Background: Our health care is facing with the challenges of bed crunch and increasing number of patients with prolonged hospital stay. Aims: This study aimed to determine factors contributing to the prolonged hospital stay in a tertiary hospital in Singapore. Methods: A random sample of 600 medical records of patients' staying in hospital for more than 21 days was retrieved. The reasons for their prolonged hospital stay were categorized into ‘medically unfit’ and ‘medically fit’. Results: The top three reasons for prolonged hospital stay among the ‘medically unfit’ group were ongoing medical treatment, surgical interventions and receiving intravenous chemotherapy/radiotherapy. The top three reasons for the ‘medically fit’ group were waiting for community hospital bed, waiting for a new caregiver and undecided on discharge disposition. Conclusion: The results inform health care stakeholders in planning measures to minimize the incidence of unnecessary prolonged hospitalization for optimal health care resource utilization. Implications of Nursing Management: Ineffective discharge planning can lead to serious adverse outcomes such as hospital readmission and prolonged hospital stay. Patient navigators have a crucial role in facilitating safe, smooth and timely discharge of patients from acute care hospital to community. Understanding the reasons behind extended hospitalization is essential in order to better provide support.

Objective: Western models of psychology have long been dominant in the discipline. However, the presumed universality of Western psychological treatment models is increasingly coming under scrutiny; there is a clear need for research to evaluate the cross-cultural applicability of these treatment models. Schema therapy (ST) has been widely disseminated in recent years due to its efficacy in treating chronic psychological difficulties. However, the acceptability and efficacy of ST have yet to be examined in non-Western cultural contexts. This study aimed to investigate the suitability of ST in Hong Kong and Singapore. Method: A thematic analysis of qualitative interviews with clinicians practicing ST in Hong Kong (n = 6) and Singapore (n = 6) was undertaken. Results: Overall, the ST model was generally acceptable to clinicians in Hong Kong and Singapore. However, therapists reported some cultural challenges in the practice of ST. Four key themes describe these cultural challenges: language differences, difficulties in the expression of affect, issues related to filial piety, and differences in social norms and expectations. Conclusion: While the ST model appears acceptable to clinicians in Hong Kong and Singapore, there are some important adjustments needed in the practical application of ST to ensure more culturally sensitive treatment. © 2022 Australian Psychological Society.

https://doi.org/10.1371/journal.pone.0252913

Illness perceptions form a key part of common-sense models which are used widely to explain variations in patient behaviours in healthcare. Despite the pervasiveness of depressive disorders worldwide and in young adults, illness perceptions of depressive disorders have not yet been well understood. Moreover, while a high proportion of cases of depressive disorders reside in South-east Asia, few have explored illness perceptions that are culturally relevant to this region. To address these limitations, this study aimed to understand illness perceptions of young adults diagnosed with depressive disorders. Face-to-face semi-structured interviews were conducted among Chinese, Malay, and Indian young adults aged 20 to 35 years old, who were seeking treatment at a psychiatric hospital. Data reached saturation after 33 interviews (10 to 12 interviews per ethnic group) and five themes emerged from the thematic analysis: 1) A reduced state of being experienced at a point of goal disengagement, 2) the accumulation of chronic stressors in a system that demands success and discourages the pursuit of personally meaningful goals, 3) a wide range of symptoms that are uncontrollable and disabling, 4) poor decision making resulting in wasted opportunities, with some positive takeaways, and 5) accepting the chronicity of depression. Young adults typically experienced depression as a reduced state of being and it was thought of cognitively as an entity that may be a part of or separate from the self. Over and beyond these aspects of cognitive representations was the emergence of themes depicting conflicts and dilemmas between the self and the social environment that threatened self-identity and autonomy. Addressing these conflicts in therapy would therefore be of utmost relevance for young adults recovering from depressive disorders in the local setting.

Background: With more frail elderly living and likely to die in nursing homes, advance care planning (ACP) is critical in overall efforts to provide good palliative care. However, it is unclear how willing older, vulnerable residents in nursing homes are to take on an active role in care decisions. Aim:The objective of this pilot study was to examine nursing homes' healthcare professionals' and residents' views on ACP and the extent of similarities and differences in their views. Methods: Our sample of 24 healthcare professionals and 24 residents were identified and recruited through contacts established from existing collaborations with the nursing homes. Surveys were administered to the participants by a trained research assistant between April 2015 and August 2015. Results:Almost all the healthcare professionals (95.8%) would like to make an ACP for themselves in the future, while residents were divided in their choices (P<<0.01). Most residents (79.1%) felt that the most important guide for their surrogate in making decisions for them when they lose decision-making capacity should be based on their best interests. However, most healthcare professionals (75.0%) felt that it should be based on the resident's wishes and values. Conclusions: Healthcare professionals tended to overestimate the importance of patient autonomy compared to the residents.This study demonstrates that as much as advocacy and awareness are ongoing, nursing home residents' motivation to participate in ACP is lacking.The lack of motivation in ACP participation could be due to medical paternalism and familial determination, which have been a cultural norm for older Singaporeans. This study demonstrates there is a lack of cultural sensitivity in this group of healthcare professionals in approaching nursing home residents' end-of-life care decision-making. © 2022 MA Healthcare Ltd

Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.