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.

Due to the rapid growth of technology, most people in the community have at least an idea that smoking harm smokers and its surrounding. Despite the fact that various ways have been devised to assist smokers in quitting smoking, smoking addiction still remain to be an issue. Therefore, this research is conducted to analyse the available smoking cessation strategies to develop the potential anti-smoking strategy for adult smokers in Kuantan Pahang, Malaysia. This research is divided into 3 phases thas and Phase 3: to identify one potential approach for anti-smoking strategy based on the outcome of Phase 1 and 2. In Phase 1, the current anti-smoking campaign was judged to be ineffective. New campaign ideas and strategies must be implemented. The community has a high level of anti-smoking knowledge. During this phase, it was discovered that smokers sincerely want to quit smoking, but the system and facilities need to be improved. Systematic search of Cinahl, Proquest and Scopus from year 2007 until 2017 using identified keyword and retrospective data analyses at anti-smoking clinics from period of June 2015 – June 2017 were conducted in Phase 2. This phase found that internet intervention is the best method for smoking cessation worldwide and smokers are advised to stop smoking and seek health professional advice. Findings from Phase 1 and 2 had been used to generate findings for Phase 3. As a result, internet intervention has been chosen to be one of the potential approaches in Phase 3. International website searches were conducted by entering the identified keywords into Google.com. The international websites of Smokefree.gov and NY SmokeFree can be claimed as the most effective designs with extensive coverage on key component of smoking cessation treatment as described in national treatment guidelines. This study managed to adapt the Standardized Checklist to be use in assessing the local smoking cessation website in term of content. Then a cross-sectional study using a mix method was conducted among smokers in Kuantan, Pahang to assess the local website on smoking cessation in two phases: Phase I is the selection of a website by a content expert, and phase II is the review of a selected local website using Standardized Checklist by local respondents. The website JomQuit.com was identified as comprehensive anti-smoking website in Malaysia. Malaysian online smoking cessation websites need to improve their content as well as increase their advertising and promotion across the country. Regular website assessments must be performed on a regular basis to ensure that the information on the website is applicable to local communities and for content improvement purposes. This study benefits the community by presenting a comprehensive anti-smoking website through the use of a standardized checklist.

Diabetes-based foot complications have become a healthcare burden to many developing countries where 25% of diabetics with poorly controlled diabetes tend to develop diabetic foot ulcer (DFU) in their lifetime. DFU is resistant to conventional methods and takes a longer time to heal. Medical-grade manuka honey has been proven to show positive wound healing outcomes and is used alternatively in healthcare settings. However, research on stingless bee (kelulut) honey has not been forthcoming. Thus, this study was conducted to evaluate the efficacy of kelulut honey in the healing of DFU as compared to medical-grade manuka honey based on the ulcer size reduction from baseline to days 7 and 14. Maggot debridement therapy (MDT) using sterile maggots of local species Lucilia cuprina was utilised as the debridement modality in this study. Quasi-experimental study design was applied to perform the study in University Malaya Medical Centre (UMMC) involving 60 participants with DFU who were divided into two groups receiving kelulut honey (Group 1) and medical-grade manuka honey (Group 2). Wound measurements were done at baseline, day 7, and day 14 using a mobile wound monitoring application system, NDKareTM. Statistical analysis with Mann-Whitney U test yielded a statistically significant percentage of ulcer size reduction (p<0.001) on day 14 between the kelulut honey group and medical-grade manuka honey group (47.10% vs 7.5%). The findings indicated that kelulut honey is more effective than medical-grade manuka honey and advocated kelulut honey as a potential wound dressing to improve the healing of DFU.

Mental disorders such as depression and anxiety are common comorbid with HIV. They are also more prevalent in WLHIV particularly in low-income countries, yet, it is vastly undetected and under-served. The purpose of this study is to explore the experience of depression among WLHIV and understand the HCP’s practice towards the management of depression in WLHIV.A sequential explanatory mixed-method design was used. In the quantitative part, a facility-based cross-sectional study was conducted. The study participants were identified using systematic random sampling method and HADS was used for anxiety and depression screening. The gathered data was analyzed using SPSS version 23. In the second phase of the study, a generic qualitative design was employed. An-in-depth interview was carried out among women who follow-up ART and HCPs in the selected health facilities. The transcript of the in-depth interview was analyzed with application of N-Vivo (version 11.0). A total of 357 women participated in the first phase of the study. The results revealed the prevalence of both depression and anxiety amidst HIV positive women were 32.5% and 28.9%, respectively. In the multivariate analysis, it was discovered that lack of formal education, being divorced, unemployed, and earning a monthly income less than 1400 ETB (37.5 USD) were significantly associated with depression and anxiety. Women with symptomatic HIV clinical stage III and IV, with CD4 cell count below 250, and with co-infections also suffered from depression and anxiety. In addition to this, PSS was negatively associated whereas stigma was positively associated with depression and anxiety. A total of twenty-one women and twelve HCPs completed in the second phase (qualitative part). Women mostly described experience of stressful life events, lower participation of social activities, poor community acceptance, negative self-perception, and hopelessness as their main experience of living with these comorbid illnesses. Considering the HCPs, majority of them described absence of screening practice, low professional ownership and readiness as the main gap on the introduction of depression care and management in the ART set-up. This finding has shown, in the course of the multifaceted nature of HIV and depression comorbidity, both women’s and HCP’s experience was dynamic in terms of the different psychosocial and clinical dimensions. In conclusion depression and anxiety was highly prevalent in WLHIV and circumstances like the psychosocial and clinical attributes, Perceived Social Support and stigma were associated with developing depression and anxiety. This study presents an insightful understanding of the social, psychological and clinical determinants from the women and the HCPs perspectives. Hence, future interventions should focus on the integration of mental health in HIV clinical set up. Keywords: Human Immuno-Deficiency Virus, depression, anxiety, comorbidity, Ethiopia.

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

Introduction: Self-directed learning (SDL) has been proven effective to enhance learning experience and it is essential for the effectiveness of mobile learning interventions. Although a lot mobile-based interventions have been implemented in nursing education, it did not provide a consistent result on the improvement of knowledge and skill among nursing students. Many mobile learning interventions were built without implying the important elements of use behaviour of a technology. Objectives: This study aimed to explore the important factors of perceived behavioral intention to use smartphone application, develop and evaluate the usability of a smartphone application prototype that facilitate SDL of clinical skills among undergraduate nursing students. Methods: A sequential exploratory mixed-method design was used and adapted in this study. Phase 1 includes the qualitative aspect using in-depth, semi-structured interview to investigate the challenges of SDL of clinical skills among nursing students, at the same time, to explore the perception of using smartphone application to cope with the challenges. In Phase 2, a quantitative aspect utilizing survey instrument based on Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) was used to identify the significant factors that give positive effect on behavioural intention to use the smartphone application. In Phase 3, the relevant smartphone features were identified and mapped with its significant behavioral determinant using methodological triangulation followed by the development of smartphone application prototype. In Phase 4, usability studies and end-user perception were carried out to evaluate the prototype using observation, in-depth interview, and survey. Qualitative data was analyzed using thematic analysis meanwhile quantitative data was analyzed by performing PLS-SEM analysis. Findings: The first interview findings suggested that undergraduate nursing student were lack of self-management skill, lack of desire of learning and lack of self-control skill. Meanwhile, in assessing their perception for adopting smartphone application for SDL of clinical skills, an additional factor which is self-management of learning was found. On larger scale study, the most significant factors that give positive effect on behavioural intention to use the smartphone application were habit, facilitating condition and social influence. On analysis of usability and end-user perception of the prototype, tasks completion rate, usability score and perceptions were good. But there is still a need of improvement in terms of navigability, flow process and interface design of the app. Likewise, the mobile features’ improvement such as profile personalization, content credibility, interface design, and app notification, were indeed necessary. Conclusion: This finding proves that the smartphone application developed based on UTAUT2 is useful in exploring needed mobile apps features and requirements in facilitating SDL of clinical skills among undergraduate nursing students.

