Post-traumatic stress disorder in children after discharge from the pediatric intensive care unit: a scoping review.

As the prevalence of post-traumatic stress disorder (PTSD) among children discharged from pediatric intensive care unit (PICU) continues to rise, corresponding research efforts have also increased. This scoping review aimed to review the PTSD prevalence, influencing factors, and tools used for PTSD measurements in children discharged from the PICU. This review employed the five-stage framework proposed by Arksey and O'Malley. The data sources included PubMed, Web of Science, Ovid, ScienceDirect, Springer, Scopus, CNKI, and WANFANG. Studies in English or Chinese published up to September 2023 were eligible for inclusion. The search yielded a total of 3536 results, with 31 articles meeting the inclusion criteria. The included studies reported that the prevalence of PTSD ranged from a minimum of 13% to a maximum of 84.6%. Risk factors for PTSD included medical interventions, child-related factors, and family environment. A total of 17 assessment tools for PTSD in PICU patients were reported. Given the significance of PTSD in this pediatric population, further attention, research, and intervention are warranted to help alleviate the burden of PTSD.

Translation, cross-cultural adaptation, reliability, and validity of the Chinese version of the intensive care unit environment stress scale for pediatric patients.

PURPOSE: There is currently a lack of understanding of children's experience in the pediatric intensive care unit (PICU) environment. Additionally, pediatric patients may experience post-PICU syndrome following discharge. Thus, we aimed to adapt and evaluate the psychometric properties of a tool specifically for use with children in the PICU. DESIGN AND METHODS: According to Brislin's Model, the Intensive Care Unit Environment Stress Scale (ICUESS) was translated both forward and backward and adapted cross-culturally. A total of 210 PICU patients were selected from four hospitals in XXX to analyze the final translated version of the questionnaire, the Pediatric Intensive Care Unit Environmental Stress Scale (PICUESS). Content validity, exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to assess the validity, while reliability was assessed using Cronbach's alpha and split-half reliability analysis. RESULTS: For PICUESS, seven of 42 items were modified. Content validity was high (overall = 0.96, item validity = 0.8 to 1.0). Exploratory factor analysis revealed eight common factors (Kaiser-Meyer-Olkin = 0.857, significant Bartlett's test). The results of the CFA indicate that the scale model fits well across the 8 factors. The entire scale demonstrated excellent internal consistency (Cronbach's alpha = 0.934). The overall split-half reliability was 0.935. CONCLUSIONS: The Chinese version of PICUESS demonstrates good reliability and validity, making it suitable for assessing pediatric patients' perceptions of the PICU environment. PRACTICE IMPLICATIONS: The PICUESS can assist healthcare professionals in providing personalized environment care for PICU patients. It has the potential to serve as a tool for further testing and international comparisons of pediatric patients' perceptions of the PICU environment.

The mediating effects of self-efficacy and study engagement on the relationship between specialty identity and career maturity of Chinese nursing students: a cross-sectional study.

BACKGROUND: Career maturity is a crucial indicator of career preparedness and unpreparedness can cause the turnover of new nurses. Considerable empirical work demonstrates the potential associations between specialty identity, self-efficacy, study engagement, and career maturity. This study aimed to explore the mediation role of self-efficacy and study engagement on the relationships between specialty identity and career maturity among Chinese nursing students. METHODS: Four hundred twenty-six Chinese nursing students were recruited between September 11 and October 30, 2022. The online survey was conducted following the CHERRIES checklist. Electronic questionnaires assessed their perceived specialty identity, self-efficacy, study engagement, and career maturity. The descriptive analysis, Harman single-factor analysis, Pearson correlation tests, structural equation modeling, and the bootstrap method were employed in data analysis. RESULTS: Bivariate correlation analysis identified a positive correlation between specialty identity, self-efficacy, study engagement, and career maturity (r = 0.276-0.440, P < 0.001). Self-efficacy and study engagement partially mediated the relationship between specialty identity and career maturity. Self-efficacy and study engagement played a chain mediating role between specialty identity and career maturity. CONCLUSIONS: The underlying mechanism can explain the relationships between specialty identity and career maturity: a direct predictor and an indirect effect through self-efficacy and study engagement. Policymakers and educators should emphasize the importance of specialty identity and provide tailored strategies for improving care maturity depending on nursing students' specialty identity, self-efficacy, study engagement in the early stages of career development.

Internet-Based Cognitive-Behavioral Therapy for Individuals Experiencing Panic Attacks: A Scoping Literature Review.

Panic attacks (PAs) are prevalent and highly comorbid with various physical and psychological disorders. Cognitive-behavioral therapy (CBT) is a well-established psychosocial intervention. Internet-delivered CBT (ICBT) presents a promising avenue to overcome barriers and provide evidence-based support to those in need. The current scoping review aimed to systematically map the existing literature and identify knowledge gaps regarding the impact of ICBT on outcome measures for individuals experiencing PAs. The PRISMA guidelines for scoping reviews were used. A total of 3,044 records were retrieved, and 18 studies from 2013 to 2023 were ultimately included in the analysis. ICBT demonstrated effectiveness as a psychosocial intervention for improving panic symptoms and anxiety in individuals with PAs. However, the impact of ICBT on quality of life (QOL) remains inconclusive. All studies included in this review focused on assessing the severity of panic symptoms, with limited emphasis on measuring QOL. This scoping review holds significant implications for research and practice. However, further addressing the research needs identified in this review will enhance our understanding and improve treatment outcomes for PAs. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 9-15.].

Effects of marital self-disclosure on marital relationship and psychological outcome for cancer patients: a systematic review.

PURPOSE: Literature on marital self-disclosure interventions for cancer patients lacks consistency in methodology and content. Moreover, the impact of such interventions on physical and psychological health, marital relationships, and self-disclosure ability is controversial. This review aims to systematically analyze the studies of marital self-disclosure intervention, synthesize the structure and topics of marital self-disclosure, and summarize and evaluate its effects on improving physical and psychological outcomes and marital relationships in cancer patients and their spouses. METHOD: This systematic review used the preferred reporting items of Systematic Reviews and Meta-Analyses (PRISMA). We conducted a systematic review of randomized controlled and quasi-experimental studies published from the establishment of the database to October 2022. Marital self-disclosure interventions were conducted with both cancer patients and their spouses. Studies published in a language other than English or Chinese, and studies below a quality grade of C were excluded. Data were extracted through a standardized data collection form, and two reviewers independently extracted and evaluated the data. The quality of the included studies was assessed using the Cochrane Handbook of Systematic Reviews of Interventions, and a third reviewer adjudicated in case of disagreement. The data were synthesized by vote counting based on direction of effect according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. RESULTS: Thirteen studies were included in the review. Based on quality evaluation, three studies were categorized as grade A (good), and ten studies were grade B (moderate). Seven studies reported moderate rates of participant refusal and attrition. The structure and topics of marital self-disclosure varied across different studies. The five studies had various prespecified disclosure topics, such as fear of cancer recurrence, benefit finding, and emotional distress. The overall results suggest that marital self-disclosure interventions can improve physical and psychological health, enhance marital relationships, and increase self-disclosure ability. CONCLUSION: The limited number of studies, small sample sizes, diverse intervention strategies, and methodological heterogeneity weakened the evidence base for the effectiveness of marital self-disclosure interventions. Therefore, further high-quality randomized controlled trials (RCTs) are recommended to confirm the effectiveness of such interventions. These studies should also evaluate the interventions' long-term impact, analyze optional topics and methods, identify key features, and explore the development of the best intervention program.

Effect of mindfulness intervention on anxiety, distress, and depression for chronic diseases: a scoping review.

