Open Access Policy Article

Placebo and Nocebo: Legal and Ethical Implications for Nursing Practice

Styliani Kotrotsiou, Sotirios Tozios, Dimitrios Theofanidis

Asian Journal of Research in Nursing and Health, Page 1-8

Aim: The purpose of this discussion paper is to contemplate on the placebo and nocebo phenomena providing legal, ethical and clinical implications for nursing practice.


Methodology: This is a critical review for which a selection of key references were used based on a critique of placebo and nocebo that provided a balanced discussion and evaluation of the strengths, weakness and notable features of the both terms.

Results and Discussion: From a legal point of view, there is a clear reference to the informed consent of the patient involved in the investigation, the way it is carried out and the conditions to be met for the conduct of a clinical study. In Greek legislation, the rights of the hospital patient are determined ex lege and the protection of the study participants by specific ministerial decisions. With regard to the moral aspect of the use of placebo, the Helsinki Declaration refers in specific articles to medical research which should promote respect for human beings and the protection of health. More recently rather than denying the patient essential treatment by using placebo, a new drug is tested against a drug which is known to be effective to check if the new drug is more effective or not.

Conclusions: The term ‘placebo’ refers to a pseudo-drug or procedure i.e. an inert treatment while ‘nocebo’ is a phenomenon where the symptoms of a condition unjustifiably worsen when the patient is dissatisfied with a treatment.

There are many views on the appropriateness of the existence and use of the placebo method. From a moral point of view, one could argue that it would be unfair to use it in some cases. Yet, in the authors’ view, there should be a balance between conflicting opinions and whether these relate to ethics, religion or science per se. Neither the abolition nor the excessive and irrational use of placebo would in any way serve the direct interests of mankind.

Open Access Original Research Article

Apoptotic and Structural Changes in Lungs Tissues of Toluene Induced Respiratory Injury in Wistar Rats

Michael O. Onyewuchi, Ovie F. Ogbo, Charles C. Nwafor, Oliver N. Lilian, W. Ikpama

Asian Journal of Research in Nursing and Health, Page 9-17

To investigate the impact of toluene exposure on the functional-morphology of the pulmonary tissues, 35 Wistar rats were acquired. The study was divided into three (3) groups: A, B, and C, with three (3) phases: acute (7 days), subchronic (14 days), and chronic (21 days). Group A was used as a control group, and they were given rat food and tap water ad libitum. Group B was given 200ml of toluene and observed for seven days, fourteen days, and twenty-one days. Group C was given 400ml of toluene and was kept under observation for seven days, fourteen days, and twenty-one days. The animals were euthanized after three weeks of exposure, with each exposure lasting 60 minutes each day. Finally, the lungs of each group were removed for histological examination. The study animals' mean body weights reduced significantly (P<0.05) when compared to the control group, according to the findings. In contrast to group A, histopathological evaluation of all treatment groups indicated pulmonary tissue inflammation and necrosis in groups B and C. Finally, the findings of this investigation revealed that toluene exposure can affect Wistar rats' lung functioning and morphology.

Open Access Original Research Article

Use of Personal Protective Equipment’s for Prevention of Covid-19 Infection among Students of Selected Nursing College of Kashmir

Ulfat Amin, Asmat Parveen, Arjumand Ashraf, Inabat Ramzan, Ekleela Hamid, Binshee Bashir, Shahid Manzoor

Asian Journal of Research in Nursing and Health, Page 18-29

Background: Covid19 has affected people all over the world especially health care workers who are constantly exposed to this virus while providing services to their clients. They need to be up to-date regarding infection prevention measures like the use of personal protective equipment’s.

Aim: To assess the pre-test and Post-test knowledge and Practice score related to use of personal protective equipment’s. To find association of knowledge & practice with selected demographic variables.

Methods: A pre-experimental one group pre-test post-test design was adopted for the study. 60 B.Sc. Nursing students from SMMCNMT, IUST, Awantipora, Kashmir and Institute of Nursing, South Campus, University of Kashmir were selected by Convenient Sampling technique. A standardized questionnaire and observational checklist was used to collect the data. Descriptive & Inferential statistics was used to analyze the data.

Results: Study reveals that 6.7% of the subjects had inadequate knowledge, 93.3% subjects had moderate knowledge while only 0% subjects had adequate knowledge during Pre-test. Pretest practice score revealed that 8.3% of subjects had poor practice, 78.3% of subjects had average practice and 13.3% of subjects had good practice regarding the use of PPE's. Post-test knowledge score revealed that 0% subjects had inadequate knowledge, 13.3% subjects had moderate knowledge and 86.7% subjects had adequate knowledge regarding the use of PPE's. Post-test practice score revealed that 0% subjects had poor practice, 15% subjects had average practice and 85% subjects had good practice regarding the use of PPE's.

This indicates that the mean post-test knowledge scores i.e. 23.47(78.20%) is higher than the mean pretest knowledge scores i.e. 13.72(45.7%). The mean posttest practice scores i.e. 9.93(82.80) is higher than the mean pretest practice scores i.e. 6.88(57.40).

Conclusion: The results revealed that Instructional Module was highly effective as there was significant increase in the post-test knowledge and practice scores among the B.Sc. Nursing students of SMMCNMT, IUST Awantipora, Kashmir and Institute of Nursing, South Campus, University of Kashmir.

Open Access Original Research Article

Prevalence and Barriers to Treatment Compliance and Its Determinants among Ill Secondary School Students

Akoko Sokiprim, Uahomo Precious Ojo

Asian Journal of Research in Nursing and Health, Page 30-40

Compliance and adherence to medication which requires an individual to complete their medication for an illness without skipping doses is an issue for patients. This research is a secondary school-based study to determine the prevalence and barriers to medication compliance and its determinants among students with acute illness in Elele, Ikwerre Local Government Area, Rivers State, Nigeria. This is a cross-sectional descriptive study. The study was conducted in Adventist Comprehensive High School (ACHS) Elele, Ikwerre LGA, a semi urban area of Rivers state, between July-August 2021. Using a purposive sampling technique, 104 students met the inclusion criteria. The instrument for data collection is a standardized univariate questionnaire called Morisky Medication Adherence Scale that is normally used to measure the level of compliance to medication. Data collected were presented in frequencies and percentages in tables, pie charts and bar charts using Microsoft Excel 2016 Version. Data were analysed using bivariate analysis (Chi-square test/Fisher’s Exact test) to test for association between socio-demographic factors and medication adherence (Compliance) at 95% CI. Result from the study showed that 88.5% of patients had low compliance while, only 11.5% showed moderate to high compliance to medication among patients attending ACHS Clinic. Similarly, the reasons for intentionally low adherence to medication included; studying, unpleasant taste of the drug, fear of taking too many drugs and absent health worker in the sick bay, while, forgetfulness was the key reason for unintentional low compliance. Also, snacking was a common habit among low adherent students (about 78%). Low compliance to prescribed medications amongst the students was observed to be high due to studying, unpleasant taste of medication, fear of taking too many drugs, unavailability of health worker in sick bay and forgetfulness among secondary school students presenting for treatment with acute illness. Hence, medications with pleasant tastes, few drugs yet effective for presented illness and employment of a school stationed health worker are advised. Also, notice should be passed to the student’s parents/guardian to supervise the compliance of students to medication at home. Finally, supervision both in school and at home is a leeway to improving medication compliance.

Open Access Original Research Article

Determinants of Mental Health Status of Youths during COVID-19 in Andoni Local Government Area of Rivers State

Samuel G. K., Bariaara Promise James, F. George, Funkebi

Asian Journal of Research in Nursing and Health, Page 41-49

This study investigated the determinants of mental health status of youths during COVID-19 in Andoni Local Government Area. The design for this study was descriptive cross sectional survey design. The population for the study consisted one hundred and sixteen thousand, eight hundred and twenty six youths (116, 826). The sample size of the study was 600 youths which was estimated using Taro Yamane’s method for a large population. Multistage sampling procedure was adopted for the study to select the sample. The instrument used for data collection was the questionnaire titled: “Determinants of Mental Health Status Questionnaire (DMHSQ). The validated instrument had a reliability coefficient of 0.74. which was high enough and was used for this study. The data was analysed using the Statistical Products for Service Solution (SPSS) version 25.0. The result of this study indicated that the determinants of mental health among youths during COVID-19 pandemic in Andoni Local Government Area. The result of this study showed that there was a very high positive relationship between age and mental health of youths during COVID-19 pandemic (r = 0.922). The result of this study also indicated that there was a very high positive relationship between gender and mental health of youths during COVID-19 pandemic (r = 0.931). The result of this study illustrated that there was a high positive relationship between religion and mental health of youths during COVID-19 pandemic (r = 0.887), and that there was a very high positive relationship between socioeconomic status and mental health of youths during COVID-19 pandemic (r = 0.949). The findings further revealed that there was a very high positive relationship between age and mental health of youths during COVID-19 pandemic (r = 0.943). The study concluded that the upsurge of COVID 19 to a large extent affected the mental and social health status of youths in Andoni Local Government Area of Rivers State, the following recommendations were made; government should implement mental health promotion/education efforts and keep adequate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions.