between August 2023 and July 2024, involving 17 patients with an intestinal stoma and 15 HCPs. The data were analysed using framework analysis, which comprises data management, descriptive, and explanatory accounts. The analysis identified five major themes from the patients’ perspective: dealing with physical discomfort, dealing with emotional and psychological discomfort, support offered by HCPs and the healthcare context, and factors that influence self-care engagement. From the HCPs' perspective, two key themes emerged: the role of HCPs in self-care support and the barriers in support provision for patients with a stoma. In addition, the study identified two central issues affecting patients with an intestinal stoma: struggling to adapt to the new self-care routine and the interpretation of the role of Patient-Centred Care (PCC) in supporting the self-care of patients living with an intestinal stoma. In conclusion, the study underscores the complex nature of self-care for patients with an intestinal stoma, shaped by a range of enabling and inhibiting factors. While HCPs made commendable efforts in equipping patients with knowledge and guidance on managing the physical aspects of stoma care in the early recovery phase, support for patients' emotional and psychological well-being, as well as long-term care, was reported to be lacking. The findings call for enhancements in current support nursing practices, advocating for a more holistic, patient-centred approach that addresses both the physical and psychosocial dimensions of living with a stoma.

Household insecticide has become a necessity among the urban community in Malaysia including Kuantan City, Pahang as a control vector for tropical diseases such as dengue and malaria, which are highly influenced by the humid climate and urbanisation. The insecticide is made of type 1 pyrethroid chemicals that recognised to be safe. However, the incidence of insecticide intoxication suggested insufficient studies on its usage and exposure effects. Thus, it high lightened the importance of toxicology study as part of forensic nursing elements in understanding the toxicity aspect of insecticide that appeared on the patient. The study aimed to assess the knowledge, attitude, and practice (KAP) level on household insecticide toxicity and its associated factors among the community in Kuantan and gather biological data through animal toxicological test. The information obtained was used to design a presentation slide containing information regarding household insecticide exposure risk and safe handling and disseminate it to the public. This study was a multi-methods study comprising of three phases. The first phase was a cross-sectional survey involving 199 respondents conducted through a selfadministered questionnaire, that contained sociodemographic and KAP's data. The second phase comprised a chemicals assessment which conducted using the zebrafish model to evaluate the potential insecticide (cl-trans allethrin and d-phenothrin) exposure toxicity effects at different concentrations (0.20, 0.40, , 0.80, 1.60, 3.20 and 0.13, 0.25, 0.51, 1.00, 2.0 μg/L, respectively) for 96 hours. The gill morphology and gene expression of the zebrafish were analysed. During the third phase of the study, data collected previously were used to develop educational materials on toxic insecticide information and validated process by four content experts and a feasibility study involving 128 target audiences. The first phase of the study showed that respondents had adequate KAP scores. The marital status affected knowledge of singles and married person. There were significant associations between females with knowledge and attitude levels (p < 0.05). Strong positive correlations between knowledge and attitude (r + 0.80,p 0.01), between knowledge and practice (r + 0.76,p 0.01), and a good positive correlation between attitude and practice (r = + 0. 74, p 0.01 ). The second phase of the study indicated that the adult Maximum Tolerated Dose ford-trans allethrin and d-phenothrin was 0.18 and 0.12 μg/day, respectively, which is lower than the normal levels detected in a household environment. The insecticide also caused gills injuries such as hypertrophy, lamellar fusion, lamellar lifting and necrosis to the zebrafish, which alter the gill's morphology and structure. The insecticide also altered baxa, c-myca, gadd45b and p53 gene function. Overall, the experimental studies explained that insecticide poses an exposure risk to human in a form of harmful effects on the respiratory system. For the third phase of the study, the content expert and target audience highly validated the developed educational material, with the overall Content Validity Index of0.85 and 0.91. In conclusion, phase one indicated that community had adequate insecticide KAP level. The phase two reveals the effects of acute insecticide exposure on the respiratory systems. In phase three, the study concludes with the establishment of education material. Since the usage of insecticide in the community in the study was only at observational level, hence, it requires further investigation to evaluate actual practices at individual household level. The education material developed in this study can be used as a tool for risk assessment in forensic nursing field in relation to insecticide usage in broader community.