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Belitung Nursing Journal

Belitung Nursing Journal (BNJ) is a peer-reviewed, "Gold" open-access journal that offers a platform for nursing scholarship with an Asian focus and perspectives from the region. BNJ welcomes submissions, including original research, review article, theory & concept development, and case study.

  • Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study
    by Rachel Serwaah Antwi, Jefferson Galanza

    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.

  • Barriers to clinical learning skills development among midwifery students and newly qualified midwives in Morocco: A qualitative study
    by Majida Mramel, Mustafa El Alaoui, Rachid El Janati Idrissi

    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.

  • Effects of the mindfulness program for male substance abusers in Thailand on stress, deliberate self-harm, and drug abstinence intention: A repeated-measure design
    by Arunothai Singtakaew, Nujjaree Chaimongkol, Skaorat Puangladdac, Yongyud Wongpiromsarn

    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

  • Measuring the purpose in life in the adult population: A scoping review
    by Somrudee Arunjit, Karnsunaphat Balthip, Jos M. Latour

    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.

  • Exploring the linkages between social media use, self-esteem, and academic performance among nursing students in Saudi Arabia: A descriptive correlational study
    by Ibrahim Abdullatif Ibrahim, Mona Hamdy Mostafa Mohamed, Atallah Alenezi

    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.

  • The experiences of Chinese colorectal cancer survivors in marital intimacy after ostomy creation: A qualitative study
    by Xixi Du, Suchira Chaiviboontham, Bualuang Sumdaengrit

    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.

  • Experiences and perceptions of nurses and air ambulance service providers in carrying out aeromedical evacuations in Indonesia: A qualitative research
    by Dwi Ambarwati, Sri Warsini, Sunartini Hapsara, Fitri Haryanti

    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.

  • Infection-related mortality and infection control practices in childhood acute myeloid leukemia in a limited resource setting: Experience with the Indonesian national protocol
    by Eddy Supriyadi, Ignatius Purwanto, Zeni Widiastuti, Inggar Armytasari, Salsabila Sandi, Bambang Ardianto, Gertjan J. L. Kaspers

    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.

  • Effects of stress and self-efficacy on quality of life of mothers with autistic children: Covariance-Based Structural Equation Modeling (CB-SEM) approach
    by Yap Bee Wah, Noor Nadia Mohd Nasir, Mohd Fikri Hadrawi, Ainur Amira Kamaruddin, Zeinab Jannoo, Asyraf Afthanorhan

    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.

  • Causes of medication administration errors and barriers to reporting as perceived by nurses in Saudi Arabia: A qualitative study
    by Jazi Shaydied Alotiabi

    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.

  • Psychometric properties of the Thai Qualifications Framework for Higher Education instrument among Royal Thai Air Force nurse stakeholders
    by La-Ongdao Wannarit, Bangorn Ritudom

    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.

  • Viewing persons solely as the summation of organ systems confines nursing practice
  • Readiness for hospital discharge perceived by caregivers of patients with traumatic brain injury: A cross-sectional study
    by Amelia Ganefianty, Praneed Songwathana, Jintana Damkliang

    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.

  • Occurrence of musculoskeletal disorders, burnout, and psychological suffering in Brazilian nursing workers: A cross-sectional study
    by Marília Duarte Valim, Raymara Melo de Sousa, Bruno da Silva Santos, André Luiz Silva Alvim, Fábio da Costa Carbogim, Vanessa Albuquerque de Paula, Fabiana Guerra Pimenta, Aires Garcia dos Santos Junior, Odinea Maria Amorim Batista, Layze Braz de Oliveira, Denise Andrade, Álvaro Francisco Lopes de Sousa

    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.

  • Implementation of coaching methods to decrease the parenting stress levels among teenage mothers in Indonesia: A quasi-experimental study
    by Ariyanti Saleh, Andi Masyitha Irwan, Aulia Insani Latif, Syahrul Syahrul, Veni Hadju, Irma Andriani, Indah Restika

    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.

  • Prenatal passive smoking at home: The experiences of women in Thailand
    by Idchayar Mornsaeng, Kasara Sripichyakan, Nantaporn Sansiriphun, Nonglak Chaloumsuk

    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.

  • Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study
    by Cecep Eli Kosasih, Tetti Solehati, Ida Maryati

    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.

  • Evaluating ICU nurses’ education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study
    by Afaf Alrimali, Nashi Alreshidi

    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.

  • Psychometric properties of a Saudi Arabian version of the Birth Satisfaction Scale-Revised (BSS-R)
    by Juliana Linnette D'Sa, Ibtesam Omar Jahlan, Eman S. Alsatari, Sahar Zamzam, Colin R. Martin

    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.

  • Gender role conflicts experienced by Indonesian women with gynecological cancer: A phenomenological study
    by Atun Raudotul Ma'rifah, Yati Afiyanti, Wisnu Djatmiko, Ida Ruwaida, Ariesta Milanti

    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.

  • The potential risk components and prevention measures of the Ebola virus disease outbreak in Liberia: An in-depth interview with the health workers and stakeholders
    by Moses Tende Stephens, Juniastuti, Sulistiawati, Peter Chilaque Dossen

    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.