This scoping review describes the research-based mindfulness intervention on anxiety, distress, and depression. The search strategy retrieved articles published in English from 2014 to 2019 and were retrieved across Scopus, Web of Science, Science Direct, CINAHL, and Google Scholar. The PRISMA-Scr checklist is a tool to evaluate the quality of the articles. The selection criteria initially included all original articles in English, with 1,527 that were related to mindfulness intervention for anxiety, distress, and depression. A total of 490 full texts were retrieved, and after the abstracts were reviewed, 124 full-text articles were included for eligibility, and the final eight studies were determined. The articles were reviewed and screened for relevance to mindfulness intervention in reducing anxiety, distress, and depression among those with chronic diseases. The results have shown that mindfulness intervention reduces anxiety, distress, and depression among patients with chronic diseases. The review contributes further insight into the fact that mindfulness intervention is also appropriate for other conditions to facilitate reducing psychological symptoms.

The mediating role of coping styles in the relationship between second victim experience and professional quality of life among nurses: a cross-sectional study.

BACKGROUND: Studies have shown that second-victim experiences could increase risks of the compassion fatigue while support from individuals and organisations is most often protection. However, the risk for poor compassion satisfaction and increased compassion fatigue in nurses aroused by adverse events remains an underestimated problem, meanwhile, litter known about the role of positive and negative coping styles among nurses suffering from adverse events. This study aims to investigate the effect of second-victim experiences on the professional quality of life among nurses and to determine the mediating role of coping styles in the relationship between second-victim experiences and professional quality of life. METHODS: Multistage sampling was used to recruit registered nurses from Hunan province in China. Registered nurses who identified themselves as experiencing adverse events from nine tertiary hospitals were included in this study. Participants were recruited to complete a survey on the second victim experience and support tool, the simplified coping style questionnaire, and the professional quality of life scale. The stress coping theory was used to develop the framework in this study. The structural equation modelling approach was used for conducting the mediating effects analysis via IBM SPSS Statistics 26.0 and Mplus 8.3. RESULTS: In total, 67% (n = 899) of nurses reported a second victim experience during their careers. In a bivariate analysis, both second-victims experiences and coping styles were significantly associated with their professional quality of life. The results showed that the effects of second victim experiences on their professional quality of life were fully mediated by coping styles. A total of 10 significantly indirect pathways were estimated, ranging from -0.243 to 0.173. CONCLUSIONS: Second-victim experiences are common among nurses in this study. Since the mediating effects of coping styles were clarified in this study, it is imperative to promote the perception of negative coping styles and encourage nurses to adopt more positive coping styles with adequate support systems.

Factors associated with complementary feeding practices among children aged 6-23 months in Indonesia.

BACKGROUND: Complementary foods with breastfeeding are foods or drinks given to children aged 6-23 months to meet their nutritional needs. The non-optimal provision of complementary feeding influences malnutrition in children of this age. AIMS: To analyze the factors associated with complementary feeding practices among children aged 6-23 months in Indonesia. METHODS: A cross-sectional design was employed using data from the 2017 Indonesia Demographic and Health Survey. A total of 502,800 mothers with children aged 6-23 months were recruited through multistage cluster sampling. Data were analyzed using a logistic regression test to determine the correlation between predisposing, enabling, and reinforcing factors and complementary feeding practices. RESULTS: A prevalence values of analysis showed that approximately 71.14%, 53.95%, and 28.13% of the children met MMF, MMD, and MAD, respectively. The probability of achieving minimum dietary diversity (MDD) was high in the following: children aged 18-23 months (odds ratio [OR] = 9.58; 95% confidence interval [CI] = 7.29-12.58), children of mothers with higher education (OR = 5.95; 95% CI = 2.17-16.34), children from households with upper wealth index (OR = 2.53; 95% CI = 1.85-3.48), children of mothers who received childbirth assistance by professionals (OR = 1.63; 95% CI = 1.20-2.20), and children of mothers who had access to the Internet (OR = 1.26; 95% CI = 1.06-1.50). Moreover, children from households with the upper wealth index (OR = 1.40; 95% CI = 1.03-1.91), children whose mothers were employed (OR = 1.19; 95% CI = 1.02-1.39) living in urban areas (OR = 1.28; 95% CI = 1.06-1.54) and children of mothers who received childbirth assistance by professionals (OR = 1.33; 95% CI = 0.98-1.82) were more likely to meet Minimum Meal Frequency (MMF). Finally, children aged 18-23 months (OR = 2.40; 95% CI = 1.81-3.17), of mothers with higher education (OR = 3.15; 95% CI = 0.94-10.60), from households with upper wealth index (OR = 1.41; 95% CI = 1.05-2.90) and born with professional childbirth assistance (OR = 1.82; 95% CI = 1.21-2.75) were significantly associated with minimum acceptable diet (MAD). CONCLUSIONS: The findings revealed that the prevalence of MDD and MAD in Indonesia was low. Strategies such as improving health services, economic conditions, and education level of mothers are needed to improve infant and young child feeding in Indonesia.

Health Benefits of Social Participation Interventions among Community-Dwelling Older Persons: A Review Article.

BACKGROUND: Social disengagement among older persons may result from accumulated physical impact and social stressors experienced throughout life. Conversely, interventions that enhance social participation addresses social isolation with positive influences on health. This article, therefore, aimed to review the range of published studies that evaluated the health benefits of interventions on social participation among community-dwelling older persons. METHOD: We conducted a search using the databases CINAHL, MEDLINE, EBSCOhost, PubMed, ProQuest, SAGE, ScienceDirect, SpringerLink, Web of Science, and Open repository/archive. RESULTS: Twenty-five studies from Asia, Europe and America were selected. Included articles described randomized controlled trials (9), quasi-experimental studies (9), mixed-methods studies (2), participatory action research (3), and community-based intervention research (2). Social interventions described are group or cultural activities, personal/group monitoring and discussion, and communications devices. Intervention designed utilized theories, models, concepts, principles, and evidence from published literature. CONCLUSION: Most social intervention studies evaluating health outcomes have been conducted in North America and Western Europe. Group-based activities were most commonly employed, but personal/group discussions, home visits and technology-based interactions have also been used. While social isolation is now a widely accepted risk factor for ill-health, research evidence for improvement of health through reduction of social isolation remains limited.

Knowledge, attitude and practice in relation to catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study.

BACKGROUND: Healthcare-associated infection (HAI) is one of the major threats to patients' safety besides being among the principal causes of patient morbidity and mortality. Catheter-associated urinary tract infection (CAUTI) is reported to be the most common HAI worldwide. CAUTI can be prevented with appropriate practice and care by healthcare personnel, especially nurses, who play the main role in urinary catheter care. Nurses' knowledge and attitude are considered to be important factors that influence their practice. OBJECTIVES: To assess nurses' level of knowledge, attitude and perceived practice regarding CAUTI and its preventive measures. METHODS: A cross-sectional design was adopted, and a self-administered questionnaire was used to collect data. Nurses from the medical and surgical inpatient wards of a tertiary teaching hospital in Malaysia were recruited in two stages using the stratified and simple random sampling methods. A total of 301 nurses participated. Descriptive analysis, an independent t test, ANOVA and hierarchical multiple regression were employed to analyse the data using SPSS software version 25. In addition, a STROBE checklist was used to report the results of this study. RESULTS: Nurses were found to have good knowledge, a positive attitude and good perceived practice regarding CAUTI prevention. Nurses aged above 30 and who had more than ten years of experience reported higher knowledge levels. Knowledge was found to be positively correlated with attitude and perceived practice; however, attitude explained a higher variance in perceived practice of CAUTI prevention compared with knowledge. CONCLUSION: Attitude was found to have a higher significant influence on perceived practice in this study. Educators need to emphasise the inculcation of a positive attitude among nurses rather than just knowledge for CAUTI prevention. Since this study assessed perceived practice, examining nurses' actual practice and its impact on patient outcomes is recommended in future studies.

Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review.

AIMS AND OBJECTIVES: To map research-based psychological distress among the family members with patients in the intensive care unit (ICU). BACKGROUND: Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery. DESIGN: The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist. METHODS: A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed. RESULTS: From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress. CONCLUSIONS: Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members. RELEVANCE TO CLINICAL PRACTICE: The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.

The effect of mobile applications in enhancing asthma knowledge among school children with asthma in Malaysia.

PURPOSE: This study set out to evaluate the impact of health education provided on mobile applications (app) to urban-living school children with asthma in Malaysia to improve their asthma-related knowledge. DESIGN AND METHODS: This was a quasi-experimental study with pre-and post-intervention involving 214 respondents from six schools were selected randomly and assigned to the experimental and control groups. The intervention, i.e. the health education via mobile apps was given to the experimental group while the control group received the routine face-to-face education. RESULTS: The mean knowledge score increased post-intervention in the experimental group from 15.5 ± 8.77 to 24.6 ± 6.69. Children with a moderate level of knowledge accounted for the biggest proportion in both group control and experimental groups in the pre-intervention stage. In contrast, the proportion of children with a high level of knowledge was the highest in the experimental group post-intervention. Therefore, health education delivered via mobile apps led to a statistically significant improvement in the asthma knowledge of the children (F [1, 288] = 22.940, p ≤0.01). CONCLUSION: Compared to the conventional face-to-face education methods of lectures or handbooks, mobile technology is more effective in delivering health education and improving the knowledge of school children with asthma. Therefore, educational modules aimed at improving knowledge should be modified to incorporate mobile apps. PRACTICE IMPLICATIONS: Health education via mobile applications is considered a great innovation in school children with asthma education, or as a supplement to conventional learning methods. It is necessary to place health education via mobile applications as a prominent learning strategy for school children with asthma.

Effect of Health Education via Mobile Application in Promoting Quality of Life Among Asthmatic Schoolchildren in Urban Malaysia During the COVID-19 Era: A Quasi-experimental Study.

Bronchial asthma among children is a common chronic disease that may impact quality of life. Health education is one of the strategies to improve knowledge and quality of life. This study aims to assess the effect of health education via a mobile application in promoting the quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (an intervention group and a control group). The control group received face-to-face health education, whereas the experimental group received health education via a mobile application. The findings showed that the total score of quality of life improved from a mean total score at pre-intervention of 5.31 ± 1.27 to post-intervention of 5.66 ± 1.28 for the control group, compared with the experimental group with a mean total score of quality of life at pre-intervention of 5.01 ± 1.36 and post-intervention of 5.85 ± 1.29. A comparison between the experimental and control groups using an independent t test showed statistically significant differences in their mean quality of life scores. The effect of health education via a mobile application showed a statistically significant improvement in the mean quality of life score from pre- to post-intervention ( F1,288 = 57.46, P < .01). As recommended, the use of mobile technology in health education improved the quality of life of schoolchildren with asthma as compared with the traditional methods of a face-to-face lecture and/or a handbook. Thus, educational modules using mobile applications do improve quality of life.

The impact of organisational communication satisfaction on health care professionals' work engagement.

AIM: To assess the impact of organisational communication satisfaction (OCS) on the work engagement of health care professionals (HCPs). BACKGROUND: Organisational communication can influence employees' work engagement, which is an essential component of an organisation's effectiveness. However, these concepts have not been broadly investigated in health care organisations. METHODS: A cross-sectional survey was administered to 235 HCPs in the Gaza Strip, Palestine. The SPSS statistical software (version 25) and partial least squares structural equation modelling (PLS-SEM) were used to analyse the collected data. RESULTS: The HCPs reported a moderate level of OCS (M = 4.96, SD = 0.94) and work engagement (M = 5.56, SD = 0.96). The impact of OCS on work engagement was found to be positive and statistically significant (ß = .524, p < .05). No significant difference was revealed in level of OCS or work engagement among the HCPs according to their job categories. Only years of experience significantly influenced their OCS. CONCLUSION: Improving HCPs' satisfaction with organisational communication is vital in enhancing their work engagement and, ultimately, sustaining health care manpower. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies for improving the quantity and quality of organisational communication must be prioritized to strengthen work engagement among HCPs. These strategies include management's role in and ways of communicating essential information about their organisations to HCPs.

