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Background: Healthcare providers must possess the necessary knowledge and skills to perform effective cardiopulmonary resuscitation (CPR). In the event of cardiopulmonary arrest, basic life support (BLS) is the initial step in the life-saving process before the advanced CPR team arrives. BLS simulation training using manikins has become an essential teaching methodology in nursing education, enhancing newly employed nurses’ knowledge and skills and empowering them to provide adequate resuscitation. Objective: This study aimed to evaluate the potential effect of BLS simulation training on knowledge and practice scores among newly employed nurses in Jordanian government hospitals. Methods: A total of 102 newly employed nurses were randomly assigned to two groups: the control group (n = 51) received standard training, and the experimental group (n = 51) received one full day of BLS simulation training. The training program used the American Heart Association (AHA)-BLS-2020 guidelines and integrated theoretical models such as Miller’s Pyramid and Kolb’s Cycle. Both groups were homogeneous in inclusion characteristics and pretest results. Knowledge and practice scores were assessed using 23 multiple-choice questions (MCQs). Data were analyzed using one-way repeated measures ANOVA. Results: The results indicated significant differences in knowledge scores, F(2, 182) = 58.514, p <0.001, and practice scores, F(2, 182) = 20.134, p <0.001, between the control and experimental groups at all measurement times: pretest, posttest 1, and posttest 2. Moreover, Cohen’s d reflected the effectiveness of BLS simulation training as an educational module, showing a large effect (Cohen’s d = 1.568) on participants’ knowledge levels and a medium effect (Cohen’s d = 0.749) on participants’ practice levels. Conclusion: The study concludes that BLS simulation training using the AHA-BLS-2020 guidelines and integrating theoretical models such as Miller’s Pyramid and Kolb’s Cycle significantly improves knowledge and practice scores among newly employed nurses, proving highly effective in enhancing their competencies in performing CPR. Implementing BLS simulation training in nursing education programs can significantly elevate the proficiency of newly employed nurses, ultimately improving patient outcomes during cardiopulmonary arrest situations. This training approach should be integrated into standard nursing curricula to ensure nurses are well-prepared for real-life emergencies. Trial Registry Number: NCT06001879

Background: The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted. Objective: This paper seeks to explore the essence of the concordance concept in the healthcare context. Methods: Walker and Avant’s eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022. Results: The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients’ beliefs, healthcare providers’ characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life. Conclusion: This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients’ beliefs and effectively communicating to improve patients’ understanding in dealing with complex treatment plans.

Background: The strategic response of nurses in addressing health inequities in marginal sectors led to the conduct of a health leadership governance training program for local chief executives. Objective: This study aimed to explore and provide a description of the experiences of local chief executives (LCEs) or mayors who participated in the nurse-initiated health training named Municipal Leadership and Governance Program (MLGP). Methods: A qualitative descriptive design was used through key informant interviews of fifteen mayors or local chief executives (LCE) in the provinces of Bohol and Negros Oriental, Philippines. Data were collected from 16 to 20 November 2022 and analyzed using a thematic approach. Results: The findings generated six themes: a) Leadership capacitation promoting transformative experience, b) Pandemic and program-induced limitations in the training implementation, c) Personal leadership motivation, d) Experiential learning promoting learning as applied in real-world situations, e) Celebrating leadership transformation, and f) 3R’s of MLGP: revisit, review, recommend. Conclusion: The realizations of the training participants provided valuable implications for the quality of training offered by nurse leaders who advocated the MLGP implementation. It served as a proactive and responsive approach to the health leadership capacitation of mayors. It guided them in their personal realizations that inspired them to apply what they had learned and enabled them to effect experiences of personal to institutional transformation.

Background: Late antenatal care (ANC) has significant implications for maternal and infant morbidity and mortality among Muslim pregnant women in Indonesia. Existing literature has primarily focused on gestational weeks at the first ANC contact, with limited attention to the total number of ANC visits. Objective: This study aimed to explore the factors predicting late antenatal care contact among Muslim pregnant women, including the gestational weeks of the first ANC contact and the total number of ANC visits in Aceh, Indonesia. Methods: A predictive correlational study design was utilized. Eighty postpartum women who received late ANC were purposively sampled and included in the study. Data were collected in May 2023 using ANC knowledge, beliefs, and social support questionnaires. Statistical analyses included descriptive statistics, Spearman’s rank correlation, Chi-Square tests, and binary logistic regression with the enter method. Results: Pregnant women residing farther from home to ANC services were more likely to have their first ANC contact after 20 weeks than those with a shorter distance (AOR = 1.06; 95% CI: 1.02-1.10; p = 0.007). Additionally, women with a history of multiple abortions were more inclined to have four or more ANC visits compared to those with fewer abortions (AOR = 6.78; 95% CI: 1.64-28.09; p = 0.008). Conclusion: Distance from home to healthcare services emerged as a significant barrier to ANC contact, while a history of abortion appeared to motivate pregnant women to seek ANC more frequently. To address these issues effectively, nurses should consider implementing telemedicine services for ANC provision, integrating information on pregnancy complications to better support pregnant women in their care journey.

Background: In the contemporary healthcare environment, managing human resources expertise is just as imperative as having the supreme amount of working capital. Every business must constantly build its capacity, expertise, and competitive edge by utilizing its intellectual property and experience. Objective: This study aimed to assess the relationship between green intellectual capital and organizational competitive advantage among nurses. Methods: The study employed a descriptive correlational design among 350 nurses selected using convenience sampling. Data were collected from March 2023 to June 2023 using the Organizational Competitive Advantage Scale and the Green Intellectual Capital Questionnaire. Data were analyzed using t-test, ANOVA, and Pearson correlation. Results: Most nurses had a moderate level of green intellectual capital (Mean = 3.60, SD = 0.27). The overall mean score for organizational competitive advantage was moderate (Mean = 3.34, SD = 0.34). The overall score of the green intellectual capital (r = 0.257, p <0.001) and its dimensions—green human capital (r = 0.257, p <0.05), green structure capital (r = 0.257, p <0.001), and green relational capital (r = 0.257, p<0.001)—had significant positive correlations with organizational competitive advantage. Conclusion: Being eco-friendly has become a determining factor in the organizational competitive advantage. The study highlights the significance of nursing management in establishing partnerships with external entities to share knowledge and advance sustainable healthcare methods. It advocates for assessing organizational environmental performance and its influence on competitive edge through creating metrics, monitoring progress, and utilizing data for decision-making. Healthcare and nurse administrators are advised to set performance benchmarks, track advancements, and integrate eco-friendly strategies to bolster the hospital’s competitiveness in the market.

Background: Breast cancer is the most common female malignancy. Although chemotherapy is the primary treatment for breast cancer, it frequently has several detrimental side effects. Patients with breast cancer require self-compassion to regulate their emotions in order to cope with their suffering. Factors affecting self-compassion have mostly been investigated in the context of chronic diseases in general, not specifically in relation to patients receiving chemotherapy for breast cancer. Objective: This cross-sectional study sought to describe the self-compassion level and to examine the predictive ability of self-critical judgment, body image, stress, attachment style, social support, hope, and self-reassuring on self-compassion among patients with breast cancer undergoing chemotherapy. Methods: The participants were 210 Thai women with breast cancer who received chemotherapy in northern Thailand and were selected using proportionate random sampling. Data were collected from December 2021 to January 2023 using validated instruments. Data were analyzed using descriptive statistics and hierarchical regression analysis. Results: Self-compassion was moderate (Mean = 2.91, SD = 0.91). Self-critical judgment (β = 0.487, p <0.001) and hope (β =0.128, p = 0.032) could predict self-compassion in patients with breast cancer undergoing chemotherapy and explained 40.1% of the variance. Conclusion: The study’s findings highlight the importance of addressing self-critical judgment and fostering hope in patients with breast cancerundergoing chemotherapy to enhance their self-compassion. Nurses and other healthcare providers can use the findings to provide interventions to promote self-compassion.

Background: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, leading to visual impairment and eventual blindness. Promoting self-care behaviors is crucial in controlling DR progression and preventing blindness. Objective: This study aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, HbA1c levels, visual acuity (VA), severity of DR, and vision-related quality of life (VRQoL) among individuals with type 2 diabetes and DR. Methods: This study employed a single-blind randomized controlled trial design to compare SCPP with conventional diabetic care interventions (standard care). The SCPP was based on the Self-Care of Chronic Illness Theory, Self-efficacy theory, and the Association of Diabetic Care and Education Specialist (ADCES) guidelines incorporating health education, self-care maintenance, monitoring, and management skills training over 12 weeks. Ninety-eight participants were randomly allocated to the experimental or control group (n = 49 per group). While the experimental group received SCPP alongside standard care, the control group received standard care alone. Data collection occurred between May 2022 and March 2023 and included demographic information, the Self-Care of Diabetes Index questionnaire (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment questionnaire (IVI-Thai version), and retinal images for DR severity grading. Data analysis utilized descriptive statistics, Chi-Square tests, t-tests, and MANOVA. Results: Following 8 and 16 weeks of SCPP, the experimental group had significantly higher mean scores in engagement with self-care and eye-care behaviors compared to the control group (p <0.001). The highest scores were observed in self-care and eye-care confidence behaviors, followed by maintenance, monitoring, and management. Furthermore, HbA1c levels and VRQoL significantly decreased and were lower than those of the control group at week 16 (p <0.001 and p <0.05, respectively). However, there were no significant differences in VA, and DR severity increased in both groups by week 16. Conclusion: SCPP benefits individuals with DR, enhancing their confidence and ability to perform, monitor, and manage self-care behaviors. These strategies contribute to improved diabetes management, enhanced quality of life, and reduced DR-related blindness. Integrating SCPP into routine DR management is recommended, with nurses playing a pivotal role in overseeing and driving this integration, highlighting the critical role of nurses in managing this widespread global disease. Trial Registry Number: Thai Clinical Trials Registration (TCTR20230302002)

Background: Patients with heart failure (HF) often experience cognitive impairment, which negatively affects their quality of life. An effective screening tool is essential for nurses and healthcare professionals to assess cognitive function as part of HF management. Although many instruments exist, none are specifically designed for patients with HF. Objective: This study aimed to map the instruments for screening cognitive function in patients with HF. Design: A scoping review. Data Sources: Articles published between 2019 and 2023 were searched in PubMed, ScienceDirect, and Google Scholar, with the last search conducted on 27 January 2024. Review Methods: The review followed the scoping review framework by Arksey and O’Malley and adhered to PRISMA guidelines for scoping reviews. Results: Of the 21 articles meeting inclusion criteria, six cognitive function screening instruments were used across various cognitive domains, effectively identifying cognitive impairment in both inpatient and outpatient HF settings. The Montreal Cognitive Assessment (MoCA) was the most frequently used tool, covering a broad range of cognitive domains. MoCA showed high efficacy with a kappa coefficient of 0.82, Cronbach’s alpha reliability of 0.75, sensitivity of 90%, and specificity of 87%. Conclusion: Instruments like MoCA, Mini-Cog, and TICS-m show promise for assessing cognitive function in patients with HF, each with specific strengths and limitations. MoCA is notable for its comprehensive coverage despite being time-consuming and having language barriers. Further research is needed to revalidate and improve the existing instruments. It is crucial for nurses and healthcare professionals to integrate these tools into regular patient management, highlighting the need for continued research in their application.

Background: A well-functioning multidisciplinary team optimizes resource utilization and reduces care redundancy, fragmentation, and wastage. Collaborative efforts yield a clearer understanding of older people’s needs and desires, significantly reducing hospitalization days. Despite limited studies, particularly in Indonesia, investigating professionals’ experiences in implementing multidisciplinary collaboration in government nursing homes, nursing care quality remains a concern. Objective: This study aimed to explore the implementation of multidisciplinary collaboration in nursing homes from the perspectives of various disciplines. Methods: A descriptive phenomenological study was used with semi-structured interviews and focus group discussions with multidisciplinary care providers, including nurses, doctors, social workers, physiotherapists, psychologists, occupational and recreational activity instructors, and clergy in nursing homes owned by the Jakarta provincial government. A total of 64 participants were involved, and data were collected from September 2022 to July 2023. Data were analyzed using content-based analysis. Results: Three main themes emerged: 1) context of multiple collaborations, 2) barriers to implementing multiple collaborations, and 3) impacts of non-optimal multidisciplinary collaborations. Nursing home management’s multidisciplinary teams predominantly implement professional-centered care with limited support systems. While providers generally perceive collaboration positively, shared responsibility and joint work among professionals are lacking. Conclusion: This study highlights the need to improve multidisciplinary collaboration in nursing homes to enhance care quality for older individuals. While providers view collaboration positively, barriers like a lack of shared responsibility and joint work persist. Enhancing teamwork cohesion through improved communication and integrated case reporting systems is crucial. Addressing human resource and systemic barriers is also vital. By overcoming these challenges, nursing homes can optimize resource use, reduce care redundancy, and better meet the diverse needs of older residents.

Background: Social media has many positive and negative influences on individuals, especially for adolescents related to HIV. However, little is known about how social media impacts HIV-related outcomes among adolescents in boarding schools. Objective: This study aims to investigate the social media use, knowledge, attitudes, and sexual behavior at risk of HIV transmission and their relationship with the demographic characteristics of adolescent students at boarding schools. Methods: This study was school-based and used a cross-sectional design. The questionnaires were used to assess social network site usage, knowledge, attitudes, and risky behavior. Cluster random sampling involved students (n = 214) from three boarding schools in Cirebon City, West Java, Indonesia, in 2022. Chi-square tests and Cramer’s V were used to explore correlations between social and demographic factors. Results: A considerable number of adolescent students exhibited high social media addiction (58.4%), with the majority possessing limited knowledge of HIV transmission (54.7%). Additionally, nearly half displayed a negative attitude towards preventing HIV transmission (47.2%), while only a small fraction engaged in risky behavior (2.8%). Bivariate analysis revealed that social media use was moderately associated with the type of social media application (φc = 0.246, p <0.05). Knowledge of HIV transmission exhibited a moderate correlation with age (φc = 0.331, p <0.05), education level (φc = 0.240, p <0.001), and exposure to information (φc = 0.269, p <0.001). Similarly, attitudes toward HIV prevention demonstrated moderate associations with age (φc = 0.341, p = 0.001), education level (φc = 0.317, p <0.001), and exposure to information (φc = 0.266, p <0.001). Furthermore, risky sexual behavior exhibited a strong association with exposure to pornographic content (φc = 0.730, p <0.001). Conclusion: The study found a high prevalence of social media usage among adolescents, coupled with low knowledge about HIV, negative attitudes, and risky behavior. Significant relationships were observed between social media use, knowledge, attitudes, and risky sexual behavior related to HIV transmission and demographic characteristics. This study emphasizes the vital role of nurses and healthcare professionals in implementing targeted educational interventions in boarding schools to address gaps in HIV risk knowledge influenced by social media, ultimately improving strategies for adolescents’ sexual health.

Background: Patients with lupus nephritis experience disease symptoms and side effects from treatment. Although self-management behaviors are important in patients with this disease, there is limited research on the factors influencing these behaviors. Objective: This study aimed to examine the factors influencing self-management behaviors in patients with lupus nephritis. Methods: This cross-sectional study was conducted in 240 patients with lupus nephritis at a university hospital in Thailand between August 2019 and December 2020 using a random sampling method. Data were collected using a demographic and clinical characteristic questionnaire, Self-Management Behavior Questionnaire, Self-efficacy for Managing Chronic Disease: A 6-item Scale, Knowledge about Lupus Nephritis Questionnaire, Family Support Scale, Social Networks in Adult Life Questionnaire, and Memorial Symptom Assessment Scale for Lupus Nephritis. Descriptive statistics and multiple linear regression analyses were employed. Results: The participants reported a moderate level of self-management behaviors. Multiple regression analyses revealed that disease duration, income, symptoms, self-efficacy, knowledge, family support, social networks, and classes of lupus nephritis significantly explained 21% of the variance in self-management behaviors (R2 = 0.21; F(8,231) = 7.73; p <0.001). Family support (β = 0.32, p <0.001) and symptoms (β = −0.23, p<0.001) were significant determinants of self-management behaviors in patients with lupus nephritis. Conclusion: The findings provide valuable insight for nurses to better understand the factors influencing self-management behaviors in patients with lupus nephritis. Patients with low family support and high symptom severity may face difficulty in performing self-management behaviors. Nurses should pay more attention to these patients and provide family-based interventions to optimize self-management behaviors in this population.

Background: Effective communication is vital in nursing, influencing patient safety, satisfaction, and care quality. The AIDET framework is a proven tool for reducing patient anxiety and enhancing their experience. However, perceptions and experiences of Filipino nursing students with AIDET remain unexplored. Objective: This study explored Filipino nursing students’ use of AIDET, focusing on benefits, challenges, and improvements. Methods: A qualitative, interpretive phenomenological approach informed by the philosophy of Martin Heidegger was employed. This 2023 study, conducted at a university in Angeles City, Philippines, explored Filipino nursing students’ experiences with the AIDET communication framework. Thirty participants were purposefully selected to participate in facilitated discussions following a semi-structured interview guide. Thematic content analysis of the transcribed audio recording identified recurring themes in their narratives, focusing on the meanings they ascribed to their experiences using AIDET. Results: Four themes emerged: (a) Streamlined nurse-patient interaction (organizes communication, rapport building, alleviate anxiety, acknowledgment, and empowerment as sub-themes), (b) Enhances patient-centered care (empathy and compassion, improved patient experience as sub-topics), (c) Challenges with specific patient populations (patient preferences, language barrier, patient condition, acknowledgment of cultural differences as sub-themes), and (d) AIDET in nursing education strengthening application through practice, optimizing frequency and timing, promoting deeper understanding, enhancing feedback mechanism) as student nurses’ recommendations. Conclusion: Early integration of AIDET in nursing education is essential for student nurses to enhance communication, improve patient satisfaction, and deliver patient-centered care, equipping them with valuable communication skills.

Background: In China, adults with ischemic stroke are getting younger. Additionally, following a stroke, they often neglect self-management (SM), which significantly impacts the rehabilitation process and treatment outcomes. Objective: This study aimed to describe SM behavior and examine the relationship between stroke prevention knowledge, life stress, family relationships, and SM behavior among adults with ischemic stroke. Methods: A total of 125 participants were recruited between October 2022 and March 2023 based on defined inclusion criteria. Research instruments included a demographic questionnaire, the Stroke Self-management Behavior Scale for Young Adults, the Stroke Prevention Knowledge Questionnaire, the Perceived Stress Scale, and the Brief Family Relationship Scale. Data were analyzed using descriptive statistics and Pearson’s product-moment correlation. Results: The mean score of SM behavior was 88.1 out of 130 (SD = 16.5). Stroke prevention knowledge and family relationships showed a moderate positive significant relationship with SM behavior (r = 0.39, r = 0.34, p <0.001, respectively). Life stress had a significant negative relationship with SM behavior (r = -0.33, p <0.001). Conclusion: The findings offer insights for nurses to develop nursing interventions to promote SM behavior among adults with stroke. Furthermore, they can assist hospitals in transitioning care to the community by emphasizing holistic nursing practices that educate about stroke prevention knowledge, encourage family support, and provide stress management strategies to enhance the SM abilities of adults with stroke.

Background: In resource-limited settings, addressing infections remains a substantial challenge in the management of children with Acute Myeloid Leukemia (AML). In Indonesia, infection-related mortality (IRM) is thought to be high compared to high-income countries. However, there has been no previous study of infection profile and IRM in Indonesian patients with AML. Objective: This study aimed to describe infections and IRM in children with AML treated according to the Indonesian National AML protocol and to describe the implementation of infection control practices in resource-limited settings. Methods: This retrospective observational study used secondary data from the medical records of pediatric patients with AML treated with the National Protocol at Dr. Sardjito Hospital, Yogyakarta, Indonesia, from April 2012 to September 2018. Essential patient characteristics, time of IRM, and cause of death were recorded, and infection control practices were observed. Data were analyzed using descriptive statistics. Results: 113 patients with AML were treated with the National protocol, and 83 met the inclusion criteria. Infections occurred in 69 (83%) patients with a total of 123 episodes (mean 1.8/patient). Death was seen in 48 (58%) patients, with 19 (23%) IRM. The majority of infections were in the gastrointestinal tract (n = 51, 30.5%), sepsis (n = 29, 17%), and respiratory tract (n = 28, 17%). Infections mostly occurred during the first induction (41%). There were 90 (73%) episodes of clinically documented infection and 33 (27%) episodes of microbiologically documented infection. The positivity rate of blood cultures was only 27%. The majority of bacteria detected were gram-negative (n = 25, 69%), and among them were Klebsiella pneumonia (19%) and Escherichia coli (19%). Candida albicans was detected in 1 (2%) culture. Suboptimal infection prevention and control were found in the clinical practice. Conclusion: Infections and infection-related mortality in children with AML treated using the National protocol were frequent, mainly occurring during the first induction phase. Compliance with infection prevention and control measures needs improvement. Urgent attention is required for better supportive care, including isolation rooms, antibiotics, and antifungals. The predominance of Gram-negative bacterial infections highlights the necessity for further research into effective prophylaxis. Enhanced healthcare and nursing professional vigilance and tailored antibiotic strategies are vital. Improving compliance and ensuring adequate supportive care resources are essential, emphasizing nursing’s pivotal role. Further research is crucial to drive advancements in infection control strategies.

Background: In Morocco, despite various initiatives to improve the quality of reproductive healthcare, the indicators remain unfavorable. To strengthen the skills of midwives and support the achievement of Millennium Development Goals (MDGs) 4 and 5 by 2030, Morocco has developed and implemented a competency-based training framework. However, there is a lack of information on the successful implementation of this program and its impact on the quality of student midwives’ preparation for practice. Objective: This study aimed to gain a deeper understanding and explore the barriers affecting the development of clinical learning skills among midwifery students and newly qualified midwives. Methods: This study employed a descriptive, exploratory qualitative approach. Data were collected through nine focus group discussions with 30 midwifery students and 24 newly graduated midwives between April and June 2023 from six higher education institutions in northern and central Morocco. Inductive content analysis was used to analyze the transcribed discussions. Results: The barriers varied between locations. Overall, the internship design was inadequate, and the clinical environment was insufficient. Participants highlighted limited opportunities to experience the full range of midwifery skills. However, most midwifery students and new graduates had deficient competencies in managing high-risk situations and emergencies. Conclusion: This work provides an overview of the nature and extent of the challenges faced by many student midwives in Morocco, resulting in newly graduated midwives being poorly prepared for the full range of midwifery practice. These findings can inform various initiatives to strengthen midwifery education at the global, regional, and national levels.

Background: Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress. Objective: This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings. Methods: This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman’s Correlation. Results: The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001). Conclusions: Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses’ moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.

Background: The purpose in life can motivate individuals to realize that life is essential for existence and well-being. Adults might experience crises that can lead to a lack of purpose in life. Consequently, promoting purpose in life is necessary, but it requires a suitable measurement scale. Objective: This scoping review aimed to identify and map the content, psychometric properties, and answer option scales of instruments intended to measure purpose in life in adult populations. Design: A scoping review was employed. Data Sources: The database used was PubMed. The libraries were APA PsycNet, Wiley Online Library, and Cochrane Library. The search strategy was performed between 1 November 2023 and 14 February 2024. Review Methods: This review used the scoping review framework described by Arksey and O’Malley. The identified instruments were assessed for quality based on the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This study also used the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting guideline. Results: A total of 348 studies were identified, and seven articles were involved in the final synthesis. These seven articles included five instruments measuring the concept of purpose in life, of which two instruments had two versions: 1) Purpose in Life Test (20 items, 4 items); 2) Life Engagement Test (6 items); 3) Psychological Well-Being (120 items, 18 items); 4) Self-Assessment Goal Achievement (9 items); and 5) National Institutes of Health Tuberculosis Meaning and Purpose Scale Age 18+ (18 items). The validity of all instruments was tested using factor analysis, known groups, face, concurrent, convergent, discriminant, and construct validity. The reliability of four instruments was tested by Cronbach’s alpha and Spearman-Brown formula. Conclusion: Five instruments measuring purpose in life in the adult population with adequate psychometric properties were identified. The clinical implication of this study suggests that nurses may consider employing an appropriate instrument to assess the purpose of life in the adult population, thus enabling them to offer holistic, individualized care to adults, particularly addressing the spiritual dimension.

Background: Substance abuse is prevalent among males, and mindfulness could serve as a means of helping individuals suffering from the adverse effects of substance abuse find relief. Objective: This study employed a one-group repeated-measure design and aimed to evaluate the effects of the mindfulness program on stress, deliberate self-harm, and drug abstinence intention among male substance abusers. Methods: The mindfulness program was implemented for Thai males with a history of narcotic drug use. Five participants were recruited from a rehabilitation institute in Thailand using convenience sampling. The program consisted of eight sessions over four weeks. The study outcomes were measured at three time points: pre-intervention (Time 1, Week 1), post-intervention (Time 2, Week 4), and follow-up (Time 3, Week 6). Research instruments included the Deliberate Self-Harm Inventory, the Perceived Stress Scale, and the Drug Abstinence Intention Questionnaire, all of which had Cronbach’s alpha values above 0.80. Data analysis was carried out using the Friedman test and Dunn-Bonferroni post-hoc test. Results: The eight-session program was implemented as intended, with a retention rate of 100%. The mean scores of deliberate self-harm and drug abstinence intention were significantly different across the three time points (χ2 = 10.000 and χ2 = 9.579, p <0.01, respectively). After conducting pairwise comparisons, the mean scores of deliberate self-harm at Time 2 and Time 3 were significantly lower than those at Time 1. Additionally, the mean scores of drug abstinence intention at Time 2 and Time 3 were higher than those at Time 1. However, the mean score of stress did not have a significant difference. Conclusion: This program was both acceptable and effective in reducing deliberate self-harm and improving drug abstinence intention. These findings suggest that nurses and healthcare teams involved in caring for individuals with substance abuse issues could utilize this intervention alongside other therapies or hospital treatments. Consequently, relapse prevention among substance abusers could be achieved. Thai Clinical Trials Registry Number: TCTR20230404001

Background: The prevalence of social media influence in education makes it necessary to investigate how it might affect nursing students’ academic achievement and sense of self. To our knowledge, the associations between academic performance, self-esteem, and social media usage among nursing students from Saudi Arabia remain understudied. Objective: This study aimed to examine the relationships between academic performance, self-esteem, and the utilization of social media platforms by Saudi Arabian nursing students. Methods: This descriptive correlational study employed a convenience sample of 220 nursing students (response rate 95.2%). An online survey with questions about demographics, students’ academic performance, social media usage, and self-esteem was used for data collection from 1 March to May 2023. Pearson correlation coefficients, independent t-tests, Analysis of Variance, and hierarchical regression were used for data analysis. Results: Social media use had an average score of 3.60 ± 0.66, self-esteem was 2.13 ± 0.27, and academic performance was 3.95 ± 0.58. The students’ academic performance related positively to the utilization of social media platforms (r = 0.210, p <0.01). There were statistically positive correlations between academic purpose and social motives domains of utilizing social media and academic performance (r = 0.304, p <0.01; r = 0.208, p <0.01) respectively. The amount of time students spent on social media was not related to their self-esteem (r = 0.047, p >0.05). The students’ self-esteem was unrelated to their academic achievement (r = 0.059, p >0.05). Conclusions: Utilizing social media channels can assist nursing students in improving their academic achievement. Therefore, nursing educators and decision-makers in nursing education have the opportunity to establish collaborative learning environments by integrating social media. This approach aims to improve communication, enhance the learning experience, and ultimately improve the academic achievements of nursing students.

Background: Colorectal cancer (CRC) ranks as the third most prevalent cancer globally. The disease and its treatment significantly impact marital intimacy, particularly among individuals who have undergone ostomy creation. Therefore, it is necessary to explore their experiences. Objective: This study aimed to explore the experiences of colorectal cancer survivors in marital intimacy after ostomy creation and clarify the domain and sub-domain of marital intimacy in CRC survivors with ostomy. Method: This study used a qualitative descriptive design, and participants were selected by purposive sampling from two hospitals in Henan province, China. Sixteen patients participated in this research, and the data were collected through an in-depth interview from June 27 to September 27, 2023. Colaizzi’s method was used to analyze the data. Results: Five themes emerged from data analysis, including physical intimacy, psychological intimacy, social intimacy, spiritual intimacy, and operational intimacy. Conclusion: By profiling the experiences of CRC survivors in marital intimacy after ostomy creation, the domain and sub-domain of marital intimacy were clarified in this cohort and revealed that ostomy had a severe effect on marital intimacy among colorectal cancer survivors. The results from this study could be used by nurses, midwives, and other healthcare professionals to design specific interventions covering all aspects of marital intimacy. Also, the findings will guide the development of a particular instrument for marital intimacy in CRC survivors with ostomy.

Background: Basic non-military flight nurse training is essential for enhancing nurses’ competency in conducting aeromedical evacuations. Trained nurses possessing flight nurse proficiency are indispensable for ensuring stable patient conditions amidst the unique physical, physiological, and psychological challenges encountered during flights. Objective: This study aimed to describe the experiences and perceptions of nurses and air ambulance service providers regarding aeromedical evacuations. Methods: This study employed a qualitative descriptive design. Data were gathered from February to July 2023 through semi-structured online interviews with seven nurses and air ambulance service providers engaged in aeromedical evacuation. Content analysis was utilized to interpret the interview data. Results: Seven themes were generated: 1) Experiences in aeromedical evacuation experiences, 2) Challenges faced by nurses and air ambulance service providers during aeromedical evacuations, 3) Essential knowledge for nurses involved in aeromedical evacuations, 4) Efforts to improve nurses’ knowledge and skills, 5) Leveling of flight nurse training, 6) Flight nurse training methods, and 7) Flight nurse training evaluation strategies. Conclusion: Nurses and air ambulance service providers acknowledge the significant influence of the flight environment on changes in patient conditions during aeromedical evacuations. To effectively manage alterations in patient conditions during flights, healthcare workers equipped with aviation health competency are imperative. One approach to enhancing the competency of healthcare workers is through flight nurse training. The findings from this study serve as a valuable resource for policymakers and health-related institutions endeavoring to formulate aeromedical evacuation strategies.

Background: Medication administration errors significantly impact patient safety, potentially leading to severe harm or fatality. Reporting such errors through active systems improves medication administration, thereby enhancing patient safety and the quality of care. However, in the context of Saudi Arabia, little is understood about the causes of medication administration errors and the obstacles hindering their reporting. Objective: This study aimed to explore nurses’ perceptions of the causes of medication administration errors and the barriers to reporting them. Methods: The study employed a qualitative descriptive design, conducting face-to-face semi-structured interviews with 43 nurses from three hospitals in Taif Governorate, Saudi Arabia, between October and November 2023. Purposive sampling was used to recruit participants, and thematic analysis was utilized for data analysis. Results: The following themes emerged regarding the causes of medication administration errors: order deficiencies, high workloads and staff shortages, and malpractice. Regarding the barriers to reporting errors, the emerging themes were fear of punishment and lack of support, lack of knowledge and awareness about reporting, and lack of feedback. Conclusion: This study reveals nurses’ perceptions of the causes of medication administration errors and the barriers to reporting them. Recognizing and addressing these causes and barriers are essential for patient safety and the improvement of the healthcare environment. Efforts should be directed toward implementing interventions that address high workloads, enhance staff education and awareness, and promote a workplace culture conducive to reporting errors without fear of repercussions. Additionally, supportive mechanisms, such as feedback systems and resources for professional development, should be implemented to empower nurses to actively participate in error reporting and contribute to continuous improvement in medication administration practices.

Background: The high rate of early marriage, teenage pregnancy, and teenage mothers increases the prevalence of emotional and mental disorders, depression, parenting stress, and child stunting. Parenting coaching is among the effective ways to overcome parenting stress and improve parents’ knowledge, skills, and behaviors, thereby avoiding child stunting. However, studies on parenting coaching are not widely conducted, particularly in Indonesia. Objective: This study aimed to present the current status of parenting stress among teenage mothers and assess whether parenting coaching effectively reduces parenting stress among teenage mothers. Methods: A quasi-experimental design was used. The participants were randomly selected into two groups: the intervention group receiving parenting coaching intervention and the control group receiving standard education using a leaflet. Data were collected in June 2021 in Takalar Regency, South Sulawesi, Indonesia. Statistical Program for Social Science version 21 (Armonk, NY, USA) was employed for all statistical analyses. Results: The parenting coaching intervention had a significant effect on parenting stress (p <0.001), with significant positive changes in knowledge, attitude (p <0.001), behavior (p <0.001), self-efficacy (p <0.001), and maternal function (p <0.001). Additionally, a significant difference in the achievement of z-score values was observed between the intervention and control groups based on Body Weight/Age (BW/A) (p <0.001) and Body Length/Age (BL/A) (p <0.001). However, Body Weight/Body Length (BW/BL) did not show a significant difference in the achievement of z-score (p = 0.34) in the third month. Conclusion: Parenting coaching can reduce parenting stress among teenage mothers and improve their knowledge, attitudes, behavior, self-efficacy, and maternal function; hence, this intervention can be used as a reference in the nursing process to reduce parenting stress and prevent child stunting.

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Background: There is a growing emphasis on evaluating discharge readiness, particularly for those involved in the care of patients in transition. Caregivers supporting individuals with traumatic brain injury are a specific focus due to the potential impact of adequate discharge preparation on patient recovery and post-discharge outcomes. Objective: This research aimed to evaluate the preparedness of caregivers for the discharge of patients with moderate or severe traumatic brain injury from the hospital. Methods: This cross-sectional study was carried out in a tertiary hospital in Indonesia from January to April 2023 using the Indonesian adaptation of the Preparedness for Caregiving Scale. The study comprised seventy-four caregivers of individuals with traumatic brain injury, chosen through a purposive sampling approach based on pre-established inclusion and exclusion criteria. Data collection involved a questionnaire covering caregiver information (gender, age, education level, income, and psychological status) and discharge readiness. Descriptive statistics and correlation analyses, employing Pearson and chi-square, were conducted. Results: Most caregivers were female (83.8%), spouses of patients (50%), and had a moderate education level (52.7%). The average age of caregivers was 43.7 ± 8.7 years, with an average duration of patient care of 4.22 ± 1.2 days and a monthly income of 220 US dollars. The mean score for readiness for hospital discharge was low (10.08 ± 1.91), indicating that caregivers were not adequately prepared for discharge. Age and education were significant factors (p <0.05) related to hospital discharge readiness. Conclusion: This study emphasizes the importance of assessing caregiver readiness for the discharge of patients with traumatic brain injury from the hospital. Findings indicate a concerning trend of inadequate preparedness among caregivers, with factors such as age and education level significantly influencing readiness. The predominance of female caregivers, often spouses of patients, indicates the need for tailored support strategies. Prioritizing caregiver preparation and support, especially by nurses, is crucial for optimizing patient recovery and post-discharge outcomes.

Background: Mothers who have children with autism encounter significant difficulties in caring for their autistic youngsters, leading to higher stress levels and a reduced overall quality of life. External or internal factors can cause and respond to stress, affecting an individual’s physical, psychological, and emotional health. Thus, it is crucial to examine the quality of life of mothers with autistic children. Objectives: This study aimed to investigate the relationships between stress, self-efficacy, and quality of life (QoL) in mothers of children with autism. Methods: A cross-sectional study design was used. Self-administered questionnaires were distributed from October to November 2019 to mothers with autistic children using cluster sampling techniques to capture their demographics and perceptions of stress, self-efficacy, and QoL. The data analysis was performed using covariance-based structural equation modeling (CB-SEM). Results: Of the 290 questionnaires distributed, 238 (response rate of 82%) sets were returned, but only 181 questionnaires were usable for further analysis. The findings demonstrated a notable impact of stress and self-efficacy on quality of life and an adverse effect of stress on self-efficacy. Self-efficacy serves as an intermediary in the relationship between stress and quality of life. Conclusion: In general, mothers of autistic children typically face moderate stress levels, but they have low levels of self-efficacy and quality of life. Mothers of children with autism need assistance and support from healthcare professionals, such as doctors, nurses, and psychiatrists, so that they can bear the challenges of raising children with special needs and enjoy a higher standard of living with less emotional and physical strain.

Background: Musculoskeletal disorders (MSDs) pose a pervasive concern among nursing professionals due to the high physical workload. Simultaneously, the complex relationship between MSDs and mental health outcomes in this population remains an area of significant interest and importance. Objective: This study aimed to investigate the occurrence of MSDs and their relationships with burnout and psychological suffering within the nursing workforce. Methods: A cross-sectional study was conducted in 2020 involving 291 nursing professionals in Brazil. Standardized questionnaires were employed to gather information on MSDs, mental health outcomes, and pertinent work-related factors. Robust statistical analyses were conducted to ascertain the prevalence of MSDs, establish associations between MSDs and mental health outcomes, and delineate the influence of work-related factors on these associations. Statistical analysis was performed using the R software. Results: The study revealed a significant prevalence of musculoskeletal injuries (MSIs) among nursing workers, focusing on regions that include the lower back, upper back, neck, and shoulders. Individuals with MSIs in the lower back showed a marked increase in emotional exhaustion (p = 0.02), as did those with MSIs in the upper back (p <0.01) and depersonalization (p = 0.07). On the other hand, nursing professionals who reported MSIs in the neck and shoulders had considerably higher scores in emotional exhaustion (p <0.01 and p = 0.01, respectively) and depersonalization (p = 0.05 and p = 0.05, respectively). However, no significant correlations emerged between MSIs and depression or work-related factors. Conclusions: This study highlights the urgency of implementing proactive measures to prevent and manage MSDs within the nursing profession. Moreover, it emphasizes the critical need to enhance working conditions and provide robust support mechanisms to safeguard the mental health of nursing professionals.

Background: The Thai Qualifications Framework for Higher Education (TQF: HEd) serves as a framework to enhance the quality of higher education in Thailand. However, no valid and reliable TQF: HEd instrument is available to measure the quality of graduates among Royal Thai Air Force Nurses. Objective: This study aimed to assess the psychometric properties of the TQF: HEd instrument among graduate nurses of the Royal Thai Air Force. Methods: Psychometric testing of the instrument was conducted. The instrument’s validity was evaluated through a review by a panel of five experts, providing a content validity index (CVI). Construct validity was assessed using Confirmatory Factor Analysis (CFA) with a sample size of 308, and Cronbach’s α coefficient was utilized to measure the scale’s internal consistency. Results: The Scale-Content Validity Index (S-CVI) was 0.88. CFA yielded the following fit indices: X2 = 265.861, p = 0.068, df = 233, X2/df ratio = 1.141, Comparative fit index (CFI) = 0.996, Tucker Lewis Index (TLI) = 0.993, Root Mean Square Error of Approximation (RMSEA) = 0.021, and Standardized Root Mean Square Residual (SRMR) = 0.033. The scale reliability was acceptable, with a Cronbach’s alpha coefficient of 0.93 and 0.85-0.92 for the six factors. Conclusion: The TQF: HEd instrument demonstrates satisfactory psychometric properties, which will be valuable for those in charge of the curriculum in utilizing the instrument to measure graduate competency and guide curriculum development.

Background: Men’s health is influenced by a complex interplay of social, economic, and cultural determinants. Understanding how these aspects affect the health of adult cisgender men in medium and high-complexity healthcare settings is essential for improving healthcare services and promoting better health outcomes. Objective: This study aimed to analyze the health status of adult cisgender men in medium and high-complexity healthcare settings based on social determinants and conditioners. Methods: This study employed a qualitative design involving 45 adult cisgender men receiving care in medium/high complexity services in Bahia, Brazil. Semi-structured interviews were conducted from July 2019 to February 2020, and data were interpreted based on Dahlgren and Whitehead’s Model of Social Determinants of Health using deductive thematic analysis. Results: Proximal determinants included biological aspects, preventive behaviors, lifestyle/social life, and aging processes. Intermediate factors included work conditions, access/utilization of healthcare services/medications, and psychosocial factors. Macro determinants involved income distribution, power dynamics, resource allocation, health inequalities/iniquities, morbidity, culture, political decisions, environmental factors, and structural elements. Conclusion: The health status of men in medium/high complexity care was profoundly influenced by structural social determinants. These determinants impacted healthcare attention, service organization, cultural influences, the reproduction of hegemonic masculinity patterns, lifestyle, social support, and socioeconomic conditions necessary to realize the right to health. Nursing practices should conduct comprehensive assessments that extend beyond physical health indicators.

Background: Adolescent populations face reproductive health challenges. Persisting gaps in Triad Adolescent Reproductive Health (ARH) comprehension and risky behaviors emphasize the necessity of integrating social media apps into health education to address Triad ARH risks among youths. Teenagers commonly use WhatsApp and LINE for social media communication, and determining the effectiveness of these two apps is scarce. Objective: This quasi-experimental study aimed to investigate and compare the impacts of educational interventions delivered through WhatsApp and LINE platforms on enhancing the knowledge, attitudes, and behaviors of adolescents concerning the Triad ARH. Methods: A total of 154 senior high school students were randomly recruited from two public schools in Bandung Regency, West Java, Indonesia. These students were divided into two groups: Group A, consisting of 78 students who received material messages using LINE, and Group B, consisting of 76 students who received material messages using WhatsApp. Participants completed a pre-test prior to the intervention and a post-test one month after the intervention. Data were collected using validated questionnaires and analyzed using Chi-square and Wilcoxon tests. Results: In the LINE group, there was an average increase in knowledge from 15.68 to 20.21, attitudes from 29.05 to 59.12, and behavior from 55.95 to 64.81 before and after the intervention period (p = 0.001). In the WhatsApp group, there was an increase in knowledge from 15.16 to 19.67, in attitudes from 34.71 to 59.54, and behavior from 54.75 to 65.97 before and after the intervention period (p = 0.001). Further analysis showed no significant difference between the LINE and WhatsApp groups in increasing the average level of knowledge (p = 0.973), attitude (p = 0.682), and behavior (p = 0.067) before and after the intervention. However, it was observed that the increase in knowledge and attitude was slightly higher in the LINE group, while the increase in behavior was slightly higher in the WhatsApp group. Conclusion: This study demonstrates that educational interventions using LINE and WhatsApp both increased the knowledge, attitudes, and behavior of adolescents related to the Triad ARH. This finding is valuable, considering the popularity of LINE and WhatsApp as mobile applications. Leveraging these platforms by nurses and other healthcare professionals can significantly improve adolescents’ health, influencing their knowledge, attitudes, and behavior regarding reproductive health.

Background: In palliative and end-of-life (PEOL) care, especially within intensive care units (ICUs), nurses’ unique skills are critical, yet their expertise remains under-explored, particularly in Saudi Arabia Objective: This study aimed to evaluate the education, practice, and perceived competence of adult ICU nurses in Saudi Arabia regarding PEOL care and to pinpoint key factors that influence this aspect of healthcare delivery. Methods: A cross-sectional design was utilized in this study. Participants were recruited from five public hospitals and one specialized center in Hail, Saudi Arabia. Data were gathered in September 2023 using the PEOL Care Index, which measures various care dimensions on a Likert scale in Arabic and English. IBM SPSS Statistics 29.0 was used for statistical analysis, particularly to conduct ANOVA, t-test, and multiple regression. Results: 142 out of the targeted 171 ICU nurses completed the survey, yielding a response rate of 83.04%. Although 81% of the nurses had experience caring for dying patients, only 30.3% had received in-service PEOL care training. Those with this training demonstrated significantly higher scores in education, clinical practice, and perceived competence than their counterparts (p <0.05). Mean scores across these areas were 69.67, 71.01, and 71.61, respectively. In-service training positively correlated with these metrics (p <0.05). Multiple regressions also revealed that in-service training, job satisfaction, and communication authority are strong influencers, explaining 21.6% of the variation in clinical practice and 16.9% in perceived competence. Conclusion: The study highlighted the proficiency of ICU nurses in PEOL care, emphasizing that in-service training, job satisfaction, and the authority to communicate effectively with patients and their families significantly improved clinical practice and nurses’ competence in PEOL care. This underlines the critical need for healthcare institutions to acknowledge and address these key factors to optimize patient care outcomes.

Background: Maternal outcomes are closely associated with birth satisfaction, and the Birth Satisfaction Scale-Revised (BSS-R), a concise, multidimensional self-report measure, has undergone translation and validation internationally. However, research on birth satisfaction in Saudi Arabia is scarce. The absence of valid Arabic-language tools for the Saudi population may impede critical research on this topic, necessitating the translation and use of psychometrically sound instruments for measuring birth satisfaction in Saudi women. Objective: This study aimed to translate and evaluate the psychometric properties of the Saudi Arabian version of the BSS-R (SA-BSS-R). Methods: A total of 218 Saudi women participated in the study, and psychometric analysis of the translated SA-BSS-R involved confirmatory factor analysis, divergent validity analysis, and known-group discriminant validity assessment within a cross-sectional study design. Results: The three-factor BSS-R measurement model displayed poor fit, and internal consistency fell below the threshold value. Additionally, it was observed that women undergoing an episiotomy had significantly lower overall SA-BSS-R scores. Conclusion: The SA-BSS-R manifested atypical measurement properties in this population. Despite insightful observations related to episiotomy, the identified measurement shortcomings highlight the need for a more robust and culturally sensitive translation to enhance measurement characteristics.

Background: Gynecological cancer and its treatments can lead to sexual problems, potentially disrupting the gender role performance of women. Sexuality and gender roles are context-specific, yet these issues remain unexplored in the Indonesian context. Objective: This study aimed to explore the gender role conflicts experienced by Indonesian women having gynecological cancer. Method: A qualitative design with a phenomenology approach was utilized in this study. Data were collected through individualized, face-to-face, in-depth interviews conducted from 1 April to 30 December 2022 with 22 women diagnosed with gynecological cancer who had undergone treatments at the Dharmais Cancer Hospital, Jakarta, Indonesia. Data were analyzed using thematic analysis. Results: Three themes were developed: 1) challenges in fulfilling female gender roles after having cancer diagnosis and therapies, 2) emotional struggles related to gender role conflicts, and 3) efforts to cope with gender role conflicts. Conclusion: The study sheds light on how sexual complications due to gynecological cancer and its treatments extend beyond physical issues. A deeper layer of problems around sexual dysfunctions among gynecological cancer survivors is often rooted in traditional gender-role expectations. Nurses should have a comprehensive and contextual understanding of the unique experiences of women living with gynecological cancer to facilitate a positive adaptation to their cancer journey.

Background: The Ebola virus, a highly infectious and deadly pathogen, has posed a significant public health threat in West Africa for several decades. Liberia is one of the most severely affected countries. Healthcare personnel, including nurses, are on the front lines of patient care, and their perspectives are invaluable in understanding the challenges that arise during outbreaks, especially in implementing prevention measures. Objective: This study aimed to explore the potential risk components and prevention measures of the Ebola virus disease (EVD). Methods: This study used an exploratory descriptive qualitative design. Five stakeholders, ten doctors and five nurses who had suffered from EVD during the outbreak in Liberia participated in semi-structured interviews to provide their experience and comprehensive perspectives on EVD. Data were collected from February 2022-August 2023. NVivo 12 plus was used for inductive thematic analysis. Results: Six themes and several subthemes emerged: 1) transmission modes (body contact, body fluid, sexual intercourse, traditional burial), 2) funeral attendance (traditional practices and crowded gatherings), 3) community-led prevention (promoting good hygiene practices, increasing awareness, contact tracing, and surveillance), 4) Ebola virus vaccine (false sense of security, potential side effects, and limited data), 5) challenges in implementing prevention measures (inadequate health infrastructures, difficulty of tracing infected people, lack of resources, and cultural-social barriers), 6) Liberia’s health systems (a weak, underfunded, fragile health infrastructure, lack of health facilities and shortage of health workers). Conclusion: Several potential risk components contributing to the EVD outbreak should be a public concern. Strengthening the current healthcare system supported by local community and international aid providers (multidisciplinary teams) is needed to anticipate behavioral problems and to improve the efficacy of the prevention measures appropriate to the conditions in Liberia. Accordingly, the nurses’ compliance with the recommended prevention practices is necessary.

Background: Adolescents face increased vulnerability to HIV/AIDS due to factors such as insufficient knowledge and awareness, stigma, and restricted access to information. The Indonesian government initiated a peer education program through the Planning Generation Program (GenRe) ambassadors. These ambassadors are tasked with educating their peers about HIV/AIDS. However, their experiences are largely underexplored. Objective: This study aimed to explore the GenRe ambassadors’ experience in improving adolescents’ HIV/AIDS prevention behavior. Methods: This study employed a qualitative phenomenological approach, with in-depth and semi-structured interviews of GenRe ambassadors who had served for at least three to six months within the South Jakarta Health Sub-Department, Indonesia. Purposive sampling and data saturation techniques were utilized. Data were collected from 13 May to 31 August 2022, and Colaizzi’s steps were used to guide the data analysis. Results: Nineteen GenRe ambassadors participated, predominantly female university students ages 18–22. Six themes were developed: 1) the impact of GenRe ambassadors’ roles in improving HIV/AIDS prevention behavior, 2) activities to improve HIV/AIDS prevention behavior, 3) enhancement of self-concept as GenRe ambassadors, 4) obstacles to activities for improving HIV/AIDS prevention behavior, 5) support for activities to improve HIV/AIDS prevention behavior, and 6) hope for improving the GenRe ambassador program’s implementation. Conclusion: GenRe ambassadors are influencers who play a critical role in promoting HIV/AIDS prevention behaviors and fostering positive change in the broader youth community. Despite their positive self-concept, they encounter challenges in fulfilling their roles. Utilizing their insights, community health nurses can create effective peer-led HIV/AIDS prevention programs and contribute to a model of health promotion for adolescents. Leveraging the role of GenRe ambassadors as peer educators is recommended to enhance HIV/AIDS prevention efforts among adolescents.

Background: The diagnosis of diabetes mellitus adversely impacts the quality of life due to treatment, changes in daily life, functional disability, and emerging complications. Using metaphors to convey perceptions of diseases and life experiences is crucial for understanding healthcare behaviors. Objective: This study aimed to explore the metaphorical perceptions of “diabetes” and “being a person with diabetes” within a sample group of individuals with diabetes in Turkey. Methods: A qualitative design was employed to investigate the metaphoric perceptions of 72 people with diabetes. Data were collected face-to-face between 15 May and June 2023 using a semi-structured questionnaire. Data were analyzed using content analysis. Results: From the statements of the individuals with diabetes in the sample, seven metaphoric themes related to diabetes – “pain and distress, helplessness and hopelessness, instability, attention and sensitivity, captivity, positive outlook and acceptance, deprivation” – and six metaphoric themes concerning being a person with diabetes – “suffocation and distress, helplessness, powerlessness and disappointment, captivity, attention and sensitivity, guilt, and being worn out” - were identified. Commonly recurring sub-themes with negative connotations included “darkness, well, convict, prison, captivity, microbe, infectious disease, a hot flush, guilt, clouding life, and being ruined.” Some positively framed statements included “friend, traffic sign, and driving a car.” Conclusion: The majority of patients in the study used negative metaphors, with fewer expressing positive sentiments regarding the necessity of accepting and paying attention to the disease. Defining individuals’ metaphorical perceptions of their disease may enable the provision of better quality and holistic care. Nurses, in particular, play a crucial role in facilitating behavioral changes for patients with diabetes to achieve self-management.

Background: Multiple sclerosis presents a significant burden, with balance disturbances impacting patients’ daily living. Conventional therapies have been supplemented with technological advancements like virtual reality (VR) and exergaming, providing engaging, multisensory rehabilitation options. Objective: This study aimed to synthesize evidence on exergaming’s role in multiple sclerosis treatment, particularly to evaluate the impact of exergaming on cognitive, motor, and psychological outcomes in patients with multiple sclerosis. Methods: A systematic review and subsequent meta-analysis design were employed. An extensive search was conducted up to June 2023 across five electronic databases - Web of Science, Scopus, PubMed, Cochrane, and EMBASE. The data extraction process from the selected studies was conducted independently. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 1 (ROB1) and the National Institutes of Health (NIH) assessment tool. Continuous outcomes were consolidated as mean differences (MD) with 95% confidence intervals (CIs). Meta-analyses were performed using RevMan ver. 5.4. Results: Out of 1,029 studies, 27 were included for meta-analysis. There were no significant differences in cognitive outcomes between the exergaming and the no-intervention group or the Conventional Physiotherapy and Rehabilitation interventions (CPRh) subgroups. However, the Symbol Digit Modalities Test (SDMT) showed a statistically significant difference in favor of exergaming in the no-intervention subgroup (MD = 5.40, 95% CI [0.08, 10.72], p = 0.05). In motor outcomes, exergaming only demonstrated better results in the 6-minute walking test compared to the no-intervention group (MD = 25.53, 95% CI [6.87, 44.19], p = 0.007). The Berg Balance Scale score in both studied subgroups and the Timed Up and Go (TUG) test in the no-intervention group favored exergaming. In terms of psychological outcomes, the Beck Depression Inventory did not reveal any significant differences, while the Modified Fatigue Impact Scale (MFIS) score favored exergaming in the CPRh subgroup. Conclusion: Exergaming shows promise for enhancing cognitive and motor functions, motivation, adherence, and quality of life in MS patients, which is beneficial for nurses. It can be tailored to individual preferences and easily conducted at home, potentially serving as a viable alternative to traditional rehab programs, especially during relapses. However, further research is necessary to fully understand its optimal and lasting benefits.

Background: Passive smoking poses a threat to the well-being of an unborn baby; however, women’s understanding and practice in this regard remain unclear. Objective: This study aimed to describe prenatal passive smoking at home based on the experiences of women in Thailand. Methods: A qualitative descriptive approach was employed. Data were collected between September 2020 and April 2022 through semi-structuredin-depth interviews with 16 postpartum women purposively selected from five hospitals. Thematic analysis was used for data analysis. Results: Three themes emerged. The first theme, ‘safeguard for an unborn baby,’ was performed through smoking reduction, far distance, abstinence from smoke/odor inhalation, and residual elimination since harm was highly aware. However, justifying safety from the absence of smoke and foul odor was misperceived. The second theme, ‘intervention for smoking cessation,’ was attempted through various methods, including acquired empathy, persuasion, compromise, and supportiveness. They also needed family/friend assistance in warning and professional care in terms of advice, health education, learning materials, cessation therapy, care continuation, and dealing with complex situations. The last theme, ‘maternal perseverance,’ was acquired by the motives of safety goals, rights/responsibilities, changeable norms, and a golden period. Conclusion: Pregnant women persistently aimed to prevent their husbands from smoking and safeguard their unborn babies from passive smoking. However, misunderstandings and improper practices were observed. Healthcare and nursing services need comprehensive approaches to enhance understanding, perseverance, and tailored practices catering to women’s needs.

Background: Patient safety is crucial in healthcare, with incident reporting vital for identifying and addressing errors. Near-miss incidents, common yet underreported, serve as red flags requiring attention. Nurses’ underreporting, influenced by views and system usability, inhibits learning opportunities. The Electronic Reporting System (ERS) is a modern solution, but its effectiveness remains unclear. Objective: This study aimed to investigate the role of the ERS in enhancing the voluntary reporting of near-miss (VRNM) incidents among nurses. Methods: A cross-sectional study was conducted in the Al Dhafra region of the United Arab Emirates, involving 247 nurses from six hospitals. Data were collected using a questionnaire between April 2022 and August 2022. Structural Equation Modelling Partial Least Square (SEM-PLS) was employed for data analysis. Results: The average variance extracted for the ERS construct was 0.754, indicating that the common factor accounted for 75.4% of the variation in the ERS scores. The mean ERS score was 4.093, with a standard deviation of 0.680. For VRNM, the mean was 4.104, and the standard deviation was 0.688. There was a positive correlation between ERS utilization and nurses’ willingness to report near-miss incidents. Additionally, our research findings suggest a 66.7% relevance when applied to various hospital settings within the scope of this study. Conclusion: The findings suggest that adopting a user-friendly reporting system and adequate training on the system’s features can increase reporting and improve patient safety. Additionally, these systems should be designed to be operated by nursing staff with minimal obstacles.

Background: There is an upward surge in diabetes patients worldwide, including in Indonesia, annually. Diabetes can lead to new diseases that burden patients’ lives further. Nurses can reduce this problem by identifying people at risk of developing diabetes and educating them on how to prevent diabetes. Objective: The study aimed to determine the risk of diabetes in the Indonesian population. Methods: The descriptive research involved a sample of 1216 Indonesians living in North Sumatra Province. Participants were nondiabetic individuals selected using the convenience method from May to October 2020. This study utilized the Indonesian version of the Finnish Diabetes Risk Score (FINDRISC) tool and employed various statistical analyses, including frequencies, percentages, chi-square test, and Fisher’s exact test. Results: Of the total samples, 372 were males (30.6%), and 844 were females (69.4%). The risk of developing diabetes was classified as low (57.1%), slightly elevated (36.4%), moderate (5.3%), high (1.0%), and very high (0.2%). Only one of the eight risk factors that differed significantly between men and women was a history of elevated blood glucose levels, with a p-value of 0.02. Conclusion: The study identified a portrait of the number and percentage of diabetes risk factors in a community setting in Indonesia. Nurses must provide education on diabetes prevention to not only members of the local community at the research site but also the general public, nationally and globally.

Background: Acculturation provides a framework for exploring the health behaviors of ethnic minority or cultural groups. Research on the acculturation level and patterns of Myanmar migrants is crucial since there is ample evidence that acculturation promotes health-promoting behaviors. However, no Myanmar version has undergone cross-cultural validation. Objective: This study aimed to translate the original East Asian Acculturation Measure (EAAM) into the Myanmar version (EAAM-M) and investigate its psychometric properties. Methods: The validation study was conducted on a sample of 200 Myanmar migrants in three factories in Bangkok, Thailand, by a multistage random sampling method from August to September 2023. Brislin’s back translation technique was applied to convert the original EAAM into its modified version, EAAM-M. The reliability, content validity, and construct validity of the EAAM-M were examined, and confirmatory factor analysis (CFA) was employed to test the appropriateness of the model that underpins the EAAM-M structure. Results: The average age of the participants was 38.39 years (SD = 5.56), and 68% of participants reported they earned less than 9000 baht. In terms of how long they stayed in Thailand, slightly over half (52.5%) did so for 1-5 years. Nearly half of them (46%) cannot communicate at all regarding their proficiency in speaking Thai. The score regarding the comparability of language and similarity of interpretability between the original EAAM and the EAAM-M was satisfactory. The overall alpha reliability of the EAAM-M was 0.76. Based on the CFA, the measurement model was well fit, with acceptable goodness-of-fit values (Chi-square test of model fit (p = 0.05), CMIN/df = 1.70 (X2 = 624.931, df = 366), RMSEA = 0.02, CFI = 0.98, and SRMR = 0.06). The validity and reliability of the factors were affirmed through appropriate factor loadings and satisfactory levels of composite reliability (0.942) and average variance extracted (0.538). Conclusion: The EAAM-M is a reliable and valid instrument to measure the acculturation patterns of Myanmar migrants. It is beneficial for scholars across various disciplines, including health professionals and nurses, to deliver culturally tailored care for migrants.

Background: Self-care behavior is crucial in preventing chronic diseases, such as hypertension, which has become highly prevalent in Indonesia. Hypertension, often referred to as the “silent killer” due to its asymptomatic nature, can easily go unnoticed. Neglecting its treatment can lead to severe complications, including heart disease, heart failure, and stroke. Despite adults with hypertension feeling well, embracing self-care behavior, including making healthy lifestyle choices, disease management, and enhancing life quality, remains essential. Objective: This study aimed to describe the self-care behavior of adult patients with hypertension in Indonesia. Methods: A cross-sectional study design was employed, involving 270 participants selected through consecutive sampling. Data were collected between 15 March and 4 April 2023, using the Hypertension Blood Pressure Self Care Profile (HBP-SCP) questionnaire in six public healthcare centers in Padang City, West Sumatra, Indonesia. The data were analyzed using descriptive analysis, Mann-Whitney, and Kruskal-Wallis tests. Results: The self-care behavior among adult patients with hypertension was at a moderate level (Mean = 49.78, SD = 6.64), and it had significant differences according to ethnicity (p = 0.041), marital status (p = 0.017), and body mass index (p = 0.008). Conclusion: The findings highlight the influence of diverse ethnic backgrounds, various marital statuses, and differing body mass index levels, which may lead to distinct approaches to managing hypertension. These results offer valuable insights for nurses and other healthcare professionals to develop comprehensive strategies to enhance self-care among adult patients with hypertension.

Background: Intern nursing students not only belong to the high-risk group for human papillomavirus (HPV) infection and its associated complications but also represent the future healthcare workforce. Therefore, they constitute a significant group that should comprehensively understand HPV and its vaccine. Objective: This study aimed to assess the impact of educational interventions on intern nursing students’ knowledge and considerations related to HPV and its vaccine. Methods: A repeated measures design with pretest/posttest measures was employed. The study involved 88 students at a university in Turkey and was conducted between November 2021 and February 2022. Data were collected using a Personal Information Form and the HPV Information Scale. All participants received theoretical and student-centered interactive education, and data were analyzed using numerical data, percentage distributions, Bonferroni correction, and one-way repeated measures ANOVA. Results: The total score of the scale and the scores of all four sub-dimensions obtained in the first and third months after the education were significantly higher than those obtained before the education (p <0.001). Additionally, the proportion of students considering getting an HPV vaccine increased following the education (p <0.001). Conclusions: The education on HPV and its vaccine potentially improved students’ knowledge levels and increased consideration for vaccination. Implementing interventions that equip nursing students with sufficient knowledge about HPV and its vaccine can contribute to reducing HPV-related cancer rates. Therefore, it is recommended to implement educational programs focused on the prevention of HPV-related cancers.

Background: Nurses routinely encounter ethical dilemmas with patients and healthcare professionals. Therefore, it is crucial for them to be conscious of ethical principles and apply them in their decision-making processes. However, no specific questionnaire is available to assess nurses’ ethical conduct in Indonesia. Objective: This study aimed to assess the psychometric properties of the Indonesian version of the Nurses’ Ethical Behavior in Protecting Patients’ Rights (I-NEBPPR) scale. Methods: Following the World Health Organization’s guidelines and utilizing the WHODAS 2.0 translation package, the NEBPPR was translated into Bahasa Indonesia and underwent a rigorous translation and adaptation process. Data were collected between October and November 2022 and included 283 Indonesian nurses as participants. Confirmatory factor analysis (CFA) was used to evaluate construct validity. Convergent validity, discriminant validity, and reliability were also performed for comprehensive evaluation. IBM SPSS statistics version 27.0 and AMOS 24.0 were used for statistical analysis. Results: Five items were excluded from the original versions, forming five subscales that include a combined total of 23 items. The subscales are as follows: Factor 1 (Respect for right to information and decision), Factor 2 (Providing fair care), Factor 3 (Providing benefit-not harming), Factor 4 (Respect for patient values and choices), and Factor 5 (Attention to privacy). The I-NEBPPR model demonstrated robust construct validity with factor loadings ranging from 0.453 to 0.871. CFA showed satisfactory model fit indices (χ2/df = 1.554 (p <0.001), GFI = 0.906, CFI = 0.929, IFI = 0.930, RMSEA = 0.044). Reliability metrics were solid, with a Cronbach’s alpha of 0.819 and composite reliability exceeding 0.6. Both convergent validity, as indicated by AVE, and discriminant validity, as confirmed by the Fornell-Larcker criterion, met established thresholds. Conclusion: It is affirmed that the 23-item I-NEBPPR demonstrated strong psychometric properties, making it a valuable, practical, and time-efficient tool for nurse supervisors, nurse managers, and nurse leaders to assess nurses’ clinically-based ethical behavior in their efforts to protect patient’s rights.

Background: The internship year marks the culmination of the nursing program across all Saudi universities, bridging theoretical learning and practical application. The significance of the internship year lies in the application of skills acquired during the preceding years of study. Understanding interns’ experiences, identifying influences, and sharing their recommendations for best practices become crucial. Objective: This study aimed to explore the experiences of internship students and address the challenges they encountered in a clinical environment. Methods: A qualitative naturistic descriptive approach was employed, involving 20 purposively selected participants from internship students in two regions in Saudi Arabia. Data were collected in January 2023 through semi-structured interviews, focus group discussions, and observation. A conventional content analysis approach was used for data analysis. Results: Four major themes were generated: 1) Transferring Shock, 2) Self-Learning, 3) Supportive Environments, and 4) Factors Facilitating Learning. Transferring Shock comprised two subthemes: feeling lost and feeling left out. Conclusion: Internship students acknowledged the utility of orientation and mentorship programs in advancing the practical skills of new nurses and enhancing patient safety. The findings also indicated that those with prior preparation and robust communication skills reported a positive experience. Consequently, integrating communication courses into the nursing education curriculum could be beneficial. Establishing a supportive learning environment for nursing interns is imperative to address challenges and ensure the delivery of safe and effective patient care.

Background: Discharge planning is vital to preventing hospital readmission, and nurses play a key role. The COVID-19 pandemic has posed challenges to hospital services that may persist or recur. Therefore, exploring nurses’ experiences with discharge planning practices before and during this pandemic is crucial. Objective: This study aimed to describe the experiences of discharge planning practices among nurses at an Indonesian tertiary hospital before and during the COVID-19 pandemic. Methods: A qualitative descriptive study design was used. Telephone interviews were conducted to collect data among ten nurses from March 2019 and continued between December 2020 and August 2021. Content analysis was done for data analysis. Results: Two main themes emerged: 1) Challenges in discharge planning practices and 2) Perceived discharge planning as a professional responsibility. Implementing the inpatient ward fusion policy as part of the hospital’s pandemic response presented greater challenges to nurses in coordinating care and performing discharge planning. Fear of COVID-19 infection, social distancing measures, and using personal protective equipment also affected how nurses delivered discharge education during the pandemic. However, the nurses sensed a greater responsibility to ensure the maintenance of essential components of discharge planning procedures to guarantee the patient’s capability to perform self-care at home. Conclusion: Nurses viewed discharge planning practices as their responsibility and continued them during the pandemic despite facing various challenges. In addition to recognizing the significance of nurses’ roles in discharge planning practices and overall patient care, it is crucial to anticipate and address the diverse working patterns and styles among healthcare professionals in unified wards, ensuring effective coordination.

Background: Feeding practices are crucial in ensuring toddlers receive an appropriate and varied diet to support their growth and development. In Tanzania, maternal feeding practices for young children are inadequate, and there is limited research on the influencing factors. Objective: This study aimed to examine the factors influencing Tanzanian mothers’ feeding practices for toddlers, utilizing the health promotion model as the theoretical framework. Methods: A predictive correlational design was employed, with a random sample of 399 mothers who brought their toddlers for health supervision at a tertiary care hospital in the United Republic of Tanzania. Data on personal information, depression, perceived benefits, perceived barriers, perceived self-efficacy, social support, situational influences, and maternal feeding practices were collected using self-administered questionnaires between September 2021 and November 2021. Descriptive statistics, correlations, and multiple regression analysis were employed for the analysis. Results: All the factors examined in the study accounted for 18.9% of the variance explained in maternal feeding practices. Significantly, only two factors, perceived self-efficacy (β = 0.32, p <0.001) and situational influences (β = 0.24, p <0.001), could predict maternal feeding practices. Conclusion: Perceived self-efficacy and situational influences emerged as the primary influencing factors on maternal feeding practices for toddlers. Pediatric nurses should address these modifiable factors when developing nursing interventions and strategies to promote a healthy nutritional status in toddlers.

Background: Assessing the professional interpersonal competency of novice nurses is crucial for preventing staff turnover and promoting effective work. However, none of the instruments identified in the literature specifically target novice nurses. Objective: This study aimed to develop and psychometrically test the perception dimension of the Professional Interpersonal Competency Assessment Scale for Novice nurses (PICASN) in Japan. Methods: The study comprised four steps: 1) concept identification, 2) item construction, 3) validity measure, and 4) reliability measure. A cross-sectional web-based questionnaire was administered from February to April 2023 and was completed by 203 novice nurses. Data quality was assessed using mean, item response, missing values, floor and ceiling effects, internal consistency, and item-rest correlations. Content validity index (CVI) was used to determine the instrument’s validity, while exploratory factor analysis (EFA) using maximum likelihood estimation with Promax rotation was employed to assess the factor structure. Cronbach’s alpha was used to evaluate reliability. Results: The 27-item PICASN demonstrated an Item-CVI of 0.94 and a Scale-CVI of 0.88. EFA revealed two factors: 1) Basic competencies as a novice nurse (15 items) and 2) Relationship building skills within the healthcare team (12 items), which explained 80% of the variance. Internal consistency reliability was excellent at 0.94 and 0.91 for the factors, and the overall scale reliability was 0.95. The item-rest (I-R) correlation values exceeding 0.6 were considered acceptable. Conclusion: The PICASN demonstrates satisfactory psychometric properties, making it an effective tool for measuring professional interpersonal competency among novice nurses in Japan. This instrument serves to assist novice nurses by promoting self-awareness and offering targeted insights into specific areas requiring improvement. Additionally, it provides experienced nurses and nurse managers with valuable insights into team dynamics, guiding interventions for continuous quality improvement.

Background: Due to the cervical cancer screening campaign, there is a gradual increase in the number of women diagnosed with abnormal cervical cytology results. Most women experience high anxiety upon learning about these results, leading to adverse psychological effects. Therefore, nurses play a vital role in counseling these women to alleviate their concerns. Objective: This study aimed to examine the effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results. Methods: The study employed a time-series quasi-experimental design with a comparison group. It was conducted at the colposcopy clinic of a university hospital in Bangkok, Thailand, from August 2022 to April 2023. A total of 68 women with abnormal cervical cytology results were purposively recruited based on inclusion criteria. The comparison group (n = 34) received only usual care, while the experimental group (n = 34) received colposcopy counseling and usual care. Colposcopy counseling was provided after collecting baseline data. Anxiety was assessed at baseline, immediate post-test, and 12th week post-test. Data were analyzed using descriptive statistics, Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA). Results: There was no statistically significant difference in anxiety across the three-time points between the two groups (F1, 66 = 0.062, p = 0.804). However, anxiety in the experimental group significantly decreased over time (p <0.05). In contrast, anxiety in the comparison group at baseline was not significantly different from that at the immediate post-test (p = 0.480). Conclusion: Colposcopy counseling was effective in reducing anxiety in Thai women with abnormal cervical cytology results, especially during the initial period after receiving the results. Nonetheless, anxiety could gradually decrease regardless of the intervention. Therefore, colposcopy counseling by nurses and healthcare providers is helpful for women in relieving anxiety during their first colposcopy attendance.

Background: Inadequate diabetes self-management leads to foot infections and lower extremity amputations. Effective self-care, supported by nurse-provided information, is crucial, particularly in foot care. However, the current approach in Thailand focuses more on what nurses want patients to know rather than addressing patients’ actual needs. Consequently, nurses might misunderstand their patients' perspectives. Hence, nurses need to grasp patients’ needs for successful foot care behavior. Objective: This study aimed to explore the needs of patients with diabetes regarding the prevention and treatment of foot complications. Methods: The study employed a qualitative descriptive design. Thirty participants classified as high risk for foot ulcers were purposively selected from Thailand's university hospitals. Focus group discussions were used for data collection between June and July 2021. Verbatim transcription and content analysis were carried out for data analysis. Results: Four emergent themes highlighted patients’ needs: 1) information-giving, 2) proactive foot screening with foot-care affirmation, 3) foot care services, and 4) relieving foot burdens and limb loss. Conclusion: Nurses should change their mindset to care for and continually understand patients' needs. This involves adapting educational strategies like the teach-back method and coaching while providing skill training. Offering diverse service platforms, both online and onsite education programs and counseling, is essential. Additionally, ensuring accessibility and affordability, such as establishing after-hours clinics and supplying foot care toolkits, remains crucial.

Background: Child sexual abuse (CSA) has emerged as a global concern, particularly affecting children in Indonesia. However, there remains a scarcity of research on CSA within the Indonesian context. Objective: This study aimed to explore the educational needs of primary school teachers in preventing child sexual abuse. Methods: A qualitative descriptive study design was employed, with eight teachers and school principals selected through purposive sampling. Data were collected through focus group discussions and analyzed using content analysis. Results: Six categories emerged: 1) The risk of sexual abuse, 2) The necessity for clear CSA preventive regulations and sanctions for abusers, 3) Lack of CSA program socialization, 4) The need for structured CSA prevention education for children, 5) The importance of effective coordination with various relevant stakeholders, and 6) The presence of barriers and obstacles. Conclusion: This study provides valuable insights into the educational prerequisites for teachers to implement CSA prevention measures effectively. The findings emphasize the pressing need for school teachers to develop and implement CSA prevention programs, with the government’s and nursing professionals’ support, to enhance educators’ abilities in combating CSA. Nurses have a pivotal role in preventing and addressing child sexual abuse, and they should actively contribute to improving child safety and well-being through knowledge, collaboration, and advocacy for comprehensive prevention strategies.

Background: The crucial role of fathers in the well-being of mothers and infants is widely acknowledged. This study focuses on the specific context of how Thai fathers support their partners in breastfeeding, with the goal of gaining a deeper understanding of the strategies they employ in providing this support. Objective: This study aimed to explore the experiences of fathers in supporting their partners in breastfeeding. Methods: The study used a qualitative descriptive design from December 2018 to February 2020. Nineteen Thai fathers were purposefully selected, each with partners and infants who did not face any complications that would serve as barriers to breastfeeding. Data collection occurred at vaccination clinics and family planning wards in two major hospitals in Chiang Mai province, Thailand. The data were collected through in-depth interviews, and a thematic analysis approach was employed for data analysis. Results: Four themes emerged: a) Facing barriers to breastfeeding support, b) Believing in the value of breast milk, c) Seeking ways to increase milk supply, and d) Making an effort to support continued breastfeeding. Conclusion: Thai fathers demonstrated a strong eagerness to support their partners in sustaining breastfeeding. Their willingness highlights the importance of nurses, midwives, and other healthcare providers providing additional education and support to empower them as supportive partners to mothers.

Background: Obesity and underweight can have adverse effects on adolescents. However, previous obesity management program conducted in Korea for adolescents with obesity showed low effectiveness, and there are few studies on underweight Korean adolescents. Objective: This study aims to analyze differences in the health behaviors and mental health of adolescents based on their body mass index (BMI). Methods: Data from the 2021 Korea Youth Risk Behavior Survey were examined. The health behaviors and mental health of 53,445 adolescents were analyzed according to BMI using SAS version 9.4 with the Rao-Scott χ2 test and logistic regression analysis. Results: Regarding the difference in health behaviors according to BMI, a higher proportion of participants who are drinking alcohol and are exposed to secondhand smoke were in the underweight group than in the obesity group. The rate of obesity among those engaged in physical activity was higher than that among those involved in non-physical activity. In addition, the obesity group used smartphones more than the underweight group, while the quality of sleep was better among the underweight group than the obesity group. Conclusion: While the health behaviors and mental health of adolescents according to BMI are similar to those of previous studies, there are also distinct aspects. Consequently, further exploration of health behaviors and mental health based on BMI is crucial for developing and implementing targeted nursing intervention programs for adolescents with different weights.

Background: Healthcare services in Islamic hospitals are becoming increasingly important due to the growing global Muslim population and the demand for spiritually sensitive healthcare. Understanding the factors contributing to patient satisfaction in this context is paramount. Objective: This research aimed to investigate the relationships between nurses’ work factors, Sharia-based nursing care, and patient satisfaction in an Islamic hospital in Indonesia. Methods: This study employed a cross-sectional design involving 260 respondents, comprising 130 patients and 130 nurses in inpatient rooms. Data collection took place in August 2022 at an Islamic Hospital in Indonesia using validated questionnaires. SmartPLS 3.2.8 was used to generate Partial Least Square Structural Equation Modeling (PLS-SEM) to assess and analyze relationships between research variables. Results: Nurses’ work factors had a significant impact on Sharia-based nursing care (β = 0.813, t = 18.582, p <0.001). Furthermore, Sharia-based nursing care had a significant influence on patient satisfaction (β = 0.509, t = 3.941, p <0.001), while nurses’ work factors had a moderately significant effect on patient satisfaction (β = 0.396, t = 3.079, p = 0.002). The interaction between work factors and Sharia-based nursing care had an influence on patient satisfaction (β = 0.366, t = 3.666, p <0.001), explaining 74.4% of the variance observed in patient satisfaction. Conclusion: This study offers valuable insights into the significance of improving nurses’ work factors, including elements such as performance, feedback, correction, and job design, along with the integration of Sharia-based principles in nursing care. The study suggests that nursing administrators, healthcare policymakers, and academic institutions should prioritize the creation of supportive work environments and culturally sensitive care practices for nurses to enhance patient satisfaction.

Background: Enteral nutrition is a common yet vital practice in the pediatric intensive care unit (PICU). However, the status of substandard feeding of enteral nutrition in PICU children undergoing mechanical ventilation remains unclear and can be detrimental to the children’s prognosis. Objective: This study aimed to evaluate the incidence, nursing care status, and influencing factors of substandard feeding in children undergoing mechanical ventilation in the PICU. Methods: This study employed a retrospective cohort design. Children undergoing mechanical ventilation and enteral nutrition in the PICU of a public hospital in China from 1 June 2021 to 31 December 2022 were selected using convenience sampling, and their characteristics were collected and evaluated. Pearson correlation analysis and multivariate logistic regression analysis were conducted to assess the influencing factors of substandard feeding in PICU children with mechanical ventilation. Results: A total of 156 PICU children undergoing mechanical ventilation were included for analysis in this study. The rate of substandard feeding in PICU children was 65.38%. Statistically significant differences were observed in diarrhea, vomiting, the use of sedatives, and average infusion speed between the substandard feeding group and the standard group (p <0.05). Pearson correlation results indicated that diarrhea (r = 0.595), vomiting (r = 0.602), and average infusion speed (r = 0.562) were correlated with substandard feeding and characteristics of included ICU children undergoing mechanical ventilation (p <0.05). Logistic regression results found that diarrhea (OR = 2.183, 95%CI: 1.855~2.742), vomiting (OR = 3.021, 95%CI: 2.256~4.294), and average infusion speed ≤40 mL/h (OR = 2.605, 95%CI: 1.921~3.357) were independent risk factors for substandard feeding in mechanically ventilated children in the ICU (p <0.05). Conclusion: The rate of substandard feeding in children with mechanical ventilation in the PICU was high. Diarrhea, vomiting, and slow infusion speed are important influencing factors for substandard feeding. It is suggested that nurses and other healthcare professionals take targeted measures, including the prevention and care of diarrhea and vomiting, as well as monitoring and adjusting the infusion speed of enteral nutrition, to reduce the occurrence of substandard feeding.

Background: Many preterm infants face feeding difficulties during the transition from enteral to oral feeding due to organ immaturity, resulting in aspiration, airway instability, and oral feeding intolerance. These challenges can increase morbidity and mortality among preterm infants. Nurses play a vital role in providing interventions to minimize negative impacts and enhance the safety of preterm oral feeding. Objective: This study aimed to explore the experiences of Indonesian nurses in improving preterm oral feeding readiness. Methods: A qualitative descriptive study was conducted involving ten nurses working in intensive care units as participants through purposive sampling. Data were collected through semi-structured, in-depth interviews conducted from January to March 2023. Thematic analysis was applied for data analysis. Results: Four key themes developed in this study: 1) comprehensive and holistic nursing assessment, 2) challenging and complex nursing issues, 3) the need for nutritional management skills, and 4) the necessity of collaborative support. Conclusion: Nurses play a pivotal role in enhancing oral feeding readiness among premature infants. Their responsibilities include assessing oral feeding readiness, addressing nursing challenges, and implementing multidisciplinary stimulation involving parents. This study provides a foundational framework for developing interventions to improve preterm oral feeding readiness.

Background: Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital. Objective: This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG. Methods: In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher’s exact, and Mann–Whitney U tests. Results: The intervention group had significantly lower mean scores—indicating favorable wound healing—for SVG donor site wound healing level than the control group on days 14–21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores—indicating good wound healing—than the control group. Conclusion: The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge. Trial registration: Thai Clinical Trials Registry (TCTR20211112002)

Background: Recognizing the significance of effective communication in raising emergency department service standards and preventing misinterpretation of patient needs among registered nurses is crucial for improving patient satisfaction. The utilization of the AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) communication framework is acknowledged to enhance communication among registered nurses, patients, family members, and other healthcare professionals. Objective: This study aimed to explore Thai nurses’ experiences in applying the AIDET framework for communications with patients and their relatives in the emergency department. Methods: A qualitative descriptive research design was employed. Semi-structured interviews with 15 emergency nurses were conducted between September and March 2022 in a regional hospital in Thailand. Data were analyzed using content analysis. Results: Three themes were generated: 1) Ability to follow the AIDET framework, 2) Recognizing the value of using AIDET steps for positive communication, and 3) Establishing a foundation for successful communication. Conclusion: The study’s findings highlighted the AIDET framework’s potential to enhance communication skills between nurses, healthcare professionals, and patients. The results also emphasized the importance of providing training and mentorship to junior nurses, integrating AIDET into daily routines and institutional policies, and facilitating continuous education for registered nurses. These efforts contribute to improving care quality and aligning with patient and family needs.

Background: Emotional intelligence is an individual’s capacity to comprehend, use, and control their own emotions to communicate and connect with people successfully. The emotional intelligence level among nursing students indicates their ability to regulate their emotions, possess self-awareness, demonstrate empathy, have motivation, and display social skills, impacting how they adapt during their education and preparation for nursing care. However, studies investigating emotional intelligence in the Saudi Arabian context are scarce. Objective: This study aimed to evaluate the degree of emotional intelligence and its differences according to sociodemographic variables among nursing students in Saudi Arabia. Methods: A cross-sectional study was undertaken with 322 nursing students conveniently selected at Majmaah University, Saudi Arabia. Data were collected between May and June 2023 utilizing the Schutte Self-Report Emotional Intelligence Test (SSEIT). Descriptive statistics, such as mean, standard deviation, frequency, and percentage, independent t-test, and one-way ANOVA were used for data analysis. Results: Most of the students had emotional intelligence levels ranging from moderate to high (96.6%). There were significant differences in emotional intelligence levels according to the age of students, gender, year of study, marital status, mother’s education, physical and psychological health, and grade point average (p <0.05). Conclusion: The study findings may offer valuable insights for nursing educators in universities, emphasizing the importance of enhancing emotional intelligence and integrating it into nursing curricula. Additionally, it highlights the need to develop effective strategies and training sessions and workshops according to sociodemographic factors to enhance emotional intelligence levels among nursing students.

Background: Over the years, a few tools and instruments have been developed to assist in the assessment within a palliative care setting. However, many of these tools and instruments do not reflect a person-centered palliative care model. Objective: This study aims to develop a Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines. Methods: An exhaustive search of the literature was conducted to develop a pool of items for the instrument. The validity of the instrument was evaluated using the content validity index (CVI), while the factor structure was assessed using exploratory factor analysis (EFA) using maximum likelihood estimation with Promax rotation. Also, the internal reliability was evaluated using Cronbach’s alpha. Results: EFA yielded three factors: 1) Caring as maintaining person’s dignity (13 items), 2) caring as empowerment of person’s autonomy (14 items), and 3) caring as understanding person’s momentary concerns (10 items). Whereas the internal consistency reliability of these subscales appeared excellent (i.e., 0.95, 0.96, and 0.93, respectively), the Cronbach’s alpha for the overall scale was 0.98. The item-total correlation coefficients were >0.30 for all items, ranging from 0.310 to 0.726. Conclusion: Findings support a three-factor, 37-item PPCNI that can be used in clinical practice to ensure that nurses provide palliative care based on patient needs and preferences.

Background: Patient compliance with regimens is one of the most researched and least-understood behavioral concerns in the healthcare profession due to the many meanings employed in multidiscipline over time. Thus, a thorough examination of the idea of patient compliance is necessary. Objective: This paper aims to explore and identify the essence of the term patient compliance to achieve an operational definition of the concept. Method: Walker and Avant’s eight-step approach was used. A literature search was conducted using keywords of patient compliance AND healthcare profession from five databases: PubMed, Medline, CINAHL, ProQuest, ScienceDirect, and Cochrane database, published from 1995 to 2022. Results: The attributes of patient compliance include 1) self-care behavior, 2) following health recommendations, and 3) willing collaboration with health professionals. Antecedents of patient compliance were characteristics of therapeutic regimens, communication of health advice, and patients’ attitudes toward professional recommendations. Consequences include improved clinical outcomes, quality of life, and lifestyle or behavior modification. Conclusion: This concept analysis offers a valuable perspective on patient compliance that guides the nursing practice in providing better interventions to promote compliance among patients.

Background: Dyslexia—a learning disorder characterized by difficulty in word-level reading skills—can negatively impact nursing students’ practice, which can, in turn, affect patient safety. Individuals with dyslexia are often stigmatized. There is a need to explore dyslexia awareness among nursing students and its relationship with stigma in Saudi Arabia. Objective: This study aimed to assess the dyslexia awareness levels among nursing students and its relation to stigma. Methods: A quantitative cross-sectional study was conducted on 154 nursing students at King Abdulaziz University, Saudi Arabia. Data were collected by asking the students to virtually complete the Knowledge and Beliefs about Developmental Dyslexia Scale (KBDDS) and the Consciousness Questionnaire-Learning Disabilities (SCQ-LD) from February to March 2021. Data were analyzed using chi-square tests to test significance and Cramer’s V to determine the strength of the relationships among the categorical variables. Results: The overall dyslexia awareness level was moderate. Most participants believed that people had negative assumptions about individuals with dyslexia and that they judged and treated them differently. A moderately strong positive association was revealed between knowledge of the stigma surrounding dyslexia and knowledge of dyslexia itself (p <0.001). Conclusions: Increased dyslexia awareness is correlated with greater anticipation that dyslexic individuals will be stigmatized. Therefore, dyslexia awareness should be raised among nursing students. Students or nurses with dyslexia should also be encouraged to learn appropriate coping strategies to ensure patient safety.

Background: Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system. Objective: This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus. Methods: A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis. Results: Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01). Conclusion: The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions. Clinical trial registration number: NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100)

Background: Recently, there has been an increasing concern regarding matters concerning the LGBT community that should not be overlooked. Even though the Philippines is among the Asian nations with strong public tolerance towards homosexuals, numerous individuals still encounter discrimination. And while studies have been conducted elsewhere, the literature is limited among Filipino nursing students. Objective: This research assessed the knowledge and attitude towards lesbian, gay, bisexual, and transgender (LGBT) healthcare concerns among nursing students in the Philippines. Methods: A descriptive, cross-sectional survey was conducted among nursing students (N = 354) in a public university in the Philippines. The Nursing Students’ Knowledge and Attitudes of LGBT Health Concerns was used to gather survey data online in April 2022, and data were analyzed using IBM SPSS version 26 software. Results: While a large majority of nursing students had positive attitudes, many had only low to moderate knowledge about LGBT healthcare concerns, although no significant correlation (p = 0.081) was found between knowledge and attitude. There were significant differences in knowledge based on gender (p = 0.049), religious affiliation (p = 0.023), and academic year level (p <0.001). A significant difference was also identified in attitude based on sexual orientation (p <0.001). Conclusion: Certain measures should be taken to address the gaps in the curricular content of undergraduate nursing programs directed at the LGBT topic to deliver culturally competent care grounded in evidence-based practices for LGBT individuals.

This editorial presents eight concept analysis methods for use in nursing research and education. In addition to the two classical methods of Walker and Avant’s and Rodgers’ concept analysis approaches that are typically utilized in nursing education and briefly discussed within this editorial, six additional methods are also presented including Schwartz-Barcott and Kim’s Hybrid model, Chinn and Kramer’s approach, Simultaneous Concept Analysis, Pragmatic Utility, Principle-Based Concept Analysis, and Semantic Concept Analysis. By familiarizing nursing educators, researchers, and students with these methods, educators can enhance their critical thinking and understanding of complex nursing concepts, preparing them for enhanced, multi-faceted contributions to nursing science.

Background: Despite the shift from the COVID-19 pandemic to an endemic phase, many individuals, including nurses, may still be facing psychosocial challenges after enduring three years of the pandemic. Although the anticipation that psychosocial issues, such as work demand and workplace violence, have diminished and nurses’ job satisfaction has improved, there is a scarcity of studies in Indonesia investigating this matter. Objective: This study aimed to 1) explore the current state of nurses’ work demands, workplace violence, and job satisfaction and 2) examine the relationships between work demands, workplace violence, and respondents’ characteristics with nurses’ job satisfaction. Methods: The study employed a cross-sectional survey design involving 247 nurses from a regional general hospital in Jakarta, Indonesia. Simple random sampling was used to select the participants, and the Copenhagen Psychosocial Questionnaire (COPSOQ) III was used for data collection. Data were analyzed using multiple linear regression. Results: The types of cognitive demands (M = 12.46, SD = 3.461), demands for hiding emotion (M = 11.66, SD = 3.554), and work pace (M = 9.87, SD = 2.847) scored an average close to or within the “sometimes/quite extensive” range on the scale. All types of workplace violence and conflicts occurred among nurses (Mean range = 1.21-2.57). Nurses perceived themselves as fairly satisfied with their job (M = 18.47, SD = 3.18). The results of the multiple linear regression indicated that nurses’ job satisfaction was predominantly influenced by workplace violence (β = -0.191), followed by the type of care unit (β = -0.167) and work demands (β = -0.126). These factors collectively accounted for 9.1% of the variance in the job satisfaction variable (R2 = 0.091, p <0.005) Conclusion: Despite the decreasing number of COVID-19 cases, nurses still experience high work demands and continue to face workplace violence. These factors, as well as the type of care unit, influence nurses’ job satisfaction. Therefore, further actions need to be taken by hospital management to address these psychosocial conditions. It is recommended that future research explore the role of nurse managers in managing the psychosocial factors associated with these three factors.

Background: In most resource-limited countries, palliative care is still under development. Despite the differences, the involvement of family caregivers is fundamental in both High-Income Countries (HICs) and Low-Income Countries (LICs). The lack of formal support in LICs implies that educational interventions to support family caregivers in this region could be more complex and urgently needed than in HICs. To comprehend the existing situation and identify the gaps in LICs, using HICs as a benchmark standard and conducting a review comparing educational interventions in both regions is essential. Objective: To identify and compare the existing implementation of education for family caregivers of patients with advanced cancer in LICs and HICs. Design: An integrative review guideline by Whittemore and Knafl was followed. Interventional studies related to education for family caregivers providing care for adult patients with cancer were included, and review articles were excluded. Data Sources: Data were obtained from PubMed, EBSCO, ProQuest, and ClinicalKey. The search was conducted on 18 November 2021 and updated on 9 August 2023. Review methods: Data reduction, data comparison, conclusion drawing, and data verification were conducted. Results: Out of the 11 studies included, nine were randomized controlled trials, and two were quasi-experimental studies. Among them, seven (63%) were conducted in HICs, and four (37%) were carried out in LICs. In both regions, the psychological aspect was the most commonly addressed subject in palliative care education for family caregivers. However, in LICs, no articles specifically addressed the social and spiritual aspects of family caregivers’ education. Research conducted in LICs mostly involved nurses, while studies in HICs included a more diverse range of healthcare professionals. Typically, these programs required two to three sessions, with 30-60 minutes duration for 3-12 weeks. Conclusion: The social and spiritual aspects can be integrated into family caregivers’ training programs in LICs in the near future. Nurses, as an integral part of the multidisciplinary team, are capable of contributing to the development of educational programs for family caregivers, especially in resource-limited countries where patients rely heavily on their caregivers and relatives. Support from nurses is fundamental in such contexts.

Background: The COVID-19 pandemic has posed a global challenge, leading different nations to adopt diverse strategies for prevention and control. In Thailand, Village Health Volunteers (VHVs) have played a pivotal role in the fight against the virus. As the pandemic unfolded, the critical role of VHVs became apparent, prompting a closer examination of their practices and the underlying factors contributing to their effectiveness. Objective: This study aimed to uncover the underlying factors and indicators contributing to the successful prevention and control of COVID-19 by VHVs in Thailand. Methods: The sample group included 10,400 VHVs nationwide. Data were collected from October 2020 to February 2021 using five-point Likert rating scale online questionnaires. Data were analyzed using the Exploratory Factor Analysis technique, with Principal Component Analysis and the orthogonal Varimax method. Results: The study revealed nine effective factors and 52 indicators contributing to the prevention and control of COVID-19 in Thailand. The identified factors are as follows: 1) Personal precautions, 2) Proactive disease control strategy, 3) Awareness of COVID-19 severity, 4) Pride and job motivation, 5) Adequate medical equipment and support, 6) Communication, planning, and monitoring processes, 7) Self-care for health, 8) Data collection, record maintenance, and report submission, and 9) Proper hand washing. Conclusion: This research emphasizes the importance of a holistic approach to community-based health interventions. It highlights the crucial role of VHVs in disseminating information, ensuring preparedness, and fostering a sense of responsibility among community members. This strategic approach will effectively contribute to ongoing efforts to successfully prevent and control the spread of COVID-19 and potential future outbreaks.

Background: Diabetes mellitus (DM) is an emerging global public health challenge worldwide, including Nepal. Social determinants of health (SDOH) play a major role in glycemic control among persons with type 2 DM (T2DM). However, little is known about the association between SDOH and glycemic control among individuals with T2DM in Nepal. Objective: This study aimed to identify the level of glycemic control and SDOH associated with glycemic control among Nepalese with T2DM. Methods: This cross-sectional study was conducted at a tertiary hospital in Kathmandu, Nepal, among 135 Nepalese diagnosed with T2DM who attended follow-up appointments. Convenience sampling and inclusion criteria were utilized for participant selection. Data were collected from April to June 2021 using validated scales. Descriptive statistics, Chi-square test, and binary logistic regression were employed to analyze the data. Results: The mean age of the participants in this study was 53.84 (SD = 11.78) years, and the average monthly household income was 567.64 (SD = 362.30) USD. The majority of the participants (77.8%) were literate and had no health insurance coverage (73.3%). Approximately 64.4% of the participants showed suboptimal glycemic control indicated by glycated hemoglobin (HbA1c) ≥7%. The significant determinants of good glycemic control included monthly household income of >850 USD (odds ratio [OR] = 12.20, 95% confident interval [CI] = 1.76–84.61, p = 0.011) and 341–600 USD (OR = 7.64, 95% CI 1.35–42.98, p = 0.021), being literate (OR = 6.37, 95% CI = 1.65–24.49, p = 0.007), having health insurance (OR = 5.82, 95% CI = 1.49–22.65, p = 0.011), sufficient health literacy (OR = 3.46, 95% CI = 1.10–10.83, p = 0.03), and high (OR = 16.17, 95% CI = 2.36–110.67, p = 0.005) and moderate (OR = 7.02, 95% CI = 1.26–39.07, p = 0.026) food availability, respectively. Conclusion: The study revealed suboptimal glycemic control in Nepalese with T2DM. This study presents essential social determinants of glycemic control in this population. Therefore, healthcare providers, particularly nurses, should pay more attention to assessing social determinants and provide targeted interventions to patients with T2DM who have low income, are illiterate, have no health insurance coverage, have insufficient health literacy, and have low resources for food availability.

Background: The internet has become an inevitable tool for information-seeking and communication in today’s modern era. However, ironically it has driven humankind to become more dependent, leading to addiction. Internet addiction has increased exponentially at all levels of society, especially university students, impeding their physical, psychological, and social well-being. Objective: This study aimed to examine the relationship between academic procrastination and internet addiction and determine the influence of academic procrastination on internet addiction among Thai university students. Methods: A cross-sectional study was conducted involving 470 participants selected through multi-stage cluster random sampling from a university in eastern Thailand. The data collection was conducted between 29 November 2022 and 27 January 2023. The data were gathered using a demographic data form, an internet addiction test, and a procrastination assessment scale for the students’ questionnaire. Descriptive statistics, Pearson correlation coefficient, and simple linear regression were employed for data analysis. Results: The results revealed that academic procrastination (M = 49.68, SD = 12.61) and internet addiction (M = 65.26, SD = 5.60) were at a moderate level. A positive correlation was identified between academic procrastination and internet addiction (r = 0.33, p <0.01), indicating a low relationship. Academic procrastination also had a significant predictive power on internet addiction, accounting for 11.3% of the variance (R2 adjusted = 0.113, F (1, 468) = 59.583, p <0.001). Conclusion: The findings indicated the significant role of academic procrastination on internet addiction. Therefore, it is crucial that nurses should formulate interventions by considering this factor and emphasize self-regulatory and time-management skills and practical ways to limit internet dependence. Furthermore, the findings suggest that nurses could assess the procrastination level among students, devise prevention strategies, and organize awareness campaigns to instill information about rational internet use that aids in mitigating the risks and preventing them from getting addicted.

Background: Adolescent problem behavior in research and practice has been traditionally categorized as Oppositional Deviant Disorder and Conduct Disorder. However, a significant number of adolescents remain underdiagnosed. To address this issue, the term “Conduct Problem” has emerged as a commonly used descriptor for those who have not yet received a formal diagnosis, particularly within the community. It is crucial for nurses to comprehend the characteristics of these conduct problems to address them effectively. Objective: This concept analysis aimed to clarify the concept of conduct problems among adolescents aged 14 to 16, specifically within community settings. Methods: The concept analysis followed Walker and Avant’s approach. The usage of the concept was examined in five databases (PsyINFO, ProQuest, PubMed, ScienceDirect, Scopus), which yielded 41 relevant studies for comprehensive analysis. Results: The identified attributes of conduct problems in adolescents included oppositional problems, antisocial problems, and criminal-related problems. These conduct problems were found to have antecedents stemming from personal, parental, and environmental factors. Furthermore, the consequences of conduct problems significantly impacted both middle adolescents and their parents. Conclusion: The findings of this concept analysis contribute to a better comprehension of the concept of conduct problems among middle adolescents in community settings. The insights gained from this analysis will assist in using this term more effectively in research and nursing practice, ultimately leading to improved care and support for affected adolescents and their families.

Background: Exercise adherence is essential for maintaining the physical and mental health of patients after coronary artery bypass grafts (CABG). However, adherence is often poor, particularly in the early weeks after hospital discharge, leading to adverse health outcomes. Therefore, implementing self-management programs is crucial to promote and sustain long-term exercise adherence among these patients. Objective: This study aimed to examine the impact of self-management programs on exercise adherence in post-CABG patients. Methods: A quasi-experimental posttest-only control group study was conducted from April to November 2022 at Surat Thani Hospital in Thailand. Forty post-CABG patients were gender and age-matched and randomly assigned to either the control group (n = 20) or the experimental group (n = 20). The experimental group participated in a six-week self-management program for exercise adherence, utilizing telephone and LINE applications, while the control group received standard care. Data were collected using validated exercise adherence rating scales and a self-management questionnaire. Descriptive statistics and independent t-tests were employed for data analysis. Results: The mean exercise adherence score in the control group was 9.30 (SD = 4.91), whereas it was 21.30 (SD = 3.20) in the experimental group. The experimental group, which received the self-management program, exhibited significantly higher exercise adherence scores compared to the control group (t = 9.16, df = 32.65, p <0.001). Conclusions: This study demonstrates the effectiveness of a post-CABG self-management program in improving exercise adherence. Nurses play a crucial role in promoting and enhancing self-management during the pre-and post-discharge phases, and regular phone or LINE application contacts can have a positive impact on post-CABG patients. Policymakers should consider implementing self-management programs to encourage patients to maintain their exercise routines, leading to improved physical and mental well-being.

Background: Motivation plays a crucial role in lifestyle modifications for disease control and preventing recurrent cardiac events. Higher motivation levels are associated with improved health outcomes, including adherence to a healthy diet and sustained behavior change. However, there is a lack of evaluation of instruments for assessing motivation to adhere to diet recommendations, specifically among patients in Thailand. Objective: This study aimed to assess the psychometric validity of the Thai version of the Motivation for Healthy Eating Scale (MHES) in patients with acute coronary syndrome in Thailand. Methods: The study was conducted between May and August 2022, involving 200 patients with acute coronary syndrome selected through multistage random sampling from tertiary care institutions in Bangkok, Thailand. The scale was translated from English to Thai using the back-translation method. Principal Component Analysis (PCA) and Cronbach's alpha were employed to evaluate the validity and reliability of the scale. Results: The Thai version of the MHES demonstrated satisfactory reliability with a Cronbach's alpha coefficient of 0.73. The analysis revealed four factors consisting of 16 items: 1) ‘integrated and integrated regulation’ with seven items, 2) ‘intrinsic and external regulation’ with three items, 3) ‘introjected regulation’ with three items, and 4) ‘amotivation’ with three items. These factors collectively explained 66.78% of the total variance. Conclusion: The findings indicate that the Thai version of the MHES is a reliable and valid instrument for assessing motivation related to dietary behavior among Thai patients with acute coronary syndrome. Nurses and healthcare professionals can use this scale to evaluate the motivation of dietary behavior among this population, thereby facilitating targeted interventions and promoting positive health outcomes.

Background: Hemodialysis is the most commonly used renal replacement therapy for end-stage renal disease. The collaborative efforts of multidisciplinary teams comprising nephrologists, nurses, pharmacists, and dietitians play a crucial role in enhancing patient outcomes, improving the quality of care, and reducing treatment costs. However, various factors such as healthcare cost reduction, limited resources, profit-driven systems, organizational structure, and involvement in patient care decisions impact the provision of hemodialysis care by the multidisciplinary teams. Objective: This study aimed to explore the institutional practices of multidisciplinary teams within a hemodialysis unit. Methods: This institutional ethnography study was conducted between April 2019 to February 2020 in a hemodialysis unit of a public university hospital in Kathmandu, Nepal. Data were collected through face-to-face interviews with ten nurses (including supervisors and incharge), two nephrologists, two dietitians, two pharmacists, and two technicians. Additionally, 167 hours of observation, two focus groups with nurses, analysis of institutional texts, and field notes were conducted. Participants were purposively selected based on their ability to provide diverse information regarding institutional practices in hemodialysis care. Interviews were recorded and transcribed. Results: The analyzed data were presented in: 1) the context of hemodialysis care, 2) textual practices: the ruling relations of hemodialysis care (staffing, protocol, job description), 3) hemodialysis decision, and 4) institutional support. Conclusion: Hemodialysis care provided by multidisciplinary teams is constrained by limited resources, particularly in terms of physical space, dialysis machines, nurses, doctors, and dietitians. The hospital's cost-cutting policies lead to reduced investment in patient care equipment, particularly dialysis machines, which significantly impact the workload of nurses and technicians. Insufficient nurse staffing necessitates the provision of other renal care responsibilities, resulting in increased workload, reduced time available for hemodialysis care, and unfinished tasks. The absence of clear job descriptions for hemodialysis care places an additional burden on nurses, who are often required to fulfill the responsibilities of other healthcare teams. Doctors hold the authority in making care decisions, which are subsequently followed by other team members.

Background: Postpartum depression is a prevalent mental health issue among mothers after giving birth. Adolescent mothers are believed to have a higher rate of postpartum depression than adult mothers. However, research on postpartum depression among teenage mothers in Indonesia remains limited. This research gap emphasizes the need for more comprehensive studies to address the mental health and well-being of postpartum mothers in Indonesia, especially among adolescents. Objective: This study aimed to investigate the correlations between Islamic religiosity, social support, marital satisfaction, and postpartum depression in teenage mothers in Indonesia. Methods: A cross-sectional study was conducted involving 203 adolescent postpartum mothers selected through cluster sampling. Data were collected using validated questionnaires from July to August 2020 in Cianjur and Sukabumi districts, West Java Province, Indonesia. Descriptive statistics, chi-square, and multiple logistic regression were employed for data analysis. Results: The study revealed that 35.96% of teenage mothers experienced symptoms of postpartum depression. Among the variables studied, marriage satisfaction (p = 0.002), education level (p = 0.012), family income (p = 0.003), number of children (p = 0.044), and baby weight at birth (p= 0.0001) were significantly associated with postpartum depression. However, social support (p = 0.688) and religiosity (p = 0.788) showed no significant association with postpartum depression. Multiple logistic regression analysis further confirmed that marriage satisfaction (p = 0.001; OR = 0.365; 95% CI 0.197 - 0.676), family income (p = 0.001; OR = 0.326; 95% CI = 0.165 - 0.644), and the number of children (p = 0.026; OR = 3.68; 95% CI = 1.173 – 11.547) were the most significant factors associated with postpartum depression. Conclusion: The study highlighted a high prevalence of postpartum depression among adolescent mothers. Marital satisfaction, family income, and the number of children were identified as key factors associated with postpartum depression in this population. These findings emphasize the importance of considering these factors in nursing and midwifery practice to provide targeted support and interventions, ultimately improving the mental health outcomes for teenage mothers during the postpartum period.

Background: The exposure of unborn babies to harmful substances during prenatal stages can lead to fetal anomalies, emphasizing the significance of pregnant women’s practices in ensuring optimal fetal outcomes. However, there is a lack of understanding regarding this issue from the perspective of pregnant women. Objective: This study aimed to describe the experiences of pregnant women in avoiding harmful substances to their unborn babies. Methods: This study used a qualitative descriptive approach. Data were collected between September 2020 and April 2021 through in-depth interviews with 17 pregnant women purposively selected from two hospitals in southern Thailand. Data were transcribed verbatim and analyzed using thematic analysis. Results: Four themes emerged from the participants’ experiences: 1) understanding of harms, which included substance characteristics, exposure characteristics, body’s protective mechanism, personal experiences, and obtained information; 2) practices for safety, which consisted of food safety, work safety, ambient air safety, and safety in personal/household products; 3) challenges in avoiding harmful substances, which were unrecognition, unavailability of safe substances, discomfort and inconvenience, inevitability, and family traditions; and 4) overcoming the challenges through personal changes, obtaining support, and ensuring a peaceful mind. Conclusion: The findings provide valuable insights into prenatal exposure to harmful substances, which can serve as a basis for developing comprehensive guidelines for best practices. It is crucial for nurses to receive training that enables them to educate pregnant women, enhancing their awareness of important harmful substances and promoting effective methods for maintaining safety in their daily activities. Additionally, nurses can develop interventions to empower pregnant women to overcome challenges by involving significant individuals, particularly family members, in providing support and creating an optimal prenatal environment.

Background: Intestinal stomas are surgical interventions that have an impact on both physical and psychological health, necessitating patient self-care. Insufficient knowledge regarding peristomal skin care, prevention, and treatment of potential problems can lead to an increase in stoma-related complications. Objective: This study aimed to assess patients’ knowledge of self-care for intestinal stomas and examine the relationship between background information and self-care knowledge. Methods: A descriptive cross-sectional study was conducted from December 2021 to December 2022 at the Can Tho University of Medicine and Pharmacy Hospital in Vietnam, involving 74 participants with intestinal stomas. A questionnaire consisting of 24 closed-ended questions was used to evaluate participants' knowledge of self-care for intestinal stomas. Descriptive statistics, Chi-square, and Fisher’s exact tests were employed for data analysis. Results: The findings revealed that 54.1% of participants had good knowledge of general self-care for intestinal stomas. The distribution of good knowledge among participants was as follows: basic knowledge (66.2%), self-care practice (56.8%), recognizing and managing complications (31.1%), and dietary knowledge (64.8%). Significant relationships were observed between participants’ self-care knowledge and their education level (p = 0.002), marital status (p = 0.017), nurses’ education (p = 0.021), and hospitalization (p = 0.001). Conclusion: The proportion of participants with good knowledge of self-care for intestinal stomas was relatively low, and it was associated with individuals' education level, marital status, nurses’ education, and hospitalization. This study highlights the need for ongoing development of educational programs on self-care for intestinal stomas. These programs should be tailored to address the specific needs of each patient and aim to improve their self-care knowledge in a meaningful and sustainable manner. By investing in patient education, healthcare professionals, particularly nurses, can assist individuals with intestinal stomas in achieving better outcomes and preventing potential complications.

Background: Fatigue is one of the most commonly reported symptoms among patients undergoing continuous ambulatory peritoneal dialysis (CAPD). However, only a few studies have addressed the prevalence of fatigue and its influencing factors within this population in Thailand. Objective: This study aimed to explore the prevalence of fatigue and its influencing factors, including duration of CAPD initiation, body mass index, insomnia, social support, functional status, and depression among patients undergoing CAPD. Methods: This cross-sectional study involved 136 participants from the outpatient department of a general hospital in Thailand. Data were collected from January to March 2023, utilizing validated self-reported questionnaires, which included the Center for Epidemiologic Study Depression Scale, Insomnia Severity Index, Multidimensional Scale of Perceived Social Support, Functional Status Scale, and Fatigue Severity Scale. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and Stepwise multiple regressions. Results: The study achieved a 100% participation rate among the selected participants. The prevalence of fatigue among patients undergoing CAPD was 55.88%, including mild fatigue (20.59%), moderate fatigue (19.85%), and severe fatigue (15.44%). Bivariate analysis indicated that fatigue-related factors were insomnia, depression, body mass index, social support, and functional status. However, the multiple regression analysis revealed that only insomnia (β = 0.399, p <0.001), social support (β = -0.302, p <0.001), depression (β = 0.201, p = 0.003), and functional status (β = -0.149, p = 0.021) jointly influenced fatigue among patients undergoing CAPD, explaining 50.10 percent of the variance (R2 = 0.501, F(4, 131) = 32.871, p <0.001). Conclusion: The findings indicated that more than half of the participants experienced fatigue. Insomnia, social support, depression, and functional status emerged as significant predictive factors of fatigue. Therefore, it is advisable for nurses and other healthcare providers to evaluate fatigue and its associated factors routinely. Nursing interventions to alleviate fatigue should prioritize improvements in sleep quality, reduction of depression, preservation of functional status, and promotion of family engagement.

Background: Self-esteem is a subjective assessment of one’s own value and worth as a person. Self-esteem is recognized as an indicator of a person’s mental health, with lower levels associated with mental conditions such as stress and depression. In the context of nursing education, self-esteem has been linked to student’s academic performance, clinical competence, and overall well-being. Existing literature suggests that self-esteem among student nurses varies across countries and cultures. Assessing the self-esteem level among student nurses is essential for identifying students at risk of experiencing academic difficulties or mental health problems. Objective: The study aimed to assess the self-esteem level among student nurses at Al-Majmaah University, Saudi Arabia. Methods: A cross-sectional design was employed and conducted with 346 nursing students conveniently selected at Majmaah University in Saudi Arabia in May 2023. A self-reported questionnaire utilizing the Rosenberg Self-Esteem Scale (RSES) was employed. Data were analyzed using SPSS Statistics software, including descriptive and inferential statistical techniques. Results: The findings revealed that 265 students (76.6%) had moderate self-esteem levels, 53 students (15.3%) had low self-esteem, and 28 students (8.1%) had high levels of self-esteem. Examination of self-esteem in relation to socio-demographic variables resulted in statistically significant correlations with the year of study, physical health, psychological health, and father’s education (p <0.05). Conclusion: The study’s results offer valuable insights for nurse educators, which can serve as a compass for designing educational and awareness programs to boost self-esteem among student nurses. These initiatives hold significance in equipping students with the necessary attributes for their upcoming roles as professional nurses. Nonetheless, further investigations are warranted to delve into self-esteem and associated factors.

Background: After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand. Objective: This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. Methods: A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis. Results: The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001). Conclusion: The study’s results provide valuable insights for nurses to target these modifiable factors to enhance patients’ mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Background: Universities are responsible for providing education and support to all students, including those who may be underachieving. To fulfill this responsibility, universities need effective strategies to help these students graduate successfully. Objective: This study aimed to evaluate the effectiveness of a midterm remedial exam strategy in improving the academic performance of nursing students. Methods: A quasi-experimental design was employed to conduct this research at a private college in Dammam, Saudi Arabia’s eastern region. The study included 306 convenient bachelor nursing students who had failed their midterm exam. Of these, 103 students voluntarily participated in the remedial midterm exam (intervention group) to enhance their midterm scores, while 203 students did not take the remedial exam (control group). Data collection took place in the spring of 2022 by reviewing course files and student records, encompassing formative and summative evaluations across 14 courses. Data analysis involved using SPSS (2023) and Jamovi (version 2.3, 2022) software to conduct paired t-tests, Mann-Whitney, and correlational tests. Results: The remedial group demonstrated significant differences between their midterm and remedial exam scores. However, only 15.5% of students in the remedial group passed the exam, despite 68% showing improvement. Additionally, there were significant differences between the intervention and control groups in midterm and overall course scores. The control group outperformed the remedial group in the midterm, final exams, and overall course scores (p <0.05). Conclusion: Remedial exams can be beneficial for students who are close to passing but may not effectively support those who perform poorly. To address this, implementing a comprehensive remedial program or providing ongoing remedial activities throughout the course can offer better support for strongly underperforming students. Additionally, educational institutions can enhance students’ motivation and performance by providing study skills classes and time-management workshops, equipping them with valuable tools for academic success.

Background: Older adult patients often experience delayed postoperative recovery due to a lack of self-efficacy in engaging in physical activities during early rehabilitation. Concurrently, family caregivers play a crucial role in caring for older adults. However, the extent of family involvement in improving self-efficacy and facilitating recovery following major abdominal surgeries in older adults remains largely unexplored. Objective: This study aimed to examine the effect of a preoperative preparation program on the recovery of older patients undergoing major abdominal surgeries. Methods: A quasi-experimental study with a two-group, pretest-posttest design was conducted. The participants included 60 older adult patients undergoing abdominal surgeries at Thammasat University Hospital, Thailand, between September 2019 and March 2020. Participants were selected by purposive sampling with the inclusion criteria and were assigned to the experimental (n = 30) or the control (n = 30) groups using matched pair according to the type of operation. The control group received standard care, while the intervention group underwent a two-week preoperative preparation program developed based on self-efficacy theory and family support. Data were collected using validated tools. Recovery was assessed at one week and two weeks after surgery. Descriptive statistics, as well as dependent and independent t-tests, were used for data analysis. Results: The results revealed that the intervention group had significantly higher mean recovery scores than the control group at one week (M = 56.93, SD = 16.42; M = 44.60, SD = 16.30, t = -2.92, df = 58, p <0.01) and two weeks after surgery (M = 66.64, SD = 8.63; M = 61.68, SD = 7.86, t= -2.33, df = 58, p <0.05) when comparing between the two groups. Conclusion: The preoperative preparation program effectively enhanced recovery one week and two weeks after surgery. The study findings can be valuable for nurses in implementing the preoperative preparation program to facilitate recovery among older adult patients undergoing abdominal surgeries.

Background: Locally advanced head and neck cancer (LAHNC) can significantly impact the quality of life of patients in various ways. However, several factors can contribute to the decrease in quality of life. In Thailand, there is limited knowledge about the factors that affect the quality of life of patients with LAHNC before they receive treatment. Objective: This study aimed to examine the correlations between Palliative Performance Scale (PPS), family income, body mass index (BMI), age, comorbidity index, and the quality of life of patients with LAHNC before they undergo treatment. Methods: A correlational cross-sectional study was conducted, and data were collected from 94 pretreatment patients with LAHNC who were admitted to a cancer center in central Thailand using purposive sampling. The data collection instruments included a demographic data form, a medical record form, the Charlson Comorbidity Index (CCI), the Palliative Performance Scale (PPS), and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4. Descriptive statistics, Pearson’s correlation, and Spearman’s rank correlation were used to analyze the data. Results: All study participants completed the questionnaire. The results showed that the overall quality of life of the patients was moderate. PPS, family income, and body mass index were moderately positively correlated with quality of life (r = 0.494, p <0.01; r = 0.420, p <0.01; r = 0.339, p<0.01, respectively). Age had a moderate negative correlation with quality of life (r = -0.596, p <0.01), while comorbidity was not significantly associated with quality of life. Conclusion: The quality of life of patients with LAHNC before treatment was associated with various factors, including PPS, family income, body mass index, and age. These findings highlight the importance of nutritional support before treatment and the need for social support, especially for older adult patients, to improve their quality of life. The results of this study can be valuable for nurses in developing care programs that enhance the quality of life for patients with LAHNC during the pretreatment phase.

Background: Adolescence is a transitional phase from childhood to adulthood, characterized by various biological, psychological, and social changes. Adolescents living in coastal regions are exposed to social-environmental risk factors that can affect their emotional wellbeing, primarily due to the demanding and unpredictable nature of coastal communities. These challenging and volatile circumstances can have a negative impact on adolescents’ emotions, making them more vulnerable to mental and emotional disorders. Objective: This study aimed to examine the self-concept and its differences according to sociodemographic factors among adolescents residing in coastal areas of Indonesia. Methods: A cross-sectional design was employed for this study, which involved 644 adolescents living in coastal regions of Indonesia, specifically in the West Sumatra and Bali provinces. The Tennessee Self Concept Scale (TSCS) 2nd Edition Short Form was used to assess self-concept from August to September 2022. Descriptive statistics, Independent-t-test, and One-way ANOVA were utilized for data analysis. Results: The findings revealed that adolescents in coastal areas had a high level of self-concept. A statistically significant difference was discovered in the overall self-concept according to gender (p = 0.002). Similarly, a significant difference was observed in the physical domain based on class level (p = 0.019). Regarding the personal domain, significant differences were identified according to age (p = 0.030), class level (p = 0.030), parent's marital status (p = 0.030), father's education (p = 0.05), and family income (p = 0.01). Furthermore, in the family domain, significant differences were found based on parents’ marital status (p <0.001) and adolescents’ residence status (p = 0.002). Additionally, a significant difference in the academic domain was observed with respect to gender (p = 0.001). However, no significant differences were noted in the moral ethics and social domains across all sociodemographic variables (p >0.05). Conclusion: This study emphasizes the need for attention from various stakeholders, including mental health nurses, to prioritize interventions to promote positive self-concept among adolescents, consider sociodemographic factors that influence self-concept, and address areas of dissatisfaction such as moral behavior and academic/work efficiency. Incorporating family support and nurturing positive parent-child relationships are also important for fostering a healthy self-concept in adolescents.

Background: The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. Objective: This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. Design: The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Data Sources: Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Review Methods: Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Results: Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. Conclusion: This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals’ quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.

Background: One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China. Objective: This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China. Methods: This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson’s correlation coefficient were utilized to analyze the data. Results: The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty. Conclusions: The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.

Background: Parents of newly diagnosed cancer children often experience significant concerns about the implications of the diagnosis. They find themselves in challenging decision-making situations, navigating through uncertain conditions following the disclosure. Uncertainty is a prevailing issue in healthcare, yet its interpretation and application within the context of health and nursing practice exhibit multiple meanings and variations. Objective: This study aimed to clarify the concept of parental uncertainty arising from having children with cancer. Methods: The concept analysis followed the steps outlined by Walker and Avant. A thorough literature search was conducted using the Embase, CINAHL, and MEDLINE databases to identify articles published between 1980 and 2022. Results: The literature search yielded 147 articles from various disciplines, including health, nursing, medicine, psycho-oncology, and management. After analysis, 20 articles were selected for inclusion. This study identified four key attributes of parental uncertainty associated with having a child with cancer: (1) emotional disturbance, (2) unpredictability, (3) insufficient information, and (4) problems with decision-making. The antecedents of parental uncertainty encompassed the complexity of the disease, the diagnostic and treatment processes, the hospital environment, communication, and support from credible authorities. The consequences of parental uncertainty included the pursuit of new information, parental adaptability to their role, and parental distress. Conclusion: Understanding the four attributes of parental uncertainty, along with their antecedents and consequences, can facilitate the future development and operational translation of the concept of uncertainty in nursing practice. This concept is valuable in the evidence-based provision of nursing care to parents of children with cancer, enabling comprehensive recognition and assessment of parental uncertainty and the implementation of appropriate interventions that are sensitive to parental experiences. Ultimately, this approach promotes the adaptation of both the child and the parent.

Background: Malaysia is projected to become an aged country by 2030, with the older age group comprising 10 percent of the total population. To address this demographic shift, comprehensive plans and initiatives are being implemented at various levels, ranging from the government to local communities. A crucial aspect of these efforts is community empowerment, which requires a reliable and validated tool for measurement. Objective: This study aimed to validate the Individual Community Related Empowerment (ICRE) scale in alignment with the national language of Malaysia. Methods: This cross-sectional study was conducted from May to December 2019. Back-to-back translation from the English to Malay version of the ICRE scale was done. A total of 328 older persons aged 60 years old and above who attended clinics and understood Malay had been randomly selected. Exploratory factor analysis (EFA), particularly Principal Component Analysis (PCA) with Varimax rotation and Kaiser Normalization, was performed in this study using IBM SPSS version 27 Amos graphic. Results: The findings revealed that the Malay version of the Individual Community Related Empowerment (ICRE-m) scale consists of five components: self-efficacy, intention, participation, motivation, and critical awareness, which collectively accounted for 92.3% of total variance. All five components demonstrated Cronbach’s alpha values greater than 0.7, indicating the reliability of the selected items for field studies. Conclusion: The ICRE-m scale is acceptable for field studies and valid for measuring individual-related community empowerment. Nurses and other healthcare professionals can employ this scale specifically within the Malay-speaking population, particularly in the Asian region. Future studies on community empowerment among older individuals can utilize this tool to assess community readiness for participating in community health interventions.

Background: The rising prevalence of chronic obstructive pulmonary disease (COPD) in China has led to a decline in the health-related quality of life (HRQOL) of employed individuals with the condition. Consequently, healthcare providers play a crucial role in identifying the factors associated with HRQOL in this population. Objectives: This study aimed to describe the HRQOL of employed individuals with COPD and determine the relationships between symptom burden, functional performance, social support, and HRQOL. Methods: A cross-sectional correlational research design was employed for this study. A total of 130 employed individuals with COPD who visited the respiratory outpatient department at the Second Affiliated Hospital of Wenzhou Medical University were selected through simple random sampling. Data were collected between August and September 2021 using a demographic questionnaire and four scales. Descriptive statistics and Pearson correlation were used for data analysis. Results: The study findings revealed that the mean HRQOL score among the participants was in the moderate range (M = 69.46, SD = 16.82). The correlation analysis revealed a significant negative association between symptom burden and HRQOL (r = -0.80, p <0.001). On the other hand, a positive relationship was observed between functional performance and HRQOL (r = 0.56, p <0.001), while social support did not show a significant relationship with HRQOL (r = 0.04, p >0.05). Conclusion: These findings serve as a foundation for healthcare service providers and policymakers in developing targeted nursing interventions and comprehensive management approaches for employed individuals with COPD. By addressing the symptom burden and promoting functional performance, nurses can strive to enhance the HRQOL of this population. Moreover, strategies to improve social support networks and facilitate access to emotional and practical assistance may further contribute to improving the overall well-being and satisfaction among employed individuals with COPD.

Background: Antiretroviral therapy (ART) has played a crucial role in saving countless lives of patients with HIV/AIDS across the world. However, despite its effectiveness, ART adherence still falls short globally, and non-adherence remains the primary cause of treatment failure. In the rural areas of southern Thailand, where the population is predominantly conservative Muslims, there has been an observed increase in ART non-adherence. Objective: This study aimed to explore experiences of inconsistent ART adherence among Thai-Muslim patients with HIV/AIDS (PWHAs) in southern Thailand. In addition, the perspectives of healthcare providers were also sought. Methods: Data were collected by conducting semi-structured in-depth interviews with ten Thai-Muslim PWHAs and five healthcare providers at a Voluntary Counseling-and-Testing Clinic. A content analysis approach was utilized to analyze the data. Results: Inconsistent ART adherence was reported. Religion/spiritual imperatives, forgetfulness, inadequate knowledge (of drug side effects and drug regime), misunderstandings (about being symptom-free and feeling well), boredom from long-term drug-taking regimes, as well as poor transportation and lack of family support (arising from non-disclosure of one’s HIV-serostatus due to HIV stigma) were emergent themes derived from the interviews with Thai-Muslim PWHAs. The healthcare providers’ interview data revealed their need for the integration of Islamic beliefs to provide better care. Conclusion: It is essential for healthcare teams to work collaboratively with patients’ religious beliefs to enhance ART adherence. Clinical nurses can contribute to the promotion of HIV-care services by integrating Islamic beliefs and Muslim culture into their practice, thus increasing patients' knowledge and motivation for ART adherence. This could entail utilizing Islamic prayer rituals as drug reminders, elaborating on Islamic moral beliefs concerning sickness and healing, and integrating the cultural imperatives of self-care in the Muslim community into ongoing care delivery. Cross-cultural nursing education and specialized training in HIV care should incorporate knowledge about Islamic and Muslim cultural beliefs.

Background: Body image is a significant concern for patients who have undergone a coronary artery bypass graft (CABG) surgery, as the presence of scars on the chest, arms, and legs can impact their self-perception. Difficulty accepting these scars may lead to negative body image, non-compliance with prescribed treatments, and potentially poorer health outcomes. However, the Body Image Scale, commonly used to assess body image, has not been validated for Thai patients. Objective: This study aimed to evaluate the validity and reliability of the Body Image Scale in Thai post-CABG patients. Methods: This instrument validation study was conducted between April and July 2022. A total of 320 post-CABG patients were randomly selected to participate in the study. The scale was translated from English to Thai and adapted to address the concerns of CABG patients specifically. Validity and reliability were assessed using Principal Component Analysis and Cronbach’s alpha. Results: The Thai version of the Body Image Scale demonstrated satisfactory internal consistency, as indicated by a Cronbach’s alpha coefficient of 0.88. The factor analysis revealed a single-factor structure, and each component had communalities ranging from 0.63 to 0.76, explaining 70.07% of the variance in body image. Conclusion: The Thai version of the Body Image Scale exhibited good validity and reliability for assessing body image in Thai patients undergoing CABG surgery. Nurses and other healthcare professionals can effectively utilize this measurement tool to evaluate the body image concerns of Thai patients following a CABG procedure.

Background: Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants. Objective: This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments. Design: A scoping review. Data Sources: The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals. Review Methods: The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format.Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles’ quality. A descriptive method was used to analyze the data. Results: The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized. Conclusion: The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.

Background: Advanced cancer and its treatments lead to various detrimental impacts on patients. Resilience is an important ability to adapt to such adversity, but there is limited information about its influencing factors, specifically in patients with advanced cancer. Objective: This study aimed to examine the influence of social support, depression, anxiety, hope, optimism, spiritual well-being, religious belief,and hardiness on resilience among adults with advanced cancer. Methods: This cross-sectional research used multi-stage sampling to select 288 participants from a university hospital and three tertiary hospitalsin northern Thailand. Data were collected using a demographic data collection form, the Hospital Anxiety and Depression Scale (HADS), the Thai version of the Social Support Questionnaire (SSQ), the Herth Hope Index (HHI), Life Orientation Test-Revised (LOT-R), Buddhist Belief Questionnaire, Health-Related Hardiness Scale (HRHS), and Connor-Davidson Resilience Scale (CD-RISC), from February 2021 to February 2022. Data were analyzed using descriptive statistics, Pearson correlation, and regression analysis. Results: Depression (r = -0.47, p <0.01) and anxiety (r = -0.39, p <0.01) had a significant negative relationship with resilience. Spiritual well-being(r = 0.74, p <0.01), hope (r = 0.67, p <0.01), religious belief (r = 0.53, p <0.01), optimism (r = 0.40, p <0.01), social support (r = 0.33, p <0.01), and hardiness (r = 0.21, p <0.01) had significant positive relationships with resilience. Only hope (β = 0.29, p <0.01) and spiritual well-being (β = 0.59, p<0.01) together influenced resilience by 64.70%. Conclusion: Spiritual well-being and hope are crucial to resilience in patients with advanced cancer. Nurses should provide spiritual support to strengthen patients’ ability to adapt successfully to life with advanced cancer.

Background: Mild cognitive impairment (MCI) is an early stage of cognitive decline in individuals who are still able to perform their activities of daily living. They are at increased risk of developing dementia. Improving and maintaining cognitive functions are essential goals for older people with MCI to delay or prevent the transition to dementia. Objective: This study investigated the effect of the neurobic exercise program on memory performance among community-dwelling older adults with MCI. Methods: A single-blind, randomized, controlled, two-period crossover design was used. Thirty-two older adults who met the study criteria were randomly assigned to one of two sequence groups, A (n =16) and B (n = 16). Group A received three weeks of neurobic exercise, followed by a three-week washout period, and then three weeks of the traditional brain exercise program. Group B received the treatments in the reverse order but otherwise in a similar manner. Two aspects of memory performance were evaluated: subjective memory and objective memory. Blinded evaluators measured the outcomes four times at baseline, post-intervention (week 3), follow-up stage (week 7), and the end of the study (week 9). Descriptive statistics, independent t-tests, and repeated measures ANOVA were employed for data analyses. Results: For subjective memory, rmANOVA revealed a significant difference of within-subject (F1.437, 43.113 = 9.324, p <0.05) and interaction effect (time*group) (F1.437, 43.113 = 12.313, p <0.05) and also showed significant differences of within-subject (F1.794,53.811 = 28.931, p < .05) and interaction effect (time*group) (F1.794, 53.811 = 31.190, p <0.05) for objective memory. The study results revealed that the participants in both groups had significantly lower mean scores on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), indicating better or improved subjective memory. They also had significantly higher mean scores on the Common Objects Memory Test (COMT) after receiving the neurobic exercise program, indicating improvement in cognitive performance. Conclusion: The neurobic exercise intervention could improve subjective and objective memory among community-dwelling older adults with MCI more than those who received the traditional brain exercise program. Therefore, the neurobic exercise program can be used by the nurse and multidisciplinary teams to enhance memory performance among older adults with MCI. Trial registration: Thai Clinical Trials Registry (TCTR) 20210326003.

Background: Losing competent nurses due to turnover can have adverse effects on healthcare administration, service delivery, and organizational dynamics. Frequent staff turnover can hinder optimal nursing practices, but some nurses remain committed. Therefore, understanding factors that foster sustained engagement and retention is crucial to create a retention strategy. Objective: This study aimed to explore the current experience of Indonesian nurses who retain their jobs in the hospital setting. Methods: A phenomenological design was employed in this study, with ten nurses selected using purposive sampling. Semi-structured interviews were used to gather data from a private hospital in Batam, Indonesia, between January and March 2022. A conventional content analysis was used to analyze the data. Results: The participants had an average total work experience of 10.4 years and an average age of 35.6 years, ranging from 28 to 44 years. The majority of the participants were females, held bachelor’s degrees, and were married. Three main themes were developed in this study: solid teamwork, adequate compensation, and professional career development. Conclusion: Retaining experienced nurses in hospitals is influenced by antecedents such as teamwork, pay, and career growth. These findings offer nursing and hospital managers insights into developing policies and strategies to improve hospital nursing retention programs in Indonesia and beyond.

Background: Children born to mothers with HIV require special care from the womb to the postnatal period, and caregivers involved in their care face several challenges. Objective: This study aimed to explore caregivers’ experiences providing care for HIV-exposed children under five. Methods: This study employed a phenomenological approach. Ten caregivers of HIV-exposed children living in Jakarta, Indonesia, were selected using snowball techniques. Online in-depth interviews were conducted to collect data from September 2021 to July 2022, and thematic analysis using Colaizzi’s method was performed for data analysis. Results: The study involved ten caregivers (nine females and one male) aged between 23 and 42 years. Seven of them were mothers who tested HIV-positive, while one was an adoptive father, one was a mother’s sister, and one was an aunt of HIV-exposed children. The majority of them were housewives and had a low educational background. Three themes were generated: (i) disease-transmission foreboding, (ii) prejudice against mothers and children exposed to HIV, and (iii) seeking support. Conclusion: Caring for HIV-exposed children poses emotional and physical challenges for caregivers, necessitating support from health professionals and peer groups. Nurses play essential roles in improving caregiver well-being and supporting optimal growth and development in HIV-exposed children under five by designing intervention programs. Furthermore, to enhance home-based HIV care in Indonesia, the government must implement social interventions that target families with limited resources.

Background: The Infection Prevention and Control Nurse (IPCN) is a professional nurse with a crucial role in promoting patient safety and service quality by preventing and controlling infections. However, little is known about their experiences regarding their roles and duties, particularly in Indonesia. Objective: This study aimed to explore IPCNs’ experiences in performing their roles and responsibilities, including motivations and obstacles encountered, as well as organizational support while carrying out their jobs. Methods: This research used a qualitative descriptive study design, collecting data through Focus Group Discussions (FGDs) with six purposively sampled participants in April 2021 at the Gatot Soebroto Army Central Hospital (RSPAD), Jakarta, Indonesia. Thematic analysis was used to analyze the data. Results: Five themes were identified: 1) roles and duties of IPCNs, 2) conducive work environment, 3) constraints in carrying out tasks, 4) management support, and 5) hopes. Conclusion: This study provides new insights into IPCN roles and duties that require collaboration and coordination with multiple professions, as well as management support to overcome obstacles that hinder fulfilling tasks and hopes of improving IPCN performance according to competency-based career paths to achieve patient safety, service quality, and job satisfaction.

Background: Nursing services play a crucial role in addressing the healthcare needs of inmates in correctional facilities while upholding their human rights. However, delivering nursing services in this context is challenging. Unfortunately, there is a dearth of research on this topic in Indonesia. Objective: This study aimed to explore the experiences of inmates in receiving nursing services in order to provide insights into professional nursing services in the correctional context in Indonesia. Methods: A qualitative phenomenological approach was used in this study. Twenty inmates were selected purposively from four prisons, three jails, and one child penitentiary in Jakarta, Indonesia. Semi-structured in-depth interviews were conducted from August to October 2021, and thematic analysis was used to analyze the data. Results: Five themes were generated: (1) conditions requiring nursing services, (2) types of nursing services received, (3) nurse competence, (4) barriers to receiving nursing services, and (5) expectations for nursing services in the future. Conclusion: This study highlights the importance of nursing services in correctional facilities and the unique challenges that correctional nurses face in providing services professionally and ethically. Strategies to enhance nursing services, advance nurse competence, and reduce barriers to accessing care are needed to improve inmates’ health outcomes.

Background: Adherence to antiretroviral therapy (ART) continues to pose a significant challenge for people living with HIV (PLWH). Non-adherence to ART can have far-reaching implications for patient well-being, particularly in increasing the risk of opportunistic infections when medication is not taken as prescribed. Objective: This study aimed to develop a theoretical model that explains how PLWH in Indonesia adhere to their ART regimen and the strategies they follow to maintain adherence. Methods: The study used a grounded theory approach. Data were collected through face-to-face in-depth interviews with 21 PLWH who had been taking ART for six months or more at a non-governmental organization (NGO) in Jakarta, Indonesia, between July 2019 and November 2019. Theoretical sampling was used, and the data analysis method of Corbin and Strauss was utilized, including open coding, axis coding, and selective coding. Results: Three stages were identified as a process of adherence to the ART regimen: 1) initiating ART, 2) missing the connection, and 3) taking control. Self-awareness was identified as the central core theme describing the ART adherence process. Conclusion: Having adequate self-awareness to take ART regularly is crucial to improving adherence to ART. Moreover, social support from one’s spouse and family members can help patients maintain adherence. Therefore, self-awareness and support systems should be included as components in nursing interventions when starting ART therapy. In addition, nurses can help identify potential support persons and provide information related to ART therapy.

Background: Breastfeeding is an essential source of nutrition for infants and offers numerous benefits for both the mother and child. Despite the consensus on its advantages, limited research in Saudi Arabia has explored the factors influencing breastfeeding duration. Objective: This study aimed to examine the relationships between breastfeeding self-efficacy, intention, social support, and breastfeeding duration. Methods: The study employed a correlational research design, and data were collected from three armed forces hospitals in Taif, Saudi Arabia, from December 2020 to February 2021. The samples comprised 356 conveniently selected breastfeeding mothers, assessed using the Breastfeeding Personal Efficacy Beliefs Inventory, Modified Infant Feeding Intention Scale, and Exclusive Breastfeeding Social Support Scale. Simple linear regressions were conducted for data analysis. Results: Breastfeeding duration was divided into two groups. Group 1 consisted of mothers still breastfeeding at the time of data collection, while Group 2 comprised those who had discontinued breastfeeding. Of the total samples, 51.6% (n = 184) of mothers were classified under Group 1, while the remaining 48.4% (n = 172) were allocated to Group 2. Specifically, 78.3% of mothers had stopped breastfeeding by the time their infants were six months old, and 93.3% intended to introduce formula feeding at three months. In Group 1, the results revealed that self-efficacy (β = 0.625, p <0.001), intention (β = 0.643, p <0.001), and social support (β = 0.612, p <0.001) were positively associated with breastfeeding duration. Similarly, in Group 2, a strong positive correlation was observed between self-efficacy (β = 0.72, p <0.001), intention (β = 0.73, p <0.001), social support (β = 0.699, p <0.001), and breastfeeding duration. These three factors jointly explained 40% of the variance in breastfeeding duration in Group 1 (adjusted R² = 0.4) and 50% in Group 2 (adjusted R² = 0.5). Conclusion: Breastfeeding intention was found to have a more significant impact on breastfeeding duration than self-efficacy and social support. These results can inform nurses and midwives in supporting breastfeeding mothers by providing them with the necessary information and increasing their awareness of breastfeeding-related factors.

Background: The care and treatment management of people with mental health problems has become a prominent global concern in recent years that requires consistent attention. However, the literature suggests that only a small percentage of individuals with mental health problems in Indonesia receive the necessary mental health care. Therefore, it is crucial to explore this gap. Objective: This study aimed to explore barriers and facilitators that affect access to mental health services among people with mental health disorders in Indonesia. Methods: The study employed a qualitative descriptive design and focused on individuals with depression, anxiety, or bipolar disorder. Data were collected through in-depth interviews conducted via WhatsApp chat with 90 participants aged 18-32, who were purposively selected from Sumatra, Java, Kalimantan, and Papua Islands in Indonesia between January and June 2022. Thematic analysis was used to analyze the data. Results: The barriers to accessing mental health services included: 1) uneasy access to mental healthcare facilities, 2) stigma, lack of social support, and delay in receiving proper treatment, and 3) expensive treatment costs without national health insurance membership. Importantly, the facilitators to access mental health services included: 1) national health insurance membership, 2) support from spouse, family, and closest friends and its association with mental health literacy, and 3) self-help. Conclusion: The widespread distribution of mental health knowledge is recommended among healthcare providers, including public health practitioners and primary care nurses, to enhance their mental health literacy and competencies while rendering services to individuals with mental disorders. Additionally, efforts should be made to educate and promote awareness among caregivers and communities to reduce the stigma faced by those with mental disorders.

Background: Plagiarism is an ethical concern among students but is insufficiently discussed and acknowledged in some educational institutions. Determining what factors influence plagiarism can help the academic community manage its incidence. Objective: This study determined the factors affecting the intention to plagiarize among Filipino nursing students. Methods: Utilizing a cross-sectional research design, data were gathered from 304 nursing students last June 2021 using valid instruments administered online. Regression analysis identified influencing factors of intention to plagiarize. Results: Findings indicated a generally low intention (M = 1.47, SD = 0.74) to plagiarize among nursing students. Internet literacy (B = -0.314, p <0.001), attitude (B = 0.257, p <0.001), moral obligation (B = -0.236, p <0.001), past behavior (B = 0.139, p <0.001), and subjective norm (B = -0.095, p = -0.001) influenced nursing students’ plagiarism intention. Conclusion: Several interrelated factors play major roles in nursing students’ tendency to plagiarize. Creating an educational environment that does not favor the unethical practice of plagiarism is recommended for nursing schools.

Background: Voice behavior among nurses in public hospitals lacks profound disclosure despite knowing its imperatives. This situation needs to be continuously studied, and the best practices discovered, disclosed, and implemented in hospitals that are serious in curbing unprofessional conduct while advancing healthcare requirements for the benefit of humanity. Objective: This empirical research investigated the significant implications of psychological safety and intrinsic motivation in the mostly uncultivated link concerning the empowering leadership style and leader-member exchange (LMX) constructs and the practice of voice behavior among nurses in the selected Malaysian public hospitals. Methods: Primary data of the study were from nurses employed in the selected large public hospitals within the Klang Valley, also known as the Greater Kuala Lumpur of Malaysia. A total of 366 complete and valid responses were collected with the help of head nurses via a self-administered survey in February 2020. The SmartPLS 4 for Windows software generated the standard partial least squares structural equation modeling (PLS-SEM) to estimate associations between research variables and evaluate the model’s strength in explaining the proposed constructs. Results: This research disproved the indirect effects of psychological safety on the connection explorations between empowering leadership-voice behavior (β = 0.015, t-value = 0.300, 95% CI [-0.090, 0.110]) and LMX-voice behavior (β = 0.002, t-value = 0.285, 95% CI [-0.014,0.020]). Intrinsic motivation partially mediates the link between empowering leadership-voice behavior (β = 0.214, t-value = 7.116, 95% CI [0.160, 0.279]) and LMX-voice behavior (β = 0.114, t-value = 4.669, 95% CI [0.071, 0.168]) of the nurses. Conclusion: Patients, non-governmental organizations, volunteers, nurses, and other hospital staff are vested in how voice behavior signifies in the healthcare context. Essential factors for nurses to become more outspoken are discovered in this study, providing nurse managers and other leaders with numerous recommendations for encouraging vocal behavior and bolstering psychological safety and intrinsic motivation. More competent nurses will improve workplace culture, deliver superior healthcare services, and manage publicly financed hospitals with an overall sense of trust, but only after a substantial effort to execute reforms.

Background: Tuberculosis (TB) remains a significant public health challenge in Indonesia, with the country experiencing one of the highest numbers of lost cases in TB management. Therefore, there is a need to identify the underlying reasons for this problem. Objective: This study aimed to explore the experiences of TB-diagnosed patients and their families during the time of diagnosis and while undergoing the TB medication program. Methods: This study employed a qualitative descriptive-interpretive approach. The study was conducted in government community health centers (CHC) from May 2022 to July 2022. A total of 22 participants, consisting of 12 TB-diagnosed patients and ten family members, were included in the study. Data were collected through focus group discussions and analyzed thematically. Results: Five themes were developed: (1) Delay in tuberculosis diagnosis, (2) Delay in starting TB treatment, (3) High willingness of patients and their families to recover, (4) Understanding that TB is an infectious disease, and (5) Factors affecting patient recovery. Conclusion: The study findings might contribute to the National TB elimination program. It is recommended that all health workers practicing in the community should be involved in the TB program to improve its management. Collaboration between multiple sectors in the community can also provide an advantage in solving TB problems by increasing new case detection. Additionally, it is suggested that all nurses working with TB patients establish rapport with health cadres and patients’ families to enhance medication adherence in patients.

Background: The COVID-19 pandemic has presented challenges to nursing practice globally. However, utilizing digital notebook applications to support nursing student practices may be an effective tool for surgical nursing practicum. Objective: This study aimed to design a blended learning curriculum for surgical nursing practicum, utilizing a digital notebook platform. Methods: This study applied the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model to create a blended learning curriculum for surgical nursing practicum, employing the OneNote application platform. The study included three experts and 90 third-year nursing students who evaluated the model. The study was conducted from July 2021 to March 2022 at the Faculty of Nursing, Chiang Mai University, Thailand. Data were analyzed using descriptive statistics. Results: The experts rated the model highly (Mean = 4.33, SD = 0.57). The satisfaction level of the students with the blended learning curriculum using a digital notebook application was also high (Mean = 4.88, SD = 0.31). Conclusion: The blended learning curriculum using a digital notebook application for surgical nursing practicum was satisfactory for learners. The results from this research can be applied in online learning or incorporated into nursing clinical practicum curricula during and even post-pandemic. The study results may also serve as an example or a piece of basic information to further develop an advanced online platform for teaching learning, either in Thailand or globally.

Background: Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties. Objective: This study aimed to explore nurse team leaders’ experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia. Methods: This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen’s approach was used for data analysis. Results: The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training. Conclusion: Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.

Background: The global incidence of maternal mortality remains high, including in Indonesia, and the utilization of antenatal care services can help reduce these rates. Despite numerous studies examining factors affecting antenatal care utilization, there has been limited focus on identifying factors related to the completion of these services. Objective: This study aimed to analyze factors associated with the completion of antenatal care in Indonesia. Methods: The study used a cross-sectional analysis of secondary data from the Basic Health Research conducted by the Indonesian Ministry of Health in March 2018. The sample consisted of 65,929 pregnant women aged 15 to 49. Descriptive statistics, chi-square tests, and multiple logistic regression were used for data analysis. Results: The majority of respondents (75.2%) completed antenatal care. Factors significantly correlated with antenatal care completion were education level, occupation status, health insurance ownership, place of antenatal care services, travel time to health facilities, area of residence, history of pregnancy, parity, desired pregnancy, and pregnancy complications (p <0.05). The multiple logistic regression test showed that education level was the most dominant factor associated with antenatal care completion (p <0.001, OR = 2.023, 95% CI = 1.839-2.225). Conclusion: Completion of antenatal care is influenced by various factors, including education, job status, health insurance ownership, antenatal care services’ location, travel time to health facilities, residence area, previous pregnancy history, number of children, desired pregnancy, and pregnancy complications. However, education is crucial in determining a mother’s understanding and approach toward using these services. The Indonesian government should enhance public education and awareness initiatives to increase utilization. Healthcare professionals, particularly nurses and midwives, play a vital role in educating pregnant women about the significance of utilizing prenatal care services consistently and facilitating their access to these services efficiently.

Background: The Clinical Learning Environment (CLE) is integral to pre-registration nursing curricula. Assessing the student’s perceptions of their CLE is essential to adjust clinical placement to trainees’ needs. Clinical Learning Environment Inventory (CLEI) appears to be widely used in measuring CLE, but no previous study has reported a full structural validity and its association with students’ satisfaction in the Moroccan context. Objectives: This study investigated the psychometric properties of the CLEI and its subscales association with Moroccan nursing students’ satisfaction. Methods: The research design was descriptive, cross-sectional, and conducted from March and June 2022 using convenience sampling in three nursing institutes of the Fez-Meknes region of Morocco. The selected sample involved Moroccan nursing students undertaking clinical practice. First, exploratory factor analysis (EFA) was used to determine the factor structure of the pilot sample (N = 143). The second sample (N = 206) was then used to confirm this structure using partial least squares structural equation modeling (PLS-SEM) confirmatory composite analysis (CCA). Finally, using a bootstrapping method, the significance of the structural path was evaluated. Results: The CLEI scale depicted convergent validity (AVE = 0.56 - 0.71), discriminant validity, estimated by the square roots of AVE and bootstrapped HTMT confidence interval, and significant reliability (rhoC = 0.83 - 0.92). Using a bootstrapping approach, structural path significance displayed a substantial association between task orientation and students’ satisfaction (β = 0.29, p <0.001). This ascertains that nurse students need well-planned guidelines from their facilitators in clinical wards. Conclusions: The CLEI instrument revealed adequate psychometric properties and supported its original structure. As a result, the instrument might be used to measure students’ perceptions of their CLE. Task orientation appeared to be the most important factor influencing the students’ satisfaction in CLE.

Background: Gestational Diabetes Mellitus (GDM) is a common form of poor carbohydrate intolerance, prevalent among pregnant women and associated with unhealthy lifestyle behaviors. Given the dearth of information on self-empowerment among mothers with GDM, a self-care health education package needs to be developed to prevent related complications. Objective: This review aimed to identify self-care approaches, domains, and their effectiveness for a proper self-care educational guide package for women with GDM. Design: A systematic review using electronic literature databases published between January 2016 and December 2022 was conducted. Data Sources: Web of Science, Scopus, and Ovid databases were used. Review Methods: This review utilized the PICO (Population, Intervention, Comparison, and Outcomes) framework to screen the retrieved articles for eligibility in which mothers with GDM, educational materials, standard practice or intervention, and effectiveness were considered the PICO, respectively. The CIPP (Context, Input, Process, Product) model served as a framework for adopting the education development model. Mixed methods appraisal tool was used for quality assessment. Data extraction and synthesis without meta-analysis were presented as evidence tables. Results: A total of 19 articles on GDM were included in the final analysis (16 Intervention studies, two qualitative studies, and one mixed-methods study). Four broad domains emerged from the analysis: 1) information or knowledge of GDM, 2) monitoring of blood glucose levels, 3) practice of healthy lifestyles, and 4) other non-specific activities. The majority of the articles employed a face-to-face approach in executing the educational group sessions, and most studies disclosed their positive effects on GDM management. Other methods of evaluating intervention effectiveness were described as improved self-care behavior, increased satisfaction score, enhanced self-efficacy, good glucose control, and better pregnancy outcome. Conclusion: Knowledge or information about GDM, healthy diet, and exercise or physical activity was found to be the most applied domains of intervention. Framework domains based on the present review can be used in the future development of any interventional program for GDM women in enhancing health information reaching the targeted group in promoting self-efficacy. PROSPERO registration number: CRD42021229610.

Background: Age-friendly environment helps promote older people’s health practices and healthy aging. However, little is known about health practices among those living at home in a Thai Muslim community. Objective: This study aimed to explore the health practices of Thai Muslim Homebound Older Adults (HOAs) in relation to their beliefs and experiences to maintain their holistic health. Methods: An ethnographic study design was used. Purposive and snowball sampling methods were used to select 15 HOAs as key informants, among whom nine were living in an urban area, and six were living in a rural area. Data were collected using in-depth interviews, participant observation, and field notes. Data were analyzed using thematic analysis. Results: Muslim HOAs performed their health practices culturally under the central theme of “Life and health are designated by God (Allah) for living with nature and comfort at their age.” The health practices consisted of four patterns: 1) Maintaining day-to-day functioning to stay independent, 2) Having a simple and comfortable life with support, 3) Performing religious activities as a priority of life for well-being, and 4) Managing symptoms to gain a balance and restore health. Conclusions: Understanding health practice patterns among HOAs would help nurses, especially primary care professionals, to promote healthy aging and independent living. In addition, culturally sensitive nursing care may be required to maintain the healthy living of Muslim older adults in the long term.

This editorial aims to provide a comprehensive overview of the future of nursing through the lens of the ChatGPT model, a state-of-the-art language processing artificial intelligence (AI) developed by OpenAI. The edited chat transcripts with ChatGPT may offer key trends and developments in nursing, such as the increasing use of technology and digital tools, the integration of AI, and the use of robotics in patient care, as well as insights into the implications of these changes for nurses, patients, and the healthcare system as a whole. However, the future of nursing is continuously evolving. Therefore, nurses need to keep abreast of the latest developments and adapt to them while remaining committed to providing quality care.

Background: Illness uncertainty in parents of children with congenital adrenal hyperplasia (CAH) refers to parents’ inability to create meaning in events related to their children having CAH. This may influence their role in caring for children with CAH. Objective: The study aimed to determine factors associated with illness uncertainty experienced by parents of children with CAH in a developing country. Methods: A cross-sectional study was conducted on 80 parents (43 mothers and 37 fathers) of children with CAH, selected using consecutive sampling methods. The Parent’s Perception of Uncertainty Scale (PPUS) was used to measure the illness uncertainty levels. Data were collected from March 2020 to October 2020. Independent t-test and chi-square test were used to determine factors (parent’s gender, age, educational level, monthly household income, number of children with CAH, history of child death due to CAH, child’s age when first diagnosed with CAH, duration of therapy, gender change, type of CAH (salt wasting/SW or simple virilizing/SV), current gender, and genitoplasty) influencing illness uncertainty in parents. Results: The mean scores of PPUS were 42.3 ± 12.91, and the majority of parents had a low PPUS score (49; 61%). Parents of children with SW-CAH showed higher uncertainty (44.2 ± 12.77) than those with SV-CAH (32.6 ± 8.86; p = 0.003). Parents who lost their children due to CAH were more likely to report a moderate illness uncertainty than parents who never experienced child mortality due to CAH (χ2(1, 80) = 4.893; p = 0.027). Conclusion: The factors significantly affecting uncertainty in parents of children with CAH determined in this study might help healthcare professionals, including nurses, to play a pivotal role in giving pertinent information regarding their children’s health, disease, and therapy to help manage parental uncertainty.

Background: Multimodal intervention is currently promoted to control blood pressure in patients with first ischemic stroke. However, a dearth of studies has examined the influence of the intervention among patients with ischemic stroke, particularly in Thailand. Objective: This study aimed to determine the effect of the multimodal intervention on blood pressure in patients with first ischemic stroke. Methods: A randomized controlled trial was conducted. Sixty participants were randomly selected from two tertiary hospitals in Thailand. Eligible participants were randomly assigned into an experimental group (n = 30) and a control group (n = 30). The experimental group was provided with the multimodal intervention, while the control group was given the usual care. Data were collected from May 2021 to October 2021 at baseline (pre-test), 4th week, 8th week, and 12th week using the demographic data form and sphygmomanometer. The data were analyzed using the Chi-square test, t-test, and repeated measure analysis of variance (ANOVA). Results: The participants’ blood pressures after receiving the multimodal intervention were lower than those before receiving the multimodal intervention. Both systolic and diastolic blood pressure were statistically significantly decreased over time, starting from baseline to the 8th week and 12th week (p <0.001). In addition, the participants’ mean scores of systolic blood pressure (F (1, 58) = 4.059, p = 0.049) and diastolic blood pressure (F (1, 58) = 4.515, p = 0.038) were lower than the control group. Conclusion: The multimodal intervention is effective in controlling blood pressure. Therefore, nurses should educate patients with ischemic stroke to manage systolic and diastolic blood pressure, facilitate the patient’s participation in the exercise program, and monitor the patients via telephone to continue blood pressure control. Trial Registry: Thai Clinical Trials Registry (TCTR) identifier number 20210318001.

Background: People at high risk of stroke reported having difficulty performing self-care behavior. Although the literature has identified various factors related to self-care behavior in this population; however, there is a lack of studies to conclude the associated antecedents of self-care behavior, particularly in Thailand. Objective: This study aimed to examine the relationships between illness perception, functional status, social support, and self-care behavior among people at high risk of stroke. Methods: A correlational cross-sectional study design was used. One hundred and seventy people at high risk of stroke were selected from ten health-promoting hospitals in the Northeast region of Thailand using multi-stage sampling. Data were gathered using self-report questionnaires, including the brief illness perception questionnaire, functional status scale, multidimensional scale of perceived social support, and self-care behavior questionnaire, from November 2021 to February 2022. Data were analyzed using mean, standard deviation, and Pearson’s product-moment correlation. Results: One hundred percent of the participants completed the questionnaires. The participants had a moderate level of self-care behavior (M = 64.54, SD = 7.46). Social support and functional status had medium positive significant correlations with self-care behavior among people at high risk of stroke (r = 0.460 and r = 0.304, p <0.01), respectively. In contrast, illness perception had a small negative significant correlation with self-care behavior among people at high risk of stroke (r = -0.179, p <0.05). Conclusion: Social support, functional status, and illness perception are essential factors of self-care behavior among people at high risk of stroke. The findings shed light that nurses and other healthcare professionals should promote self-care behavior in these people by enhancing them to maintain proper functioning, positive illness-related perception, and family members' involvement. However, further study is needed to determine a causal relationship between these factors with self-care behavior.

Social media is one convenient way to express ourselves. Much information is offered; most is difficult to filter and can be consumed by anyone, anywhere, anytime. However, sometimes it crosses the boundaries of someone else’s life or privacy, especially when discussing sensitive issues, such as mental health problems. There are a lot of discussions about whether bringing the personal experiences of people with mental health problems to the public domain can potentially increase the community’s attitudes toward them or not. Still, one thing is for sure, this kind of content has caught public attention by having more viewers. Unfortunately, it potentially brings other consequences for people with mental health problems, such as stigmatization, discrimination, and sadfishing. Therefore, this paper aims to provide the viewpoints of psychiatric nurses regarding how to address mental health-related issues and appropriately put content about mental health problems on social media.

Background: Public Health Nurses (PHNs) collaborate with community volunteer welfare commissioners to support children with developmental disorders and their families lead a life without isolation. Objective: This study aims to clarify the roles and competencies that PHNs expect of welfare commissioners in supporting children with developmental disorders and their families. Methods: An online survey was administered through Survey Monkey© to 220 PHNs working in Japanese municipalities using an independently developed questionnaire regarding the roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by PHNs. Exploratory Factor Analysis (EFA) was performed to simplify the data structure and enhance understanding. The reliability of the scale was confirmed using Cronbach’s α. Differences due to PHN attributes (e.g., experience collaborating with welfare commissioners) were analyzed using Welch’s t-test. This study was conducted between April and September 2021. Results: The highest scoring items were, for the role, “a welfare commissioner’s role is to pass on accurate information to their successor,” and for competencies, “a necessary competency for a welfare commissioner is to protect the information about children with developmental disorders, and their families learned during one’s work.” The EFA results revealed a two-factor structure for role items: Factor 1, “Supporting children with developmental disorders and their families and preventing abuse,” and Factor 2, “Connecting to social resources.” Competency items were also found to have a two-factor structure: Factor 1, “Understanding the position of children with developmental disorders and their families and connecting with local residents,” and Factor 2, “Understanding developmental disorders and supporting them based on assessment.” A comparison of the attributes of PHNs showed no significant differences. Conclusion: PHNs feel welfare commissioners should pass on the information and protect confidentiality when supporting children with developmental disorders and their families. Furthermore, PHNs expect welfare commissioners to connect children with developmental disorders and their families to the community, prevent abuse, and provide support based on assessment. PHNs had the same expectations regarding the roles and competencies of welfare commissioners regardless of their own attributes.

Background: The negative health results associated with the family caregivers of older people can be alleviated with social support, which is considered a valuable resource. Hence, the factors contributing to social support need to be understood. Objective: This study aimed to evaluate the social support associated with the family caregivers of older people. Methods: A cross-sectional study was conducted among 231 family caregivers of older people conveniently selected from two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. Data were gathered between June to December 2021 using a Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. Descriptive statistics were used to summarize the data in frequencies and percentages. Independent t-test and one-way analysis of variance were used to examine correlations among variables. Results: The mean scores of social support for family caregivers were significantly higher among their family (Mean ± SD; 5.44 ± 0.969) and other important people (5.25 ± 1.123) compared to their friends (4.84 ± 1.094). Caregivers’ gender and duration of caregiving were significant factors associated with social support (p <0.05). Conclusions: The family caregivers received maximum support from their family and other important people, but they were less supported by their friends. This study also observed that the perceived social support of the caregivers of older people was affected by several factors, such as gender and duration of caregiving. This finding gives nurses and other healthcare workers the basic information they need to enhance nursing interventions and promote social support among those who care for older people, which can positively impact caregiving.

Background: Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. Objective: This study aimed to clarify the concept of patient and family-centered care for children. Methods: Walker and Avant’s concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. Results: The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Conclusion: Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.

The debate regarding the variation of names used for labeling the patient in a nursing care situation has always existed in nursing. Names such as patient, client, person, and nursed have been used widely among healthcare disciplines, including nursing. However, does the use of any of these identifying terms establish the appropriate identification of the nurse and the persons being nursed in a nursing care situation participating in a mutual relationship? This editorial aims to address the varieties and rationales of identifying persons participating in or receiving nursing care. Among these terms, “person” describing human beings underscores personhood, allowing nurse-nursed relations to foster, support, celebrate, and affirm living the meaning of what matters most to one’s life. Therefore, it will be advantageous to nursing practice if the term “person being nursed” is the relevant descriptor to be considered as the primary label.