  • Metaphoric perceptions of individuals with diabetes in Turkey: A content analysis
    by Aslı Tok Özen, Özlem Bulantekin Düzalan, Betül Yalçın

    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.

  • Exercise-based gaming in patients with multiple sclerosis: A systematic review and meta-analysis
    by Amal Mohamed Elhusein, Hammad Ali Fadlalmola, Eltayeb Mohammed Awadalkareem, Ekram Yahia Mahmowd Alhusain, Soad Mohamed Alnassry, Mukhlid Alshammari, Elsadig Eltahir Abdulrahman, Doaa El Sayed Fadila, Fatma M. Ibrahim, Abdalrahman Abdallatif Mohmmed Saeed, Adel Abdalla, Hassan N Moafa, Ehab I. El-Amin, Daniel Mon Mamanao

    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.

  • Translation and validation of the East Asian Acculturation Measure (EAAM) among Myanmar migrants in Thailand
    by Htet Shwe Wah Oo, Ratsiri Thato, Nyan Win Phyo

    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.

  • Identifying diabetes risks among Indonesians: A cross-sectional study in a community setting
    by Mula Tarigan, Setiawan, Rosina Tarigan, Fatwa Imelda, Darunee Jongudomkarn

    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.

  • Exploring men’s health in medium and high complexity care in Brazil: A deductive thematic analysis of social determinants
    by Márcio Soares de Almeida, Bruna Rafaela Carneiro, Albert Ramon Oliveira Santos, Claudia Geovana da Silva Pires, Fransley Lima Santos, Alvaro Francisco Lopes de Sousa, Anderson Reis de Sousa, Álvaro Pereira, Layze Braz de Oliveira, Liliane Moretti Carneiro, Isabel Amélia Costa Mendes

    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.

  • Improving adolescents’ HIV/AIDS prevention behavior: A phenomenological study of the experience of planning generation program (GenRe) ambassadors as peer educators
    by Diah Ratnawati, Agus Setiawan, Junaiti Sahar, Widyatuti, Astuti Yuni Nursasi, Tatiana Siregar

    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.

  • The predictive power of electronic reporting system utilization on voluntary reporting of near-miss incidents among nurses: A PLS-SEM approach
    by Mohammed Abdalraheem Alalaween, Noorliza Karia

    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.

  • Self-care behavior among adult patients with hypertension in Padang, West Sumatra, Indonesia: A cross-sectional study
    by Rika Sarfika, Sulistiawati, Esi Afriyanti, I Made Moh. Yanuar Saifudin

    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.

  • The effect of theoretical and student-centered interactive education on intern nursing students’ knowledge and consideration regarding human papillomavirus and its vaccine in Turkey: A repeated measures design
    by Serap Açıkgöz, İlknur Göl

    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.

  • Psychometric testing of the Indonesian version of the Nurses’ Ethical Behavior in Protecting Patients’ Rights (I-NEBPPR) scale
    by Dian Susmairni, Do Thi Ninh, Cheng Li, GunJeong Lee

    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.

  • The effect of colposcopy counseling with a feminist model on anxiety in Thai women with abnormal cervical cytology results: A time-series quasi-experimental study
    by Sarwitree Pornsinsiriruck, Bualuang Sumdaengrit, Suvimol Kongrot, Ketkaew Jengprasert, Noppamat Puntusopon

    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.

  • Do internship students do well in a clinical environment? A qualitative naturistic study
    by Fadiyah Jadid Alanazi, Mada Huwaydi M Alenezi, Atheer Abdullah N Alanazi, Taif Salem R Alanazi

    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.

  • Experiences of discharge planning practices among Indonesian nurses: A qualitative study
    by Titis Kurniawan, Kittikorn Nilmanat, Umaporn Boonyasopun, Amelia Ganefianty

    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.

  • Substandard feeding in children undergoing mechanical ventilation in pediatric intensive care unit: A retrospective cohort study in China
    by Meng Li, Ying Wang, Qingxiu Chen

    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.

  • Development and psychometric testing of the Professional Interpersonal Competency Assessment Scale for Novice nurses (PICASN)
    by Yuko Sato, Yuko Yasuhara, Hirokazu Ito, Gil P. Soriano, Allan Paulo Blaquera, Rozzano Locsin, Tetsuya Tanioka

    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.

  • The needs of patients with diabetes for the prevention and treatment of foot complications in Thailand: A qualitative descriptive study
    by Piyawan Kanan, Boonying Siribamrungwong, Thipapron Tarawanich, Saritpat Arapinth, Phunyada Napunnaphat

    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.

  • Child sexual abuse prevention: A qualitative study of teachers’ educational needs
    by Tetti Solehati, Cecep Eli Kosasih, Yanti Hermayanti, Henny Suzana Mediani

    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.

  • A qualitative descriptive study of Thai fathers’ experiences in supporting their partners’ breastfeeding
    by Patcharin Ngoenthong, Nantaporn Sansiriphun, Warunee Fongkaew, Nonglak Chaloumsuk

    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.

  • Health behaviors and mental health among adolescents: A comparison based on BMI using the 2021 Korea Youth Risk Behavior Survey
    by Hye-Ryeon Park, Na-Geong Kim

    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.