This is a study of Islamic ethical responses to the moral problems of the nursing profession, particularly, the difficulties related to ethical challenges of harm prevention practices. Nowadays, nurses worldwide are using the ethical theories and models that were developed by the Western scholars to help in the decision-making process. Till now, the knowledge of nursing ethics and Islamic ethics is fragmented, lacking of work to integrate between these two. Therefore, this study attempts to integrate these two knowledge into a comprehensive framework. In doing so, this study use combined approach which incorporates, library research, textual analysis, interviews and personal communication. Based on the objectives, library research method is used to achieve the first to the fourth objectives, which are to explore the understanding of nursing practices and nursing ethics, to explore the Islamic moral teachings related to life saving and harm prevention, to examine Islamic ethical principles of moral judgments on harm prevention in healing and medical care practices, and to unveil ethical issues and moral problems of nursing profession and medical care practices, respectively. The works of Muslim scholars, particularly the works of theologians, scholars of Islamic law (fuqaha), and jurists (usul al-fuqaha) on harm prevention and medical care also has been thoroughly discussed. On the other hand, textual analysis is used to analyze some Qur’?nic verses and Hadith pertaining to harm prevention. In addition, interview with nurses, personal communication with the ethical committees and religious experts are done to achieve the fifth objective that is to analyze the nurses’ experiences of handling ethical issues in nursing practices of selected hospitals. Using all the data gathered, an Islamic ethical framework for handling ethical issues in nursing practices, which is the sixth objective of this study is integrated. ‘Islamic Ethical Framework on Handling Ethical Issues in Nursing Practices’ is a main product of this thesis. The integration of nursing ethics and Islamic ethics of knowledge in this framework could be a better alternative in dealing and solving ethical issues since nurses are always guided with only nursing ethics previously. For Muslim nurses, this ethical framework could be the right option to guide them in searching for a solution while referring to the ultimate goal of the Shari?ah. Islam with its spiritual values and holistic view plays the prominent role to embed cognitive ethical values. This makes Islamic ethical framework different from conventional theories of ethic or any conventional ethical framework, in which ethical judgment are constructed out of human desires and tendencies to bias.

Thyroid disorder patients have a high chance of experiencing depression, resulting from multifactorial aspects including biological, psychological and sociological. Eventhough many tools available to screen depression, there was lack of tool to screen depression among thyroid disorder patients. Therefore, the objective of the study was to develop modified depression anxiety stress scale-depression. The cross-sectional study was carried out at four selected government hospitals in Malaysia. The participants included 846 thyroid disorder patients who had follow-ups at the endocrinology clinics in the selected hospitals. Data were collected from 1st March 2016 until 28th February 2017 using three questionnaires, including the Depression Anxiety Stress Scale-Depression (DASS-D), the List of Threatening Experiences (LTE) and the Multidimensional Scale of Perceived Social Support (MSPSS). The findings of this study showed that 13.9% (n = 118/846) had various depression levels, from mild to extremely severe depression; depression was more common among the group of patients with hypothyroidism. Meanwhile, young adult (p = 0.001), high TSH (p = 0.05), stressful life events (p = 0.01) and low perceived social support (p = 0.01) were found to have significant association with depression among thyroid disorder patients. The model of factors associated with depression among thyroid disorder patients was fitted with Modified Depression Anxiety Stress Scale-Depression (MDASS-D) demonstrated good fit in CFA with adequate divergent and convergent validity and good factor loading (0.62-0.83). The MDASS-D also displayed excellent internal consistency with Cronbach’s alpha of 0.91. Therefore the MDASS-D is reliable to screen depression among thyroid disorder patients.

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

This randomised controlled trial aimed to determine the effect of nurse-led motivational construct intervention programme, in comparison to the standard lifestyle modification intervention (LMI), on lifestyle changes and cardiometabolic risk (CMR) profiles among obese adults in Kuantan, Pahang. One hundred obese adults (50 participants in each group) were randomised into either an intervention or control group. Both groups received lifestyle advice on dietary modification, physical activity and behavioural modification skills at baseline. The intervention group also received monthly home visits follow-up for subsequent nurse-led, tailored lifestyle advice. Seventy-nine participants completed the study (39 participants in the control and 40 participants in the intervention group). The outcome measures for lifestyle changes include dietary intake and physical activity level and the CMR includes body mass index (BMI), waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG) and high-sensitivity C-reactive protein (hs-CRP) levels, assessed at baseline and after six months. Data were analysed using SPSS Version 21. No significant difference in the lifestyle and CMR measures between groups found at baseline. The post-intervention assessments showed that there are no significant changes in the physical activity level and dietary intake except for a reduction in saturated fat intake among the obese adults in the control group after six months (p < 0.05). In addition, the post-intervention assessment reported that the intervention group resulted a significant reduction in BMI, WC, diastolic BP and a significant rise in HDL levels (all p < 0.05). Similarly, the control group exhibited a significant reduction of WC and TG levels after six months (p < 0.05). However, the control group showed a significant rise in the FBG level after six months (p < 0.05), while it stabilised in the intervention group. Additionally, the intervention group also achieved a reduction in the LDL and hs-CRP levels after six months. Nonetheless, there were no statistically significant differences in the lifestyle and CMR measures between the groups after six months (p > 0.05). This study demonstrates that the nurse-led motivational construct intervention programme may be beneficial to treat obesity as well as stabilising the diastolic BP, hs-CRP and the FBG level of adults with obesity. Hence, a larger trial with modifications, sensibly informed by this trial, can now build upon and confirm these results.

Introduction: Caregivers are commonly engaged in the care of severe traumatic brain injury (TBI) survivors in the home setting. They often face challenges that are little understood by others outside the circle of care as a large portion of the energy must be devoted to meeting the needs of the traumatic brain injury (TBI) survivors. This study aimed to develop a model to meet the needs of caregivers for sTBI survivors at home. Method: This was a qualitative study that involved three sequential phases of data collection. In Phase 1, document analysis was done by searching related documents in two hospitals on the East Coast of Malaysia to explore how hospitals prepare the caregivers prior to discharging TBI survivors to be cared for at home. All data were then analysed using content analysis. Following that, in-depth individual interviews were conducted in Phase 2 followed by a focus group discussion among caregivers of sTBI survivors in Phase 3 to explore the caregivers’ needs, experiences, and challenges while caring for survivors at home. All data obtained were managed using Nvivo 11 software. After verbatim transcriptions, the data were analysed using content analysis based on the Grounded Theory technique of analysis. Finding: A total of 40 caregivers were involved in the study. The majority of the caregivers were Malay. A substantive theory known as “A Shining Cave” was developed from the three main categories that emerged; (1) Being in a state of gloom and chaos, (2) Making every effort to improve, and (3) Achieving a peaceful life. The categories projected that the resilience of caregivers in going through each phase of caring ultimately may increase their acceptance of sTBI survivors at home and motivation to care for them. This model can be used to guide the development of specific intervention programmes and the preparation of booklets for the caregivers and survivors of TBI at home. Conclusion: The basic theory of “A Shining Cave” from this study provides a framework to improve the understanding of the prioritised care needs of patients suffering from sTBI. Increased support and resilience are both vital in achieving a peaceful life. To achieve a peaceful life, the caregiver must also make an effort to change. A model to meet the needs of caregivers provides an opportunity for them to form the necessary support in care. Additionally, a series of strategies and processes are proposed in this study for professionals and caregivers on the best ways to reduce risk and share responsibility for the care of sTBI survivors at home. These findings have implications for nursing practice, education, and research.

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

In Indonesia, the rising number of street children presents significant social challenges, particularly in Aceh Province. The government's efforts to address this issue, including providing shelters such as Panti Asuhan (orphanages), have been insufficient to cope with the growing population of street children and street families. As a result, many street children do not receive the necessary support for their well-being, which leads them back on the street to meet their end needs. Furthermore, the issues around the phenomena of street children in Aceh, particularly on their experience, needs and the impact of support received by them, are still unclear. This study aims to explore the experiences and support of street children in Aceh, specifically the types of support they receive and assessing its impact on their well-being, and development. An exploratory qualitative case study design was employed to achieve the research objectives. Three methods of data collection were utilized: (1) in-depth interviews, (2) participant observation, and (3) document analysis. A purposive sampling technique was used to select 41 participants, comprising ten children living in Panti Asuhan, 11 children living on the street, 10 caregivers at Panti Asuhan, and 10 parents who are having children working on the street or living at Panti asuhan. Data were analyzed according to framework techniques using N-vivo software to manage the data. Triangulation was applied through cross-referencing different data sources (interviews, observations, documents) to ensure robust and comprehensive insights methods were applied to deeply understand the issues around street children in Aceh Province. Three major themes emerged from the analysis. First, the experience of children living on the street captured the reasons behind their street involvement, the significant issues of street children in Aceh, and the types of work they engage in. Second, the trajectory of experience of children living in Panti Asuhan illustrated their initial experiences in the shelter and how their feelings, behaviors, and perceptions evolved over time. Finally, the theme of impact of support shed light on how the assistance provided influenced their personal development and helped shape their future prospects. The findings from this study offer profound insights and recommendations for policymaking, health care practices, education, and future research on vulnerable populations in Aceh Province. These insights have the potential to significantly enhance our understanding of the complex issue of street children in Indonesia and can contribute to the development of more effective strategies to address this growing social problem.

Background: Premature infants in the Neonatal Intensive Care Unit require specialized medical support including receiving good nutrition after birth. Therefore, breast milk is an ideal source of nutrition that has be chosen to optimize the growth and development of premature infants. The process of preparation expressed breast milk from mothers to premature infants in the Neonatal Intensive Care Unit could be challenging. In order to facilitate mothers to express breast milk and promoting exclusive breastfeeding practice, mutual agreement between mothers and nurses in Neonatal Intensive Care Unit is essential. Objectives: This study aimed to explore mothers experience in handling expressed milk and to understand the nurses’ practice in supporting EBM mothers in the Neonatal Intensive Care Unit. This study also to identify the current guidelines including policies and procedures related to breastfeeding management specifically on expressed breast milk. Methods: A qualitative research design using purposive sampling with multiple method was conducted involving 19 in-depth interviews with mothers those their premature infants hospitalized in neonatal intensive care unit, 4 focus groups discussion among 16 nurses working in Neonatal Intensive Care Unit and analysis of 20 documents related to breastfeeding and breast milk management. Data were digitally recorded, transcribed, and analyzed using NVivo. Thematic analysis and content analysis were adopted concurrently in analysis the rich data from participants. Results: This study identify four major conceptual ideas derived from participant’s experience in handling expressed breast milk: (1) received good support and motivation; (2) challenges and obstacles faced during expressing breast milk; (3) efforts to continue expressing breast milk; and (4) mothers’ needs. On the other hand, six themes were captured in the focus groups: (1) prioritized main topics for health education, (2) follow checklist and guideline, (3) engaged in education session, (4) encountering the difficulties, (5)nurse’s needs, and (6) valuing mothers’ feedback. Documents on breastfeeding management were tabulated under two topics: (1) management of expressed breast milk in the NICU; and (2) breastfeeding practice in the NICU. Conclusions: Hospital management, nurses’ commitment, and maternal awareness on the importance of breast feeding play an important role in ensuring that premature infants receive optimal nutrition. However, some factors influence these three components. By implementing standard guidelines in the management of expressed breast milk in the NICU gave staff an advantage in managing expressed breast milk and providing support to mothers. Keywords: Expressed breast milk, mother, nurses, premature infant, NICU

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

The intensive care environment is intimidating, too focused on the disease management and causing stress to the patients and the family members. As more patients survive critical illnesses, experts began to shift treatment focus towards survivorships. Based on previous literatures, critically ill patients of the intensive care unit (ICU) need psycho-emotional and spiritual care. These cares are also vital for their family members as they are also under distress with their loved ones being ill. However, clinicians were reported to be unprepared to provide spiritual care in the ICU because of poor knowledge, attitude and communication skills leading to inconsistent practice. This study sought to develop a model of spiritual care to guide ICU clinicians in providing spiritual care to their patients and family members in the intensive care unit (ICU) by utilizing grounded theory methodology. Interview guides were developed for the data collection. The researcher also conducted participatory observation and used field notes while conducting fieldwork in three ICUs in Johor, Malaysia. The study was commenced in October 2019 until June 2020, starting with the exploration of the experience and the spiritual needs of patients admitted in the ICUs and their family members. Another focus of this study was to explore the perceptions of the ICU clinicians on spirituality and the spiritual care that they provide for the patients and their families. A panel of six experts were invited to establish the usability and applicability of the model. A total of 47 patients, family members, ICU nurses and physicians were interviewed. The interviews and field notes were recorded, anonymized, transcribed. Data analysis was performed using grounded theory analysis in Atlas.ti software. The findings indicated there are nine dimensions of spiritual needs of ICU patients and family members consolidated upon four concepts. These concepts later become the foundational parts in the lnte1faith Spiritual Care Model for ICU Patients and Their Family Members. There are also multiple barriers to spiritual care as discussed by the ICU clinicians; nurses and physicians in this study. Further involvement of ICU stakeholders, education, training and research are needed to apply this spiritual care model in the management of critically ill patients and the family members.

Fragility fracture is extremely prevalent in older adults, and is known to have a staggering cost of treatment. Nearly 1 in 3 women, especially Post-Menopausal Women (PMW) over the age of 50, will develop fragility fracture in their lifetime. The management of osteoporosis in PMW involves pharmacological intervention as well as non-pharmacological methods, particularly in providing education and preventive behaviour programs. Education materials that suit and are tailor- made for our local PMW population are currently limited. Information inside the booklet can assist users in memorizing, and guide their health education activities. Realizing the importance of developing educational resources based on local needs, this study aims to develop and validate bone health educational booklet for PMW in preventing fragility fracture. This research was conducted in 2016, covering needs assessment study by distributing questionnaires on Knowledge, Attitude and Practice (KAP), and an assessment of fracture risk factors by using the Fall Free Prevention Questionnaire (FFPQ), the Activity Specific and Balance (ABC) scale, and the Fracture Risk Assessment (FRAX) tool; followed by conducting a physical examination using the Time up and Go (TUG) test, the Bone Mineral Density (BMD) analyses, and the Blood Serum Calcium level among local PMW. The process was continued by establishing the booklet content by including the findings from the needs assessment study, drafting of text, designing of illustrations and layout, validation process by content experts and end users, followed by the process of revising, editing and proofreading of the text.The needs assessments results shows respondents age and level of education was associated with their knowledge on bone health, (χ²=8.515; p=0.014), (χ²= 16.514; p= 0.001), and calcium intake among age of 70 and above having adequate intake based on calcium daily requirement intake (RDI) (χ²= 12.544; p= 0.002). The year of menopause was highly correlated to age (r = 0.82, p < 0.001) and FRAX major osteoporotic fracture shows a moderate correlation (r = 0.581, p < 0.001). The FRAX hip fracture was highly correlated to age (0.694, p < 0.001).Significant level with highly correlation were found between BMD and independent variables FRAX major osteoporotic fracture score (-0.606, p < 0.001) and FRAX hip fracture score (-0.708, p < 0.001) respectively and ABC scale had positive with weak association with BMD (0.200, p < 0.001). The booklet was validated using content and face validity. As a result, the booklet shows an excellent content validity with 0.77 of the global Content Validity Index (CVI). The level of agreement within the experts (91.1% -100%) and representatives of the end users (100%) was excellent. Overall, all of the participating end users were satisfied with the booklet and found the booklet very useful in guiding them. In addition, improvements proposed by the experts were included and modification of the final version was made accordingly. Thus, this booklet can be considered as an instrument to promote the prevention of osteoporosis and fragility fracture among PMW.

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.

In Malaysia, nasopharyngeal cancer (NPC) is a major health problem. The treatment is a major concern given that patients chronically suffer from side effects. Self-management (SM) has been a promising strategy in managing chronic conditions, including cancer. However, it is very complex and individual, resulting in a complex need for support. This study aimed to explore SM from the perspective of patients living with NPC and their significant others, such as family and healthcare providers (HCPs), which might enlighten specific SM engagement concerns. An exploratory qualitative case study design was conducted based on the study aim. With pragmatism as the philosophical underpinning this study, data were collected using three methods; (1) in-depth, semi structured interviews; (2) participant-observation; and (3) document analysis. A purposive sample of 40 participants of patients (16), family members (7), and HCPs (17) was recruited from two general hospitals. Data analysis was conducted using framework analysis (interviews transcripts/observation field notes) and content analysis (documents). Findings from multiple sources and methods were triangulated to understand in-depth SM as the centre case of this study. The NPC trajectory experienced by the patients was presented in four phases; (1) Pre-diagnosis; (2) When being diagnosed; (3) During treatment; and (4) After treatment. Patients practised several SM strategies across the four phases, mainly based on their health beliefs. Four main themes emerged in each phase. Phase one; Process to health care seeking behaviour where patients tried to comprehend their situation ineffectively because of lack of cancer knowledge. Phase two; Process of accepting the disease to explain the emotional changes and management. Phase three; Dealing with treatment challenges to explain patients’ self-determination and strategies for gaining energy during treatment. Phase four; Dealing with the physical and emotional sequel as NPC survivors to explain how patients managed fears of cancer recurrent and health conflicts after cancer treatment. Patients needed support from family, HCPs and health care facilities. However, patients’ perceptions seemed different in certain aspects when compared to each other. Patients perceived they only need psychological (encouragement and companionship), and financial and logistic support to help them self-manage. Family had revealed otherwise. The family informed that patients need extended support in managing physical and social needs, which introduced challenges to the family to change life roles and responsibilities with patients. Although patients highly valued discussion on health problems with HCPs, they had issues in communicating actual needs. Informational support was obtained (advice and support to self-manage physical condition and treatment complications) mainly during the treatment phase. As a result, patients’ perceived support received as inadequate since they need specific and long-term support. In conclusion, SM of patients with NPC existed but was greatly influenced by their health beliefs/cultural beliefs and, in most cases, without sufficient and accurate knowledge, especially on symptoms management and psychological disturbances. Support from HCPs was mainly focused on direct medical management and not clearly defined in practice. Family holds a critical role in supporting patients, mainly to help with NPC’s physical and psychosocial changes/needs, but they are heavily impacted because of a lack of knowledge and experience in supporting the family with cancer. The study findings could inform recommendations in certain aspects of policy and guidelines, healthcare practice, education, and future research on SM of patients with NPC in Malaysia. Keywords: Cancer, nasopharyngeal cancer, self-management, self-management support

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.