Yanika Kowitlawakul

Exploring new healthcare professionals’ roles through interprofessional education

Abstract This article presents findings from a simulation-based interprofessional education (IPE) program involving trainee advanced practice nurses (APNs) and internal medicine residents (IMRs) based in Singapore. Trainee APNs and IMRs participated in a semester-long series of high-fidelity simulations of medical emergencies. Learners’ attitudes toward the IPE intervention were assessed using validated Likert scaled surveys and written comments. Overall satisfaction was high among learners, with strongly positive attitudes toward teamwork, collaboration and patient centredness. Of most interest, written comments highlight the utility of IPE in defining the professional scope and boundaries of APNs. Comments from both professions observed that participation in the IPE scenarios greatly aided their understanding of the scope and role of APN’s practice within the health care team. This aspect of IPE may find further application in other similarly novel roles in healthcare.

Predictors for success for first semester, second‐degree Bachelor of Science in Nursing students

Second-degree Bachelor of Science in Nursing (BSN) programmes have grown rapidly in the past 5 years to respond to the nursing shortage in many countries. The purposes of this study are to describe the relationships among age, prerequisite grades, previous degree grade point averages (GPAs), admissions test scores and first semester test scores, and to investigate the most influential predictor for success in the first semester in the nursing program. Pre-existing data from academic records were used. There were 60 participants and SPSS version 15.0 was used to analyze the data. The results show that age has no relationship with the first semester performance. Fifty-four per cent of variance in the first semester GPAs (R(2) =0.54) was explained by previous degree GPAs, prerequisite GPAs and admissions test scores in the second-degree nursing student population. The most influential predictor for success for the first semester of the second-degree BSN program is admissions tests scores.

The adductor pollicis muscle: a poor predictor of clinical outcome in ICU patients

No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world.

An education booklet to aid cardiac patients' recovery at home

BACKGROUND Hospital and home-based cardiac rehabilitation programmes improve the health outcomes of cardiac patients. Both types of programmes include patient education as a core component. However, many patients do not attend cardiac rehabilitation programmes for a variety of reasons. In Singapore, where cardiac rehabilitation is comparatively uncommon, patient education is usually delivered face-to-face by healthcare professionals because educational materials designed specifically for cardiac patients recovering at home are not available. AIM This paper describes the development of a patient education booklet designed to aid recovery at home after a myocardial infarction in Singapore. METHODS The conception and development of this evidence-based Heart Recovery Education Booklet was based on patient need and current clinical guidelines pertaining to cardiac rehabilitation and planned in consultation with specialists such as cardiologists, psychiatrists and physiotherapists. RESULTS The booklet is a patient resource to aid recovery at home after an myocardial infarction. It is interactive, based on identified need and aims to guide and assist the patient in performing their usual activities of daily living and adhering to treatment regimens, including exercise. CONCLUSION This booklet is a resource for patients with myocardial infarction and healthcare professionals and its effectiveness in improving health-related quality of life, psychological status and coronary risk profile is to be tested in a randomized controlled trial. IMPLICATIONS FOR NURSING AND HEALTH POLICY Policy makers in health and nursing must find ways of developing and implementing cardiac rehabilitation programmes that aid recovery from myocardial infarction. This education booklet offers one way to do this.Background Hospital and home-based cardiac rehabilitation programmes improve the health outcomes of cardiac patients. Both types of programmes include patient education as a core component. However, many patients do not attend cardiac rehabilitation programmes for a variety of reasons. In Singapore, where cardiac rehabilitation is comparatively uncommon, patient education is usually delivered face-to-face by healthcare professionals because educational materials designed specifically for cardiac patients recovering at home are not available. Aim This paper describes the development of a patient education booklet designed to aid recovery at home after a myocardial infarction in Singapore. Methods The conception and development of this evidence-based Heart Recovery Education Booklet was based on patient need and current clinical guidelines pertaining to cardiac rehabilitation and planned in consultation with specialists such as cardiologists, psychiatrists and physiotherapists. Results The booklet is a patient resource to aid recovery at home after an myocardial infarction. It is interactive, based on identified need and aims to guide and assist the patient in performing their usual activities of daily living and adhering to treatment regimens, including exercise. Conclusion This booklet is a resource for patients with myocardial infarction and healthcare professionals and its effectiveness in improving health-related quality of life, psychological status and coronary risk profile is to be tested in a randomized controlled trial. Implications for nursing and health policy Policy makers in health and nursing must find ways of developing and implementing cardiac rehabilitation programmes that aid recovery from myocardial infarction. This education booklet offers one way to do this.

Narrative review of health‐related quality of life and its predictors among patients with coronary heart disease

This paper summarizes the empirical evidence concerning health-related quality of life (HRQoL) of patients with coronary heart disease (CHD) and attempts to identify its significant predictors. A systematic search of the literature from 2002 to 2012 was conducted using seven electronic databases (CINAHL, ScienceDirect, Medline, Scopus, PsycINFO, PubMed and Web of Science) using the search terms ‘HRQoL’. ‘CHD’, ‘social support’, ‘depression’, ‘anxiety’, ‘psychosocial factors’, ‘sociodemographic factors’, ‘clinical factors’ and ‘predictors’. A total of 1052 studies were retrieved, of which 24 articles were included in this review. Previous studies have consistently demonstrated the negative impact of CHD on HRQoL, citing three major types of predictive factors: sociodemographic, clinical and psychosocial factors. Studies have also highlighted the advantageous use of HRQoL as a gauge for treatment satisfaction and efficacy. There are, however, few studies that collectively investigate the relationship among concepts such as HRQoL, anxiety and depression, social support, and sociodemographic and clinical factors in relation to CHD. This review highlights the need to conduct further study on HRQoL of patients with CHD in the Asian context. Such research will promote patient-centric care and improved patient satisfaction through incorporation of the concept of HRQoL into clinical practice.