Background: The World Health Organization estimates that between 80,000 and 180,000 medical personnel perished as a result of COVID-19. Although studies about nurses’ organizational commitment during the COVID-19 pandemic have been conducted, the sources of motivations and resilience strategies of nurses in providing a quality healthcare service amidst the COVID-19 pandemic have yet to be explored. Objective: This study aimed to investigate how motivation and resilience influence nurses to serve and cater to patients during the COVID-19 pandemic. Methods: A sequential exploratory mixed approach was used in this study between July and August 2022. The Connor-Davidson Resilience Scale (CD-RISC-10), Work Extrinsic and Intrinsic Motivations scale (WEIMS), and Garbee and Killacky’s Intent to Stay Scale (GKISS) were used to measure resilience, motivation, and intention to stay, among 50 nurses within Metro Manila. Quantitative data were analyzed using quantile regression, while qualitative data from eight participants were analyzed using thematic analysis. Results: The majority of the nurses were working 12 hours and above (52%) and earning a bi-weekly income of PHP 15,001 to 20,000 (96%). The GKISS scores of most respondents indicated their likelihood of remaining in their current profession was moderately low (Mdn = 12.5; IQR = 12-14). It was also found that there was no sufficient statistical evidence to conclude that intention to stay was associated with resilience (p = 0.914) and work motivation (p = 0.560). The qualitative strand of this study explored the significant influences of motivation, resilience strategies, and sources of intention to stay among Filipino nurses while facing the COVID-19 pandemic. The primary motivations of nurses lie in family, passion for work, and career development, while the resilience strategies include adaptiveness, time management skills, and self-fulfillments. On the other hand, the intent to stay greatly lies in serving the people and the country. Conclusion: This study concludes that positive and negative resilience and motivations from different facets of the social life of Filipino nurses, including passion, familial ties, patient care, and faith are the antecedents influencing the intention to serve in the healthcare service. In terms of staying for an extended period in a nursing career, the study found that institutionalized interventions, adequate compensation and benefits, and a good workplace are determinants of staying longer in the Philippines as Filipino nurses.

Background: Helping first-time mothers who have just undergone cesarean section and transitioning from hospital to home with their infant is a complex process. Therefore, understanding what contributes to discharge readiness is necessary. Objective: This study aimed to determine discharge readiness level and its associated factors among first-time mothers who have undergone cesarean section. Methods: A descriptive cross-sectional study was conducted among 233 first-time mothers who had undergone cesarean sections selected using quota sampling from the two largest referral centers in China. Data were collected from March to June 2021 using a demographic characteristics form, Readiness for Hospital Discharge Scale-New Mother Form (RHDS-NMF), and Quality Discharge Teaching Scale-New Mother Form (QDTS-NMF). Descriptive and inferential statistics were used for data analysis. Results: The discharge readiness of the respondents was at a moderate level. Age (r = -0.129, p = 0.049) and complications after cesarean section (r = -0.136, p = 0.038) had a negative correlation with discharge readiness. In contrast, the subscales of QDTS-NMF, particularly the content (r = 0.519, p = 0.000) and delivery (r = 0.643, p = 0.000), had a positive correlation with discharge readiness. Conclusion: The findings enable nurses, midwives, and other healthcare professionals to understand discharge readiness and its related factors among first-time mothers undergoing cesarean section. It is also suggested that the quality of discharge teaching with a comprehensive assessment of first-time mothers preparing for discharge from the hospital and following the guideline to prevent post-cesarean section complications should be reinforced.

Background: Although there are fewer COVID-19 cases in Indonesia, the pandemic is still ongoing. COVID-19 has a significant death rate in Indonesia, but lack of information on the effect of different clinical and demographic factors on COVID-19-related grimness and mortality in Indonesia. Objective: This study examined the clinical profile, treatment, and outcomes of patients with COVID-19 at Lahat Regency Hospital in South Sumatera, Indonesia, to find relevant markers that might be utilized to predict the prognosis of these patients. Methods: This was a retrospective single-center study of all medical record files of confirmed patients with COVID-19 admitted to Lahat Hospital from September 2020 to August 2021 (n = 285). Descriptive statistics, Chi-square, Mann-Whitney, Multiple Logistic Regression, and Cox's proportional hazards model were used for data analyses. Results: This study included 65 non-hospitalized and 220 hospitalized patients. Hospitalized patients were divided into dead and alive groups. The median age was lower in the non-hospitalized group without gender discrimination, and most hospitalized patients had comorbidities. Vital signs and clinical features were significantly different in hospitalized patients compared to non-hospitalized. The survival patients in the hospitalized group showed lower white blood cell (WBC), neutrophil percentages, and neutrophil-lymphocyte ratio (NLR) but higher lymphocyte and eosinophil. Non-survival patients had elevated alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine, blood glucose, and potassium. The use of Favipiravir and Remdesivir was significant between the alive and dead groups. The mean hospital stay for all patients was 9.49 ± 4.77 days, while the median duration of hospital time was 10.73 ± 4.33 days in the survival group and 5.39 ± 3.78 days in the non-survival group. Multiple logistic regression analysis determined respiration rate, WBC, and BUN as predictors of survival. Conclusions: Age and comorbidities are significant elements impacting the seriousness of COVID-19. Abnormal signs in laboratory markers can be used as early warning and prognostic signs to prevent severity and death. Potential biomarkers at various degrees in patients with COVID-19 may also aid healthcare professionals in providing precision medicine and nursing.

Background: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population. Objective: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area. Methods: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis. Results: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015). Conclusion: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.

Background: Diabetes mellitus and its prevalence are rising dramatically in Korea and throughout the world, not only in adults but in adolescents. Objective: This study aimed to identify the sex-specific factors that influence eating disorders in adolescents with type 1 diabetes. Methods: A secondary analysis of a descriptive survey was employed. Raw data from 136 adolescents aged 13 to 18 years who were diagnosed with type 1 diabetes were obtained in the original study using the Diabetes Eating Problem Survey-Revised (DEPS-R), Rosenberg Self-Esteem Scale (RSES), and Beck Depression Inventory-II(BDI-II). The data were analyzed using the independent t-test and multiple regression analysis. Results: The female and male participants with eating disorders scored 21.67 ± 11.70 and 13.15 ± 8.03 points, respectively. Among the adolescents with type 1 diabetes, the factors related to eating disorders in female participants were body image satisfaction (β = 0.48, p <0.001) and depression (β = 0.22, p = 0.043), accounting for 33.4% of the variance. While the factors related to eating disorders in the male participants were BMI (β = 0.33, p = 0.006) and depression (β = 0.28, p = 0.017), accounting for 17.4% of the variance. Conclusion: Sex-specific factors should be considered to induce healthy eating behavior in adolescents with type 1 diabetes and reduce eating disorders. Moreover, it is necessary for female adolescents to perceive their body type accurately, and male adolescents need exercise and nutrition education to lower their body mass index. Collaborations between medical practitioners, changes in the medical environment, and social interests are necessary. Since depression is the common factor associated with eating disorders in female and male adolescents with type 1 diabetes, a periodic depression screening test and intervention program that can lower depression should be developed. At the government level, it is necessary to strengthen economic support for cost interventions.

Background: Thrombectomy treatment is a critical procedure that emerged a few years ago, and nurses play a crucial role in the process, particularly in preventing complications and improving outcomes. Therefore, determining the quality of nursing care with best-fit quality indicators in patients with ischemic stroke receiving thrombectomy is necessary. However, no research has determined the nursing outcome quality indicators for these patients. Objective: This research aimed to identify the nursing outcome quality indicators for patients with ischemic stroke receiving thrombectomy treatment. Methods: Nineteen experts involved with patients with ischemic stroke receiving thrombectomy treatment were recruited. The Delphi method was implemented with three rounds between October 2021 to February 2022. Medians and interquartile ranges were analyzed. Results: Twenty-eight nursing outcome quality indicators were developed and grouped into three components, including 1) pre-procedure (five indicators), 2) intra-procedure (six indicators), and 3) post-procedure (17 indicators). Conclusion: This study revealed that the post-procedure of thrombectomy treatment had a greater number compared to pre and intra-procedures. The quality indicators developed in this research are practical and appropriate for nursing practice to enhance the quality of nursing care for patients with ischemic stroke receiving thrombectomy treatment.

Background: Negative Pressure Wound Therapy (NPWT) is considered an effective treatment in facilitating the healing of chronic wounds. However, its effect remains inconsistent, which allows for further investigation. Objective: This study aimed to assess the effectiveness of the NPWT program in improving the management of chronic wound healing. Design: Systematic review and meta-analysis was used. Data Sources: The search strategy ranged from 2016 to 2021 in PubMed, CINAHL, ProQuest, and ScienceDirect. Review Methods: Risk of bias was done based on the Risk of Bias 2.0 guideline using RevMan 5.4.1, and meta-analysis was done using Jeffreys’s Amazing Statistics Program (JASP) software version 0.16.3. Critical appraisal of the included articles was done according to Joanna Briggs Institute’s (JBI) appraisal checklist. Results: A total of 15 articles were included, with 3,599 patients with chronic wounds. There was no publication bias in this study seen from the results of the Egger’s test value of 0.447 (p >0.05), symmetrical funnel plot, and fail-safe N of 137. However, heterogeneity among studies was present, with I2 value of 66.7%, Q = 41.663 (p <0.001); thus, Random Effect (RE) model was used. The RE model showed a significant positive effect of the NPWT on chronic wound healing, with z = 3.014, p = 0.003, 95% CI 0.085 to 0.400. The observed effects include decreased rate of surgical site infection, controlled inflammation, edema, and exudate, as well as increased tissue with varying forest plot size, as demonstrated by the small effect size (ES = 0.24, 95% CI -0.26 to 0.79, p <0.05). Conclusion: The analysis results show that the standard low pressure of 80-125 mmHg could improve microcirculation and accelerate the healing process of chronic wounds. Therefore, applying the NPWT program could be an alternative to nursing interventions. However, it should be carried out by competent wound nurses who carry out procedure steps, implement general patient care, and give tips on overcoming device problems and evaluation. PROSPERO registration number: CRD42022348457

Background: Maternal mortality reduction remains a world health priority. One of the causes of maternal death is bleeding after childbirth. However, little is known regarding barriers to reporting for postpartum hemorrhage care among postnatal women in Nigeria. Objective: This research aimed to understand the perceived barriers to reporting postpartum hemorrhage care experienced by women and healthcare workers in Birnin Kebbi, North west-Nigeria. Methods: Qualitative case research was employed in this study with face-to-face interviews among ten postnatal women who experienced bleeding and six healthcare workers. Data were collected from September to November 2021. The interviews were all audio-taped, transcribed verbatim, and analyzed using thematic analysis. NVivo Pro Version 12 was applied to organize further and manage the data. Results: Six themes were developed: (1) knowledge deficit, (2) poor attitudes, behaviors, and performances, (3) low socioeconomic status, (4) lack of healthcare personnel, (5) cultural norms, and (6) lack of access to healthcare facilities. Conclusion: The study findings might serve as input for healthcare policymakers and healthcare workers to improve health and reduce maternal mortality. Enhancing knowledge and awareness about reporting process is necessary to improve reporting for postpartum hemorrhage care among women. Training and continuous professional development of health care workers are also highly suggested to enhance the quality of care.

Background: Owing to everyday educational activities, academic advisors often have to deal with mental health problems among students. Therefore, their mental health literacy must be assessed to determine whether they can detect mental health problems when working with the students. Objective: This study aimed to assess health sciences academic advisors’ mental health literacy and their experiences dealing with university students facing mental health challenges. Methods: A cross-sectional descriptive study was undertaken among a convenience sample of 133 health sciences academic advisors at the medical campus of a public university in Jeddah, Saudi Arabia. An electronic self-administered questionnaire using the Mental Health Literacy Scale (MHLS) was used to appraise participants’ recognition, knowledge, and attitudes toward ways to solve mental health difficulties. Data collection was completed from November 2020 to February 2021. Descriptive statistics, Student’s t-test for independent samples, One-Way Analysis of Variance (ANOVA), and Tukey’s test were selected for data analysis. Results: Academic advisors were found to be highly literate about matters of mental health. The mean mental health literacy score was statistically significantly higher in those advisors who were lecturers, assistant professors, associate professors, and professors (p <0.001). Additionally, the mean scores were significantly higher among advisors with a teaching role of lecturer rather than those who did not have the teaching role of a clinical supervisor (t = -2.331; p = 0.021). Conclusions: The academic advisors had an elevated level of mental health literacy, and the highly experienced academic advisors could deal better with students having mental health problems. Hence, it is essential to continue to provide educational programs and training on mental health literacy to academic advisors, as it helps them identify the signs of mental health complications. Furthermore, it improves their skills and confidence when they offer student support in coping with mental health issues.

Background: Palliative care is an integral approach to enhancing patients’ overall quality of life by taking into account their entire lives and addressing any suffering they may be experiencing. Thus, palliative care education and training should be advanced. However, palliative care training and education in Liberia have just started, and their development warrants further investigation. Objective: This research aimed to explore the state of palliative care education in Liberia and highlight its barriers and challenges. Methods: A descriptive qualitative exploratory study design was adopted in this study. Semi-structured interviews were conducted with ten male lecturers and four female nurses to gain in‐depth insight into their perspectives on palliative care education. Thematic analysis with NVivo 12 plus was used for data analysis. Results: Four themes emerged from the data: 1) the need for palliative education (lack of healthcare professionals, government support, regular workshops, integration, and interprofessional education on palliative care), 2) palliative care barriers (lack of curriculum implementation, lack of experience, lack of government actions, and poor infrastructures), 3) the level of student knowledge (senior and junior level, same educational level, and regular teaching materials), and 4) the roles of health care professionals (attention on palliative care, providing education on pain, and public awareness). Conclusion: The study findings may serve as input to develop palliative care education and training in Liberia. The identified gaps must be filled, and critical barriers must be overcome if the area of palliative care needs to be advanced. However, the comprehensive knowledge gathered in this study can be used by nurses, lecturers, and multidisciplinary teams to achieve the effectiveness of palliative care for patients.

Background: The COVID-19 pandemic has resulted in severe mental health problems worldwide. Thus, in addition to the high number of people who have died from infection with complications, some have committed suicide. Objective: This study aimed to determine the relationships between stress, stress-coping behaviors, and suicidal risk among those who had become unemployed in Thailand due to the COVID-19 pandemic. Methods: This study had a cross-sectional correlational design and included 447 unemployed Thais at least 18 years of age who had become unemployed due to the COVID-19 pandemic. The participants were selected through multistage sampling. A self-administered questionnaire was used for data collection. The data were then analyzed using frequency, percentage, and Spearman’s correlation coefficient. Results: Most participants had moderate-level stress (73.16%) and stress-coping behaviors (71.81%). Almost all the participants had no suicidal risk (76.73%). The stress level and overall stress-coping behavior were positively correlated with suicidal risk (r = 0.305, p <0.01 and r = 0.352, p <0.01, respectively). Conclusion: Stress and stress-coping behaviors were associated with suicidal risk among Thais who had become unemployed due to the COVID-19 pandemic. Hence, nurses must screen patients with psychological problems, especially those who have become unemployed due to the COVID-19 pandemic, for suicide risk. Developing interventions to reduce such patients’ stress and promote appropriate stress-coping behaviors is essential.

Background: In China, the prevalence of Type 2 Diabetes Mellitus (T2DM) continues to rise, and Diabetes Self-Management (DSM) is generally suboptimal. Thus, identifying the factors influencing DSM in adults with T2DM is crucial for healthcare providers. Objectives: This study aimed to 1) describe DSM among adults with T2DM in Wenzhou, China, 2) examine the correlations between diabetes knowledge, perceived self-efficacy, fatalism, social support, and DSM, and 3) determine how much power of the correlated independent variables could predict DSM. Methods: This study adopted the cross-sectional design and included 108 adults with T2DM who were randomly selected from the outpatient clinic of a hospital in Wenzhou, China. Data were recruited using a demographic questionnaire, and standardized tools were utilized to determine the correlation between DSM, diabetes knowledge, perceived self-efficacy, fatalism, and social support. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression analysis. Results: 62% of participants had poor blood glucose control (HbA1c ≥8.0%) and suboptimal DSM. Significant factors related to DSM were diabetes knowledge (r = 0.594, p <0.001), perceived self-efficacy (r = 0.447, p <0.001), and social support (r = 0.312, p = 0.001). The regression analysis revealed that all variables significantly explained 38.2% of the variance in DSM among adults with T2DM. However, only diabetes knowledge and perceived self-efficacy significantly predicted DSM (β = 0.468, p <0.001; β = 0.184, p = <0.05, respectively). Conclusion: The findings indicated that increasing diabetes knowledge and perceived self-efficacy could help improve DSM in T2DM to ascertain the ultimate treatment outcomes. Nurses and healthcare providers should improve the ability of patients and their families to think critically and act autonomously.

Background: Postembolization syndrome (PES), including abdominal pain, nausea, and vomiting, are complications most severe on the first day after transarterial chemoembolization (TACE). Music therapy has been found to help manage pain. If pain, a cause of nausea and vomiting, can be relieved, then nausea and vomiting should also be reduced. Objectives: This study aimed to examine the effect of music therapy on PES in patients with liver cancer after receiving TACE. Methods: This study employed a quasi-experimental crossover design. The study was conducted at the inpatient units of a specialized hospital for cancer in Bangkok, Thailand, from March 2020 to October 2021. Thirty patients with liver cancer were purposively selected based on the pre-determined criteria. A change-over design was used to compare patients’ changes in abdominal pain, nausea, and vomiting from the experimental period to the other control period. During the experimental period, music therapy was administered for 30 minutes on Day 0 after TACE, then twice a day in the morning and evening of Days 1 and 2 after TACE, and in the morning of Day 3 after TACE. During the control period, the patients used silent headphones. Data were analyzed using Wilcoxon signed ranks and Friedman tests. Results: The participants perceived abdominal pain, nausea, and vomiting at a mild level during all periods. Pain scores in the music therapy period were significantly lower than those in the control period on Days 0, 1, and 2 after TACE (p <0.001, p <0.01, and p <0.001, respectively) and lower than at the baseline (p <0.001). There were no statistically significant differences in nausea and vomiting scores between the music therapy period and the control period on Days 0, 1, and 2 after TACE and no statistically significant differences at the baseline. Conclusion: Music therapy effectively reduces mild pain among patients with liver cancer experiencing PES. This therapy can be used as a non-pharmacological treatment for nurses and other healthcare professionals in caring for patients with liver cancer.

Background: Adolescents’ sexual health is vital to overall health and well-being to achieve sustainable development goals. Yet, research on the strategies used by Malaysian school health teams regarding their experiences of providing sexual health information to adolescents is sparse. Objective: This study was conducted to explore the experiences of school health teams in Malaysia who provide unmarried adolescents with sexual health information either during school health visits or at health clinics, with a particular interest in the strategies they use to educate these young people. Methods: This qualitative study used semi-structured interview data from twenty participants from four multidisciplinary school health teams. The participants included staff nurses, medical officers, and family medicine specialists. The transcripts were analysed for common themes. Results: Four main themes were identified: discourse on risk, being selective, using scare tactics and maintaining own honour. The findings indicate that the interactions between school health teams and unmarried adolescents were not always ‘adolescent friendly’. The school health teams tended to use discourses of ‘risk’ or scare tactics to encourage abstinence in the adolescents they advised. Staff were also selective about the information they gave, prioritising notions of ‘maintaining honour’ over ‘safer sex’ messages. Conclusion: This study revealed how school health teams perceived sexual health education to be about moral issues and social attitudes. Influenced by both culture and religion, the sexual health services provided were underpinned by a ‘moral’ approach and promoted abstinence. However, most of the nurses in this study held the belief that sexual health knowledge acts as an encouragement for sexual activity. Thus, as part of school health teams, nurses need to embrace evidence that improved sexual health education may delay sexual initiation and prevent unintended pregnancy and HIV/STDs.

Background: Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are commonly associated with conflict areas. In Thailand, conflict situations have occurred from 2004 until the present in three Muslim-majority southernmost provinces, including Yala, Pattani, and Narathiwat. However, Islam provides strict guidelines on sexuality. Therefore, those who strictly practice Islam will have lower sexual risk behavior. Objective: This study aimed to examine the relationship between Islamic values-based sexual knowledge, sociodemographic factors, and risk for HIV/STIs among Thai Muslim army conscripts in the unrest situation area. Methods: A cross-sectional study was conducted between May and July 2020. Data were collected using a validated questionnaire among 421 participants. Descriptive statistics and Chi-square were used to examine the association among variables. Results: 57.5% of Muslim army conscripts had poor sexual knowledge based on Islamic aspects, and the participants showed high-risk profiles for HIV/STIs (32.5%). Marital status, hometown, smoking and drinking status, and Islamic values-based sexual knowledge were significantly associated with the risk of HIV/STIs (p <0.05). Conclusion: Participants with poor sexual knowledge according to Islamic values, smokers, single-status, alcoholic drinkers, and non-three southernmost provinces’ hometowns had higher risks of HIV/STIs. Thus, it is suggested that nurses and public health professionals implement sexual health promotion and prevention for HIV/STIs. In addition, misperceptions of Islamic aspects toward sexual behavior should receive immediate adjustments.

Nursing support for mothers whose newborns are admitted to the neonatal intensive care unit (NICU) has been a subject of interest in nursing practice. The article by Ong et al. acknowledges the salient role of nurses in supporting mothers in the neonatal intensive care unit. While the study suggested a moderate quality of life among mothers, the authors emphasised the necessity for hospital management to provide tangible and structured strategies to reduce maternal stress. The paper describes some existing nursing support programs to illustrate the approaches.

Background: Water birth has been considered an efficient non-pharmacological modality with numerous maternal and neonatal benefits as well as rare complications. Perception and knowledge about water birth can affect women’s decisions in the future. Few available studies addressed this area in Saudi Arabia. Thus, the current research fills this gap and contributes to further understanding this phenomenon. Objective: This study aimed to assess the perception and knowledge of Saudi women about water birth. Methods: A cross-sectional study was employed among 388 Saudi women conveniently enrolled for the study. An online questionnaire that included four sections: sociodemographic characteristics, obstetrical history, perception, and knowledge of water birth, was used for data collection. Descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (Chi-Square, Fisher Exact, and t-tests) were used for data analysis. Results: The participants’ mean age was 34.91 ± 8.851, with 83.2% of them highly educated. The mean number of deliveries was 3.36 ± 2.167, with 60% having no history of abortion. Less than half of the participants (40.2%) preferred to have a water delivery. Of the total participants, 96.4% had a fair knowledge level, and 3.6% had a good knowledge of water delivery. A significant relationship was found between age, educational course, and the knowledge of the participants about water delivery (p <0.05). Conclusion: Most Saudi women had a fair knowledge of water birth; however, they wanted more information on it. It is recommended that midwives and nurses broaden their understanding of water birth and enhance its practice in order to educate and inspire women to make informed decisions about all available childbirth delivery methods, including water birth.

Background: At the time that the mother and baby transit from breastfeeding to weaning, maternal-fetal attachment becomes a crucial basis for maintaining their emotional relationship. Conceptualization is needed to better understand the phenomenon of maternal-infant attachment during the weaning process. Objective: The purpose of this paper is to explore and identify the essence of the term maternal-infant attachment during weaning and to arrive at an operational definition of the concept. Method: Concept analysis following Walker and Avant. Results: The attributes of maternal-infant attachment during the weaning process include (1) consistent and properly timed, (2) dynamic transactional interaction, and (3) secured adjustment. Maternal-infant attachment during the weaning process is brought by maternal sensitivity, closeness and proximity seeking, gentle and positive weaning, and breastfeeding experiences, which later turn into favorable emotion regulation, maturity, self-efficacy, secured bond, less intrusive interaction, resilience, and child’s behavioral and development. Conclusion: This concept analysis provides new insight into maternal-infant attachment during the weaning process that guides the nursing practice. Also, the findings can help develop or improve the models, theories, and instruments collected for maintaining maternal-fetal attachment during the weaning process.

Background: A competent nursing workforce plays an important role, as it will ensure effective management of the healthcare system by providing quality nursing care. However, from the literature, it is evident that the learning needs of new professional nurses are not well explored and documented. Objective: The objective of this paper was to report identified learning needs of new professional nurses to enhance their clinical competence to ensure that they are able to provide excellent quality nursing care to patients with confidence. Methods: A qualitative study design was used to understand the perceptions of operational managers regarding the learning needs of new professional nurses to enhance their clinical competence. The study was conducted at seven public hospitals in the three districts of the North West Province, South Africa, between September and November 2021. Data were analyzed thematic. Results: Four themes emerged from data analysis: 1) Ethos and professional practice, 2) Management and leadership skills, 3) Assessment and observation skills, and 4) Documentation and record keeping. Conclusion: This study provides valuable information regarding the learning needs of new professional nurses. Understanding these learning needs can provide insight into how to better transition student nurses to registered nurses so that they are able to adequately and safely take care of a diverse patient population and work successfully as new nurses.

The “pressure” or “passion” to publish is a common reality in academia. All faculty are required to demonstrate that they are engaged in research and that their work is disseminated in reputable journals. However, writing manuscripts is quite challenging; some papers for publication may take days, weeks, months, and even years. This editorial aims to provide the editors’ points of view to assist authors in successful acceptance and publication in an international nursing journal.

Background: Stroke is a major cause of long-term disability and has a potentially enormous emotional and socio-economic impact on patients, their families, and health services. Perceptions of patients with stroke have already been studied worldwide, which are unique in terms of their cultural background. However, in India, there is a lack of studies about the experience of the disease by stroke survivors and their perspectives of understanding the situation. Objective: This study aimed to explore lived experience of stroke survivors in India. Methods: A phenomenological study design was used. In-depth interviews were conducted with a purposive sample of ten stroke survivors who had experienced post-stroke deficits three months to one year after stroke. Data were analyzed using Diekelmann’s hermeneutical approach to identify underlying themes. Results: Two main themes emerged: (1) emergence of stroke (actual occurrence, mental perception, and recognition of illness) and (2) therapeutic concerns (enhanced and weakened recovery). Conclusion: Recognizing how patients experience the illness is crucial in planning care for stroke survivors. Strengthening factors enhancing recovery and limiting the hindering factors through effective therapeutic management is a necessity. The findings might also contribute to refining existing interventions and designing holistic multi-component rehabilitation programs that facilitate easy recovery. The study also highlights the need for providing information to general public on recognizing warning signs of stroke.

This letter aims to respond to the editorial’s viewpoint by Aungsuroch, Y. and Gunawan, J. related to nurses’ preparation in the industrial revolution 4.0. Without a doubt, the era of disruption creates massive changes in many sectors, including in the health industry, and nurses are demanded to adopt and adapt to the rapid development of information technology. Therefore, digital competence is highly emphasized as an essential skill for today’s nurse generation in order to be the “big gun” of tomorrow.

Background: The delay in developing oral feeding skills becomes a problem experienced by premature infants. One of the reasons for the delay may be related to inconsistent definitions of oral feeding skills, which can cause discrepancies in the provision of nursing care. Objective: This study aimed to clarify the concept of oral feeding skills in premature infants. Methods: The Walker and Avant concept analysis method was used. A literature search was also conducted from five databases: CINAHL, PubMed, ProQuest, EMBASE, and Google Scholar, to find articles between January 2020 and December 2022. Results: The literature search obtained 20 articles on oral feeding skills from various disciplines. Five attributes were developed from the concept analysis, including (1) coordination ability to suck, swallow, and breathe, (2) the ability to regulate oral-motor functions, (3) the ability to regulate sensory functions, (4) the ability to maintain the stability of physiology function, and (5) the ability to regulate feeding behavior. Antecedents to oral feeding skills include immaturity of the nervous system, gestational age, feeding intolerance, increased length of stay and cost of care, increased rehospitalization, stress on parents, and increased morbidity and mortality. Consequences include optimization of growth and development, reduction of length of stay and cost of hospitalization, increased bonding attachment, increased self-efficacy of parents in caring for premature infants, and improvement of the quality of life of premature infants. Conclusion: The concept analysis provides five comprehensive attributes and their antecedents and consequences. However, this concept can be used to provide nursing care to premature infants, assess the criteria for discharge, and optimize nutrition for the growth and development of premature infants.

Background: Helping the woman to adopt a comfortable position during childbirth significantly affects labor changes and pain management. However, there is a lack of consensus on the impacts of different childbirth positions on labor outcomes. In addition, a scarce of studies have assessed the effects of the upright and recumbent positions on delivery outcomes, especially in the Kingdom of Saudi Arabia. Objective: This study aimed to examine and compare the influence of upright and recumbent childbirth positions on birth outcomes. Methods: The setting was the childbirth unit at East Jeddah Hospital from November 2020 to March 2021. The research design was quasi-experimental, including 300 women in labor under 18-45 years. The sample includes two equal groups of 150 women: upright (experiment) and recumbent (comparison) position groups. Three tools were used to collect data: a structured interviewing questionnaire, the modified WHO partograph, and the Wong-Baker FACES® pain rating scale. Descriptive statistics, chi-square, independent t-test, and paired t-test were used for data analysis. Results: Women in the recumbent position spent a longer duration in the first, second, and third stages of childbirth and had higher pain scores and less satisfaction with the assumed position than women in the upright position, with a highly significant difference (p <0.001). Conclusion: Laboring women in upright positions experienced faster progress of labor, shorter duration of childbirth, less pain, and higher satisfaction than those assumed recumbent positions. This study serves as an input for midwives and nurses to enable them to offer appropriate advice to improve intrapartum care. In addition, educational programs targeting pregnant women about the positive impacts of upright position on women’s birth experience are encouraged.

Background: Technology-based intervention showed a promising approach to health promotion strategies. There had been limited knowledge of the existing program for technology-based intervention in promoting foot care and dietary behavior modification. Thus, a mobile app was developed as an alternative strategy for promoting foot care and dietary behavior modification. Objective: This paper aims to elaborate on the process of developing, validating, and examining the Diabetic Care Self-Management Mobile Health Application (Diabetic Care). Methods: There are two phases conducted. The first phase is the process of developing and validating Diabetic Care. Intervention Mapping (IM) Framework was used to guide the process of developing Diabetic Care, while in assessing validity, guidance from Kassam-Adams et al. was used. A team of experts was appointed to validate the mobile app developed. Next, the usability of Diabetic Care was conducted among ten conveniently chosen patients with diabetes in a governmental primary care clinic. Results: The process of developing Diabetic Care was clearly explained. The Diabetic Care app showed a good I-CVI score (1.00) and general CVI score (1.00) after the expert team assessed. During the trial, two drawbacks were identified and explored to find solutions. Conclusion: The Diabetic Care app is proven appropriate to be employed in the study. Even though there were two drawbacks encountered, however, possible solutions were able to be explored in addressing the issues. Further research should be conducted to examine the effectiveness of this mobile app in modifying foot care behavior and dietary behavior. Hence, it will assist in the translation of advanced technology in nursing care.

Background: The way patients perceive nurses’ caring behaviors can potentially impact patient outcomes and satisfaction. Studies have revealed incongruence between nurses’ and patients’ perceptions with regard to which behaviors are considered caring. Objective: This study aimed to conduct a cross-cultural validation and evaluation of the psychometric properties of the Caring Behaviors Inventory (CBI-16), a self-report questionnaire, from English to Filipino. Methods: A descriptive cross-sectional design involving forward and back-translation with bilingual translators, expert validation, and a survey in a sample of patients and nurses was used. The psychometric evaluation used a sample of 142 staff nurses and 180 hospitalized patients. Exploratory factor analysis, internal consistency reliability, and inferential statistics were used for data analysis. Results: The Filipino version of the CBI-16 (CBI-16-FIL) had excellent internal consistency (Cronbach’s alpha of 0.95) and a unidimensional factor structure (accounted for 85% of total variance). The CBI-16-FIL was found to be a valid, reliable, and unidimensional tool to measure the perceptions of nurse caring behaviors in the Philippines. Conclusion: The CBI-16-FIL can be used to measure perceptions of nurse caring behaviors. There is a need for further studies involving other cultures, dyadic samples of nurses and patients, and larger sample sizes.

Qualitative research methods allow researchers to understand the experiences of patients, nurses, and other healthcare professionals. Qualitative research also provides scientists with information about how decisions are made and the aspects of existing interventions. However, to get to obtain this important information, qualitative research requires holistic, rich, and nuanced data that can be analyzed to determine themes, categories, or emerging patterns. Generally, offline or in-person interviews, focus group discussions, and observations are three core approaches to data collection. However, geographical barriers, logistic challenges, and emergency conditions, such as the COVID-19 pandemic have necessitated the utilization of online interviews, including chatting as an alternative way of collecting data. This editorial aims to discuss the possibility of online chat interviews as an acceptable design in qualitative data collection.

Background: Variable environmental temperature changes have affected different population groups; however, limited empirical studies in nursing have focused on older adults. One of the most pressing issues of today is climate change, where nurses should explore and advance their roles. Objective: This study aimed to explore and describe the experience of older adults with temperature variations as a consequence of climate change and its impact on mental health. Methods: Descriptive phenomenological approach was used in this study. Purposeful sampling was used in selecting key informants, while individual telephone interviews and videoconferencing platforms using a semi-structured interview guide were used as the data gathering method to gather key informants’ accounts of their experiences. Prior to data collection, authors bracket their preconceived beliefs and values regarding the phenomenon at hand. Colaizzi’s seven-step method of data analysis combined with the use of qualitative data analysis software was used to develop the themes and sub-themes. Results: Eleven key informants aged 60-77 participated in this study. Sixty significant statements on temperature variations and mental health were extracted, while forty-one meanings were formulated from the significant statements. Important meanings were grouped into a cluster of themes which built the three major themes and seven sub-themes. The major themes are Theme 1: Active recollection and recognition of their experience; Theme 2: Symptoms of physical, social, mental, and cognitive aspects transformation; and Theme 3: Establishing adaptive mechanisms. The themes reflect a mental or cognitive process of recognizing and understanding their experiences, experiencing their impacts, developing adaptive mechanisms, and showing characteristics of resilience. Conclusion: The themes and sub-themes developed in this study showed that despite their vulnerability, older adults were able to implement adaptive mechanisms and showed signs of resiliency. Temperature variations brought limitations or adjustments to the physical, social, mental, and cognitive aspects of the key informants. Further studies should be conducted in other population groups and various geographical locations to identify sources of adaptive mechanisms and resilience to temperature variations and climate change among older adults. The findings should be used in developing health programs and crafting policies.

This article is intended to provide an appropriate context for adopting sexual abstinence from a health-promoting behavioral perspective that can be applied to women of reproductive age worldwide to improve reproductive health, maintain well-being, and prevent health problems in women. The topics related to women’s health status, sexual abstinence definitions, benefits, and application, as well as sexual autonomy and efficacy, including family collaboration, are discussed. This article will provide health care providers, especially nurses and midwives, with new ideas for integrating sexual abstinence into nursing and midwifery practice.

Background: Holistic admission processes are needed to promote diversity in nursing students. Previous research had identified different variables related to the average grade point at the end of the first semester. There is a need to examine if those variables are associated with ongoing student success. Objective: The purpose of this study was to analyze experience, attributes, and academic variables for an association with nursing student success. Student success was defined as being an active student at the end of the first year and at the end of the second year of a baccalaureate nursing program in Indonesia. Methods: Binary logistic regression analysis was used to determine what relationship, if any, the variables had with student success, measured at the end of the first and second academic years. The data of 341 nursing students enrolled in August 2018 was analyzed. Results: The variables accounted for 40.3% of the variance at the end of the first year and 24.3% of the variance at the end of the second year. There was a significant (p < .05) relationship between being enrolled at the end of the first year and 1) academic variables of first semester grade point average and the admission score of Raven’s Advanced Progressive Matrices, and 2) attribute variables of reason for entering nursing and brief calling presence scale. A significant relationship was found between being enrolled at the end of the second year and the attribute variable of grit score. No variables had a strong correlation with other variables. Conclusion: Holistic admission processes and promoting student success can create the future of the nursing workforce. Improving the diversity in admitted nursing students will enhance the diversity in the nursing workforce. To promote the success of all students, a variety of support interventions will need to be developed. As students’ calling and grit may play a role in student success, a better understanding is needed. In addition, more research is needed to explore how developing calling and grit throughout the nursing program can impact student success.

Background: Although acute coronary syndrome impacts patients’ health-related quality of life, a dearth of studies explore this issue in Indonesia. Thus, understanding factors associated with health-related quality of life among patients with acute coronary syndrome is a necessity. Objective: This study aimed to examine the relationships between age, pain, dyspnea, functional status, self-efficacy, social support, and health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia. Methods: This study employed a descriptive correlational study involving 186 patients with acute coronary syndrome purposively selected in the outpatient clinics of the top referral public hospital. Data were collected in 2020 using validated instruments: Rose Questionnaire for Angina (RQA), Rose Dyspnea Scale (RDS), Seattle Angina Questionnaire (SAQ), General Self-efficacy Scale (GSE), ENRICHD Social Support Instrument (ESSI), and MacNew Health-Related Quality of Life. Data were analyzed using descriptive statistics and Spearman-rank correlation. Results: Overall, the health-related quality of life in patients with acute coronary syndrome was high (Mean = 4.97, SD = 0.92), including in its subscales: emotional (Mean = 4.94, SD = 0.88), physical (Mean = 5.07, SD = 1.12), and social (Mean = 5.05, SD = 1.55) subscales. Significant factors related to health-related quality of life were pain (r = 0.296, p <0.001), functional status (r = 0.601, p <0.001), dyspnea (r = -0.438, p<0.001), and self-efficacy (r = 0.299, p <0.001). Meanwhile, age and social support had no significant relationships with health-related quality of life (p = 0.270, p = 0.059). Interestingly, social support was significantly correlated with the emotional subscale of health-related quality of life (r = 0.156, p = 0.034). Conclusion: Functional status, pain, and self-efficacy were positively correlated with health-related quality of life, while dyspnea had a negative association. This finding serves as basic information for nurses and other healthcare professionals to consider the related factors identified in this study to improve nursing interventions in order to increase health-related quality of life among patients with acute coronary syndrome.

Background: Fatigue is the most common symptom in patients with breast cancer undergoing chemotherapy. Benson’s relaxation technique is considered effective to reduce fatigue, but its effect in combination with smartphone technology is limited. Objective: This study aimed to analyze and determine the effect of the Benson relaxation application (Bens app) on fatigue in patients with breast cancer undergoing chemotherapy. Methods: A quasi-experimental design with a pretest-posttest comparison group was used. Fifty-six patients were included using consecutive sampling technique, of which 28 were assigned to the experimental group (received Benson relaxation technique using Bens app) and comparison group (obtained Benson relaxation technique using booklet). The Benson relaxation was done two times per day for seven days, and the Brief Fatigue Inventory questionnaire was used to measure the patients’ fatigue levels. Data were analyzed using paired and independent t-tests. Results: The experimental group (p = 0.001) and the comparison group (p = 0.015) showed a significant reduction in fatigue after receiving the Benson relaxation for seven days. However, there was a statistically significant difference in fatigue between the experiment and comparison groups after the intervention (t55 = 2.481, p = 0.016). Conclusion: Benson relaxation could reduce fatigue in patients with breast cancer using the Bens app and booklet. However, the Bens app is considered more effective than a booklet. Therefore, the Bens app can be viewed as an alternative to help patients perform Benson relaxation and integrated into the nurse palliative care program for patients with cancer.

Background: Post transarterial chemoembolization (post-TACE) causes side effects that impact patients, which leads to fatigue symptoms and reduced functional status. However, unrelieved fatigue and reduced functional status may cause patients to withdraw from treatment and negatively affect their lives. Unfortunately, the patients post-TACE only receive routine medical care at the hospital but no follow-up and continuity of care back home. Therefore, comprehensive discharge planning for these problems is necessary. Objective: This study examined the effectiveness of the comprehensive discharge planning program on fatigue and functional status of patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Methods: A randomized clinical controlled trial was used. Fifty-two patients who met the study criteria were randomly assigned to an experimental group (n = 26) receiving the comprehensive discharge planning plus routine care and a control group (n = 26) receiving routine care only. The discharge planning program was developed based on the Transitional Care Model. A demographic and health data questionnaire, Fatigue Severity Scale (FSS), and Enforced Social Dependency Scale (ESDS) were used for data collection. Chi-square, Fisher’s exact, Wilcoxon signed-rank, and Mann-Whitney U tests were used for data analysis. Results: The mean scores for fatigue at 30 days after treatment between the experimental and control groups were significantly different (p = 0.003). The mean scores for the fatigue symptoms in the experimental and control groups were 1.27 ± 0.58 and 1.77 ± 0.85, respectively. The functional status from Day 7 to Day 14 after transarterial chemoembolization was different (p = 0.020). In addition, the mean scores for functional status between the experimental and control groups were significantly different (p = 0.020). On Day 14, after transarterial chemoembolization, the experimental group had an increased score in functional status from Day 7 over the scores for those in the control group. Conclusion: The comprehensive discharge planning program effectively reduces fatigue symptoms and enhances the functional status in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Therefore, the comprehensive discharge planning program can be used by nurses and multidisciplinary teams in order to achieve the effectiveness of nursing care for patients.

Background: A hemodialysis is a treatment option for patients with End-Stage Renal Disease (ESRD). However, patients undergoing hemodialysis three times per week may experience psychological issues, including depression, which are highly prevalent among patients. Unfortunately, most healthcare providers fail to recognize the symptoms of depression due to overlap with other somatic symptoms; thus, depression remains undiagnosed. Objective: This study aimed to estimate the prevalence of depression and compare the differences in depression symptoms according to the sociodemographic characteristics of patients with ESRD undergoing hemodialysis. Method: A descriptive, cross-sectional study was conducted from August to October 2021 with a total of 132 hemodialysis patients using the Beck Depression Inventory (BDI II) questionnaire to examine symptoms of depression at multiple health centers in Jeddah. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, Post-hoc analysis using Conover tests were used for data analysis. Results: The prevalence of depression in hemodialysis patients was 51.5%, 25.8%, 15.9%, and 6.8%, with minimal, mild, moderate, and severe symptoms, respectively. Depression exhibited a significant relationship with sex (p = 0.034), with females showing higher mean depression scores than males. Additionally, depression scores were statistically significant across the different levels of education (p = 0.019), with the mean depression scores significantly highest in subjects who had only primary school level of education. Furthermore, the most common symptoms associated with depression were found to be energy loss and fatigue. Conclusion: Depression prevalence was relatively low among patients with ESRD undergoing hemodialysis, and a loss of energy and fatigue were the most common symptoms correlated with depression. Hence, nurses should be trained on how to routinely use psychological screening scales among patients with ESRD undergoing hemodialysis.

Background: Developing countries, including Indonesia, commonly face maternal mortality as a public health concern, which needs special attention. Using maternal delivery services in health facilities may reduce maternal mortality. However, little is known about the general use of delivery services in health facilities in rural areas, Indonesia. Objective: This study aimed to analyze determinants in choosing delivery places in rural areas of Indonesia. Methods: A cross-sectional quantitative design with secondary data from the 2014 Indonesian Family Life Survey (IFLS) was used in this study. There were 2,389 mothers aged 15-49 years in rural areas were included. Data were analyzed using a logistic regression test. Results: It was found that 67% of mothers gave birth in health facilities. Tertiary and secondary education levels, residence in Java and Bali regions, economic status, insurance ownership, and job status were significantly related to the choice of delivery place in health facilities. Tertiary education was the most dominant factor correlated with the use of delivery services in health facilities (p < 0.001; PR = 4.55; 95% CI = 3.751-5.542). Conclusion: Education is the key factor associated with the choice of delivery place. Therefore, it is suggested that the government and healthcare workers, especially nurses and midwives, improve mothers’ education and provide strategies to increase knowledge in choosing delivery services to enhance their health outcomes.

Background: Patients’ long waiting time still exceeds the set target of 120 minutes. As a result, the volume of complaints remains a concern that points to systems inefficiencies. Minimal attention has been given to the experiences of nurse managers regarding patients’ long waiting time Objective: To explore and describe the experiences of nurse managers regarding patients’ long waiting time at Community Health Centers (CHCs) in Gauteng Province, South Africa Methods: The research applied qualitative exploratory descriptive and contextual design. Non-probability purposive sampling techniques were used to select eight nurse managers. Individual semi-structured interviews were conducted and captured with an audio tape. Tesch’s 8-steps of data analysis were followed to analyze the data. Results: Three themes and seven categories emerged from the study: (1) The adverse effects of patients’ long waiting time (early birds to evade long queues, increased patients’ complaints and compromised quality care), (2) Factors that contribute to patients’ long waiting time (records and patient administration system deficiencies, poor time management, patients’ lack of adherence to booking system), (3) Measures to mitigate patients’ long waiting time (embracing decongestion systems to mitigate patients’ overflow at CHC). Conclusion: The study recommends the optimal implementation of an appointment system to avert long waiting times. Collaboration between CHCs’ management and clinic committees is encouraged to provide the best solutions to the reduction of patients’ long waiting times. In addition, time management is one area that needs to be improved. A digital record management system can assist in better-sought problems related to filling. Studies are encouraged on a model to enhance collaboration in reduction of patients’ long waiting time.

Background: Despite the rising number of COVID-19 cases in the Philippines and the world, our aging population, especially older adults working in the academe, has not ceased with their desire to provide quality education among our student nurses continuously. Aside from the fact that most of these nursing mentors in the field of education have been closer to the age of retirement, they still opt to continue their passion for teaching. Hence, knowing their lived experiences can be a great anchor on how to support them effectively. Objective: This study aimed to explore the older adults’ lived experiences while working in the academe amidst the pandemic. Methods: A qualitative descriptive phenomenological approach was employed. Purposive sampling was used to select twelve informants based on the set inclusion criteria, such as older adults aged at least 60 years old and above residing within Cebu City, Philippines, who were currently employed as nursing mentors in any private or public academic nursing institution. Colaizzi's method of data analysis was used. Results: Four themes emerged: (1) Diversifying Teaching and Learning Strategies, (2) Labyrinthing Through the Challenges, with three subthemes (Coursing through struggles and adversities, Thriving with the teaching and learning during the pandemic, and Coping with the changes), (3) Strengthening Health, Adhering to Protocols, and (4) Moving Forward with the New Normal, with two subthemes (Adapting to be technologically resilient and Having a positive outlook). Conclusion: The older adults learned to teach, adapt, adjust, and move forward in the academe amidst the pandemic. They keep up with the changes and the challenges despite being an older adult having limited experience and knowledge of the use of technology. They continue to strive, live and be more productive amidst the pandemic.

Background: Providing care for older people with memory loss is a significantly stressful task. The caregiver experienced deterioration of the care recipients regarding their cognitive and functioning abilities, often resulting in the caregiver’s feelings of distress, stress, and unsatisfactory sleep quality. Objective: This cross-sectional study aimed to examine the relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia. Methods: A simple random sampling method was used to recruit participants of seventy-two family caregivers who received care from a community long-term care facility at two primary hospitals in Thailand. Research instruments included the Relative Stress Scale and the Pittsburgh Sleep Quality Index. The data were analyzed using descriptive statistics, means, standard deviation, and simple linear regression. Results: The study revealed that caregivers had a high level of caregiving stress (M = 49.68, SD = 4.71), and poor sleep quality (M = 12.44, SD = 3.60). Caregiving stress was positively correlated with poor sleep quality (r = 0.54, p < 0.01) with a large relationship. Conclusion: Thai family caregivers of people with dementia reported high stress level and had poor sleep quality. The findings suggest that nurses in primary health care should focus on assessing stress levels and sleep quality as well as improving sleep quality for family caregivers by developing interventions.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic prompted rules and laws such as lockdown, which contributed to staying at home and participating in sedentary activities such as using smartphones, tablets, televisions, gaming devices, and computers. As a result of the increased use of digital screen time, a worldwide issue has arisen among various age groups, especially adolescents, which may have affected their psychological well-being, increasing their susceptibility to anxiety-related disorders. Objective: This study aimed to assess the relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic. Methods: A quantitative descriptive cross-sectional design using convenience sampling was used in this study. The online self-administered questionnaire, including the Arabic-translated version of the Screen for Child Anxiety-related Disorders (SCARED-C), was distributed through social media using Google forms between February and April 2021. The Chi-Squared test was used for data analysis. Results: Of 625 participants, majority were females (n = 527, 84.3%) than males (n = 98, 15.7%). A significant difference between screen time and the presence of an anxiety-related disorder among adolescents during the COVID-19 pandemic (p = .021) was noted. More than half of the participants (n = 410, 65.6%) scored above 25 in the SCARED-C test, indicating the presence of an anxiety-related disorder regardless of the type. Of those, more than a quarter (n = 176, 28.2%) used screens for more than 8 hours a day. Conclusion: The results indicated a relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the pandemic. In particular, adolescents are more susceptible to the adverse effects of increased exposure to screen time, which is constantly on the rise. Therefore, nurses and other healthcare professionals can play a significant role in providing guidance and advice to parents, caregivers, and adolescents themselves on how to limit screen time exposure. The findings can also be useful for future studies to build on and develop screen time management interventions and guidelines.

Background: Peripheral venous cannulation (PIVC) is one of the most common needle procedures associated with the therapies of pediatric patients, which causes pain and anxiety in children. Trace Image and Coloring for Kids-Book (TICK-B) is one of the arts-based interventions to relieve pain and anxiety, but none of the existing studies use the TICK-B to decrease children’s pain intensity and anxiety levels during PICV. Objective: This study aimed to investigate the effectiveness of the Trace Image and Coloring for Kids-Book (TICK-B) in decreasing children’s pain and anxiety during PIVC. Methods: A parallel, randomized, double-blind controlled trial was used in this study. Children aged 6–12 years were randomly allocated to one of two groups: intervention or control. The intervention group (n = 48) received the TICK-B during the PIVC, compared to no intervention in the control group (n = 52). The children, their parents, and an observer nurse rated outcomes 1-2 min after completion of the procedure. The patients in both groups were similar in age, gender, duration of hospitalization, injections, mother’s age, and education. Faces Pain Scale-Revised (FPS-R), Children’s Fear Scale (CFS), and Visual Analog Scale (VAS) were used to measure pain and anxiety. Paired and independent t-tests were used for data analysis. Results: Patients in the intervention group reported significantly reduced pain levels than those in the control group (p <0.001), as reported by children (3.08 vs. 7.06), parents (3.08 vs. 7.13), and the observer nurse (3.06 vs. 7.13), respectively. Anxiety levels were also significantly lower among patients in the intervention group than in the control group (p <0.001), as reported by children (0.88 vs. 3.17), parents (0.94 vs. 3.19), and the observer nurse (0.85 vs. 2.94), respectively. Conclusions: TICK-B is an effective technique for reducing children’s pain and anxiety during PIVC. TICK-B is a simple, inexpensive, and effective technique that nurses can use to decrease the levels of pain and anxiety of pediatric patients during intravenous cannulation.

Background: Depression is one of the most severe mental disorders experienced by older adults worldwide. The prevalence of depression among older adults in nursing homes is three-time higher than in the community. Therefore, knowing the incident rates of depression and its related factors would help provide appropriate intervention and prevention programs in the future. Objectives: The study aimed to determine the prevalence of depression and compare the difference in depression status according to the sociodemographic characteristic of the older adults in the Indonesian nursing homes. Methods: A descriptive cross-sectional study design was used in this study, which involved 116 participants selected using convenience sampling from five different general nursing homes in Bandung City, Indonesia. The Short Form (SF) of the Geriatric Depression Scale (GDS) was used to evaluate depression among older adults in nursing homes. The t-test and one-way ANOVA were used for data analysis. Results: Of the total participants, 56.9% had depression, which 7.8% with mild depression, 37.1% with moderate depression, and 12% with severe depression. In addition, there were significant differences in depression according to age, gender, marital status, educational background, ethnicity, disease history, duration of stay, and the visitor frequency among the older adults in nursing homes (p <.001). Conclusion: A high rate of depression among older adults in Indonesian nursing homes was identified. Therefore, attention to caring for more specific needs, such as the psychosocial needs of older adults in nursing homes, is urgent.

This letter aims to respond to Tosepu et al. that workplace violence against nurses increases dramatically in developed and developing countries. This leads to a frustrating and unsustainable work environment. Furthermore, workplace violence has the potential to have long-term physical and psychological implications for all employees and a detrimental effect on the general morale of a healthcare organization. In this letter, we add the evidence of the workplace violence against nurses in Bangladesh, which contributes to increased health job discontent, decreased employee engagement, excessive absenteeism from work, a strong desire to resign, low medical safety ratings, and a high frequency of adverse clinical outcomes. In addition, people who live in hill communities and waterlogged areas do not have access to health care privileges due to workplace violence against nurses. Efforts to combat workplace violence against nurses are therefore very much needed.

Background: Cancer is one of the major leading causes of childhood death, and the most common type is acute lymphoblastic leukemia. The survival rate has increased in recent years; however, the long patient trajectory may trigger psychological distress among caregivers as they play an active role in ensuring that the child’s basic needs are met. Being in a patient-focused system, the needs of caregivers may be neglected. Objective: This study aimed to explore the caregivers' beliefs on children with acute lymphoblastic leukemia caregiving experiences in order to promote their well-being. Methods: Caregivers from thirteen families of children with acute lymphoblastic leukemia participated in this phenomenological study. NVivo 12 was used for the thematic analysis of the data. Consolidated criteria for reporting qualitative research (COREQ) were used in this study. Results: Overall, five main themes for caregivers’ beliefs were identified from their responses: 1) dietary intake with emphasis on its importance in aiding recovery and its potential influence on cancer complications, 2) childcare which emphasized the need to be strong and self-sacrifice, 3) treatment which reflected the use of home or natural remedies and caregivers’ negative perception towards chemotherapy, 4) causes of cancer believed to be linked to early childcare choices on food, beverage, and stress imposed on the child, and 5) source of beliefs that included doctors, online platforms, personal encounters and information on food labels. Conclusion: Caregivers’ beliefs are varied and nuanced, formed in a multicultural social background of Malaysia. These findings provide knowledge for future supportive cancer care for patients, their caregivers, and the treatment outcome in the Malaysian context. Nurses, who play an essential role between healthcare professionals and patients and/or their caregivers, can be empowered to provide psychological support, early detection of psychological distress, and exploration of caregiver beliefs, given that the number of clinical psychologists in Malaysia is lacking, and there is greater preference for care to be provided by doctors or nurses.

Background: Effective nurse educators will improve students’ performance. Therefore, examining the characteristics of an effective nurse educator is essential, especially from nursing students’ perspectives, which will provide an additional point of view to improve the teachers’ quality. Objectives: This research aimed to identify nursing students’ opinions regarding the characteristics of effective nurse educators and to compare those characteristics according to age, year of study, and cumulative grade point average. Methods: A descriptive quantitative design was used. Data were collected from 400 nursing students in Thailand using a validated questionnaire. Descriptive statistics, t-tests, and F-tests were used for data analysis. Results: The overall mean scores of effective nurse educators’ characteristics based on students’ perspectives were 4.36 (SD = 0.45). Subject expertise was the most essential characteristic of the effective nurse educators (Mean = 4.45, SD = 0.47), followed by relational expertise (Mean = 4.44, SD = 0.52), personality (Mean = 4.36, SD = 0.45), and teaching-related behavior (Mean = 4.33, SD = 0.46). The results also showed that participants with different cumulative grade point averages had no different views on the characteristics of effective nurse educators (p > 0.05). However, participants of different ages and years of study had significantly different perspectives on the characteristics of effective nurse educators (p < 0.05). Conclusion: The study offers necessary information regarding the essential characteristics of effective nurse educators. Therefore, nurse educators can use the study results to improve their desired characteristics. In addition, faculty development programs may be planned to help nurse educators improve these characteristics.

Background: Loneliness is a problem experienced by most older adults due to internal and external factors. This condition may lead to various physical and psychological health problems, including depression, sleep disturbances, stress, and suicidal ideation. Therefore, exploring social environment support to reduce loneliness is a necessity. Objective: This study aimed to identify various kinds of social support to overcome loneliness in older adults. Methods: A scoping review was performed on studies retrieved from Embase, CINAHL, Cochrane, PubMed, and Google Scholar from 2012 until early 2022. Data were analyzed according to Arksey and O’Malley’s scoping review guideline. Results: Ten studies were systematically selected from 2,410 articles. The analysis indicated that the social environment support, including family support (affection, attention, emotional, motivation, and financial support), friends (peer group, partnership, advice, and appreciation), neighbors (work around the house, society involvement, and emergency), and government support (healthcare facilities and community programs), contribute to loneliness in older adults. Conclusion: The social environment support from families, friends, neighbors, and government may potentially help older adults to reduce their loneliness but need further validation. The variables included in each component also need construct exploration. However, the study findings may serve as basic knowledge for nurses to provide interventions to prevent and reduce loneliness among older adults.

Background: Breast cancer is the most commonly diagnosed cancer in women; it is also the second-leading cause of death from cancer. Persistent pain after breast cancer surgery is a serious clinical problem that negatively impacts the health-related quality of life of breast cancer survivors. Although persistent post-surgical pain following breast cancer surgery has long been under-reported; however, it is less explored in Pakistan's geographical background. Objective: The study aimed to examine the persistent post-surgical pain after breast cancer surgery and its relationship to health-related quality of life among Pakistani women. Methods: A descriptive correlational research design was employed in this study. The Brief Pain Inventory Short Form (BPI-SF) was used to assess the persistent post-surgical pain. The Functional Assessment of Cancer Therapy-Breast (FACT-B) was used to measure the health-related quality of life. Data were collected between February and May 2019 from Pakistani women who have undergone breast cancer surgery for at least three months and attended follow-up visits at two tertiary care hospitals in Pakistan. A Spearman’s correlation coefficient was used for data analysis. Results: The study included 91 Pakistani women. The participants were all females, with an average age of 45.6 years (SD = 6.53). The majority received radical mastectomy (n = 84, 92.3%) with adjuvant therapy (n = 91, 100%). The prevalence of breast surgery-related persistent pain was 100%, with 63 (69.2%) rating the pain as moderate to severe and reported neuropathic pain. The data analysis revealed a statistically significant negative correlation between BPI-SF items and FACT-B dimensions (r = -.43, p < 0.01). The participants appeared to show the highest score of the FACT-B in the social/family well-being (M = 16.58, SD = 3.44). The lowest score of the FACT-B was physical well-being (M = 6.98, SD = 6.38). Conclusion: Persistent post-surgical pain has a negative impact on the health-related quality of life of Pakistani women breast cancer survivors, particularly on their physical well-being. Therefore, follow-up care of breast cancer survivors after treatment completion requires proper persistent pain-relief treatments and interventions to control pain and maintain health-related quality of life in oncology and research in this sphere. This basic knowledge from this study will enlighten the nurses and health care professionals to pay more attention to pain management and regular evaluation of persistent post-surgical pain after breast cancer surgery in order to improve their health-related quality of life.

Background: Preventable illnesses cause many emergency department visits in older adults, which can be minimized by implementing appropriate transitional care interventions. However, the most effective transitional care strategies for older adults are unknown. Objective: To discover and consolidate transitional care interventions that can help older people avoid going to the emergency department. Methods: From January 2011 to August 2021, PubMed, The Cochrane Library, CINAHL, Web of Science, ProQuest, and The JAMA Network were used to search. Two authors independently screened and selected papers, assessed the risk of bias, and extracted data into a standardized form in accordance with Cochrane guidelines. For the risk of bias in studies, the RevMan 5.4.1 program was utilized. Results: Six randomized controlled trials, four non-randomized controlled trials, and three retrospective investigations were among the 13 studies examined. All studies evaluated emergency department visits but in different periods (ranging from 1-12 months after discharge) and with varying groups of baselines (pre-post intervention and between groups). The multi-component strategies, either pre or post-discharge phase using high-intensity care delivered within six months of discharge, were implemented in transitional care that had been shown to reduce emergency department visits in older adults. Conclusion: To prevent emergency department visits by older patients, nurses should arrange for a high-intensity transitional care intervention that involves both pre-and post-discharge interventions. The effectiveness of the intervention in reducing emergency department visits in older adults is difficult to determine due to inter-study heterogeneity and poor methodological quality. There is a need for more evidence-based research with consistent and trustworthy effect assessments. PROSPERO registration number: CRD42021261326

The COVID-19 pandemic highlighted that nursing cannot go back to its old way of providing care. Care is central to what nurses do and the profession itself, and now is the time for nursing to innovate and reimagine what nursing will look like in the future. From new models of care to technology, nursing has an endless opportunity to innovate the profession. The new model of nursing care must be sustainable and work to maximize nurses while leveraging technology as a tool to help improve quality outcomes. The opportunities are endless, and the time is now to innovate and reimagine nursing and its caring core.

Background: A natural family planning device, Fertility Tracking Tool (FTT), was developed to serve as a visual and tactile guide in monitoring the fertile and infertile days of the menstrual cycle. However, there is lack of preferences about the tool among visually impaired and non-visually impaired women. Therefore, understanding their viewpoints will provide additional input for the final design of the product. Objective: This study aimed to explore the opinions of potential users of FTT in terms of acceptability, price sensitivity, buying intention, product placement, branding, and packaging. Methods: The study employed a qualitative research design with data gathered from focus group discussions. Eleven FGD sessions were conducted participated by one group of visually impaired and ten groups of non-visually impaired women from Iligan City, Philippines, selected through purposive sampling technique. Semi-structured FGD guide was utilized, and the sessions were audio-recorded. The data were analyzed through thematic analysis. Results: The themes that emerged in the study were “adaptable” with three sub-themes (easy to use, safe to use, and aesthetic), “cost-effective”, “marketable”, “accessibility convenience”, “remarkable brand”, and “complementary packaging”. The study shows that the FTT is acceptable to both visually impaired and non-visually impaired women because it is user-friendly, has no side effects, and has a unique design. The accounts implying less price sensitivity, buying intention, accessibility preferences, notable branding, and auxiliary packaging are indications of the business potential of FTT. Conclusion: This study made a novel contribution to the nursing practice as the FTT is a newly invented device for natural family planning. The strong support from the government is necessary for FTT commercialization or even free distribution to the qualified users, not only in the research locale but extending the nationwide. The extensive FTT use may increase the natural contraceptive utilization in the Philippines, resulting in improved women’s health and population control. The FTT utilization can also be adapted across the globe to result in a better impact.

Background: Pregnancy period is a period for mothers to empower themselves to be safe and comfortable. Pregnant women must acquire pregnancy-related information, such as warning signs of pregnancy, to avoid severe complications and even death during pregnancy and childbirth. Therefore, developing an application for pregnant women would be very helpful. Objective: This study aimed to apply Human-In-The-Loop design with an android application to detect pregnancy risk early and avoid maternal morbidity and mortality. Methods: We collected data from the cohort of 5324 pregnant women at the community health centers in the West Lombok District from 2020 to February 2021. The data included age, parity, height, inter-pregnancy interval, hemoglobin levels, upper arm circumference, previous diseases, and bleeding history. We developed a Human-In-The-Loop mobile application and employed the decision tree for identifying pregnancy danger signs. The midwife (human-in-the-loop) reviewed and clarified the data to generate the final detection and made a recommendation. Results: The ordinal regression model revealed that older patients who have more parity, lower height, the distance of children <2 years, hemoglobin <11 g/dl, upper arm circumference (UPC) <23.5 cm, have positive HBsAg, have HIV disease, have a history of diabetes mellitus (DM), have a history of hypertension, positive protein urine, and have other diseases are more likely to have a high maternal risk. The decision tree outperformed and obtained a high accuracy of 92% ± 0.0351 compared to the nine individual classifiers (Nearest Neighbors, Random Forest, Neural Net, AdaBoost, Gaussian Naïve Bayes, Bagging, Extra Tree, Gradient Boosting, and Stacking). Conclusion: The Human-In-The-Loop mobile app developed in this study can be used by healthcare professionals, especially midwives and nurses, to detect danger indications early in pregnancy, accurately diagnose the high risk of pregnancy, and provide treatment and care recommendations during pregnancy and childbirth.

Background: The current earthquake disaster in Lombok, Indonesia, in July 2018 has caused 564 deaths, and 445.343 were evacuated to refugee camps, including children. Disasters have the potential in resulting short-and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. Nurses play a significant role when a disaster occurs. One of the nurses’ roles is to give a traumatic healing intervention to the victims Objective: This study sought to assess children’s psychosocial state after the 2018 Lombok earthquake. Methods: A total of 189 children from five regencies in Lombok were selected to participate in the study using accidental sampling. Data were collected using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics and cross-tabulation were used for data analysis. Results: The participants consisted of 98 girls (51.9%) and 91 boys (48.1%), with the majority (n = 142 [75.1%]) being from school-aged children. The SDQ results showed that most of the children were at the abnormal stage for difficulties (n = 103 [54.5%]), and most of them were at a normal stage for strength (n = 97 [51.3%]). The cross-tabulation analysis revealed that gender might influence the SDQ score for the strength (p = 0.034), but not for difficulties (p = 0.482). However, age did not have a correlation with SDQ score, either for strength (p = 0.475) or difficulties (p = 0.836), respectively. Conclusion: The study found that children in Lombok generally displayed positive behavior and emotional progress after the earthquake. However, some children remained in distress and thus required more observation from parents or other social welfare agencies. This research may help nurses decide on their nursing care for children who experience disasters.

Background: Depression is a common psychological condition after spinal cord injury. There are increased incidences of self-harm, suicidal behavior, and lower quality of life among people with spinal cord injury and depression. However, self-management of depressive symptoms in the community is less explored. Objective: This study aimed to examine the prevalence, severity, and self-management of depressive mood in community-dwelling people with spinal cord injury. Methods: A descriptive study was conducted in 2019 among 115 people with spinal cord injury discharged from three health centers and living in the 13 districts of Bagmati Province. Participants were selected using stratified random sampling. Questionnaires were related to demographics, health and environment, depressive mood, and self-management. Descriptive statistics and quantitative content analysis were used to analyze the data. Results: Ninety-seven (84.3%) people with spinal cord injury had a depressive mood. Of these, 60.8% had moderate to severe depressive moods. They mainly used the internet and social media, shared feelings with family members, and practiced Hindu religious activities for depressive mood management because of the physical barriers to accessing a healthcare facility and easiness to use of non-pharmacological methods. Nearly half of participants who used sharing of feelings felt their depressive mood disappeared when they often used the method. Conclusion: Depressive mood following initial hospitalization is highly prevalent among people with spinal cord injury in Nepal, most of whom live in rural settings. Therefore, nurses and other health professionals should provide psychoeducation for this population and their family members to better address mental health problems. Facilitating pathways for those in rural areas to engage in social activities and timely treatment access may improve depressive mood. Nurses and other rehabilitation professionals can use social media to assess depressive moods and deliver management approaches in the community.

Background: Employees’ work experience significantly impacts their cognition and workplace actions. Anger and negative affectivity are two personality traits that have been linked to workplace deviant behavior conduct. Objective: This study aimed to empirically analyze the deviant workplace behavior and its antecedents among Malaysian nurses in public hospitals. Methods: A cross-sectional design was employed in this study. The survey questionnaires were distributed proportionately to staff nurses in six government hospitals in 2020, with a total of 387 nurses selected using a simple random sampling. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used for data analysis. Results: Trait anger triggered deviant workplace behavior in Malaysian nurses, thus supporting the argument that the personality trait could increase deviant behavior (β = 0.245, p = 0.000). At the same time, there was no evidence that negative affectivity could influence deviant behavior in the workplace among nurses in selected public hospitals in Malaysia (β = 0.074, p = 0.064). Conclusion: The Malaysian nurses had positive affectivity, related to positive emotions like happiness, work interest, and attentiveness. On the other hand, the nurses were suffering from high levels of emotional tiredness. Further research should highlight a deeper understanding of Malaysian nurses’ work experiences and workplace stress affecting their physical and mental health.

Background: Enhancing patient safety awareness competency in nursing students is a necessity as they will be the next generation of professional nurses to take care of patients. One of the strategies is to create an innovative learning model using questioning as part of the metacognitive thinking concept. Objective: This study aimed to develop a clinical learning model to enhance patient safety awareness competency among Thai nursing students and determine its effectiveness. Methods: The study used a research and development design with two phases: (1) the development of a clinical learning model to enhance patient safety awareness competency among nursing students, and (2) the evaluation of the effectiveness of the developed clinical learning model. The evaluation was done quantitatively and qualitatively. In the quantitative strand, a quasi-experimental method using repeated measures design was used in 24 students. While in the qualitative strand, a qualitative descriptive design was employed in 24 students and three teachers. Results: In the first phase, the DUIR clinical learning model was developed, consisting of four processes: 1) Doubt (D), 2) Understanding (U), 3) Insight (I), and 4) Reflected value (R). The patient safety awareness competency included two components: managing patient safety and solving problems related to unsafe patient care. In the second phase, the model was evaluated by the students and the teachers. It revealed that nursing students’ patient safety awareness competency was very high, and the competency was statistically different before and after the learning model. Conclusion: The developed DUIR learning model using a questioning strategy is considered effective to encourage students to reflect critically on their own clinical experiences in order to achieve quality and safe care outcomes, thereby enhancing patient safety awareness for nursing students in a sustainable way. This model serves as an input for Thai nursing education and beyond.

Background: Expressing enjoyment when conversing with healthcare robots is an opportunity to enhance the value of human robots with interactive capabilities. In clinical practice, it is common to find verbal dysfunctions in patients with schizophrenia. Thus, interactive communication characteristics may vary between Pepper robot, persons with schizophrenia, and healthy persons. Objective: Two case studies aimed to describe the characteristics of interactive communications, 1) between Pepper as a healthcare robot and two patients with schizophrenia, and 2) between Pepper as a healthcare robot and two healthy persons. Case Report: The “Intentional Observational Clinical Research Design” was used to collect data. Using audio-video technology, the conversational interactions between the four participants with the Pepper healthcare robot were recorded. Their interactions were observed, with significant events noted. After their interactions, the four participants were interviewed regarding their experience and impressions of interacting with the Pepper healthcare robot. Audio-video recordings were analyzed following the analysis and interpretation protocol, and the interview data were transcribed, analyzed, and interpreted. Discussion: There were similarities and differences in the interactive communication characteristics between the Pepper robot and the two participants with schizophrenia and between Pepper and the two healthy participants. The similarities were experiences of human enjoyment while interacting with the Pepper robot. This enjoyment was enhanced with the expectancy of the Pepper robot as able to entertain, and possessing interactive capabilities, indicating two-way conversational abilities. However, different communicating characteristics were found between the healthy participants’ impressions of the Pepper robot and the participants with schizophrenia. Healthy participants understood Pepper to be an automaton, with responses to questions often constrained and, on many occasions, displaying inaccurate gaze. Conclusion: Pepper robot showed capabilities for effective communication pertaining to expressing enjoyment. The accuracy and appropriateness of gaze remained a critical characteristic regardless of the situation or occasion with interactions between persons with schizophrenia, and between healthy persons. It is important to consider that in the future, for effective use of healthcare robots with multiple users, improvements in the areas of the appropriateness of gaze, response time during the conversation, and entertaining functions are critically observed.

Background: Analyzing how nurses handle professionalism in their careers will help all concerned individuals identify areas of concern to develop and enhance further to achieve or maintain a high degree of professionalism. Objective: This study aimed to determine the level of professionalism among nurses and its differences according to socio-demographic characteristics. Methods: A quantitative cross-sectional approach was utilized in three significant regions of Saudi Arabia. A simple random sampling technique was employed with 305 respondents, resulting in a 95.9% response rate. A Google Form survey was used to collect the data between January and April 2021. Results: Nurses perceived themselves highly in professional organization (Mean = 3.94, SD = 0.17), belief in public service (Mean = 3.91, SD = 0.22), belief in self-regulation (Mean = 3.97, SD = 0.08), sense of calling (Mean = 4.01, SD = 0.13), and belief in autonomy (Mean = 3.71, SD = 0.15). There was no significant difference between gender and professional organization, belief in public service, self-regulation, or belief in autonomy. Still, there was a significant difference in belief in public service (t = 2.794; p = 0.006) and sense of calling (t = 4.290; p = 0.001). As to age, only belief in self-regulation was significant (t = 5.984; p = 0.003). Moreover, the educational qualifications reached an insignificant difference in professionalism. Conversely, the type of facility has been found to have reached significant differences with a professional organization (F = 3.057; p = 0.029), belief in public service (F = 4.130; p = 0.007), beliefs in regulation (F = 3.452; p = 0.017), sense of calling (F = 3.211; p = 0.023), and belief in autonomy (F = 5.995; p = 0.001). Lastly, the current position found no significant difference in professionalism. Conclusion: Nurses in the Kingdom of Saudi Arabia perceived themselves as highly professional, and male nurses were found to have a sense of calling more than their female counterparts. Age, educational qualification, and current position had no significant difference in professionalism. Conversely, the type of facility had a significant difference with the belief in autonomy. These findings support and sustain the role of nurses in this 21st-century health care that is significantly needed to provide the most quality care.

Background: Surgical site infection has become a problem in the operating room, and the nurses’ knowledge, attitude, and practice could impact the incidence of the infection. Unfortunately, there is a dearth of studies on this issue in China. Therefore, determining nurses’ knowledge, attitude, and practice of surgical site infection prevention is necessary. Objectives: This study aimed to examine the knowledge, attitude, and practice of surgical site infection prevention and their relationships, as well as to identify differences in knowledge, attitude, and practice of surgical site infection prevention according to nurses’ demographic characteristics. Methods: A sample of 999 operating room nurses participated in 49 tertiary hospitals and 75 secondary hospitals in Guizhou Province, Southwest China. Data were collected using validated questionnaires through a Chinese survey website. Data were analyzed using descriptive statistics, One-Way Analysis of Variance, and Pearson product-moment correlation. Results: The knowledge of surgical site infection prevention was at a low level, the attitude was positive, and the practice was at a high level. Approximately 39% of the nurses passed knowledge scores of ≥ 70%, 60% gave a positive attitude score of ≥ 80%, and 76% achieved a practice score of ≥ 80%. The nurses’ attitude was positively related to knowledge (p < .01), and practice (p < .01), respectively. However, knowledge and practice did not significantly relate. The age group of 30-39 years old had significant higher knowledge than other age groups. The nurses with working experience of 6-15 years had significant higher knowledge scores than other groups. In addition, the nurses with one time of training frequency had significant lower attitude and practice scores than those with six to ten times of training frequency. Conclusion: Approximately 60% of operating room nurses still had inadequate knowledge regarding surgical site infection prevention, but they had a positive attitude and high level of practice. The findings of this study might serve as an input for nurse administrators or policymakers to provide updated knowledge or guideline, closed supervision, and in-service training on surgical site infection prevention for operating room nurses.

Background: Adherence to antiretroviral therapy (ART) can be challenging since it needs to be continued for a lifetime. At their age, adolescents start to be responsible for their life, and this continued therapy might be a challenge for them. Objective: This study explored the experiences of adherence to ART in adolescents living with HIV in Jakarta, Indonesia. Methods: A qualitative study with an Appreciative Inquiry (AI) approach was employed to explore challenges adolescents face in ART adherence which focused more on positive aspects of the experience. In-depth interviews were conducted with ten adolescents who were selected purposively based on criteria including those aged 13-19 years, having been diagnosed with HIV infection and receiving ART for more than a year, and never having discontinued ART. All participants were registered in the outpatient clinic in one top referral hospital in Jakarta. The data were analyzed using thematic analysis. Results: Five themes were identified from the data: living a normal life, wanting to be healthy, taking medication on time, challenges in undergoing treatment, and there is hope. Conclusion: Adolescents with HIV want to live as normal and healthy as possible, like other adolescents. Even though adolescents face several challenges to comply with ART, they try to take the medication as prescribed. The findings of this study serve as input for nurses to maintain compliance with ARVs in adolescents who have HIV.

Background: As Quality of Life (QoL) becomes progressively vital in health care services, its importance in mother and child health is of no exception too. Quality of life among mothers with a premature newborn is an issue that has led to growing concerns in the health care system. Yet, despite the knowledge about mother’s QoL being essential to family-centered planning on prematurity integrated healthcare, current evidence has been scant. Objective: To examine factors related to the QoL of mothers having preterm newborns hospitalized in the neonatal critical unit. Methods: A non-probability convenience survey was used in a public hospital in Malaysia, covering 180 mothers whose preterm newborns were hospitalized into level III Neonatal Intensive Care Unit (NICU) through the completion of a 26-questions survey of the World Health Organization Quality of Life (WHOQOL-BREF) and the 26-questions of Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU). The data were analyzed using descriptive statistics, bivariate analysis, and Pearson correlation coefficients. Result: The mean scores for mothers' quality of life were (M = 3.67, SD = 0.73) and maternal stress (M = 3.03, SD = 0.90) out of 5. A mother’s occupation was found to be the only factor associated with the quality of life among mothers who have preterm newborns admitted to the NICU. Furthermore, maternal role change was found to have a moderate negative relationship with the quality of life (r = 0.310, p = 0.05). Conclusion: The findings of this study revealed that the main factors contributing to the mother’s QoL during their preterm newborns’ NICU admission were role change-related stress. Thus, to maintain a better QoL among this group of mothers during this traumatic period, a special nursing intervention program must be implemented immediately, right after the preterm newborns’ admission, to relieve the mothers’ stress which has been proven to have a direct effect on the mothers’ QoL. The study results will alert healthcare providers, particularly neonatal nurses, on the need to support mothers psychologically in terms of role change. This is to ensure a better quality of life among mothers whose newborns were admitted to the NICU.

Background: Adolescents require life skills and individual and interpersonal abilities to grow into adults with a healthy lifestyle. Although the majority of the literature indicates that life skills increase teenagers’ cognitive, social, and emotional abilities, there is a lack of data correlating life skills to sexual risk behaviors. Objective: This study aimed to examine the relationship between life skills and sexual risk behaviors among adolescents aged 15–19 in Bandung, Indonesia. Methods: This study was conducted using a cross-sectional survey of 480 adolescents from April to May 2021. A representative sample was drawn from the students aged 15–19 years. The participants were selected using simple random sampling generated by computer software. Life Skill Training Questionnaire High School (LSTQ-HS) and sexual risk behaviors instruments were used for data collection, and logistic regression was used for data analysis. Results: From a total of 480 respondents, about 23.3% had masturbation experience, 25.8% had petting experience, 8.3% had sexual intercourse, 5% had sex before 18 years of age, and 4.2% had oral sex experience. Sexual risky behaviors were associated with unfavorable refusal skill (AOR = 6.46, 95% CI = 2.37, 17.53), assertiveness skill (AOR = 3.51, 95% CI = 1.32, 4.33), problem-solving skill (AOR = 5.35, 95% CI = 2.88, 11.39), and self-control skill (AOR = 7.31, 95% CI = 2.79, 17.24). Conclusion: Life skills are important protective aspects for those who engage in sexually risky behavior. Considering the study findings, tailored life skills programs are critical for adolescent wellbeing and risk reduction. Nurses who take a proactive role in providing sexual and reproductive health services may provide more accurate information and provide early screening and assessment for sexual and reproductive behavior to reduce risky sexual behavior among adolescents. Schools are also encouraged to work with local health departments to conduct sexual education counseling programs.

Acceptance of roles in the care of older adults by a family caregiver depends on factors emanating from commitment to familial relationships, widespread cultural expectation, and debt of gratitude. This study aims to develop a theory that explains the acceptance of the role of caregiving of the older adults by the family caregiver necessary to predict behavioral adaptation and control caring phenomenon that favors successful meeting of caring expectation across trajectory phases and transitions. A deductive axiomatic approach to theory generation was utilized, resulting in four axioms that served as bases for four propositions. Acceptance Theory of Family Caregiving implies that older adults who expect their children to take care of them as they age have cultural influence and that the acceptance of the role will determine the caregiver’s acceptance of consequences in the form of physical, economical, psychological, and spiritual aspects. In terms of preparedness, family members who accept the possibility of the decline of their older adults are more likely to be assume caregiving roles efficaciously. In the process that family members face in this so-called trajectory caregiving process, resources play a significant role. The developed theory suggests that the care of the older adult in the family caregiving process is determined by the acceptance of role assumption by the family caregiver across trajectory phases. This study highlights the vital implication of acceptance of role assumption to the outcomes of the caregiving process with respect to older adult care, prevention of family caregiver burden, and establishment of strong familial and social relationships.

Background: Hospital Survey on Patient Safety Culture (HSOPSC) is considered one of the most scientifically rigorous tools available with excellent psychometric properties. However, it is not yet available in an Indonesian version. Objective: This study aimed to determine the validity of the content and psychometric properties of HSOPSC 2.0 for use in Indonesian hospitals. Methods: The study was divided into three stages: translation, adaptation, and validation. Culture-adaptation was assessed using cognitive interviews with ten direct care nurses who worked in the hospital to evaluate their perceptions and the coherence of the translated items, response categories, and questionnaire directions. Content validity was also done by ten experts from academic and clinical settings. Finally, Confirmatory Factor Analysis (CFA) and reliability testing were conducted among 220 nurses from two Indonesian hospitals. Results: The cognitive test results indicated that the language clarity was 87.8 % and 84.5% for cultural relevance. The Content Validity Index (CVI) ranged between 0.73 to 1.00, while the construct validity results indicated that each factor had factor loadings above 0.4, from 0.47 to 0.65. The fit indices showed an acceptable fit for the data provided by the 10-factor model, with RMSEA = 0.052, SRMR = 0.089, and CFI = 0.87. The Pearson correlation coefficients between the ten subscales ranged from 0.276 to 0.579 (p < 0.05). The Cronbach’s alpha for all sub-scales was more than 0.70, except for organizational learning – continuous improvement, response to error, and communication openness. Conclusion: This study offers initial evidence of the psychometric properties of the Indonesian-HSOPSC 2.0. Future studies are needed to examine its psychometric features to improve generalizability. However, nurses and other healthcare professionals could use the tool to measure hospital patient safety culture in Indonesia.

Nursing handover exemplifies both the nurse’s professional ethics and the profession’s integrity. The article by Yetti et al. acknowledges the critical role of structure and process in handover implementation. At the same time, they emphasised the fundamental necessity to establish and update handover guidelines. I assert that effective patient handover practices do not simply happen; instead, nurses require pertinent educational support. It is also pivotal to develop greater professional accountability throughout the handover process. The responsibility for ensuring consistent handover quality should be shared between nurse managers and those who do the actual handover practices.

As a dynamic developmental process, the older population further displays the capacity to resist change over time, improve resilience, and keep a basis for the continuity working and progress over positive management of detrimental consequences of life risks and difficulties. This study aims at developing a theory that endeavors to explore the process of developing aging-related resiliency in people’s later in life that can lead to a successful aging experience. In the development of a theory, this study utilized a deductive reasoning approach specifically, using the axiomatic approach. Aging-related Resiliency Theory was efficaciously developed by three propositions generated from four axioms that were derived after reviewing several sets of literature and studies. This developed theory implies that various deleterious events in life activate older persons to respond, adapt, and recover effectively. Acceptance emerges as they acknowledge the natural effects of aging while taking adaptive strategies and supportive resources to be resilient to one’s environment. In this sense, it impacts their optimistic outlook towards successful aging. Based on the extraction of axioms, such propositions denoted those older adults call to respond with their total capacity to accept, adapt, recover, and continuously resist deleterious life experiences while using enriched coping strategies and resources towards an optimistic outlook in achieving successful aging. Therefore, emphasizing to improve their capacity to respond to natural decline to essential processes could benefit them at promoting a healthier life span.

Background: Suicide is the second leading cause of death among adolescents around the globe. Therefore, understanding its causes and prevention is needed. Objective: This study aimed to explore Thai secondary school students’ perceptions related to causes and preventions of suicide and the learning needs of suicide prevention. Methods: A descriptive qualitative approach was employed in this study. Purposive sampling was used to select 32 adolescents for focus group discussions and ten adolescents for in-depth interviews. Data were collected from September 2019 to March 2020 and analyzed using content analysis. Results: Causes of suicide included seven sub-categories: parents’ expectations of children’s academic achievement, bullying, family problems, teenage love, lack of stress management skill, imitation behavior on social media, and substance use behavior. Suicide prevention consisted of five sub-categories: peer support, parental support, school support, health professionals and significant support, and knowing the value and believing in self. In addition, students’ learning needs had two sub-categories: developing online learning platforms regarding suicide prevention and mental health promotion and prevention projects. Conclusion: The findings of this study could guide nurses and other health professionals to develop a suicide prevention program for secondary school students. The study results could also be used as essential evidence for driving health care policy in promoting and preventing suicide in adolescents with the involvement of key stakeholders.

Background: Nurses are involved in all aspects of health, including reproductive health. They play a fundamental role in family planning and are often designated as point persons in family planning-related concerns. In order to provide effective counseling on family planning, the nurse must understand issues, practices, and prospects of family planning among married couples in their community. Objective: This exploratory multiple case study investigates family planning issues, practices, and prospects among couples in a municipality located in Southern Philippines. Methods: Ten married couples of varying characteristics were interviewed to elicit their perspectives on family planning practices. The data were analyzed using coding transcriptions and thematic analysis. Results: Five sub-themes emerged under the theme of Family Planning Issues: family planning as a burden; fear of side effects; peer-driven contraceptive choice; family planning as a social stigma; family planning as a sin. Two sub-themes emerged under the theme of Family Planning Practices: knowledge of family planning commodities; availability and acceptance of the contraceptive method. Finally, two sub-themes also emerged under the theme of Family Planning Prospects: family planning as a financially beneficial practice; prospects on family planning depend on husband’s acceptance. Conclusion: These sub-themes were also distinguished by their similarities and differences based on the four parameters identified, including age, sex, financial status, and educational attainment, which aided in the development of recommendations that could be implemented in the local community. The results of this study especially have a bearing on nurses and their role in the family planning process. Nurses play a fundamental role in guiding community members and families toward health and wellness. Thus, it is crucial for nurses to understand family planning issues underpinning their community so they can better exercise their role.

Background: Diabetes management is applied for the entire patients’ lives, so it requires lifelong sustainable self-management actions to have a positive impact. Integrated care as coaching intervention is considered a program that facilitates and supports patients in managing diabetes more effectively and optimally. However, there are limited studies regarding this program in Indonesia. Objective: This study aimed to explore the opinions of healthcare professionals concerning the importance of health coaching for patients with diabetes in Indonesia. Methods: An invitation letter via email was distributed individually to participants from the three provinces of Java, Indonesia, between June and August 2020. The open-ended questions that consist of two sections were developed to explore the matter related to health coaching for patients with diabetes. A descriptive analysis of the participants’ answers was used to explain the data comprehensively and accurately reveal the complete information. Results: A total of seven healthcare professionals from four professions participated in the study. Based on healthcare professionals’ opinions, this study revealed that the most common reason health coaching needs to be implemented is related to self-management in dealing with diabetes. Health coaching as a tailored-intervention strategy in diabetes self-management requires a multidisciplinary approach and considers the local wisdom to achieve the expected goals in all aspects of patients’ lives. Thus, health coaching as an integral part of diabetes self-management is considered an appropriate program to cope with this problem. Conclusion: Health coaching for patients with diabetes is useful and reasonable to implement among patients with appropriate strategies, especially in Indonesia and beyond.

Background: While aesthetics in nursing practice brings out the beauty in nursing, studies regarding how aesthetics are implemented in practice are lacking. Objective: To describe the meanings of aesthetics in nursing practice experienced by nurses in Indonesia. Methods: This qualitative study employed a hermeneutic phenomenological approach based on Gadamerian philosophy. Thirteen nurses were asked to reflect on their experiences of providing aesthetics in their practice through drawing, followed by individual face-to-face interviews. Data were collected in a public hospital in West Sumatra, Indonesia. The interview transcripts and the pictures were analysed following van Manen’s approach. Results: Five thematic categories were revealed: 1) Engaging in caring for persons; 2) Full of compassion; 3) Sympathetic place of care; 4) A joyful time of care; and 5) Distracting the inconvenience in care. Conclusion: Aesthetics in nursing practice is understood and experienced by Indonesian nurses in various ways, not only limited to the visual beauty, cleanness or tidiness of nursing intervention, but are expressed in other ways within caring, including providing care with compassion, applying the art of communication, relieving the pain, and applying innovation in care. These findings can be used to inform nurses in practising aesthetic nursing for enhancing the quality of care.

Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms.Nurses’ workplace stress is also linked to increased absenteeism and decreased job satisfaction. Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms. Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses’ workplace stress, coping strategies, and depressive symptoms. Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items.  Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses’ work experiences and the unique contribution that workplace stressors have on their physical and mental health.

Background: The COVID-19 pandemic has become a global public health issue, and the roles of nurses are very much needed in providing nursing services in the current situation. The enforcement of appropriate nursing diagnoses for patients with COVID-19 is also fundamental in determining proper nursing care to help the patients achieve maximum health. Objective: This study aimed to describe and analyze nursing diagnoses in patients with COVID-19 treated in the isolation rooms and ICUs. Methods: This study used a secondary data analysis from hospital medical record data of patients with COVID-19 from early December 2020 to the end of February 2021. Data were selected using a cluster random sampling technique and analyzed using descriptive statistics. Results: The results showed that the signs and symptoms of the patients with COVID-19 that often appeared were fever, cough, shortness of breath, and decreased consciousness. The common nursing diagnoses in the hospitalized patients with COVID-19 were hyperthermia, ineffective airway clearance, gas exchange disorder, self-care deficit, spontaneous ventilation disorder, spontaneous circulation disorder, knowledge deficit, and shock risk. Conclusion: This study offers an insight into nursing practices in the hospital setting, which can be used as a basis for nurses to perform complete nursing assessments and nursing diagnoses during the pandemic.

Background: The incidence of latent tuberculosis among healthcare workers, especially nurses, at public health centers in Indonesia has been increased. Therefore, factors related to the tuberculosis incidence need to be further investigated. Objective: This study aimed to identify the determinants of latent tuberculosis infection among nurses at public health centers in Indonesia. Methods: This non-experimental, cross-sectional study included 98 nurses. Data on the determinants of latent tuberculosis infection were collected using validated questionnaires, and the infection status was confirmed by Interferon Gamma Release Assay or IGRA test. Logistic regression was used for statistical analysis, with a significance level of p < 0.05. Results: Health facilities for tuberculosis transmission prevention were available in all public health centers (100%). Protocols for preventingtuberculosis transmission including occupational health and safety training (OR = 13.24, 95% CI [2.29–58.55]; p = 0.001), handwashing after contact with patients or specimens (OR = 20.55, 95% CI [4.23–99.93]; p = 0.000), and wearing of medical masks (OR = 9.56, 95% CI [1.99–45.69];p = 0.005) were found to be significant determinants of latent tuberculosis infection among nurses. Conclusion: The availability of protective equipment and implementation of health protocols among nurses at public health centers are the main determinants of latent tuberculosis infection. Hence, they should be maintained by all nurses to prevent the spread of tuberculosis.

Background: The transition from hospital to home among patients with stroke is quite challenging. If the patients are not ready for hospital discharge, their condition may worsen, which also causes a high rate of readmission. Although instruments to measure readiness for hospital discharge exist, none of them fit with the Thailand context. Objective: This study aimed to develop a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. Methods: The study was conducted from February to September 2020, which consisted of several steps: 1) conducting an extensive literature review, 2) content validity with five experts, 3) pilot testing with 30 samples, and 4) field testing with 348 participants. Content validity index (CVI) was used to measure the content validity, Cronbach’s alpha and inter-item correlation to evaluate reliability, and multiple logistic regression analysis to measure the construct validity. Results: The findings showed good validity and reliability, with I-CVI of 0.85, Cronbach’s alpha of 0.94, and corrected item-total correlation ranging from 0.43 to 0.86. The construct validity was demonstrated through the results of regression analysis showing that the nine variables include level of consciousness (OR = 0.544; CI 95% = 0.311 - 0.951), verbal response (OR = 0.445; 95% CI 0.272- 0.729), motor power right leg (OR = 0.165; 95% CI 0.56- 0.485), visual field (OR = 0.188; 95% CI 0.60-0.587), dysphagia (OR = 0.618; 95% CI 0.410-0.932), mobility (OR = 0.376; 95% CI 0.190 - 0.741), self-feeding (OR = 0.098; 95% CI 0.036 -0.265), bathing (OR = 0.099; 95% CI 0.026-0.378), and bladder control (OR = 0.589; 95% CI 0.355-0.977) that significantly influenced the hospital readmission within 30 days in patients with stroke. Conclusion: The Readiness for Hospital Discharge assessment tool is valid and reliable. Healthcare providers, especially nurses, can use this tool to assess discharge conditions for patients with stroke with greater accuracy in predicting hospital readmission.

At the convergence of the “new normal” from the COVID-19 pandemic and the combination of caring, leadership, and technology, a new environment for organizational culture was formed. The injection of technology into how leaders provided care to their organization launched e-caring, and this is now considered a key in employee engagement and retention post COVID-19 pandemic. The purpose of this editorial is to briefly reflect on the importance of e-caring for leadership during the crisis and increase the commitment of nursing leaders to continue their great works even after the pandemic with an organizational culture infused with e-caring.

Background: The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources. Objective: This study aimed to explore the experiences of nurse managers in managing staff nurses’ work schedules during the COVID-19 pandemic. Methods: A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study. Results: Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff. Conclusion: The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

Background: Integration of rational drug use (RDU) into a nursing program to increase nurse graduates’ RDU competencies is essential to solving the problem of irrational drug use. Objective: This study aimed to evaluate the integrated model of the RDU into the Bachelor of Nursing Science (BNS) program developed by the Thailand Nursing and Midwifery Council (TNMC). Methods: A mixed-methods study was designed using a sequential explanatory design. The whole population of 3,848 nurse educators and 9,249 nurse graduates from 86 nursing education institutions across Thailand in Academic Year 2018 were recruited for quantitative data collection. Fifty nurse educators selected as representatives of the nursing education institutions were recruited for qualitative data collection. Online questionnaires were sent to collect information regarding the context, input, process, and product relating to the model, while structured focus group guidelines were developed to obtain more details in assessing the model. The data were analyzed using descriptive statistics and content analysis. Results: The findings showed that the context and policy of utilizing the model to increase nurse graduates’ RDU competencies were well accepted. The nurse educators’ RDU competencies, the input of the model, were rated at a high level. The process of the model was implemented as guided at almost all nursing education institutions. The product of the model, the RDU competencies of the nurse graduates, was reported at a high level. Conclusion: The model of integrating the RDU into the BNS program developed by the TNMC was well performed and resulted in high RDU competencies of the nurse graduates. This integration model should be published and applied in nursing schools worldwide to enhance RDU competencies of nurse graduates.

Background: Nurses as primary healthcare providers demonstrate quality nursing care through competencies with healthcare technologies, while nurse managers assume the primacy of managing quality healthcare in their respective care settings. However, little is known about perceptions of the influence of care technologies on their nursing practice. Objective: This study aimed to determine managers’ and staff nurses’ perceptions regarding the Technological Competency as Caring in Nursing (TCCN) theory in general hospitals in Japan. Methods: This study employed a cross-sectional survey design, with 421 participants selected using a stratified sampling method. Technological Competency as Caring in Nursing Instrument–Revised (TCCNI-R) was used for online data collection using Survey Monkey©. Data were analyzed using Welch’s t-test and ANOVA. Results: Nurses with years of experience within the range of 20 to less than 30 years showed the highest TCCNI-R scores among the two groups. Nurses who had received education on caring in nursing showed significant differences for Factor 2 (Technological Competency as Caring), that of expressing Technological Competency as Caring. Three other factors showed no significant difference, namely in Factor 1 (Nursing Expression as Caring), Factor 3 (Technology and Caring), and Factor 4 (Technological Knowing). However, the average scores of these factors were high, which reflect high professional ethics and occupational discipline and increased awareness of caring in nursing. It was also found that the nurse managers were more aware of the TCCN than were the staff nurses. The nurse managers were also more aware of providing care using technology, recognizing the need-to-know patient needs through technology and providing care to the ever-changing patient’s condition. Conclusion: The study discovered that continuing education is needed regarding the practice of nursing based on theory, enabling appropriate and accurate understanding of practicing knowing persons as caring in nursing.

Background: Caring practice for critically ill patients refers to the actions/behaviors/performance of nurses while caring for critically ill adult patients in the intensive care unit (ICU). Although the caring practice is vital in ICUs and complex due to the multitude of availabletechnologies, research on ICU nurses’ caring practice and its predictive factors are lacking. Objective: This study aimed to explore the level of nurses’ caring practice for critically ill patients in critical technological environments in China and its predictors. Methods: This was a cross-sectional online survey study with 218 ICU nurses in 29 tertiary hospitals of Guizhou province, China, from 1st to 30th April 2020. Data were collected by using e-questionnaires made in the Questionnaire Star program, including the Demographic Data Questionnaire (DDQ), Practice of Technological Competency as Caring in Nursing Instrument (P-TCCNI), Influence of Technology Questionnaire (ITQ), and Nurses’ Professional Value Scale (NPVS). The questionnaires were content validated by three experts. Cronbach’s alpha coefficient was 0.96 for the P-TCCNI, 0.70 for the ITQ, and 0.95 for the NPVS. Links to the questionnaires were distributed by research assistants to WeChat groups including target participants. Statistical Package for the Social Science (SPSS) program version 26 (IBM Corporation, Armonk, NY, USA) was used for data analysis. Descriptive and inferential statistics were used to analyze the data. Multiple linear regression analysis using stepwise solution analysis was performed to identify unique predictors of nurses’ caring practice. Results: The level of nurses’ caring practice for critically ill patients was high (mean = 87.30, standard deviation = 13.73). The professional value was a significant predictor of nurses’ caring practice (β = 0.41, p = 0.00). Conclusion: ICU nurses exhibited a high level of caring practice. Professional value was a significant predictor of ICU nurses’ caring practice. Nursing administrators should understand the current situation of caring practice in critical technological environments and design strategies to maintain and improve ICU nurses’ professional value to increase the level of caring practice.

Background: Understanding the true world of children needs a special method. Using aesthetic expressions through artworks with reflections assists nurse researchers in exploring children’s feelings, thoughts, and behaviors in relation to their health and well-being. Objective: This article focuses on the use of aesthetic expressions as innovative data sources in a study of the lived worlds of children experiencing advanced cancer. Method: The use of aesthetic expressions in Gadamerian hermeneutic phenomenology and aesthetics, by means of van Manen’s approach using draw and write, is examined as a suitable approach in a study of the lived worlds of children experiencing advanced cancer. Results: The aesthetic expressions through the Draw-and-Write method of data generation were well-suited to a hermeneutic phenomenological study involving the group of Filipino children living with advanced cancer. The children drew images and figures of themselves, their families, classmates, friends, and teachers in several places and events during the series of two days. The drawings showed their facial expressions, home, parents, hospital stay, school activities, extracurricular activities, and other daily activities. Conclusion: Aesthetic expression linked to art and connected to human experience drew the participants into different realms and expanded their perceptual capacities so that the fullness of the meaning of the experience was appreciated. The understanding of the experience through aesthetic expression provided sensitivity to and awareness of the variation of experience among children with advanced cancer. It is hoped that this paper can contribute to an understanding of aesthetic expressions as pathways to understanding and support health professionals as they embark on their goal of creating or restoring a comfortable relationship with children.

Background: Breast cancer genetic (BRCA) testing for cancer susceptibility is an emerging technology in medicine.  Objective: This study assessed the knowledge and attitude of nurses regarding BRCA genetic testing in a tertiary teaching hospital in Malaysia. Methods: A descriptive cross-sectional study was conducted among 150 nurses using a simple random sampling technique in a tertiary teaching hospital in northeast peninsular Malaysia. Data were collected using a self-administered questionnaire consisting of socio-demographic data, assessing nurses’ knowledge and attitude regarding BRCA genetic testing. Fisher exact test analysis was used to determine the association between socio-demographic characteristics with knowledge and attitude level. In addition, the overall knowledge and attitude were analysed using the sum score of each outcome based on Bloom’s cut-off point. Results: Of the 150 nurses, 66.7% had high knowledge level about BRCA genetic testing, and 58% were positive towards genetic testing. The participants’ mean age was 28.9 years (SD = 6.70). Years of working experience (p = 0.014) significantly influenced knowledge level on BRCA genetic testing, whereas speciality working experience (p <0.001) significantly influenced BRCA genetic testing attitudes. Conclusions: The results show that most nurses have adequate knowledge of BRCA genetic testing. However, their attitude could be termed negative. Therefore, targeted education programs on BRCA genetic testing and risk are needed to improve the knowledge and attitude of nurses and, ultimately, can educate the women and increase health-seeking behaviour among eligible women.

Background: Consideration needs to be given to variables that impact the application of evidence-based nursing practice. Objective: This study aimed to generate and validate a structural model of factors predictive of evidence-based nursing practice. Methods: A cross-sectional descriptive design was used, with 612 registered nurses in the southern area of Saudi Arabia selected using a convenience sampling procedure. Data were collected during the period from November 2019 to January 2020 using valid and reliable questionnaires, including the novel Registered Nurses’ Competencies, Beliefs, Facilitators, Barriers, and Implementation of the Evidence-based Practice Questionnaire. A structural equation modeling technique was used for data analysis. Results: Evidence-based nursing practice was significantly influenced by nurses’ competency, beliefs, barriers, and facilitators. 38.75% of the variance was explained by all factors. Specifically, nurses’ beliefs partially mediated the relationship between nurses’ competency and the evidence-based application of nursing practice. In addition, the relationship between nurses’ beliefs and evidence-based application of nursing practice was partially mediated by organizational facilitators. Nurses’ competency and beliefs were significantly influenced by attending the workshop, education level, years of experience, and previous research work. Conclusion: The current study highlights the significant effect of personal and organizational variables toward the application of evidence-based nursing practice.

Background: Heart failure is a complex clinical syndrome that disturbs physical and psychological health and the quality of life of persons with heart failure and their families. Physical activity is one of the essential self-care in persons with heart failure, which can decrease the exacerbation of the heart failure symptoms, increase activity tolerance, ability to accomplish daily activities, and improve quality of life. Objectives: This research aimed to determine the physical activity level among persons with heart failure and explore the relationship between physical activity and its related factors based on the self-and family management framework, including motivation, functional ability, family support, and perceived quality of patient-provider relationships. Methods: A correlational cross-sectional study was conducted with a total of 70 participants who visited the Multidisciplinary Heart Failure Clinic of a university-affiliated hospital, Bangkok, Thailand, from December 2020 to May 2021. Participants were asked to complete five questionnaires that explored their physical activity and its related factors. Data were analyzed and reported using descriptive statistics and correlation coefficient, and the p-value of .05 was considered to be statistically significant. Results: The results showed most participants (78.50%) had a high physical activity level, and the other participants (21.50%) had a moderate physical activity level. Regarding the relationship between physical activity and its related factors, a total physical activity had a significant positive correlation with a functional ability (rs = .309, p < .05), and family support (r = .210, p < .05). While the physical activity had a positively non-significant correlation with motivation (r = .050, p > .05), and a negatively non-significant correlation with perceived quality of patient-provider relationships (r = -.049, p > .05). Conclusion: The research can be used to gain more understanding of physical activity among persons with heart failure. Nurses play an accountable role in promoting and providing appropriate interventions to constantly maintain and enhance physical activity as secondary prevention in persons with heart failure. Additionally, measuring physical activity using an objective measurement with the self-report should be considered for the favorable outcome.

Background: Patients with chronic kidney disease (CKD) spend substantial money on hemodialysis (HD) treatment. The growing intersection between socioeconomic status and financial burden represents an emerging challenge to the CKD community. Objective: This study assessed the financial burden of HD treatment on patients at a Malaysian tertiary teaching hospital. Methods: A cross-sectional study was carried out in the HD unit at a Malaysian tertiary teaching hospital from January to February 2021. Patients undergoing HD were purposively selected. A self-administered questionnaire was used to collect data on socio-demographic, finances, the patient's health history, treatment costs, and healthcare utilization. In addition, Pearson Chi-Square tests were used to analyze the data. Results: A total of 100 patients receiving HD treatment were included in the study. The mean age was 62.06 years (SD = 27.50), with 52% reporting moderate financial burdens. The financial burden was associated with employment status, salary, and income class among HD patients (p <0.05).  Conclusion: Evidence showed a large proportion of Malaysian patients receiving HD treatment came from the B40 income bracket. The findings indicate that financial burdens can impact HD patients and are related to employment status, salary, and income class. Therefore, the ability to identify HD patients' financial needs is critical in nursing practice.

Background: Effective nursing interventions for caring for patients with moderate to severe traumatic brain injury are still challenging during a transition from hospital to home. Since traumatic brain injury has deep-rooted sequelae, patients and their caregivers require better arrangement and information on the condition to achieve improved outcomes after discharge. Objective: This study aimed to assess transitional care programs to improve outcomes of patients with traumatic brain injury and their caregivers. Methods: A systematic review and meta-analysis were performed on studies retrieved from ProQuest, PubMed, Science Direct, CINAHL, and Google Scholar from January 2010 to July 2021. RevMan 5.4.1 software was used for meta-analysis. Results: Nine studies were systematically selected from 1,137 studies. The standard approaches of interventions used in patients with traumatic brain injury and their caregivers were education, mentored problem-solving, home-and community-based rehabilitation, counseling, skill-building, and psychological support. We observed that there was significant evidence indicating beneficial effects of intervention in increasing the physical functioning of patients with traumatic brain injury (SMD = -0.44, 95% CI -0.60 to -0.28, p <0.001), reducing the psychological symptoms among caregivers (SMD = -0.42, 95% CI -0.59 to -0.24, p <0.001), and increasing the satisfaction (SMD = -0.35, 95% CI -0.60 to -0.11, p = 0.005). Conclusion: Education, skill-building, and psychological support should be the main components in transitional care nursing programs for patients with traumatic brain injury and their caregivers.

Background: Resilience has become highly relevant for nurses working to avoid the negative impact of stress and maximise the positive benefits. Objective: This study aimed to explore and describe experiences of resilience among nurses when they first started working in paediatric wards. Methods: A qualitative, interpretive descriptive approach was used to guide the study. Purposive sampling was employed to recruit 8 participants, which proved sufficient to achieve theoretical saturation. Semi-structured individual interviews were conducted in 2020 and audio recorded. An inductive analytic approach was utilised. Results: Three overarching themes arose from the analysis: (1) The transition period (2) Gaining the trust of others (3) Having a positive mindset. Conclusion: This study found that nurses used multiple strategies of resilience in order to cope with workplace stress when they first began the transition period. However, as they become familiar with the workplace and gain the trust of others, this factor enables nurses to have a positive outlook toward job setbacks.  

Background: Tuberculosis (TB) has become a significant public health problem leading to a top ten morality. Directly Observed Therapy, Short-course (DOTS) is recommended as a critical element for curing and preventing TB. However, patients who have been living with TB often receive barriers and challenges, which may lead them to discontinue the DOTS treatment. Objective: This study aimed to understand patients’ experiences living with TB and receiving DOTS regimens. Methods: A qualitative descriptive study was employed. Semi-structured interviews were done among twenty tuberculosis patients selected using convenience sampling from the slum community in Bangkok, Thailand. The thematic approach was used for data analysis. Results: Two main themes were developed: (1) troublesome disease and (2) emotional challenges. The first theme comprises three subthemes: confronting death, accepting lifestyle change, and DOTS challenges. The second theme consists of two subthemes: isolation from others and stigma. Conclusion: The findings could guide nurses and other healthcare professionals to develop the treatment guideline and the DOTS strategy using a holistic approach.

Background: Most parents of Neonatal intensive care unit (NICU) babies often expressed dissatisfaction with the nursing care in NICU because of their unaddressed needs, resulting in emotional strain. This raises an essential question of how NICU nurses provide support for the parents. However, this can be relatively challenging in the NICU setting. Objective: To explore nurses’ views on the nature of parental support provided in NICU settings in Brunei Darussalam. Methods: This study employed a qualitative research approach conducted in 2020. Ten nurses were individually interviewed in semi-structured interviews. The data were analysed using thematic analysis. Results:  Three broad themes were identified, namely: (1) Emotional and informational support (2) Keeping the support going (3) Seeking help from others. The data provide insights into how nurses provide emotional and informational support to parents in the NICU setting. Challenges were encountered in providing support and were addressed through the involvement of the doctors and emotional support continuity by nursing colleagues. Conclusion: This paper describes two critical supports given to the parents in the NICU setting and the challenges that underline these supports and proposes strategies used by nurses to help the parents. The balance needed between work demand and parental support is highlighted. In order to give more robust parental support, ongoing interactions with doctors and nursing colleagues are required.  

Background: The COVID-19 pandemic and the increased workload and stress associated with the disease prevalence have posed a high risk of burnout to nurses. The effects of the workplace and environmental factors on resilience and burnout among nursing professionals have not been investigated in Iran. Objective: Present study aimed to assess a model linking quality of work-life to the resilience and various dimensions of burnout among Iranian nursing professionals based on the health service workplace environmental resilience model. Methods: This was a cross-sectional study performed on 202 Iranian nurses employed in three educational hospitals. Maslach burnout inventory, Brooks’ quality of nursing work-life survey, and an abbreviated version of the Connor-Davidson resilience scale were used to collect data. The correlation between the study variables was assessed by conducting path analysis in AMOS 22. Results: The final model demonstrated adequate fit. The quality of working life indirectly affected burnout via a direct impact on nursing professionals’ resilience (p <0.001, β = 0.39). In addition, resilience had negative, significant effects on all the dimensions of job burnout. The quality of work-life also had negative and significant effects on emotional exhaustion (p <0.001, β = -0.38) and reduced personal accomplishment (p <0.001, β = - 0.38). Conclusion: Resilience and quality of work-life are protective variables against burnout in nursing professionals. Nursing managers can increase resilience and decrease burnout among nursing professionals by adopting policies that can improve the quality of work life.

Background: Hope is essential for patients with acute myocardial infarction, which is often regarded as an active coping for those with life-threatening diseases. Higher hope consistently is related to better health outcomes. However, the instrument for assessing hope has not been previously tested among Thai patients. Objective: This study aimed to assess the validity and reliability of the Hope Scale among Thai patients with acute myocardial infarction patients. Methods: This was an instrument validation study conducted from March to December 2020. A total of 213 patients with acute myocardial infarction were included and selected using a simple random sampling. The back-translation method was used to translate an English version to a Thai version of the scale. Principal Component Analysis (PCA) and Cronbach’s alpha were used for construct validity and reliability. Results: The findings showed that the Cronbach’s alpha of the Thai version of the Hope Scale was acceptable (.75), and the scale consists of four factors, which explained 63.36 % of the total variance. Communalities in each factor ranged from .45 to .84. Overall, the appearance of the factor structures was reasonable and understandable. Conclusion: The reliability and validity of the Thai version of the Hope Scale were suitable for the measurement of hope in Thai patients. This scale can be used by nurses and others to assess hope in Thai patients with acute myocardial infarction.

Background: People with Diabetes Mellitus (DM) tend to seek herbal medicine or complementary drugs in their treatments. But, unfortunately, the existing nursing assessment forms have not prepared the format for the use of complementary medicine. Objective: This study aimed to develop a nursing assessment form in patients with DM based on the Chronic Care Model (CCM) approach. Methods: This study employed a Research and Development study design, which consists of ten stages. The nursing assessment form was developed based on CCM theory and integrated complementary medicines into the assessment form. A content validity test was done by four experts and calculated using Aiken's V formula. Face validity among 12 nurses through Focus Group Discussions (FGDs) was also employed to test the quality of the nursing assessment form based on three aspects: functionality, efficiency, and usability. In addition, nine nurses were included for pilot testing of the form. Data were analyzed using descriptive analysis. Results: The nursing assessment form demonstrated a good content validity, with Aiken's V value of 0.94. The form was categorized based on four components of CCM: self-management support, decision support, social activities, and clinical information. Additionally, all nurses could fill the form properly. Conclusion: The nursing assessment form is valid. It can be used for nurses to assess patients with DM based on the CCM with an additional component to evaluate the use of complementary medicine.

Background: Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce. Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Methods: A cross-sectional, correlational study design was employed among 182 participants coming to follow up at two tertiary hospitals in Vietnam. The participants were selected by a convenience sampling technique. Data were collected using Participant Demographic Information Form, Clinical Characteristics Form, Alcohol Use Disorders Identification Test, Pittsburgh Sleep Quality Index, Charlson Comorbidity Index, and an automated office oscillometric upper arm device. Descriptive statistics, Chi-square, Fisher’s Exact Test, and binary logistic regression were used to analyze the data. Results: 63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets. Conclusion: Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities.

The number thirty is often used as the sample size in multiple questionnaires and identified as appropriate for validation of nursing research. However, this is not the best tool or strategy for sample size selection for development and validation, and this often causes immediate rejections of manuscripts. This editorial aims to provide an overview of the appropriate sample size for questionnaire development and validation. The article is the amalgamation of technical literature and lessons learned from our experiences in developing, validating, or adapting a number of questionnaires.

Background: Although advanced treatment and accessibility of HIV/AIDS prevention and care have been increased, HIV-related stigma persists in the Indonesian community, especially among HIV-negative Muslim wives in a serodiscordant relationship. Therefore, understanding their coping strategies of the stigma is a necessity. Objective: The study aimed to explore HIV-related stigma and coping strategies of HIV-negative Muslim wives in a serodiscordant relationship. Methods: A qualitative study was conducted among seven HIV-negative Muslim wives in a serodiscordant relationship who experienced stigma. Data were collected by in-depth interview, and content analysis was used for data analysis. Findings: Three themes emerged from the data. The first theme was the meaning of HIV/AIDS to Muslim wives, including perceiving HIV as a wanita nakal (immoral women) disease, perceiving HIV causes death, assuming herself as a carrier, and presuming HIV is less harmful than Diabetes Mellitus. The second theme was HIV-related stigma experiences, including being shunned by people, rejected by a midwife, and humiliated by a health worker. Finally, the third theme was coping strategies with the stigma, consisting of hiding the husband's HIV-positive status from the neighbors, disclosing HIV-positive status to a selective person, seeking support from the peer group, and strengthening the relationship among family members. Conclusion: HIV/AIDS-related stigma affected people living with HIV/AIDS and their families, and it becomes a barrier to HIV/AIDS reduction programs in the marriage relationship. These findings will be beneficial to nurses and other health professionals to develop stigma reduction interventions related to HIV/AIDS.

Background: Readmission becomes inevitable with the vast development of mental health services worldwide and the challenges faced by mental health services. This readmission is often caused by a relapse from an illness whereby the psychiatric patient needs nursing care. Objective: This study aimed to explore psychiatric nurses’ perceptions of reasons for readmission and nurses’ further role in reducing readmission. Methods: In this descriptive qualitative study, thematic analysis of five focus group discussions (n= 24 nurses) in one psychiatric department in Brunei Darussalam was identified through purposive sampling. Results: The nurses perceived the role of family and non-adherence to medication as a significant reason for psychiatric readmission. Simultaneously, nurses viewed that it was necessary to implement systematicchoeducation to strengthen the role of family and community service support to curb readmission rates. Conclusion: The phenomenon of mental health readmission impacts psychiatric nurses due to many stressful challenges with nurses wishing to respond personally, humanely and professionally. These challenges require suitable interventions, such as debriefing to ensure that nurses continuously strive to deliver quality care to psychiatric readmission patients.  

Background: Nutrition in dialysis patients plays an essential role in their life. Diet in dialysis patients are catered individually and applied according to the situation of the patients. A dietary recommendation is vital to dialysis patients, and nephrology nurses help patients understand the reasoning behind the dietary restrictions enforced. Objective: This paper aimed to explore nephrology nurses’ views in giving dietary recommendations for dialysis patients. Methods:  In this descriptive qualitative study, one focus group discussion (n = eight nurses) and four individual interviews in one Renal Centre in Brunei Darussalam was conducted through purposive sampling. This interview took place between October 2020 and December 2020. Results: Three major themes were identified: (1) Approaches in giving dietary information, (2) Getting patients to follow a diet plan, and (3) Negotiating with patients. Conclusion: The importance of nephrology nurses in improving patient care, particularly in providing dietary recommendations to dialysis patients, cannot be overstated. They adopted different approaches, including negotiating with patients and using available resources to ensure that patients followed the dietary recommendations. However, they believe their current method and strategy for offering dietary recommendations to dialysis patients could be improved.  

Background: Cardiopulmonary resuscitation (CPR) and early defibrillation are the most common procedures performed by nurses as the first responders to cardiac arrest patients in the hospital setting. Therefore, nurses are demanded to have high skills for effective performance. Self-efficacy and knowledge are considered significant factors affecting early initiation of CPR and automated defibrillation. However, previous studies mostly focused on nursing students instead of frontline nurses. Objective: This research aimed to assess the relationship between nurses’ knowledge and self-efficacy regarding the early initiation of CPR and automated defibrillation of cardiac arrest patients. Methods: The study employed a cross-sectional, descriptive, correlational survey. Using convenience sampling, two hundred eighty-seven nurses working in critical areas and inpatient and outpatient departments, King Abdulaziz University Hospital (KAUH), Saudi Arabia, were selected. Resuscitation Knowledge and Self-Efficacy Scales were used for data collection (using Google Form) from November 2020 to January 2021. Descriptive statistics and Pearson correlation were used for data analysis. Results: Overall, 61.3% of participants had moderate knowledge (13.659 ± 2.175), and 63.8% had high self-efficacy (44.627 ± 58.397). The highest domain of self-efficacy was responding and rescuing, while the lowest domain was debriefing and recording. There was a significant positive relationship between knowledge and self-efficacy (p <0.001; r = 0.207). Conclusion: The positive relationship explained a high level of self-efficacy if there was a high level of knowledge. Thus, it is recommended that nursing programs apply CPR and automated defibrillation curricula during nurses’ internships, clear policies and procedures about CPR and automated defibrillation, continual updates about CPR and automated defibrillation, and knowledge and continuance training (on-job-training) about CPR and automated defibrillation, which can enhance and improve knowledge and self-efficacy among health care workers, especially for nurses.  

Background: As the incidence of COVID-19 is increasing, the Bangladesh government has announced a countrywide shutdown instead of a lockdown. Consequently, front-line healthcare workers, particularly nurses, are confronting more challenging situations at work. Objective: This study aimed to explore front-line nurses’ experiences caring for patients with COVID-19 in Dhaka, Bangladesh. Methods: A qualitative descriptive study was conducted among front-line nurses caring for patients with COVID-19. Twenty nurses were purposively chosen from January to March 2021 to participate in semi-structured online interviews. Interviews on audio and video were collected, analyzed, interpreted, transcribed verbatim, and verified by experts. Thematic analysis was used. Results: Nine themes emerged and were grouped into negative and positive experiences. The themes of negative experiences include lack of necessary medical equipment, use of non-standard personal protective equipment, work overload, long working hours, poor working environment, and lack of quality of nursing care. The positive experiences include feeling self in a patient position, nurses’ coping strategy in COVID-19 patient care, and establishing emotional control. Conclusion: The study results encourage national and international health care professionals to cope with adverse working environments. Also, the findings provide nurses with techniques for dealing with any critical situation, controlling patients’ emotions, and how empathy increases self-confidence and patient care. The research should also be used to enhance government policy, nursing council policy, ministry of health policy, and other healthcare agencies.

Background: The transition process of migration to work abroad can be challenging and, depending on how it is handled, can impact the job satisfaction level of these foreign-educated nurses. A clear understanding of migrant nurses’ job satisfaction is critical for effective translation of nursing practice across the health systems and cultures. Objective: This study examined the job satisfaction of the foreign-educated nurses in Malaysia, which includes the job satisfaction dimensions and the significant difference between sociodemographic status and job satisfaction. Methods: A cross-sectional survey of 102 foreign-educated nurses working in private hospitals, clinics, hemodialysis centers, nursing homes, and private homes in Malaysia was conducted from September 2017 to March 2018. Data were collected using a structured questionnaire. Descriptive statistics, Mann-Whitney U, and Kruskal Wallis tests were used to analyze the data. Results: The study revealed that the participants had a median satisfaction score of 22 (IQR = 19 to 24). Serving the sick and needy and participants’ self-respect were the highest satisfaction dimensions among the participants (Median = 3, IQR = 3 to 3). Moreover, the job satisfaction was significantly higher for registered foreign-educated nurses (mean rank = 62.5) than for unregistered foreign-educated nurses(mean rank = 48.65) when working in other countries (p = 0.02). Indian nurses (mean rank = 60.36) also expressed higher satisfaction in terms of working in other countries than Filipino nurses (mean rank = 46.88; p = 0.02). In addition, positive relationships with colleagues and superiors led to higher satisfaction among Indian nurses (mean rank = 61.02) than among Filipino nurses (mean rank = 47.24; p = 0.04). The job satisfaction of male foreign-educated nurses was significantly higher than their female counterparts in terms of self-respect, relationship with fellow nurses and superiors, working in other countries, career development, and ease of finding employment (p < 0.05). Conclusion: The overall job satisfaction among the foreign-educated nurses in Malaysia is high, mainly when serving the sick and needy, and their degree of self-respect. Understanding job satisfaction among foreign-educated nurses in Malaysia enables the management team to develop effective strategies for addressing nursing shortages and improving the quality of patient care.

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Background: Existing evidence showed that adverse psychosocial factors contribute to burnout in oncology nurses and impose profound implications to nursing practice. Due to the complexity of this relationship, more studies are still needed. Objective: To investigate the prevalence and relationship between burnout and psychosocial factors among oncology nurses.  Methods: A descriptive cross-sectional study design was conducted in 2018 using the Maslach Burnout Inventory and the Copenhagen Psychosocial Questionnaire to measure burnout and psychosocial factors, respectively. Descriptive and multivariate regression using maximum likelihood procedures were used for analysis.  Results: Out of three burnout variables, emotional exhaustion demonstrated a highly significant relationship towards psychosocial factors, particularly quality of leadership (p <0.001), justice and respect (p <0.001), and rewards (p <0.001) – congruent to a high prevalence of emotional exhaustion reported.  Conclusion: Improvement in leadership quality, rewards, justice and respect could minimise emotional exhaustion among oncology nurses. These findings further inform management and policymakers to target these specific psychosocial factors in addition to using other interventions to counter the harmful effects of burnout. A positive psychosocial workplace would consequently decrease the risk of nurses’ intention to leave, reduce nurse shortages, and increase the quality of patient care.

Background: People living with HIV (PLWH) today have to deal with a chronic condition that requires efficient self-management due to increased longevity. Self-management interventions have been shown to improve physical and psychological symptoms as well as clinical results in chronic diseases. However, few studies have investigated the effect of self-management on quality of life (QOL) among PLWH in Indonesia. Objective: To examine the effect of a self-management program on QOL among PLWH in Indonesia. Methods: This was a quasi-experimental study with a comparison group in a general hospital in Jakarta, Indonesia. Of the 114 recruited PLWH, 57 were assigned to the intervention group and 57 to the comparison group. The self-management group attended a four-week program workshop. The intervention consisted of five sessions: need assessment and goal setting, maintaining a healthy lifestyle, educational participation to increase communication and self-esteem, and evaluation. The comparison group received standard educational material throughout the leaflet regarding HIV prevention. The post-test assessment was conducted immediately after intervention (T1) and two months (T2) after the intervention in both groups. QOL was measured using the World Health Organization Quality of Life (WHOQOL)-HIV brief Bahasa version. The estimations were obtained using fixed-effect regressions. The differences between T0, T1, and T2 for the intervention and comparison groups were evaluated and compared using the DI Differences method (DID). Results: The self-management program improved outcomes relative to the comparison group at T1: 1) overall QOL score increased 8.7% (95% CI 0.021–0.149), 2) physical domain saw a modest increased 8.8% (95% CI 0.017–0.125), 3) psychological domain increased 23.5 % (95% CI 0.085–0.689), and 4) environmental domain showed a modest increase of 18.7% (95% CI 0.053–0.371). At T2, the total QOL score and the physical, psychological, and environmental dimensions were significantly improved compared to the comparison group. Conclusion: The self-management program appears to improve the QOL of the life of PLWH. Nurses are advised to provide PLWH with self-management training. Future research on self-management intervention would need to be refined further to ensure that each community achieves consistent intervention outcomes.

Patients with Coronavirus Disease 2019 (COVID-19), particularly those with a severe condition, might not survive. Pandemic situation challenges the healthcare providers in addressing palliative care to the patients. This paper aimed to describe the importance of providing palliative care for patients with severe COVID-19 in Indonesia. We used a case scenario to illustrate the common condition experienced by a patient with severe COVID-19. Health care providers in Indonesia could address palliative care for patients with COVID-19 by focusing on controlling the symptoms, avoiding futile intervention, and connecting the patients and their families. Nurses need to consider the patients’ needs for family supports, even though not in physical or psychosocial support, and help the patients who need end-of-life care to be dying with dignity. Communication technology must be utilized optimally by healthcare providers to realize the communication among the patients, families, and health workers.

Background: Volunteering among nursing students has become a valuable resource during an outbreak to help alleviate the strain in nursing staff shortages. However, evidence of willingness to volunteer is scarce, particularly in Asian countries.Objective: To study Bruneian university nursing students’ willingness to volunteer during a pandemic in Brunei. Methods: An online cross-sectional study was conducted at Universiti Brunei Darussalam from January to February 2021. A self-administered questionnaire was used to measure willingness factors, including motivational factors, barriers, enablers, and level of agreement to volunteer during the COVID-19 pandemic. Sub-group inferential analysis was applied. Results: 72 participants were included in this study. 75.0% of whom were willing to volunteer during the COVID-19 pandemic. Factors that influenced the willingness of nursing students to volunteer were marital status (p <0.001), year of study (p <0.001), altruism (p <0.001), personal safety (p <0.001), and knowledge level (p <0.001). Conclusion: Nursing students are an invaluable resource, and they are highly willing to be part of disaster management. Training and planning should prepare the nursing students for disaster or pandemic readiness and integrated them into the undergraduate nursing curriculum. Align with this, safety aspects of nursing students during volunteering should also be considered, including the provision of childcare assistance, sufficient personal protective equipment, vaccination, and prophylaxis to the volunteers.

“Publish or Perish” is no longer an imagination. On the contrary, it is considered a new reality in nursing education today. All nurse scholars, researchers, faculty members, and students are eager and compete with each other to publish their research works in academic journals. Success in this challenge brings personal benefits, especially for academic reputation and promotion, as well as organizational benefits, such as university ranking and sponsorship. However, despite the advantages of faculty publication, the pros and cons of this topic are on the rise. Therefore, this article aims to discuss the publication-related phenomenon in nursing education, followed by concerns and recommendations for consideration.

Background: Stunting is a common malnutrition problem among children in the world. The Care for Children Development (CCD) intervention is a strategy to reduce stunting. Objective: This study aimed to identify the effect of culturally modified CCD training on the knowledge, attitude, and efficacy (KAE) of cadres about stunting in the community.Methods: We conducted a community-based study with a quasi-experimental research design using a comparison group. The study was conducted from March 2018 to February 2019 at three Public Health Centers in Yogyakarta, Indonesia. The total participants were 69 in the intervention group and 53 in the comparison group. Cadres in the intervention group received two days of training on a culturally modified CCD guideline. In contrast, cadres in the comparison group received a brief explanation (a one-day training) on that program. The nurses from three public health centers were facilitators in this training. Knowledge and self-efficacy were assessed using a modified Caregiver Knowledge of Child Development Inventory and General Self-efficacy Scale, respectively. Data were analyzed using Mann-Whitney U and Wilcoxon tests.Results: All 122 cadres completed the training. In the intervention group, CCD training significantly increased cadres’ knowledge (median score 14 vs. 11), attitude (58 vs. 55), and efficacy (30 vs. 28), all with p <0.001. In the comparison group, the short explanation of CCD significantly improved cadres’ knowledge (median score 12 vs. 10) and efficacy (29 vs. 27) but not their attitude. The delta or change in score before and after CCD training for cadres’ attitude in the intervention group was significantly higher than that of the comparison group (3.78 vs. 0.72; p = 0.050). Conclusion: A culturally modified CCD training significantly improves cadres’ KAE in the intervention group and cadres’ knowledge in the comparison group. The learning delivery methods with demonstrations and role-plays significantly improved the cadres’ attitudes as health educators for stunted mothers in the community. For sustainability, community health nurses should regularly collaborate with cadres to improve the nutritional status of children in their area.

Background: Universal immunization coverage among children in Indonesia is low compared to the global target. Many children in Indonesia are not fully immunized as recommended by the government, which results in a high mortality rate. The government has developed a mobile application (PrimaKu) to provide information on vaccinations and reminder features. However, the successful use of the immunization features of the app has not been widely studied. Objective: This study aimed to evaluate the use of PrimaKu on maternal attitudes toward immunization and complete basic immunizations status among Indonesian children aged 12 to 24 months. Methods: A cross-sectional research was conducted at a public health center in West Java Province, Indonesia, from August to December 2020. Convenience sampling was used to select the respondents. Data were collected using validated questionnaires and analyzed using binomial logistic regression. Results: A total of 119 mothers were included. About 44.5% of children had a complete basic immunization status. Mothers who had a supportive attitude toward immunization were 3.58 times (95% CI 1.49-8.57, p 0.003) more likely to complete the basic immunization, and those who used the mobile app were 3.23 times (95% CI 1.18-8.87, p 0.034) more likely to complete the immunization. Conclusion: Using the PrimaKu mobile application could increase maternal attitudes toward immunization and complete basic immunization status. Therefore, public health nurses should provide comprehensive education and improve mothers’ literacy to use the application.

Background: Depression is a significant predictor of the quality of life among patients with coronary heart disease. Therefore, it is essential to explore the factors associated with depression. Illness cognition is considered one of the factors affecting depression. However, the relationship between illness cognition and the incidence of depression among Indonesian patients have not been widely investigated.Objective: This study aimed to investigate the correlation between illness cognition, consisting of the acceptance, perceived benefits, and helplessness variables, and depression in patients with coronary heart disease. Methods: This study employed a correlational research design with a total of 106 patients undergoing treatment at a hospital in West Java, Indonesia, selected using convenience sampling. Data were collected using a demographic questionnaire, Beck-Depression Inventory-II (BDI-II), and ICQ (Illness-Cognition Questionnaire). Data were analyzed using mean (SD), median, frequency distribution, and Spearman-rank. Results: 72% of respondents had no depression. Nevertheless, mild, moderate, and major depression suffered by 15%, 9%, and 4% of respondents, respectively. In terms of illness cognition, patients scored higher within the perceived benefits dimension (mean 20.13, SD 3.05), followed by acceptance (mean 18.22, SD 3.33) and helplessness (mean 13.20, SD 4.77), respectively. Furthermore, helplessness was significantly associated with depression (p <.01) with a positive correlation coefficient (r). Also, all items on the helplessness dimension had a significant correlation (p <.01) with depression accompanied by a positive r-value. Conclusion: Helplessness had a significant relationship with depression. So, cardiovascular nurses can anticipate depression in patients by making nursing interventions that can decrease the patients’ feelings of helplessness. Thus, factors that reduce helplessness need to be explored and taken into accounts in the treatment of patients with coronary heart disease.

Background: Caring expressions between humans and nonhuman intelligent machines are futuristic prototypes with healthcare robots as major advocates. Objective: To examine the experience of older persons with mental health conditions, particularly patients with schizophrenia and with dementia in the interaction with healthcare robots and intermediaries in a transactive relational engagement. Methods: Two qualitative case studies were conducted using sophisticated audio-video technologies to record the conversation and activities that were carefully documented. Following the procedure for qualitative descriptive analysis, a framework based on the Transactive Relationship Theory of Nursing was employed to analyze and interpret the data. Results: Three themes were revealed, including feelings for the other, inspiring meaningful responses, and demonstrating expressions of joy. The description of the experience of older persons involved in the conversation with humanoid robots was feeling for the other while inspiring meaningful responses in demonstrating expressions of joy. Conclusion: This study provided initial evidence that the transactive engagements of robots with older persons with schizophrenia and dementia and nurse intermediaries in psychiatric and mental health settings can result in occasions of ‘joy’ for the patients. These findings suggest that transactive engagements with robots facilitate expressions of joy among older persons with schizophrenia and dementia. However, these findings are not intended to prescribe nursing care actions but to describe the experience of older persons who are in transactive engagements with intelligent machines, indicating the importance and value of healthcare robots in nursing older persons with schizophrenia and with dementia.

Background: Nursing jobs are very complex and stressful, and nurses are demanded to have high competency and soft skills to keep their performance. However, the nursing workload often leads to fatigue, and it will be very challenging for novice nurses. Therefore, they need to be trained in soft skills in order to be able to control their emotion and adapt to the situation. Unfortunately, studies on essential soft skills for novice nurses in Indonesia are scarce; further research on this topic is a necessity. Objective: This study aimed to explore the perception of senior nurses about the essential soft skills for novice nurses during their work adaptation process. Methods: This qualitative study used an interpretive phenomenology approach, which was conducted in a private hospital in Jakarta, the capital city of Indonesia. Data were collected using semi-structured interviews from ten senior nurses selected using a purposive sampling technique. Data were analyzed using Gadamer’s hermeneutic approach. Results: Nine essential soft skills were developed for novice nurses during their transition phase from education to practice, including self-control, initiative, caring, self-motivated, hospitality, flexibility, adaptability, analytical skill, and presentation skill. Conclusion: Findings of this study serve as a basis for developing the soft skills of novice nurses in their clinical practice in hospitals in Indonesia. It is also recommended that soft skills should be included in the nursing education curriculum. However, soft skills are essential for novice nurses to succeed in their adaptation and future career.

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Background: Recovery is a way of life to make people’s lives more meaningful by working and interacting socially in the community. The recovery has become a new vision of mental health services, including in persons with schizophrenia. However, this concept is relatively new and still limited to nurses in developing countries, such as Indonesia. Several studies among nurses related to this topic have been conducted in the Western part of Indonesia. Yet, no studies have been implemented in the Eastern part of Indonesia. Therefore, exploring nurses’ perspectives in the Eastern island of Indonesia is necessary to provide a complete understanding of recovery in patients with schizophrenia.Objective: To explore the perspectives of mental health nurses on recovery from schizophrenia. Methods: This was a qualitative study using a phenomenological design. The study was conducted from April to May 2020 at community health centers in Maluku, Indonesia. Eight nurses recruited using purposive sampling participated in in-depth interviews. The interviews were audio-recorded, transcribed verbatim, validated, and analyzed based on Colaizzi’s method of data analysis.Results: Five themes were generated, including (i) treat a patient like a brother, (ii) recovery as an unfamiliar term with various meanings, (iii) medication as the primary action but also the main problem, (iv) being recovered if referred to a mental hospital, and (v) ineffective mental health programs.Conclusion: The findings of this study can be used as an input and evaluation for nurse managers to make an effort to uniform the perception among nurses in Indonesia regarding the recovery process in schizophrenia. It is also suggested that community health centers leaders and mental health policymakers prioritize and optimize recovery-oriented mental health programs and services in the Eastern island of Indonesia. Additionally, the findings offer new insight about ‘we are brothers’ or called ‘hidop orang basudara’, which is expected to be one motto for nursing care in Indonesia and beyond.

Background: The quality of management has become a problem and significant issue of the late decade in Indonesia's professional nursing practice. By implementing total quality management (TQM), the organization would identify a health organization system's performance to improve patient satisfaction and patient safety for independent nursing practice services. Objective: This study aimed to assess the quality of independent nursing practice in Indonesia based on TQM indicators.Methods: This study employed a sequential explanatory mixed methods design. Participants were 105 Chief Executive Officers (CEOs) of independent nursing practices who answered a TQM survey using The Malcolm Baldrige Criteria for Performance Excellence (MBCfPE). The quantitative responses were analyzed using SmartPLS version 3.0. For qualitative data, selected six participants from total respondents were interviewed to explore the participants' understanding of TQM. All the responses were transcribed and uploaded using NVIVO ver. 11 for thematic analysis.Results: Leadership positively influenced strategic planning, customer attention, assessment analysis, and information management (focusing on personnel process management and efficiency) (p <0.001). In addition, process management indicated a positive influence on performance results (p <0.001). Interview transcriptions concentrated on the following themes that emerged, such as quality focus, service focus, human resource focus, performance result, leadership, service system design, strategic planning, and information system.Conclusion: TQM with the adaptation of MBCfPE criteria improves the organization's performance and serves as a strategic component in assessing and implementing sustainability change. The findings of this study can be used by CEOs of independent nursing practices for continuous improvement. In addition, the results serve as a basis for the ministry of health for accreditation to ensure the high quality of health care services.

Background: Understanding the health practice of Indonesian residents and its related factors during the COVID-19 pandemic is crucial, but such association necessitates clarity. Objective: To examine the health practices of the Indonesian citizens and their correlations with knowledge and health belief model (perceived susceptibility, barriers, benefits, severity, and self-efficacy) during the COVID-19 pandemic. Methods: A community-based online cross-sectional design was employed. The study was conducted from 10 July to 30 August 2020 among 552 citizens selected using convenience sampling. Sociodemographic characteristics, knowledge, health belief model, and health practices, including wearing a mask, social distancing, and washing hands, were measured using validated questionnaires. Adjusted odds ratios (AORs) and logistic regression were employed for data analysis. Results: The adjusted AORs (95% CIs) of a good level of health practices—wearing the mask, social distancing, and washing hands—were 3.24 (1.52~6.89), 2.54 (1.47~4.39), and 2.11 (1.19~3.75), respectively, in citizens with the high level of knowledge. Interestingly, respondents with positively perceived susceptibility exhibited significantly good practice in wearing the mask (4.91; 2.34~10.31), social distancing (1.95; 1.08~3.52), and washing hands (3.99; 2.26~7.05) compared to those with negatively perceived susceptibility. In addition, perceived barriers, benefits, severity, and self-efficacy also exhibited a significantly good all variables of health practice regarding COVID-19 pandemic after adjusting for confounding variables. Conclusion: Citizens with high levels of knowledge and positive levels of the health belief model had good practice of wearing masks, social distancing, and washing hands. The outcomes of this survey could encourage health professionals, including nurses, through management practices of nursing intervention based on the health belief model during the pandemic.

Background: The emergence of the COVID-19 pandemic has distorted the education system, which greatly challenged educators in the pursuit of the continuity and quality of education. Commitment to perform duties and responsibilities are bounded in coping with the situation, emotional state, and the support from the organization.Objective: To analyze and understand the presumed interrelationship of modeled variables, such as the coping style, anxiety level, organizational support, and work commitment of educators during the COVID-19 pandemic.Methods: It is a mixed-methods study through an explanatory sequential approach. The path analysis technique was applied for quantitative with 116 educators as sample respondents guided by selection criteria. Digital immigrant educators with extreme responses were identified and asked permission for an interview. Open-access adapted questionnaires used were Simplified Coping Style Questionnaire (SCSQ), Beck Anxiety Inventory (BAI), Perceived Organizational Support (POS), Allen and Meyer’s Organizational Commitment Questionnaire (OCQ). Data were processed and analyzed using SPSS and AMOS for descriptive and inferential statistics. A four-domain semi-structured questionnaire served as a guide in interviewing participants in the context of coping, anxiety, support, and work commitment. Thematic analysis was performed to generate themes. Results: This study shown that educators often used coping style (1.87 ± 0.84; Mean ± SD), have a low level of anxiety (0.58 ± 0.69; Mean ± SD), have perceived uncertainty related to organizational support (4.03 ± 1.37; Mean ± SD), and neither agree nor disagree in terms of their work commitment (3.02 ± 0.93; Mean ± SD). The presumed model through path analysis has significantly predicted 28% plausibility (R2= 0.28) with only organizational support that shown significant influence towards educators’ work commitment (β = 0.22). The themes that emerged are challenging adjustment, predestined situation, fear of getting infected, difficulty teaching effectively, technologically challenged, psychosocial assistance, uncertainty, and willingness to explore.Conclusion: Educators during the COVID-19 pandemic were able to cope and control their anxiety through the test of time, seamless work commitment, and presence of support. This study can be considered a framework for situational analysis of nurse educators in the academic realm in times of emergency and disaster.

Background: Assessing the current understanding of future health care workers about the COVID-19 is very important in order to identify gaps that affect their perceptions and responses, which they can integrate into the people in the community.Objective: This study aimed to investigate the knowledge, attitude, and practice towards COVID-19 of student nurses in Manila, Philippines.Methods: This study utilized a descriptive cross-sectional survey of 314 individuals from October 2020 to December 2020 to evaluate the association of different factors to knowledge, attitude, and practice towards COVID-19. Frequency, percentage, mean, standard deviation, t-test, and one-way ANOVA were used to analyze the data gathered.Results: The survey revealed that the respondents have a mean knowledge score of 18.76 (SD = 1.64), a mean score for attitude of 26.58 (SD = 2.71) and a mean score for practice of 4.26 (SD = 0.93). A significant different were noted in terms of year level with level 3 having a higher mean score (M = 19.01, F = 2.696, p = 0.046) compared to other levels and type of school, with public university students having a higher level of knowledge (M = 18.97, t = 2.070, p = 0.039). In terms of attitude, females have higher mean scores (M = 26.85, t = -2.630, p = 0.009 and students from public university have higher scores (M = 2.81, t = -4.406, p = 0.000) than students from private university. For practice, a significant difference was noted in terms of year level, with level 3 students having a higher mean score (M = 4.42, F = 3.180, p = 0.024) compared to other year levels.Conclusion: Filipino student nurses have a high level of knowledge about COVID-19 and are mainly optimistic about controlling the pandemic. Nevertheless, having constant reminder from the authorities and health care professionals are the solution to aid public knowledge and comprehension relating to COVID-19.

Background: The COVID-19 pandemic significantly impacts students’ mental health. Most of them may experience depression. Due to restrictions and social distancing during the pandemic, counseling may not be applicable in detecting the problems. Therefore, an Islamic spiritual mindfulness-based application called DAHAGA is created in order to detect and reduce depression. It is believed that this innovative app could reduce mental health problems among students. Objective: This study aimed to determine the effect of DAHAGA on reducing depression among nursing students during the COVID-19 pandemic in Indonesia. Methods: This was a quasi-experimental study with a comparison group pretest/posttest design conducted from May to June 2020. Seventy students were selected using convenience sampling, of which 35 were assigned in an experimental group and a comparison group. The validated Indonesian Version-Beck Depression Inventory-II (BDI-II) was used for data collection. Paired t-test and independent t-test were used for data analysis. Results: There was a significant effect of DAHAGA on depression (p < 0.001). The level of depression after intervention (mean 11.49, SD 4.49) was lower than it before the intervention (mean 17.20, SD 4.94). Additionally, there was a significant difference in depression level between the experimental and comparison groups after the intervention with a p-value of < 0.001.  Conclusion: The DAHAGA is proven effective in reducing depression. Therefore, this study offers a new and innovative app that fits with the COVID-19 pandemic to help Muslim students maintain their health status. The findings also support Islamic spiritual mindfulness as a part of nursing interventions among psychiatric nurses to deal with mental health problems, especially depression.

Background: The progress of the fight against HIV is highlighted by significant change. HIV of the past is different from HIV of the present. Healthcare services have played an essential role in achieving the optimal goals needed to end the HIV epidemic. However, people living with HIV and those at risk of catching it (PLWH) often misunderstand the rapid growth of HIV healthcare service options.Objective: This study aimed to explore the experiences of PLWH in the healthcare services featured in this study.Methods: A qualitative phenomenological approach was used. Semi-structured interviews were conducted in 2017 with 12 PLWH who engaged with healthcare services in Jakarta, Indonesia, by using a purposive sampling technique. Semi-structured questions were asked which related to their experiences of using the services. Stevick Colaizzi Keen method was used to extract the thematic analysis of the study.Results: The study developed four essential themes of PLWH healthcare use. They were accessibility, availability at all healthcare levels, comprehensiveness of service, and affordability.Conclusion: Providing accessible healthcare services is considered essential by PLWH. It is also pivotal to helping people feel positive about the community-related healthcare services on offer. Nurse-led HIV services must maintain this progress by continuously evaluating the quality-of-service outcomes and promoting the accessibility of the services to the broader population.

Background: Being assertive is essential skill nurses need to learn and develop. While many studies exist on nurses’ assertiveness, there is limited research on the factors associated with Filipino nurses’ assertive behaviors. Objective: This study examined the correlation of self-esteem, psychological empowerment, and leader empowering behaviors on staff nurses’ assertiveness in the workplace. Methods: This cross-sectional study conducted in 2019 involved 223 staff nurses working in two tertiary hospitals in the Philippines. Data were gathered using four validated self-reported scales: self-esteem scale, psychological empowerment scale, leader empowering behavior questionnaire, and workplace assertive behavior questionnaire. Correlational analysis using Pearson’s r was performed to test the relationship between the key variables. Results: The composite scores for the self-esteem, psychological empowerment, empowering leader behaviors, and workplace assertiveness were 32.06 (SD = 3.65), 4.22 (SD = 0.43), 3.86 (SD = 0.51) and 3.61 (SD = 0.55), respectively. Self-esteem (r = 0.216; p = 0.001), psychological empowerment (r = 0.455, p = 0.000), and empowering leader behaviors (r = 0.269; p = 0.000) were significantly correlated with staff nurses’ assertiveness in the workplace. Conclusion: Self-esteem, nurse leadership behaviors, and empowerment play vital roles in staff nurses’ assertiveness. Understanding the factors influencing nurses’ assertiveness is important, and looking into these variables can be beneficial for nursing management when developing strategies to build nurses’ assertiveness. Thus, it is vital to focus on helping nurses nurture healthy self-esteem and initiate empowering conditions at work to aid nurses in setting healthy boundaries and supporting assertive behaviors at work.

Background: Limited studies focus on the effects of the pandemic on the nurses' overall risks and wellbeing. At present, no single study has been published on Filipino nurses’ experiences outside the country during the COVID-19 pandemic.Objective: This descriptive phenomenological study explored the Overseas Filipino Worker (OFW) nurses’ experiences working in COVID-19 intensive care units.Methods: The study was conducted in Dubai, United Arab Emirates, where there is a high number of COVID-19 cases. This study utilized a qualitative Husserlian phenomenological approach to describe and explore the lived experiences of the OFW nurses’ caring for COVID-19 critically ill patients. The research key interview informants were eight ICU nurses who cared for COVID-19 patients in Dubai hospitals. Data saturation was reached. Data collection was done in 2020, and Collaizi’s method of data analysis was utilized.Results: A total of 135 significant statements were extracted from the interview transcripts. There were 36 formulated meanings generated, and four themes emerged from this study. The first theme is Challenges During the Pandemic with the following subthemes: Away from Home, Caring for the COVID-19 Patients, and Fear of the Unknown. The second theme is Patient Care during COVID-19 with the following subthemes: COVID-19 ICU Patient Care and The Nursing Profession. Third, Adapting to Change with the subthemes: Living the New Normal and Protecting One’s Self from COVID-19. Lastly, Resilience Amidst the Pandemic with the following subthemes: Being with Others and Seeing Oneself.Conclusion: Despite the existing challenges like cultural differences and homesickness faced by these OFW nurses and the new challenges they are faced with the pandemic today, they were still able to continue living and do what is expected of them. From the hassle of wearing the PPEs, shortage of PPE, and being transferred from one unit in the hospital to another, the OFW nurses were able to adapt to these changes. The nurses already got used to the routine, but the fear of getting infected by the virus is still there.

Background: Warm compress is believed to reduce perineal tear occurrence and decrease pain intensity during the second stage of childbirth.Objective: This study aimed to determine the effect of warm compresses on perineal tear and pain intensity during the second stage of labor. Methods: A randomized controlled trial was conducted between 28 September 2018 to 30 October 2018 in King Khaled Hospital (KKH), affiliated with the Ministry of National Guard Hospital Affairs, King Abdul-Aziz Medical City Western Region, Saudi Arabia. According to eligibility criteria, the sample randomly recruited through lottery included 100 primigravida pregnant women, with 50 in each intervention and control group. Data were presented in the form of frequency and percentages, standard deviation, and mean. Chi-square test was used for data analysis, with p-value significance at ˂ 0.05.Results: Sociodemographic data revealed no statistically significant difference in the age, education, occupation, and residence of both the control and experimental group. The perineum area’s pain intensity after birth showed a statistically significant difference between the intervention and the control groups (p = 0.001). The perineal tear was also significantly different between both groups (p = 0.001). Conclusion: The applied warm compresses on the perineum area positively reduce second and third-degree perineal tear and pain intensity during the second stage of labor and after childbirth. Therefore, midwives and nurses are expected to actively provide effective planned in-service training programs regarding warm compresses' advantages in the second stage of labor and apply this procedure actively.

Background: Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses’ role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings. Objectives: This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications. Design: This study was conducted following the framework of scoping review.Data Sources: The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included. Review Methods: The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result.Results: A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training.Conclusion: Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses’ advocacy competence for future implications.

The concepts of spirituality and spiritual well-being are not novel ideas as they have been subjects of scrutiny in several studies. However, there has yet to be a formalized framework of spiritual nursing in the Philippines despite its importance. Developing such a framework is significant, especially since holistic nursing believes in the relationships among body, mind, and spirit. Thus, the Spiritual Nursing Care theory was conceptualized, which states that every person has holistic needs, including spiritual needs that must be satisfied to attain spiritual well-being. It forwards that for the patient’s spiritual needs to be met, what is required is the triumvirate interconnection among the nurse, the external environment, and the spiritual nursing care which may be provided by the nurse as a healthcare provider and the significant others or family as part of the external environment. The theory has two propositions that were subjected to validation studies that either strengthened or repudiated the propositions presented: (1) the meaning of spirituality differs from person to person, and (2) the patient’s spiritual well-being is influenced by the nurse’s spiritual care competence, as well as the patient’s internal and external variables.

Family caregivers, especially in Asian countries, have a profound role in caring for a sick family member. However, there are wide variations between the Asian and western world in terms of culture and facilities. Therefore, the problems and needs of family caregivers between those two regions may also be distinct, and it is important to explore and elaborate based on our empirical evidence. In Indonesia, motives and values in caregiving and religion become the wheel-power of the family caregivers in providing care. This affects action and consequences for caregivers. This paper attempts to elaborate on common ethical dilemmas that usually face by family caregivers in Indonesia. Unfortunately, family caregivers typically are not prepared to make those challenging decisions. Therefore, we recommend not only that family caregivers need to be involved in the caring process, but also their issues and ethical dilemmas should be assessed and addressed by health care professionals, especially nurses, who have the most frequent contact with patient and family caregiver.

Background: Child development monitoring and screening have been mandated as a national health service worldwide, including Indonesia; however, a recent study found that Indonesian community health nurses experienced difficulties detecting and stimulating a child suspected of a developmental delay. Objective: To explore and provide an example of how Australian community health nurses, along with other professionals, contribute to a Universal child and family health service (UCFHS), a similar programme name in Indonesia is child developmental stimulating, detecting monitoring and early intervention programme or SDIDTK. Case study: This is a case study of a young Australian boy (4 years old) whom the mother reported that her son has unclear speech and he was not speaking as much as other children at his age. The researcher, as a nurse, delivered the child developmental assessment and play skills assessment and found that the child has subtle developmental gaps and was at risk for developmental delay. Several goal setting and programming ideas have been developed to meet the child developmental milestones. These include goals in fine motor skills, communication, problem-solving and personal-social skills which have been regarded as early intervention for the child. Together with the therapy from a Speech Pathologist, these goal settings and programming ideas have been collaborated with the kindergarten teachers and the family as well as the UCFHS nurses as part of the child developmental monitoring programme. Conclusion: Developmental delays can be detected through developmental and play assessments and can be followed by developmental stimulation and early intervention programme by developing goal settings and programming ideas around the delays or gaps in play or development.

Background: Self-control is associated with multiple positive outcomes. There are several studies on self-control, yet no literature describing the mechanism of self-control in old age. Objective: This study aims to develop a substantive theory on the exercise of self-control in old age. Methods: Grounded Theory methodology developed by Glaser & Strauss was utilized in the conduct of this study with ten (10) older adults as participants following the set of inclusion and exclusion criteria. Individual in-depth interviews of 30-45 minutes were observed to gather the needed verbatim narrative responses from each participant after careful consideration of the ethical procedures approved by the University research ethics board. Major themes with their respective sub-themes were generated after rigorous analysis of the participants’ responses following the steps provided by Glasser & Strauss in conducting grounded theory studies. Results: This study resulted in the formulation of three propositions such as: (1) Older adults exercise self-control differently, (2) several personal motivations are involved in the exercise of self-control, and (3) the exercise of self-control leads to life satisfaction. From the propositions emerged the Theory of Self-control in Old age, which states that the process of self-control encompasses the human capability of exercising self-restraint to overrun different types of desires, passions, and temptations. The theory posits that older adults vary in their exercise of self-control depending upon their personal motivations. The theory also assumes that the exercise of self-control results in life satisfaction as displaying self-control is attributed to a host of positive life outcomes. Conclusion: The present study has important implications in the field of gerontology and health care services since the older population is growing, and so does the demand for health care services. The need to understand the choices and decisions of older adult clients is fundamental in individualizing the health care services that may be designed and provided for them.

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Background: The patient’s quality of life immediately after mastectomy usually receives less attention than the quality of life after three months, six months, or a year. It is because the focus is mainly on surgical complications. Many instruments measure the quality of life from three months onwards. Still, the quality-of-life instruments right after postmastectomy is not yet verified. Objective: This paper aimed to test the reliability and validity of the Quality-of-Life Index Vietnamese version (QOLI-V) in Vietnamese women with breast cancer three weeks postmastectomy. Methods: The descriptive cross-sectional study was designed to analyze the psychometric properties of a Vietnamese version of the modified Quality of Life Index. The modified process was conducted after granting permission from the original authors. The content validity of the modified index was examined by five experts. Brislin’s model was used for the translation process. The 26-item QOLI-V was tested in 265 patients with breast cancer stage II three weeks postmastectomy who expected to have a poorer quality of life score. The reliability of the index was measured by Cronbach's alpha. The construct validity was examined using confirmatory factor analysis (CFA). Result: The content validity index results showed that the lowest I-CVI was .80 and the highest was 1.00. S-CVI/Ave was 0.95, and S-CVI/UA was 0.76. The Cronbach's alpha of QOLI-V was .84, which was considered acceptable. Most of the 26 items featured the correct item-total correlation of .30 to .60. There were only two items correlated with the total scale at .18, and the item with the lowest correlation (.06) was deleted from the item set. The CFA of model 1 with 26 items was not an ideal fit with the data, with Chi-Square/df = 2.15, CFI =.815, GFI = .853, TLI=.792 RMSEA =.066. After deleted an item #general quality of life, and the CFA of model 2 was conducted on the 25-item index. The final result indicated the improvement of the model fit, with Chi-Square/df =2.26, CFI=.852, GFI=.814, TLI=.790, RMSEA=.069. Conclusion: The 25-item QOLI-V version is considered valid and reliable to measure the quality of life of Vietnamese women with breast cancer three weeks postmastectomy. Nurses and midwives could use this instrument to measure the quality of life of the patients, and the patients could use it for self-assessment.

Background: Patients with newly diagnosed pulmonary tuberculosis often suffer from adverse drug reaction symptoms, which leads to the automatic discontinuation of anti-tuberculosis drugs. Thus, understanding symptom experience of adverse drug reactions is necessary. Objective: This study aimed to examine differences in symptoms experienced in four dimensions: presence, frequency, severity, and distress of adverse drug reactions, between male and female patients. Methods: This was a quantitative survey with a cross-sectional design, with data collected between January and April 2020. A total of 394 patients with newly diagnosed pulmonary tuberculosis was selected through a purposive sampling technique. The symptom experiences of adverse drug reactions were measured using a validated instrument. Data were analyzed using mean, standard deviation, and independent t-test. Results: The most commonly reported symptom was itchiness (24.1% in males and 34.9% in females). Vomiting occurred as the most frequent symptom among males (x̅ ± SD = 2.73 ± .88), and fatigue was found to be the most severe and distressing symptom across male patients (x̅ ± SD = 2.50 ± 1.61 and 2.06 ± 1.30, respectively). In contrast, yellowing of the eyes and skin was most frequent and severe among females (x̅ ± SD = 3.17 ± .75 and 3.83 ± 1.47, respectively). In addition, flu-like symptoms were evaluated as the most distressing symptom for female patients (x̅ ± SD = 2.80 ± 1.09). The symptom burdens of the females ranged significantly and reached higher than those of the male patients at a p-value of .05 (t = 3.33). Conclusion: Females taking anti-tuberculosis drugs should be carefully monitored to deal with adverse drug reaction symptoms. This finding would help to decrease the severity of disease and improve their quality of life.

Background: Exclusive breastfeeding provides numerous benefits to the health of infants, mothers, economics, and the environment. However, during the exclusive breastfeeding period, the mothers face many barriers. Objective: This study aimed to describe the perceived barrier of breastfeeding and compare its differences among mothers in Vietnam according to demographic and individual characteristics. Methods: A cross-sectional study was conducted among 246 women in Ho Chi Minh City, Vietnam. Data were derived from the original survey using a self-administered questionnaire asking about the barriers of breastfeeding in three aspects: maternal, infant, and socio-environment. Descriptive statistics, Independent t-test, and ANOVA were used to describe the mothers’ characteristics and the breastfeeding barriers. Results: The barrier from the infants was the most noticeable, followed by socio-environment and maternal barriers, respectively. Breastfeeding in public places (M = 2.93, SD = 0.92), baby’s illness (M = 2.74, SD = 0.99), and insufficient milk supply (M = 2.70, SD =0.99) were considered as major barriers to six-month exclusive breastfeeding among mothers in Ho Chi Minh City, Vietnam. Among the age groups, mothers who were more than 35 years old perceived had lower breastfeeding barriers than the younger mothers (F = 3.67, p = 0.03). Conclusion: The investigation of the barriers against exclusive breastfeeding practice can help nurses and midwives develop breastfeeding promotion programs to promote exclusive breastfeeding rate for women in Vietnam.

Background: Diabetes risk assessment is an essential preboarding tool before implementing health literacy programs to change an adult’s health behavior positively. Research has shown an association between health literacy and health behaviors, but there is a dearth of literature that delineates the difference between the health literacy and health behaviors of adults according to their diabetes risks; high risk vs. low risk.Objective: This study aimed to determine the difference between the health literacy and health behaviors of adults and establish the relationship between the two variables when classified according to their diabetes risks.Methods: This study utilized a descriptive cross-sectional design with 400 adults in a remote Filipino community in November 2019. Data were gathered using the Health Promoting Lifestyle Profile II (HPLP II) and Health Literacy Survey-Short Form 12 (HLS-SF12) questionnaires. Descriptive statistics, independent t-test, and Pearson’s r were used to analyze the data. Results: There is a significant difference between the health literacy index scores (p < .05); but no significant difference between the health behavior mean scores (p > .05) of adults when grouped according to their diabetes risks. Health literacy is significantly (p < .05) correlated with health behaviors of adults, with a moderate positive correlation in the high-risk group (r = .43), and both weak positive correlation in the low-risk group (r = .13) and entire group (r = .17).Conclusion: All adult inclusion efforts in promoting health literacy, with emphasis on the high-risk group, are needed to improve awareness of the degree of diabetes risks. Nurses should take an active role in the assessment of diabetes risks, evaluation of results, and implementation of interventions that could increase health literacy to facilitate the development of healthy behaviors. Stakeholders are urged to advance the availability of evidence-based lifestyle interventions to reduce the growth in new cases of diabetes.

Resiliency for older people represents the capacity to return to equilibrium when difficulties arise and was found as integral predictor of their health status. This study aims to develop a theory that attempts to explain the older adults’ resiliency perspectives during crisis and how it has affected their well-being and quality of life as population group. Deductive theory generation using axiomatic approach was adopted resulting to five axioms that served as basis for the generation of three propositions such as: (1) An older person’s health needs have tendencies to develop into a health threat, (2) when the threat is perceived, older persons developed a sense of internal control and adaptation to the changes it creates known as internal resiliency, and (3) internal resiliency can influence the quality of life in old age. The evolved theory suggests that in times of crisis (e.g., COVID-19 pandemic), health needs develop into a health threat that compels older persons to develop internal resiliency in order to preserve their integrity, wellbeing and quality of life. This study widens the nursing perspectives in addressing older persons’ resiliency by the unique condition at which older clients are placed affecting both the pathological nature of the illness as well as the preventive interventions which the society is forced to implement.

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Background: The condition of the Indonesians’ unpreparedness for the COVID-19 pandemic has caused anxiety and fear. The public’s fears of COVID-19 cases have led to a negative stigma. As part of health workers in disaster management’s main pillars in health services, nurses are most vulnerable to infection and not free from the stigma. Objective: This study aimed to describe the social stigma against nurses taking care of patients with COVID-19 and experiencing suspected or probable or confirmed COVID-19 cases in Indonesia. Methods: This study was a mixed-method study using a sequential explanatory design-participant selection model. The selection of respondents used the convenience sampling technique. The number of respondents in the quantitative stage was 118 respondents. For qualitative data, selected participants were respondents with a stigma score of more than 21 nurses and willing to continue the interview process. There were 11 participants in the qualitative stage. This study used the modified Stigma Scale of the Explanatory Model Interview Catalog for quantitative data and four semi-structured questions to obtain qualitative data. Quantitative data were processed in descriptive statistics, and a thematic analysis was performed to analyze the qualitative data. Results: The highest stigma score of 118 respondents was 37, and the lowest score was zero. The stigma score had a mean of 12.28 (SD ± 7.9). The higher the score obtained leads to a higher level of stigma received. From a total of 11 participants interviewed, four main themes emerged: rejection, feeling down and afraid, sources of support, and professional vigilance. Conclusion: The social stigma experienced by nurses comes from colleagues and society and impacts psychological distress. Support from families and colleagues strengthens nurses in facing social stigma. Nevertheless, nurses uphold the values to remain grateful and carry out professional responsibilities in taking care of patients. Nurses should be provided with psychological support and be prepared for disasters to provide excellent health services and reduce adverse mental health.

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Background: Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest.Objective: This article presents the development of a Proposed Theory of Symptom Cluster Management.Methods: The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles.Results: The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced.Conclusion: The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.

Background: Asthma is a significant health issue among Vietnamese adults in both urban and rural areas. The disease needs serious concern to minimize impact and improve the situation. Objective: This study aimed to describe the level of health literacy, symptom control, and medication management and determine the relationships among them in patients with asthma in Da Nang, Vietnam. Methods: A cross-sectional descriptive study was conducted among 84 patients with asthma. The questionnaires were used in this study, including demographic form, the Short-Form Health Literacy questionnaire (HL-SF12), Asthma Control Test (ACT), and Medication Adherence Reporting Scale for Asthma (MARS-A). Pearson product-moment correlation was applied to determine the relationship between health literacy, symptom control, and medication management. Results: The score revealed for general-health literacy, symptom control, and medication management were 28.70 (SD = 9.66), 17.72 (SD = 4.67), and 3.63 (SD = 0.75), respectively. Health literacy level had moderate positive relationships with symptom control (r = 0.41) and medication management (r = 0.44). Conclusion: The patients had limited health literacy, partially controlled symptom, and poor adherence to the medication. Health literacy level had moderate positive relationships with symptom control and medication management. These findings are crucial for effective treatment and management of the disease in Vietnam. To improve medication management and symptom control among patients with asthma, nurses should concern patients’ health literacy level.

Background: Postpartum depression has become a mental health problem in Indonesia. Screening symptoms of postpartum depression as early as one month during the postpartum period is needed. A smartphone application is considered one of the fastest ways for screening. Objective: To develop an android-based application to early detect the symptoms of postpartum depression and evaluate its effectiveness. Methods: The smartphone application was developed using Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instruction model. The survey design was carried out to evaluate the effectiveness of the application among 109 postpartum mothers selected using convenience sampling. Data were collected from August to October 2019 in South Tangerang, Indonesia. Results: The evaluation showed that the application is mostly positive. The appearance of the application is adequate (92.67%), easy to download (89.90%), understandable (96.33%), easy to fill-in (94.50%), beneficial (96.33%), new (90.83%), and reflecting psychological conditions (90.83%). Conclusion: The symptoms of postpartum depression can be measured by the android-based application. It is therefore recommended to Indonesian mothers use this app to detect postpartum depression symptoms early. This app also helps nurses and midwives to prevent depression among postpartum mothers. Also, the app can be imitated by other developers for non-Indonesian mothers.

Background: Understanding factors influencing Internet and game addiction in children and adolescents is very important to prevent negative consequences; however, the existing factors in the literature remain inconclusive.Objective: This study aims to systematically map the existing literature of factors related to Internet and game addiction in adolescents.Methods: A scoping review was completed using three databases - Science Direct, PROQUEST Dissertations and Theses, and Google Scholar, which covered the years between 2009 to July 2020. Quality appraisal and data extraction were presented. A content analysis was used to synthesize the results.Results: Ultimately, 62 studies met inclusion criteria. There were 82 associated factors identified and grouped into 11 categories, including (1) socio-demographic characteristics, (2) parental and family factors, (3) device ownership, Internet access and location, social media, and the game itself, (4) personality/traits, psychopathology factors, self-efficacy, (5) education and school factors, (6) perceived enjoyment, (7) perceived benefits, (8) health-compromising behaviors, (9) peers/friends relationships and supports, (10) life dissatisfaction and stress, and (11) cybersafety.Conclusion: Internet and game addiction among adolescents are multifactorial. Nurses should consider the factors identified in this study to provide strategies to prevent and reduce addiction in adolescents.

Background: Childhood pneumonia is the leading cause of death. Family caregivers may have a poor understanding of pneumonia, especially related to prevention and treatment. It is crucial to understand country-specific knowledge and healthcare-seeking behaviors of caregivers of children with pneumonia before planning programmatic responses, particularly in an urban community where the culture-social economic status is diverse. Objective: This study aimed to describe the knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia in Indonesia’s urban community. Methods: A descriptive qualitative study was conducted at a public hospital in Jakarta, Indonesia, from 10 December 2019 to 28 January 2020. Ten family caregivers of children with pneumonia were included, and a semi-structured interview was conducted for data collection. The audio recording was transcribed verbatim, and the data were analyzed using content analysis. Results: The emerged data indicated low knowledge of the family caregivers, especially mothers, which considered pneumonia a common cold only, and they failed to understand the risk of its transmission. Using traditional medicines was the first stage of healthcare-seeking behavior. If the symptoms worsened, the caregivers brought their children to the nearest health center. If there was no change in the symptoms, they headed to the hospital. The health center’s location, condition, services, and staff attitude were considered factors to choose the services. Conclusion: Living in an urban area does not guarantee the family caregivers have better knowledge and good healthcare-seeking behavior. Therefore, nurses should provide comprehensive education about pneumonia, its symptoms, and treatment management to improve family care and prevent pneumonia-related deaths. Integrated management of children with illness is recommended to help the family caregivers of children with pneumonia receive treatment as quickly as possible.

Background: Working alliance between therapist and client in psychotherapy practice has become proven to compensate for a significant difference in various psychotherapy modalities. However, few studies have investigated the structure of alliance in the context of nurses working at mental health hospitals in Indonesia. Objective: This study aimed to compare the working alliance of mental health nurses according to socio-demographic characteristics. Methods: A cross-sectional research was performed at the Mental Health Hospital in West Java, Indonesia, as a referral hospital in Indonesia from May to December 2019. The inclusion criteria were nurses with a minimum of one year of working experience and a Diploma III certificate in nursing. Convenience sampling was used to recruit 120 nurses who agreed to join in this study. The working alliance was measured using Working Alliance Inventory-Short Revised-Therapist (WAI-SRT). Results: The majority of the respondents were female (77.5%), holding a Diploma III degree in nursing (49.17%), having working experience ranged from 11 to 15 years (34.17%), and working at the chronic unit (32.5%). The mean score of the working alliance was 44.46 (SD = 11.32). The domain of agreement on goals had a higher mean score (17.65 ± 3.45), followed by the task domain (16.56 ± 5.81) and bond domain (22.10 ± 7.23). There was a significant difference in working alliance according to education level and working experience (p < 0.05), while no significant differences in terms of gender and working unit. Conclusion: Mental health nurses with higher education levels and more vast working experience had higher working alliances. Thus, nurse managers and hospital policymakers should provide Continues Nursing Education (CNE), working alliance training, and therapeutic strategies for nurses to improve their working alliances. It is also essential to cooperate with nursing schools to include working alliances as learning objectives.

Background: Nursing handover is an essential part of nursing practice to safe patient care, which occurs among nurses between shifts for transferring professional responsibility and accountability. However, there is limited information about the implementation and evaluation of nursing handover in Indonesian hospitals. Objective: This study aimed to describe the structures, processes, and barriers of the nursing handover in the Indonesian hospital context. Methods: This study employed a case study design in five inpatient units, especially in the medical-surgical wards of a referral hospital in Indonesia. The study was conducted from August to November 2018. A total of 100 handovers and 76 nurses were included. Focus group discussions were conducted in head nurses, nurse team leaders, and registered nurses. Observations were implemented to capture the handover process, including the number of the nurses in and out and the content of the information covered situation, background, assessment, and recommendations (SBAR). Data were analyzed using content analysis and fishbone analysis. Results: The nursing handover consisted of three phases: before, during, and after. The handover barriers were divided into manpower, material, money, method, environment, and machine. The content of handover varied according to nurses’ familiarity with the patients and their complexity. The nurses also actively participated during the handover process, although some nurses were absent in the handover time. About 75% of nurses had sufficient knowledge about the shift handover process using SBAR. The SBAR was adopted as a standard for handover, but no specific guideline or standard operating procedure. Conclusion: The results of this study can be used as basic information to develop a guideline of nursing handover and supervision in the context of hospitals in Indonesia and beyond.

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Background: The number of COVID-19 cases in Indonesia continues to rise. The roles and responsibilities of healthcare workers are crucial in the battle of the COVID-19. Objective: This study aimed to explore the experience of healthcare workers in combatting COVID-19 in some parts of Indonesia. Methods: This study employed a descriptive qualitative study design. Online semi-structured interviews were conducted in April 2020 among thirteen participants who were purposively selected. Data were analyzed using thematic analysis. Results: Eight themes emerged from data, including lack of personal protective equipment, lack of referral hospitals and limited facilities, dealing with patients with unknown status, feeling worried about getting infected or being a source of viral transmission, being creative, too long shift and fatigue, being surrender to God, and government issues. Conclusion: Findings of this study could be used as the input for the government, healthcare workers, and the general population in combatting COVID-19.

Palliative care is an important approach for nurses to improve the quality of life of patients holistically and mitigate suffering among the patients in critical condition and near to death. This article provides an Islamic perspective about nurses’ roles in palliative care, which can be applied worldwide, especially in Muslim-majority countries. Understanding Islamic beliefs will help nurses provide professional and culturally sensitive nursing care. In its principle, Islam always respects the process of life until death comes. So, the application of Islamic values in palliative care will make the patients accept their ill condition completely, keep being close to Allah SWT (God), and die peacefully. The concepts of illness, death, early action on the dead, and palliative care application in nursing are explained in this article to open up new ideas rather than provide definitive answers. We hope that this perspective will highlight healthcare policymakers the need to integrate Islamic values in nursing practice.

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Background: University students are an essential human resource for national development. Thus, it is important to study the stress, adversity quotient, and health behaviors of these students during the COVID-19 pandemic.Objective: This study aimed to identify stress, adversity quotient, and health behaviors and examine the relationship between these factors in undergraduate students during the COVID-19 outbreak.Methods: The current study was a quantitative study with a cross-sectional design. A total of 416 undergraduate students in a Thai university were selected using a convenience sampling technique. A questionnaire was used to collect the data on stress, adversity quotient, and health behaviors of undergraduate students during the COVID-19 outbreak. Data were analyzed using mean, standard deviation, and Pearson’s Product Moment Correlation Coefficient.Results: This study indicated that stress was at a high level (3.54 ± .53; Mean ± SD), adversity quotient was at a high level (3.77 ± .63; Mean ± SD), and health behaviors were at a moderate level (3.06 ± .53; Mean ± SD). The current study also found that stress and adversity quotient were irrelevant. Stress and health behaviors were negatively correlated with a level of significance of .01 (r = -.31), and adversity quotient and health behaviors were positively correlated with a level of significance of .01 (r = .051).Conclusion: It is suggested that healthcare providers, families, and professors should consider stress and adversity quotient in developing interventions to promote healthy behaviors in terms of physical and psychological factors in university students.

Background: Studies have shown that resilience has a buffering effect on mental health problems. However, the influence of resilience on the impact on the Quality of Life (QoL) in the context of the COVID-19 pandemic has not been well documented. Objective: This study examined the influence of resilience on the COVID-19 impact on QoL among nursing students. Methods: A cross-sectional research design was utilized. Three hundred and forty-five students of a government-funded nursing school in the Philippines responded in the web-based survey. Data were gathered using two adopted instruments from 18 to 31 August 2020. Test for differences and correlational analyses were performed. Results: The COVID-19 pandemic had a moderate impact on the QoL of nursing students. The COVID-19 impact on QoL significantly varied with sex and the nearby presence of COVID-19 cases. Bivariate analysis revealed a significant moderate inverse relationship between psychological resilience and the impact of COVID-19 on QoL. Conclusion: Resilience has a protective influence on the impact on QoL concerning main areas of mental health in the context of the COVID-19 pandemic. Understanding the factors and developing interventions that build the resilience of students is a focal point of action for nursing schools.

Background: Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients’ health-promoting behaviors, spirituality, and interpersonal relationships. Objective: This study aimed to determine holistic nursing care and compare its differences based on individual characteristics. Methods: This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences. Results: Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001]. Conclusion: Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients.

Background: Despite children’s frequent use of electronic devices, there is a lack of evidence showing how such media use influences their behavior. Objective: This study was to assess the relationship between media use and behavior among a sample of children aged three to 11 years. Methods: This was a descriptive cross-sectional study. An electronic self-administered questionnaire was completed from January 2020 to March 2020 by a convenience sample of 234 parents with healthy children in the target age group. Descriptive statistics and One-Way Analysis of Variance (ANOVA) were used for data analysis. Results: There was no significant difference in children's behavior according to the type of media [F(3, 230) = 1.673, p = 0.174]. In contrast, there was a significant difference in children's behavior according to hours per day of media use [F(4, 229) = 2.701, p = 0.031]. The most commonly used mobile device was the smartphone (n = 87, 37.2%). More than a quarter of the children spent three hours a day using media. Conclusions: This study offers insight into associations between children’s frequent media use and their behavior. The results suggest that the significant factor associated with behavioral problems is not the type of media but the time spent using it. Nurses are encouraged to use these findings in developing educational programs that raise awareness among parents and children regarding the consequences of excessive media use.

Background: Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective: This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods: This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results: The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (c2 = 1.39, df = 2, p < 0.50, c2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusions: These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.

Background: Healthcare-Associated Infections (HAIs) are infections that often occur in hospitals with Staphylococcus aureus as the primary cause. Staphylococcus aureus is usually found on nurses' hands and easily transferred by contact. Cell phones can be a convenient medium for transmitting bacteria. Accordingly, hand washing is one of the effective ways to prevent the transmission of Staphylococcus aureus. Objective: This study aimed to determine the relationship between hand hygiene behavior and the colonization of Staphylococcus aureus on cell phones of nurses in the intensive care unit of the academic hospital. Methods: This was an observational study with a cross-sectional design conducted from December 2019 to January 2020. The observations of hand hygiene behaviors were performed on 37 nurses selected using total sampling. Colonization of bacteria on each nurses' cell phone was calculated by swabbing the cell phones' surface. Colony counting was done using the total plate count method. Spearman Rank test and Mann Whitney test were used for data analysis. Results: The nurses' hand hygiene behavior was 46.06%. Staphylococcus aureus colonization was found on 18.2% of the nurses' cell phones. However, there was no significant relationship between the nurses' hand hygiene behavior and the colonization of Staphylococcus aureus on their cell phones. Conclusion: The hand hygiene behavior of nurses was still low, and there was evidence of Staphylococcus aureus colonization on their cell phones. As there was no relationship between the nurses' hand hygiene behavior with the colonization of Staphylococcus aureus on the cell phones, further research is needed to determine if there is an increase or decrease in colonization before and after regular observations.

Background: Literature suggests that merely omitting nursing care can put patients in danger and that avoiding these omissions potentially prevents deaths in hospitals. Objective: This study aimed to determine the perspective on the degree of missed nursing care among hospital nurses as it relates to their demographic profile. Method: A quantitative comparative research design was employed in this study. The study was conducted in the public hospitals in Hail City, Kingdom of Saudi Arabia. The study participants were 317 staff nurses, chosen through a simple random sampling, from the public hospitals of Hail City. Data were collected through a self-administered questionnaire between February and June of 2019. Results: The overall mean of the participants’ reported scores was “never missed” at 4.62. Statistically significant results were found in terms of the number of children (0.001), years of experience (0.004), unit of assignment (0.001), and the level of satisfaction with the profession (0.001). All other variables such as gender, age, marital status, and shift were found insignificant, where all of the p-values were more than 0.05. Conclusion: Nurses who had more children, a greater lack of experience, were assigned to a complex unit, and were less satisfied in the profession were more likely to miss nursing care. As such, these errors can compromise the outcomes of nursing care in hospitals.

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Background: The COVID-19 pandemic has resulted in people avoiding hospital admission for non-COVID patients and forcing people to seek help via telehealth or alternative medicine. Case study: A 30-year-old man from Solo, Indonesia, complained of left chest discomfort with an irregular heartbeat. This man sent an inquiry and his left eye sclera profile through WhatsApp on July 20, 2020 to a researcher, who is a nurse and “Su jok” therapist. Protocol for “Su jok” therapy was sent back through WhatsApp, and after applying the treatment for 30 minutes, the patient felt better, and symptoms were less severe. The full protocol to be applied for the following days was then sent to the patient. After three weeks, there was a less sharp red line in the sclera area of the vessel blockage, and he only experienced mild symptoms. Conclusion: The case study shows that “Su jok” therapy may become an alternative therapy for managing chest pain at home. Sclerology can be a complementary choice to monitor a patient’s heart condition. Visiting the hospital, however, is still necessary when the symptoms become worse.

Background: The Indonesian government has launched a clean and healthy living behavior program as one of the efforts for school health promotion. However, the healthy behaviors of the elementary students remain low. Objectives: This study aimed to examine the effect of audiovisual-based education on the knowledge and attitudes of clean and healthy behavior in elementary students. Methods: This was a quasi-experimental study with a pretest-posttest comparison group design conducted from 1 October to 17 October 2018. A total sample of 272 students was selected using purposive sampling, with 136 assigned in an experimental group (audiovisual group) and a comparison group (poster only group). Knowledge and attitudes of clean and healthy living behavior were measured using validated questionnaires. Data were analyzed using a paired t-test and independent t-test. Results: There was a significant effect of the interventions given in the experimental and comparison group on knowledge and attitude of clean and healthy living behavior (p<0.05). However, the experimental group showed a higher mean score compared to the comparison group in knowledge and attitudes, which indicated that the use of audiovisual-based education was more effective than the use of poster alone in improving the knowledge and attitudes of clean and healthy living behavior. Conclusion: The students who received audiovisual-based education had higher knowledge and attitudes of clean and healthy living behavior than those who only received poster-based education. This study provides input for pediatric and community nurses to provide better health education for the community, specifically for school health promotion.

Background: Nursing students are prepared to deliver care for vulnerable people, including people with dementia. Nursing students tend to have lower levels of knowledge and attitudes toward dementia compared to registered nurses. While there is less evidence that discussed this topic in the Indonesian nursing student's context, it will be necessary to identify an aspect related to knowledge and attitude among students to be considered for improvement in the future. Objective: This study aimed to identify the knowledge and attitudes toward dementia among nursing students in Indonesia. Method: This study was a quantitative study with a cross-sectional design. There were 334 nursing students recruited using a total sampling method at Universitas Gadjah Mada, Yogyakarta. Data were collected using the Dementia Knowledge Assessment Scale (DKAS) and Dementia Attitude Scale (DAS). Spearman Rank, Mann Whitney Unpaired, Kruskal-Wallis test, Pearson Correlation, Unpaired t-test, and Unpaired ANOVA were used for data analysis according to the type and the distribution of the data. Results: The median of the DKAS was 24 (min - max = 7 - 40), and the mean of DAS was 99.60 (SD = 10.25). The variables that were statistically significant correlated to knowledge of dementia were age (r = .332, p < .001), class standing (H = 72.253, p < .001), and experience in taking care of people with dementia (U = 3314, p = .047). Meanwhile, only the age of the students was found to have a statistically significant correlation with attitudes toward dementia (r = 158, p = .004). Conclusion: In general, among the nursing students, knowledge toward dementia was relatively low, while the attitudes toward dementia were relatively high compared to other research. Age, class standing, and experience in taking care of people with dementia had significant correlations to the knowledge score of the students. Lastly, age also had a significant correlation with the attitude score of the students.

Background: At present, the existing studies which explore the factors influencing elderly widows to remarry and their achievement towards successful step-parenthood are limited. Remarriage and step-parenthood are integrated into the complexities of the social phenomena in human experiences, which entail coping and adjustments to life changes. Objective: The study explored the lived experiences of elderly widows regarding coping and adjustments to remarriage and step-parenting as new roles. Methods: The study made use of a phenomenological approach, particularly the transcendental approach, to have a better understanding of their lived-experience after remarriage. Self-made open-ended questions were raised in the series of interviews using interview guides. The study was conducted in Iligan City, Philippines, where all the six participants reside. Purposive sampling was used wherein participants are selected based on criteria necessary to answer the objectives of the study: (1) He/ she should be at least 60 years of age; (2) must be remarried after the death of the previous spouse; and, (3) must be a bi-parent. Thematic analysis was used for data analysis. Result: Three themes emerged in all interviews: (1) adjusting to a new marital role, (2) sharing responsible parenthood, and (3) rewarding new parental role. Results highlighted bi-parenting among elderly widows as an aptly complex lived- experience as widows enter remarriage. Conclusion: It is concluded that the remarried widows view life after remarriage with the new family and children as a positive experience despite the challenges. Remarriage and being with another family can improve the wellbeing of the elderly widows. Having children and a new partner around is an opportunity to bring back a complete family structure together. This research recommends further that the understanding of their experiences and phenomena should be the basis of identifying their status. Researchers and clinicians should provide essential information to elderly remarried widows about the healthy and proper coping and adjustment to this life-changing event.

Background: Repeated hand and wrist movements increase the risk of carpal tunnel syndrome (CTS). The administrative staff is one of the high-risk classes that repeatedly involve the execution of identical tasks. Objective: This preliminary study was conducted to determine the prevalence of CTS among administrative staff and identify the socio-demographic and occupational risk factors for this syndrome. Methods: Descriptive cross-sectional study design was conducted amongst administrative staff at one of the higher learning institutions in Pahang, Malaysia. A total of 61 respondents were conveniently sampled according to the inclusion criteria. Respondents were required to undergo three tests (Phallen’s test, Thinel’s test, Durkan’s test) to identify probable CTS and answer questionnaires (socio-demographic background, occupational risk factors, and Boston Carpal Tunnel Syndrome Questionnaire). Data were analyzed using SPSS, and a Chi-square test was used to identify risk factors for CTS. Results: The average age for respondents was 31.72 (+5.38). The majority of respondents were female (70.5%), with a bachelor’s degree background and below (91.2%), and never used ergonomic tools (68.9%). The prevalence of probable CTS was 16.5% (n=10). There is no statistically significant finding between socio-demographic and occupational risk factors with probable CTS (p >.05). Conclusion: The data from this preliminary study revealed no association between the use of computers at work and probable CTS in a higher learning institution. Although the findings are not significant, this study can be used as a baseline for a future longitudinal study for nurses and other healthcare professionals to encourage good occupational and environmental health.

Background: Vitamin D deficiency is today acknowledged as a pandemic. Vitamin D deficiency and insufficiency are associated with many chronic diseases, including common cancers, cardiovascular diseases, metabolic syndrome, and infectious and autoimmune diseases. Objective: This study aims to investigate the relationship between the cotinine level in urine and Vitamin D. Methods: This study employed a descriptive and relational screening design.  It was conducted with 74 smoking university students between January 2019 and March 2020. Data were collected through socio-demographic form and Fagerstrom test for nicotine dependence. Besides, the participating students’ blood and urine samples were taken in a suitable environment. Results: The average age of the participating students was 21.50±2.09. Of all the students, 71.6% were males, 62.2% were exposed to the sun between 12 p.m. and 2 p.m., and the average number of cigarettes smoked daily was 13.52±8.22. The average Vitamin D level in blood was 32.4±15.3 (ng/mL), and the average cotinine level in urine was 1.60 ± .32 (ng/L). No statistically significant relationships were found between the Vitamin D level and the cotinine level (p<0.05). Conclusion: Smoking causes diseases and death in many people, and it is a changeable risk factor.  Nursing practices on the struggle against smoking are effective. No significant relationships were found between the Vitamin D level in blood and cotinine level in urine. Similar studies are recommended to be conducted with larger groups and participants from different age groups.

This article aims to decipher the effects of COVID-19 on humans, thus maintaining the equanimity of life. Ecclesiastes continually radiates its significance these trying times with the operation that everything has its season under heavens. Only an undesirable and existential peril like COVID-19 steered to such profound transformation vastly. The portrayal is considered some of the many obvious outgrowths of the COVID-19 plague. Compared to 2019, levels of pollution have significantly subtracted to 50% because of the measures to ensure the virus is contained. Recognizing health-wealth worth took place when the world watches someone busy picking up the pieces of their lives amidst helpless speculators. In the busyness of life, most, if not all, rarely spend time to slow down, stay home, and go inward. The pandemic teaches us lessons about relationships. The invisible lines that divide people into strata - religion, sex, age, and country have all disappeared as humanity is confronted with this menace as people.

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Background: Breast cancer patients need to be treated not only physically and emotionally but also spiritually. Hence, the assessment of the spirituality of patients is essential to provide holistic nursing care. However, there was no culturally valid and reliable instrument that measures spirituality among Filipino women with breast cancer. Objective: The study was conducted to determine the psychometric properties of the spiritual index of well-being among Filipino women with breast cancer. Methods: A descriptive cross-sectional design was utilized in the study, and a sample of 170 Filipino women with breast cancer were included. The World Health Organization guidelines were used to translate the original instrument to Filipino, and content validity was computed using the Davis technique. Also, confirmatory factor analysis with maximum likelihood estimation was performed to assess the construct validity of the instrument. Cronbach’s α and item-total correlations were done to assess the internal consistency of the Filipino version of the spiritual index of well-being. Results: The Filipino version of the spiritual index of well-being had an item content validity index (I-CVI) ranging from 0.86 to 0.92 and a scale content validity index (S-CVI) of 0.95. The confirmatory factor analysis (CFA) showed factor loadings of 0.42 to 0.72. Also, the CFA model revealed a X2/df = 2.51, root mean square error of approximation= 0.074, comparative fit index= 0.091, goodness of fit index=0.98, Tucker-Lewis index= 0.93, incremental fit index= 0.91, and standard root mean square residual= 0.072. Conclusion: The Filipino version of the spiritual index of well-being was cross-culturally valid and reliable in measuring the spiritual index of well-being among Filipino women with breast cancer.

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Background: Ineffective handover is considered a major factor that endangers patient safety in hospitals. Preparing and handing over patients before surgeries directly impact the outcome of the surgery. If errors occur, they could jeopardize the patient’s life. Objectives: To determine the level of nurses’ compliance during the pre-operative patient handover process at the anesthesia department. To examine nurses’ evaluation on using a pre-operative patient handover checklist. Methods: This was a descriptive observational study with a cross-sectional approach to examine 196 cases of handing over pre-operative patients performed by 53 nurses from the surgical department, maternity department, obstetrics and gynecology department, emergency department, and anesthesia department. Data were collected from November 2019 to February 2020 using “The Checklist of Assessing Nurse’s Compliance on Pre-Operative Patient Handover” and “The Survey Form of Nurse’s Evaluation on Using Pre-Operative Patient Handover Checklist.” Descriptive statistics, including frequencies and percentages, were used for data analysis. Results: Nurses’ compliance on handing over pre-operative patients with a high level was 71.9%, and with an average level was 28.1%. The handover areas with low compliance rate included: the patients need to be isolated (63.3%), identifying patient information verbally (75%), identifying patient information by hospital bracelet (77%), time to use antibiotics (78.1%), and marked surgical site (79.6%). Over 90% of nurses agreed on the usefulness of the pre-operative handover checklist. Conclusion: The process of handing over pre-operative patients was performed relatively well, but there were still shortcomings to overcome. Nurses positively evaluated the use of the handover checklist for preparing pre-operative patients.

The COVID-19 pandemic has caused people worldwide, such as in Thailand, to be frightened of being infected from the coronavirus. Exposure to media - including unreliable news sources - trigger people's stress and anxiety. This leads to increased mental health problems and psychiatric disorders in the population, resulting in higher suicide rates. Furthermore, this also affects medical and public health care staff working until emotional exhaustion and physical health deterioration. The ongoing fight against the outbreak of the COVID-19 virus increases the likelihood of pressure, stress, and anxiety. Therefore, a mental health care model for the people of Thailand is necessary. With the appropriate format for people to receive correct information, people will be more likely to accept changes, think logically and positively, not be discouraged, and be ready to improve themselves and their mental health.

Background: Knowing about prenatal attachment is crucial because it plays a significant role in pregnant women and their babies' health. Healthcare providers, particularly midwives, need to understand the concept of attachment between mother and unborn baby. However, surrogate terms to apply the concept of maternal-fetal attachment are found, and ambiguity on the definition remains. Objective: To provide a more precise definition of the concept of maternal-fetal attachment Method: The Walker and Avant's concept analysis approach was applied. Results: The attributes of maternal-fetal attachment include (i) having a positive emotion, (ii) paying attention to the physical progress of the fetus and mothers themselves, (iii) having a reciprocal interaction with the baby, (iv) monitoring and imaging the unborn baby, and (v) having a desire to protect her unborn baby from harm and increase her health practices. Maternal-fetal attachment is the affection relationship, desire for protection, building the interaction, and the emotional tie between the mother and her unborn baby during the pregnancy. This personal connection is developed, mainly when the quickening is present during the late stage of pregnancy. Maternal-fetal attachment creates an emotional relationship with the unborn baby and leads the mother to express it with behavior. Conclusion: This concept analysis provides new insight into the maternal-fetal attachment concept used for nurses and midwives in their practice.  

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After the publication of the article (Yani et al., 2018), it has been brought to our attention that the wrong title was used on the initial publication. The correct title of this article is “Knowledge, attitude, and practice of cough etiquette in patients with tuberculosis in the community health centers.” The original version of the article has been updated to reflect this. The reference and layout formats in this article have also been updated. The publisher apologizes for the errors. The corrected article can be seen at https://doi.org/10.33546/bnj.509

Background: In managing life with coronary artery disease, having self-efficacy is considered important. Self-efficacy reduces risk factors for coronary artery disease by encouraging the self-control process. The involvement of religiosity aspects can be a motivation to increase self-efficacy in maintaining an individual’s health status. Objective: This study aimed to examine the correlation between religiosity and self-efficacy in patients with coronary artery disease. Methods: This was a correlational study with a cross-sectional approach involving 112 respondents selected using an accidental sampling method in a hospital at Jember District, East Java, Indonesia. Data were collected from December 2019 to January 2020 using the Religiosity Scale and Cardiac Self-Efficacy (CSE). The Spearman’s rank test was used to analyze data. Results: The results showed that the respondents’ religiosity had a median value of 3.84 (min-max: 3.00-4.00), while the median value of self-efficacy was 3.60 (min-max: 2.90-4.00). There was a significant correlation between religiosity and self-efficacy (p = <0.001, r = 0.540, α = 0.05). Conclusion: The moderate positive correlation between religiosity and self-efficacy indicated that the higher value of religiosity leads to a higher value of self-efficacy. The religious value through rituals of prayer or meditation could increase the self-efficacy of patients with coronary artery disease. Nurses are recommended to maintain the religiosity of patients at a good level to improve their self-efficacy and maintain the optimal health status.

After the publication of the article (Fahmi & Nurachmah, 2018), it has been brought to our attention that the wrong title was used on the initial publication. The correct title of this article is “Implementation of Internet-based emergency medical service: A solution to improve response time in out-of-hospital cardiac arrest and its potential application in Indonesia.” The original version of the article has been updated to reflect this. The reference format in this article has also been updated. The publisher apologizes for the errors. The corrected article can be seen in the following link: https://doi.org/10.33546/bnj.573

After publication of the article (Gustryanti et al., 2017), it has been brought to our attention that the wrong title was used on initial publication. The correct title of this article is “Factors related to depression among older people living in Cimahi, West Java Province, Indonesia”. The original version of the article has been updated to reflect this. In addition, the reference format in this article has also been updated. The publisher apologizes for the minor errors. The corrected article can be seen in the following doi: https://doi.org/10.33546/bnj.50

After publication of the article (Lestari et al., 2017), it has been brought to our attention that the wrong title was used on initial publication. The correct title of this article is “Caregivers’ experience in meeting self-care needs of adolescents with autism spectrum disorder: A qualitative study”. The original version of the article has been updated to reflect this. In addition, the reference format in this article has also been updated.  The corrected article can be seen in the following link  https://doi.org/10.33546/bnj.123 The publisher apologizes for the errors.

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Background: Poor family healthcare-seeking behavior may cause delays in pediatric tuberculosis management. Knowledge and attitude are among the basic factors that influence in the family healthcare-seeking behavior. Objective: This study aimed to explore the knowledge, attitude, and healthcare-seeking behavior among families of children with tuberculosis. Methods: This was a cross-sectional descriptive quantitative study using accidental sampling method. Eighty-three families of children with tuberculosis were recruited. World Health Organization's Knowledge, Attitude and Practice Survey guideline was used to develop the questionnaires used in this study. Data were analyzed using descriptive statistics. Results: Results showed that 51.8% of the families had good knowledge and 53% had a positive attitude while 74.7% of the families did not do early screening, 67.5% preferred hospital for examinations, and 51.8% directly visited a health care facility when the child showed signs and symptoms of tuberculosis. In these families, 77.1% delayed taking the child for treatment for < 1 month, and the reason for the delay in 100% of these families was because they did not know that their children had signs and symptoms of tuberculosis. Conclusion: In conclusion, more than half of the families in this study already had good knowledge, attitude, and practice in accessing healthcare services although poor screening practice was still seen in most families. Thus, nurses have opportunities to provide appropriate health-related education to achieve the desired behavioral change.

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Background: The Center for Disease Control and Prevention in 2016 identified and further classified Diabetes Mellitus as one of the chronic diseases, a leading cause of morbidity, and considered a major health problem in the Asia Pacific. Hence the quality of life as the optimum goal of any person is only achieved through appropriate self-care management. The person is a major key player of the nursing paradigm plays a crucial task in self-care since his/her responsibility is to assure balance between behavioral and environmental dynamics. Objective: To examine the self-management behaviors of clients medically diagnosed with Diabetes Mellitus and evaluate the correlation between self-management behaviors and glycated hemoglobin (HbA1c). Methods: The study utilized the validated Diabetes Self-Management Questionnaire (DSMQ) tool to 600 adults from the lower district of Khong Khlong, Kamphaengphet, Thailand. Through descriptive design, the investigation focused on major behavioral categories such as glucose management, physical activity, health care use and dietary control on at-risk stroke clients with DM aging 35 years old and above. Respondents with absolute complications of Diabetes Mellitus like stroke, blindness, undergoing dialysis even amputation are excluded to participate. Results: The findings revealed that most clients with DM are married female, ages 51-60 years old and is diagnosed of living with the disease for 6-10 years. Further, the respondents are generally aware on self-management activities for DM, however not all of them submitted for glucose monitoring program. On one hand, the respondents have high regard on controlling dietary intake to avoid the increase of blood glucose during scheduled tests while results also show that most of the respondents are having poor engagement on physical activities. Conclusion: It is concluded that self- management behaviors are strongly associated with HbA1c. Nonpharmacologic and identified independent nursing actions proven to aid clients with diabetes mellitus should be advocated in combating the disease.

Background: Smoking is a significant problem especially among Indonesian adolescents. A number of smoking prevention programs have been developed and implemented, but most of them do not work significantly for the Indonesian adolescents who are mostly Muslim. Objective: The aim of this article is to outline a study protocol for measuring the effects of Islamic-based program using family approaches on the prevention of adolescents’ smoking behavior. Methods: The study will use a cluster randomized controlled trial conducted in three junior high schools, in Aceh Province, Indonesia. A total of 150 students will be involved in this study, where each school will be represented by 50 students. Each school group will be given the respective treatments. The first group will receive health-based intervention program, the second group will receive Islamic-based intervention program, and the last group will act as a control group receiving no intervention. The outcomes include the knowledge about smoking, attitudes toward smoking, smoking intention and smoking behavior of the adolescents. All outcomes will be measured using validated questionnaires. Discussion: If the Islamic-based intervention using family approach is effective, then this approach could be implemented not only in Indonesia but also in other countries with the same social characteristics. Trial registration: Australian New Zealand Clinical Trial Registry, ACTRN 12620000465954

Background: The rate of cardiac arrest outside hospitals remains high in Indonesia. Performing Cardio Pulmonary Resuscitation (CPR) is advised as an emergency procedure to save a person’s life. However, lack of ordinary people is able to do CPR. Therefore, cardiac arrest management training is considered important to form a bystander in the community. Objective: This study aimed to determine if there is an effect of cardiac arrest management training on the ability of ordinary people to perform high-quality CPR. Methods: This study used one-group pretest-posttest design method with a total sample of 35 participants. Observation sheet based on American Heart Association was used to measure the ability to perform CPR. Paired-t test was used for data analysis. Results: There was a significant effect of the cardiac arrest management training on the ability to perform high-quality CPR (p<.001), with an increase of the mean value from 19.62 (SD=5.50) before intervention to 37.91 (SD=1.29) after intervention. Conclusion: The cardiac arrest management training at the community level is considered effective in increasing the ability to perform high-quality CPR. The findings of this study can be used as input for community nurses to provide pre-hospital management training specifically on cardiac emergency management training continually for ordinary people in order to help improve good prognosis and reduce mortality risk of out-of-hospital cardiac arrest.

Background: Life in prison may cause negative feelings and thoughts which triggers depression for female inmates. This results in difficulty in finding purpose in life and loss of interest or motivation. Group-based hope intervention seems to be effective in decreasing depression, but it has not yet been applied in female inmates in a prison. Objective: To determine the effect of group-based hope intervention on depression level in female inmates. Methods: This study used a quasi-experimental study with pre-test post-test and control group design. Eighty-eight participants were selected using proportionate stratified random sampling, with 44 assigned into intervention and control groups. Data were collected from September to November 2019.  The level of depression was measured using Beck Depression Inventory-II (BDI-II). Mann Whitney U and Wilcoxon tests were used for data analyses. Results: Both group-based hope intervention in the intervention group and routine intervention in the control group has a significant effect on depression level (p<.01). However, further analysis showed that the group-based hope intervention was much more effective than the routine group in decreasing depression level in female inmates (p<.01). Conclusion: Group-based hope intervention is effective in lowering the depression in female inmates. Therefore, this therapy can be used as a valuable intervention in nursing practice, especially in a correctional setting.

Background: Competency of nurses is vital to safe nursing practice as well as essential component to drive quality of nursing services. Competency development is a continuous process of improving knowledge, attitudes and skills, and is influenced by a numerous of factors. Purposes: This study aims to explore factors that influence the development of competencies of nurses working in clinical settings in Vietnam. Methods: A descriptive qualitative research was conducted in Ho Chi Minh City, Vietnam with a purposive sample of twenty-seven participants including nurses, nurse managers, administrators, nurse teachers, medical doctors, and other health care providers. Data collection was by in-depth interviews and focus group discussions. Content analysis was used to analyze the data. Findings: The research participants described numerous of factors that influence the journey of developing nurses’ competencies. The identified factors were relevant to nursing education and training system in Vietnam; working environments of nurses; public image and values of nursing profession; characteristics of nurses themselves; Vietnamese nursing profession; sociocultural-economic and political aspects in Vietnam; and global contexts. Conclusion: The derived knowledge would greatly benefit clinical nurses, administrators, nursing educators, health care services managers, policy makers as well as other relevant health care stakeholders in proposing of solutions to promote nursing education, nursing workplace environments, and the appropriate regulations in order to enhance the nursing competency and quality of nursing services in Vietnam.

Healthcare robots are used in Indonesia and other countries to combat COVID-19 pandemic. This article was aimed to describe a perspective about healthcare robots, and to recommend ways for Indonesian nurses to engage with healthcare robots during the COVID-19 pandemic. One view hindering healthcare robot appreciation as partners of nurses is its threat to their practice. However, with the current environment of COVID-19 ‘frontline’ situations, increasing infections of patients with SARS COV2, limited personal protective equipment, and the fastidious nature of maintaining social distancing and mask-wearing, it may be best to view healthcare robots as significant partners to facilitate safety, and ease the demands of nursing care activities in order to safeguard human lives while enhancing human well-being. Educating healthcare practitioners about healthcare robot programming and assurance of its safe and secure use can advance robot appreciation as partners in healthcare. These goals, challenges, and recommendations can provide Indonesian nurses some pathways-to-readiness towards a partnership involving healthcare robots, particularly during this COVID-19 pandemic, and in the future.

Background: COVID-19 is caused by the 2019 novel coronavirus (2019nCoV) which was identified on 7 January 2020 by the Chinese Center for Disease Control and Prevention (CDC) from the throat swab sample of a patient. This novel coronavirus is phylogenetically similar to the severe acute respiratory syndrome coronavirus (SARS-CoV) that caused SARS outbreak in 2002. Objective: To describe a case of a COVID -19 patient in a hospital in Indonesia. Case Report: A 55-year-old male was admitted to the Emergency Department of Arifin Achmad Hospital on 31 March 2020. He was transferred from a private hospital after three days of hospitalization. Previously, he came to another hospital complaining palpitation, cough, having difficulty of breathing, and intermittent fever. He then was advised to be admitted and tested for a COVID-19 test. At first, he did not admit to having traveled recently. After three days, the pharyngeal swab test was received confirming that he was contracted with COVID-19. The patient was then transferred to our hospital and hospitalized for ten days. Discussion: The patient was fully recovered after ten days of treatment with antiviral drug namely Oseltamivir 75 mg orally twice a day and chloroquine phosphate 500 mg twice a day orally. The combination of both drugs showed an immune-modulating activity which might increase its antiviral effects. Therefore, the use of this agent in COVID-19 patients might be worthwhile. During hospitalization, reducing patient anxiety was also one of our main goals as many studies has found that anxiety is associated with poor immune system. Conclusion: This case report demonstrated the current situation in Indonesia where people become reluctant to fully disclose their symptoms or travel history to the health care workers, which may put many others on the risk of being transmitted with the virus. Although the proven efficacy of chloroquine is still lacking, it has become the favorable choice at this moment as indicated in our study. Reducing the patient’s anxiety towards the disease may help to speed the patient’s recovery. Also, we need to educate public that COVID-19 might be a life-threatening disease but it is also a treatable disease.

Background: Anemia during pregnancy is a health problem that often occurs in developing countries. Local wisdom-based counseling is considered a new approach in preventing iron deficiency anemia among pregnant women by integrating cultural beliefs into antenatal counseling. Objective: The study aims to measure the effectiveness of local wisdom-based counseling model among pregnant women to prevent iron deficiency anemia. Methods: This paper outlines the protocol of a randomized controlled trial method. Two intervention programs will be developed, the local wisdom-based program and health-based counseling intervention program, and will be tested among 150 pregnant women from nine public health centers in one district of Aceh Province. Sample selection will be completed through a simple random selection process. The effectiveness of the interventions will be assessed using a self-report questionnaire and a hemoglobin test. Data will be analyzed using descriptive and inferential statistics. Discussion: The expected outcome in this study is a significant difference in hemoglobin levels between both intervention groups. It is also expected that there will be an increase in knowledge, attitude, and behavior in the group who will receive local wisdom-based counseling intervention than the other group who will receive health-based counseling intervention. A local wisdom-based counseling approach is expected to give an effective model to reduce the prevalence of iron deficiency anemia among pregnant women. The effectiveness of this model may suggest the further application in the other regions. Registration trial number: ACTRN12620000299909

Background: Nurse performance plays an important role in ensuring high quality care to achieve patient outcomes in hospitals. Therefore, factors related to the performance warrant investigation. Emotional intelligence and workplace culture are assumed to be related to nurse performance. Objective: To determine the relationship of emotional intelligence, workplace culture, and nurse performance at one of private hospitals in Medan Indonesia. Methods: This study employed a cross-sectional design with 126 associate nurses who were selected using a simple random sampling technique. Emotional intelligence, workplace culture, and nurse performance were measured using valid questionnaires. Spearman-Rank correlation test was used for data analysis. Results: Majority of nurses had high performance, emotional intelligence and workplace culture. There were significant relationships between emotional intelligence, workplace culture, and nurse performance, with a strong (r= .68; p= .01) and medium level (r= .30; p= .01), respectively. Conclusion: Nurses with high emotional intelligence and good workplace culture would show good performance in providing professional nursing care to patients. It is recommended for the hospital managers and nurse managers to improve emotional intelligence of nurses and create better workplace culture in order to improve the nurse performance.

Introduction: Indonesia has the highest risk and vulnerability to both natural and non-natural disasters in the world. Aceh Province located on the confluence of two earth fault plates has been discovered to be exposed to a higher risk leading to significant physical, emotional, and psychological problems. Therefore, there is a need for immediate disaster response efforts to reduce the impacts, and nurses are the largest care providers with adequate competencies to ensure effectiveness. Objective: The study aims to develop a study protocol to measure the effectiveness of the intervention program to improve nurses’ competencies in disaster response. Methods: A sequential exploratory mixed-method study design will be used. A qualitative phase is to explore nurses’ competencies in disaster response according to nurses, disaster survivors, hospitalized patients, members of the Ulama Consultative Assembly of Aceh, and hospital policymakers using FGDs and in-depth interviews. The result of this phase is to develop intervention and instruments. Data are analyzed using a content analysis. A quantitative phase is to examine the effectiveness of the initiated intervention programs on nurses’ competencies in disaster response with a randomized controlled trial study design. There will be three groups in this phase, namely Evidence-Based Intervention (EBI) group, Islamic-Based Intervention (IBI) group, and Control Group (CG). The nurses’ competencies related knowledge, skill, and attitude will be measured using valid and reliable instruments. Data will be analyzed using independent t-test, and a repeated measure one way ANOVA.  Discussion: The findings are expected to be the basis for the development of appropriate tools and better intervention in nursing practice and education in relation to evidence and Islamic-based disaster curriculum as well as a guide for future research. Trial registration: on process with request number ANZCTR 378930

Background: Nursing presence is an essential nurse caring behavior of being with the patient. This is particularly true for those with chronic renal disease and who regularly undergo maintenance hemodialysis treatment in the hospital setting. When nursing presence is perceived by patients in a nurse-patient relationship, it is more likely to result in enhanced satisfaction with the quality of nursing care. Thus, it is important for hemodialysis nurses to be aware of the relevance of nurse-patient interactions in planned care considering that these interactions are integral to the extent to which nursing presence is experienced and perceived by patients.Objective: This study aims to determine the hemodialysis nurses’ extent of nursing presence as perceived by patients undergoing hemodialysis treatment in two hospitals in Iligan City, Philippines.Methods: Utilizing the descriptive research design, the study was conducted in two hospitals in Iligan City, Philippines. A total of 121 hemodialysis patients were purposely selected to determine their perception as to the extent of hemodialysis nurse’s nursing presence utilizing the 25-item Presence of Nursing Scale (PONS) instrument. Descriptive statistics were used for data analysis.Result: The overall rating by the hemodialysis patients in both hospitals was “always" on the hemodialysis nurses’ extent of nursing presence with an average mean score of 4.47 in all 25 items of the PONS. The highest rated item which reflects that the nurse cares for the patient as a person had an average mean score of 4.63 (always) while the lowest rated item indicating that the nurse is meeting the spiritual needs of the patient had an average mean score of 4.23 (always).Conclusion: The nurse-patient relationship is enhanced by the presence of nurses who are more responsive and interactive with the patients, resulting in patients who are more satisfied with nursing care. Thus, it is suggested that nurses in dealing with patients of varying backgrounds should consider their unique needs when giving information, explanations, health education and nursing care.

Background: Several screening tools for elderly abuse have been developed but they have rarely been validated properly for wider use. The multiplicity of the tools available revealed the need to develop through collaborative research, a simple and reliable tool that can be adapted and used in different geographical and cultural settings. As the cases of abuse increase, nurses are in a position to rescue this vulnerable population through equipping knowledge and be knowledgeable on using elderly assessment tool for abuse cases. Objective: To validate the developed Filipino-based elderly abuse assessment tool.   Methods: The study utilized descriptive confirmatory method design and underwent validation and reliability process. Five experts conducted the scrutiny during validation and 220 elderly clients’ subjected the tool for reliability tests. Data are analyzed using SPSS version 23, while frequency and percentage were used for continuous variable. Results: The Elderly Abuse Assessment Tool is valid and reliable. The tool is clear in terms of the word composition, the texts are understood easily, comprehensive, and relevant based on expert reviews.  It has I-CVI of 0.84 (44 items) and increases value in its second version to 0.87 (42 items). On one hand, the tool obtained a very high degree of reliability with Cronbach’s Alpha of 0.974 during the second version. Regardless of item numbers are retained, the value remains high. Constructs identified from the validated tool. Kaiser’s criterion or the Eigenvalue result of the second version of the developed tool revealed six factors that can be extracted. However, in the Scree test or plot, only two factors located above the inflection points. This means that two factors or constructs can be named. The researcher decided to choose the lesser number for easier naming of factors.  The tool was classified into two constructs, namely physico-sexual and psycho-financial factors, respectively. Conclusion: The Elderly Abuse Assessment Tool (EAAT) is valid and has a very high degree of reliability. Physico-sexual and Psycho-financial are the two major constructs of the tool. Filipino nurses can now articulate their expression of unending caring through the utility of the validated Elderly Abuse Assessment Tool (EAAT).

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Caring as an unending expression of nursing holds true this very time of trials. Humanity is faced with a crisis in the COVID-19 however healthcare professionals are standing still to save the world. This document illustrates how CUEN theory is applied in the care of patients undergoing emerging infectious diseases and stipulates its contribution to the care of patients having infected with the disease.

Background: Out-of-hospital cardiac arrest can occur anywhere, including in rural areas. Nurses are demanded to have skills for critical care to save lives. Objective: This study aimed to explore lived experience of nurses in caring for persons with out-of-hospital cardiac arrest in the rural areas of East Java, Indonesia. Methods: This study employed a phenomenological research design. Five nurses were selected from five village health posts using a purposive sampling. A semi-structure interview was used to collect data. Colaizzi’s method was used for data analysis. Results: Four themes emerged, including (1) being fast and responsive, (2) needing a family trust, (3) feeling worried, and (4) lacking personnel and infrastructure. Conclusion: The role of nurses in saving lives of persons with out-of-hospital cardiac arrest is very important. It is suggested for the nurses to always improve the quality of knowledge management of persons with critical conditions, provide understanding of basic life support in community, increase the trust of family in nurses, and improve the collaboration between nurses and community. The government also need to provide better emergency equipment and add health personnel in community.

Background: To promote excellence in nursing research, setting research priorities is needed to meet the need of community aligned with the national context. Unfortunately, limited number of studies has examined nursing research priorities in Indonesia. Objective: To identify nursing research priorities in Indonesia from the perspectives of nursing experts. Methods: This was a descriptive qualitative study. Focus group discussion was conducted among participants who were purposively selected (n = 13). Data were analyzed using a consensus-based method. Results: The top ten research priority lists were identified. The priorities were nurse competence, quality of nursing care in nursing services, nursing policy, nurse work environment, nurse mobility, interprofessional education and collaboration, teaching learning evaluation, nursing career, complementary therapy in nursing, and technology and informatics in nursing. Conclusion: Findings of this study could be used as the basis of direction for development of future research in Indonesia.

Background: Sleep disturbance is prevalent among patients with chronic diseases. Thus, the use of non-pharmacological interventions is needed. Progressive muscle relaxation is considered effective to improve sleep quality, but its discussion is still limited. Objective: To investigate the effect of progressive muscle relaxation on sleep quality among chronic disease patients. Design: Literature review. Data Sources: Search was performed through the CINAHL, Science Direct, and ProQuest database from 2014 to 2019 for English-based, full-text research articles. Review Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods was used to select articles. Critical Appraisal Skills Programme was used for quality assessment. Results: From the 644 articles yielded, six articles were included. Progressive muscle relaxation could be given alone or in combination with cognitive behavioural therapy. It also has been proven to improve sleep quality among patients with chronic diseases regardless their ages. Procedures in progressive muscle relaxation vary, but all studies reported significant improvements on sleep quality. Most of studies used audio as a medium for progressive muscle relaxation training. Conclusion: Progressive muscle relaxation significantly improves the sleep quality among patients with chronic diseases. It is recommended for future studies to compare the effectivity between 4 or 7 muscle groups and 16 muscle groups on sleep quality.

Background: Developmental delays can be a basis for identifying children who may experience a disability. Accordingly, developmental screenings and monitoring are implemented to facilitate early identification of developmental disabilities Objective: To explore Indonesian’s community nurses’ perceptions regarding their roles in the early identification and intervention of developmental disabilities Method: This was a descriptive phenomenological study. Eleven community health nurses participated in a multiple semi-structured interview. Thematic analysis was used to analyse data. Findings: Four themes of nursing roles emerged, these include parents’ expression of need, a focus on curative management, provision of nursing care and being alert to discuss a possible developmental delay. Indonesian nurses describe their roles as focusing on curative management and include monitoring child growth and nutritional status because they perceive these roles as the main program of the centres and as to fulfilling parents’ expressions of needs, however they will raise concern when it is suspected or observed, that the child has delayed development. Conclusion: Child’s developmental surveillance has been implemented in developed countries as the basis to identify developmental disabilities earlier in children, however Indonesian nurses focus more on nutrition and eradicating communicable diseases rather than child’s developmental monitoring. More investigation is needed to find barriers of implementation of developmental screenings.

Background: Treatment of children with cancer can affect daily lives of family caregivers. This can disrupt roles in social life, limit daily activities, disrupt health and physical and emotional balance as well as causing economic problems and creating poor quality of life. Objective: To describe the quality of life of family caregivers of children with leukemia based on characteristics of parents and children. Methods: This was a descriptive quantitative study. The population was all parents as the primary caregivers who had children aged 0-15 years diagnosed with leukemia in pediatric wards of Provincial General Hospital of Dr. Hasan Sadikin Bandung, Indonesia. Thirty-four respondents participated in this study selected using a total sampling. The quality of life of family caregivers was measured using the quality of life family version standard questionnaire, and the children's severity of leukemia was identified by the severity of illness scale standard questionnaire. Data were analyzed using frequency distribution, mean, and standard deviation. Results: The study results showed that family caregivers had poor quality of life (58.8%), with the worst sub-dimension including physical and psychological health conditions (55.9%), followed by social conditions (52.9%), and spiritual health conditions (50.0%). The majority of family caregivers who had the poorer quality of life were at the older age, male, having a primary education level, caring for their children for less than 12 months with severe leukemia, and having an average monthly income of fewer than 1.5 million rupiahs. Conclusion: Poor quality of life was identified among family caregivers of children with leukemia. Therefore, it is suggested for nurses to provide nursing care holistically not only for the children but also the families to increase their quality of life.

Background: The essence of transcultural nursing is to guide nursing students in order to be able to provide nursing care based on patients’ needs and their cultural backgrounds. To transfer the knowledge and attitude of the transcultural nursing effectively among generation Z students, an android-based module can be used and it is considered effective. Objective: This study aimed to determine the effect of using an android-based module on the knowledge and attitudes of nursing students regarding the provision of transcultural nursing. Methods: This study employed a quasi-experiment with a non-equivalent control group design. Ninety-four students were selected using a purposive sampling, which forty-seven were assigned in an android-based module group and a printed-module group. Data were measured using knowledge and attitude questionnaires about transcultural nursing, and perceived usefulness and perceived ease of use questionnaire for android-based modules. Data were analyzed using paired t-test and independent t-test with a significance level of < .05. Results: There was a significant effect of both android and printed based modules on knowledge of transcultural nursing (p <.05), but not for the attitude (p >.05). Based on the Independent t-test, there was no significant difference in students' knowledge and attitude about transcultural nursing between both groups (p >.05). However, the android-based module was considered useful (97.9%) with a mean value of 44, and was easy to use (91.5%) with a median value of 40. Conclusion: The use of both printed-based module and android-based module is effective to increase the students’ knowledge and attitudes about transcultural nursing.

Background: Bonding is an emotional bond between a mother and a baby that develops gradually and immediately after birth until it is formed into an attachment. Bonding is considered important to ensure the baby’s protection. However, bonding remains challenging for mothers with spontaneous childbirth because they are most likely to focus on themselves. Objective: To explore the bonding and attachment experience among postpartum mothers with spontaneous childbirth. Methods: This was a qualitative study with a phenomenological approach. Data were collected from nine participants using semi-structured interviews and observations. Data were analyzed using Colaizzi’s analysis method. Results: Five themes emerged, namely 1) feeling relieved and happy with the birth of the baby, 2) bonding and attachments are important, 3) stimulating the baby’s sense, 4) the need of social supports in bonding and attachment, and 5) internal and external factors of bonding and attachment. Conclusion: Bonding and attachment are very important that should be done by the mothers to the baby. However, it takes time and needs the supports from the husbands, parents, relatives, and health workers. Therefore, nurses or midwives should pay attention to this process to create the better bonding and attachment between the mothers and the babies.

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Background: Oral infections can be a potential source of infection resulting in a variety of systemic diseases, especially in intubated patients in an Intensive Care Unit (ICU). Endotracheal tube (ETT) of the intubated patient’s mouth can be an entry point and place of bacteria colonization that causes ventilator-associated pneumonia which is one of the causes of the patient’s death in ICU. Nurses as caregivers have an important role in providing oral care intervention to maintain oral health and prevent the infection. Objective: This study aimed to analyze the effect of oral care intervention on oral health status of intubated patients in the ICU.  Methods: This was a pre-experimental study with one group pre-test post-test design. A consecutive sampling was used to select 18 intubated patients in the ICU of Al Islam hospital in Bandung. Oral health status was evaluated by Beck Oral Assessment Scale (BOAS). Descriptive analysis was used for the univariate analysis and t-test was used for bivariate analysis.          Results: The results showed that oral health scores before and after intervention were 11.94 and 13.28 (p=.004). The BOAS subscales had a significant worsening of the lips, gingiva, oral mucosa and saliva (p<.05), while there was an improvement in teeth subscale after oral care intervention (p<.001). Conclusion: The results suggested that the oral health status of intubated patients had worsened, despite routinely oral care intervention using chlorhexidine gluconate. Mucosa care may become an essential part of the oral care intervention for intubated patients. Therefore, additional topical agent is needed to maintain the moisture of the mucosal membrane, so that the oral health status of intubated patients will be better.  

In the article by Fadlilah et al. (2019) published in the December 2019 issue of Belitung Nursing Journal, the following ORCID for Adi Sucipto was incorrectly inserted on page 237: “https://orcid.org/0000-0002-1693-4495” The authors retract this ORCID and change to  https://orcid.org/0000-0001-6740-1835. They also apologize for the error. The corrected article can be seen in the following link: https://doi.org/10.33546/bnj.822

Background: Depression can occur in elderly, but it is not a part of normal aging. Untreated depression increases rates of completed suicide and mortality. Therefore, an effort to reduce depression level is needed. Reminiscence and psychoeducation therapy are assumed to be effective in reducing the level of depression in elderly.    Objective: To compare the effects of reminiscence therapy alone and in combination with psychoeducation therapy on depression level in elderly. Methods: This study employed a quasi-experiment with comparison group design. Seventy-two respondents were selected in this study using a simple random sampling, which 36 were assigned in each group. Data were collected in 2018 using Geriatric Depression Scale (GDS). Dependent and Independent t-test were used for data analyses. Results: The reminiscence therapy alone or in combination with the psychoeducation therapy were effective in reducing depression level in elderly (p<.05). The combination of reminiscence and psychoeducation therapy was much more effective than reminiscence therapy alone (p<.05). Conclusion: These findings serve as an input for the Government of Indonesia to provide the combination of the reminiscence and psychoeducation therapy in the elderly program. This study provides a new knowledge for geriatric nurses to provide new interventions specifically to reduce depression level among elderly.

Background: Diabetes mellitus is a critical public health problem, and its prevalence in Indonesia remains high. Diabetes mellitus may cause complications, one of which is neuropathy that can impair foot sensitivity. This requires a treatment by doing diabetic foot exercises using sponges and paper. Objective: To examine the effectiveness of diabetic foot exercise using sponges and newspapers on foot sensitivity in patients with diabetes mellitus. Methods: This is a quasi-experimental study with pretest posttest with a control group research design, which was conducted at Public Health Center Depok III, Sleman Regency, Yogyakarta, Indonesia. An accidental sampling technique was used to select participants, with a total sample of 108 respondents consisting of 36 respondents in a control group, 36 respondents in a sponge group, and 36 respondents in a newspaper group. Data were analyzed using Wilcoxon and Mann-Whitney test. Results: Among the three groups, only those who received foot exercises using sponges and newspapers had a significant effect on foot sensitivity (p <.05). However, there was no significant difference on the effect of foot exercise on foot sensitivity between sponges and newspapers group (p >.05). Conclusion: The use of sponges and newspapers in foot exercise could significantly improve foot sensitivity in patients with type 2 diabetes mellitus. It is therefore recommended for nurses to provide the foot exercise as a part of nursing practice in both hospitals and community health centers.

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Background: Patient satisfaction has been revealed to affect patient outcomes and has been used as an indicator for measuring quality in health care. However, there are no culturally appropriate instruments that measure Filipino patient satisfaction receiving nursing care. Objective: The objective of the study is to examine the validity and reliability of the Filipino version of Patient Satisfaction Instrument (F-PSI). Methods: The study utilized a cross-sectional study and included 131 Filipino patients in selected hospitals in Manila and were selected through convenience sampling. The tool undergone cross cultural adaptation following the WHO guidelines. Also, content validity following Davis technique and construct validity through confirmatory factor analysis was done to assessed its validity. To measure its internal consistency reliability, Cronbach’s α, inter-item and total-item correlation was conducted. Results: The construct validity of the Filipino version of PSI showed a good model fit while the item content validity index (I-CVI) ranges from 0.83-1.0 and a scale content validity index (S-CVI) of 0.96. Also, the translated tool showed an acceptable internal consistency reliability. Conclusion: The Filipino PSI is a valid and reliable instrument for measuring satisfaction among Filipino patients. Supplementary studies are needed to ascertain its validity and reliability for clinical use.

Background: Diabetes mellitus (DM) is a major health problem in the world. DM patients should be able to perform self-care behavior. Diabetic self-care behavior is an effective strategy for controlling diabetes. Objective: The purpose of this study was to examine a health promotion model in patients with type 2 diabetes mellitus. Methods: A cross-sectional design was used, which involved 177 patients with type 2 diabetes from primary health care in Denpasar Bali Indonesia with a stratified random sampling. Independent variables were personal factors (age, sex, education, body mass index, socioeconomic status, self-motivation, illness perception, and belief), self-efficacy, and family support. The dependent variable was self-care behavior. A structural equation model was used to confirm the hypothesis model. Results: Personal factors (education, socioeconomic, and perceptions) (t = 2.891) and family support (t = 5.746) were associated with self-care behavior. Self-efficacy did not affect self-care behavior (t = .139). Conclusion: Diabetes self-care behavior is influenced by socioeconomic status, level of education, perception of the illness, and family support. Therefore, it is suggested for nurses to apply the health promotion model approach to increase self-care behavior of patients with type 2 diabetes mellitus.

Objective: This study explored the religious or spiritual beliefs and behaviors of the elderly that could somehow translate to their level of death acceptance or lack thereof.Methods: A total of four (4) elderly participants, ages 60 and above whom meet the criteria set for this study was interviewed to assess their spiritual upbringing and experiences that resulted to their death acceptance. The study involves qualitative approach using thematic analysis. The narrative testimony of the old adult participants in this study which includes cases of older adult that believes in God, older adult having shifted from one religious organization to another, and older adults’ instilled spirituality comes from religious imprint from family members during childhood describes the three important patterns in the religious or spiritual standing of the participants.Results: The themes signified that (1) older adults are inherently religious and this nature is a subsequent factor in (2) their faith in God basing on their life experiences and life’s meaning. Furthermore, this (3) belief or faith in God offers them a sense of security and hope in the afterlife.Conclusion: These themes explain the pattern in the creation of a religious/ spiritual standing that leads to death acceptance among participants as evident in their interview results.

Background: In general, mental illness poses the burden to the government, family, and community because of the patient’s low productivity and high-cost treatment. Recovery Based Program is a method to treat people with a mental health issue, which focus on the patient’s personal journey to have meaningful life despite the limitation of the illness. Several stakeholders of mental health have been trying to adopt it. Nevertheless, various problems arise at the time of the program execution. Objective: Purpose of this study is to obtain information regarding the experiences of stakeholder in recovery-based program implementation. Methods: Qualitative research with a phenomenological approach has been conducting. Five program holders from various institutions/organizations which running mental health program in West Java interviewed. Data were analyzed using Colaizzi’s method. Results: The result of this study revealed three themes: mental health services from stakeholder’s perspective, awareness of recovery, and efforts to overcome mental health challenges. Discussion: There is an urgency for enacting mental health regulation in a local scope, incorporating evidence-based practices into mental health programs and creating nursing homes for people with mental illness after being hospitalized at a psychiatric hospital. Conclusion: Mental health stakeholders encountered varied experience. However, they maintained an optimistic perception about Recovery Based Program for Mental Health in future.

Background: Coronary Heart Disease (CHD) has a high recurrence in Indonesia. This condition may occur as a result of the failure of compliance with post-acute management following a heart attack by CHD patients. One of the causes is the lack of effective health education. Objective: The aim of this study was to identify the feasibility of the workbook in improving patients’ self-efficacy (SE) and quality of life (QoL). Methods: This research used a quasi-experimental with pretest-posttest control design. A pretest was done to the patients who were treated in the cardiac intensive unit, and a posttest was carried out at the end of the first and second month after the pretest. The population was all post-acute CHD patients who were admitted to the cardiac intensive unit in one of the referral hospitals in West Java, Indonesia. A purposive sampling was used and obtained 39 respondents who were divided into control and intervention groups. The intervention group was given a health education using a workbook, and the control group was given a direct health education. Self-efficacy was measured using a questionnaire developed by the authors, with high validity and reliability. A SF-12 instrument was used for measuring the quality of life.  Data were analyzed using a descriptive quantitative analysis such as mean, Mann Whitney test, and Independent t-test. To estimate the effects of the intervention to QoL and SE, Kruskal Wallis test and One-way ANOVA were used. Results: The results showed that there was an increase in SE and QoL in both groups, either in the posttest 1 or posttest 2. The comparison of QoL in the pretest, posttest I and II obtained p=.452, .741, and .826, while SE between and within groups obtained p = .732, .220, and .009, respectively. Conclusions: Health education using the workbook was significantly more effective to increase SE than QoL of the CHD patients.

Background: Depression level among elderly remains high in Indonesia. One of efforts to decrease depression is laughter therapy, which is assumed able to lower depression. Objective: This study aimed to examine the effect of laughter therapy on depression level in elderly at Nursing Home of Binjai Integrated Social Service Unit for the Elderly, North Sumatra, Indonesia. Methods: This was a quasi-experimental study with pretest posttest with control group design. Forty-two participants were selected using a purposive sampling, with twenty-one participants were randomly assigned in each group. An experimental group received one-hour laughter therapy for 3 times a week in 4 weeks, and a control group received usual care. Depression was measured using Geriatric Depression Scale-15. Data were collected from April to June 2018. Independent and dependent t-test were used for data analysis. Results: Findings revealed that the level of depression in elderly significantly decreased in the experimental group (p<.05), but there was no significant change of it in the control group (p=.648). Between the two groups, there was a significant difference in depression level in elderly (p<.05). Conclusion: Laughter therapy could reduce depression among elderly. Therefore, this therapy can be used as one of interventions in nursing practice, especially at nursing homes.

Background: A surgical procedure using general anaesthesia in laparotomy surgery results in reduced bowel sound. A large number of patients who experience a delay in returning bowel sound after laparotomy surgery become the reason to give proper intervention in order to increase bowel sound return time. One of the non-pharmacological interventions that can be used is chewing gum. Objective: The purpose of this study is to identify the difference of bowel sound return time between groups of intervention and control after being given chewing gum intervention among post-laparotomy surgery patients. Methods: This quasi-experimental study used post-test only control group design. Thirty respondents were selected by purposive sampling technique. Data were collected through observation by calculating the bowel sound return time among post laparotomy surgery patients in the intervention group (n=15) and control group (n=15), and were analyzed using the Mann Whitney test.  The intervention group was asked to chew the gum once for 30 minutes, and bowel sound was measured every 30 minutes for 120 minutes. Results: The results showed that bowel sound return time in the intervention group was 90 minutes and the control group was 150 minutes, and p-value was 0.005. Conclusion: There was a difference in the return time of bowel sound between the intervention and control groups. Therefore, the intervention of chewing gum could become one of the non- pharmacological interventions that can be considered in increasing the bowel sound return time among post-laparotomy surgery patients.

Background: Constipation is one of the most common problems in stroke due to inactivity and immobility. Objective: To compare one hour and every two-hour turning regimens in the prevention of constipation in patients with stroke. Methods: This was a quasi-experimental research with pretest posttest with control group design. There were 39 participants assigned in intervention group (n=17) and control group (n=22). The intervention group turned every one hour, while control group turned every two hours. The turning regimen was implemented for five days. A bowel score was used to measure constipation. McNemar Test and Fisher Test were used to measure and compare the bowel score between the two groups. Results: There was no significant difference in the effect of two turning regiments on constipation (p > .05). However, based on a descriptive result, there was a slight decrease in the number of constipation from 47% to 29.4% in the intervention group, and from 32% to 27% in the control group. Conclusion: Turning might still become an effective way to prevent constipation in patients with stroke either every one hour or two hours without diet modification.

Philippines as one of the top producers of nurses worldwide must benchmark its national nursing standards to the rest of the world. Therefore, the standards must be compared and contrasted with other countries like Australia. The main purpose of this study is to compare and contrast nurse’s competency and performance indicators between the Philippines and Australia nursing competency system. This is a review article guided by Donnelly and Weichula’s Qualitative- Comparative Analysis (QCA). The process includes identification of the condition of interest, dichotomization and development of truth tables. Two official documents namely the Philippines’ National Nursing Core Competency Standards and Australia’s National Competency Standards for the Registered Nurse were selected as the condition of interest. Findings show that Australia adopted a one pronged-generalist, non-linear approach, and policy-based nursing education system while the Philippines emphasized on three-pronged specialization, work-based, and linear approach nursing competency standards. The Australia and Philippine nursing competency trails a different path in adopting standards for nursing education system. The strengths and weaknesses of each national nursing competency standards were discussed.

Background: The use of smartphones increases in Indonesia, its users are no longer among adults but have also spread to teenagers and children. Smartphone addiction causes a variety of problems, both physical, social, behavioral, and psychological problems of adolescents. Objective: The objective of this study is to identify the association between the tendency of smartphone addiction and the occurrence of emotional mental disorders in adolescents of junior high school students in Samarinda. Methods: This study used a descriptive analytic design through cross-sectional approach conducted in junior high schools in Samarinda. Sample of this study were 127 students. The 20 self-questionnaire adopted from the 2013 Basic Health Research questionnaire was used to measure emotional mental disorders, and the Smartphone Addiction Scale - Short Version (SAS-SV) questionnaire was used to measure smartphone addiction. Data were analyzed with multiple logistic regressions. Results: Results showed that there was an association between smartphone addiction and emotional mental disorders among junior high school students in Samarinda (p < .05). Adjusted Odds Ratio (AOR) was obtained at 2.418 (95% CI was 1.033 – 5.660). Conclusions: Smartphone addiction may lead emotional mental disorder among Junior High School students. The decisive rules are needed in the use of smartphones, both at school and at home to prevent the occurrence of smartphone addiction.

Background: The existing standard of nursing language consists of NANDA-I for diagnostic language standard, Nursing Intervention Classification (NIC) for nursing intervention, and Nursing Outcome Classification (NOC) for nursing outcomes. One way to improve the quality of nursing care documentation is to provide training in the documentation system. Objectives: To determine the effect of providing NANDA-I, NIC, and NOC (NNN) nursing care documentation systems training on the quality of nursing documentation. Methods: This was a pre-experimental study with pretest posttest design without a control group.  Twenty-one nurses and eighty-six Medical Records (MR) of patients who were treated in the perinatal ward of Yogyakarta Regional Public Hospital were used as samples selected using purposive sampling. Those nurses were trained in the nursing care documentation system. The quality of nursing care documentation was measured using modified Quality of Diagnoses, Interventions and Outcomes (Q-DIO) instrument. Data were analyzed using Independent samples t-test with a confidence level of 95%. Results: The average of the scores of the quality of nursing documentation before training was lower (1.91) than the average after training (2.78). There was a significant difference in the quality of nursing documentation before and after training (p < 0.001). Conclusion: Training of NNN nursing documentation system could improve the quality of nursing documentation in the perinatal ward of Yogyakarta Regional Public Hospital.

Background: Leukemia in children is not only a stressor for children but also all family members, especially for parents. Caring for children with leukemia relies on the importance of social support to overcome various crises caused by the disease and its treatment. However, parents' perceptions of social support can be affected by several factors. Thus, assessment of factors that impact social support of parents of children with leukemia is needed. Objective: This study aimed to analyze the social support perceived by parents of children with leukemia and examine the relationship between perceived social support and characteristics of parents and children. Methods: A quantitative study with cross-sectional approach in 104 parents of children with leukemia aged 3-18 years. Social support was measured using Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire. Data were analyzed using univariate analysis, Mann-Whitney U, Kruskal-Wallis, and Spearman Test. Results: Total scale score of the Multidimensional Scale of Perceived Social Support (MSPSS) of parents of children with leukemia was 5.74 ± 0.48. The highest subscale score was on family support (6.06 ± 0.46). There were statistically significant differences in MSPSS total scores based on parental education and family income (p <0.05). Conclusion: Nurses play an important role to provide support for parents who have children with leukemia, especially in risky families. Support that nurses can provide among parents of children with leukemia is by giving information about disease and care, empowering the family, and finding support outside the family, such as the source of financial support related to treatment, utilization of cancer foundations, and supporting group and others.

Background: Nurses have a key role in promoting patients’ involvement in decision-making process of palliative care to improve their dignity and satisfaction. However, there is a dearth of studies exploring this involvement, especially in public health centers in Indonesia. Objective: This study aimed to explore the perception of nurses in decision-making process and to understand what type of decision-making made by health care providers in palliative care. Methods: This was a descriptive explorative study with qualitative approach. Participants were selected using purposive and snowball sampling. Data were collected using Focus Group Discussion (FGD) and in-depth interview. Content analysis method by inductive approach was used for data analysis. Consolidated criteria for reporting qualitative research (COREQ) was also used. Results: Eight themes emerged in this study, namely: (1) Collecting information about patients’ current physiological condition, (2) Creating alternative strategies according to the patients’ current physiological condition, (3) Establishing implementation type to be performed, (4) Providing information to the patients, (5) Discussing decision-making between patients and family, (6) Choosing/rejecting an action by patients,  (7) Performing selected actions, and (8) Evaluating action. Three points that are different from the existing theory were: (i) there was a discussion between patients and family, (ii) the absence of the process of collecting information after a patient rejects to act, and (iii) there were three types of decision-making: paternalistic, shared, and informed decision-making. Conclusion: This study serves as an input for nurses to pay more attention in decision-making process in palliative care in patients with cancer, and to encourage patients to give contribution in decision-making as part of shared decision-making.

Background: Schizophrenia is a mental disorder with a high incidence and relapse due to a lack of family support. Families do not understand how to treat patients with schizophrenia. There are several factors related to the family’s abilities in treating patients with schizophrenia, there are the level of family’s knowledge, perception, and burden. Objective: This study aimed to describe the knowledge, perception and burden of family in treating patients with schizophrenia who experience a relapse. Methods: The research used descriptive quantitative method. Samples were selected by consecutive sampling technique and obtained 100 respondents. Data were collected by a questionnaire consisting of family knowledge and perception developed by the researcher, and Zarit Burden Interview scale was used to measure the family burden. Data were analyzed using percentages, score T, and the Zarit Burden Interview analysis. Results: Findings showed that 31 respondents (31%) had good knowledge, 42 respondents (42%) had sufficient knowledge, and 27 respondents (27%) had insufficient knowledge. In terms of perception, 66 respondents (66%) had a positive perception and 33% had a negative perception. In addition, 42 respondents (42%) had moderate to heavy burden levels, 23 respondents (23%) had a very heavy level of heavy burden, and 3 respondents (3%) with very heavy levels of burden. Conclusions: Based on the results, it is necessary to increase the frequency of health education for the families. In addition, it is also important to hold a sharing program between families to reduce family burden.

Background: Many tuberculosis sufferers experience recurrent events due to incomplete treatment processes. It is often found that tuberculosis sufferers re-enter the hospital because the condition is getting worse. Thus, factors related to the successfulness of the treatment of tuberculosis warrant identification.  Objectives: This review was to summarize and identify the current literature related to the successful treatment of tuberculosis and its factors. Design: A Whittemore and Knafl’s integrative review was used. Data Sources: Data sources included four electronic databases: EBSCO, PubMed, Science Direct and Google Scholar to search literature published between 2002 and 2017. Review methods: A systematic process was carried out to extract and analyze the data of all included studies. Results: A total of 146 articles were deemed appropriate for the topic, but only 28 articles were included based on inclusion criteria. It was found that a wide range of factors related to the successful treatment of tuberculosis, including predisposing factors (socioeconomic, knowledge, psychological stress, and availability to access health service), reinforcing factor (family support and social stigma), and enabling factor (physician and nurse support). Conclusion: Family support, socioeconomic, physician and nurse support, availability to access health services, social stigma, psychological stress, and knowledge were significant factors of the successful treatment of tuberculosis. For future research, the interventions to promote the program for decreasing the occurrence of the recurrent tuberculosis in the community need to consider these factors for the successful treatment of tuberculosis and collaborates with tuberculosis patients, family and health service for development of appropriate intervention.

Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are the leading causes of death from infectious diseases. Because of sharing same transmission routes, the co-infection of HIV with HBV or HCV is common. And the co-infections make HIV infected persons have higher morbidity and mortality than those who infected only with HIV. This study aims to investigate factors that may have influence on the co-infections of HBV or HCV among HIV positive individuals. Objective: The goals of this study were to identify factors associated with the co-infection of HBV or HCV among people living with HIV. Methods: Quantitative research method was applied in this study to examine factors associated with HBV or HCV co-infection among HIV infected people. A total of 250 HIV infected individuals in Khanh Hoa province, Vietnam were the sample of this study. It employed the Social Ecological Model (SEM) as a theoretical perspective that focused on multiple levels of factors. Descriptive statistic was used to describe the general characteristics of the respondents. And Binary logistic regression was carried out to measure the influence of factors on the co-infection. Results: The multivariate analysis of this study showed that HIV-HBV co-infection was associated significantly with residents of Nha Trang (OR= 7.179). Regarding HIV-HCV co-infection, being men (OR= 7.617), unemployed (OR= 4.013), a resident of Nha Trang (OR=10.894) and an injecting drug user (OR= 16.688) were risk factors of the co-infection. Conclusions: This study recommended that intervention strategies to prevent HIV-positive individuals from co-infection with either HBV or HCV should focus on altering individuals’ risk behaviors and their socio-economic environments. Also, specific preventing programs should be implemented and focus on unemployed populations, injecting drug users, men in general, as well as people living in particular areas, especially cities having a large number of people living with HIV.