  • Investigating the complex relationships between nurses’ work factors, Sharia-based nursing care, and patient satisfaction in an Islamic hospital: A PLS-SEM approach
    by Iwan Ardian, Nursalam, Ahsan, Nutrisia Nuim Haiya, Intan Rismatul Azizah

    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.

  • Factors influencing Tanzanian mothers’ feeding practices for toddlers: A predictive correlational study
    by Debora Dyson Bukuku, Tassanee Prasopkittikun, Sudaporn Payakkaraung, Chayapa Lenwari

    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.

  • Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial
    by Siriporn Sumrattana, Usavadee Asdornwised, Kessiri Wongkongkam, Kriangkrai Tantiwongkosri

    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)

  • Exploring nurses’ experiences in applying AIDET framework to improve communication skills in the emergency department: A qualitative study
    by Werapol Panchuay, Thassanee Soontorn, Praneed Songwathana

    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.

  • Experiences of Indonesian nurses in improving preterm oral feeding readiness in special care units: A qualitative descriptive study
    by Dyah Dwi Astuti, Rinawati Rohsiswatmo, Dessie Wanda, Diah Mulyawati Utari

    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.

  • Development and psychometric properties of the Person-centered Palliative Care Nursing Instrument (PPCNI) in the Philippines
    by Gil P. Soriano, Kathyrine A. Calong Calong, Rudolf Cymorr Kirby Martinez, Hirokazu Ito, Yuko Yasuhara, Evalyn Abalos, Tetsuya Tanioka

    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.

  • Patient compliance: A concept analysis
    by Saowaluk Thummak, Wassana Uppor, La-Ongdao Wannarit

    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.

  • Relationship between dyslexia awareness and stigma among nursing students in Saudi Arabia: A cross-sectional study
    by Duaa Hafez, Raghad Shafie, Renad Alasiri, Renad Bamasag, Zikra Batwa, Alaa Mahsoon, Loujain Sharif, Nofaa Alasmee

    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.

  • Knowledge and attitude towards lesbian, gay, bisexual, and transgender healthcare concerns: A cross-sectional survey among undergraduate nursing students in a Philippine state university
    by Ryan Michael F. Oducado

    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.

  • The level of emotional intelligence among Saudi nursing students: A cross-sectional study
    by Ahmed Mansour Almansour

    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.

  • Beyond the classics: A comprehensive look at concept analysis methods in nursing education and research
    by Joko Gunawan, Yupin Aungsuroch, Colleen Marzilli

    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.

  • The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study
    by Mohd Khairul Zul Hasymi Firdaus, Piyanuch Jittanoon, Umaporn Boonyasopun, Muhammad Kamil Che Hasan

    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)

  • Comparison of palliative care education for family caregivers in high-and-low-income countries: An integrative review
    by Martina Sinta Kristanti, Nurdina Wahyu Hidayati, Maryadi

    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.

  • Exploring the aftermath: Work demands, workplace violence, and job satisfaction among nurses in a public hospital in the post-COVID-19 era
    by Dita Sulistyowati, Hanny Handiyani, Moh Heri Kurniawan, Rahma Dwi Syukrini, Turyatiningsih

    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.

  • Uncovering the underlying aspects of successful COVID-19 prevention and control in Thailand through factor analysis: Lessons we have not yet learned from village health volunteers
    by Kittiporn Nawsuwan, Roshinee Oupra, Noppcha Singweratham, Phayong Thepaksorn

    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.

  • Social determinants of health and glycemic control in persons with type 2 diabetes mellitus attending a tertiary hospital in Nepal: A cross-sectional study
    by Prava Adhikari, Aurawamon Sriyuktasuth, Warunee Phligbua

    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.

  • Psychometric validity of the Thai version of the Motivation for Healthy Eating Scale in patients with acute coronary syndrome
    by Ratchadaporn Boonsanong, Rapin Polsook

    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.

  • Institutional ethnography of hemodialysis care: Perspectives of multidisciplinary health care teams in Nepal
    by Devaka Kumari Acharya, Kittikorn Nilmanat, Umaporn Boonyasopun

    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.

  • Addressing academic challenges: A quasi-experimental study on the effect of remedial exam strategy for nursing students with low academic performance
    by Eman M. Gaber Hassan

    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.

  • Prenatal harmful substances: Thai pregnant women’s experiences
    by Jatuporn Tantanokit, Nantaporn Sansiriphun, Kasara Sripichyakan, Pimpaporn Klunklin

    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.

  • Self-care knowledge in patients with intestinal stomas in a selected hospital in the south of Viet Nam: A descriptive cross-sectional study
    by Thi Dung Ngo, Miranda Hawks, Thi Thanh Truc Nguyen, Thi Ngoc Han Nguyen, Hong Thiep Nguyen, Nguyen Thanh Truc Mai

    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.

  • Prevalence and influencing factors of fatigue among patients undergoing continuous ambulatory peritoneal dialysis: A cross-sectional study
    by Surachai Maninet, Bangaorn Nakrit, Phasuk Suttavat

    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.

  • Self-esteem among nursing students at a public university in Saudi Arabia: A cross-sectional study
    by Ahmed Mansour Almansour

    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.