Mitigation of COVID-19 Risk Among Older Adults in Nursing Homes: A Public Survey.

The current study examines the public's perception on the mitigation of COVID-19 risk and knowledge of disease symptoms among older adults in nursing homes, with the intention to address gaps in knowledge using mobile technologies. An online survey questionnaire was completed by 611 adults residing in Malaysia. The four domains, derived from factor analysis, affirmed the supportive perception among the public (score range = 4.42 to 4.64/5.0). However, among the gaps identified were the perception toward hand sanitizing and susceptibility of older adults to COVID-19. Public knowledge on symptoms of COVID-19 was limited (e.g., 41.4% to 53.4% incorrect responses to anosmia, diarrhea, confusion). Multivariate analysis of variance found that males and participants with less education had significantly lower supportive perceptions (p < 0.05). With >86% of participants having access to internet communication technology, mobile interventions tailored to gender and educational level are recommended to promote long-term pandemic preparedness among stakeholders and the public. [Journal of Gerontological Nursing, 47(3), 23-28.].

The Relationship Between Psychological Distress and Religious Practices and Coping in Malaysian Parents of Children with Thalassemia.

STUDY PURPOSE: This study was conducted to examine the relationship between religious practice, religious coping methods and psychological distress among parents caring for children with transfusion-dependent thalassemia. DESIGN AND METHODS: This is a cross-sectional survey. Data were collected on 162 parents of children diagnosed with thalassemia aged 12 years and younger in thalassemia day care centers of three public hospitals in Sabah, Malaysia. Data were collected using questionnaires, including General Health Questionaire-12 (GHQ-12), Duke University Religion Index (DUREL) and Brief RCOPE. RESULTS: Forty-two percent of parents had psychological distress with GHQ score ≥ 3 (mean score of 2.85 ±â€¯3.17). Ninety-five percent of parents used positive religious coping methods (mean P-COPE score 22.35 ±â€¯2.33) more than negative religious coping methods (mean N-COPE score was 12.19 ±â€¯5.23). They used Organized Religious Activities (mean ORA score of 4.20 ±â€¯1.27), and Non-Organized Religious Activities (NORA, the mean was 4.17 ±â€¯1.37). Positive and negative religious coping methods were significantly related to parents' psychological distress (P-COPE and GHQ-12 scores (rs (df) = 0.19, p < .05; N-COPE and GHQ-12 scores rs (df) = 0.38, p < .001)). CONCLUSION: The study findings showed the parents experienced psychological distress. They used positive religious coping methods more than negative religious coping methods. Psychological distress was significantly related to organized religious activities, non-organized religious activities and positive and negative religious coping methods. PRACTICE IMPLICATION: The study findings facilitate understanding of psychological distress and how parents use religious coping strategies to deal with the stress caring for their child.

Nurses' perceptions of barriers and facilitators and their associations with the quality of end-of-life care.

AIMS AND OBJECTIVES: To examine nurses' perceptions of barriers to and facilitators of end-of-life care, as well as their association with the quality of end-of-life care. BACKGROUND: Often, dying patients and their families receive their care from general nurses. The quality of end-of-life care in hospital wards is inadequate. METHOD: A self-administered questionnaire was completed by 553 nurses working in a tertiary teaching hospital in Malaysia. RESULTS: The barrier with the highest mean score was "dealing with distressed family members." The facilitator with the highest mean score was "providing a peaceful and dignified bedside scene for the family once the patient has died." With regard to barrier and facilitator categories, the barrier category with the highest total mean score was patient-related barriers and the facilitator category with the highest total mean score concerned facilitators related to healthcare professionals. In the multivariate analysis, age, patient family-related barriers and healthcare professional-related facilitators significantly predict the quality of end-of-life care. CONCLUSION: The results of this study suggest that there is an urgent need to overcome barriers related to the patient and family members that hinder the quality of care provided for dying patients, as well as to enhance and implement the facilitators related to healthcare providers. In addition, there is also a need to enhance the quality of end-of-life care provided by younger nurses through end-of-life care courses and training. RELEVANCE TO CLINICAL PRACTICE: Helping nurses overcome barriers and implement facilitators may lead to enhanced quality of care provided for dying patients.

The effect of mobile messaging apps on cardiac patient knowledge of coronary artery disease risk factors and adherence to a healthy lifestyle.

AIMS: To determine the effect mobile messaging apps on coronary artery disease patient knowledge of and adherence to a healthy lifestyle. BACKGROUND: Due to the increasing incidence of coronary artery disease in recent years, interventions targeting coronary artery disease risk factors are urgent public priorities. The use of mobile technology in healthcare services and medical education is relatively new with promising future prospects. DESIGN: This study used a quasiexperimental design that included pre- and posttest for intervention and control groups. METHODS: The study was conducted from January-April 2017 with both intervention and control groups, in a teaching hospital in Klang Valley. Convenience sampling was used with inclusive criteria in choosing the 94 patients with coronary artery disease (intervention group: 47 patients; control group: 47 patients). The pretest was conducted as a baseline measurement for both groups before they were given standard care from a hospital. However, only the intervention group was given a daily information update via WhatsApp for 1 month. After 1 month, both groups were assessed with a posttest. RESULTS: The split-plot ANOVA analysis indicates that there is a significant and positive effect of the intervention on coronary artery disease patients' knowledge on coronary artery disease risk factors [F(1, 92) = 168.15, p < 0.001] with a large effect size ( η p 2  = 0.65). The mobile messaging apps also significantly improve the patients' adherence to a healthy lifestyle [F(1, 92) = 83.75, p < 0.001] with a large effect size ( η p 2  = 0.48). CONCLUSION: This study concluded that WhatsApp was an effective health intervention in increasing coronary artery disease patient's knowledge and subsequently increasing their adherence to healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE: In clinical setting, mobile messaging apps are useful in information delivery and efficient patient monitory.

A systematic review of psychometric testing of instruments that measure intention to work with older people.

AIMS: To review systematically the psychometric properties of instruments used to measure intention to work with older people. BACKGROUND: Nursing students are part of the future healthcare workforce; thus, being aware of their intention to work with older people would give valuable insights to nursing education and practice. Despite a plethora of research on measuring intention to work with older people, a valid and reliable instrument has not been identified. DESIGN: A systematic literature review of evidence and psychometric properties. DATA SOURCES: Eight database searches were conducted between 2006 - 2016. REVIEW METHODS: English articles were selected based on inclusion and exclusion criteria. The COSMIN checklist was used to assess instruments reporting a psychometric evaluation of validity and reliability. RESULTS: Of 41 studies identified for full text review, 36 met the inclusion criteria. Seven different types of instruments were identified for psychometric evaluation. Measures of reliability were reported in eight papers and validity in five papers. Evidence for each measurement property was limited, with each instrument demonstrating a lack of information on measurement properties. Based on the COSMIN checklist, the overall quality of the psychometric properties was rated as poor to good. CONCLUSION: No single instrument was found to be optimal for use. Studies of high methodological quality are needed to properly assess the measurement properties of the instruments that are currently available. Until such studies are available, we recommend using existing instruments with caution.

Stress, Anxiety, Depression and Sleep Disturbance among Jordanian Mothers and Fathers of Infants Admitted to Neonatal Intensive Care Unit: A Preliminary Study.

PURPOSE: To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance. DESIGN AND METHODS: A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS. RESULTS: Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43). CONCLUSIONS: The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance. PRACTICAL IMPLICATIONS: The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents.