International Journal of KIU Volume (2) Issue (2) December 2021

International Journal of KIU is a peer-reviewed multidisciplinary open access journal published online and bi-annually in print version. The Journal provides a research platform for the researchers and practitioners in all regions of the world thus contributing new insights into current and emerging concepts, theories, research and practice through diverse disciplines. The Journal maintains high quality standards by exercising peer review and editorial quality control. Facts and opinions in articles published on International Journal of KIU are solely the personal statements of respective authors. Authors are responsible for all contents in their article(s) including accuracy of the facts, statements, citing resources, and so on. International Journal of KIU and editors disclaim any liability of violations of other parties’ rights, or any damage incurred therefore to use or apply any of the contents of the International Journal of KIU. Material submitted to International Journal of KIU considered to be original and not published or submitted for publication elsewhere. All rights reserved by International Journal of KIU. No part of this publication may be reproduced, stored or transmitted in any form or by any means without the prior permission in writing from the copyright holder. Special requests should be addressed to [email protected]

Women with Split Identity; A Literary Analysis based on the selected Female Portrayals in Literature

Female characters in Literature are portrayed through diverse dimensions such as heroic figures, objects of desire, rebellious individuals, icons of female liberation and individuals with fragmented identities. Those potrayals reflect the the feminine self which is surrounded by the awareness of her negated existence, stereotyped images of womanhood, the sense of lack of belonging, and repressed individuality. Thus the study focuses on analyzing the female literary portrayals like ‘Nora Helmer’in ‘The Dolls House’ by Henric Ibsen, ‘Adela’ in ‘The House of Bernarda Alba’ by Federico Garcia Lorca and ‘Emma Bovary’ in ‘Madame Bovary’ by Gustave Flaubert, ‘Maggie Tulliver’ in The Mill On the Floss by George Eliot and ‘Kattrin’ in Mother courage and Her children by Bertolt Brecht with the objective of bringing to the surface the socially determined fatal end and the symbolic disappearance of the feminine figure. In analyzing and elaborating the perspectives which are discussed within the research paper the theoretical perspectives of Simon de Beauvoir (‘The second sex’), Sigmund Freud, (‘Civilization and its Discontents’,)and Slavoj Zizek, (‘Looking Awry’) are referred with a thorough consideration. Consequently the woman figure whose identity is negated and given less vitality is identified as an inferior and vulnerable social figure within the existing social order and thus the literary characters like Adela, Nora, Emma, and Maggie Tulliver portray the antagonism between the social principle of ‘Repression’ and the feminine ‘ Liberation’. In contrast to the characters such as Adela, Emma and Nora who negate the social other in pursuing their determined routes towards the self-satisfaction, the feminine portrayals like Kattrin and Maggie Tulliver adopt the self-denial and renunciation of desires for the betterment of the social other. Thus the characters like Nora, Emma and Adela become capable of gratifying their intense abomination towards the social order while Kattrin and Maggie Tulliver with their self-sacrifice and altruistic motives achieve a serene satisfaction. In that sense it can be identified that their self-annihilation leaves behind a symbol of identity rather than nihilistic reality implying a more psychological vitality without being just a physical deterioration.

Mupirocin Resistance of Staphylococcus aureus in Clinical Isolates of National Hospital and in the Nasal Carriage of Healthy Undergraduates in Colombo, Sri Lanka

Introduction and Objectives : Mupirocin resistance in Staphylococcus aureus is increasingly reported in many parts of the world. This study was conducted with the objective of describing high-level and low-level mupirocin resistance of S. aureus in clinical isolates and nasal carriage. Materials and Methods : A descriptive study was conducted including 45 nasal isolates of S. aureus collected from healthy university students in Colombo and 249 clinical isolates of S. aureus from the patient specimens in National Hospital of Sri Lanka. All of the confirmed S. aureus strains were tested for methicillin resistance using cefoxitin disc (30μg). S. aureus isolates were considered methicillin-resistant if the diameter of zone of inhibition was 21mm or less (CLSI, 2017). The S. aureus isolates were then tested for mupirocin resistance. Disk diffusion method was utilized with 5μg and 200μg mupirocin discs to determine low-level and high-level resistances respectively. The criterion employed for interpretation of mupirocin resistance was a combination of the widely accepted criterion described by Finlay, Miller, and Poupard (1997) for low-level mupirocin resistance and CLSI (2017) criterion for high-level mupirocin resistance. If both inhibition zone diameters for 5μg disk and 200μg were ≥14mm, the isolate was considered mupirocin sensitive. If 5μg disc displays <14mm and 200 μg disk displayed ≥14mm inhibition zone diameter, the isolate was considered to be mupirocin low level resistant. If there is no inhibition zone in 200μg disk, the isolate was considered as mupirocin high level resistant. Results : From the 45 nasal carriage isolates, 33 (73%) were Methicillin sensitive Staphylococcus aureus (MSSA) and 12 (27%) were Methicillin Resistant Staphylococcus aureus (MRSA). Among the clinical isolates, majority (n=158, 63%) were MRSA while only 91 (37%) MSSA. An overall mupirocin resistance rate of 4.4% among S. aureus was observed. Low-level mupirocin resistance was observed in 3.7% Staphylococcus aureus isolates and high-level mupirocin resistance was observed in 0.7% isolates. Mupirocin low-level and high-level resistance in MRSA isolates were 5.3% and 0.6% respectively. MSSA isolates demonstrated 1.6% (n=2) and 0.8% (n=1) mupirocin low-level and high-level resistances respectively. None of the nasal isolates were resistant to mupirocin while 6% (n=15) mupirocin low-level resistance and 0.8% (n=2) mupirocin high-level resistance was observed in clinical isolates. Conclusion : This initial survey of mupirocin resistance among S. aureus in a country with fairly high usage of mupirocin emphasizes that although the overall mupirocin resistance is relatively low in this population, regular surveillance of mupirocin resistance remains a necessity.

Practice of Skipping Breakfast and Associated Factors among Nursing Officers in A Selected Hospital in Colombo District

Background: Breakfast is the most vital meal of the day, which helps to start metabolism by providing the energy and nutrients required by the body. Skipping breakfast by nursing officers can negatively affect their health and also patient care. Hence, the study aimed to assess the practice of skipping breakfast and its associated factors among nursing officers. Methods: A descriptive cross-sectional study was conducted using a randomly selected sample of 384 nursing officers of the Colombo South Teaching Hospital, Kalubowila. A self-administered questionnaire and validated measuring scales were used to collect data. Data were analyzed using descriptive statistics and Chi-square test using IBM SPSS version 25. Results: Among the nursing officers, 53% were in the normal BMI category, while 36% were reported as overweight or obese and 10% were underweight. Of the participants, 12% (n=47) skips their breakfast as a practice while 48.2% (n=185) skipped sometimes. During the 14 days prior to data collection, 42.7% (n=164) and 40.0% (n=154) of nursing officers had skipped their breakfast 1-3 times and > 4 times, respectively. The main reason for skipping breakfast was lack of time (31%, n=119) (48%, n=174). Age (p=0.042) and marital status (p=0.007) were significantly associated with the practice of skipping breakfast. Conclusion: The study revealed that most nursing officers skip breakfast as a practice. Age and marital status were the significant predictors for skipping breakfast. Appropriate interventions are needed to improve the good practices related to breakfast and extensive assessments are required to evaluate the consequences of skipping breakfast.

Perceived workplace violence reported by nurses enrolled in B.Sc Nursing degree programme at KIU, Sri Lanka

Background: Workplace violence (WPV) can be defined as a violent act directed towards workers, including physical assault, threat of assault and verbal abuse and it is widely recognized as having far-reaching consequences for workers’ health and safety. Nurses are the most vulnerable group for WPV. In recent years WPV against nurses has significantly increased, becoming a nationwide phenomenon across the hospital settings. Furthermore, it can impact the quality of patient care and reduce the efficiency and quality of the entire health system. Therefore, this study aimed to determine the perceived workplace violence reported by nurses enrolled in the B.Sc Nursing degree programme at KIU, Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 306 undergraduate nurses in KIU. A pretested self-administered questionnaire was used to collect data which consisted of demographic information, the prevalence of WPV and factors associated with WPV. Data analysis was done with descriptive statistics and chi-square test using SPSS version 23. Ethical approval was obtained from the Ethics Review Committee of KIU (KIU/ERC/20/05). Results: The majority of participants were females (97.4%, n=298), aged between 20-30 years (61.4%, n=188) and had working experience of <5 years (63.7%, n=195). The prevalence of workplace violence was 75.5%, n=231. The commonest type of reported violence was verbal violence (87.8%, n=203) followed by emotional violence (65%, n=150), physical violence (15%, n=35), sexual violence (3.8%, n=9) and racial harassment (2.1%, n=5). Medical and Surgical wards (39.6%, n=91) were the most frequent working areas where nurses faced violent behavior. The perpetrators were found to be supervisors (73.1%, n=168), patients’ relatives (53.2%, n=122), and patients (52.3%, n=120). The working unit of the nurses (p< 0.001), designation (p<0.001), number of night duties per month (p=0.019), and ability to access the ward without permission (p=0.042) were significantly associated with WPV among nurses. Conclusion: The study concluded that the prevalence of WPV was high among nurses while verbal violence from nursing supervisors was the most common WPV. Therefore, it is mandatory to place appropriate measures to prevent the WPV among nurses.

Counselling Patterns of Community Pharmacies when Dispensing Antibiotics in Galle DS Division, Sri Lanka

Antibiotic resistance has been identified as a significant health issueacross the world. Inappropriate antibiotics prescribing by physicians, dispensing antibiotics without prescription and counseling by pharmacists, and the misuse of antibiotics by patients make them chief parties responsible for this global problem. Community pharmacists have a major responsibility to counsel the patients before dispensing antibiotics. The objectives of this study was to investigate the counselling patterns of community pharmacies when dispensing antibiotics and to examine whether the community pharmacists demand a prescription when dispensing antibiotics in Galle, Sri Lanka. This was a simulated patient study involving community pharmacists/ pharmacy assistants who work in community pharmacies in the Galle DS division (Divisional Secretary Division), Sri Lanka. Case scenarios of specific product requests (Erythromycin tablets, Ciprofloxacin tablets, Amoxicillin syrup) were presented by a simulated patient, and data were recorded after purchasing each product. Most of the pharmacists/ pharmacy assistants (72%) didn’t demand a prescription for antibiotic dispensing. About 82% of the visited pharmacies had dispensed antibiotics without a prescription. Only 14% of community pharmacies in the area had taken medical and lifestyle history of simulated patients (investigators) before dispensing. Advice or counselling regarding antibiotics were given only by 24% of the community pharmacies. Counselling patterns of community pharmacies in the area were unsatisfactory. Major issues of dispensing antibiotics and, not demanding a prescription were common. These issues need to be addressed by health authorities and policymakers to safeguard patients.

Effectiveness of currently used urinary preservatives in preserving high demand biochemical analytes. A study in the context of Sri Lankan laboratory setting