  • Conduct problems among middle adolescents in the community settings: A concept analysis
    by Fauzan Saputra, Penpaktr Uthis, Sunisa Sukratul

    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.

  • The impact of a self-management program on exercise adherence among patients discharged after coronary artery bypass grafts: A quasi-experimental study in Thailand
    by Sudarat Tippinit, Rapin Polsook

    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.

  • Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study
    by Chanipa Yoryuenyong, Chanokporn Jitpanya, Siriphan Sasat

    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.

  • Enhancing recovery in older patients undergoing abdominal surgery: Examining the effect of a preoperative preparation program using a quasi-experimental design
    by Issarapong Penphumphuang, Yaowarat Matchim, Prasit Mahawongkhajit, Thanyarat Boontoi

    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.

  • The role of academic procrastination on Internet addiction among Thai university students: A cross-sectional study
    by Sivasankari Nadarajan, Pornpat Hengudomsub, Chintana Wacharasin

    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.

  • Association between Islamic religiosity, social support, marriage satisfaction, and postpartum depression in teenage mothers in West Java, Indonesia: A cross-sectional study
    by Irma Nurbaeti, Kustati Budi Lestari, Moch Syafii

    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.

  • Preterm infant cues during breastfeeding and its measurement: A scoping review
    by Haryatiningsih Purwandari, Meivita Dewi Purnamasari, Wastu Adi Mulyono, Mei-Chih Huang

    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.

  • Uncertainty of parents due to having children with cancer: A concept analysis
    by Ikeu Nurhidayah, Nani Nurhaeni, Allenidekania Allenidekania, Dewi Gayatri, Yeni Rustina

    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.

  • Quality of life and its correlates in pretreatment patients with locally advanced head and neck cancer: A cross-sectional study in Thailand
    by Sirinya Pimvichai, Yaowarat Matchim, Tanadej Sinthusake, Kiratiya Wongkalasin

    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.

  • Self-concept among Indonesian adolescents in coastal areas: A cross-sectional study
    by Rika Sarfika, I Made Moh. Yanuar Saifudin, Eka Oktavianto

    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.

  • Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review
    by Jutharat Thongsalab, Jintana Yunibhand, Penpaktr Uthis

    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.

  • Psychometric evaluation of the Malay version of the Individual Community-Related Empowerment scale among older adults in Malaysia
    by Zuraidah Zaidun, Rosnah Sutan, Azimatun Noor Aizuddin

    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.

  • Factors associated with health-related quality of life among employed individuals with chronic obstructive pulmonary disease: A correlational study in China
    by Peihua Zhang, Niphawan Samartkit, Khemaradee Masingboon

    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.

  • Experiences of Thai-Muslim patients regarding inconsistent antiretroviral therapy adherence: An exploratory descriptive qualitative study
    by Pajongsil Perngmark, Oatcharaphon Sahawiriyasin, Eleanor Holroyd

    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.

  • Factors influencing resilience in patients with advanced cancer: A cross-sectional study
    by Pimonpan Niamhom, Tipaporn Wonghongkul, Jindarat Chaiard, Chomphoonut Srirat

    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.

  • Validity and reliability of a Thai version of the Body Image Scale among patients with post-coronary artery bypass graft
    by Pannawit Moonkaew, Rapin Polsook

    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.

  • Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study
    by Huaiyu Shen, Khemaradee Masingboon, Niphawan Samartkit

    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.

  • Effectiveness of neurobic exercise program on memory performance in community-dwelling older adults with mild cognitive impairment: A randomized controlled crossover trial
    by Wiyakarn Sanghuachang, Pornpat Hengudomsub, Nujjaree Chaimongkol, Naiphinich Kotchabhakdi

    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.

  • Understanding the experiences of caregivers of HIV-exposed children under five: A phenomenological inquiry
    by Happy Hayati, Nani Nurhaeni, Dessie Wanda, Nuraidah Nuraidah

    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.

  • Retaining employment in the hospital setting: A descriptive phenomenological study of Indonesian nurses’ experiences
    by Utari Christya Wardhani, Rr. Tutik Sri Hariyati

    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.

  • Exploring the tuberculosis medication program in Indonesia as perceived by patients and their families: A qualitative study
    by Imelda Liana Ritonga, Setyowati Setyowati, Hanny Handiyani, Astuty Yuni Nursasi

    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.

  • Experiences of Infection Prevention and Control Nurses (IPCNs) in performing their roles and duties in the Indonesia Army Central Hospital: A qualitative descriptive study
    by Laurentia Dewi, Achir Yani S. Hamid, Rita Sekarsari

    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.

  • Nursing services as perceived by inmates in correctional facilities in Jakarta, Indonesia: A qualitative study
    by Wilma Wilma, Achir Yani S. Hamid, Hanny Handiyani, Ede Surya Darmawan

    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.

  • Self-awareness as the key to successful adherence to antiretroviral therapy among people living with HIV in Indonesia: A grounded theory study
    by Sri Yona, Chiyar Edison, Astuti Yuni Nursasi, Rita Ismail

    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.

  • A correlational study of breastfeeding duration among Saudi mothers: The role of self-efficacy, intention, and social support
    by Nourah. M Al Naseeb, Hanan Badr, Salmah Alghamdi

    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.

  • Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study
    by Lafi Munira, Pranee Liamputtong, Pramon Viwattanakulvanid

    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.

  • Factors influencing intention to plagiarize among nursing students in the Philippines
    by Mary Bless G. Debuque, John Bernard A. Dofitas, Dorothy Arlene Paz P. Espia, Trixie Camille R. Ferrariz, Francis John P. Gargarita, Ryan Michael F. Oducado

    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.

  • Investigating the complex relationships between leadership, psychological safety, intrinsic motivation, and nurses’ voice behavior in public hospitals using PLS-SEM
    by Thuraisyah Jaaffar, Naresh Kumar Samy

    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.

  • Developing a blended learning curriculum using a digital notebook application for a surgical nursing practicum: The ADDIE model
    by Apichat Kardosod, Kanittha Rattanakanlaya, Lalida Noppakun, Chutima Meechamnan, Rujadhorn Indratula, Sirinard Deechairum

    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.

  • Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders
    by Ni Made Nopita Wati, I Gede Juanamasta, Jutharat Thongsalab, Jintana Yunibhand

    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.

  • Factors influencing illness uncertainty in parents of children with congenital adrenal hyperplasia in a developing country: A cross-sectional study
    by Irene Astrid Larasati, Fanti Saktini, Tri Indah Winarni, Annastasia Ediati, Agustini Utari

    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.

  • Factors associated with the completion of antenatal care in Indonesia: A cross-sectional data analysis based on the 2018 Indonesian Basic Health Survey
    by Haerawati Idris, Indah Sari

    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.

  • Psychometric properties of Clinical Learning Environment Inventory and its association with Moroccan nursing students’ satisfaction: A PLS-SEM approach
    by Khadija Saka, Mohamed-Yassine Amarouch, Mohamed El Amine Ragala, Zarrouq Btissame, Adel Tahraoui, Youness El Achhab, Jaouad El-Hilaly

    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.

  • Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness
    by Zarina Haron, Rosnah Sutan, Roshaya Zakaria, Zaleha Abdullah Mahdy

    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.

  • Health practice among Muslim homebound older adults living in the Southern Thai community: An ethnographic study
    by Praneed Songwathana, Tippamas Chinnawong, Benjawan Ngamwongwiwat

    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.

  • The roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by Japan’s public health nurses
    by Chihiro Kawai, Tomoya Yokotani, Feni Betriana, Hirokazu Ito, Yuko Yasuhara, Tetsuya Tanioka, Kenji Mori

    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.

  • Exploring the future of nursing: Insights from the ChatGPT model
    by Joko Gunawan

    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.

  • The effect of the multimodal intervention on blood pressure in patients with first ischemic stroke: A randomized controlled trial
    by Orapin Jullmusi, Jintana Yunibhand, Chanokporn Jitpanya

    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.

  • Relationships between illness perception, functional status, social support, and self-care behavior among Thai people at high risk of stroke: A cross-sectional study
    by Surachai Maninet, Chalermchai Desaravinid

    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.

  • Patient and family-centered care for children: A concept analysis
    by Tuti Seniwati, Yeni Rustina, Nani Nurhaeni, Dessie Wanda

    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.

  • Social support and associated factors among family caregivers of older people in North-East Peninsular Malaysia
    by Aniawanis Makhtar, Nor Nadiya Ab Ghani, Sharifah Munirah Syed Elias, Salizar Mohamed Ludin

    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.

  • Let’s put mental health problems and related issues appropriately in social media: A voice of psychiatric nurses
    by Fauzan Saputra, Penpaktr Uthis, Sunisa Sukratul

    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.

  • Variations on a theme: Labeling patients as persons, the nursed, or client in nursing
    by Feni Betriana, Rozzano C. Locsin

    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.

  • ‘Should I stay or should I go?’: A mixed methods study on nurse retention during challenging times
    by Michael Joseph S. Diño, Paul John B. Bracero, Arnel Buencamino, Sharon B. Cajayon, Michael William Q. Catajan, Michaela Liel L. De Leon, Jessie Elsid Jr. Gregorio, Pamela Anne A. Lucelo, Bavy Charmy Cindy P. Odon, Jasmin Anne F. Palma, Roi Roel C. Rosado, Martin Phillip D. Taboada, Maria Luisa Uayan

    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.

  • Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia
    by Rose A Nain, Deena Clare Thomas

    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.

  • Discharge readiness and its associated factors among first-time mothers undergoing cesarean section in China
    by Mingfei Ran, Praneed Songwathana, Jintana Damkliang

    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.

  • Nursing outcome quality indicators for patients with ischemic stroke receiving thrombectomy treatment: A Delphi study
    by Chaiyuth Kotalux, Thanpimol Kensakoo, Werayuth Srithumsuk

    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.

  • Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis
    by Asmat Burhan, Nizam bin Ali Khusein, Septian Mixrova Sebayang

    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

  • Assessment of health sciences academic advisors’ mental health literacy and their experiences with students facing mental health problems
    by Fatimah Raji, Nahed Morsi, Alaa Mahsoon, Loujain S. Sharif

    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.