Awareness, knowledge and healthy lifestyle behaviors related to coronary heart disease among women: An integrative review.

The purpose of this review is to examine recent literature on the awareness, knowledge, and healthy lifestyle behaviors related to Coronary Heart Disease (CHD) among women. Literature published in the English language from 2004 to 2015 was reviewed. Of the 684 articles retrieved, 21 were deemed relevant. Being aware that CHD is the leading cause of death in women and knowledge of the risk factors of CHD were found to be generally suboptimal in the women studied. Awareness was seen to be positively associated with healthy lifestyle behaviors, though findings on the predictive relationship of knowledge of risk factors on healthy lifestyle behaviors in women seem to be divided. Diabetes was the prominent risk factor that most women did not associate with CHD. Translating these findings into clinical practice can help health care providers be more attuned when discussing CHD with their female patients so as to provide targeted education on CHD prevention.

Predictors of Health-Related Quality of Life Among Patients With Myocardial Infarction

This cross-sectional correlational study aimed to examine health-related quality of life (HRQoL) and its predictors among patients with myocardial infarction (MI). One hundred and twenty-eight outpatients with MI were recruited from a university hospital. The 12-item Short-Form Health Survey version 2, Myocardial Infarction Dimensional Assessment Scale (MIDAS), and Hospital Anxiety and Depression Scale (HADS) were used to measure the study variables. Compared with the findings of similar studies of patients with MI, this sample, despite having significant coronary risk factors, reported generally better HRQoL. Predictors of physical HRQoL included low monthly household income, whereas predictors of mental HRQoL included ex-smoker, alcohol use, hypertension, anxiety, and depression. Special attention may need to be given to those people with a low income level, who are ex-smokers, use alcohol, or have hypertension, anxiety, or depression.

Development of an e-learning Research Module Using Multimedia Instruction Approach

Students nowadays feel more comfortable with new technologies, which increase their motivation and, as a result, improve their academic performance. In the last two decades, the use of information communication technology has been increasing in many disciplines in higher education. Online learning or e-learning has been used and integrated into the curriculum around the world. A team of nursing faculty and educational technology specialists have developed an e-learning research module and integrate it into the nursing curriculum. The aim was to assist master of nursing and postgraduate nursing students in developing their research knowledge before and throughout their enrollment in the research course. This e-learning module includes interactive multimedia such as audiovisual presentation, graphical theme, animation, case-based learning, and pretest and posttest for each topic area. The module focuses on three main topic areas: (1) basic research principles (for review), (2) quantitative method, and (3) qualitative method. The e-learning module is an innovative use of the information and communication technology to enhance student engagement and learning outcomes in a local context. This article discusses the development journey, piloting process, including the variety of evaluation perspectives, and the ways in which the results influenced the e-learning resource before its wider distribution.

Emergency medicine staff's perception of SimWars: A Singapore view

Background: SimWars is an onstage competition among teams of health care providers in front of an audience. Participants demonstrate communication, teamwork, clinical management, and problem-solving skills. Upon completion, judges debrief participants’ clinical actions and team dynamics. Purpose: The Society for Emergency Medicine in Singapore hosted the inaugural SimWars in 2014. This study investigated whether SimWars was effective in teaching emergency medicine staff, explored how the competitive nature of SimWars affected the performance and learning of participants, and identified strategies to implement SimWars effectively in Singapore. Methods: A descriptive qualitative design was selected owing to the exploratory nature of the questions. Thirteen SimWars participants, six audiences, and three judges participated in the study. Results: (1) Twenty-one out of 22 considered SimWars useful for learning; (2) 14 out of 19 agreed that SimWars closely resemble clinical practice compared to clinical practice; (3) 16 out of 19 agreed that competition induced stress from participants and enhanced performance; (4) 16 out of 22 said SimWars was psychologically safe; (5) 18 said the team worked well together; (6) 19 said that debriefing helped them to improve through clarification, discussion, and reflection; debriefing should be personalized, longer, more structured, more detailed, and in a more private manner; (7) 13 said their knowledge and skills on the content areas will change; 21 said what they learned will be transferred to clinical practice; (8) the useful parts of SimWars included practicing under stress, debriefing, teamwork, and critical thinking; and (9) future improvements included avoiding technical problems and providing clear guidelines. Conclusion: Our responders perceived SimWars to be effective for professional development.

Investigation of the key determinants of Asian nurses’ quality of life

The study aimed to compare nurses’ quality of life and investigate key determinants among Asian countries with different economic status. A cross-sectional survey was conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data were assessed. Stepwise multivariate linear regression analysis was performed to identify the key determinants of quality of life. Participants were 3,829 nurses (response rate: 82%) with a mean age of 33 ± 10 yr and majority were women (92%). Regarding quality of life, Bhutan yielded the highest scores, followed by Malaysia, Thailand, Singapore, and Japan, and these results were statistically significant. The key determinants that were significantly related to quality of life were “stress coping ability,” “life satisfaction,” “Japan,” “social support,” “job stress,” and “Singapore” (adjusted R2=0.46). In conclusion, nurses’ quality of life differs across Asian countries and is not linked to the country’s economic development. To maintain a good quality of life for nurses, an international exchange program like international nursing conferences for work environment and staff coping strategies is recommended to broaden institution’ minds and share experiences and exchange views to be able to realize their own problems and discover global solutions to them.