Analysis of 24-hour urine composition is widely used in diagnosis of acute and chronic kidney diseases. In Sri Lanka, no guidelines are available on preservation of urine. This study aimed to identify an effective preservation technique/s among currently practiced techniques in laboratories to maintain chemical stability of high demand bio chemical analytes in a 24-hour urine collection. An experimental study was undertaken using urine samples from volunteers (n=42, National Hospital of Sri Lanka and University of Sri Jayawardenepura, Nugegoda, Sri Lanka). Each sample was divided in to 10 ml aliquots; Out of the lot, one was preserved without any preservative and another refrigerated at 4ºC for 24 hours. Other aliquots were preserved for 24-hours by addition of following preservatives in a 24-hour collection: boric acid g/ urine (5, 7.5, 10), sodium azide g/ urine (0.3, 0.6, 0.9), HCl ml/ urine (1N;10ml, 6N;10ml, 25ml and 30ml). The aliquots with preservatives were kept at room temperature for 24 hours. Protein, Creatinine, Ca2+, Mg2+ and PO43- concentrations were measured in each aliquot. Least mean squared error for each analyte in different preservatives was calculated. For protein and creatinine, least mean squared error was given by, 10g/L boric acid. That of Ca2+, Mg2+ and PO43 were observed when the sample was refrigerated or after addition of 10g/L boric acid as the preservative. Sodium azide and HCl that are utilized in current practice as preservatives for 24-hour urine collections do not show better performance in selected analytes. Boric acid (10g/L) is more effective in persevering protein and creatinine. Due to practical issues in acquiring refrigeration facilities, Ca2+, Mg and PO4 3- also can be preserved effectively by using the same preservative. Consequently, Boric acid (10g/L) could be recommended as an effective preservative to preserve selected analytes in 24-hour urine collection

Antimicrobial activity of Rhipsalis baccifera and Drymoglossum piloselloides against Methicillin Resistant Staphylococcus Aureus and Drug Resistant Acinetobacter baumanii.

Methicillin Resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumanii are known to cause delayed healing of infections in both acute and chronic wounds. Plants are a natural source of novel antimicrobials and many new drugs are derived from plants, as plants contain phytochemicals that have antimicrobial activity. Sri Lanka is a tropical country with a wide variety of plant species, many of which were identified as possessing medicinal qualities and have been used by traditional medicinal practitioners in the treatment of various diseases and ailments. Dressings made of Rhipsalis baccifera and Drymoglossum piloselloides have been used to treat wounds by Sri Lankan traditional medicine practitioners. This study determined the antibacterial activity of aqueous and methanol extracts of R. baccifera and D. piloselloides against MRSA and Multidrug-resistant A. baumanii. Aqueous and methanolic extractions of both plants were done by maceration. Their antibacterial properties were checked against MRSA and A. baumanii by the well diffusion method. The effectiveness of the extract was further tested against factors like temperature and storage time. R. baccifera (aqueous extract) exhibited antimicrobial properties against MRSA but no activity against A. baumanii. The antibiotic activity against MRSA was increased after two months of storage at 4°C. D. piloselloides exhibited no antibiotic activity against both MRSA and A. baumanii. The methanolic extracts did not demonstrate any antibacterial activity.

Front Line Nurse Managers’ Attitudes And Perceived Barriers Towards Continuous Education In Nursing; Sri Lanka

Continuous education is a vital factor which contributes towards the professional development in nursing and it is directly associated with the health of a country. Continuous education is essential to maintain and improve the knowledge, skills, and attitudes of nurses and provide better health care. The objective of this study was to assess the attitudes and perceived barriers towards continuous education in nursing among the front-line nurse managers in Sri Lanka. A descriptive cross-sectional study was conducted among 555 front line nurse managers in Sri Lanka using a self-administered questionnaire. Data analysis was done using descriptive statistics. SPSS 25 version was used as the data analysis tool. Thirty-one special grade nursing officers and 524 grade 1 nursing officers participated in this study. The majority (73%) had more than 20 years of working experience as a nursing professional. Most of the nurse managers were diploma holders (83%), 3% undergraduates, 14% graduates, and 1% were reading for Masters. Attitudes towards continuous education were good among all the nurse managers, while 92% were willing to continue their education. The majority (96%) has perceived that continuous education is vital for professional development in nursing, and 91% has stated that the opportunities and facilities for continuous education and nursing research should be improved. The attitudes borne by the front line nurse managers towards continuous education, were considered to have been very positive. Further, continuous education was perceived by them as a vital part of professional development. Therefore, it could be surmised that the opportunities and facilities for continuous education and research on continuous nursing education should be improved in order to facilitate the provision of better health care. Keywords: Continuous Education, Nurse Managers, Attitudes