The mediating role of pre-operative patient readiness on surgical outcomes: A structural equation model analysis.

AIMS: To determine the mediating role of surgical readiness on patient characteristics (surgical risk, type of surgery, pre-operative anxiety, and health literacy) and its influence on surgical outcomes (pain, postoperative complications, and surgical experience). DESIGN: Correlational, theory testing using structural equation modelling. METHODS: A total of 376 consecutively selected surgical patients from four tertiary hospitals were recruited and followed-up 48-72 hr postoperatively from May-October 2017. Consenting respondents answered questionnaires measuring basic surgical information, health literacy, anxiety, surgical readiness, pain score, and surgical experience. Further, records review was conducted to identify occurrence of any postoperative complications and use of additional analgesics. RESULTS: A good fit and parsimonious model (χ2 /df = 0.75, RMSEA = 0.00, GFI = 0.99, CFI = 1.00, PNFI = 0.50) highlighted the mediating effect of pre-operative readiness between patient characteristics and surgical outcomes. The type of surgery (curative) influenced patient readiness, surgical complications, and use of additional postoperative analgesics. Higher health literacy negatively influenced patient readiness; can decrease the use of postoperative analgesics; and lessen postoperative pain. Further, pre-operative anxiety decreased patient readiness and increased postoperative pain and negatively influenced the surgical experience. CONCLUSION: Patient readiness is beyond the physiological aspect of pre-operative preparation and it is influenced primarily by the mental and emotional state of a patient. Addressing issues such as anxiety and health literacy can improve pre-operative readiness that can enhance pain management and surgical experience. Hence, the mediating role of readiness in improving surgical outcomes emphasizes the need to deliver a patient-centred and individualized approach to patient preparation with a key focus on their readiness for surgery. IMPACT: This study demonstrates the difference between preparing patients and promoting readiness for surgery. Surgical readiness requires patient-centred approach in promoting a more engaged and confident patient who is capable to use appropriate health information and how it can lead to better surgical outcomes.

Doctoral nursing education in east and Southeast Asia: characteristics of the programs and students' experiences of and satisfaction with their studies.

BACKGROUND: The characteristics of nursing doctoral programs and the doctoral students' experience have not been thoroughly investigated. Hence, this study aimed to describe the characteristics of nursing doctoral programs in East and South East Asian (ESEA) countries and regions from the views of doctoral program coordinators, and to explore the students' experiences of and satisfaction with their doctoral nursing program. METHODS: A cross-sectional survey was conducted using two self-designed questionnaires, one focusing on PhD program coordinators and the other on doctoral students. Characteristics of the nursing doctoral programs focused on program characteristics, faculty characteristics, career pathways for graduates, and challenges for nursing doctoral education. Doctoral students' assessment of study experiences included quality of supervision, doctoral training programs, intellectual/cultural climate of institutions, general facilities/support, and the overall study experience and satisfaction. RESULTS: In the PhD coordinators survey, 46 institutions across nine ESEA countries and regions participated. More than half of nursing departments had academic members from other health science disciplines to supervise doctoral nursing students. The majority of graduates were holding academic or research positions in higher education institutions. Faculty shortages, delays in the completion of the program and inadequate financial support were commonly reported challenges for doctoral nursing education. In the students' survey, 193 doctoral students participated. 88.3% of the students were satisfied with the supervision they received from their supervisors; however, 79% reported that their supervisors 'pushed' them to publish research papers. For doctoral training programs, 75.5% were satisfied with their curriculum; but around half reported that the teaching training components (55.9%) and mobility opportunities (54.2%) were not included in their programs. For overall satisfaction with the intellectual and cultural climate, the percentages were 76.1 and 68.1%, respectively. Only 66.7% of the students felt satisfied with the facilities provided by their universities and nursing institutions. CONCLUSION: Doctoral nursing programs in most of the ESEA countries value the importance of both research and coursework. Doctoral nursing students generally hold positive experiences of their study. However, incorporating more teaching training components, providing more opportunities for international mobility, and making more effort to improve research-related facilities may further enhance the student experience. There is also a need to have international guidelines and standards for quality indicators of doctoral programs to maintain quality and find solutions to global challenges in nursing doctoral education.

Exploring the status and critical issues in mixed methods research in doctoral nursing education in the Philippines.

BACKGROUND: Mixed methods research (MMR) can be a pathway for doctoral nursing students to create innovative and noble contributions for the advancement of nursing theory, practice, and education. Several issues and challenges must be identified to successfully train, mentor, and support doctoral nursing students in conducting MMR. AIM: The study aimed to explore the status and critical issues in conducting, mentoring, and training MMR in doctoral nursing programs in the Philippines. METHODS: A descriptive qualitative study was conducted by performing semi-structured online interviews with 10 purposively selected participants who were faculty and educators with doctoral degrees, involved in teaching and mentoring MMR among doctoral nursing students in the last 10 years. Data were analyzed using Braun and Clarke's thematic analysis. FINDINGS: Four key themes emerged, namely, (1) perceptions on the use of MMR, (2) facilitators to use MMR, (3) barriers to the use of MMR, and (4) recommendations to promote the use of MMR focused on the student, faculty, and educational institution levels. CONCLUSION: Providing educational, institutional, and research support for doctoral nursing students and faculty could flourish the use of MMR in doctoral nursing programs with deeper meaning and reasoning.

A Comparative Study on Health Risks, Lifestyle Behaviors, Health Perceptions, and Health Seeking Patterns between Older and Younger Filipinos in the Rural Areas.

Background: Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥ 60 years). Objectives: This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines. Methods: A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests. Results: Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician. Conclusion: There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.

The health of women and girls determines the health and well-being of our modern world: A white paper from the International Council on Women's Health Issues.

The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

Are Health Behaviors and Risk Factors for Altherosclerotic Cardiovascular Disease Interrelated Among Older Filipinos in Underserved Communities?

Introduction: Moving individuals toward ideal cardiovascular health through adoption of healthy lifestyle behaviors is critically important for prevention of atherosclerotic cardiovascular disease (ASCVD) and other important health conditions. However, associations between health behaviors and risks for ASCVD is poorly understood among older adults (≥ 60 years) living in rural areas in the Philippines. Likewise, their access to healthcare and health-seeking practices are unknown. Purpose: To 1) compare risk profiles of Filipinos at low- vs. moderate to high-risk for ASCVD; and 2)examine the relationships befiveen demographic variables, risk profiles, and health behaviors. Methods: A convenient sample of 427 Filipinos (≥ 60 years old) were recruited to participate in this comparative, cross-sectional study. Data on sociodemographic characteristics, risk profiles, and health behaviors (e.g., dietary patterns, physical activity, smoking status,and alcohol use)were collected. Results: Of the 427 participants (mean age was 69.2± 6.7 years, primarily women [65%], married [52.8%]), 319 (75%) were at low-risk and 108 (25%) were at moderate to high-risk for ASCVD. Those at moderate to high-risk were more likely to have cardiometabolic diseases(e.g., hypertension, hyperlipidemia, diabetes, and obesity, all p's < .001).Health behaviors did not differ between the two groups except for consumption of≥ 5 servings of fruit which was higher in the low-risk group. Conclusion: Findings showed that there is highly consistent and convergent evidence that older Filipinos living in rural areas are at high risk for ASCVD and other health conditions. Much of this is attributable to the suboptimal implementation of prevention strategies, uncontrolled ASCVD risk factors, and poor access to effective and equitable healthcare services commonly observed in low-income countries. Clinicians, researchers, policy makers, and other stakeholders need to address these issues to improve primary and secondary prevention and disease management in this population.

Blood Pressure Measurement Training Program and Adherence of Public Health Nurses to BP Measurement Guidelines.

OBJECTIVE: To compare the level of adherence of public health nurses to BP measurement guidelines based on their knowledge if the guidelines and skills in BP measurement before and after Blood Pressure Measurement Training Program (BPMTP). METHODS: An experimental pre- and post-test design using two-staged cluster randomization was conducted. 118 PHNs (mean age ± 38.45 years, mean years of experience ± 13.45 years; 84.1% women) from six districts in Manila were equally assigned to either the BPMTP group or control group. Structured instruments were used. RESULTS: Demographic characteristics, current BP measurement practices, and level of adherence to BP measurement guidelines based on knowledge of the guidelines and skills in BP measurement were equivalent in both groups at baseline. Nurses in the BPMTP group showed improved adherence (p=<0.05) compared to nurses in the control group. Both groups did not show significant change in their skill on recording, interpretation, and referral (p=1.000). CONCLUSION: This study showed that Blood Pressure Measurement Training Package is feasible in improving adherence of nurses based on their increased knowledge of the BP measurement guidelines and skills in BP measurement. A larger-scale study is warranted to show that BPMTP can potentially improve clinical management of hypertension in public health clinics globally.

A study to evaluate the pain knowledge of two sub-populations of final year nursing students: Australia and Philippines.

BACKGROUND: Pain management is an essential and important aspect of nursing care. Deficits in pain knowledge and attitudes continue to be reported despite a growth of educational programmes. A lack of basic knowledge of pain at an undergraduate level may limit nurses from effectively developing their knowledge after graduation. AIM OF THE STUDY: To assess the type and level of knowledge of basic aspects of pain mechanisms and treatment principles in complete classes of final year nurses, at three nursing schools. METHOD: Data were collected in 1999, from 150 students (81 Australian and 69 Philippine) via a 23-item pain knowledge test questionnaire, previously used to assess undergraduate health professionals including nurses. RESULTS: The mean score of concordant answers for all students was 38.6%, scores ranged from 0% to 70%, 95% Confidence Interval of the mean was 36-41%. There were few significant differences between the groups for individual questions and no significant difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitization. Most students perceived their undergraduate pain education to be minimal. Thirty-six per cent of Australian students compared with 50% Filipino students perceived their pain knowledge was adequate for their clinical needs. Additionally, most students believed that graduating doctors should be able to answer the test questions correctly. CONCLUSION: The results demonstrate consistently low levels of knowledge and also knowledge gaps about basic pain mechanisms, terms and treatment amongst these three final year nursing classes. Such information is useful to define levels of basic knowledge about this topic, and can be explored further as to whether some or all of these facts are deemed necessary for inclusion in nursing curriculum by reference to documents such as the International Association for the Study of Pain curriculum.