  • Barriers to reporting postpartum hemorrhage at different levels of healthcare facilities in Nigeria: A qualitative study
    by Sirajo Mohammed, Lee Khuan, Ruth Packiavathy Rajen Durai, Irmi Zarina Binti Ismail, Saleh Ngaski Garba

    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.

  • Eating disorders between male and female adolescents with type 1 diabetes mellitus in Korea
    by Hye-Ryeon Park, Na-Geong Kim

    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.

  • Clinical profile, treatment, and outcomes of patients with COVID-19 in a tertiary referral hospital in South Sumatera, Indonesia: A retrospective single-center study
    by Deli Marteka, Amarila Malik, Ingrid Faustine, Nadia Farhanah Syafhan

    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.

  • Factors influencing diabetes self-management among adults with type 2 diabetes mellitus in China
    by Ni Yang, Khemaradee Masingboon, Niphawan Samartkit

    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.

  • Effect of music therapy on postembolization syndrome in Thai patients with hepatocellular carcinoma: A quasi-experimental crossover study
    by Wassana Khuntee, Kanitha Hanprasitkam, Bualuang Sumdaengrit

    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.

  • The strategies used by the school health team during the delivery of sexual health information to unmarried adolescents in Malaysia
    by Siti Hazariah Abdul Hamid, Debbie Fallon

    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.

  • Sexual knowledge based on Islamic values and sexual risk behaviors of HIV/STIs among Thai Muslim army conscripts: A cross-sectional study
    by Awirut Singkun, Kraiwuth Kallawicha, Khemika Yamarat

    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.

  • Palliative care education and training in Liberia: A qualitative exploration of current state and challenges to further development
    by Moses Tende Stephens, Erna Rochmawati

    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.

  • Novelty: Nursing scholars’ guide for successful publication
    by Joko Gunawan, Yupin Aungsuroch, Mary L Fisher, Colleen Marzilli

    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.

  • Every nursing support matters: Mothers of hospitalised preterm newborns
    by Yusrita Zolkefli

    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.

  • The relationships between stress, stress-coping behaviors, and suicidal risk among Thais who had become unemployed due to the COVID-19 pandemic: A cross-sectional study
    by Chalermpon Kajai, Wanich Suksatan, Nittaya Promkunta, Natakorn Kamkaew

    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.

  • Digital competence: What makes nurses a ‘big gun’ in the future health industry
    by Yunus Adhy Prasetyo

    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.

  • Lived experiences of stroke survivors in India: A phenomenological study
    by Manjula G Bhagavathy, Saravana Anniyappa, Radhakrishnan Thankappan, Bindhu Bharathi

    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.

  • Concept analysis of maternal-infant attachment during the weaning process
    by Artemio M. Gonzales Jr, Lourdes Marie S. Tejero

    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.

  • Understanding the learning needs to enhance clinical competence of new professional nurses in public hospitals of South Africa: A qualitative study
    by Kholofelo L. Matlhaba, Naomi L. Nkoane

    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.

  • Perception and knowledge of Saudi women about water birth: A cross-sectional study
    by Saja Bashaikh, Fouzia Mahboub, Abeer Orabi

    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.

  • Factors related to health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia: A correlational study
    by Haerul Imam, Chanokporn Jitpanya

    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.

  • Examining the impact of upright and recumbent positions on labor outcomes in Saudi Arabia: A quasi-experiment
    by Zahra Al Aryani, Abeer Orabi, Howieda Fouly

    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.

  • Developing, validating, and pre-testing of a diabetic care self-management mobile health application: A technology-based intervention for patients with diabetes in Malaysia
    by Mohd Khairul Zul Hasymi Firdaus, Piyanuch Jittanoon, Umaporn Boonyasopun

    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.

  • Translation, adaptation, and validation of the Filipino version of the Caring Behaviors Inventory
    by Reiner Lorenzo Tamayo, Dan Louie Renz Tating, Ericka Louise Gilo, Hannah Kristine Mugol, Karen Grace Laureta

    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.

  • A comprehensive discharge planning program on fatigue and functional status of patients with hepatocellular carcinoma undergoing transarterial chemoembolization: A randomized clinical controlled trial
    by Nawiya Yenjai, Usavadee Asdornwised, Kessiri Wongkongkam, Nutcha Pinjaroen

    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.

  • Uncovering adaptive mechanisms and resilience among older adults: A qualitative study on the mental health impacts of temperature variations
    by Jerick B. Tabudlo, Gerardo F. Joven, Marjorie F. Joven

    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.

  • Sexual abstinence as a reproductive health-promoting behavior for women: A perspective
    by La-Ongdao Wannarit

    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.

  • Factors influencing nursing students’ continued success in a baccalaureate nursing program in Indonesia
    by Christine L. Sommers, Grace Solely Houghty, Rijanto Purbojo, Innocentius Bernarto

    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.

  • Online ‘chatting’ interviews: An acceptable method for qualitative data collection
    by Joko Gunawan, Colleen Marzilli, Yupin Aungsuroch

    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.

  • Oral feeding skills in premature infants: A concept analysis
    by Dyah Dwi Astuti, Yeni Rustina, Dessie Wanda

    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.

  • The effect of Benson relaxation application (‘Bens app’) on reducing fatigue in patients with breast cancer undergoing chemotherapy: A quasi-experimental study
    by Hendra Dwi Cahyono, Dewi Irawaty, Muhamad Adam

    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.

  • Prevalence of depression in patients with end-stage renal disease undergoing hemodialysis in Saudi Arabia: A cross-sectional study
    by Lujain Sallam, Fatmah Alsharif, Sarah Abaalalaa, Rawan Alakeely, Zahraa Abdullah, Zahra Alkhamis, Najla Sindi, Loujain S Sharif

    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.

  • Factors associated with the choice of delivery place: A cross-sectional study in rural areas of Indonesia
    by Haerawati Idris

    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.

  • Nurse managers’ views regarding patients’ long waiting time at community health centers in Gauteng Province, South Africa
    by Solly Ratsietsi Makua, Sisinyana Khunou

    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.

  • The relationship between screen time exposure and the presence of anxiety-related disorders among adolescents during the COVID-19 pandemic: A cross-sectional study
    by Rasha Rashad Alsaigh, Ghadeer Essam Assas , Nashwa Hussain Yahia , Najwan Faisal Sharaf , Shahad Fareed Shaikh, Hadeel Majed Alghamdi, Hanan Abdullah Badr, Salmah Awad Alghamdi

    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.

  • Effectiveness of art-based distraction in reducing pain and anxiety of hospitalized children during cannulation procedure: A randomized controlled trial
    by Sherzad Khudeida Suleman, Akram Atrushi, Karin Enskär

    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.

  • Prevalence of depression and its related factors among older adults in Indonesian nursing homes
    by Indra Gunawan, Xuan-Yi Huang

    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.

  • Combatting workplace violence against nurses in Bangladesh
    by Silvia Ferdousi, Moustaq Karim Khan Rony

    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.

  • Exploring the beliefs of caregivers about the caregiving experiences of children with acute lymphoblastic leukemia in Malaysia
    by Agnes Shu Sze Chong, Ahmad Mahadir, Alias Hamidah, Iqbal Hussain Rizuana, Lateh Afifi, Caryn Mei Hsien Chan

    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.

  • Characteristics of effective nurse educators from Thai nursing students’ perspectives
    by Ausanee Wanchai, Chanakan Sangkhamkul, Benchamaphorn Nakamadee

    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.

  • Persistent post-surgical pain and its relationship to health-related quality of life in Pakistani women after breast cancer surgery
    by Rukhsana Bibi, Khomapak Maneewat, Hathairat Sangchan, Wipa Sae-sia

    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.

  • Lived experiences of older adults while working in the academe amidst the COVID-19 pandemic: The Philippine context
    by Lovelyn G. Tipon, Jose Mari Louis Alforque, Jezyl C. Cutamora

    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.

  • Transitional care interventions to reduce emergency department visits in older adults: A systematic review
    by Latifah Jehloh, Praneed Songwathana, Wipa Sae-Sia

    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

  • Relationships between caregiving stress and sleep quality among family caregivers of older adults with dementia in Thailand
    by Panawat Sanprakhon, Nujjaree Chaimongkol, Pornpat Hengudomsub

    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.

  • Creating the future of nursing in the post-pandemic world
    by Colleen Marzilli

    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.

  • Social environment support to overcome loneliness among older adults: A scoping review
    by Riksa Wibawa Resna, Widianti Widianti, Wahyu Nofiantoro, Rachmayanti Iskandar, Dwi Meilina Ashbahna, Royani Royani, Susi Susilawati

    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.

  • Fertility tracking tool for visually impaired and non-visually impaired women: A qualitative study
    by Roselyn M. Butalid, Reynaldo M. Vequizo, Pamela F. Resurreccion

    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.

  • Human-In-The-Loop (HITL) application design for early detection of pregnancy danger signs
    by Melyana Nurul Widyawati, Ery Hadiyani Puji Astuti, Kurnianingsih Kurnianingsih

    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.

  • Children’s psychosocial state after the 2018 Lombok earthquake
    by Ariyanti Saleh, Budi Anna Keliat, Herni Susanti, Heni Dwi Windarwati, Framita Rahman, Ahmad Sapoan, Fitrawati Arifuddin

    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.

  • Prevalence, severity, and self-management of depressive mood among community-dwelling people with spinal cord injury in Nepal
    by Mandira Baniya, Luppana Kitrungrote, Jintana Damkliang

    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.

  • The mechanism of anger and negative affectivity on the occurrence of deviant workplace behavior: An empirical evidence among Malaysian nurses in public hospitals
    by Maslina Mansor, Rashidah Mohd Ibrahim, Asyraf Afthanorhan, Ahmad Munir Mohd Salleh

    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.

  • Development of a clinical learning model to enhance patient safety awareness competency among Thai nursing students
    by Jutarat Bandansin, Danulada Jamjuree, Manat Boonprakob, Saisamorn Chaleoykitti

    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.

  • Characteristics of interactive communication between Pepper robot, patients with schizophrenia, and healthy persons
    by Feni Betriana, Ryuichi Tanioka, Tomoya Yokotani, Kazuyuki Matsumoto, Yueren Zhao, Kyoko Osaka, Misao Miyagawa, Yoshihiro Kai, Savina Schoenhofer, Rozzano C. Locsin, Tetsuya Tanioka

    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.