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Background: Literature revealed that men tends to use healthcare services much lesser and visit much later, resulting in poor health outcomes. This is often regarded as a way of exhibiting masculinity.  In Brunei, there is an increasing number of mortality resulting from the complication of diabetes mellitus, a non-communicable disease, which arguably can be prevented. Objectives: To explore their health-help seeking behavior and health maintenance pattern of male diabetic patients in Brunei. Methods: Qualitative research guided by phenomenology research design. COREQ Checklist was used to prepare the report of this study. Individual semi-structured interview on eleven men were conducted from February to November 2018. Interviews were audio-recorded, transcribed and analyzed thematically. Results: Three themes were developed: “Maintaining health to enable the performance of masculine roles”, “Men delay seeking healthcare services”, and “Maintaining control and self reliance in looking after own sick body”. Conclusion: Health is perceived as important - it enables men to perform their ‘masculine responsibilities’. When men are in ill-health and realized how this could jeopardize their masculine roles, they would actively involve in taking care of their own body. This suggested how masculinity is in fact context –dependent. Level of knowledge and experiences with healthcare services and treatments also influenced men decision in health-help. Despite evidence that suggests how men often decline involvement with health promoting activities and delay seeking health from healthcare professionals, it was found that being able to continue supporting their family act as a legitimate reason for them to access healthcare services.

Grounded theory has been utilized in nursing research in order to develop theory from data. Since there are three approaches in the grounded theory methodology that consist of Classic grounded theory, Straussian grounded theory, and Constructivist grounded theory, thus understanding about perspective of each approach is needed. Those approaches have different points of views regarding the philosophical position, role of literature review, and coding process in data analysis. This review provides an understanding about the grounded theory approaches for researchers particularly the novice researchers, and selects an appropriate approach in their study.

Background: As future professionals, nursing students are expected to exhibit online professionalism and to be responsible users of social media. However, the rapid sharing of information on social media exposes nursing students to the risk and danger of spreading unprofessional behaviors like breaches of privacy and confidentiality. Objective: This study looked into the nursing students’ perceptions and attitude toward responsible use of social media. Methods: A descriptive cross-sectional research design was utilized and participated by 298 nursing students in a College of Nursing in Iloilo City, Philippines. The Responsible Use of Social Media Attitude Scale (RUSMAS) created by the researchers was used to collect the data. Results: Findings indicated that nursing students widely use social media and that nursing students had good perceptions and had positive attitude toward responsible use of social media. A significant difference was found in the attitude of nursing students when grouped according to year level. Conclusion: Social media continue to gain interest among nursing students and using it responsibly must be continuously upheld. Academic nursing institutions should develop approaches promoting social media literacy in nursing education.

Background: Evaluation of nursing outcome based Nursing Outcome Classification (NOC) is very important. However, there is dearth of information regarding its validation in Indonesian language. Objective:  To validate four nursing outcomes’ indicators of the Nursing Outcome Classification (NOC) for stroke patients with self-care deficit problems. Methods: This was a descriptive quantitative study with cross sectional design. Outcomes indicators of self-care: bathing, dressing, eating, and toileting were developed for measuring its relevance, clarity, simplicity and ambiguity. Content validity index was used for analysis, which involved three nursing experts. Results: Out of the 59 outcome indicators, 49 (83.05%) were considered as passing indicators and 10 (16.95%) were eliminated. Conclusion: The passing indicators can be applied in caring for stroke patients. The NOC indicators can be implemented in clinical setting, particularly for stroke patient with self -are deficit problems.

Background: Health disparity can be observed using the lens of emancipation through nursing. Objective: This paper aims to describe the concept of emancipation through nursing, situate its position within the theory of ’Emancipation through Nursing,’ and illuminate the implications of caring within the context of health disparity. Methods: The sequential process of Rodgers’ Evolutionary Concept Analysis and Chinn and Kramer’s Process of Theory Construction were applied. Review of the literature utilizing six major databases was conducted using the keywords ‘emancipation’ or ‘empowerment’ and ‘health disparity’ and ‘nursing’ and with year restrictions from 2000-2017. Results: Findings revealed that the attributes of the concept of ‘emancipation through nursing’ are conscientization or critical consciousness, correct and adequate health information, co-construction of a creative process for health service, and collective action. These attributes were preceded by the following antecedents: marginalization, hegemony, the oppressed and the emancipator, centering, and liberation. The resulting features of enlightenment, enervation, empowerment, and evolvement served as constructs that collectively structured the theory of Emancipation through Nursing in the Context of Health Disparities. Conclusion: Nurses worldwide will benefit from descriptions and illuminations of the concepts of emancipation and nursing within the theory of Emancipation through Nursing in the Context of Health Disparities.

Background: Cambodia’s nursing profession and nursing education system continue to progress 40 years after destruction by the Khmer Rouge. The author, who has a relationship with a hospital in southern Cambodia, was asked to teach physical assessment techniques to improve patient care. Objective: This study aimed to evaluate the impact of culturally congruent physical assessment media on the knowledge-base of Cambodian nurses. Methods: This article describes two years of an on-going project designed by the author who annually recruits US based BSN nursing students to use the ADDIE model to create and record segments on physical assessment which are posted on a private You Tube channel for the limited English- speaking Cambodian nursing staff. Optional post-tests are administered by the Cambodian hospital’s nursing director. Results: Test results reflect knowledge gained on cardiac, pulmonary, and gastrointestinal physical assessment skills with means ranging from 73.55% to 95.71%. Physical assessment skills until recently were not taught in Cambodia's nursing programs. Cambodia's nursing profession is advancing and a corresponding skill set including conducting physical assessments is necessary. As a majority of the project participants did not have prior exposure to the material, a pre-test was not provided and participation in post-testing was optional.  The objective was to provide useful professional educational materials at a comfortable language level for the Cambodian nurses using examples which were culturally relevant. Conclusion: The BSN students successfully developed culturally relevant educational products the Cambodian nurses found useful.

Background: Nursing intervention is part of nursing process. The accurateness of intervention needs to be explored through an effort to measure validity and reliability of the intervention. Objectives:  This study aimed to investigate the validity and reliability of four Nursing Intervention Classifications (NICs) of Self-Care Assistance (SCA) on patients with stroke. Methods: Validity measurement involved 4 experts, while reliability involved 7 samples for each NIC. Validity was analyzed using content validity index (I-CVI and S-CVI), while reliability was analyzed using kappa and percent agreement. Results: Sixteen activities of NICs (I-CVI score less than 0.78) were eliminated and two activities considered not applicable. The results of reliability were above 0.85 kappa value with 85% of percent agreement. Conclusion: Elimination of not valid activities increased reliability.

Meningioma is the most common type of primary brain tumor, which affect several domains of life, such as physiological, psychological, and social life conditions. Although surgery has been performed on meningioma patients in Indonesia, some patients still experience sequelae such as headache, impaired mobilization, disruption of activity, and visual disturbances. This narrative review aims to describe nursing rehabilitation programs in patients with meningioma in Indonesia. As a result, the nursing rehabilitation program is considered as an integral part of multidisciplinary rehabilitation, which can be applied in the nursing rehabilitation center and in the form of telenursing. The roles of nurses include providing evidence-based direct care, psychosocial support, patient / family education, care coordination, and continuing health promotion starting from the period of patient care in the hospital to discharge. In conclusion, the nursing rehabilitation program has the potential to improve the quality of life in meningioma patients, especially in Indonesia.

Background: Peripheral artery disease is a type of cardiovascular disease which belongs to vascular system disease and ranked the second most common non transmissible disease that cause death in the Philippines. The ankle brachial index (ABI) constitutes simple, non-invasive, cost-effective method for the early detection of peripheral artery disease (PAD) which complements assessment of cardiovascular risk. Objective: The study aims to determine who are at risk of peripheral artery disease among the Geriatrics and Policemen in Iligan City. Methods: It utilized descriptive-correlational-comparative research design and purposive sampling method. The data were gathered among 40 respondents: 20 Geriatrics and 20 policemen from Camp Tomas Cabili in Iligan City with the use of modified standardize questionnaire from Southern California Health Specialist Peripheral Artery Disease Patient Questionnaire. Results: Results showed majority (50%) of respondents were 50 years old and above; most (65%) were male. Pearson Correlational Coefficient shows that, among the demographic profile of the respondents, only age and lifestyle (diet and exercise) had a significant relationship with their degree of suspicion of having PAD. On the other hand, there was no significant relationship between gender, history of heredo-familial diseases, smoking, alcohol drinking habits, and the respondent’s degree of suspicion of having PAD. The result contradicts the nursing maxim that smoking is the most important risk factor for PAD; as in this case, even if most of the respondents were non-smokers and non-alcoholics, their poor diet and exercise alone increased their risk or degree of suspicion of having PAD. Conclusion: While age is beyond the control of the respondents, there is much that they could do to improve their lifestyle (diet and exercise) to lessen their risks for PAD. An institutional cafeteria serving nutritious food and exercise gyms could greatly benefit both the geriatrics and the policemen.

Background: Patients with advanced cancer require treatment and the fulfillment of their needs, based on the results of assessments regarding their physical symptoms, psychological and spiritual needs. Palliative care should be delivered with a person-centered care approach. It is important to consider the patients’ reports of their carings’ outcomes.  Comparisons between the patients’ and nurses’ perceptions of palliative care outcomes can be used to improve the quality of palliative care. Objective: The purpose of this study is to compare the patients’ and nurses’ perceptions of palliative care outcomes during the patients’ hospitalization. Methods: This is a comparative descriptive study with a cross-sectional design. Data were collected from May to June 2018 from a total of 106 patients with advanced cancer, and 61 nurses. The versions of the Palliative care Outcome Scale (POS) for patients and nurses were used to measure the palliative care outcomes of the patients’ and nurses’ perceptions. Result: The study found a significant difference between the perceptions of the patients and nurses for the palliative care outcomes, particularly in the information availability domain (p = 0.001), the other symptoms domain (p = 0.029), and the anxiety feelings domain (p = 0.030), while the other seven domains had no significant differences between both groups (p > 0.05). Conclusion: The anxiety feelings, other symptoms and information availability domains are the aspects of palliative care which need more attention from health care providers, especially nurses, when caring for patients with advanced cancer.

Background: The Expanded Program on Immunization (EPI) was developed to ensure access of infant and children to recommended vaccines. In the Philippines, nurses are deployed in the community to ensure that children in their assigned units are fully immunized before they reach 1 year old. However, despite the various immunization campaigns, many children still remain unprotected and at-risk to life-threatening vaccine-preventable diseases. Thus, identifying the barriers that have averted parents from adhering to complete and timely immunization is important, most especially to nurses who are the primary program implementers in the community. Objective: This study chiefly aimed to determine the respondents’ perceived barriers along the aspects of Personal, Geographical and Social Barriers, Beliefs and Myths on Immunization, and Knowledge and Awareness on EPI and their relationship to the respondents’ level of adherence to immunization. Methods: Descriptive correlational design was used to explore the perceived barriers to immunization and examine its relationship to the respondents’ level of adherence. A researcher-constructed questionnaire was used after being pilot tested to gather data from 352 random respondents. Results: Using frequency counts, percentages, and weighted arithmetic mean, the results showed that most of the respondents considered only geographical factors as barrier along with social factors. Moreover, it has been found out that respondents lacked knowledge and awareness on the benefits of immunization, the number of vaccines their child needs to receive, site and schedule, side-effects, and contraindications. However, with mean above 2.34 indicated that respondents were informed on the appropriate interventions for side-effects of vaccines, as well as their right to refuse vaccination. The respondents’ over-all level of adherence was moderate. Conclusion: The identified barriers geographical, social, personal, beliefs and myths on immunization and respondents’ level of knowledge and awareness have influenced respondents’ level of adherence to a moderate level only. Based on the results, health care providers, especially nurses, and other concerned program implementers need to consider and address these barriers when formulating or improving strategies to increase immunization compliance. Lastly, more intentional follow-up campaign drives in spreading information about Expanded Program on Immunization using media and other ways is needed.

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The notion of reflective practice has been considered important in healthcare professionals’ practice. In nursing, particularly in developed countries such as the United Kingdom, Canada, Australia, it has been set as a required competence for registration. Some action has been taken to support the achievement of competent and reflective practitioners, including embedding reflection in the nursing pre-registration education curriculum. In the past twenty years, there has been focus on using art-based initiatives to help student nurses to reflect on their clinical experience. Amongst the art forms, poetry has been used as a reflective tool. Many studies found that poetry could be helpful for developing students’ reflective skills. This literature review was conducted to identify the feasibility and promising benefit of using poetry to increase student nurses’ reflective skills. A comprehensive search of the literature and integrative review were undertaken for reviewing and discussing the evidence-based literature that supports the using of poetry as a reflective tool. A critical and narrative approach was undertaken for 16 relevant literature related to the importance of reflection in practice, the promising potential to enhance students’ reflective skills during academic education, and how poetry might promote students’ reflective skills. The literature review showed that using poetry in education have been carried out, and have yielded positive results. It is promising to note that the development of reflective practice, as required to be an attribute of a registered nurse, could be stimulated and achieved by the employment of poetry as a reflective tool in clinical education. The literature review also demostrated that using poetry as a reflective tool in nursing education is both feasible and worthwhile. Therefore, it is proven that using poetry as a means of reflection in an education setting is beneficial and valuable.  

Background: The increasing need for palliative care in intensive care unit (ICU) is indicated by the increasing number of patients with critical and terminal conditions or life-threatening diseases. A comprehensive handling through palliative care by nurses is needed. Self-efficacy is the main predictor that influences the application of palliative care in ICU. Therefore, nurses should have high self-efficacy in order to provide qualified palliative care for patients and their families. Objective: This study aimed to analyze the relationship between perceptions and self-efficacy of nurses in applying palliative care in ICU. Methods: This study was a correlational study with a cross sectional approach. The sampling technique used was total sampling, which involved all nurses who were actively working at the Bandung General Hospital during the study. There were 127 people in total. Data were collected using questionnaires. Descriptive analysis was used for the univariate analysis and Pearson correlation test was used for bivariate analysis. Results: The results of univariate analysis showed that the majority of respondents had high self-efficacy (56.7%) and negative perceptions (52%) related to palliative care in the intensive room. Based on the results of bivariate analysis, there was a significant relationship between perception and self-efficacy variables (p value = 0.000). Conclusion: The results showed that high number of respondents had negative perceptions related to their competences in implementing palliative care in the ICU. Therefore, socializations and trainings related to this are needed, which focus on nurses' beliefs in their abilities.

Background: The decline in Maternal Mortality Rate (MMR) in developing countries still does not meet the target of Sustainable Development Goals (SDGs). The rise of childbirth with the help of traditional birth attendants and cultural practices still becomes the choice of women of productive age to give birth today. Objective: This study aimed to explore the Malay culture practice and childbirth with traditional birth attendants in women of productive age in West Borneo, Indonesia. Methods: This was a phenomenological study conducted on in 2018 in one district in West Borneo. Focus Group Discussion (FDG) was done with eight Malay tribal women who had given birth with the help of Traditional Birth Attendants (TBAs). Thematic analysis was used. Results: Cultural practices during pregnancy, childbirth and the care of newborns, the services of TBAs, and the economy factor were strong reasons for mothers to choose to give birth assisted by TBAs although they were aware of the risks. This study identified five main themes, namely: 1) Reason for choosing TBAs, 2) TBAs’ service, 3) Cultural trust in pregnancy, 4) Cultural trust in labor, and 5) Cultural trust in caring for newborns. Conclusion: Our findings revealed that culture and childbirth cannot be separated. Health practitioners should have different approach by involving culture and TBAs in childbirth among women of productive age in West Borneo Indonesia.

Background: As nursing programs in Indonesia admit students, it is important that student factors are identified that provide information about necessary resources that are needed to support the student, both academically and psychosocially, to succeed in the nursing program. Obejctive: The purpose of this study was to use regression analysis to analyze admission and academic data of two cohorts of nursing students to know what relationship that information has with first semester grade point average (GPA). Methods: A descriptive correlation design was used. In a previous study with one cohort of nursing students, the researcher found that the variables accounted for only 28% of the variance. This research added the variable of age, increased the categories for region of origin from five to seven, increased the categories for type of high school from three to four, and analyzed the data from two cohorts. Data from 947 students were included for analysis. Mulivariate linear regression was used to analyze the variables of city of origin, attendance at pre-nursing course, gender, age, type of high school, and admission exam scores to determine the relationship, if any, between the first semester GPA of nursing students in a large university in an urban area of Indonesia. Results: A significant relationship (p<.05) was found between experience factors, attribute factors, and academic metric factors and first semester GPA. For students admitted in 2016, the study variables accounted for 30% of the variance in GPA; for students admitted in 2017, the study variables accounted for 37% of the variance in GPA. Conclusion: It is important that student factors are identified that provide information about succeeding in the nursing program, both academically and psychosocially. Additional research is needed to identify other admission factors and any factors in the first semester that may also have a relationship with GPA.

Background: The number of cervical cancer still remains high among women, including nurses in Indonesia. This is due to low participation of them to early detect and prevent it.Objective: This study aimed to identify the factors associated with the participation of nurses in early detection (pap-smear test) of cervical cancer at the hospitals in Bandung Indonesia.Methods: This was a correlational study with a cross-sectional approach on 286 nurses selected using cluster sampling at three hospitals in Bandung on March 2018. Data were collected using health belief model (HBM) questionnaire. Data were analyzed using Chi-square or Fisher exact and multivariate logistic regression test.Results: Factors associated with pap-smear behavior were the level of education, perceived susceptibility, perceived barrier and self-efficacy (p-value <0.05). Perceived susceptibility was the most correlated factor with pap-smear behavior with relationship strength (OR) of 16.259 and gave an effect of 27.89% as illustrated in the model equation of y = 0.324 + 2.789 susceptibility + 2.738 barriers.Conclusion: Pap smear behavior of the nurses was still relatively low because they had a negative perception of susceptibility to cervical cancer. Therefore, information is needed to change the nurses' perception related to the susceptibility of symptoms and risk factors that encourages nurses to do the pap-smear and increase nurses' awareness to actively participate in cervical cancer prevention program.

Emergency nurses often find themselves doing triage under time pressure and with only limited information, while the accuracy and rapidity of triage assessment may well determine a patient’s safety. A question may emerge as to whether novice nurses, who may have lack of experience and knowledge, could deal with such a demanding practice. Equipping novice nurses with important aspects in triage decision-making processes is pivotal. The aim of this literature review is to identify potential elements that could be utilised as supports for novice nurses in developing their expertise of making decision in triage. This study employed CINAHL, ScienceDirect, and PsycINFO to find relevant articles, using search terms “triage”, “decision-making”, “clinical decision-making”, combined with “expert”, and “novice”. The publication dates of those articles ranged from 1990 to 2015. 1487 articles was found and sorted based on inclusion and exclusion criteria, resulting in seventeen articles that had been used in this study. Literature review suggests four important elements for developing novices’ expertise in triage decision making: understanding the difference of novices’ and experts’ performance, critical analysis on theoretical approaches of clinical decision-making processes, defining factors that may influence nurses’ triage decision making, understanding errors that might be made by novices, and using appropriate learning strategies.

Background: Quality of life of caregiver of children with leukemia is important because it can affect the quality of care provided and can affect the health of children and the caregiver themselves. One of the factors that influence the caregiver’s quality of life is the family functioning. However, a few number of research on the correlation of family functioning in the caregiver's situation. Objective: The aim of the study was to analyze the correlation between family functioning and the caregiver’s quality of life of children with leukemia. Methods: This study used a Quality of Life Family Version questionnaire and a Family Assessment Device questionnaire. The populations in this study were all parents (father or mother) who were the primary caregiver of children with leukemia aged 0-15 years and were being treated at a referral hospital in West Java, Indonesia. Thirty-two respondents were determined by a total sampling technique. The data analysis used frequency distribution and chi-square. Results: The results showed that the family functioning and quality of life of the caregiver had the same results, 50% good and 50% poor. Correlation test in this study showed a negative value with p value > 0.05 (0.480), which indicated that there was no correlation between family functioning and the quality of life of the caregiver. Conclusion: The correlation between family functioning and caregiver's quality of life was not significant. This is likely due to the variable family functioning and the caregiver’s quality of life having balanced results. The results of this study need to be followed up by providing nursing care holistically not only to children, but also to families, especially who are directly involved in child care.

Background: Nursing students are allowed to give medication with clinical supervision to enhance skills in medication administration. However, studies suggest that some students commit medication errors due to knowledge, personal, administrative and environmental factors. Objective: This study will identify factors that cause student nurses to commit medication errors and correlate it to the number of perceived medication errors committed. Methods: A correlational design was used to correlate the factors contributing to medication administration and the number of medication errors committed by the students. 388 randomly selected nursing students were asked to answer Modified Medication Error Questionnaire which measures the knowledge, administrative, personal and environmental factors which may contribute to medication administration errors. Medication administration errors are measured according to the number of times a student commits as perceived by them. Results: Lack of knowledge of the drug and equipment to be used for administration, decrease in confidence, poor clinical assessment of patients’ conditions, and poor follow ups from clinical instructor are identified concerns under knowledge factor. Poor positive feedback, inadequate supervision and belittling ways of clinical instructors are identified under the administrative factor. Fear of administering an injection or giving medications is a common problem under personal factor. Inappropriate labelling of medications, unfavorable room temperature, lack of space, inadequate lighting, disorganized medication administration schedule and noise are problems found under environmental factor. A minority of 17.3% claimed that they have encountered a medication error in any of their clinical duties. Conclusion: Knowledge, administrative, personal and environmental factors have no effect towards medication errors. However, the relationship between age and the number of perceived medications errors is established. More in-depth investigation is recommended to determine the type of medication errors committed and its detrimental effects towards patient safety.

Background: Caring is the essence of nursing that is believed vital in improving the health and well-being of patients and in facilitating health promotion. Nursing education has a fundamental role in shaping a positive student’s caring behavior. Objective: This study identified the caring behavior of the final-year nursing students after completing a critical care nursing course unit by implementing assorted teaching-learning strategies. Methods: This study was a descriptive research using a comparative design. Samples were recruited from a group of 152 final-year students using a random sampling technique (n=76). Data were collected using a valid and reliable Indonesian caring instrument consisting of 32 items based on Watson’s ten carative factors. Data were analyzed using descriptive statistics by calculating mean scores of students’ caring behavior. A paired t test was performed to evaluate the difference between caring behavior before and after completion of the course unit involving a diverse teaching learning strategy, such as face-to-face lectures in the class, quizzes and practicums, facilitated small group case-based discussions, and expert reviews. Results: Results showed that more than half of the students had negative caring behavior before (59.22%) and after (54.55%) participating in learning process. There was also a barely statistical insignificance in the change of caring behavior following the course unit that involved various learning strategies (p value = 0.276). Further analyses of the 10 carative factors revealed that there was a significant change in transpersonal teaching-learning, provision for a supportive, protective, and/or corrective mental, physical, sociocultural, and spiritual environment, and spiritual environment and existential-phenomenological spiritual forces (improved, p value <0.05). Conclusions: Student-centered learning is a good approach to enhance the students’ critical thinking skills. However, in implementing the approach, there is a need to reevaluate appropriate method so as to simultaneously develop students’ critical thinking skills, caring behavior, and empathy.

Background: Mortality in people living with HIV/AIDS is one of measures to the success of its treatment. Study related to their deaths seen from gender is still very limited. Objective: The aim of this study was to determine the incidence rate of mortality between men and women living with HIV/AIDS and receiving antiretroviral therapy. Methods: This was a retrospective study using secondary data of HIV/AIDS-infected patients in Buleleng District Hospital in the period of 2006-2015. This research used survival analysis, Kaplan-meier, incident rate comparison and logistic regression with STATA SE 12. Results: A total of 1204 HIV/AIDS-infected patients’ data was included. The incidence of total mortality rates was 27.7 per 1000 person-years. Based on gender, the mortality in men (35 per 1000 person-years) was higher than women (14 per 1000 person-years) with the incidence rate ratio (IRR) of 2.39 (p 0.01).  Fifty percent of cases of mortality occurred at 0.15 years of observation. The median time of mortality in men was 0.14 years (1.7 months) and in women was 0.15 years (1.8 months). The poor clinical condition was seen from a body weight <50 kg, which increased the risk of death with aOR 3.85 (p 0.01 CI 2.40-6.16). Nevirapine increased the risk of mortality (aOR 2.18; p 0.01; CI 1.18-4.03). and CD4 cell counts of ≤ 200 cells / mm3 reduced the risk of death by 69% (AOR 0.31; p 0.01; CI 0.18-0.53). Conclusion: The incidence of mortality in men was greater than it in women, which is caused by poor clinical conditions. It is better to evaluate the success of antiretroviral therapy by considering the needs of patients according to their gender. Further research is needed in regard to adherence of treatment and loss to follow-up events.

Out-of-Hospital Cardiac Arrest (OHCA) is a condition when heart stops beating in out of the hospital. The majority of OHCA leads to death because of the delay response. Emergency Medical Service (EMS) system is needed to take care of the patients carefully. The development of Internet-based EMS is one of the best solutions, which is not only to improve the response time, but also to help patients to get the ambulance immediately. The aim of this paper is to understand how the Internet-based EMS can be used and how it will affect the patients with OHCA. Our findings indicated that the Internet-based EMS with mobile web service is critically needed for immediate response of cardiac arrest and accident situation in pre-hospital condition. However, the Internet-based EMS development needs to involve inter-sectoral agencies, such as fire fighter, police, and National Search and Rescue (SAR) Agent. This article has been updated. A separate erratum can be seen at https://doi.org/10.33546/bnj.1147

Background: Self-efficacy has been described as dominant factor associated with physical exercise in adult patients with type 2 diabetes mellitus, but to improve self-efficacy to regulate exercise of adult patients with type 2 diabetes mellitus is a challenge for health workers. Objective: This study was to determine the effect of exercise consultation program on self-efficacy to regulate exercise in adult patients with type 2 diabetes mellitus. Methods: A quasi-experimental study with two comparison groups was purposively designed for pre-test and post-test procedures. Sixty-one patients of type 2 diabetes mellitus were allocated into the experimental group (31 patients) and the control group (29 patients). While the experimental group received the exercise consultation for 12 weeks and routine care, the control group received routine care only. Comparative assessments on differences in self-efficacy to regulate exercise were examined both within and between groups using paired or unpaired t-test. Results: After receiving exercise consultation program, self-efficacy to regulate exercise significantly increased within the experimental group (p < .05), but there was no significant change with in the control group.  Between groups, there was a significant difference self-efficacy to regulate exercise in adult patients with type 2 diabetes mellitus (p < .05). Conclusion: The exercise consultation program could increase self-efficacy to promote the physical exercise among adult patients with type 2 diabetes mellitus.

Background: Repositioning the patients every 2 hours were often not implemented during patient care. One of the causes perceived by nurses as contraindications to repositioning in critical patients is the use of vasoactive agents. This condition increases the risk of decubitus, decreased orthostatic stability and muscle atrophy. Objective: The purpose of this study was to identify the effect of body reposition on hemodynamic patients receiving vasopressor therapy in Intensive Care Unit (ICU). Methods: The research method used Quasi Experiment with non-equivalent control group design. The subjects were ICU patients who received vasopressor therapy. The respondents recruited using consecutive sampling technique for a-four-month period and obtained 34 respondents, which was divided into control and intervention group. Data analysis used paired t-test to analyze the difference in the same group and unpaired t-test to test the difference between two groups. Results: Pre-post hemodynamic differences in the intervention group when patients were repositioned from supine to the right lateral and right lateral to left lateral showed p> 0.05. The hemodynamic difference between the control and the intervention group also had p> 0.05. The results showed there were no significant difference. Conclusions: In general, there is no effect of body repositioning on hemodynamic status. Critical nurses can perform body repositioning activities every two hours including in patients with vasopressor therapy to prevent complications of immobilization, still considering contraindication condition.

Background: Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) has become a global problem nowadays. To reduce its spread, Voluntary Counseling and Testing (VCT) and Provider-Initiated Testing and Counseling (PITC) have been provided. However, these interventions remain ineffective to discover new cases, as the stigma among health officers may exist. Objective: To compare the stigma towards people living with HIV/AIDS between VCT and PITC officers. Methods: This was a descriptive comparative study conducted in Makassar City, Parepare City and Sidenreng Rappang Regency, South Sulawesi Province, Indonesia. There were 139 samples were selected using a convenience sampling technique, which consisted of 66 VCT counseling officers and 73 PITC officers. The questionnaire from Health Policy Project in Thailand was used to measure the HIV/AIDS related-stigma. Data were analyzed using descriptive statistics and Mann Whitney test.  Results: Findings showed that there was a statistically significant difference in stigma between the group of VCT and PITC on people living with HIV/AIDS (PLWHA), which the mean of stigma in the PITC group (73.07) was higher than the mean value in the VCT group (66.61).  Conclusion: There was a significant difference in stigma between VCT and PITC officers towards PLWHA. It is suggested that PITC curriculum should be evaluated, and supervision and monitoring in both VCT and PITC groups should be implemented regularly to reduce the stigma towards PLWHA.

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Background: Emergency nurses are required to always carry out their roles in a variety of situations and conditions. Nursing services in the emergency unit must be done quickly and accurately. Data showed that the number of patient visits in the Emergency Unit of Hasan Sadikin Hospital in August 2017 was 3,059 (73% of patients with category III) with an average visit of 99 people per day. This causes overcrowding in the emergency unit, which lead to fatigue and influence work satisfaction. Aim: The aim of this study was to determine fatigue and job satisfaction of emergency nurses in Hasan Sadikin Hospital in Bandung, West Java, Indonesia. Methods: This was a quantitative descriptive study, which involved 55 respondents. Fatigue was measured using Individual Strength Checklist Instrument of 20-self-reported questionnaire (CIS20R), and job satisfaction was measured using McCloskey / Mueller Satisfaction Scale (MMSS). Results: The mean value of work fatigue was 3.4 with the highest value at the sub variable of physical activity. In general, the mean value of nurse work satisfaction was 2.66. Conclusion: Emergency nurses in the emergency unit of Hasan Sadikin hospital has high level of fatigue and low work satisfaction. The hospital management is suggested to provide better work schedule for better interaction among nurses, provide opportunities for all staff to be involved in research or other scientific work, and schedule family gatherings regularly to improve togetherness between staff and their families.

Background: Stroke patient has a risk of experiencing pressure injury, which could affect patient’s life and quality of life; therefore, optimum pressure ulcer prevention should be done. Patients experiencing pressure ulcer should be given appropriate care, to prevent infection and worse conditions. Objective: To identify the prevalence, prevention and treatment of pressure injury of stroke patients in the neurological ward. Methods: This research was a quantitative descriptive research using Landelijke Prevalentiemeting Zorgroblemen instrument. The samples were collected using consecutive sampling method with inclusion criteria of stroke patients experiencing paraplegia, which obtained 30 respondents. Data were presented in frequency distribution format. Results: The result showed that the prevalence of pressure injury was 3.3% of degree III and brought from home. Based on risk assessment, 43.3% of patients had a very high risk of getting pressure injury, and 56.7% had changed position, 100% had received nutritional support but 80% of patients had not received health education and 83.3% did not get a pillow on their heels, and 100% did not get pressure injury mattress, massage, moisturizing cream and oil. Treatment of pressure injury was using 0.9% NaCl liquid with hydrocolloid dressing. Conclusion: It can be concluded that there are still some patients experiencing pressure injury and in terms of items of pressure injury prevention, which often done is malnutrition prevention, the least are the changes of position in using pillows, and in health education. The one that have never been done are the use of oil, moisturizing cream, massage and pressure air mattress. The injury treatment provided to the patient has been adequate. The suggestion that can be given is the preparation of standard operating procedure, leaflets and the provision of pressure air mattress.

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Background: Cervical cancer is the second cancer disease that attacks women in the world, and it ranked the first in developing countries. It is expected that woman’s knowledge about cervical cancer will prevent the incidence among them.   Objective: To examine the effect of health education on the knowledge level of women about cervical cancer prevention. Methods: This was a pre-experimental study with one group pretest posttest at Bahorok’s Village, North Sumatra, Indonesia on April to May 2016. There were 36 samples selected using purposive sampling. Paired t-test was used for data analysis. Results: There was a significant difference in the mean value of women knowledge levels (p=0.004), with the increase of the mean of knowledge before intervention (mean= 1.0) and knowledge after the intervention (mean= 2.14). Conclusion: There was a significant effect of health education in increasing the level of women knowledge about prevention of cervical cancer. It is suggested that that health education should be done routinely to increase women knowledge in order to prevent cervical cancer.

Background: Schizophrenia is a severe mental illness with the majority of patients’ experiences relapses. Family support is not a new topic, but still considered as an important factor to prevent the relapse. However, little is known about the correlation between family support and relapse in schizophrenia patients in North Sumatra, Indonesia. Objective: This study aims to examine the relationship between family support and relapse in schizophrenia. Methods:  This was a correlational cross-sectional study conducted from January to May 2015 at the psychiatric hospital in Medan North Sumatra Indonesia. There were 90 samples selected using purposive sampling. Chi-square test was used to analyze the data. Results: Findings of this study reveals that there was statistically significant relationship between family informational support (p=0.00), appraisal support (p=0.00), instrumental support (p=0.00), and emotional support (p=0.00) with relapse in schizophrenia. Conclusion: There is a significant correlation between family support (informational support, appraisal, instrumental and emotional support) and relapse in schizophrenia. Therefore, it is recommended that health care professional should continuously promote the important of family support and increase their knowledge regarding the type of supports needed for patients with schizophrenia.

Background: Fever is manifestation of acute disease on children and contributes to incidence of severe malnutrition and morbidity and the most common reason for parents to deliver children on hospital. Currently, parents still lack knowledge of determination and proper management of fever although intervention of health education has been widely practiced. One obstacle to widespread success of educational intervention is inadequacy of health literacy. Utilization of media with simple and completed information with picture can be developed in communities with low levels of health literacy. Objective: To understanding the effect of health education using video and brochure on maternal health literacy in the working area of Saptosari Public Health Center, Gunungkidul Yogyakarta, Indonesia. Methods: This was a quasi-experimental study with pretest and posttest nonequivalent control group design conducted on 15 – 27 May 2017. The questionnaire used was HLS-Asia Q which had been modified. Health education intervention was done using a five minute-duration video about fever management in children preceded by discussion about the content of the video. Cluster sampling technique was applied with mothers who have under five children as the respondent involving 45 respondents for intervention group and 42 respondents in control group. Data analysis used independent sample t-test. Results: There was an increase in average maternal health literacy provided with video and brochure media compared to the maternal health literacy given with standard treatment. Intervention group mean difference value was 6.6444 ± 9.6086 and value of difference of control group mean equals to -2.4762 ± 12.0674 (p value <0.001). Conclusion: Health education intervention using video has a higher impact in the development of maternal health literacy compared with the standard intervention using brochure. 

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Background: Patients with congestive heart failure need a comprehensive rehabilitative program to restore post-attack physical ability and prevent re-attacks, therefore, it is necessary to develop physical activity protocols for these patients. Objective: This study aims to develop physical activity protocols for patients with congestive heart failure in the inpatient wards of the Level II Putri Hijau Hospital, Indonesia. Methods: This was an action research with 3 cycles consisting of four stages, namely: (1) reconnaissance, (2) planning, (3) action and observation, and (4) reflection. Data were collected quantitatively and qualitatively. Qualitative data were collected using in-depth interview, focus group discussion, and self-report, while quantitative data were collected using nursing knowledge questionnaire to 35 nurses selected using total sampling, and self-efficacy questionnaire about physical activity exercise to 9 patients with congestive heart failure selected using accidental sampling. Qualitative data were analyzed using content analysis, while quantitative data using descriptive statistical test. Results: Findings showed the completed compilation of physical activity protocols for patients with congestive heart failure. The results of observation showed a decrease in blood pressure of patients with congestive heart failure on the average of 3.12 mmHg after given physical activity protocol by nurses. Conclusion: The physical activity protocols for patients with congestive heart failure have been developed, and it has an impact on the increase of nurses' knowledge concerning physical activity exercise for CHF patients as well as the improvement of patients' self-efficacy or self-confidence in doing the physical activities.

Background: The common problems suffered by children with intellectual disability are difficulty to perform of daily activities or self-care including eating activity. NOC Self-care: eating is a measurement of client’s status regarding eating skill after provides nursing intervention. NOC was translated into Indonesian and its indicators were operationalized. The measurement of self-care: eating need to be evaluated, thus the reliability of this instrument was tested to determine whether the NOC is also reliable for use in Indonesia. Objective: The aim of this study was to investigate the interrater reliability of the NOC: Self-care: eating in the Indonesian Language in children with intellectual disability. Methods: Two raters assessed 124 children with intellectual disability using NOC: Self-care: eating. The study was conducted on December 2017 to January 2018. NOC was translated into Indonesian and each indicator was operated. Kappa and percent agreement were used for the analysis. Results: The overall kappa value of NOC: Self-care: eating was 0.55, while the percent agreement was 88. The highest kappa value and percent agreement was indicator of swallowing the food (0.8 and 99). Conclusions: The interrater reliability of NOC: Self-care: eating in Indonesian was at the level of great reliability.

Background: Tuberculosis is the major global health problem. A high number of tuberculosis cases are as a result of the disease spreads through droplet nuclei which mainly through a cough. Transmission prevention of tuberculosis is important to lower the rate of new infection. Since the transmission is through a cough, therefore, one of the preventive behaviors is by implementing the good and right cough etiquette. Objectives: The aim of this study was to find out the overview of knowledge, attitude and practice of cough etiquette in patients with tuberculosis. Methods: This study was descriptive quantitative with the cross-sectional approach. The population were all patients with Acid-Fast Bacillus (AFB) and tuberculosis registered in Community Health Centers of Rancaekek, Linggar and Nanjung Mekar in Bandung, Indonesia. A total sampling was used with a total number of 52 patients. Data on knowledge, attitude, and practice were measured via validated questionnaires and observation sheets. Frequency distribution, mean and median were used for data analysis. Results: Of the total respondents, 65.4% of the respondents had good knowledge about cough etiquette (median value 83.33 and IQR 20), 50.9% had negative cough etiquette attitude (mean value 47.87 and SD 5.885), and 63.5% had bad practice in cough etiquette (median value 5 and IQR 2). Conclusions: The result of this study is expected to be an input for primary health care facilities in doing improvement in delivering health education to patients with tuberculosis and their families about the good and right cough etiquette, which focus on the affective and psychomotor aspects to prevent the spread of tuberculosis and decrease its infection. This article has been corrected. A separate erratum can be seen at  https://doi.org/10.33546/bnj.1153

Background: Decreased brain aging is due to impaired cognitive function. One effort to inhibit cognitive decline due to aging is by doing brain gym. Objective: This study aims to examine the effect of light and medium intensity brain gymnastic on the improvement of cognitive function of elderly, and compare its result between the two intervention. Methods: This was an experimental research with pre-test and post-test group design conducted in 2016. There were 66 people included in this study, which 33 randomly assigned in the light intensity brain gymnastic group (group I) and medium intensity brain gymnastic group (group II). Mini Mental State Examination (MMSE) questionnaires was used to measure cognitive function of elderly. Data were analyzed using univariate and bivariate analysis. Bivariate analysis used paired t-test and independent sample t-test. Results: Findings of this study reveal that there was a significant effect of light and medium intensity brain gymnastic on the improvement of cognitive function of elderly (p=0.000). However, light intensity brain gymnastics (mean= 6.61) is better in improving the cognitive function of the elderly compared with medium intensity brain gymnastics (mean 2.18), with p=0.000, respectively. Conclusions: Brain gymnastic with light intensity for 10 minutes per exercise with frequency of 3 times a week is more effective in improving the cognitive function of the elderly compared with brain gymnastic with medium intensity for 15 minutes per exercise with frequency of two times a week.

Background: One of the efforts in the health sector for programs to reduce infant and under-five mortality and morbidity rates is by the competence-based integrated management childhood illness (CB-IMCI) program. However, the program has been poorly implemented by health workers at the health center. Thus, the involvement of cadres is needed and their competency remains important to be improved. Objective: To quantitatively analyze cadre knowledge and competencies in the CB-IMCI program, and its relationship with the implementation of CB-IMCI, as well as to qualitatively explore and analyze the responses of cadres, health workers, and the community to the addition of cadre roles to the management of sick children. Methods: This was a mixed methods study with randomized controlled trials and qualitative method. For randomized controlled trials, 100 cadres were selected, which 50 randomly assigned in the intervention and control group. And for quantitative methods, informants included 10 cadres, 4 health workers, and 20 mothers. Paired t-test and independent t-test were employed for quantitative analysis, and triangulation was used for qualitative analysis. Results: The improvement of knowledge in the intervention group was better (I=14.42/C=4.44/p-value 0.00). The intervention group was more competent in the management of child illness (p-value 0.00). In addition, the cadres have additional competencies assisted by health workers to confidently detect cases earlier, and health center services reach a wider coverage in the community. Conclusion: The addition of cadres’ roles and competencies in the management of child illness in the community can be implemented in Banyumas District. It is suggested that the implementation of this program should be followed up in other health centers by the Health Department of Indonesia.

Background: The target of exclusive breastfeeding decreased to 17% at the Pakualaman Health Center in Yogyakarta due to the barriers caused by the wrong perception regarding breastfeeding and returning to work. The roles of motivators in the promotion activity and exclusive breastfeeding reinforcements are expected to exchange experience among peers who have experienced of exclusive breastfeeding at maternal group activities. Objective: To identify the correlation between the role of motivators in supporting maternal groups in providing exclusive breastfeeding and exclusive breastfeeding behavior. Methods: This was a correlational study with cross-sectional design on 55 samples selected using purposive sampling technique. This study was conducted in women who had a > 6-23-month infant at Pakualaman Health Center in Yogyakarta Indonesia in 2017. Chi-square and multiple logistic regressions were used for data analysis. Results: There was no significant correlation between the role of motivators in supporting maternal groups and exclusive breastfeeding behavior in mothers with 0-6-month infants (p= 0.631). There was a significant correlation between the variable of access to information with the behavior of exclusive breastfeeding (p = 0.019). Conclusion: The role of motivators in supporting maternal groups has no significant relationship with exclusive breastfeeding behavior. It is suggested for midwives to increase the access of information among mothers, as information access has significant association with behavior of mothers in exclusive breastfeeding.

HIV-associated with neurocognitive disorder (HAND) is a major interest issues worldwide, as results from introduction of Highly Active Antiretroviral Therapy (HAART) and increasing life expectancy. However, previous studies have been limited by lack of a guiding framework. The purpose of this review was to provide a conceptual framework to guide studies of neurocognitive impairment in patients with HIV/AIDS. A literature search was conducted of articles published from 1998 through December 2015 using the PubMed, Embase, Cochrane Library and Ebscohost databases on evaluating the problem of neurocognitive impairment in HIV. This search resulted in a total of 36 articles. Evidence has indicated that there are neurobiological changes and brain abnormalities among people living with HIV/AID, which may affect cognitive functioning. Being infected by HIV and increased age are independently factors on HAND. However, there is remaining unclear the effect of HAART, is protective factors or risk factors of HAND and its consequence on quality of life among patients with HIV/AIDS. Considering the major issues in above, patient with HIV/AIDS is vulnerable population for developing HAND that might have been resulted to under report. Future studies focus on exploring HAND is necessary especially from low income countries where the accessibility to HAART are limited.

Background : Asthma is a chronic respiratory disease which affects daily life of people. The ultimate target of health care for adult people living with asthma is to control their asthma. It is important to keep asthma under control in order to avoid impact of uncontrolled asthma. Objective : The purpose of this study was to examine factors related to asthma control among adult asthmatic patients based on the Health Belief Model (HBM). Methods : This was a descriptive study with cross-sectional design, which conducted in Pulmonary Primary Health Center (PPHC) Yogyakarta on April 2016. There were 397 participants selected using simple random sampling. Asthma control was measured using Asthma Control Questionnaire (ACQ). The Rossenstock for Health Belief Model (HBM) was used to guide this study. Descriptive statistic was performed for data analysis. Results : Findings showed that age (p >.05), gender (p >.05), sufficiency of income (p >.05), educational level (p >.05), and occupation (p >.05) were not significantly related to asthma control. There was a significant correlation among perceived susceptibility (p <.05), perceived severity (p <.05), perceived benefit (p <.05), and perceived barrier (p <.05) with asthma control. Conclusion : It is concluded that asthma control of adult asthmatic patients is influenced by their perception of control their asthma. The study suggests that nurses in the community should increase health promotion to change health perceptions to keep asthma control status in adult asthmatic patients.

Background: Preterm infants are at risk for respiratory and hypothermia disorders that may affect physiologic growth and development processes that can be aggravated by treatment processes while in the neonatal intensive care unit. Treatment in the NICU can trigger stress that can affect the vital signs and healing process of preterm infants, thus requiring non-medical treatment to stimulate the condition. This research provides a different treatment of sound therapy that has never been given to preterm infants in previous studies by listening murottal Al-Qur'an. Objective: To examine the effect of listening to the murottal Qur'an on oxygen saturation in preterm infants during treatment at the neonatal intensive care unit (NICU). Method: This was a pre-experimental study with one group pretest-posttest design from September to October 2017. The samples were 30 preterm infants treated at NICU of the General Hospital of Panembahan Senopati Bantul selected using accidental sampling. The analysis used was simple linear regression. Result: There was an increase of the oxygen saturation level after given intervention of Murottal Qur'an for 3 days. The first day of oxygen saturation intervention increased by 2.07%, the second day 3.75%, and the third day 4.65% compared to the oxygen saturation level before the intervention. Conclusion: Listening to murrotal Qur'an could statistically increase oxygen saturation, but clinically there was no significant change in preterm infants, as the increase of oxygen saturation level was still within normal limits.

Background: To decrease maternal mortality rate until 70 per 100,000 living birth in 2030 (SDG’s) has become the health priority. In fact, the maternal mortality rate in Indonesia is still very high, and almost two-third maternal mortality is caused by maternal labor complications. Objective: The objective of the study was to investigate the factors influencing maternal labor complications in Kutai Kartanegara Region Indonesia in 2017. Methods: This was a correlational study with cross sectional design. The populations in the study were women who had labor process in the area of Kutai Kartanegara Region. There were 95 respondents selected using purposive sampling. Data were collected using questionnaires and medical records. Chi-square and logistic regression were used for data analysis. Results: Most of the respondents had maternal labor complication (53.7%). The highest complication occurred was prolonged labor  (58.9%).  Factors influencing maternal labor complication were antenatal care, mother’s age, education level, parity, and distance of pregnancy. Age was identified as the most dominant variable influencing maternal complication, with the value of OR was 5.837, which indicated that high-risk-age mothers have 5.837 times of labor complication than mothers with no risk age. Conclusion: Antenatal care, age, education, parity and distance of pregnancy had correlation with maternal labor complications, and its most dominant variable was age. 

Background: Infant mortality in Indonesia is at the highest level among the countries in South East Asia. Asphyxia in newborn has become the second risk factor for infant mortality. Objective: The objective of this study was to investigate the correlation between the level of hemoglobin, hematocrit, and thrombocytes of the mothers and asphyxia in the newborns at Panembahan Senopati Bantul Hospital, Indonesia. Methods: The study employed case-control method with 282 samples, which 141 assigned in the case and control group. This study used medical record of the patients as the secondary data. Chi-square, multiple logistic regression, and Odds Ratio Calculation (OR) were used for data analysis.  Results: There was a meaningful correlation between the level of hemoglobin (OR=2.3, 95%CI=1.3-4), hematocrit (OR=4.3, 95%CI=1.4-13.4, and thrombocytes (OR=5.3, 95%CI=1.14-24.6) of the mothers and asphyxia in newborns. Thrombocytes was the most dominant factor related to asphyxia in newborns. Conclusion: Mothers who have hemoglobin, hematocrit and thrombocytes levels under the normal have more than two times risk of asphyxia in their newborn than mothers who have normal hemoglobin, hematocrit and thrombocytes levels.

Background: The incidence of gout is rising both in the developed and developing countries not only in the elderly but also in young adults. Thus, the effort to reduce its incidence is necessary.Objective: To determine the effect of fruit decoction of phaleria macrocarpha on the levels of uric acid in the elderly.Methods: This was a pre-experimental study with pretest and posttest design. This study was conducted at Sei Semayang Village North Sumatra from April to May 2017. There were 10 elderly selected using purposive sampling. Urid acid levels were measured using monitoring system of Easy Touch GCU. Independent t-test was used for data analysis.Results: Findings of this study showed that there was a significant difference in the mean value of the levels of uric acid before and after given fruit decoction of phaleria macrocarpa (p=0.004).Conclusion: There was a significant effect of fruit decoction of phaleria macrocarpa to decrease the level of uric acid in elderly. It is suggested that fruit decoctions of phaleria macrocarpa can be one of alternative therapies to prevent the increase of uric acid.

Background: Teenage marriage is still found in developing countries including in Indonesia. The percentage of teenage marriage in females in Indonesia in 2016 was 11.5%. Various factors related to teenage marriage are education, knowledge, economy, and culture. Impacts caused by teenage marriages include pregnancy in adolescence which results in increased maternal and infant deaths, dropouts, and poor quality of the family. The prevalence of teenage marriage in Banjarnegara in 2016 was 23% higher than the national prevalence. Objective: This study aims to determine the correlation between factors related to knowledge of marriageable age, education, matchmaking and child marriage in females in Banjarnegara Indonesia. Methods: This was a correlational cross-sectional study. There were 96 respondents selected using proportionated stratified random sampling. Chi square and logistic regression were used for data analysis. Results: Findings show that there were statistically significant correlations between knowledge of marriageable age, education and child marriage. There was no significant relationship between matchmaking and child marriage. The respondents with low knowledge were 0.5 times more likely to have child marriage compared with those with high knowledge (p = 0.001, 95% CI = 0.320-0.782). Conclusion: Knowledge of marriageable age was considered as the dominant factor affecting child marriage in Banjarnegara Indonesia. It is suggested that health care providers should continuously promote about the impact of child marriage to increase the knowledge of marriageable age.

Background: Peripheral arterial disorders in diabetes mellitus is a common complication that often occurs and can develop into diabetic foot ulcers. High blood sugar levels in people with diabetes mellitus can cause increased blood viscosity resulting in thickening of the capillary membrane, where erythrocytes, platelets and leucocytes are attached to the blood vessels. Electrical stimulation by placing electrodes in the calf muscle is one of the measures to increase foot blood flow that can reduce the poor foot circulation. Objective: This study aims to determine the effect of electrical stimulation in improving blood flow of patients with diabetes mellitus. Methods: The research used pre-experimental design with one-group pretest-posttest. Sampling technique using purposive sampling as many as 62 patients with diabetes mellitus. Electrical stimulation was done by attaching electrodes to left and right calf muscles for 20 minutes, with frequency 3 times a week for 2 weeks. Before and after electrical stimulation performed foot circulation examination by ankle brachial index technique. Data were analyzed using Wilcoxon signed rank test. Results: The results showed that before the stimulation was obtained the mean ankle brachial index 0.82 mmHg and after stimulation it was 0.95 mmHg (p = 0.000). There was an effect of electrical stimulation in increasing foot blood flow. A calf muscle contraction during stimulation leads to increased leg blood flow through the addition of vascular endothelial growth factor and increased nitric oxide as a vasodilator of blood vessels. Electrical stimulation can be applied in increasing the blood flow of the foot, thus preventing the occurrence of diabetic foot ulcers. Conclusion: Stimulation is one therapy that can be done to prevent poor foot circulation of patients with diabetes mellitus.

Background: Fatigue as nursing diagnosis is a common phenomenon in patient undertaking haemodialysis. There is, however, no clear instrument to measure the clinical indicators of this nursing diagnosis. Objectives:  To measure the validity and reliability an instrument to measure clinical indicator in nursing diagnosis fatigue. Methods: Content Validity Index for Scale (S-CVI) and Point-Biserial Correlation were used to measure the validity of instrument. Cronbach Alpha Reliability was used for reliability of 72 patients undertaking haemodialysis. Results: S-CVI score was 1 on relevance, accuracy and clarity, 0.98 on simplicity and ambiguity. The Cronbach’s Alpha of the instrument was 0.675 which was considered reliable. Conclusion: The instrument to measure clinical indicators of nursing diagnoses fatigue has acceptable validity and reliability score in Indonesian, and it is recommended to be used in clinical setting.

Background: Balinese believe that mental disorders are caused after being possessed and cursed by one’s ancestors, so Balinese choose traditional Balinese treatment (balian/shaman) in handling patients with mental disorders. Objective: The purpose of this research was to explore deeply about the use of balian in treating patients with mental disorder. Methods: A qualitative method with an interpretive phenomenological approach was used. In-depth interview technique with semi-structured interview guidelines was used for data collection. Data were analyzed using Interpretative Phenomenological Analysis (IPA) approach. Results: Five themes emerged, including 1) ancestors’ curse, 2) possessed by a spirit, 3) believe that balian has healing power, 4) balian becomes the first choice prior to the hospital, and 5) the use of traditional and medical treatment at once. Conclusion: Balian became the first choice in treating patients with mental disorders. It is because Balinese still believes that mental disorders caused by the ancestors’ curse and possessed by the spirit.

Background: Patients with type 2 Diabetes mellitus are impaired both physically and psychologically. Based on preliminary studies carried out in public health centers in Denpasar, Bali, out of 10 patients interviewed, 70% of the patients with type 2 diabetes mellitus expressed their difficulties in adapting to the current state of the disease. One of the capabilities that must be owned by the patients to be able to adapt to the stressor is resilience. Roy adaptation model could be used in order to explain factors associated with resilience in patients with type 2 diabetes mellitus. Objective: To analyze the factors associated with resilience in patients with type 2 diabetes mellitus in Denpasar based on self-concept mode of Roy adaptation model. Methods: It used an observational analytic design with cross-sectional approach. Respondents used in this study were type 2 diabetes mellitus patients in four selected public health centers in Denpasar, Bali. 125 samples obtained by cluster sampling technique were used in this study. Conor-Davidson Resilience Scale-2 (CD-RISC-2), Illness Identity Questionnaire (IIQ) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) questionnaires were used in order to measure resilience, self-concept, and spirituality respectively. Pearson Product Moment test was used for bivariate analysis to determine the relationship between self-concept and spirituality and resilience in patients with type 2 diabetes mellitus. Multiple Linear Regression was used for multivariate analysis in order to find the most dominant factor related to resilience based on self-concept mode of Roy adaptation model. Results: The results of this study showed a significant relationship between self-concept and spirituality with resilience in patients with type 2 diabetes mellitus (p = 0.000). These two variables have r values equal to 0.599 and 0.597 respectively. Multiple linear regression showed that self-concept was the dominant factor related to resilience based on self-concept mode of Roy adaptation model with beta value equals to 0.687. Conclusion: There was a significant relationship between factors associated with resilience in patients with type 2 diabetes mellitus in Denpasar based on self-concept mode of Roy adaptation model.

Background: Comfort is one of nurses’ concerns in each of nursing care activity. There are several different instruments to measure patient’s comfort. Tools regarding comfort however, have not been developed and tested in Indonesian. Objectives:  This study aimed to assess the validity and reliability of the Shortened General Comfort Questionnaire (SGCQ) in Indonesian version. Methods: SGCQ was translated and back translated to Indonesian before it was used for this study. Three experts (two lecturers and one clinician) were recruited to measure the content validity of SGCQ in Indonesian version. S-CVI and I-CVI analyses were used to measure the content validity of this instrument, and Pearson correlation was used for the construct validity. Content validity of instruments consists of relevance, accuracy, clarity, credibility and equivalency. Reliability analysis of this instrument was performed using Cronbach’s alpha in 71 patients undergoing hemodialysis. Results: Result show that an I-CVI score was 1, which implies that each item of relevance, accuracy, clarity, credibility, and equivalency was acceptable. In addition, the S-CVI score was also 1, which implies that the validity of this instrument was acceptable. Cronbach’s alpha score was also showed 0.769 means that the SGCQ instrument in the Indonesian language is reliable because the score was in the range of 0.7–0.95. Conclusion: SGCQ in Indonesian version has acceptable validity and reliability and it can be used to measure patient’s comfort level in Indonesian.

Background: The pre-operative care aims at preparing the patient and family to face the surgery. In providing nursing care to the pediatric patients, it is better and is recommended that the nurse demonstrate a therapeutic communication. Objective: This study aims to identify the implementation of the therapeutic communication by nurses to the parents of the pediatric patients who will undergo surgery in the pediatric surgical ward based on the perspective and expectation of the parents. Methods: The study used a mixed method, with the strategy of sequential explanatory. The quantitative study involved 101 respondents. The implementation of therapeutic communication is measured by using the questionnaire of therapeutic communication implementation. The qualitative study was conducted to six participants as samples, with analysis interactive model technique. Results: The result of quantitative study found that 53.5% identified poor therapeutic communication being implemented by nurses to the parents of the patients. The result of the qualitative study foundthat parents expect comprehensive therapeutic communication from nurses, both in terms of language or behavior in any delivery of information or actions to be performed. Conclusion: The result of this study is expected to be an input for the health care institutions, especially to make it as a reference for consideration in making the standard operating procedures on the implementation of therapeutic communication to improve the nurses’ quality of care.

Background: Patients with coronary heart disease (CHD) should have good self-management capabilities. This is determined by the effective of health education which is based on the assessment of patients’ learning needs and consideration of health personnel. On the other hand, the study of perceptions of CHD patients’ learning needs in Indonesia is little known. Objective: This study aimed to identify the CHD patients’ learning needs. Methods: This study was a descriptive quantitative with cross-sectional approach. Population was CHD patients in one of the referral hospitals in West Java Indonesia. Samples were recruited using consecutive sampling technique for a 2-month period (n=106). Data were collected using TR-CPLNI instrument and analyzed using descriptive quantitative and Kruskal Wallis test. Results: The order of learning needs based on the highest to the lowest mean was  anatomy and physiology of heart (4.42); medication information (4.33); cardiopulmonary information (4.32); life style (4.28); dietary information (4.19); symptom management (4.08); psychology (4.07); and physical activity (3.64). The significant differences (p<0.05) based on ward categories were  learning needs of dietary information (p=0.002); physical activity (p=0.009) and symptom management (p=0.037), with the highest needs respectively were in High Care Unit (HCU); HCU; and non-intensive care unit. Conclusions: These eight learning needs were important for CHD patients. However, the priority of the patients’ learning needs were seen by category of ward or recovery phase and illness duration different from each other. Therefore, this can be a consideration in providing education to CHD patients.

Background: World Health Organization recommends mothers all over the world should continue breastfeeding up to the age of two years or beyond to achieve optimal health, growth and development for their infants. However, the breastfeeding practices among working mothers have been decreased by the time passed. Objective: to describe the breastfeeding experiences of mothers who returned to work after childbirth. Methods: This study was utilized a qualitative design. Purposive sampling was used to recruit the participant who met the inclusion criteria. Data were collected from 10 semi-structured in-depth interviews. All interviews were audio-recorded and transcribed verbatim. The interview transcriptions were analyzed by using the qualitative content analysis approach. Results: The breastfeeding period of 10 working mothers ranging from 7 to 15 months. Five categories emerged from the data were: 1) Attitude towards breastfeeding, 2) Breastfeeding support during working, 3) Strategic plan for breastfeeding, 4) Psychological distress, and 5) A need for support facilities and resources for breastfeeding during working. Conclusion: This research provided a better understanding of breastfeeding experiences of working mothers in Vietnam. The findings can help nurses and other healthcare professionals in providing anticipatory guidance to mothers who plan to continue breastfeeding after returning to work.

Background: Depression can occur in patients with chronic kidney disease undergoing hemodialysis and can lead to decreased quality of life, and will have a two-fold risk for the occurrence of death and hospitalization. Objective: The purpose of this study was to identify the effects of art therapy on the level of depression patients with hemodialysis. Methods: This study used a quasi-experimental method with pretest posttest with control group design. Collecting data using questionnaires of Beck Depression Inventory (BDI-II) versions of Indonesia, which was done twice, before and after art therapy intervention. Data were analyzed using paired t-test and unpaired t-test. Results: The results showed that after given intervention of art therapy there were differences in the average scores of depression in the intervention group (t = 0.764; p-value = 0.000). Art therapy is a medium to expose and express the feelings, fears or perceived problem, so it can be used as an adaptive coping method in patients with chronic kidney disease undergoing hemodialysis. Conclusion: It is concluded that art therapy could reduce depression in patients with chronic kidney disease undergoing hemodialysis. Nurses can act as a facilitator to provide art-based therapy in order to improve the ability of psychological adaptation in patients with chronic kidney disease undergoing hemodialysis.

Background: It is estimated that 49.2% of Indonesian adolescents (10-19 years) have iron deficiency of anemia. Green vegetables can be used as an alternative consumption to meet the body's need for iron. Kelakai (Stenochlaena palustris) containing 291.32 mg-100 g of Fe has been consumed by Dayak ethnic society to prevent anemia. Objective: The aim of this study was to determine the effect of Kelakai (Stenochlaena palustris) consumptions to increase hemoglobin levels among late adolescents (17-19 years). Methods: It was a quasi-experiment with pre-test and post-test study on anemic Midwifery students (8-11 g / dl) of Betang Asi Midwifery Academy of Palangka Raya Indonesia in September 2017. In which Kelakai was given as dietary supplements of the subject line and ferrous fumarate tablet as a control. There were 66 participants recruited by purposive sampling, divided into 33 subjects for each group. Kelakai (Stenochlaena palustris) (250 mg) and ferrous fumarate tablet (60 mg) were administrated daily for a week. Hemoglobin levels were measured before and after intervention using the hemoglobin testing system quick-check tool. Data were analyzed using paired and independent t-test. Result:  The result showed of significant increases on hemoglobin levels (3.24 g / dl) after consuming Kelakai (Stenochlaena palustris) for a week (p≤0.05). The hemoglobin levels after intervention in the control group were 0.03 g / dl higher than Kelakai group, but based on the analysis, there was no significant difference on both groups (p≥0.05). Conclusion: Kelakai is proven to increase hemoglobin levels. Thus, Kelakai (Stenochlaena palustris) is recommended a food supplementation to prevent iron deficiency of anemia.

Background: There have been various studies into the family caregivers’ experiences in taking care of advanced-cancer patients. But a study exploring the burden among family caregivers has not yet been conducted in Indonesia, a country which has strong family bonds among family members. Objective: This present study aimed to identify the burden among family caregivers of advanced cancer patients. Methods: This study was a cross-sectional study conducted from December 2016 to February 2017 on 178 consenting family caregivers and advanced cancer patients, selected using a purposive sampling technique. The Caregiver Reaction Assessment (CRA) was used to measure their burden. Data were analyzed using descriptive analyzes and bivariate analyzes. Results: The burden among family caregivers was 2.38 ± 0.38 (mean range 1-5). The highest burden was in the disrupted schedule domain. Conclusion: Our findings identified that the burden among family caregivers was at the medium level. The length of care per day and family support are potential targets for preventative intervention strategies to reduce the burden among the family caregivers.

Background: Children with intellectual disability has adaptation function problem, namely self-care skill dressing. Inability to dressing could affect social relationship and dependency with others. The effort to improve self-care skill could be done through self-development program and training using video modeling. Objective: This study was to investigate the effect of self-development program and training using video modeling on dressing skills in intellectual disability children. Methods: This was a quasi-experimental study with pretest posttest control group design. Sixty-two children aged between 6-12 years with intellectual disability were recruited using purposive sampling. Participants were divided into two groups (experimental group=31, control group=31). The experimental group was given training using video modeling in 4 sessions, with each for 50 minutes; and self-development program in 4 sessions, in 50 minutes per each, while control group was given self-development program for 8 sessions, with each for 50 minutes. Observation checklist of dressing skill before and after intervention was adopted from Nursing Outcome Classification in Indonesian version. Data were analyzed using Mann-Whitney to compare posttest score between experimental and control group. Results: The result showed there was a significant difference after intervention between experimental and control group (p=0.041). Eight dressing skills items increased including gets clothing from closet, gets clothing from drawer, puts clothing on upper body, buttons clothing, puts clothing on lower body, uses zipper, uses fastener, and removes clothes from upper body. Conclusion: Self-development program and training using video modeling could increase dressing skills in intellectual disability children aged 6-12 years.

Background: Obesity that occurs in adolescents (age >18 years) shows a significant increase, from 12% in 2007 to 13% in 2010 and 19% in 2019 in males, and from 13% to 28% in 2013 in females.  Objective: To analyze the prediction model of obesity among teachers in senior high school in Kendari, Indonesia. Methods: This was a prediction cross-sectional study. There were 250 high school teachers were recruited from 12 senior high schools using a purposive sampling. The instruments used were questionnaires (food frequency, consumption recall, and activities recall questionnaire), Seca weight scale, anthropometry microtoice, meter, computer program, and stationery. Data were analyzed using Chi-Square. Results: Findings showed that there was a significant correlation between age group (p = 0.05), knowledge (p= 0.02), stress (p= 0.05) and diet (p= 0.013). The prediction factor of obesity among high school teachers was that teachers with an upper age (age> 45 years) were likely to be obese 2.64 times than teachers at a young age (age <45 years). If teachers experienced stress, they would suffer from obesity 2.17 times compared with teachers with no stress. Conclusion: Factors associated with obesity in high school teachers in Kendari Indonesia were age, knowledge, stress and dietary factors. Factors that were not related with obesity were attitudes about nutrition, activity and smoking habits. The highest predictors of obesity were age and stress.

Background: Premature Rupture of Membranes (PROM) causes morbidity and mortality complications in both maternal and perinatal. Pregnancy with anemia where low hemoglobin level which is less than 11.1 g / dL can be the cause of PROM through biological mechanisms and mechanisms of disease. Objective: This study aims to compare the risk of PROM between anemic maternal mothers and non-anemic maternal mothers. Methods: A case-control study was conducted on the maternal mothers at Kertha Usada Singaraja Bali Hospital, with 106 cases and 106 controls, using maternity medical records data in January-December 2016. The cases and controls were adjusted to the parity. The data were collected using questionnaires consisting of 2 parts: the first part was about the demographic characteristics, and the second part was about the time of membrane rupture and hemoglobin level at the delivery. The obtained data were analysed using descriptive and analytic statistics on the computer program. Result: On univariable analysis, the prevalence of PROM equalled to 28,3% in maternal anemia group. In bivariate analysis, the risk factors of were anemia status, maternal activity, and maternal age (p <0.05). A multivariable analysis of conditional logistic regression analysis, controlling the possibility of confounding factors, showed that pregnant women with anemia would be at risk of PROM 3.59 times greater than non-anemic mothers (OR = 3.59, 95% CI = 1.82-7, 09). Conclusion: The risk of PROM is higher in anemic maternal mothers than in non-anemic mothers, after homogenising with parity variables.

Background: Parents often experience anxiety when seeing their children having febrile convulsion. It may be due to lack of knowledge about febrile seizure and the way of handling it. Objective: This study aims to analyze the education package of febrile convulsion and its effect on mother’s anxiety. Methods: This was a quasi-experimental study with pretest posttest with control group design.  Eighty-one participants were selected, which randomly assigned to be two groups that 41 participants in control group and 40 participants in intervention group. Anxiety was measured using State Anxiety Inventory in Indonesian version. Data were collected from March to Mei, 2017. Data were analyzed using Wilcoxon-test. Results: The results showed that the mean of anxiety level in the intervention group before intervention was 77.40 and decreased to 35.78 after intervention, while the mean of anxiety level in the control group was 68.17 before intervention and decreased slightly to 64.17 after intervention. The p-value of the difference between control and intervention group was 0.001 (<0.05). Conclusion: There was a significant effect of education package about febrile convulsion on mother's anxiety level. It is suggested that febrile convulsion educational package can be used as an alternative therapy to reduce anxiety levels among mothers.

Background: Coronary heart disease patients shall experience physical, psychological and social changes that will affect life. The psychological condition of outpatients that has been investigated include anxiety, depression and quality of life, all of these problems can be attributed to resilience. Objective: The purpose of this study was to determine the image of resilience of coronary heart disease patient following up the acute attack in outpatient ward. Methods:  The research method used quantitative descriptive using CD-RISC instrument 25. Instrument had validity value r = 0.83, P <.0001 and reliability value of Cronbach’s α 0.89. The selection of sample with consecutive sampling and got sample number 50 people for 2 weeks. Data were analyzed based on the value of each respondent categorized using tertile to see the overall resilience picture, while for the five sub-variables measured using the mean and standard deviation. Result: The results showed that almost half of respondents had 70-75 resilience. The mean value of sub-variables if sorted from the lowest to the highest is trust and reinforcement (2.71±0.58); competence and resilience (2.88±0.53); relationships with others (2.92±0.48); self-control (3.04±0.62) and spiritual influence (3.33±0.45). These results are influenced by lack of self-efficacy, optimism and family support. Conclusion: The conclusions of the research resilience of patients are in the medium category, for the lowest sub-variable value is trust and strengthening, while the highest is the spiritual influence. So, it is advisable to provide education to improve management skills post-acute attacks and increase social support in the care of patients at home.

Background: Anemia during pregnancy is a major nutritional problem that can cause health problems for mothers and their fetus. Prevention of anemia has been done but many obstacles are perceived by pregnant women. Families need to provide support to improve the prevention behavior of anemia. Objective: This research aims to explore the effect of educational intervention on family support for pregnant women  in preventing anemia. Methods: A quasi-experimental design was carried out on 60 pregnant women who had done pregnancy checkups at Community Health Centre and had received iron supplement, in which 30 women were in the experimental group and the rests were in the control group. This study was conducted from December 2016 to January 2017. Family support was measured using questionnaires before and after educational intervention. Results: After educational intervention, there was a significant change from the pretest score to the posttest score in the experimental group (p<0.05). There was an increase in the average score in the experimental group, 14.47 ± 2.89 becomes 16.83 ± 2.32. Conclusion: Educational interventions can increase family support for maternal behavior in preventing pregnancy anemia such as improving adherence to taking iron supplements and high intake of food containing iron.

Background: Critical nursing is a specific service in giving a holistic nursing service to fulfill human response to a life-threatening problem. A critical nurse can give a social support to patient’s family through assessment, counseling, and supporting group. Counseling is combination between high technology physical caring and emotional caring, which is needed by patients and the family. Spiritual counseling is a complementary medication preferred by the family of patient who is in acute and critical care. Objective: The study aimed to identify the effects of spiritual counseling on the anxiety level of patient’s family at the ICU of dr. Dradjat Prawiranegara Hospital in Serang, Banten Province, Indonesia. Methods: The study was a pre-experimental research with one group pre-test and post-test design. The samples were 25 respondents selected using consecutive sampling technique during one month (May to June 2016). The data of anxiety level were collected using HAR-S (Hamilton Rating Scale for Anxiety) questionnaire. The data were analyzed using parametrical t-test paired sample for the variable of anxiety before and after giving spiritual counseling. Meanwhile, the variable of respondents’ characteristics to anxiety was analyzed by using independent sample test. Results: The study found that the mean of respondents’ anxiety level before spiritual counseling was 33.44 and the standard deviation was 5.213. Meanwhile, after conducting spiritual counseling, the mean was 18.60 and the standard deviation was 2.582. Bivariate analysis result showed a significant difference between anxiety level of patient’s family in ICU (Intensive Care Unit) before and after conducting spiritual counseling in which p value was 0.000, with the mean value of 14.840 and SD of 5.437. Conclusion: Nurses should be more capable in implementing the intervention of spiritual counseling to patient’s family. Spiritual counseling can give a positive alteration to the family emotional situation. It impacts on the decrease of patient’s family anxiety level. By the decrease of family anxiety level, the possibility of doing mistake in decision-making is expected to be avoided.

Background: The mechanical ventilator is an indispensable breathing tool in the Intensive Care Unit (ICU). But the mechanical ventilator is associated with the risk of Ventilator Associated Pneumonia (VAP). VAP occurs due to poor hygiene of the endotracheal tube (ETT). ETT hygiene should be maintained to inhibit bacterial development in the lungs using suction above cuff endotracheal tube (SACETT) to prevent VAP. Objective: To analyze the effectiveness of SACETT in preventing Ventilator Associated Pneumonia (VAP) in critical patients in the ICU. Methods: This was a quasi-experimental study with posttest only with control group design with 15 samples in intervention group (SACETT and Chlorhexidine 0.2%) and 15 in control group (ETT, Open Suction, and Chlorhexidine 0.2%) with purposive technique sampling. The Simplified Clinical Pulmonary Infection Score (CPIS) was used to measure VAP. Results: This study illustrates that there was no VAP incidence in the intervention group, and as much as 13.3% VAP in the control group. SACETT was more effective in preventing VAP than in standard ETT on day 4 (p = 0.001). Conclusion: SACETT is more effective in preventing VAP than standard ETT in the fourth day in patients with neurological, cardiovascular, urinary, digestive, and immune system disorders.

Background: Acupressure is considered as one form of holistic therapies that can improve tissue perfusion to improve motor function in patients with stroke.Objective: To analyze the effect of 14 points acupressure on upper and lower extremity muscle strength in patients with non-hemorrhagic stroke patients.Methods: This was a quasi-experimental study with pretest posttest control group design. Paired comparative analytic design was also used. Thirty-eight participants were selected, which 19 participants assigned in the experiment and control group. The Medical Research Council (MRC) scale was used to measure the lower and upper muscle strengths.Results: There was a significant difference between the improvement of the upper muscle strength in the experimental group and the control group at day 3, 4, 5, 6, 7 (p = 0.010, p = 0.000, p = 0.000, p = 0.000, p = 0.000); and there was a significant difference between the improvement of the lower extremity muscle strength in the experimental group and the control group at day 3, 4, 5, 6, 7 (p=0.023, p=0.000, p=0.000, p=0.000, p=0.000).Conclusion: The 14 points acupressure is effective in increasing upper and lower extremity muscle strength in patients with non-hemorrhagic stroke.

Background: The instability of hemodynamic status in patients with head injury with decreased consciousness has an effect on the increase of intracranial pressure. The recovery of hemodynamic status can be done through nursing intervention either by providing a sensory stimulus (music therapy) or motor stimulus (progressive mobilization). Objective: To compare the effectiveness of progressive mobilization of level I with Mozart's music therapy on non-invasive hemodynamic status changes in patients with head injury with decreased awareness. Methods: This was a quasi-experimental study with pretest-posttest design. There were 34 samples selected using consecutive sampling, which 17 samples assigned in a group of progressive mobilization and group of music therapy. Paired t-test and Wilcoxon test were used for paired group, and Independent t-test and Mann-Whitney test for unpaired group. Results: Progressive mobilization of level I had significant effect on changes in systolic blood pressure (p = 0.0001), diastolic blood pressure (p = 0.002) and MAP (p = 0.019), and no significant effect on heart rate (p = 0.155), respiration (p = 0.895) and oxygen saturation (p = 0.248). Mozart's music therapy had a significant effect on changes in systolic blood pressure (p = 0.0001), diastolic blood pressure (p = 0.0001), respiration (p= 0.032) and oxygen saturation (p = 0.008), but no effect on MAP (p = 0.561). There was a significant difference between the two interventions in the systolic blood pressure and heart rate variables (p <0.05), while the diastolic blood pressure, MAP, respiration and oxygen saturation variables did not show a difference (p> 0.05). Conclusion: The Mozart's music therapy is more effective on non-invasive hemodynamic status changes in patients with head injury with decreased consciousness compared with progressive mobilization of level I. 

Background: The first stage of labor is a tiring moment for mothers, which may cause exhaustion, dehydration, risk of infection, uterine atony, and postpartum hemorrhage. Hypnobirthing is considered effective to speed up early labor process. Objective: This study aimed to examine the effect of hypnobirthing on the progress of the latent phase of labor. Methods: This study was a quasi-experiment with posttest only control group design. Thirty-two primigravida mothers in the latent phase of labor were selected using purposive sampling, with 16 assigned in the experiment group and the control group. The progress of labor was measured by four indicators recorded in partograph, namely frequency and duration of uterine contraction, cervical dilatation, and descent of the fetal head. Independent t-test was used for data analysis. Results: There was a significant difference in the frequency of uterine contraction (p=0.001), duration of contraction (p=0.001), cervical dilatation (p=0.007), and descent of the fetal head (p=0.001) between the experiment group and the control group. Conclusion: Hypnobirthing technique is significant in accelerating the progress of the latent phase of labor in primigravida mothers.

Background: Depression is one of the most common psychosocial problems in the elderly. The incidence of depression in the elderly is greater in the elderly living in the social service unit than the elderly in the community. Management of depression in the elderly should be more emphasized on interventions that focus on the individual needs of the biopsychosocial and spiritual aspects. Brain gym therapy and Benson relaxation are considered appropriate in decreasing depression. Objective: This study was to determine the effect of brain exercise and Benson relaxation on the level of depression in elderly in the elderly social service unit. Methods: This was a quasi-experimental study with pretest posttest control group design. Fifty-six elderly included in this study, which 28 assigned in the experiment and control group. The depression level was assessed using Geriatric Depression Scale (GDS). Wilcoxon and Mann-Whitney test were used for data analyses. Results: The study showed that the mean GDS score in the experiment group before the intervention was 7.21, while the mean value of GDS in the control group was 6.64. The mean value of GDS in the experiment group after the intervention was 5.04 and the mean in control group was 6.18. There was a significant difference of GDS score between experiment and control group with p-value of 0.021 (<0.05). Conclusion: There was a significant effect of brain gymnastics and Benson relaxation therapy in reducing depression in elderly. brain gymnastic therapy and Benson relaxation can be one of independent nursing interventions as an effort to improve care for elderly groups.

Background: Lo'i karana is one type of traditional therapies that has existed for more than one hundred years in the midst of society of Bima and Dompu to overcome the discomfort due to labor. However, lack of research has been conducted to examine its effect on pain in postpartum mothers. Objective: To examine the effect of Lo’i karana on muscle pain in postpartum mothers. Methods: This was a quasi-experimental study with posttest only control group design. Thirty mothers were selected using purposive sampling, which 10 assigned in 3 groups (standard-dose group, minimal-dose group, and maximal-dose group). Wong-Baker Faces Pain rating scale was used to measure pain on day 1 and day 3. Kruskal-Wallis Test and Mann Whitney test were used for data analysis.  Results: There were significant effects of Lo’i karana in minimal, standard and maximal dosage on pain level in the first day (p=0.004) and the third day (p=0.009) in postpartum mothers. The results revealed that the higher doses were used for the treatment, the less pain of the mothers would be.  Conclusion: Lo’i karana has a significant effect in reducing pain level in postpartum mothers. It is recommended that this intervention can be applied as a part of nursing intervention in caring postpartum mothers.

Background: C-reactive protein test is one of clinical assessments to minimize risks of infection in infants. However, its procedure may cause pain. Pain in the infants may result in negative metabolic behavior, physiology and metabolic response. Objective: This study was to describe the infant's pain response by administering a combination of breastfeeding and an effleurage massage on the blood sampling procedure of C-reactive protein examination.          Methods: This was a descriptive observational cross-sectional study. There were 30 infants selected using consecutive sampling technique, which 15 samples assigned in an intervention group (combination of breastfeeding and effleurage massage) and a control group. Premature Infant Pain Profile (PIPP) instrument was used to measure pain. Univariate analysis was performed with the aim to describe data in mean and median. Results: The average of pain response at one-minute observation in the combination of breastfeeding and effleurage massage group was 7.47 ± 1.356, and the average of pain response in the control group was 10.80 ± 1.897. The average pain at five-minutes observation in the intervention group was 3.53 ± 1.922 and control group was 6.00 ± 1.852.  Conclusions: Pain responses in the combination of breastfeeding and effleurage massage group were lower than the pain response in the control group.

Background: Ventilator Associated Pneumonia (VAP) is one of the causes of infection in the hospital and the main cause of death due to nosocomial infection. The strategy to prevent VAP is by oral hygiene. Honey may be a good solution for oral hygiene. Objective: This study aims to compare the effect of the use of 20% honey solution and 0.2% chlorhexidine as oral hygiene on VAP prevention in patients on mechanical ventilation. Methods: This was a quasi-experimental study with posttest only control group design in an incentive care unit of a general hospital in Indonesia. Thirty respondents were selected using consecutive sampling, which 15 respondents assigned in a 20% honey group and 0.2% chlorhexidine group. Clinical Pulmonary Infection Score (CPIS) was used to measure Ventilator Associated Pneumonia. Data were analyzed using Independent t-test. Results: The mean of CPIS in the honey group was 3.33 and the chlorhexidine group was 3.53. Independent t-test showed p-value 0.618 (>0.05), which indicated that there was no significant difference of the effect of honey and chlorhexidine on VAP event. Conclusion: The 20% honey solution has the same effect with 0.2% chlorhexidine in preventing VAP events in patients on mechanical ventilation.

Background: Emotions have an impact on the healing process as it affects the body's defense system. The work that can be done to control the emotions of pulmonary TB patients is mindfulness with a spiritual approach. Objective: To examine the effect of spiritual based mindfulness intervention on the emotional control in adult patients with  pulmonary TB. Methods: This was a pre-experimental study with one group pre-posttest design with a total of 45 adult patients with pulmonary TB recruited purposively in the public health centers. A questionnaire of emotional regulation was used for data analysis. Paired t-test was used for data analysis. Results: There was a significant difference in emotional control between before and after given spiritual based mindfulness intervention with p = 0.000 (<0.05). Conclusion: The spiritual based mindfulness intervention has a significant effect to  improve the emotional control of adult patients with pulmonary TB. This can be used as one of the efforts to control the emotions of pulmonary TB patients as well as to speed the healing process. 

Objective: This study was to explore the actions and factors causing abortion, killing and disposal of babies qualitatively in the detention center of Class II B, Raba Bima, West Nusa Tenggara, Indonesia. Methods: This was a descriptive qualitative study with six respondents who were purposively selected. Content analysis was used for data analysis. Member-checking and crosscheck triangulation were performed to ensure the trustworthiness of the data. Results: Findings emerged from data, namely: factors that cause adolescent abortion, killing and disposal of baby (internal factors, family factors and partner factors), the way to do those actions (to take medicine, by the help of health workers, shaman and the nearest person), and behavior after doing abortion, killing and disposal of baby. Conclusion: Understanding the factors affecting abortion, killing and disposal of baby among adolescents and the way how they did them as well as their behavior after all of these activities might help health practitioners to find the strategies to reduce the incidence of unwanted pregnancy which lead to abortion, killing and infant disposal.

Background: Coronary angiography can cause complications of arterial and subcutaneous bleeding (hematoma) and back pain. Changing the position of the patient (positioning) in bed can reduce the pain post-diagnostic catheterization complications. Objective: This study was to examine the effect of positioning on bleeding complication and low back pain after diagnostic coronary angiography in patients with coronary heart disease patient in the Integrated Heart Care Center in Indonesia.Methods: This study was a true-experimental study with randomized posttest-only control group design. Thirty respondents were randomly selected using simple random sampling, which 15 respondents were randomly assigned in the experiment group and control group. The experiment group was given a positioning with 150, 300, 450 head-of-bed elevation in left and right lateral position. An arc tool was used to measure the height of head of bed elevation, a measuring cup to measure arterial bleeding using, a perforated transparent plastic with 5 cm diameter to measure subcutaneous bleeding (hematoma), and Numeric Pain Rating Scale to measure low back pain. Data were analyzed using Kolmogorov- Smirnov and Repeated Measured ANOVA.Results: Findings showed that positioning had no effect on arterial hemorrhage (ρ=1.000) and subcutaneous bleeding (hematoma) (ρ=0.999). Repeated ANOVA test results revealed that positioning had a significant effect on low back pain (ρ=0.017). Conclusion: There was no significant effect of positioning on the occurrence of arterial and subcutaneous bleeding (hematoma), but there was a significant effect in reducing low back pain.

Background: The person suffering mental disorders is not only burdened by his condition but also by the stigma. The impact of stigma extremely influences society which is considered to be an obstacle in the mental disorder therapy. Stigma as the society adverse view towards severe mental disorders is related with the cultural aspect. The interaction appeared from each component of nursing model, called sunrise model, is a model developed by Madeleine Leininger that connects with the wide society views about severe mental disorders condition. Objective: The aim of this study was to analyze the factors related to public stigma and to find out the dominant factors related to public stigma about severe mental illness through sunrise model approach in Indonesia. Methods: This study used observational analytical design with cross sectional approach. There were 150 respondents contributed in this study selected using purposive sampling technique. Spearman Rank and multiple logistic regression were used for data analysis. Results: The results showed a significant relationship between mass media exposure, spiritual well-being, interpersonal contact, attitude, and knowledge with public stigma about mental illness. The result of multiple logistic regression revealed that the low exposure of mass media had the highest OR value at 26.744. Conclusion: There were significant correlations between mass media exposure, spiritual well-being, interpersonal contact, attitude, and knowledge with public stigma toward mental illness. Mass media exposure was a dominant factor influencing public stigma toward mental illness.

Background: Combining musical and aromatherapy therapy is expected to have a stronger effect in the reduction of anxiety and non-invasive hemodynamic stability. Objective: To examine the effect of the combination of music and aromatherapy on anxiety and non-invasive hemodynamic in patients in the intensive care unit. Methods: This was a quasi-experimental study with non-equivalent group. An experimental group was given a combined musical and aromatherapy, while a control group was given music therapy. Thirty respondents were selected using accidental sampling, with 15 randomly assigned in the music group and the combination group. HARS scale (Hamilton Anxiety Rating Scale) was used to measure anxiety. Non-invasive hemodynamic status such as blood pressure and heart rate were documented in the observation sheet. Paired t-test and one-way ANOVA were used for data analysis. Results: There were significant effects of combination therapy on anxiety (p=0.001), diastole (p=0.004) and heart rate (p=0.031), but no significant effect on systole (p=0.387). The music therapy alone had a significant effect on anxiety (p=0.001), systole (p=0.047), and diastole (p=0.037). Conclusion: The combination of music and aromatherapy had a greater effect than the music therapy alone in decreasing anxiety and stabilizing diastolic blood pressure and heart rate. This therapy can be used as an alternative in nursing interventions and as an input to develop standard of operational procedure for anxiety and non-invasive hemodynamic stability.

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Background: The SBAR (situation, background, assessment, recommendation) method assists nurses in communicating information in nursing shift handover. Inaccurate shift handover can have a serious impact on patients due to poor communication. Optimal resource development can be done by coaching as the best guidance method from manager for directional discussion and guidance activity to learn to solve problem or do better job and build nursing leadership culture in clinical service. Objective: To analyze the effectiveness of coaching method using SBAR communication tool on nursing shift handovers. Methods: This was a quasi-experimental study with pretest posttest control group design. Fifty-four nurses were selected using a consecutive sampling, which 27 assigned in the experiment and control group. An observation checklist was developed by the researchers based on the Theory of Lardner to evaluate the effectiveness of the implementation of coaching using SBAR on nursing shift handover. Independent t-test, Mann-Whitney test and Wilcoxon test were used for data analyses.  Results: There was an increase in coaching ability of head nurses in the implementation of SBAR in nursing handover after 2-weeks and 4-weeks of coaching. There was also a significant improvement of the use of SBAR on nursing shift handover in the experiment group (p <0.05) compared to the control group.  Conclusion: Coaching using SBAR (situation, background, assessment, recommendation) communication tool was effective on nursing shift handovers. There was a significant increase of the capability of head nurses and nursing shift handovers after given coaching intervention. 

Background: Chronic kidney disease is identified as kidney damage for more than three months with glomerulus filtration rate less than 60ml / min / 1.73 m2. Objective: This study aims to explore the experience of life of patients with pre-dialysis chronic kidney disease used Roy’s adaptation model. Methods: This study was a qualitative study using descriptive phenomenology approach in the General Hospital of Cibabat Cimahi West Java, Indonesia. Data were obtained with depth interviews involved eight participants with pre-dialysis chronic kidney disease consisting of two men and six women, aged ranged from 35 to 65 years. The years living with chronic kidney disease ranged from 1 to 2 years. Data were analyzed using Colaizzi’s methods. Results: We found nine themes, namely: physical stimulus, psychic stimulus, socio-economic stimulus, physical coping mechanisms to control the situation, a coping mechanism to maintain health function, selecting behavioral adaptation physiology, selecting a behavior adaptation of the self-concept, selecting adaptation behaviors role function, and selecting behavioral adaptation interdependence. Conclusion: It can be concluded that the experience of patients with pre-dialysis chronic kidney disease complained physical, psychological, social, economic, and spiritual problems. Therefore, health care professionals need to design an intervention to improve patients’ coping mechanism to maintain kidney function, and adapt to diet for foods and drinks, activity patterns and roles according to their conditions, which also elaborate the function of family support.

Background: Research in pain especially in patients undertaking hemodialysis is important to be conducted in order to help the process of their hemodialysis therapy. Aim: The aim this study was to describe pain characteristic on hemodialysis patient using Visual Analogue Scale (VAS) and mnemonic PQRST (Provocation, Quality, Regio, Radiation and Time). Methods: This was a descriptive quantitative cross-sectional research. The number of respondents were 72 and they routinely undertook hemodialysis therapy twice a week. The study was conducted in one central hospital in Yogyakarta Indonesia on February to March 2017. Univariate analysis was used to describe respondents’ pain characteristic. Results: The majority of respondents (51.39%) experienced moderate pain, followed by mild pain (33.33%) and severe pain (15.28%). The most painful characteristic in the provocation aspect was movement (87.50%), and the quality of pain was knife-like pain (83.33%). Moreover, hand was the major area of pain (84.72%), and there was no radiation of pain (91.67%). Most of pain was intermittent (97.22%). Of 53% of respondents expressed that the pain had an impact on their lives, specifically in their activities (52.63%), followed by others (15.79%), nausea/vomiting (15.79%), sleep disturbance (13.16%), and appetite (13.16%). However, the pain did not have an impact on their emotion. Conclusion: The respondents experienced mostly moderate pain. The percentage of pain characteristics on PQRST mnemonic was above 80%, and more than half of the respondents experienced moderate pain. Majority of the respondents felt the impacts of the pain in their lives.

Background: Patients who will have cardiac catheterization mostly experience anxiety. Unresolved anxiety may have a harmful effect such as increasing frequency of heart, breathing and blood pressure as well as risks of complication. Music is considered effective in reducing anxiety. Objective: This study aims to examine the effect of Sundanese zither (kacapi) music therapy on anxiety level in pre-cardiac catheterization patients. Methods: This was a quasi-experimental study. Fifty-six respondents were selected using consecutive sampling technique, which 28 respondents assigned in the experiment group and control group. Anxiety was measured using Hamilton Anxiety rating Scale (HARS). Data were analyzed using Wilcoxon and Mann-Whitney test. Results: The results showed an average decrease in anxiety value in the experiment group of 10.28, and in the control group of 3.25. Mann-Whitney test results obtained p value <0.001, which indicated that there was a significant difference of mean decrease between the experiment group and the control group. Conclusion: This study proves that the intervention of Sundanese kacapi music significantly decreasing anxiety levels (p <0.001) in pre-cardiac catheterization patients. It is suggested that Sundanese kacapi music can be used as an alternative therapy in the independent nursing interventions.   

Background: Understanding barriers to hypertension managements remains important to reduce the hypertension rate in community. Minangkabau is one of the ethnic groups in West Sumatra Indonesia that has a high proportion of people with hypertension although its management has been implemented. Objective: This study aims to explore the experiences of barriers to hypertension management in Minangkabau ethnic group in Payakumbuh, Indonesia. Methods: This was a phenomenological study with twelve respondents selected using purposive sampling. Data were collected using in-depth interview. Colaizzi’s content analysis method was used for data analysis. Results: Five themes were emerged from the data, namely: (i) lack of self-motivation in the management of hypertension, (ii) disobedience in the management of hypertension, (iii) culture pattern of food intake, (iv) lack of social support, and (v) excessive stress and anxiety. Conclusions: The barriers to hypertension management in Minangkabau ethnic group are closely related to its culture both in lifestyle and in food intake of the family members and the community. Nurses are expected to always give health education about hypertension and finding the way to control it.

Background: Patients with hemodialysis often have difficulty in controlling their fluid intake although the obedience to follow fluid and dietary restriction is the key of hemodialysis success management. Objective: The aim of this study was to examine the effect of low-sodium diet management on thirst response in end stage renal disease patients with hemodialysis. Methods:  This was a quasi-experimental study with pre-posttest with control group design. Using consecutive sampling 88 respondents were selected, which 44 assigned in each group. Thirst distress scale and visual analog scale questionnaire were used for data collection. Wilcoxon and Mann Whitney test were used for statistical analysis. Results: Of the total of respondents, thirty-seven respondents experienced a decrease in thirst distress scale with p= 0.000 (p <0.05); and 30 respondents experienced a decrease in visual analog scale with p=0.000 after given low sodium diet management. There was difference of thirst distress scale score (p=0.008) and visual analog scale of thirst score (p=0.048) between intervention and control group. The importance of continuous of diet education with counseling and home visit can increase self-management behaviors. Conclusion. Low sodium diet management could reduce the thirst response in end stage renal disease patients with hemodialysis.

Background: Physical responses that occur in patients with nasopharyngeal cancer are the emergence of pain due to the effects of treatment. The problem of pain in these patients at the stage of treatment remains critical to solve because it can cause comorbidity, psychological trauma and mortality. Mindfulness intervention is considered useful in transforming consciousness into the stage of acceptance. Objective: This study aims to determine the effect of mindfulness intervention on the intensity of pain in nasopharyngeal cancer patients undergoing radiation treatment. Methods: This was a quasi-experimental study with pretest posttest control group design. Thirty patients were selected using consecutive sampling, which divided into experiment and control group. Visual Analogue Scale (VAS) was used to measure pain. Each respondent received mindfulness intervention for six sessions, divided into three meetings. Paired t-test was used for data analysis. Results: The results showed a significant reduction of pain from 4.12 (moderate pain) to 3.06 (mild pain) in the experiment group. There was a significant difference in pain level before and after mindfulness intervention (p= 0.001). Conclusion: Mindfulness is effective in reducing pain intensity level in nasopharyngeal cancer patients undergoing radiation therapy.

Background: Child development is a very important phase, in which children learn various skills as future generations. One of disorders that can impede child development process is Attention Deficit Hyperactivity Disorder (ADHD). Children with ADHD have problems with cognitive abilities, of which about 20-60% of them have learning disorders. The efforts to support cognitive development in children with ADHD is by approaching the child's environment through parenting style. Objective: This study aimed to determine the correlation of parenting style with cognitive development in the children with ADHD in SLB Negeri 1 Denpasar, Bali, Indonesia. Methods: This study used a correlational design with cross sectional approach. The sample size of 30 respondents were selected using a purposive sampling technique. Data were collected using parenting style questionnaire (PSQ) and average value of odd semester report of 2016/2017 academic year. Results:  It was found that most parents with democratic parenting style were 19 people (63.3%), authoritarian style were 7 people (23.3%), and permissive style were 4 people (13.3%). The result of the contingency coefficient test obtained p-value of 0.039 (p <0.05) and correlation value of 0.501, which indicated that there was a high correlation between parenting style with cognitive development in children with ADHD. Conclusion: It is suggested that parents of ADHD children should be able to provide good parenting style for their children, especially for the cognitive development.

Background: Colorectal cancer continues to be a serious problem in Indonesia. A common colorectal treatment is surgical removal of the diseased colon, followed by the creation of a colostomy through the abdominal wall to bypass the colorectal function of emptying waste products. Those who require permanent colostomy are likely to have quality of life issues impacting their physical, psychological, social, and spiritual needs. There issues impact persons’ life satisfaction, happiness, and overall quality of life. Objective: The aim of study was to describe the experiences of patients with end-stoma regarding their quality of life. Methods: The study design used descriptive phenomenology following the approach of Collaizzi. There were 12 participants who qualified using purposive sampling based on the inclusion criteria. The data were gathered in-depth interviews. Analysis and interpretation used verbatim descriptions in Bahasa Indonesia and subsequently translated into English language. Results: The research emerged seven themes, namely: (i) becoming limited in doing daily activity, (ii) having limitation during sexual and social intercourse, (iii) having various negative feelings after the existence of end-stoma, (iv) having financial difficulties, (v) attempting to survive with end-stoma, (vi) experiencing changes in fulfilling rest and sleep, physic, and complication, and (vii) having expectation which has to be achieved after having end-stoma. Conclusion: The results show that patients with end-stoma run into spiritual, social, psychological and physical disorder that affect the quality of their life. This study provides an understanding of the quality of life of patients with end-stoma and nurses are able to provide appropriate nursing care.

As nurses, we seek to better understand how to apply nursing knowledge in our daily practice. Nowadays, the term philosophy is widening used in many areas, including nursing. However, there is existence of unclear understanding about nursing knowledge development derived from standpoint of philosophical and methodological perspectives. This article discusses about this issue and mainly focus on empiricism, post positivistic view, the philosophy of Buddhism and an example related to asthma.

Background: Although the WHO strategy integrated management of childhood illness (IMCI) for primary care has been implemented in over 100 countries, there is less global experience with hospital-based IMCI training. Until recently, no training had been done in Indonesia, and globally there has been limited experience of the role of IMCI in rebuilding health systems after complex emergencies. Objective: We aimed to examine the effect of hospital-based IMCI training on pediatric nurse competency and explore the perception of Indonesian doctors, nurse managers and pediatricians about IMCI training and its development in West Aceh, a region that was severely affected by the South-Asian tsunami in December 2004. Methods: This study used stepped wedge design. Training was conducted for 39 nurses’ staff, 13 midwives, 6 head nurses, 5 nurse managers, 5 doctors, 1 pediatrician, and 3 support facilities  (nutritionist, pharmacist, laboratory) in Cut Nyak Dien (CND) Hospital in Meulaboh, West Aceh, Indonesia. The IMCI training was developed based on the WHO Pocketbook of Hospital Care for Children. A nurse’s competency questionnaire was used based on the guideline of assessment of the quality of child health services at the first level reference hospitals in districts / municipalities issued by the Ministry of Health in 2007. A linear mixed model was used for data analysis. Results: The hospital based IMCI training improved the competences of nurses pediatric in assessing emergency signs of the sick children, management of cough and difficulty breathing, diarrhea, fever, nutritional problems, supportive care, monitoring, discharge planning and follow-up.  The assessment highlighted several problems in adaptation process of material training, training process and implementation in an environment soon after a major disaster. Conclusion: Hospital based IMCI training can be implemented in a setting after major disasters or internal conflict as part of a rebuilding process.  The program requires strong management support and the emergency phase to be subsided.  Other pre-requisites include the existence of standard operating procedures, adequate physical facilities and support for staff morale and well-being.  Improving the quality of pediatric care requires more than just training and clinical guidelines; internal motivation and health worker support are essential.

Objective: To examine the effect of early ambulation with cold pack on the prevention of bleeding and haematoma complications in patients post-cardiac catheterization. Methods: This research used an experimental method with randomized posttest-only control group design. Thirty respondents were randomly selected using simple random sampling, with 15 assigned in the experiment and control group. The experiment group was given cold pack and early mobilization, while the control group was given sand pillow with immobilization for 6 hours. Independent t-test and Fisher’s exact test were used for data analysis. Results: Findings showed that there was no significant difference in haemorrhage between experiment and control group after given intervention (p= 1.000), and found a significant difference in haematoma between the two groups (p=0.001). Conclusion: Cold packs with early ambulation and sand pillow with immobilization for 6 hours were equally effective in preventing haemorrhage. However, cold packs with early ambulation was more effective in preventing haematoma.

Background: Death due to acute myocardial infarction (AMI) continues to increase every year. Efforts to prevent AMI complications through the control of pain and anxiety with the approach of classical music therapy have been widely practiced, but the approach through local music has not been much done when transcultural nursing theory emphasizes the importance of cultural approaches in nursing care, while Indonesia has a lot of local music that is a cultural potential which needs to be developed. Objective: This study aims to know the effect of Hariring Kabayan instrumental music therapy in reducing pain and anxiety of AMI patients after 24 hours of CICU admission. Methods: This was a quasi-experimental study with pretest-posttest control group design.  There were 32 participants selected using consecutive sampling, which 16 assigned in an experiment group and a control group. Hariring Kabayan therapy was played at 60 BPM using headphones  connected to the MP3 player for 30 minutes. Numerical Pain Rating Scale (NPRS) was used to measure pain and Numerical Rating Scale Anxiety (NRS-A) was used to measure anxiety. Data were analyzed using Paired t-test and Independent t-test. Result: Hariring Kabayan instrumental music therapy given for 30 minutes gave a significant change on pain in the respondents (p = 0.005), but it did not give a significant change on anxiety (p = 0.053), with significant value of 0.05. Conclusion: Hariring Kabayan instrumental music therapy is effective in reducing pain in AMI patients but ineffective in anxiety reduction.

Background: The rate of incidence of physical assault on school children increases from year to year. Efforts to prevent child sexual violence can be done through school-based education with student empowerment. Objective: To identify the effect of education by peers on the knowledge and self-efficacy of primary school children in preventing sexual violence in Grabag sub-district, Magelang regency, Indonesia. Methods: This study was a quasi-experimental study with pretest and posttest non-equivalent control groups. A total of 84 school-aged children were purposively recruited from two different primary schools. Each group consisted of 42 respondents. Children's Knowledge of Abuse Questionnaire-Revised III (CKAQ-RIII) instrument was used to measure knowledge and self-efficacy questionnaire was measured for self-efficacy. Data were analyzed using Wilcoxon and Chi-Square test. Results: The study showed that a statistically significant difference in the variables of both knowledge (p=0.008) and self-efficacy (p=0.000) in the intervention group after given peer education treatment. Conclusion: Educational interventions by peers can improve the knowledge and self-efficacy of primary school-aged children in preventing sexual violence. Peer education can be used as an effort to prevent sexual violence in children through school empowerment programs. 

Background: Diabetes Mellitus is a chronic disease that requires treatment for long periods of time so it can cause physical and psychological problems for sufferers and families (caregiver). Caregiver's role is expected to provide support for people with diabetes mellitus. Family psychoeducation is a strategy that can be applied for caregiver in overcoming problems that arise during the treatment of patients with diabetes mellitus. Objective: This study aims to determine the effect of family psychoeducation on caregiver support in the treatment of patients with type II diabetes mellitus. Methods: This research used a quasi-experiment with  pre-test post-test control group design. A total of 46 caregivers and patients with diabetes mellitus were recruited purposively, with 23 respondents assigned in the experiment and control group. Caregiver support scale was used to measure caregiver support, and Hensarling Diabetes Family Support Scale (HDFSS) for measuring perception of patients toward the treatment of caregiver.  Data were analyzed using paired t-test and independent t-test.  Results: Findings showed there was an increase of caregiver knowledge from 5.39 to 9.09 and an improvement of caregiver treatment from 40.30 to 67.04 after given family psychoeducation. There was a significant difference of caregiver support in the experimental and control group with p-value <0.001 (<0.05). Conclusion: Family psychoeducation can increase caregiver support in the treatment of diabetes mellitus patients. The intervention can be one of nurses’ interventions in the empowerment of family in improving the treatment of chronic diseases, particularly in diabetes mellitus.

Background: Social-emotional development in preschooler children is an important component in child development, as it becomes the foundation in preparing children for confidence, empathy and intellect, building trust, and being able to use language in communication and connect with others. One of the factors that affect children's emotional social development is the quality of mother's care. Children of young mothers have risks in emotional and intellectual social problems in children. Objective: The purpose of the study was to determine the relationship of quality care of young mothers with social-emotional development in preschool children in the working area of the Health Center of Kemalang, Klaten Regency, Indonesia. Methods: This was a correlational analytic research with cross sectional design. The sample of the study was 124 young mothers with preschool children selected using consecutive sampling technique. The study was conducted from July to August 2017 at six kindergarten schools in the working area of the Health Center of Kemalang, Klaten Regency. Data were collected using parent behavior questionnaire and stage social-emotional instrument. Data were analyzed using chi square test. Results: Findings showed that 58.1% of young mothers had good quality of care, and 55.6% of preschoolers were at risk of developing emotional social development problems. There was a significant correlation between the quality of care of young mothers with social-emotional development in preschool children (p-value <0.05). Conclusion: There was a correlation between the quality of care of young mothers with social-emotional development in preschool children.

Background: Anxiety in stroke patients occurs as a normal reaction to stress with life changes; however, when it becomes excessive, it will be disorder. Effort to deal with anxiety is needed and spiritual approach nursing care is considered useful in caring patients with stroke. Objective: To examine the effect of spiritual nursing care on anxiety in stroke patients in the inpatient ward. Methods: This study used a quasi-experimental design with pretest-posttest control group. Thirty respondents were selected using consecutive sampling, which 15 respondents assigned in the experiment and control group. The Hamilton Anxiety Rating Scale was used to measure anxiety. Data were analyzed using paired t-test and independent t-test. Results: The results showed that the mean level of anxiety in the experiment group before intervention was 29.33 and decreased to 9 after intervention, while in the control group the mean level of anxiety before intervention was 29.47 and decreased to 17.73 after intervention. Paired t-test obtained p-value 0.000 (<0.05), which indicated that there was a significant effect of spiritual nursing care on anxiety levels in patients with stroke. Conclusion: Spiritual nursing care could reduce anxiety in patients with stroke. 

Background: Range of Motion (ROM) exercise has been identified in the literature that it has an effect in improving muscle strength, especially in patients with stroke. However, little is known about the effect of ROM exercise combined with hypnosis therapy. Objective: To determine the effect of combination of hypnosis therapy and ROM exercise on upper extremity muscle strength in patients with non-hemorrhagic. Methods: This study employed a quasi-experiment with pretest-posttest control group design. Thirty-two samples were selected using simple random sampling, which 16 randomly assigned in the experiment and control group. Muscle strength was measured using muscle strength scale. Hypnosis Deepening test was used to measure the level of hypnosis depth. Paired t-test and Independent t-test were used for data analysis. Results: The mean value of muscle strength in the experiment group was 3.50 and  the mean value in the control group  was 2.62. Independent sample t-test obtained p-value = 0.012, indicated that there was a statistically significant difference in the mean of muscle strength of upper extremity in the experiment and control group. Paired t-test obtained p-value = 0.000, which indicated that there was significant difference between the average of muscle strength value before and after treatment Conclusion: The combination of hypnosis therapy and ROM exercise has a significant effect in increasing muscle strength of upper extremity in patients with stroke non-hemorrhagic.

Background: Majority of primiparous mothers experience a wide range of postpartum blues, which leads to stress and an increase in cortisol. Therefore, efforts to reduce cortisol level is needed. Nature sound music therapy is believed to make the mothers feel relaxed and comfortable. Objective: To examine the effect of the nature music therapy on cortisol levels in postpartum primipara. Methods: This was a true experimental study with pretest-posttest control group design. The study was conducted in the postpartum ward in the General Hospital of Semarang Indonesia from November 2016 to January 2017. There were 39 postpartum primipara selected in this study using simple random sampling divided into three groups: 1) the experiment group who received the nature music therapy for 15 minutes, 2) the experiment group who received the nature music therapy for 30 minutes, and 3) the control group. One-way ANOVA test was performed for data analysis. Results: There was a statistically significant effect of the nature sound therapy on the cortisol level in the postpartum primipara, with p-value = 0.010 (<0.05). Conclusion: There was a significant effect of the nature music therapy on the cortisol levels in postpartum primipara. Thus, the application of nature music therapy can be an alternative therapy especially for postpartum primipara who experience emotional stress, physical, anxiety, and fatigue.

Background: The incidence of respiratory failure reaches 20-75 cases per 100,000 population each year with mortality rate reaching 30-50%. Provision of respiratory assistance with mechanical ventilation is provided with an indication of the inability of the respiratory function for optimal alveolar ventilation. Efforts to restore lung oxygenation ventilation function can be done through breathing exercises and are expected to improve pulmonary ventilation function. Objective: This study was to examine the effectiveness of the modified Slow Deep Pursed-Lips Breathing Exercise (SDPLBE) on vital lung capacity in patients post-extubation of mechanical ventilators. Methods: This was  a true experimental study with pretest posttest control group design. Thirty respondents were selected using stratified random sampling, with 15 samples assigned in the experiment and control group. Peak flow meter was used to measure vital lung capacity (FEV1 value). Repeated measures ANOVA was used for data analysis. Results: There was a significant difference on respondent's vital lung capacity after given slow deep pursed lips-breathing exercise at each session from session 1 to session 8 (p=0.000). However, both groups were not yet able to achieve ≥ 400 mL / min, but the experiment group was closer to the normal value (369) than the control group. Conclusion: Slow Deep Pursed-Lips Breathing Exercise may increase vital lung capacity in patients post-extubation of mechanical ventilator. 

Background: One of the complications of ventilator use in patients in Intensive Care Unit (ICU) is Ventilator-Associated Pneumonia (VAP). Oral hygiene is one of the methods to prevent VAP. Objective: The objective of this study was to compare the value of clinical infection score (CPIS) in critically ill patients after given oral hygiene using chlorhexidine and Piper betle Linn mouthwash. Methods: This was an observational study with cross-sectional study design, which consisted of two intervention groups. Thirty respondents were selected using total sampling, with 15 respondents randomly assigned in each group. Independent t-test was used for data analysis. Results: Findings showed that  the mean of CPIS in the Piper betle Linn group was 3.80 and the mean of CPIS in the chlorhexidine group was 4.07. Conclusion: CPIS in the treatment group using Piper betle Linn mouthwash was lower than the mean of CPIS in the treatment group using chlorhexidine.

Background: Children need adequate sleep for good health status. Without a balanced sleep, it will encourage the emergence of serious health or developmental problems. Previous studies showed more than 40% of preschoolers experienced sleep problems. Objective: To examine the effect of HESH (Health Education of Sleep Hygiene) on sleep problems in preschoolers. Methods: Pretest posttest design non-equivalent control group was used in this study. Sixty participants recruited by consecutive sampling. Parents in the experimental group received health education using power point and booklet HESH for 100 minutes, parents in the control group received health education using power point for 100 minutes without booklet HESH. Telephone follow up was done for evaluation program. Sleep problem was measured with Children’s Sleep Habits Questionnaire (CSHQ) completed by children’s parents. Data analysis used unpaired t-test with 95% confidence interval. Results: The result showed that there was effect of HESH toward sleep problems in preschooler (experimental group: -3.367±5.269; control group:  0.033±5.061, p= 0.015). Conclusion: HESH in parents could decrease sleep problems in preschoolers in Indonesia. It is expected that HESH can be used as an alternative nursing intervention involved parents to decreases sleep problem in preschooler.

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Objective: This study aimed to determine the effectiveness of the combination of hypnotherapy and acupressure (hypno-pressure) on anxiety levels in patients with cardiovascular disorders. Methods: A quasi-experimental research with pretest-posttest with control group design was used. Fifty-six respondents were selected using purposive sampling in this study, which 28 respondents were randomly assigned in the experiment and control group. The Spielberger State-Trait Anxiety Inventory (STAI) Form Y was used to measure anxiety. Paired t-test and Independent t-test were used for data analysis. Results: There was a significant effect of hypno-pressure on the decrease of anxiety levels in patients with cardiovascular disorder with p-value 0.000 (<0.05), t = 7.217, and effect size of 1.96. Conclusion: Hypno-pressure could reduce anxiety levels in patients with cardiovascular disorder.

Background: Anxiety and depression are problems faced by patients with chronic diseases such as patients with Coronary Heart Disease (CHD). Both of these can also worsen the condition of CHD patients, thus needs to be prevented and handled. It is stated that  spirituality can enhance constructive coping skills in patients with chronic diseases. But how it relates to anxiety and depression in patients with CHD  in Indonesia is still unknown. Objective: The study purpose was to identify the relationship of spiritual wellbeing with the incidence of anxiety and depression in CHD patients. Methods: The research used descriptive correlative quantitative with cross sectional approach. The instruments used to measure the variables were Zung Self-rating Anxiety Scale, Beck Depression Inventory II, and  Spirituality Index of Well-Being scale. Data were taken on 100 respondents within three months  in outpatient cardiac unit with the consecutive sampling technique and analyzed  by Spearman correlation test. Results: The mean of anxiety, depression, and spiritual well-being respectively were 47.66, 43, and 60. Based on Spearman test, spiritual wellbeing was correlated with anxiety significantly p= 0.000(r=-0.371) and so was depression p= 0.000 (r=-0.571). Conclusions: There was a significant relationship between spiritual well-being with anxiety and depression with negative correlation direction. The higher the spiritual well-being, the lower the level of anxiety and depression will be. Thus, nurses need to strengthen the spiritual aspects of CHD patients to prevent psychosocial problems.

Objective: To determine the effect of yoga on the duration of the second stage of labor and perineal rupture in primigravida mothers. Methods: This was a quasi-experimental study with posttest group only design. The study was conducted in the Public Health Center of Pekalongan, Central Java, Indonesia from December 2016 until January 2017. There were 50 mothers selected using purposive sampling, which 25 assigned in the experiment and control group. Independent t-test and Chi Square test were used for data analysis. Results: There was a statistically significant difference in the duration of second stage of labor (p=0.000) and perineal rupture (p=0.001) between experiment and control group. Conclusion: There was a significant effect of yoga on the duration of the second stage of labor and perineal rupture in primigravida mothers. Therefore, yoga is recommended for midwife to be included in the antenatal care.

Background: Patient immobility remains to be one of the primary causes of pressure ulcers. Therefore, mobilization is necessity for patients being treated in the intensive care unit. However, the occurrence of pressure ulcers is dependent on not only the mobilization but also the bed itself and the type of mattress. This study used the same mattress and bed and compared the effectiveness of progressive mobilization with regular mobilization. Objective: This study aims to examine the effectiveness of progressive mobilization level I and II on hemodynamic status and decubitus ulcer risk in critically ill patients. Methods: This was a quasi-experimental study using repeated measure design. There were 40 respondents selected using purposive sampling, which 20 respondents assigned in each group. A Braden scale was used to measure the risk of decubitus ulcer. Paired t-test and repeated measures ANOVA were performed for data analysis. Results: Paired t-test showed that there was a significant difference of systolic pressure, diastolic pressure, MAP, heart rate, and Braden score after given intervention with p-value <0.05. However, repeated ANOVA test showed that diastolic pressure had p-value >0.05, thus could not be continued to post-hoc test. The progressive mobilization of level I and II in critical patients can stabilize systolic pressure (52.46%), stabilize MAP (58.43%), stabilize heart rate (68.99%), and reduce the risk of decubitus (55.03%) for 7 days of recurrent intervention. Conclusion: The progressive mobilization of level I and II can reduce the risk of decubitus and stabilize the patient's hemodynamic status in critical patients.

Background: Perineal wounds are at risk for infection, without a good treatment, perineal wound can harbor sepsis and become a chronic, long-term problem. Binahong leaves is considered as an alternative to accelerate perineal wound healing process. Objective: To determine the effect of Binahong leaf extract (anredera cordifolia (tenore) steen) on perineal wound healing process in postpartum mothers. Methods: This study employed a quasi-experimental study with control group posttest-only design. The study was conducted in the working area of Telogosari Wetan Health Center and Health Center of Kulon Kota Semarang Indonesia in January-February 2017. There were 36 respondents selected using purposive sampling assigned in the intervention group (Binahong leaves extract) and the control group (Povidone Iodine 10%). REEDA scale was used for assessing perineal healing. Data were analyzed using Mann Whitney, Chi Square and Kruskal Wallis test. Results: Findings showed that the average day of perineal wound healing process in the Binahong leaves group was 6.11 days and in the povidone iodine group was 7.66 days. There was a statistically significant difference in the duration of wound healing between the experiment and control group with p-value 0,001 (p value <0.05). Conclusion: Binahong leaves extract is effective in healing perineal wound in postpartum mothers. Therefore, Binahong leaves are recommended to use as an alternative treatment for the mothers.

Background: The coverage of 90 Fe tablets in Semarang in 2015 was 26.619 of 29.490 pregnant women (97%) but the incidence of anemia in pregnant women was still quite high. One important factor which influences the levels of hemoglobin is multi micronutrient. Objective: This study aims to analyze the changes in hemoglobin levels with multi micronutrient supplementation in pregnant women with anemia. Methods: A quasi-experimental study with randomized control group pre-posttest design. The study samples were 40 pregnant women with gestational age of 20 ± 1 weeks divided into two groups, the intervention group (multi micronutrient supplementation) and the control group (Fe supplementation) for six weeks. The study was conducted from November 2016 to January 2017. The levels of hemoglobin were measured using cyanmethemoglobin. Paired t test and independent t test were used for data analyses. Results: The average of the increase in hemoglobin levels after multi micronutrient supplementation was 1.545 (1.292) g/dl, whereas the average of the increase in hemoglobin levels after Fe supplementation was 0.757 (0.742) g/dl. The difference in hemoglobin levels before and after multi micronutrient supplementation was significantly different (p=0.049). Cohen’s d effect size test showed value of 0.748. Conclusion: Multi micronutrient supplementation could improve hemoglobin levels. The increase in the levels of hemoglobin with multi micronutrient supplementation was higher than Fe supplementation.

Background: Menstrual pain can be severe enough to interfere with everyday activities for a few days every month, particularly in activities in homes and schools for late adolescents. Dark chocolate is considered effective in reducing menstrual pain. However, little is known about its effect. Objective: This study aimed to examine the effect of dark chocolate on menstrual pain in late adolescents.  Methods: This was a true experiment study with randomized pretest-posttest with control group design. This study was conducted from September to November 2016 at the Bhakti Husada Boarding School of Poltekkes Kemenkes Semarang. There were 50 samples recruited by simple random sampling, with 25 randomly assigned to the experiment and control group. Numeric Rate Scale (NRS) was used to measure pain. Independent t-test and Mann-Whitney were used to examine the effect of intervention.  Results: There were significant differences in menstrual pain (p <0.001) before and after treatment. The mean of menstrual pain in the treatment group (2.76 ) was lower than the menstrual pain in the control group (5.36) with p <0.001. Conclusion: Dark chocolate could reduce menstrual pain significantly in the late adolescents.

Background: Anemia during pregnancy is one of the most common disorders in pregnant women in Indonesia. The Government has made efforts to overcome this problem, however, the rate of anemic mothers remains high. Rosella (Hibiscus Sabdariffa) is considered able to increase the hemoglobin levels in pregnant mothers. Objective: To analyze the effect of Rosella flower extract (Hibiscus Sabdariffa) on the increase of Hemoglobin level in pregnant women with anemia receiving Fe tablet. Methods: This study was a quasi-experiment with pretest-posttest control group design conducted in November - December 2016 in the working area of Tlogosari Wetan Community Health Center. Forty-two participants were selected using accidental sampling, which 21 assigned in the experiment and control group. All samples were pregnant women in the second trimester suffering from anemia and receiving iron tablets. Hemoglobin levels were measured using hematology analyzer in laboratory. Independent t-test and paired t-test were used for data analysis. Results: Paired t-test obtained p-value 0.00 (<0.05) indicated that there was an increase of hemoglobin levels in both experiment and control group. The mean increase of hemoglobin levels in the control group was 0.61 gr/dl and in the experiment group was 1.08 gr/dl. The hemoglobin levels in the experiment group were higher than the levels in the control group. Independent t-test obtained p-value 0.000 (<0.05) indicated that there was a significant difference of mean of hemoglobin levels between the control group and the treatment group. Conclusion: The consumption of rosella extract combined with Fe tablet showed a significant increase of hemoglobin levels compared with the consumption of Fe tablet alone. Therefore, it is suggested for midwife to use the result of this research as evidence practice through counseling for pregnant mother about utilization of rosella extract that can increase hemoglobin level in pregnant woman with anemia.

Background: Cardiovascular heart disease still remains high in Indonesia. Various interventions have been implemented as an effort to deal with cardiovascular disease. However, little is known about intervention to reduce anxiety in patients with cardiovascular disease although anxiety is related to angina attack in this patient. Psychoeducation is considered effective in decreasing anxiety. Objective: To examine the effect of psychoeducation in decreasing anxiety in patients with coronary heart disease (CHD) at the General Hospital of Semarang, Indonesia Methods: This was a quasi-experimental design with pretest posttest control group design. The study was conducted in the inpatient wards of the General Hospital of Semarang on 17 January until 8 March  2017. Fifty-six respondents were recruited using consecutive sampling, with 28 assigned in the experiment and control group. Hamilton Anxiety Rating Scale (HARS) was used to measure anxiety levels. Paired t-test and Independent t-test were used for data analysis. Results: Paired test showed that there was a statistically significant effect of psychoeducation on anxiety level in the experiment group with p-value 0.001 (<0.05), and significant effect of given a brochure of CHD on the anxiety level in the control group with p-value 0.001 (<0.05). Independent t-test showed a statistically significant difference of anxiety level after intervention in the experiment and control group with p-value 0.001 (<0.05). The mean anxiety level in the experiment group (22.46) was lower than the mean anxiety level in the control group (41.54). Conclusion: Psychoeducation is effective in reducing anxiety levels in patients with CHD. It is suggested that psychoeducation can be used as one of nursing intervention in an effort to reduce anxiety in patients with CHD.

Objective: To examine the effect of yoga and acupressure in lower back pain and functional capability in pregnant women during the third semester of pregnancy. Methods: A quasi-experimental design with pretest posttest with non-equivalent control group. The research was conducted at the Community Health Center of Kalikajar I, Selomerto I and Garung I in Wonosobo regency Indonesia in January 2017. The samples of this research were 42 pregnant women in trimester III selected using purposive sampling, which 14 samples assigned in the yoga group, acupressure group, and control group. A Visual Analog Scale (VAS) was used to measure pain level, and Oswestry Disability Index to measure functional capability of lower back. Data were analyzed using paired t-test and one-way ANOVA. Results: Findings showed that there was a statistically significant effect of yoga, acupressure, and pregnancy exercise (control group) in reducing lower back pain and lower back functional capability with p <0.05. Pregnancy exercise (mean=-1.43) was more effective in reducing lower back pain compared with yoga (mean=-2.29) and acupressure (mean=-2.71); and acupressure (mean=-14.29) was more effective in improving lower back functional capability than yoga (mean=-6.57) and pregnancy exercise (mean= -13.29). Conclusion: There were significant effects of yoga, acupressure, and pregnancy exercise in reducing pain and in improving the functional ability of the lower back. It is recommended for midwife to use these interventions as an alternative to deal with back pain and functional capability in pregnant women, especially in the Community Health Center in Wonosobo regency, Indonesia.

Background: High blood pressure during pregnancy can pose significant problems such as preeclampsia, eclampsia, and premature birth. Thus, early prevention is needed. Consuming tomato (lycopersium commune) juice is considered effective to reduce blood pressure in pregnant women. Objective: This study aims to examine the effect of tomato juice on the decrease in blood pressure of pregnant women with hypertension in pregnancy. Methods: This study was a quasi-experiment with pretest-posttest control group. This research was conducted at the working area of the Community Health Center of Magelang Indonesia in July 2016 - January 2017. The target population of this study was pregnant women in trimester I, II, and III with high blood pressure. There were 30 samples selected using consecutive sampling, with 15 assigned in the experiment and control group. Wilcoxon test was performed for data analysis. Results: There was a statistically significant difference in systolic and diastolic blood pressure before and after given tomato juice with p = 0.001 (<0.05). Conclusion: Consuming tomato juice can be one of the efforts to reduce blood pressure in pregnant women with hypertension.

Objective: To examine the effectiveness of music therapy on anxiety and β-endorphin levels in primigravida during the third stage of pregnancy. Methods: This was a quasi-experimental study with pretest-posttest control group design. The research was conducted in December 2016 - January 2017. There were 39 respondents selected using purposive sampling technique, which 13 assigned in the experiment group 1 (music therapy with a sound pressure of 40 dB), experiment group 2 (music therapy with a sound pressure of 62 dB) and control group (health counseling). Anxiety levels were measured using the HARS (Hamilton Anxiety Rating Scale), and β-endorphin hormone levels were measured using ELISA (Enzyme-Linked Immunosorbent Assay) method. Data were analyzed using Paired t-test, One-Way ANOVA test with post-hoc Bonferroni, and Kruskal Wallis test with post-hoc Mann Whitney. Results: Findings revealed that there was a decrease of the mean of anxiety levels in the experiment group 1 from 31.92 (pretest) to 24.69 (posttest), and the experiment group 2 from 34.54 (pretest) to 25 (posttest) with p-value <0.05. There was an increase of the mean of β-Endorphin levels in the experiment group 1 from 53.63 (pretest) to 63.24 (posttest), and the experiment group 2 from 48.55 (pretest) to 64.9 (posttest) with p-value <0.05. However, there was no effect of counseling in the control group on anxiety levels (p=0.413) and β-Endorphin levels (p= 0.394). Conclusion: Music therapy is effective in reducing anxiety levels and increasing β-endorphin levels. Thus, music therapy can be used as an alternative treatment for pregnant mothers at home who experienced anxiety.

Objective: To examine the effect of eggshell flour on blood calcium levels in pregnant mice. Methods: This was a true experimental study with pretest and posttest control group design. The research was conducted at the Nutrition Laboratory of the Center for Food and Nutrition Studies, Gadjah Mada University on December 1, 2017 to December 31, 2017. There were 30 pregnant rats included using simple random sampling, which assigned in five groups. Spectrophotometer was used to measure blood calcium levels. Paired t-test and One-way ANOVA were used for data analysis. Results: There were significant differences in blood calcium levels before and after treatment with eggshell flour dose 5.4 mg/dl (p= 0.000), 10.8mg/dl (p = 0.000), and 21.6 mg/dl (p = 0.000). There was also significant difference in blood calcium levels in control group with generic tablet of calcium powder of 21.6 mg/dl (p = 0.000). Conclusion: There was a significant effect of given eggshell flour for 7 days with dose 5.4 mg/dl, 10.8 mg/dl, and 21.6 mg/l as well as generic tablet of calcium powder of 21.6 mg/dl in increasing blood calcium levels. Thus, eggshell can be used as alternative for calcium supplement.

Background: Endotracheal suctioning is one of the common supportive measures in intensive care units (ICU), which may be related to complications such as hypoxia. However, a questionable efficacy is still identified to choose suctioning pressure between 130 mmHg and 140 mmHg that is effective for patients with endotracheal tube.Objective: To compare the effectiveness of 130 mmHg and 140 mmHg suctioning pressure on oxygen saturation in patients with endotracheal tube.Methods: This research used a quasi-experimental design with pretest and posttest group. The study was conducted from 31 January to 1 March 2017 in the Hospital of Panti Wilasa Citarum and Hospital of Roemani Muhammadiyah Semarang Indonesia. There were 30 samples recruited using consecutive sampling, with 15 assigned in the 130 mmHg and 140 mmHg suctioning pressure group. Pulse oximetry was used to measure oxygen saturation. Paired t-test and Independent t-test were used for data analysis.Results: Findings showed that there was a statistically significant effect of 130 and 140 mmHg suctioning pressure on oxygen saturation in patients with endotracheal tube with p-value <0.05. There was a significant mean difference of oxygen saturation between 130 mmHg and 140 mmHg suctioning pressure group with p-value 0.004 (<0.05). The mean difference of oxygen saturation between both groups was 13.157.Conclusion: The 140-mmHg suctioning pressure is more effective compared with 130 mmHg suctioning pressure in increasing oxygen saturation in patients with endotracheal tube.

Background: Hypertension during pregnancy remains high in Indonesia. It is a major cause of maternal death. Aromatherapy lavender and classical music therapy are considered effective in lowering blood pressure in hypertension. Objective: To examine the effect of lavender aromatherapy and classical music therapy in lowering blood pressure in pregnant women with hypertension. Methods: A quasi-experimental study with pretest-posttest control group design. There were 52 pregnant women selected using simple random sampling, divided into lavender aromatherapy group, classical music group, combination of aromatherapy and music group, and control group. Sphygmomanometer was used to measure blood pressure. Mann Whitney and Post Hoc test were used for data analysis. Results: Results showed that four groups had a significant decrease in systolic blood pressure after given intervention with p-value <0.05. The mean decrease of systolic blood pressure among four groups was: lavender group (5.77 mmHg), music group (7.23 mmHg), combination group (9.54 mmHg), and control group (3.67 mmHg); and the mean decrease of diastolic blood pressure was: the lavender group (2.77 mmHg), music group (0.61 mmHg), combination group (8.23 mmHg), and control group (3.42 mmHg). Conclusion: There was a significant effect of lavender aromatherapy and classical music therapy in lowering blood pressure in pregnant women with hypertension. However, the combination of both interventions was more effective than lavender aromatherapy or music therapy alone.

Background: Strong organizational commitment is needed by hospitals to attract and retain nursing staffs in order to consistently deliver good quality of nursing services. The decrease in organizational commitment among nurses can cause many losses to the organization, including increased organizational spending, breakdown in patient care, and cause performance trends that appear not for the benefit of the organization or unit, but more for personal self-interest. Objective: To analyze the relationship of the application of Islamic Based Caring (IBC) model with organizational commitment among nurses. Methods: This was a correlation analytic research with cross sectional design. There were 108 nurses selected using a proportionate stratified random sampling. Islamic Based Caring was measured using a questionnaire developed based on the theory of Suhartini Ismail (2016), and organizational commitment was measured using a questionnaire developed based on the concept of Caldwell, O’Reilly & Chatmann (1990) and Mowday, Porter dan Steers (1982) in Asmaningrum (2009). Logistic regression and forward stepwise (conditional) method were used for data analysis. Results: There was a statistically significant correlation of a healing presence (p=0.000), caring relationship (p=0.010), caring environment (p=0.045) and belief in God (p=0.000). Belief in God (Allah SWT) has the highest correlation (OR=6.660) with organizational commitment among nurses. Conclusion: There is a positive and significant relationship between the implementation of Islamic Based Caring with the organization's commitment among nurses.

Background: The prolonged partus is one of the causes of maternal deaths marked by the slow progress of labor. Induction of labor and caesarean section is a common procedure performed on long-term partus events to end pregnancy. The birth acupressure technique is a complementary method to activate the hormone oxytocin at a certain point to use to soften the cervix and increase contraction. Objective: To examine the effect of acupressure point LI4, SP6 and BL60 on the duration of the first stage of labor and APGAR score of newborns in primigravida. Methods: This research employed a quasi-experimental study with posttest control group design. It was conducted at the Public Health Center of Trauma and Public Health Center of Palaran Samarinda, East Kalimantan, Indonesia. There were 40 respondents selected using purposive sampling, which 20 respondents assigned in the experiment and control group. The duration of the first stage of labor was assessed using partograph and APGAR score was assessed using APGAR score assessment sheets. Mann Whitney test was used for data analysis Results: Findings showed that the duration of the first stage of labor in the experiment group was 187 minutes and in the control group was 307 minutes. Mann Whitney test obtained p-value 0.001 (<0.05), which indicated that there was a statistically significant difference of the duration of the first stage of labor between both groups. However, Mann Whitney test for APGAR score showed p-value 0.114 (>0.05), which indicated that there was no significant difference of APGAR score in the experiment and control group. Conclusion: There was a significant effect of acupressure on the duration of the first stage of labor, but no effect of the APGAR score. Therefore, acupressure may be recommended to shorten the duration of the first stage of delivery in primigravida.

Background: Optimal nutrition from an early age can be achieved through exclusive breastfeeding. Lack of milk production is one reason why mothers decide to give formula milk to their babies. In fact, 60% of mothers were unable to breastfeed optimally, thus, breast care and oxytocin massage are proposed to increase milk secretion in postpartum mothers. Objective: To examine the effect of combination of breast care and oxytocin massage on breast milk secretion in postpartum mothers. Methods: This was a quasi-experimental study with non-randomized control trial with pretest-posttest control group, conducted in the working area of the Community Health Center of Batealit of Jepara Indonesia from December 5, 2016 to January 15, 2017. There were 44 postpartum mothers recruited in this study using purposive sampling, which 22 assigned in the experiment and control group. Data were analyzed using dependent t-test and Mann Whitney test. Results: There was a significant increase of breast milk secretion in the experiment and control group with p-value 0.000 (<0.05). In the experiment group, there was an increase of breast milk secretion from 17.09 to 220.91 cc, and in the control group there was also an increase from 17.09 to 72.00 cc. The mean difference of breast milk secretion between pretest and posttest in the experiment group was 203.82 and in the control group was 54.90 with p-value 0.000 (<0.05) Conclusion: There was a significant increase of breast milk secretion in postpartum mothers after given the combination of oxytocin massage and breast care in the experiment group compared with the education and counseling about breast care in the control group. Thus, this result can be used as an evidence to perform oxytocin massage and breast care to increase the secretion of breast milk in postpartum mothers.

Objective: This study aimed to examine the pregnancy exercise during the third trimester of pregnancy on duration of the first and second stage of labor in primigravida at the Community Health Center of Sukamaju, Bandar Lampung, Indonesia. Methods: This study employed a quasi-experimental design with posttest-only non-equivalent control group. This study was conducted from 8 January 2017 to 12 February 2017 at the Community Health Center of Sukamaju. Forty-eight primigravida mothers were selected using consecutive sampling, with 24 assigned in the experiment and control group. Data were analyzed using Mann Whitney and Chi Square test. Results: The average duration of the first stage of labor in the experiment group was 495 minutes and in the control group was 685 minutes (p= 0.000); while the average duration of the second stage of labor in the experiment group was 42.5 minutes and in the control group was 68.75 minutes (p=0.000). Conclusion: There was a statistically significant difference in the duration of the first and second stage of labor between experiment and control group. It is expected for midwives in the community health centers to implement pregnancy exercise program to help mothers in accelerating the delivery process.

Objective: This aim of this research is to describe clinical indicators of feeding self-care deficit based on Barthel Index measurement in patients with stroke. Methods: The research used a quantitative description study with cross-sectional design. This research was conducted in one hospital in Yogyakarta, Indonesia on March – April 2017 with total sampling technique. Instrument was developed based on clinical indicators of NANDA-I nursing diagnosis of feeding self-care deficit. Results: There were 28 respondents involved in this study, with males (60.7%) and females (39.3%) with an average age of 57 years. Respondents who suffered from non-hemorrhagic stroke were 60.7% and hemorrhagic stroke were 39.3%. Clinical indicator items for impaired ability to swallow sufficient amount of food (9.1%) was found in respondents with independency criteria on Barthel Index. Impaired ability to swallow sufficient amount of food item (25%) and impaired ability to prepare food (25%) were found in respondents with partial dependency criteria. The most items identified on respondents with severe dependency criteria were impaired ability to self-feed a complete meal item (53.8%) and impaired ability to prepare food item (53.8%). Conclusion: There were different pattern of clinical indicators items found in different level of Barthel index level criteria.

Objective:  To examine the effect of the combination of cold pack, water spray, and fan cooling on body temperature reduction and level of success to reach normal temperature in critically ill patients with hyperthermia. Methods: This was a randomized control trial (RCT) with pretest posttest control group design and repeated measurement, conducted on December 2016 – January 2017. There were 32 respondents selected using total sampling, with 16 respondents randomly assigned in the experiment and control group. A digital thermometer was used to measure hyperthermia. Paired t-test, Repeated ANOVA with post hoc, and Mann Whitney were used for data analysis. Results: Findings showed that the mean of body temperature in the experiment group in pretest was 38.762 oC and decreased to 37.3 oC after given intervention for 60 minutes. The mean difference of body temperature was 1.4625, with p-value 0.000 (<0.05). In control group, the mean of body temperature in pretest was 38.669 oC and decreased to 38.188 oC given intervention for 60 minutes. The mean difference of body temperature was 0.4812, with p-value 0.000 (<0.05).  Conclusion: There was a significant effect of the combination of cold pack, water spray, and fan cooling on body temperature reduction and level of success to reach normal temperature in critically ill patients with hyperthermia. This combination is more effective than water compress alone.

Objective:  This study aims to identify urinary incontinence and its prevalence in people aged 65 and over.  Methods: This descriptive study was conducted between April and June, 2017. It was conducted with 1527 volunteer people aged 65 and over who applied to A Family Health Centre. Data were collected through face-to-face interviews, using Personal Identification Form and International Consultation on Incontinence Questionnaire- Short Form (ICIQ-SF). Results: Of all the participants, 50.7% were male, and 78.8% were aged between 65 and 74. Besides, 31.2% of them had urinary incontinence, and ICIQ-SF mean score was found 11.44 ± 5.01. The most prevalent incontinence type was found to be urge urinary incontinence. ICIQ-SF total scores of elderly people with urinary incontinence were higher in those who were aged 85 and over, who were illiterate, who did not have health insurance, and who had more than one chronic disease and multiple medicine use. Conclusion: Urinary incontinence is a health problem which maintains its importance in people aged 65 and over. People in this age group do not express this problem because they feel shy; therefore, their quality of life deteriorates. 

Background: The Children’s Sleep Habit Questionnaire (CSHQ) has been utilized for assessing sleep behavior problems in children aged 4-10 years in many countries. However, a proper tool to detect of sleep behavior problems in Indonesian children has not been proven. Aims: The aim of our study was to test the item analysis and internal consistency of the Children’s Sleep Habit Questionnaire (CSHQ) in Indonesian version. Methods: We used a cross-sectional design and 305 mothers of pre- and primary school children in Yogyakarta Indonesia participated in this study. The Indonesian version of the Children’s Sleep Habit Questionnaire was used for assessing the sleep behavior problems in children. Internal consistency was evaluated by using the Cronbach α method. The internal consistency was tested with Cronbach alpha coefficients. Pearson’s Product Moment was completed to estimate the correlation between all items of CSHQ with Subscales and total scores of CSHQ. Results: Internal consistency of all items of the Children’s Sleep Habit Questionnaire was 0.80. Internal consistency of subscales ranged from 0.42 (parasomnias) to 0.66 (night wakening). 31 of 33 items had significant positive correlation with total score of Children’s Sleep Habit Questionnaire. Inter-subscales with the highest correlation were sleep onset delay with parasomnias, parasomnias with sleeps disordered breathing, and sleep disorder breathing with night waking. Conclusions: The Indonesian version of the Children’s Sleep Habit Questionnaire is suitable for screening sleep behavior problems in Indonesian children aged 4-10 years.

Objective: To examine the effectiveness of hypnodialysis on anxiety levels and adherence to medication, kidney diet and fluid intake in patients with chronic kidney disease. Methods: This was a randomized controlled trial study conducted from November to December 2016. Thirty respondents recruited using simple random sampling, which 17 respondents assigned randomly in the experiment and control group. The Hamilton Anxiety Rating Scale (HARS), Morisky scale, adherence to kidney diet questionnaire, adherence to fluid intake questionnaire were used as instruments for this study. Paired t-test and repeated ANOVA were used for data analysis. Results: Findings showed that there was a statistically significant effect of hypnodialysis in reducing anxiety levels and improving adherence to medication, kidney diet, and fluid intake in patients with chronic kidney disease with p-value 0.000 (<0.05), which its effect started from day 7 (posttest 1). Conclusion: Hypnodialysis may decrease anxiety levels and improve medication adherence, kidney diet and fluid intake. Therefore, hypnodialyis can be alternative treatment for patients with chronic kidney disease.

Background: A caregiver is a primary nurse and has a major role in providing care for people with schizophrenia. Caring for those with schizophrenia for a long period of time is challenging for families, especially for caregivers. Various needs ought to be studied by nurses to assist caregivers in providing optimal care for family members who experience schizophrenia. Objective: This qualitative study aims to explore the needs of caregivers in treating schizophrenia at home. Methods: This study employed a phenomenological study design. A total of 10 respondents were selected using a purposive sampling with criteria: 1) having family members diagnosed with schizophrenia, 2) directly involved in taking care of patients at home, 3) caring for patients with schizophrenia for more than one year, 4) willing to be a participant by signing an informed consent, and 4) being able to identify what is needed in treating schizophrenia. Colaizzi’s method was used to analyze the data. Results: There were four themes of the caregivers need in caring for schizophrenia patients at home, including 1) seeking information about schizophrenia, 2) sought healing through regular treatment, 3) looking for appropriate rehabilitation for relatives with schizophrenias, and 4) utilizing mental health facilities. Conclusions: It is expected that nurses have the knowledge and skills in identifying and helping the families, especially the caregivers, to meet unmet needs so they can optimize home care.

Background: Women are at risk of iron-deficiency anemia, especially in teenage girls. One alternative treatment to prevent the occurrence of anemia is to consume guava leaf extract. Objective: To examine the effect of guava leaves extract on changes in blood profile level in teenage girls. Methods: This study was a quasi-experiment with pretest posttest control group design. This research was conducted at SMK Palebon Semarang Indonesia conducted on December 2016 - January 2017. There were 36 samples selected using a purposive sampling, with 18 samples were assigned in the experiment and control group. Blood profiles was measured in the Laboratory of Cito Klinik Setiabudi to see the hemoglobin level, hematocrit level, erythrocyte count, and platelet count. Data were analyzed using Independent t-test. Results: There were significant differences in hemoglobin and thrombocytes levels after given intervention between the experiment and control group with p-value <0.05. However, the intervention has no effect on hematocrit and erythrocytes levels (p>0.05). Conclusion: Guava leaves (Psidii folium) extracts have a significant effect on changes in hemoglobin and thrombocyte levels in teenage girls, but not in the hematocrit and thrombocytes levels. Therefore, it is suggested that guava leaves (Psidii folium) extracts can be an alternative treatment for midwives to prevent the occurrence of anemia in teenage girls.

Background: Low independent nurse actions leads to poor health care quality. Therefore, understanding the factors affecting independent nursing action is necessity.  Objectives: This study aims to analysis the independent nurse actions and its related and predicting factors. Methods: This study used a cross-sectional design with observational technique for data collection. There were 165 nurses recruited using simple random sampling in 14 inpatient wards of the General Hospital of dr. M. Haulussy Ambon, Indonesia. Spearman Rank Correlation and multiple regressions were used for data analysis. Results: Results of this study showed that there were significant relationships of age, gender, education, employment time, family burden, working experience, knowledge, workload, and nurse ability with independent nursing action with p-value <0.05. Nurse knowledge was the most dominant factor predicting independent nursing action with R-value 0.450. Conclusions: Independent nurse actions in daily living activities, caring & support, and rehabilitation were influenced by multiple factors such as nurse knowledge, ability, education and gender. Nurse knowledge is the most predicting factors affecting independent nursing action. Therefore, hospital and nurse managers need to well manage these predicting variables in order to improve independent nurse action that leads to the better quality of health service in the hospital.

Background: Most of anemia in pregnancy is caused by iron deficiency. Thus, giving iron tablets is an effort to deal with anemia. A green bean  (Phaseolus Radiatus) juice is considered helping the absorption of iron effectively. Objective: To analyze the effect of green bean (Phaseolus Radiatus) juice on changes in blood profile levels in pregnant women with anemia who received Fe tablet supplementation. Methods: This was a quasi-experimental study with pretest posttest with control group design conducted from November 2016 to January 2017 in the working area of the Community Health Center of Kedungmundu Semarang, Indonesia. Consecutive sampling was used in this study to select 40 samples based on the hypothesis formula of two independents. There were 20 samples assigned in each group. Data were analyzed using paired t-test and Independent t-test. Results: The results of this study showed that there were significant increases in hemoglobin, hematocrit, and erythrocytes (p = 0.000) after given green bean (Phaseolus Radiatus) juice. Conclusion: There was a significant effect of green bean (Phaseolus Radiatus) juice in increasing the levels of hemoglobin, hematocrit, and erythrocytes. It is expected that this green bean juice can be used as an alternative treatment to deal with anemia in pregnant women.  

Background: Maternal and infant mortality rates in Aceh province are still quite high compared to other provinces in Indonesia. In addition to disease factors, the factor that contributes to the rates is socio-cultural factor. Objective: This study aims to know and understand the view of postpartum mothers, health personnel, cadres, and the chairperson of the Aceh traditional assembly about the culture related to postpartum and newborn and integrated infant management program (MTBM) in Aceh. Methods: This was a qualitative study. Data collection was conducted from October 2016 to January 2017 on seven health cadres by focus group discussion and in-depth interviews on five postpartum mothers, one health worker, and the Aceh traditional assembly chairperson. The open-code software program was used for data analysis. Results: Three themes emerged from data: 1) The 'Madeung' Culture in postpartum mothers in Aceh has a relationship with maternal health problems, 2) 'Peucicap' and 'troen tanoh' cultures in newborns in Aceh are at risk of causing complex problems in newborns, and 3) Community-based integrated management of young infants can be implemented while maintaining Acehnese culture. Conclusion: To improve access to maternal and neonatal health services with socio-cultural issues, the community-based integrated management of young infants is considered appropriate in Aceh culture.

Background: Post-cesarean mothers often experience anxiety and discomfort due to long-term pain. The combination of hypnobreastfeeding and acupressure is considered to be effective in reducing anxiety and pain levels.  Objective: This study aims to examine the effect of combination of hypnobreastfeeding and acupressure on anxiety and pain levels in post-caesarean mothers. Methods: This study was a true experiment with pretest-posttest control group design, conducted in the Ambarawa Public Hospital Indonesia on 5 November to 9 December 2016. There were 36 participants selected using stratified random sampling, with 18 assigned in the experiment and control group. Data were analyzed using Paired t-test and Wilcoxon test. Results: There were statistically significant differences of anxiety and pain levels before and after intervention in the experiment and control group with p-value 0.001 (<0.05). Conclusion: The combination of hypnobreastfeeding and acupressure has a significant effect in reducing anxiety and pain levels in post-cesarean mothers. This intervention could be applied as an alternative therapy in treating post-caesarean mothers.

Background: One of the puerperal complications is uterine subinvolution that can cause bleeding to maternal death. Oxytocin massage can stimulate oxytocin hormone that plays a role in the process of uterine involution. Endorphin massage can increase the release of oxytocin and endorphin hormone that give a sense of calm and comfort. It also increases production of oxytocin hormone that can improve the process of uterine involution. Objective: To prove the effectiveness of a combination of oxytocin massage and endorphin massage to uterine involution in primiparous mothers during postpartum period. Methods: This was a quasi-experimental study with pretest-posttest with control group design. Total samples were 44 normal postpartum mothers selected using purposive sampling technique, which were randomly assigned in four groups, namely: 1) oxytocin massage group, 2) endorphin massage group, 3) combined oxytocin-endorphin massage group, and 4) control group. Data were analyzed using univariate, bivariate and One-Way ANOVA to test the effectiveness of the intervention. Results: There were statistically significant differences of fundal height before and after intervention among the four groups (p=<0.05). Conclusion: The combination of oxytocin massage and endorphin massage proved most effective in accelerating uterine involution in normal postpartum mothers.

Background: Breast milk is the best natural nutrient for the baby. However, some mothers have problems with breastfeeding due to lack of breast milk production. Spinach leaf (Amaranthus Spinosus L) is considered as one of the plants that have the effect of non-synthesis lactagogues to increase milk production. Objective: To analysis the effect of spinach leaf (Amaranthus Spinosus L) extract on prolactin and breast milk production in postpartum mothers. Methods: This was a quasi-experimental study with pretest posttest with control group design conducted in the Community Health Center of Wonogiri II Indonesia from December 2016 to January 2017. There were 30 participants were selected using purposive sampling, with 15 participants assigned in an experiment group and a control group. Data were analyzed using independent and paired t-test. Results: The results showed significant differences in prolactin levels (p = 0.000), breast milk production (p = 0.000), and infant weight (p = 0.000) (<0.05) after given spinach leaf (Amaranthus Spinosus L) extract. Conclusion: Spinach leaf (Amaranthus Spinosus L) extract had a significant effect in increasing the prolactin levels and breast milk production in postpartum mothers.

Background: Job satisfaction influences the quality of health services in hospitals. However, low job satisfaction of nurses exists in the literature and influenced by various factors, including supervision. Thus, a reflective supervision model is considered effective in improving nurse job satisfaction. Objective: This study aims to analyze the effect of the reflective supervision model on nurse job satisfaction. Methods: This was a quasi-experimental study with control group design conducted from May to July 2017 at two hospitals at Central Java, Indonesia. There were sixty-eight nurses selected using purposive sampling, with 34 nurses assigned in the experiment and control group. Data were collected using questionnaires and then analyzed by paired t-test. Results: Paired t-test obtained p-value of 0.000, which indicated that the reflective supervision model has a significant influence to nurse work satisfaction. Conclusion: The reflective supervision model has a significant effect in increasing nurse job satisfaction. Therefore, this model could be applied by the head nurses to improve nurse outcome indicator, especially for nurse job satisfaction.

Background: Applying a cooling treatment from outside the body is one way to lower fever in children. Midwives commonly perform a warm water compress in their care, but it is considered less effective. Thus, compress with Aloe Vera Barbadensis Miller is proposed in this study as an alternative treatment. Objective: To examine the effect of Aloe Vera Barbadensis Miller compress in reducing body temperature in children with fever. Methods: This was a quasi-experimental study with pretest and posttest with control group design. Forty children were recruited, with twenty of them assigned in each group. Purposive sampling was performed to select the sample. A digital rectal thermometer was used to measure the temperature. Independent t- test and paired test were used for data analysis. Results: Findings showed that the Aloe Vera compress group showed a higher decrease of body temperature compared to the warm water compress group. The difference of body temperature after 20 minutes in the experiment group was 1.435 while in the control group was only 1.085. There were statistically significant differences in body temperature between the experiment and control group (p=0.013). Conclusion: Aloe Vera Barbadensis Miller compress is an effective alternative therapy in reducing body temperature in children with fever.  It is recommended for midwives to apply this intervention to reduce body temperature significantly.

Background: Autism is a neurodevelopmental disorder. Audio therapy is considered as one of the complementary therapies to improve the behavior of children with autism. Objective: This study was to analysis the effectiveness of the Al-Qur'an murrotal audio therapy on behavioral development in children with autism. Methods: This study was a true-experimental research using pretest and posttest approach with control group. This research was conducted on November 2016 in the Autism Foundation of Semarang City, Indonesia. There were 30 samples were selected using simple random sampling, with 15 samples assigned in the experiment and control group. Mann Whitney and Wilcoxon tests were used for data analysis in this study. Results: Results showed that there was a significant difference in the mean of behavioral development after given intervention between the experiment group and control group with p-value 0.034 (<0.05). The mean of behavioral development in the experiment group (4.53) was higher than the mean in the control group (3.47). Conclusion: The Al-Qur'an murrotal audio therapy is effective to develop behavior of children with autism. Therefore, it is expected that this audio therapy can be applied an alternative therapy for children with autism.

Background: Pain during pregnancy and childbirth is a physiological process, but it leads to discomfort without pain management. Acupressure and effleurage are considered to be effective in reducing labor pain. Objective: To examine the effect of acupressure and effleurage in reducing pain during in the active phase of the first stage of labor in the Community Health Center of Kawunganten, Cilacap, Central Java, Indonesia. Methods: This was a quasi-experimental study with pretest-posttest control group design. There were 33 respondents recruited using simple random sampling. Numerical rating scale was used to measure labor pain. Data were analyzed using one-way ANOVA, post hoc ANOVA and repeated ANOVA for normal data distribution. Kruskal Wallis was also used for non-normal data distribution. Results: There was a statistically significant mean difference of pain scale before and after given acupressure and effleurage (p-value <0.05). However, acupressure treatment had a greater effect  in reducing pain compared with effleurage. Conclusion: Acupressure and effleurage had a significant effect in reducing pain in mothers in the active phase of the first stage of labor. The results of this study are expected to enrich and contribute to the development of science in the field of health promotion, and  serve as an additional input for midwives in order to carry out the care of mother during labor.

Background: The dominant factor inhibiting breastfeeding is the lack of milk production. The extract of temulawak (curcuma xanthorrhiza Roxb) is considered having an effect to increase breast milk production. Objective: To examine the effect of temulawak (curcuma xanthorrhiza Roxb) extract to increase milk production in postpartum mothers in the working area of Ambarawa Community Health Center, Indonesia. Methods: This was a quasi-experimental study with non-equivalent control group design conducted on October-December 2016. There were 38 respondents included using consecutive sampling, with 19 assigned in the intervention and control group. Paired t-test and independent test were used for data analysis. Results: Findings showed that there were significant increases of prolactin hormone (p = 0.000), breast milk volume (p = 0.001), baby’s urinary frequency (p = 0.001), baby’s defecation frequency (p = 0.000), and baby’s sleep duration (p = 0.000) after given temulawak (curcuma xanthorrhiza Roxb) extract. Conclusion: Temulawak (curcuma xanthorrhiza Roxb) extract had a significant effect in increasing breast milk production and prolactin levels in postpartum mothers. Thus, it is recommended that temulawak (curcuma xanthorrhiza Roxb) extract can be an option for postpartum mother to increase milk production.

Background: Caesarean section is one of the most common interventions to overcome labor complications. However, pain cannot be avoided after the surgery.  Lavender aromatherapy is considered as one of non-pharmacological therapy to reduce pain and increase beta-endorphin levels. Objective: To examine the effect of lavender aromatherapy on the intensity of pain and beta-endorphin levels in post-caesarean mothers. Methods: This was a quasi-experimental study with pretest and posttest with control group at Sembiring Delitua General Hospital in Indonesia on December 2016 to February 2017. There were 40 samples selected using purposive sampling, with 20 samples assigned in the experiment and control group. Numerical Rating Scale (NRS) was used to measure pain and ELIZA methods to measure beta-endorphin levels. Independent t-test and paired t-test were used for data analysis Results: Results of this study showed that there was a significant difference in the mean value of pain intensity levels (p = 0.000) and beta-endorphin levels (p = 0.023) between experiment and control group. Conclusion: There was a significant effect of lavender aromatherapy on the decrease of pain intensity and the increase of beta-endorphin hormone in post-caesarean mothers. It is expected that lavender aromatherapy can be used as an alternative treatment to reduce pain and increase beta-endorphin levels in post-caesarean mothers.

Background: Integrated Management of Childhood Illness (IMCI) is an integrated guideline in dealing with infants and sick children at the community health center. However, many students cannot apply this guideline because they are not being exposed. Objective: This study aims to explore the perspectives of nurse educators and clinical instructors regarding the effectiveness of teaching learning process of IMCI in diploma nursing students. Methods: This was a qualitative study with interpretive approach. There were nine informants selected using purposive sampling, which consisted of nurse educators and clinical instructors. Data collection was conducted in December 2016 - February 2017 using focus group discussions and in-depth interviews. Data were analyzed using Colaizzi process. Result: There were four themes emerged from data, namely 1) Competency of IMCI for Diploma Nursing Students, 2) Deepening of IMCI Material, 3) Learning methods of IMCI in the class and clinic should be active and structured, 4) Student confidence in the application of IMCI in clinical setting. Conclusion: The learning process of IMCI will have an impact on the improvement of knowledge, skills and attitude in the application of IMCI in the clinical setting.

Background: Children with autism as individuals have a right to receive developmental needs obtained from parent/caregiver during their stay in the family. The family ability can be improved through empowerment training to provide stimulation for the development of children with autism. Objective: This study aims examine the effect of family empowerment in enhancing the capabilities of children with autism. Methods: The research design used a two-stage quasi-experiment. The first stage was a training for parent/caregiver of children with autism using modules. Training was done three times in the Autism Service Center (PLA) of Blitar City Indonesia. The second stage was the parent/caregiver provided stimulation to their children at home. There were 33 children selected using total sampling in the PLA of Blitar City on April – August, 2016. Data were analyzed using descriptive statistics and paired t-test. Results: The family ability to stimulate the capability of children with autism in the sense of hearing, vision, motoric, and inviting to play obtained average changes of 61.99%, with average items increased from 18.52 to 30.00. While the increase capabilities of children with autism were categorized into five classification: communication, fulfilling of activity daily living, language-numbers–tactile, psychology, and understanding commands. Conclusion: There was a significant effect of family empowerment in enhancing the capabilities of children with autism. Thus, training to improve the ability of parent/caregiver in caring children with autism needs to be implemented in a planned and gradually manner.

Background: Cardiopulmonary Resuscitation (CPR) is the emergency first aid in cardiac arrest. CPR delivery is influenced by knowledge and self-efficacy. Internship students can be the first responders of cardiac arrest in hospital and they are expected having knowledge and high self-efficacy of CPR. However, there is no data on self-efficacy of internship students in performing CPR. Objective: The purpose of this research was to identify knowledge and self-efficacy of the internship students in performing CPR. Methods: The method in this research was descriptive quantitative with cross-sectional approach on 76 internship students selected by simple random sampling. Knowledge questionnaire and Resuscitation Self-Efficacy Scale instrument were used, with validity score of 0.56-0.84 (α=0.91). Data were analyzed using descriptive statistics. Results: The results showed that 49 respondents (64.5%) had moderate knowledge and 73 respondents (96.1%) had high self-efficacy. The lowest domain in the knowledge was conceptual knowledge, while in the self-efficacy were reporting, debriefing and recording. Conclusions: Therefore, it becomes important to increase the information on the conceptual knowledge as well as to enhance training on the self-efficacy domains: reporting; debriefing and recording.

Background: Bullying is a form of repetitive persecution both on physical and emotional aggressions and potentially causing mental and physical disorders on perpetrators and victims. There are various factors that may affect a child to behave as bullies. These are important factors to be identified as one of prevention effort to stop bullying behavior on children.  Objective: This research aims to identify the association between emotional development and bullying behavior in children at the Elementary School No 7, Banyuasin Prajin, Palembang, Indonesia. Methods: This was a correlation descriptive using a cross sectional design. This research has been conducted on November 21, until December 1, 2016 involving 85 children as respondents. The instruments used for this research were Bar-On Emotional Quotient Inventory: Youth Version, school-bullying questionnaire, parenting style questionnaire and peer influence questionnaire. Chi-square test was used for bivariate data analysis and logistic regression test for multivariate analysis. Results: Results from chi-square test showed a significant association between emotional developments and parenting with bullying behavior (ρ<0.05), but no significant correlation between peer influence and bullying behavior (ρ>0.05). Logistic regression test showed a significant relationship between parenting and bullying behavior (OR) 4.655 (95% CI: 1.292-16.774), which indicated that the uninvolved parenting potentially makes bullying behavior have a chance to increase 4.655 times higher. Conclusion: There is a significant association between emotional development and parenting with children bullying behavior.

Background: Quality of life is the individuals’ perception of their place in life in the context of the cultural system and values in which they live, along with their goals, expectations, and worries. Retirement is an adaptable period that results in a change of role, changes in social interactions, and limited financial resources. Aim: This study aims to analyze the factors that affect post power syndrome and quality of life of the elderly. Methods: The design of this research was a correlation study with a cross-sectional approach. The population consisted of 44 retired elderly individuals. Purposive sampling was applied to the determined sample size. The independent variables were physiological stressors, psychological stressors and aging attitudes. The dependent variables were post-power syndrome and the quality of life of elderly people. The data were analyzed using Structural Equation Modeling- Partial Least Square (SEM-PLS) with a significance t statistic ≥ 1.96. Results: The findings showed all of the significant indicators measured to the variable factor. Physical stressor factors affect post-power syndrome with a t value of 2.366, and psychological stress factors affect post-power syndrome with a t value of 3.326. Aging behavior factors affects post-power syndrome with a t statistic of 5.296 and the post-power syndrome effect on the quality of life of the elderly has a t value of 7.689. Conclusion: There were significant effects in relation to physiological stressor factors, psychological stress factors, and aging attitudes towards post-power syndrome. There was an influence of post-power syndrome on the quality of elderly life.

Some married women are experiencing different types of intimate partner violence by their current or former husband. However, the awareness and services for those women are still needed. This study explored the key informants’ perspectives to provide more comprehensive services to those women. Qualitative feminist method was used and five participants were purposefully selected to interview in depth. Key informants reflected upon intimate partner violence as causes of intimate partner violence, why intimate partner violence cases were underreported, why didn’t women leave their violent partner, what they actually felt for intimate partner violence, gaps with intervention for survivors and planning for better outcome. It was found that awareness among women who experiencing violence and the people around them needed to be raised. And services provided for them also needed to be more concise and updated. Therefore, it is essentially important to extend education session to all people regarding violence against women. Collaboration and cooperation of government and non-governmental organizations is also helpful to decrease various kinds of violence committed to women.

Background: Pediatric nurses are susceptive with stress related to their work. It happens because they take care children who experience the disease and emotional and psychological pressure, so it can make the risk of negative symptoms related with compassion satisfaction, burnout, secondary traumatic stress. Compassion satisfaction, burnout, secondary traumatic stress has an impact not only for them, but also for the quality of treatment. Objective: To identify related factors to nurse’s compassion satisfaction, burnout, and secondary traumatic stress in pediatric care unit. Methods: This study was a descriptive analytic study with cross sectional design. The sample of this study was 107 pediatric nurses of RSUP Dr. Sardjito Yogyakarta Indonesia. The sampling techniques used proportional random sampling. The data were collected from February-March 2017 using the professional quality of life questionnaire fifth version. The data were analyzed using Chi-square, Mann-Whitney, and ordinal regression. Results: 44.9% nurses had a moderate compassion satisfaction, 52.3% nurses had a moderate burnout, and 43% had a moderate secondary traumatic stress. The work unit had p <0.05 and β value 0.945, indicated that the work unit had a significant correlation to the secondary traumatic stress. Age, work position, sex, marital status, interpersonal relationships with colleagues and supervisor, pay satisfaction, and average working hours had p > 0.05, which indicated that these factors had no correlation to compassion satisfaction, burnout, secondary traumatic stress. Conclusion: The work unit was the only related factor to the nurse’s secondary traumatic stress in the pediatric care unit and there were no factors related to compassion satisfaction and burnout.

Background: Adolescents who are in transition period have high risk behavior of juvenile delinquency. Communication between parents and adolescents effectively and openly could help adolescents to avoid delinquency behavior. Objective: This study aims to examine the relationship between family communication patterns and juvenile delinquency in junior high school. Methods: This  research employed a cross-sectional design with correlation description approach. There were 243 students selected using simple random sampling from the 7th  and 8th grade students of junior high school. A questionnaire of juvenile delinquency and family communication pattern were used in this study. Data were analyzed using Chi Square test. Result: The research  showed that the majority juvenile delinquency category was low (65%) and  the majority of communication pattern was in functional category  (73.3%). There was a significant relationship between family communication pattern and juvenile delinquency (p<0.05). Conclusion: Communication pattern within family have significant association with juvenile delinquency.

Background: Autism spectrum disorder is a complex developmental disorder, which increased rapidly than other developmental disorders in the world. This complex disorder affects a child’s self-autonomy, which has become a challenge for their parents or caregivers. Objective: This study is to explore main caregivers’ experience to meet self-care needs of adolescents with autism spectrum disorder in Pontianak, West Borneo, Indonesia. Methods: This study employed a qualitative design with semi-structured in-depth interviews. Seven main caregivers who are living together and taking care of the adolescents with autism spectrum were selected using a purposive sampling. Triangulation was conducted to ensure the trustworthiness of this study, including interviews, observations of self-care activities, documents such as photos, learning reports, and field notes. Participants’ statements were recorded using a voice recorder, and then transcribed, coded, interpreted, and categorized to form main themes and sub-themes. Results: The study identified three main themes: 1) autonomy in self-care, 2) care effort, 3) feelings, supports, and expectations. These findings emphasize the potentials of the children with autism to be autonomous in their daily self-care. Conclusions: Adolescents with autism spectrum disorder can potentially meet the needs of their daily care independently.   This article has been corrected with a separate erratum:  https://doi.org/10.33546/bnj.1146

A web-based information system in this study was developed using ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instruction model to facilitate the monitoring and reporting the existence of high-risk pregnancies in Semarang. The evaluation of the system revealed that web-based information system was very effective in terms of completeness, ease, timeliness, accuracy, and conformity with p-value <0.05. This innovation is expected to contribute positively to reduce maternal mortality rates in Indonesia, especially in Semarang.

Background: Labor and childbirth is an extremely painful process. Aromatherapy is considered as one of the nonpharmacological methods to reduce labor pain. Objective: To determine the effect of lavender (Lavandula Angustifolia) aromatherapy on the level of pain in primipara in the first stage of labor. Methods: A quasi-experimental research with pretest and posttest design with control group conducted between October until November 2016. Forty respondents selected using consecutive sampling, which 20 assigned in each group. a Numerical Rating Scale (NRS) pain scale was used. Paired and independent t-test were used for data analyses. Results: The results showed that the p-value of labor pain after intervention was 0.000 (<0.05), which indicated that there was statistically mean difference of labor pain between intervention group (6.10) and control group (4.05) in primipara in the first active stage of labor. Conclusion: The women in the lavender aromatherapy group reported lower intensity of labor pain. The intervention study could be practiced in the community health centers for pregnant women in order for them to apply this healing method.

Background: Spiritual wellbeing (SWB) is an important quality-of-life dimension for cancer patients. Therefore, health professionals are demanded to improve SWB in these patients. A deeper understanding regarding the factors associated with SWB is needed. Objective: This study aims to examine the relationships of demographic characteristics of patients and spiritual wellbeing in patients with cancer. Methods: This was a cross-sectional correlational study with 60 respondents recruited using consecutive sampling. A spiritual wellbeing scale (SWBS) was used, and data were analyzed using Kendall's Tau and Spearman's rank. Results: Findings in this study showed that only age was statistically significant with spiritual wellbeing of cancer patients with p-value 0.003 (<0.05). There were no significant relationships of gender, education, occupation, long suffering, and type of cancers with spiritual wellbeing with p-value >0.05. Conclusion: There was a significant relationship between age and spiritual wellbeing in patients with cancer. This study provides the insight of knowledge regarding the factors affecting spiritual wellbeing in patients with cancer.

Background: Normal childbirth or cesarean section has an effect on the initiation of early breastfeeding. Thus, rolling massage and oketani massage are considered helpful for milk production. However, little is known about the combination of rolling and oketani massage. Objective: To examine the effect of combination of rolling and oketani massage on the levels of prolactin and milk production in post-caesarian section mothers. Methods: A quasi-experimental study with pretest-posttest control group design. Thirty-six samples were selected using consecutive sampling, with 18 each assigned to an experiment and control group. Breast milk production was measured based on the baby's weight, while prolactin levels were measured using ELISA method. Data were analyzed using univariate and bivariate analysis. Results: Results showed that there was a statistically significant difference of prolactin levels after intervention in the experiment and control group with p-value 0.035 (<0.005), and significant difference in breast milk production in both groups in posttest 1 and posttest 2 with p-value 0.000 (<0.05). Conclusion: There was statistically significant effect of the combination of rolling and oketani massage on the increase of prolactin levels and breast milk production. It is suggested that this intervention can be applied in midwifery care in post-cesarean section mothers.

Background: Low milk production is one of the barriers to exclusive breastfeeding. Oxytocin massage is considered as an alternative treatment, which combined with lavender essential oil as an aromatherapy.Objective: This study aims to examine the effect of oxytocin massage using lavender essential oil on the increase of levels of prolactin and milk production in primiparous mothers after caesarean section.Methods: This was a quasi-experimental study with non-equivalent control group design conducted in October-December 2016 at the General Hospital of Dr.H. Soewondo Kendal, Indonesia. There were 32 recruited by consecutive sampling, divided to be intervention (16 participants) and control group (16 participants). Prolactin hormone levels were measured using Enzyme-linked immunosorbent assay (ELIZA), breast milk production was measured based on the indicators of milk volume, urination and defecation frequency and sleep duration of babies; and infant’s weight was also measured by digital scale. Data were analyzed using Mann Whitney and Wilcoxon test.Results: The mean difference of prolactin hormone level in control group was 17.82 ng / ml while mean of difference of hormone prolactin level in intervention group was 132.13 ng / ml. There were statistically significant differences between intervention and control group in prolactin levels (p-value 0.000), milk volume (p-value 0.000), infant weight (p-value 0.000), urination frequency (p-value 0.017), defecation frequency (p-value 0.002), and infant sleep duration (p-value 0.000).Conclusion: There was a significant effect of the oxytocin massage using lavender essential oil on the increase of breast milk production and prolactin levels. Therefore, oxytocin massage using lavender essential oil can be used as an alternative treatment for midwives and other health professionals in an effort to increase milk production in postpartum.

Background: Touch is crucial for optimal growth and development of preterm babies. Gentle human touch is considered as a complementary treatment to spur their growth and development. Objective: To determine the effect of gentle human touch on weight gain, body temperature and pulse rate stability in preterm babies. Methods: This was a Randomized Controlled Trial (RCT) with pretest-posttest with control group. Thirty-nine respondents were selected by consecutive sampling, assigned into two treatment groups and one control group. Data were analyzed using MANOVA . Results: The results showed that there was statistically significant difference in body weight (p = 0.047), body temperature (p = 0.021), and pulse rate stability (p = 0.001) in preterm babies.  Conclusion: Gentle human touch therapy twice a day is more effective in improving body weight, body temperature, and pulse rate stability in premature babies. It is recommended that gentle human touch be applied as an operational standard for premature baby care. 

Background: The prevalence of skinny infants in Indonesia is still high. Baby's spa is considered to be able increase infant’s weight. Objective: To determine the effect of baby spa in infant weight in in Bebengan Village, Boja Sub District, Kendal Regency, Central Java, Indonesia. Methods: This study was a quasi-experimental study with non-equivalent control group design. There were 38 infants were selected using purposive sampling, divided into three groups, namely: 1) a group received spa two times per week (12 infants), 2) a group received spa three times per week (13 infants), and 3) a control group. Baby digital scale of ARN-EBSD-04 was used to measure infant weight. Data were analyzed using paired t-test and ANOVA. Results: There was statistically significant effect of intervention in each group on the infant’s weight. However, the data showed that the intervention that had a better effect on infant weight was the intervention of spa in two times per week with mean difference before and after intervention of 603 g. Conclusions: Doing spa two times per week could significantly increase infant weight effectively. Therefore, it is recommended for midwife to apply this intervention to increase the weight gain of babies and to reduce the number of skinny infants in Indonesia. 

Background: The incidence of perineal tear is still high in Indonesia. It is therefore the intervention to accelerate wound healing is needed. The use of turmeric and tamarind is considered as the alternative treatment for wound healing. However, little is known about the effect of the combination of turmeric and tamarind. Objective: To determine the effect of consuming turmeric and tamarind on the duration of perineal wound healing. Methods: The study was a quasi-experimental study with one group post-test only design conducted in the working area of the Community Health Center of Ngesrep and Srondol, Semarang City, Central Java, Indonesia in December 2016 until January 2017. There were 28 respondents recruited using consecutive sampling, with 14 randomly assigned in each group. The REEDA scoring system was used to measure the wound healing. Data were analyzed using Independent t-test. Results: The results revealed that the average duration of wound healing in the intervention group was 6.25 days, while in the control group was 8.57 days with p-value 0.000 (<0.05), which indicated that there was statistically significant effect of tamarind turmeric drink of the duration of perineal wound healing in postpartum mothers. Conclusion: There was a significant effect of turmeric tamarinds drink on the duration of perineal wound healing in postpartum mothers. It is therefore suggested to the health providers, especially midwives, to apply this intervention the accelerate healing of perineal wound in postpartum mothers.

Background: Kangaroo mother care (KMC) and lullaby music methods have been considered as the alternative treatment for vital sign changes in low birth weight infants. However, little is known about the combination of the two methods. Objective: To identify effectiveness of combinations of Kangaroo mother care and Lullaby music methods on changes in vital signs in low birth weight infants. Methods: A quasi experiment with non-equivalent control group design. This study was conducted on October– December 2016 at the General Hospital of Ambarawa and General Hospital of Ungaran, Semarang, Indonesia. There were 36 samples selected using consecutive sampling divided into three groups, namely: 1) a group of low birth weight infants with the combination of KMC and lullaby music, 2) an low birth weight infant group with the lullaby music intervention, and 3) a control group given standard care in low birth weight infants by KMC method. Paired t-test and MANOVA test were used to analyzed the data. Results: Findings revealed that there were significant differences between the combination group, lullaby music group, and control group in temperature (p=0.003), pulse (p=0.001), respiration (p=0.001), and oxygen saturation (p=0.014) with significant value of <0.05, which indicated that there was a statistically significant difference in vital sign changes among the three groups. Conclusion: The combination of KMC method and lullaby music intervention was effective on vital sign changes (temperature, pulse, respiration, and oxygen saturation) compared with the lullaby music group alone and control group with KMC method in low birth weight infants. It is suggested that the combination of KMC and lullaby music methods can be used as an alternative to improve low birth weight care for mothers in the NICU and at home and to reach the stability of the baby's vital signs.

Background: Being hospitalized is usually related to the fear, especially for children. Nurse supports should be able to help the children to deal with the fears related to nurse and medical services.  Objective: This study aims to examine the relationship between nurse support and the fear of school-age children being treated in the PKU Muhammadiyah hospital, Yogyakarta. Methods: This study employed a cross sectional correlation design, which was conducted from October to December 2016 in PKU Muhammadiyah Hospital, Indonesia. The samples of the study were 49 mothers and school-aged children who were admitted to the children ward. A consecutive sampling was applied to determine sample size. The instruments used in this study were nurse support and CMFS-R (Child Medical Fear Survey-Revised) questionnaires. Chi square test was performed with significance level p = 0.05 and level of trust = 95% for data analysis. Results: Findings showed 42.9% of respondents had medical fear and 36.7% of them had medical fear related-behavior responses. The nurse support was in a high category (73.5%). Chi square test showed p-value 0.038 (>0.05), which indicated that there was statistically no significant relationship between nurse support and children fear. There was only age of the children had a significant relationship with fear with p-value 0.035 (<0.05). Conclusions: There was no significant association between nurse support and fear of school-age children.

Background: Dysmenorrhea is pain during menstruation in lower abdomen, and is not due to other diseases. Effleurage massage and consuming green coconut water are considered able to reduce menstrual pain. However, little is known about the effect of the combination between the two interventions. Objective: To compare the effectiveness of effleurage massage and in combination with green coconut water on pain, anxiety, and ß-endorphin level in teenage girls with menstrual pain (dysmenorrhea). Design: A quasi-experiment with pretest-posttest approach design with control group. There were 36 samples recruited in this study by purposive sampling, which were divided into a massage therapy group, the combination therapy group, and a control group. Menstrual pain was measured using Numeric Rating Scale, while anxiety was measured using Zung Self rating Anxiety Scale (ZSAS), and endorphin level using ELISA (Enzyme-Linked Immunosorbent Assay). One-way ANOVA test and repeated ANOVA were performed as a bivariate analysis. MANCOVA and post hoc ANOVA were used for multivariate analysis. Result: The combination of massage and green coconut water was more effective in reducing pain (p 0.013) and anxiety levels (p 0.000), and in increasing β-endorphin  (p 0.029) with significant value of <0.05 compared to the massage therapy alone. Conclusion: The combination of effleurage massage and green coconut water had significant effect in decreasing anxiety and pain levels, and increasing β-endorphin levels in teenage girls with painful periods (dysmenorrhea); and more effective than performing effleurage massage only. It is suggested that this combination therapy could be used as an alternative therapy for women with dysmenorrhea.

Background: Patient satisfaction has emerged as an increasingly important health outcome and is currently used to evaluate the quality of care. Objective: To describe the level of satisfaction of mothers after caesarean section and examine its relationship with the quality of Comprehensive Emergency Obstetric and Neonatal Care (CEmONC). Methods: This was an analytic descriptive study using cross-sectional design. The study was conducted in Alamanda ward in the General Hospital (RSUD) of Panembahan Senopati Bantul Indonesia during September until November 2016. There were 55 respondents selected using purposive sampling. The instruments included The Scale for Measuring Maternal Satisfaction (SMMS) – caesarean birth  and the Quality of CEmONC questionnaires. Spearman’s rho and logistic regression were performed for data analysis. Result: Results showed that 47.3% respondents rated the quality of CEmONC in high category and 56.4% were satisfied. The correlation value between quality of CEmONC and patient satisfaction was 0.285 (p = 0.035; OR = 1.96). Conclusion: Level of satisfaction of mothers after caesarean section was  associated with the quality of CEmONC in the General Hospital of Panembahan Senopati Bantul Indonesia.

Background: Patients with acute myocardial infarction have a change in sleep pattern. Acupressure is identified as a therapy with the principle of healing to deal with sleep changes. Objective: To analyze the effect of acupressure on sleep quality and pulse rate in patients with acute myocardial infarction. Methods: This study employed a quasi-experiment study with non-randomized pretest-posttest with control group design. There were 50 respondents selected in this study, with 25 assigned in the intervention and control group using consecutive sampling. Quality Sleep Questionnaire and bedside monitor were used to measure sleep quality and pulse rate. Acupressure in combination of Neiguan point (PC 6), Shenmen (HT7), Sanyinjiao (SP6), Yintang (EX3) and Tay (EX5) was given as the nursing intervention in this study. Data were analyzed using paired t-test and independent t-test. Results: There was statistically a significant increase of quality of sleep and significant decrease of pulse rate in the intervention group with p-value 0.000 (<0.05). Conclusion: Acupressure has a significant effect on the increase of sleep quality and the decrease of pulse rate in patients with acute myocardial infarction. Thus, it is suggested that acupressure could be one of the nursing interventions for AMI patients to increase sleep quality and decrease of pulse rate.

Background: Postpartum mothers are susceptible to anemia, due to loss of blood count during labor. Postpartum anemia causes uterine subinvolution which causes postpartum hemorrhage, facilitates puerperium infection, decreases breastfeeding and causes mamae infection. One alternative to prevent anemia in postpartum is to consume vegetables with high iron one red spinach. Red spinach is one of the non-heme iron sources needed to synthesize hemoglobin. Objective: To determine the effect of red spinach in increasing the levels of hemoglobin in postpartum mothers. Methods: This was a quasi-experiment with pretest posttest with control group design in October-December 2017 at the Community Health Center of PONED Tarub, Tegal regency, Indonesia. Thirty postpartum mothers were included using purposive sampling, which 15 assigned in each group. Blood sampling and examination were performed in each respondent. Paired and Independent t-test were done for data analysis. Results: The results of the 14-day intervention of given red spinach extract showed that there was a significant increase of hemoglobin level (1.25 g / dL) with p-value 0.047. Conclusion: There is a significant effect of consuming red spinach extract (Amaranthus tricolor L.) on the increase of  hemoglobin level in postpartum mother. It is recommended that midwives could apply this intervention and cooperate with agriculture and food processing in order to produce red spinach extract that increases hemoglobin, hematocrit and erythrocytes levels.

Background: The prevalence of anemia among pregnant mothers is still high in Indonesia. Fe-fortified tempe is a traditional soy product originating from Indonesia considered able to increase hematologic status. Objective: This study aims to determine the effect of Fe-fortified tempe on hemoglobin, hematocrit, and erythrocyte levels in pregnant women with anemia. Methods: This was a true-experimental study with randomized pretest and posttest control group design, conducted on November - December 2016 in Bandarharjo Health Center, Semarang, Indonesia. Sixty-eight respondents were selected using simple random sampling, with 34 respondents were randomly assigned to each group. Blood examination was performed in each respondent. Mean, percentage, and frequency distribution of respondents were described. Paired t test and independent t test with α = 0.05 were performed to analyze the data. Result: Findings showed that hemoglobin, hematocrit, and erythrocyte levels before and after intervention in the treatment group showed p-value 0.000 (< 0.05), which means there was a significant effect of Fe-fortified on the increase of hemoglobin, hematocrit, and erythrocyte levels. Conclusion: There was an increase in hemoglobin, hematocrit, and erythrocyte levels after given Fe-fortified tempe for 10 consecutive days. It is suggested that pregnant women can consume Fe-fortified tempe.

Background: Hemodialysis process is useful for patients with end-stage renal disease. However, this is a situation of abject dependence on a machine, a procedure and a group of qualified medical professionals for the rest of their lives that may influence their functional status. Objective: This study aims to describe the functional status of patients with chronic kidney disease undergoing hemodialysis. Method: This was a descriptive study with cross-sectional design, which conducted in the PKU Muhammadiyah Hospital Yogyakarta Indonesia on March 2017. There were 78 patients selected using purposive sampling. Functional status was measured using SF-36 questionnaire. Descriptive statistic was performed for data analysis Result: The total average of functional status level was 42.92, with Physical Component Scale (PCS) of 42.31 and Mental Component Scale (MCS) of 45.78. Conclusion: There were functional deficiencies in both physical and mental status in patients with chronic kidney disease undergoing hemodialysis. Thus, it is suggested that pharmacological management of these patients need stringent monitoring on part of the psychiatrist to deal with mental health problems, and the interdisciplinary team  need to do great efforts to improve functional status and quality of life of patients with chronic kidney disease.

Background: Perceptions of individuals and society about the elderly are reflected in the services provided to them.  These reflections might be revealed   in various fields such as health care services and sufficient job opportunities, or they could be revealed in the issue of discrimination against the elderly, which is a problem emerging in advanced ages. Objective: This study aims to identify the relationship between nursing and elderly care program students’ attitudes towards ageism. Methods: This study, which is descriptive and relational method, was conducted between November and December, 2016. The participants were 220 students. The data were collected through a questionnaire, and the Ageism Attitude Scale, and were analyzed using t-test, two-way multivariate analysis of variance (MANOVA) and one-way analysis of variance (ANOVA).  Findings: Results show that the students generally had positive attitudes towards ageism. Nursing department students received significantly higher scores in the Limiting the Elderly Person’s Life sub-dimension and Ageism Attitude Scale in comparison to Elderly Care Program students.  3rd year nursing department students had higher scores in the Ageism Attitudes Scale in comparison to 1st and 2nd year nursing department students and students in the Elderly Care Program. “Positive Discrimination towards the Elderly” sub-dimension and the “Ageism Attitudes Scale” total scores were found to be significantly higher in nursing department students according to the variable of desire to work in a geriatric service in the future. (p<0.05). Conclusion: This study found that students had positive attitudes towards ageism, and nursing students’ Ageism Attitudes Scale mean scores were higher than those of elderly care program students. More comprehensive studies are needed in order to improve students’ attitudes towards elderly people.

Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

Background: Patients with chronic kidney disease undergoing hemodialysis suffer changes in lifestyle, which cause physical and psychosocial problems, particularly anxiety. Progressive muscular relaxation is considered as an intervention to reduce anxiety. Objective: This study aims to examine the effect of progressive muscular relaxation in in reducing anxiety in patients with chronic kidney disease undergoing hemodialysis. Methods: This study used a quasi-experimental design involved 78 respondents, with 38 randomly assigned in the intervention and control group. The progressive muscular relaxation was performed on 14 muscle groups for 4-week period. Hamilton anxiety rating scale was used to measure anxiety. Univariate, bivariate and multivariate analyses were performed for data analyses. Results: The results showed a statistically significant difference in anxiety values between the intervention and control group with p-value 0.000 (<0.05). Conclusion: There was a significant effect of progressive muscular relaxation in reducing anxiety in patients with chronic kidney disease undergoing hemodialysis. The results of this study is expected to be one reference in making the progressive muscular relaxation as a nursing intervention in reducing anxiety in patients undergoing hemodialysis.

Background: Roselle flower (Hibiscus sabdariffa) has been used as a food and herbal drinks, in hot and cold beverages, as an herbal medicine. Objective: To examine the effect of consuming roselle dried flower petals on changes in maternal hypertensive blood pressure during postpartum period. Methods: This was a quasi-experimental study with non-equivalent control group design conducted in 2016. There were 30 samples recruited using consecutive sampling with 15 samples in an intervention group and a control group. Data were analyzed using paired t-test to know the difference of blood pressure value before and after intervention in the intervention and control group, and independent t-test to determine the difference of blood pressure decrease between intervention and control group. Mann-Whitney and Wilcoxon test were also conducted for data analysis. Results: Findings showed that there were statistically significant differences in systolic and diastolic blood pressure values before and after intervention in the intervention and the control group with p-value 0.000 (<0.05) with systolic blood pressure decrease was 5 mmHg and diastolic was 5.33 mmHg. Additionally, there was a significant effect in the duration of healing in the intervention group with p-value 0.000 (<0.05), with the average duration of healing was 2 days. Conclusion: There were significant effects of dried petals of rosella flowers (Hibiscus sabdariffa) brewed with 200 ml of hot water with temperature 90oC in lowering blood pressure, and there were significant differences in systolic and diastolic blood pressure and duration of healing between the intervention group and the control group of mothers who consumed antihypertensive drugs. The results of this study can be applied by midwives in postpartum care with the cases of hypertension. It is expected that this intervention can help the healing process more quickly through a combination of antihypertensive medicines and sedated petals of rosella flowers.

To reduce the increase of the impaired child growth and development, early detection system is needed. The system designed based on information technology will facilitate the health personnel to achieve the desired outcome. In this study, the early detection system was developed using ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instruction model. The evaluation showed that the early detection system was effective in terms of completeness (7.2), ease (13.60), timeliness (7.60), accuracy (17.10), and conformity (8.00). This innovation is expected to contribute positively for child growth and development in Indonesia

Background: Iron deficiency is the most common cause of anemia during pregnancy. Red dragon fruit is assumed having much iron to increase hemoglobin and erythrocyte level. Objective: This study aims to examine the effect of dragon fruit juice on levels of hemoglobin and erythrocytes.  Methods: This was a quasi-experimental research with non-equivalent control group design. There were 34 respondents recruited in this study using consecutive sampling. The samples were divided into intervention group (17 respondents) and control group (17 respondents). Data were analyzed using independent t-test and paired t-test. Results: There was a statistically significant effect of red dragon fruit juice Hb level on the 7th day of intervention with p-value 0.037 (<0.05), but there was no significant effect on hemoglobin level in the 14th day of intervention with p-value 0.140 (>0.05). This study also revealed that there was a statistically significant effect of red dragon fruit juice on pregnant women's erythrocyte level on the 7th day with p-value 0.025 (<0.05), but there was no significant effect on the erythrocyte level in the 14th day of intervention with p-value 0.094 (> 0.05).   Conclusion: There was a statistically significant effect of red dragon fruit juice on hemoglobin and erythrocyte levels. This study provides the insight of knowledge that the red dragon fruit juice can be an alternative treatment to deal with anemia among pregnant women.

Background: Primary dysmenorrhea occurs because of the excessive amount of prostaglandins in the blood. Papaya leaf extract is considered to be able to reduce prostaglandin and menstrual pain. Objective: This study aims to prove that papaya leaf extract (Carica Papaya L.) can decrease the level of menstrual pain and prostaglandin levels in primary dysmenorrhea. Methods: A true experimental study with randomized pretest posttest control group design. There were 32 samples recruited using simple random sampling, with 16 each assigned to an experiment group and a control group. Numerical Rating Scale (NRS) was used to measure menstrual pain, and the level of prostaglandin was measured using the enzyme-linked immunosorbent assay (ELISA) method. Independent t-test and paired t-test were performed for data analysis. Results: There was statistically significant difference of menstrual pain and prostaglandin level before and after intervention with p-value 0.000 (<0.005), which indicated that papaya leaf extract had a significant effect on reducing menstrual pain. The decrease of menstrual pain in the experimental group was -3.375 and in the control group was -3.438; while the decrease of prostaglandin level in the experimental group was -56.971 and in the control group was -57.557. Conclusion: Provision of papaya leaf extract (Carica Papaya L.) significantly decreased the level of menstrual pain and prostaglandin levels in primary dysmenorrhea. Papaya leaf extract can be used as a safe and effective herbal medicine for primary dysmenorrhea which has almost the same efficacy as mefenamic acid.

Background: Pregnancy increases the risk of developing anxiety that may affect the fetus. Yoga is considered as an alternative therapy to reduce anxiety, blood pressure, and fetal heart rate. Objective: This study aimed to examine the effect of prenatal yoga on anxiety, blood pressure, and fetal heart rate in primigravida mothers. Methods: There were 39 primigravida mothers selected using purposive sampling, which divided into three groups - an experiment group with four-times prenatal yoga, an experiment group with eight-times prenatal yoga, and a control group. The Hamilton Rating Scale for Anxiety (HRSA) was used. Data were analyzed using One-way ANOVA and MANOVA. Results: There was a statistically significant difference of prenatal yoga on anxiety (p=0.005), systolic blood pressure (p=0.045), and fetal heart rate (p=0.010). However, there was no significant difference of prenatal yoga on diastolic blood pressure with p-value 0.586 (>0.05). Conclusion: There were significant effects of prenatal yoga on anxiety level, systolic blood pressure, and the fetal heart rates in primigravida mothers. The findings of this study can be an alternative treatment for midwife to deal with anxiety during pregnancy and an input for the class program of pregnant women to improve the quality of maternal and fetal health.

Background: Pain during menstruation is not uncommon, especially in young women, which has an impact on their life activities. Objective: To examine the effect of abdominal stretching exercise and cold compress therapy on decreasing intensity of menstrual pain in teenage girls. Design: A quasi-experimental study with two group comparison pretest-posttest design at SMK Bakti Indonesia Medika, Indonesia. There were 46 respondents selected in this study by consecutive sampling that consisted of 23 samples in the abdominal stretching exercise group and 23 samples in the cold compress group. The menstrual pain was measured using VAS (visual analog scale). Data were analyzed using Mann-Whitney, Chi-Square, and Wilcoxon test. Results: Findings showed that the mean of menstrual pain before intervention in the abdominal stretching exercise was 7.04 and in the cold compress therapy was 6.74 with p-value 0.211 (<0.05), which indicated that there was no mean difference of pain between both groups. However, after intervention, the menstrual pain was reduced from 7.04 to 1.91 (5.09 difference) in the abdominal stretching exercise group; and from 6.74 to 5.52 (1.22 difference) in the cold compress group with p-value 0.000 (<0.05), which indicated that there was statistically significant difference of menstrual pain before and after intervention, both abdominal stretching exercise and cold compress therapy. Conclusion: There were statistically significant effects of abdominal stretching exercise and cold compress therapy on menstrual pain in teenage girls. The abdominal stretching exercise is more effective than cold compress therapy in reducing menstrual pain intensity. Thus, it is suggested that abdominal stretching exercise can be an alternative choice of management of dysmenorrhea in teenage girls, and can be a part of subject in the education as non-pharmacological medicine.

Background: Perineal rupture occurs almost in all the first labor and not infrequently in the next labor. Complex perineal wounds are at risk for non-healing and infection. Objective: This study aims to determine the effect of bird’s nest extract on perineal wound healing on rattus norvegicus. Methods: This was a randomized posttest only group design conducted in October 2016 at Animal Laboratory Unit of Diponegoro University, Semarang, Indonesia. There were 30 samples recruited in this study, divided into three groups: 1) the control group (with povidone iodine 10% solution), 2) the first treatment group with a bird’s nest 50% cream, and 3) the second treatment group with a bird’s nest 70% cream. The Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale was used. Data were analyzed using descriptive statistics, frequency distribution, and one-way ANOVA. Results: There were statistically significant mean differences between the three groups with p-value 0.000 (< 0.05). The time of the wound healing was 5-6 days for povidone iodine 10% group, 4-5 days for bird’s nest 50% group, and 3 days for bird’s nest 70% group. The degree of perineal wound density in the bird’s nest 70% group (0.37) was also better than the bird’s nest 50% group (0.13) and povidone iodine 10% group (0.02). Conclusion: Bird’s nest has a significant effect on wound healing process. Findings indicated that the bird’s nest 70% extract was very effective to accelerate wound healing than bird’s nest 50% extract and povidone iodine 10%.

Background: Perineal laceration during childbirth is very common among mothers; however, some of them may suffer from its complication if not treated properly. Objective: To prove the effectiveness of breast milk as an alternative topical ingredient in the treatment of perineal wound in postpartum mothers. Methods: This was a quasi-experimental study with non-equivalent control group posttest only design. There were 30 respondents selected in this study, with 15 assigned in an intervention group and a control group. Accidental sampling was used to select the samples with the criteria that the respondents had perineal laceration in level 1 and 2. Data were analyzed using Mann Whitney test. Results: Effective wound healing process can be seen in the intervention group from 80% of poor category in 6-10 hours (1st period) of postpartum became 86.7% of good category in 7 days of postpartum (4th period). Different from the control group that showed the slow progress of wound healing, which was 86.7% of poor category in the 1st period to only 33.3% of good category in the 4th period. Mann Whitney test showed that there was a significant mean difference of the perineal wound healing process between the intervention group (11.23) and the control group (19.77) with p-value 0.002 (<0.05). Conclusion: Breast milk was more effective than povidone iodine in the treatment of perineal wound. It is suggested to health workers, especially midwife to apply this intervention to accelerate the healing of perineal wound in midwifery care.

Background: The absence of contractions after childbirth can lead to a slow-running uterine involution process. Thus, the effort to maintain and accelerate the process is needed. Oxytocin massage and hypnobreastfeeding are considered as an alternative treatment, but the effect of the combination of the two treatments have not yet been examined. Objective: To examine the effect of combination of oxytocin massage and hypnobreastfeeding on uterine involution and prolactin levels in postpartum. Methods: A quasi-experimental study with pretest posttest control group design. a total of 40 respondents were recruited using simple random sampling, with 20 respondents assigned in a treatment group and a control group. Metline and ELISA methods were used to measure uterine involution prolactin levels. Paired t-test and independent t-test were used to analyze the data. Results: There was a significant decrease of uterine involution in the experiment group and control group after intervention with p-value 0.000 (<0.05), and it can be seen that the uterine involution in the experiment group (6.05) was faster than uterine involution in the control group (7.00).  Findings also showed that the prolactin level in the experiment group (273.53) was higher than the prolactin level in the control group (209.37). Conclusion: There was statistically significant effect of the combination of oxytocin massage and hypnobreastfeeding on the uterine involution and prolactin level in postpartum mothers. It is expected that the combination of oxytocin massage and hypnobreastfeeding can be used as a consideration and a reference in providing postpartum midwifery care.

Background: Musa balbisiana Colla, known as Jantung Pisang Klutuk or Pisang Batu, is considered as a traditional food that can increase breast milk production. Little is known about its benefit in Indonesia. Thus, to examine the impact of Musa balbisiana Colla on the production of breast milk is needed. Objective: This study aims to examine the effect of the extract of banana flower (Musa balbisiana Colla) to increase milk production of breastfeeding mothers. Methods: This was a quasi-experimental study with pretest-posttest control group design. This study was conducted in the working area of the Health Center (Puskesmas) of Pesantren II in January – February 2017. There were 16 respondents were selected by accidental sampling, divided into intervention group (8 respondents) and control group (8 respondents). Randomization was performed to select the respondent in each group. The quantity of milk production was measured based on the volume of milk production, while the quality of milk production was based on the levels of prolactin in early (pre) and late (post) using Electro Chemi-Luminescence Immunoassay (ECLIA) method. Independent t-test was used to analyze the data.  Results: Findings showed that the mean of the volume of the breast milk production in the experiment group was 470.681 ml and in the control group was 364.650 ml with SD 113.502. The mean of prolactin levels in the experiment group was 35.337 nanogram and in the control group was -38.381 nanogram. There was a significant effect of consuming Musa balbisiana Colla extract on the volume of breast milk production (p-value 0.003) and prolactin levels (p-value 0.001) (<0.05).  Conclusion: There was a significant effect of banana flower (Musa balbisiana Colla) extract on breast milk production and prolactin level in breastfeeding mothers. The findings of this study could be used to be alternative daily menu for postpartum mothers and a solution for midwives to deal with those who have inadequate production of breast milk and low prolactin levels. 

Background: Postpartum anemia among mothers is a health problem in Indonesia. Consuming moringa oleifera is assumed as one of the efforts to deal with anemia. However, lack of the study conducted in the working in the working area of Health Center of Tlogosari Wetan, Indonesia. Objective: This study was conducted to examine the effect of moringa oleifera on blood profile in postpartum mothers. Methods: The study was quasi-experimental study with pretest posttest control group design. The sample in this study were all postpartum mothers in the working area of the Health Center of Tlogosari Wetan. It was 30 respondents selected by purposive sampling, divided into intervention group (15 respondents) who received moringa leaf capsule and iron tablet, and control group (15 respondents) were given iron tablet. Data were analyzed using Independent t-test. Results: Findings showed a significant difference in the mean of hemoglobin level (intervention group 11.9467; control group 11.0600), hematocrit (intervention group 38.3867; control group 33.8133), thrombocyte (intervention group 3.02536; control group 2.35805), and erythrocyte (intervention group 4.30137; control group 3.78206) with p-value < 0.05. Conclusion: there was a significant effect of moringa oleifera on changes in blood profile (hemoglobin, hematocrit, erythrocyte, thrombocyte) in postpartum mothers in the working area of the Health Center of Tlogosari Wetan. Thus, it is suggested that moringa leaves could be used to prevent anemia in postpartum mothers.

Aim: This descriptive-relational study aims to identify osteoporosis health belief, knowledge level and risk factors in individuals whose bone mineral density was required. Method: Target population of the study was 110 men and 126 women aged 35 and over, who applied to Atatürk University Aziziye - Yakutiye Research Hospital Nuclear Medicine Center Bone Densitometer Unit between January 2010 and October 2010. No sampling was performed, the whole target population was involved in the study. Data were collected through the Personal Information Form that included socio-demographic features, the osteoporosis health belief scale, the osteoporosis self-efficacy scale and the osteoporosis knowledge test. Results: The osteoporosis health belief score of the participants was 139.99±14.79, osteoporosis knowledge score was 10.06±4.30, and osteoporosis self-efficacy score was 742.00±213.44. Among osteoporosis health beliefs, women’s susceptibility, seriousness, barriers of exercise, and barriers of calcium mean scores were found to be higher than those of men (p<0.001).  Men’s osteoporosis self-efficacy scale and sub-dimensions mean scores were found to be higher in comparison to women (p<0.001). DEXA analysis results show that 57.1% of the women and 27.3% of the men were diagnosed with osteoporosis.  Conclusion:  According to the Logistic regression analysis that aimed to identify the risk factors having roles in Osteoporosis diagnosis, the affecting risk factors were gender, age, and medicine use. As for women, logistic regression analysis showed that the risk factors were education level – being illiterate, medicine use, osteoporosis story in family, and 4 or more deliveries.

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Background: Needlestick and sharp injuries are a serious hazard in any health care setting for health care workers and students during clinical practice. Thus, the efforts to prevent the needlestick and sharps injuries are needed and considered a part of the routine practice.Objective: This study aimed to investigate the frequency of nursing students in doing the correct practice in prevention needlestick and sharps injuries.Methods: This cross- sectional study was conducted between 2013 and 2014 in nursing students of Tien Giang Medical College who participated in clinical practice. There were 360 students participated in the study using simple random sampling. Data were collected using the practical assessment checklist and demographic characteristics questionnaire. Data were processed using STATA 12.0, and analyzed using Chi-square and Fisher test.Results: The students who did general practice correctly accounted for 52.50%, and those who did practice incorrectly was 47.5%. The students who used gauze or wool wrap in inhaler were 59.7%, wearing gloves in practice (39.2%), do not disassemble needles from syringes after injection 50%, and removing needles into barrel after injection (65.6%). There was statistically significant relationship between time of participation in clinical practice and correct practice with p-value 0.04 (<0.05)Conclusion: The correct practice of nursing students related to the prevention of needlestick and sharps injuries remains low. There was a significant relationship between time of participation in clinical practice and correct nursing practice. It is suggested that students must be taught about the risk of infection at the beginning of clinical practice, and constantly reminded throughout the learning process, especially for injection safety awareness, knowledge and techniques about the risk of transmission of HBV, HCV and HIV by sharp objects in the healthcare facility.

Background: Type 2 Diabetes mellitus becomes the public health problem worldwide. Reasons for poor glycemic control in Type 2 diabetes are complex.Objectives: To determine factors contributed to poor glycemic control among Indonesian patients with Type 2 Diabetes mellitus.Methods: This was a cross sectional regression study. There were 70 respondents selected using purposive sampling. Pre-structured questionnaires were used to measure socio demographic, clinical characteristics, self-care management behaviors, medication adherence, barriers to adherence, and family support. Data were analyzed using chi-square and binary logistic regression.Results: Poor glycemic control was defined as HbA1c ≥7% or FBG ≥200 mg/dl. Findings of this study reported that 83% patients had or FBG ≥200 mg/dl, which confirmed as poor glycemic control. Logistic regression showed that increasing duration of diabetes (> 5 years), non-adherence to dietary behaviors recommendation through selecting healthy diet, arranging a meal plan, recognizing the amount calorie needs, managing dietary behaviors challenges, medication adherence, and family support were significantly influence poor glycemic control with increased odds ratio scores.Conclusion: The proportion of patients with poor glycemic control was raised. Increasing duration of diabetes, non- adherence to medication and dietary behaviors management, and lack of family support were associated with poor glycemic control. Thus, integration of diabetes self-management program with social support is needed to deal with patients’ need to achieve the great benefits in diabetes care.

Background: Breastfeeding among postpartum mothers has been a problem due to low milk supply. As a result, mothers often decide to give formula milk or other additional foods, which may affect infant’s growth and development. Objective: This study aims to investigate the effect of moringa oliefera on the levels of prolactin and breast milk production (baby’s weight and sleep duration) in postpartum mothers.  Methods: Quasi-Experimental study with non-equivalent control group design. There were 30 respondents recruited by purposive sampling, consisted of 15 respondents in intervention group and 15 respondents in the control group. This study was conducted from November until December 2016 in Four Midwives Independent Practice (BPM) in the working area of the Health Center of Tlogosari Wetan Semarang. Data were analyzed using Independent t-test. Results: Findings showed that there was a mean difference of prolactin level in the intervention group (231.72 ng / ml) and the control group (152.75 ng / ml), and a significant effect on increasing the levels of prolactin (p = 0.002). The mean of baby’s weight in the intervention group was 3783.33 grams and in the control group was 3599.00 grams. However, there was no significant effect of moringa oleifera on baby’s weight (p = 0.313> 0.05), while the mean difference on sleep duration was 128.20 minutes in the intervention group and 108.80 minutes in the control group. There was a significant effect on baby’s sleep duration (p= 0.000). Conclusion: There were significant effects of moringa oleifera on mother’s prolactin and sleep duration of the baby. However, there was no significant effect on baby’s weight. Thus, it can be suggested that moringa oleifera can be used as an alternative treatment to increase breast milk production and prolactin hormones. Midwives should promote the benefits of moringa leaves as one of alternative supplements.

Background: Limited choice of contraception for males is one of the reasons why their participation is low. Secang wood is considered as an alternative contraception that has an influence in the morphology and number of spermatozoa and reversible in nature. Objective: To examine the effect of extracts of secang wood in the morphology of spermatozoa, sperm count and reversible process in male mice. Methods: This was a quasi-experimental study with randomized posttest only control group design. There were 32 male rats (Mus Muscullus L) recruited in this study. Four groups were involved, namely: 1) ethanol group, 2) chloroform fraction, 3) water fraction, and 4) control group. Each group consisted of 8 mice. There were two treatments in this study: 1) each group was given secang extract with dose 50 mg/25 gram of weight, 2) the observation period was 10 days after the treatment. Four mice in each group was dissected to see the morphology and sperm count while the other four mice were allowed to live and maintained until 20 days to see reversible morphology and sperm count. Results: The extract of secang wood at a dose of 50mg/25gram weight could increase the abnormal sperm morphology and lower sperm count. There was a significant difference between the treatment group and control group with p-value <0.05. The extract was also reversible on the morphology and sperm count. Conclusion: There was a significant effect of secang wood extract on sperm morphology, the number of spermatozoa, and reversible process. This study provides the insight of scientific information about the effect of the secang extracts on the number and morphology of spermatozoa, and it could be used as a basis for further research in human in the development of natural contraceptive on a reversible man.

Background: Anxiety among primigravida mothers should be handled to avoid the risks during pregnancy. Hypnotherapy is considered to be a solution; however, there are limited studies to determine its effect on anxiety, especially in primipara mothers. Objective: To examine the effect of hypnoanxiety on the level of anxiety in primigravida. Methods: This was a Randomized Controlled Trials (RCTs) with pretest-posttest design, conducted between September – October 2016 in the working area of the Health Center of Bergas Semarang, Indonesia. There were 40 respondents recruited using simple random sampling, which divided into intervention and control group. Hypnoanxiety was performed 8 times for 4 weeks. The Zung Self-Rating Anxiety Scale (ZSAS) was used to measure anxiety in pregnant women. Data were analyzed using Mann Whitney test and Kruskal Wallis test. Results: Findings showed that after four weeks intervention, there was a decrease of the level of anxiety in the intervention group, consisted of 25% of moderate anxiety, 40% of mild anxiety, and 35 % of respondents with no anxiety. The p-value was 0.05, which indicated that there was mean difference of anxiety level between intervention and control group. Conclusions: There was a significant effect of hypnoanxiety on the level of anxiety in pregnant women. It is suggested that hypnoanxiety could be one of the alternative therapies to reduce the anxiety among pregnant women. This could be considered to be included in the standard of midwifery care in Indonesia.

Background: The prevalence of anemia among pregnant women is still high in Indonesia, especially in Bengkulu. Consuming papaya is considered as one of the solutions to increase hemoglobin and hematocrit level. Objective: This study aims to examine the effect of consuming papaya on the level of hemoglobin and hematocrit in pregnant women. Methods: This study employed a true experiment with randomized pretest and posttest design with control group. There were 42 respondents recruited in this study using simple random sampling. Randomization was performed to divide the samples into two groups, namely 21 respondents in a treatment group and 21 respondents in a control group. A total of 110 grams of papaya was given to the intervention group every day for 14 days.  Data were analyzed using dependent t-test and independent t-test. Result: There was a significant effect of consuming papaya on the hemoglobin and hematocrit level with p-value 0.000 (< .05). The mean difference between two groups showed that hemoglobin level (control group 10.010 gr/dL; intervention group 10.838 gr/dL) and hematocrit level (control group 27.43 %; intervention group 30.10 %). Conclusion: Consuming papaya has a significant effect on changes in hemoglobin and hematocrit levels. It is suggested that consuming papaya should be one of alternative treatments for midwives to prevent anemia in pregnant women.

Background: Immunization in infants is an action that can cause trauma due to injection of the immunization that can cause pain. Breastfeeding and non-nutritive sucking are considered non-pharmacologic strategies of pain management. Objective: This study aims to investigate the effectiveness of breastfeeding and non-nutritive sucking on pain relief in infant immunization. Methods: This was a quasi-experimental study with posttest only control group.  This study was conducted on 26 October till 30 November 2016 at three Community Health Centers (Puskesmas), namely Puskesmas Cilacap Utara I, Puskesmas Cilacap Tengah, and Puskesmas Cilacap Selatan I. The population was infants aged 2-4 months who got immunization of DPT-HB-Hib 1. Samples were recruited using a consecutive sampling technique. There were 69 samples in this study, which were divided into three groups: 1) The group given a breastfeeding intervention (23 respondents), 2) The second group given a non-nutritive sucking intervention (23 respondents), and 3) The control group (23 respondents). Data were analyzed using ANOVA. Results: The average of pain response of the three groups was 2.74 in the breastfeeding group, 1.87 in the non-nutritive sucking group, and 3.26 in the control group. There was a significant difference between non-nutritive sucking and control group with p-value = 0.000, and also a significant difference between breastfeeding and non-nutritive sucking with p-value = 0.016. However, there was no difference between breastfeeding and control group with p-value = 0.142. Conclusion: Breastfeeding and non-nutritive sucking were effective in reducing pain during infant immunization. It is suggested that midwives could administer these interventions to reduce pain in infant immunization, and it could be applied as non-pharmacological strategy in pain management in the community health center in Indonesia.

Background: Toddlers are vulnerable groups to malnutrition. Thus, to maintain their nutritional status is needed. Honey is considered having health benefits that may increase the nutritional status in children. However, little is known about the impact of honey on nutritional change in Sumbawa, Indonesia. Objectives: The aim of this study is to analyze the effect of honey on changes in nutritional status in children with poor nutrition in the area of the Health Center of Lopok, Sumbawa, Indonesia Methods: This study employed a quasi-experiment design with pretest-posttest with control group. The total sample in this study were 60 children recruited by simple random sampling, divided into 2 groups, namely 30 children in an intervention group and 30 children in a control group. The sampling technique used a simple random sampling. Data were analyzed using Mann Whitney and linear regression test. Results: Findings showed that there were significant mean differences between the intervention and control group in term of weight (intervention 1.316; control 0.903), height (intervention 1.586; control 1.030), weight-for-height (W/H) z-score (intervention 0.713; control 0.595), weight-for-age (W/A) z-score (intervention 0.717; control 0.531), and height-for-age (H/A) z-score (intervention 0.847; control 0.423) with p-value < 0.05. Conclusion: There was a significant effect of honey on changes in nutritional status in children with poor nutrition. It is suggested that health providers may use honey to take care of children under nutrition to increase their appetite and change their nutritional status.

Background: Sweet potato leaf is assumed to be one of alternative herbs that can increase breast milk production. However, there were no studies found in the literature that examine the sweet potato leaves to increase the levels of prolactin and milk production. Objective: To examine the effect of sweet potato (Ipomoea batatas L.) leaf on the level of prolactin and milk production in postpartum mothers. Methods: This was a quasi-experimental study with pretest-posttest design with control group, conducted on November 2016 to December 2016 in the Health Center (Puskesmas) of Boyolali I. Thirty respondents were selected using consecutive sampling, which were divided to be 15 respondents in intervention group and 15 respondents in control group. Enzyme-linked immunosorbent assay (ELISA) was used to measure prolactin levels, while breast milk production was measured based on the volume of breast milk and baby’s weight. Data were analyzed using Independent t-test and paired t-test. Results: Finding showed that there was a significant difference in prolactin levels between the intervention (270.43) and control group (156.28) after intervention  with p-value 0.000, and a significant difference in breast milk production in terms of breast milk volume (intervention group 136.33; and control group 119) with p-value 0.028; and baby’s weight (intervention group 3030.3; and control group 2787.33) with p-value 0.000. Conclusion: There was a significant effect of sweet potato (Ipomoea batatas L.) leaf on the levels of prolactin and breast milk production. Thus, it could be suggested that sweet potato leaves should be considered to be one of alternative treatments for health care providers, especially for midwives to help breastfeeding mothers in increasing their breast milk production and prolactin levels. Further research is needed to examine all factors affecting breast milk production.

To enhance the competencies of midwifery students, one must design a learning instruction in such a manner that it will optimize the learning. The learning materials designed based on technology will facilitate the learners to achieve the desired outcome. In this study, e-partograph was developed using ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instruction model. The module of e-partograph was followed the structural guideline of Department of National Education of Indonesia consisted of: self-instruction, self-contained, stand alone, adaptive, and user friendly. The evaluation showed that e-partograph was feasible (99.3) in the material subject, very feasible (195) in terms of media, feasible (101.6) in the try-out, and feasible for the students (users) (104.18). It is suggested that e-partograph could be applied in the teaching learning system, and it is expected to contribute positively to the increase in skill and competence of midwifery students who will be able to carry out its role both academic and practice.

Background: Student academic achievement is influenced by learning instruments such as: teaching staff, facility and infrastructure as well as the curricular component. Teacher-Centered Learning (TCL) or Student-Centered Learning (SCL) will also contributes to student’s outcomes as an approach to apply a curricular component. Objective: To compare students’ academic achievement levels between undergraduate students who follow TCL and SCL approaches in nursing school. Methods: This was a quantitative research with a descriptive analytic method comparative study. The entire undergraduate student population in one of nursing school in Indonesia from 1999 to 2011 was included in this research. The relevant data in this study was GPA score and length of study. A total sampling method was performed to select 918 subjects involved in the study. The data were analyzed using Mann-Whitney test. Results: Academic achievement was assessed from GPA score and length of study. The average GPA of students who followed a TCL approach was 3.28, while the score for those who followed a SCL approach was 3.54 with p-value of 0.00. The average length of study of students who followed a TCL approach was 4 years 3 months; while those with a SCL approach was 4 years 1 month with p-value of 0.279. Conclusions: There was a significant difference on GPA score and no significant differences on the length of study between the undergraduate students who followed a TCL versus a SCL approaches.

Background: The changes in menstrual cycle are commonly followed by symptoms such as hot flushes, palpitations, sleep disorders, depression, irritability, headaches and low sexual drive in women. Women’s knowledge and perception to their menopause cyclic changes are important in their adaptation to menopause symptoms. Objective: This study aims to assess women’s perception toward menopause. Methods: This study employed a qualitative research design with phenomenology approach. Nine married women aged 45-55, residing in Ngestiharjo, Bantul district, Daerah Istimewa Yogyakarta, Indonesia participated in this research. Results: Respondents perceived menopause as a natural event for every woman above 45 years old and therefore it should be accepted as it is. Participants of the study defining menopause as a period when ovaries naturally end producing sexual hormone resulting with no menstrual periods for 12 consecutive months without other identified biological or physiological causes. The participants understand the basic knowledge of menopause and remarked their menopause period with muscular pain and irregular flows. In practice, as well as other menopausal women, respondents also experienced vaginal pains during coitus. Conclusion: Women of the study acknowledged that menopause as the end of their reproductive period. It is believed as a natural event and will be experienced by every woman. Nevertheless, women’s misconception and belief to menopause myths alarms the need for an adequate information related healthy menopause. Women preparedness is expected to reduce the symptoms and disorders following menopause.

Background: Failure in the process of uterine involution can result in bleeding if not treated immediately. Provision of pineapple (Ananas Commosus (L). Merr) juice can be administered as a medicinal plant therapy to prevent sub involution of the uterus and is considered to speed up the recovery process of the uterine involution.  Objective: This study aims to examine the effect of pineapple (Ananas Commosus (L). Merr) juice to decrease fundal height in primigravida mothers during postpartum period. Design: This was a quasi-experimental study with non-equivalent control group, conducted in the working area of the Health Center (Puskesmas) of Jekulo Kudus Indonesia on 1-30 December 2016. There were 28 respondents selected using consecutive sampling technique, consisted of 14 respondents in the intervention group and 14 respondents in the control group. Data were analyzed using independent t-test and paired t-test. Results: Findings showed that there was a mean difference of the height of the uterine fundus after given pineapple juice in the intervention group with mean score 13.80 in pretest and 5.80 in posttest, while there was also a decrease in fundal height in the control group with mean score 13.35 in pretest and 7.01 in posttest. The mean of fundal height in the intervention group was 8.15 cm and in the control group was 6.09 cm in 7 days. There was significant difference of the average of the decrease of fundal height between both groups with p-value (0.000). Conclusions: Pineapple (Ananas comosus (L.) Merr) juice had a significant effect in the decrease of fundal height. It is suggested that pineapple juice can be used as herbal or medicinal plants, which can be used during postpartum period that is processed naturally without involving the use of chemical and incorporated into the procedure standard of midwives in postnatal care.

Background: The critically ill patients are having nutrition problems in dealing with the critical condition. The problem of nutrition is demanding on the severity of illness. Therefore, the ICU nurses should understand how nutrition can support the patients’ recovery.   Objective: This study’s aim was to compare the result of energy expenditure calculation of conventional method with Ireton-Jones method for critically ill patients in the intensive care unit. Methods: This was a comparative and cross-sectional study which recruited 40 samples. The samples were divided into two groups, conventional group method and Ireton-Jones group method, and they met the inclusion criteria. The sample of this study was determined by convenience sampling. To answer the hypothesis, the hypothesis test used Independent sample t-test. Results: The results revealed that there is no significance difference between energy expenditure calculation conventional method and Ireton-Jones method statically. In the other word, either used the conventional method or the Ireton Jones method, the result of energy expenditure calculation has statically significant difference. Conclusion: It can be concluded that the nurse can use both methods to calculate the energy expenditure for critically ill patients to meet their nutrition need. We suggest that for further investigation will recruit many samples and do control of other factors that might be influenced in the study.

Background: When people face health problems, their life satisfaction levels and social relations could be ruined. When it comes to an eerie, deadly and chronic disease like cancer, the individual is much more likely to be affected by it. Objective: This descriptive study aims to identify quality of life and level of social support and the affecting factors in cancer patients. Methods: The sample included 170 patients who applied to internal diseases, radiation oncology, thorax diseases clinics and chemotherapy polyclinic in a university hospital in Turkey between March and August, 2005, who met the research criteria, and who volunteered to participate in the study. The sample represented 20 % of the target population. Data were collected through SF-36 Quality of Life Scale and Multidimensional Scale of perceived social support. Results: The patients’ global quality of life mean score was found 38.67 ± 13.64, and mean score for the perceived social support was found 59.19 ± 17.5. Global quality of life score was higher in those who underwent an operation and who received ambulatory health care. Although global quality of life was not influenced by the gender variable, male patients’ level of well-being was found to be higher. Perceived social support total score was found to be higher in those who knew about their disease. Family support was found to be higher in those who were married and who lived in town; it was found to be low in those who had low socio-economic level and who received inpatient treatment. Friend support was found to be high in those who knew about their disease. Conclusion: There was a linear relationship between perceived social support and quality of life. It is recommended that more studies with wider groups of participants would shed more light to the issue of identifying quality of life, social support level and the relationships between them in cancer patients.

Background: Hypertrophic scar causes physical and psychological problems. Thus, understanding the factors related to the occurrence of hypertrophic scar tissue is needed. Little is known about its influencing factors in Indonesia, especially in Garut. Objective: This study aims to examine the relationships between hypertrophic scar and its influencing factors, and identify the most dominant factor of the occurrence of hypertrophic scars. Methods: This was an observational case control study using retrospective approach in Polyclinic of Surgery of Regional Public Hospital of dr. Slamet of Garut Regency. There were 40 samples recruited in this study by purposive sampling, which was divided to be case group (20 patients) and control group (20 patients). Data were collected using Stony Brook Scar Evaluation Scale by observation and documentation of the medical records of patients. Data were analyzed using logistic regression analysis. Results: Findings indicated that there were significant relationships between the surgical wound infection (p = 0.02), family history (p = 0.026), and type of suture (p = 0.043) with the occurrence of hypertrophic scars. The most dominant factor on the occurrence of hypertrophic scars was type of suture, acid polyglactin 910. The variables that had no significant relationships with the occurrence of hypertrophic scar tissue were age (p = 0.34), area of surgical wound (p = 0.177), and smoking habit (p = 0.479). Conclusion: There were significant relationships between infection of surgical wound, genetic history, the type of suture, and the occurrence of hypertrophic scar tissue. The most dominant factor that influenced the occurrence of hypertrophic scar tissue was the type of suture. Therefore, it is suggested to health professionals to modify the using of acid polyglactin 910 sutures, and nurses particularly need to provide the information regarding the family history and genetic-related hypertrophic scar, and prevent the infection of surgical wound after operation.

Objective: This integrative review aims to summarize and identify the current literature related to health behavior among Type 2 Diabetes Mellitus (T2DM) Patients and its factors. Methods: An integrative review was undertaken using literature published between 2000 and 2013, based on CINAHL, Springer link, PubMed, Science Direct and Google Scholar. Results: Twenty-two articles were selected based on inclusion and exclusion criteria. This review indicated a wide range of factors influencing health behavior among T2DM patients including predisposing factors (socioeconomic, knowledge, stress management, and health belief), reinforcing factor (family support), and enabling factor (health service). Conclusion: Family support, socioeconomic and knowledge are the significant major factors of health behavior among T2DM patients. However, the others factors such as stress management, health belief and health service are also the important factors for T2DM patient’s health behaviors. Therefore, these factors should be considered for development of appropriate interventions to promote health behavior among T2DM patients at community.

Background: Depression is commonly found in older people. The prevalence of depression among older people, particularly in Indonesia is increasing worldwide. Objective: This study aimed to identify the factors related to depression among older people living in Cimahi, West Java Province, Indonesia. Method: A cross sectional design was used with a total of 267 older people aged from 60 to 79 years old. A multi-stage random sampling was used in five public health centers in Cimahi. The instruments comprised of socio-demographic questionnaires, general health perceptions questionnaire, Chula Activities of Daily Living Index (CADLI), and Geriatric Depression Scale-15 (GDS-15). Data analysis was conducted using descriptive statistic, chi-square, and point-biserial. Results: The result revealed that 56.2% of respondents were no depression and 43.8% of respondents was depression. The results also showed that age, marital status, family history of depression, perceived health status, and activities of daily living was significant relationship with depression among older people (p<.01; p<.05). Conclusion: This finding can be used as a reference to implement new strategies to decrease depression among older people.   This article has been corrected with a separate erratum: https://doi.org/10.33546/bnj.1141

Background: Quality of life includes the aspects of physical, emotional, social function, welfare and perceptions about life. Quality of life of children with tuberculosis is considered lower than the quality of life of healthy children. Little is known about the factors related to the quality of life of children with tuberculosis, especially in Yogyakarta, Indonesia. Objective: This study aims to examine the relationships of adherence, social support, quality of healthcare, self-efficacy, and psychological response of parents towards quality of life of children with tuberculosis in Yogyakarta, Indonesia. Methods: This study employed a cross-sectional correlation design, which was conducted from April to November 2016, and involved 41 caregivers and children with tuberculosis according to research criteria. A consecutive sampling was applied to determine sample size. Data were analyzed by bivariate and multivariate analysis using SPSS with significant level p=0.05 and confidence interval = 95%. Results: Findings showed significant relationships between social support, psychosocial response, mainly anxiety and stress (p<0.05) with quality of life. While adherence, self-efficacy, and quality of healthcare did not have significant relationship (p>0.05) with quality of life. The results of multivariate analysis showed significant relationships between social support with r =0.305 (CI95%:0.134-0.188; p=0.026), psychosocial response of caregiver, mainly level of stress with r= 0.425 (CI95%:-1.369-0.126; p=0.007) and anxiety with r= 0.378 (CI95%: -0.107-1.692; p=0.03) and quality of children life  (R square=0.278). The strongest variable related to quality of children life was psychosocial response (anxiety) of parents (r=0.425). Conclusions: Quality of life in children with tuberculosis is related to social support and psychosocial response of parents. The dominant factor is psychosocial responses of anxiety.

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Background: Capability to provide care can be recognized as the combination of nursing knowledge, skills, and attitude of care which is dynamic. Objective: This study aims to explore the perceptions of practical nurses towards updating capability to provide care. Methods: A descriptive qualitative study was conducted to explore the deep understanding of practical nurses towards updating capability to provide care. Data were gathered using in-depth interview with 25 practical nurses from different areas of practices, three times focus group discussion (FGD) and participant-observation. Qualitative content analysis model was applied to anaylze the data. Result: There were two themes emerged from data: 1) internal perceptions of updating capacity to provide care, with three subthemes: having great expectation, being confidence as a professional nurse, and developing self-initiation, 2) external contexts driving perception of practicing nurses, with two subthemes: giving best care and acquiring requirement. Conclusions: The findings indicated that updating capacity to provide care supports practical nurses to provide better nursing services to patients and meet the regulation of nursing professionalism.

Background: HIV prevalence among female sex workers in Indonesia is among the highest in Asia after Papua New Guinea and Malaysia. Indirect sex workers posed a heightened risk of HIV infection compared to direct sex workers because they usually earn less than their direct counterpart and have lower bargaining power in condom use. Objective: This study aims to examine the factors influencing indirect sex workers’ attitudes toward HIV testing. Methods: This study employed a quantitative method with a cross-sectional approach involved 67 indirect sex workers from massage parlors and beauty salons in Bantul district. Descriptive analysis of respondents’ attitude, perceive threat and expectation was drawn from Health Belief Model Theory. Results: The majority of indirect sex workers had positive attitude towards HIV testing. They are aware to the importance of condom in every commercial sex works, but the majority believe themselves were not susceptible to HIV-AIDS due to their preference to healthy-looking clients to serve sex. Personal expenses to visit the health center for HIV testing are less considered compared to public opinion and discrimination. Peers encouraged the workers to get tested. Disseminating HIV/AIDS information to sex workers through media and mobile phone are not successful. Conclusion: The findings of the study carrying an expectation that when individuals’ attitudes toward HIV testing are positive, the likelihood of getting themselves tested would also be higher. Since the perception is driven by information as stimulus, it is important to provide continuous information to create stimulus which eventually will influence their perception.

Background: There is a general consensus that schizophrenia patients have a greater risk to become violent. Caring for schizophrenia patients with risk of violence presents difficult clinical challenges, and it complicates the efforts of nursing student. Analysis of nursing student' barriers may lead to improve nursing management of risk of violence. Objective: The aim of this study is to explore the nursing student barriers in for caring schizophrenia patients with violence risk. Method: A total sample of 22 nursing students completed their experience through reflective diary during clinical placements. The qualitative data were explored by thematic content analysis method using NVivo. Results: Three themes were emerged from the data included: emotions, personal experience, and inadequate communication skills. Conclusion: These themes reflected the barrier of the nursing students when they applied nursing care toward schizophrenia patient with violence risk. Knowing the barriers is very important for successful violence risk management for nursing student.

Background: Emergency nursing service system requires the role of nurses who are able to pay attention to the behavior of caring and patient comfort. Caring in an emergency room is an important aspect in lifesaving procedures. It might impact the psychology of patients if nurses are not caring. Caring behavior and comfort given by nurses can also affect to patient satisfaction. Patient satisfaction is considered important as a bridgehead for the treatment of patients. Objective: The purpose of this study is to determine the relationship between caring behavior and comfort with patient satisfaction in the emergency room, Ratu Zalecha Hospital, South Kalimantan, Indonesia. Method: This was an analytic correlational study with cross-sectional approach involved 341 patients in the emergency unit using consecutive sampling. Four questionnaires were used to measure the characteristics of the respondent, the nurse caring behavior, comfort given by the nurses, and patient satisfaction. Data were analyzed using descriptive statistics for respondents’ characteristic, and chi-square to analyze the relationship between variables. Result: There were 285 respondents (92.8%) who received nurses’ caring behaviors were satisfied, and 268 respondents (87.3%) stated that the nurses were able to provide comfort in nursing care in the emergency room. Conclusion: This study revealed that there was a relationship between caring behavior, and comfort with patient satisfaction. It tells that caring and comfort are very important components that influence the satisfaction of patients. Therefore, the role of nurse to provide caring and comfort for the patients in the future should be developed along with the development of science and technology and society's demands.

Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference. Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients. Method: A systematic search of electronic databases (CINAHL, ProQuest, Science Direct, and Google scholar) was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age. Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference were assessed using Brief Pain Inventory (BPI). Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking. Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

Background: Although the Indonesian government has campaigned exclusive breastfeeding during the past decade through maternal and child program of Ministry of Health, however, its coverage in Yogyakarta province remains low. Objective: This study aims to analyze factors related to exclusive breastfeeding program, especially indicators that can explain government’s regulation and mothers’ perception to exclusive breastfeeding practice. Methods: It was a cross-sectional study involved 185 mothers who have 6-12 months infants with parity 1-3. The correspondents live in Sleman district and had normal delivery in hospital, health center or midwifery private practitioner. The association between the exogenous (government policy and mothers’ perception) and the endogenous variables (mothers’ participation to exclusive breastfeeding practice) was determined using Lisrel version 8.80. Results: Although the government policy contributed to the success of implementing breastfeeding program (33%), providing breastfeeding rooms (28%), and declaring the related government regulation (17%); however, its contribution was recorded at only 2% to human resources. Knowledge significantly encouraged mothers to breastfeed whilst infrastructure was assessed as a strong determinant of mothers’ willingness to participate in the program at the contribution of 50%. Conclusion: Although there was only a weak association between government regulation to mothers’ perception and between mothers’ perception towards exclusive breastfeeding practice, the study highlights the importance of providing adequate information to improve mothers’ knowledge on exclusive breastfeeding. By knowledge improvement, mothers will have better perception, which in turn will improve their self-efficacy and practices in exclusive breastfeeding.

Background: Anemia in Indonesia is mostly caused by micronutrient deficiency such as iron. Although much have been done to address anemia in the community, the problem remains. As health is not solely government’s responsibility, community participation should be seen as an alternative effective approach. Objective: The influence of women’s organizations to community participation and their self-sustenance in anemia prevention and control was examined. Methods: It was a quasi-experimental study with pretest and post-test control group design involving 30 women in reproductive-age who were selected through a multi-stage random sampling method; and 20 health providers, of whom were members of Dasa Wisma, posyandu cadres, PKK, and Karang Taruna. At the intervention group, women’s organization in anemia prevention and control was enabled in order to increase community participation. Hemoglobin level was measured as the outcome of the intervention program. Results: By empowering women’s organization, participation level of community members in the intervention group significantly increased, shown by family’s willingness to provide and consume iron-sufficient foods in their daily diets. As an outcome, hemoglobin level of reproductive-aged women at the intervention group slightly raised from its initial level, whilst the level in the control group was relatively stagnant. Conclusion: Involving the community member has been proven as an effective approach in anemia prevention and control. Given that women’s social movement are existed in many settings, therefore, empowering such organization as a manifestation of community participation can be applied in other setting, and also for other health program.

Background: With an increasing demand of high quality of health services, challenges are addressed to all health providers to improve their skills in providing services to clients. Given that preventive dentistry clinical practice has not been satisfying, providing media as students’ guidelines is necessary. Objective: The study aims to explain the influence of multimedia use in order to improve Pit Fissure Sealant (PFS) practical skills of dental nursing students. Methods: It was a quasi-experimental study with pretest and post-test control group design. Population of the study was selected from dental nursing students in Yogyakarta. A hundred sample was drawn purposively from the population and distributed equally to two groups. The first group was exposed by PFS practice video whilst the second group as control was exposed only by the guidebook. Results: Initially, students in the control group have better PFS practical score compared to their counterpart in the treatment group. Nevertheless, after the exposure of different media, students in the treatment group demonstrated a better post-test score on their PFS practical skills. The statistical analysis certifies that there was a significant difference in the mean score of PFS practical skills of the students before and after the treatment. Conclusion: Video as a new media is able to improve the students’ motivation in learning than any traditional media such as books. It should be noted however, both printed media (guidebooks) and video only provides one-way communication. Therefore, designing an interactive media using video, which the user can be the sender, not only the receiver, can be considered for further research. 

Background: Pain-coping behavior of primiparous women may have adverse effects on the mother and fetus. In Tangerang, the majority of pregnant women have negative experiences of pain and pain-coping behaviors during labor. Objective: The purpose of this study was to examine the effect of the invocation (do’a) on pain-coping behaviors of primiparous Muslim women during the first 3 hours of the active phase of labor. Methods: It was an experimental study with pre-posttest design. Ten primiparous women were randomly selected and assigned to the control and intervention group. Each group consisted of 5 participants. Pain-coping behavior was measured by the Pain Behavior Observation Scale (POBS). Results: Findings revealed that pain-coping behaviors were increased for those who received the invocation (do’a) with p-value < .05 than those who received the routine care. The effectiveness of do'a could be seen from the average difference of scores of pain-coping behaviors before and after intervention. The intervention group significantly had higher pain-coping behaviors than the control group during three hours of posttest, while controlling for the pretest measure, F (3.24) = 15.68, p< .001. Conclusions: The invocation (do’a) program for primiparous women during labor is feasible to be conducted, and effective to increase pain-coping behaviors. Therefore, it is suggested to provide this program for primiparous women during the first 3 hours of active phase of labor.

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Background: Indonesia’s Health Law No. 36 year 2009 Section 128 states that every baby has the right to exclusively breastfed from birth for six months. The law also stipulates that during breastfeeding, the family, the government, local governments, and public should support mothers with the provision of time and special facilities. Objective: This study aims to analyze factors related to exclusive breastfeeding program, especially indicators that can explain advocacy to stakeholders, support for resources and the role of community leader toward mother’s attitude on exclusive breastfeeding program.  Methods: It was a quantitative study employed a cross-sectional approach and involved 185 mothers in Sleman district who have children aged 6-12 months. Results: Written support in the form of decree significantly contributed to the formation of advocacy factors conducted by exclusive breastfeeding program manager to the village stakeholders, whilst the provision of infrastructure and village fund did not support in creating factor of advocacy. The support from resources and the role of community leader can contribute the provision of infrastructure around 54% whilst mothers’ attitudes toward exclusive breastfeeding devoted a great share to mother’s practice. Conclusion: Advocacy for exclusive breastfeeding to the village stakeholders is expected to contribute in the form of written support (decree), providing the fund from the village budget, and providing the infrastructure. The support from resources and the role of community leaders influence advocacy and attitude of mothers on exclusive breastfeeding.

Background: Healthcare associated Infections (HAIs) is considered being the most serious patient safety issue in health care settings and nurses in Emergency Department (ED) face greater risk of exposure to infectious pathogens. Objective: The objectives of this study were to examine knowledge, attitude and behavior towards HAIs of Indonesian nurses working in ED and to examine the relationship among the above three variables. Method: A cross-sectional study with self-reported survey was conducted at four hospitals in Bandung, Indonesia. The Healthcare Associated Infections Survey consisting of four domains: demographic characteristics, knowledge, attitude and behavior related to HAIs was used. The participants of this study covered 115 nurses. Results: The mean of overall performance on the knowledge was good 21.23 ±5.173 (range 9-30) and 92.2% of them believed that guideline for HAIs control practice can reduced the risk of infections. The mean score for behavior when practicing infection control was 37.7±5.570 (26-50). Marital status and working hours per week, influenced nurses’ knowledge of HAIs (rs = 0.185, p = 0.048). Work experienced have negative correlation with attitude towards HAIs (rs = -0.196, p = 0.035). Furthermore, type of hospital and working hours per week have been associated with nurses’ behavior towards HAIs (r = 0.191, p = 0.04). There was no significant relationship between knowledge, attitude and behavior towards HAIs. Conclusion: Even though the majority of ED nurses in Indonesia believe that precautionary guidelines can reduce the risk of HAIs, this study has indicated that nurses’ behavior toward HAIs is still insufficient.

Background: Exclusive breastfeeding in Semarang during the past five years remains low. Only 20 to 64% of mothers were breastfed exclusively in 2010-2012. The incidence of postpartum blues was reported by 29.9% of mothers and most of them were primiparous. Objective: This study aims to determine the effect of loving massage, aromatherapy, and a combination of loving massage and aromatherapy on stress levels, and changes in levels of prolactin in primiparous puerperal in Semarang. Method: A true experimental study with a randomized pretest-posttest control group design. Cluster random sampling was used to select 12 health centers from the 37 health centers in Semarang. A random assignment with a sealed envelope was performed to divide study participants into four groups; loving massage group, aromatherapy group, and a combination group of loving massage and aromatherapy, and a control group. A total of 52 primiparous puerperal mothers was involved, with 13 mothers were distributed equally in each group. Results: Loving massage, aromatherapy, and a combination of loving massage and aromatherapy effectively changed mother’s stress and prolactin levels. Effectiveness of each treatment assessed from the average difference in scores before and after treatment. Combination of loving massage and aromatherapy had proven as the most effective treatment in reducing stress levels (11.61 ± 6.76), and increasing prolactin level (83.13 ± 6.41 ng/ml). Conclusions: Loving massage and aromatherapy shown to lower the levels of stress, and can increase the levels prolactin in postpartum primiparous. Therefore, it is recommended to provide loving massage therapy and aromatherapy to postpartum primiparous mothers.

Background: Hand washing is the most effective method of preventing the transmission of diseases through hands. Objective: To identify relationships between gender, availability of hand washing facilities, perception of barriers toward hand washing compliance and subjective norm in implementing hand washing practice among students of public elementary school in Belitung district, Indonesia. Method: A cross-sectional research study was used in this study. Of 309 participants were recruited in 11 public elementary schools from 3 sub districts that has been implemented the hand washing program in Belitung, Indonesia. Purposive sampling method was used to select the participants. This study was used a self-administered questionnaire with minimal interference in order to minimize bias and by emphasizing to the students that this is not an examination. Results: The results showed that 71.8% of the students were not hand washing properly. It also showed that availability of hand washing facilities and gender were not related with hand washing behavior. In regards of barrier perception toward hand washing compliance also showed that was not related to hand washing practice among elementary schools’ students. However, subjective norm (c² =4.459, p < .05) was related to hand washing practice among elementary schools’ students. Conclusion: Subjective norm has a significant relationship to hand washing behavior. Thus, health care provider could develop specific intervention programs based on TPB to promote subjective norm among elementary schools’ students since this norm or perception of norm can motivate hand washing behavior among the students effectively.

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This paper aims to explain the lifespan of nursing education in Cambodia, which has been up and down for over 66 years. The journey of Cambodian nursing education is fulfilled by many challenges faced by nursing leaders in the country, including the challenges caused by the decades of civil war devastated Cambodian society. It takes high responsibility and needs more powers, skills, and commitments to produce competent professional nurses to fulfill the tasks in the clinical settings through nursing education, and it is characterized by the progress in responding societal needs of the society.

Background: Diabetes mellitus is a crucial problem that leads to serious multiple complication. Self-management program is an essential foundation for the empowerment approach, and necessary for patients to effectively manage their behaviors. Purpose: The purpose of this study is to describe, compare and critique six existing self-management programs that are commonly used to guide self-management for type 2 Diabetes Mellitus (DM) patients. Method: An integrative review was conducted. Relevant studies published in English language and retrieved from CINAHL, PubMed, Science Direct, and Google search were included. Results: Five Randomized Control Trials (RCTs) and one quasi-experimental study were reviewed. Goal setting and action planning combined with other strategies (brief counseling, problem solving, and follow-up strategy) showed more effective to improve behavioral change and several clinical outcomes. Continuing follow-up through telephone-call and face to face follow-up becomes the essential element for successful behavior change. Conclusion: Diabetes self-management program is effective to improve behavioral change and clinical outcomes among patients with type 2 DM. Further research is needed to test the effectiveness of self-management combine with other strategies which are goal setting strategy and follow-up strategy in patients with type 2 DM.

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This article aims to provide the development strategy to see the possibility of providing health tourism in Belitung Indonesia. The Strength, Weakness, Opportunity, and Threat are provided as basic information for the action plans that consist of human resource, products, and governance.

Background: Diabetes mellitus (DM) is one of the leading causes of death and it is caused by genetics, nutrition, and unhealthy behaviors. Therefore, changes in lifestyle associated with eating behaviors in diabetes mellitus patients greatly impact on their quality of life. There are many factors related with changes in lifestyle of diabetes mellitus patients, especially eating behaviors. Purpose: This study aims to examine the relationships between self-efficacy, psychological stress, family support, and eating behaviors among type 2 diabetes mellitus (T2DM) patients in Sidoarjo, Indonesia. Method: A total of 117 T2DM patients from the Sidoarjo Community Health Center were included in the analysis. Using SPSS IBM 21.0 program, Pearson product moment correlation was performed to analyze data. Results: The findings showed that self-efficacy and family support had a positive relationship with eating behaviors (r = .692, p < .001; r = .683, p < .001, respectively). Psychological stress had a negative relationship with eating behaviors (r = -.327, p < .001). Conclusion: Self-efficacy, family support, and psychological stress had relationships with eating behaviors. Nurses should pay attention to these factors that make T2DM patients having a long-term commitment in healthy eating behaviors.

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Shifting from hospital-based care to community-based care involves the family as advanced caregivers to the patients with schizophrenia at their home. Yet, they have need of knowledge and skill in caring the patients as well as support from health care providers and society. Family caregivers should be well-prepared to take care the patients with schizophrenia at home since it gets some negative consequences on their physical, psychological, social, and financial. Nurse needs to assess the factors that might influence the family caregivers to feel burden, and include the family caregivers into nursing care in which would not only to improve the patients’ mental health but also the family caregivers.

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Qualitative research methods become increasingly popular in nursing. However, most of nursing students have argued and debated about issues and meanings of the qualitative research in nursing science. This article is noted to discuss the qualitative aspects and concerns.

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