  • Relation between socio-demographic factors and professionalism among nurses in Saudi Arabia: A comparative analysis
    by Hussein Alshumrani, Bander Albagawi, Sandro Villareal, Benito Areola Jr, Hamdan Albaqawi, Saleh Algamdi, Abdulrahman Alerwi, Ahmed Saad Altheban, Seham Alanazi

    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.

  • Knowledge, attitude, and practice of surgical site infection prevention among operating room nurses in southwest China
    by Wen Feng, Wipa Sae-Sia, Luppana Kitrungrote

    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.

  • “I can live a normal life”: Exploring adherence to antiretroviral therapy in Indonesian adolescents living with HIV
    by Nuraidah Nuraidah, Dessie Wanda, Happy Hayati, Imami Nur Rachmawati, Agung Waluyo

    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.

  • Quality of life among mothers of preterm newborns in a Malaysian neonatal intensive care unit
    by Swee Leong Ong, Kim Lam Soh, Emni Omar Daw Hussin, Salimah Japar, Kim Geok Soh, Ponpun Vorasiha, Azlina Daud

    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.

  • Life skills and sexual risk behaviors among adolescents in Indonesia: A cross-sectional survey
    by Ati Surya Mediawati, Iyus Yosep, Ai Mardhiyah

    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 Theory of Family Caregiving
    by Alfredo Feliciano, Evelyn Feliciano, Daisy Palompon, Ferdinand Gonzales

    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.

  • Cross-culture adaptation and validation of the Indonesian version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0)
    by Lilis Suryani, Santhna Letchmi, Faridah Binti Moch Said

    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.

  • Greater accountability in nursing handover
    by Yusrita Zolkefli

    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.

  • Aging-related Resiliency Theory Development
    by Evelyn Feliciano, Alfredo Feliciano, Daisy Palompon, Amira Boshra

    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.

  • Suicide prevention: A qualitative study with Thai secondary school students
    by Surachai Chaniang, Kamonnat Klongdee, Yupared Jompaeng

    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.

  • Exploring the issues, practices, and prospects of family planning among married couples in Southern Philippines
    by Sittie Mairah H. O Ali, Ashley A. Bangcola, Athena Jalaliyah Derico Lawi

    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.

  • Healthcare professionals’ opinions regarding health coaching for patients with diabetes: A pilot exploration in Indonesia
    by Niken Safitri Dyan Kusumaningrum, Fatikhu Yatuni Asmara, Devi Nurmalia

    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.

  • Aesthetics in nursing practice as experienced by nurses in Indonesia: A phenomenological study
    by Feni Betriana, Waraporn Kongsuwan, Rina Mariyana

    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.

  • The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh
    by Reva Mondal, Yajai Sitthimongkol, Nopporn Vongsirimas, Natkamol Chansatitporn, Kathy Hegadoren

    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.

  • Nursing diagnoses in hospitalized patients with COVID-19 in Indonesia
    by Nur Hidayati, Farhan Hadi, Suratmi Suratmi, Isni Lailatul Maghfiroh, Esti Andarini, Henri Setiawan, Yudisa Diaz Lutfi Sandi

    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.

  • Determinants of latent tuberculosis infection among nurses at public health centers in Indonesia
    by Meira Erawati, Megah Andriany

    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.

  • Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke
    by Nuengruethai Posri, Boonjai Srisatidnarakul, Ronald L Hickman

    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.

  • Sustaining e-caring leadership in a post-pandemic world
    by Joko Gunawan, Colleen Marzilli, Yupin Aungsuroch

    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.

  • Nurse workforce scheduling: A qualitative study of Indonesian nurse managers’ experiences during the COVID-19 pandemic
    by Kartika Mawar Sari Sugianto, Rr. Tutik Sri Hariyati, Hening Pujasari, Enie Novieastari, Hanny Handiyani

    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.

  • Evaluation of the integrated model of the rational drug use into the Bachelor of Nursing Science program in Thailand: A mixed-methods study
    by Kamolrat Turner, Kanoklekha Suwannapong, Phawida Putthikhan, Sukjai Charoensuk, Matanee Radabutr, Naruemol Angsirisak, Streerut Thadakant, Laddawon Vaisurasingha, Suntharawadee Theinpichet

    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.

  • Perceptions of nurse managers and staff nurses regarding Technological Competency as Caring in Nursing theory in general hospitals in Japan
    by Youko Nakano, Tomoya Yokotani, Feni Betriana, Chihiro Kawai, Hirokazu Ito, Yuko Yasuhara, Tetsuya Tanioka, Rozzano Locsin, Misao Miyagawa

    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.

  • Predictors of nurses’ caring practice for critically ill patients in critical technological environments: A cross-sectional survey study
    by Yinglan Li, Waraporn Kongsuwan

    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.

  • Malaysian nurses’ knowledge and attitudes regarding BRCA genetic testing
    by Kien Ting Liu, Wan Rosilawati Wan Rosli, Azlina Yusuf, Soon Lean Keng

    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.

  • Correlates of evidence-based nursing practice among nurses in Saudi Arabia: A structural equation model
    by Mohammad H Abuadas

    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.

  • Aesthetic expressions as data in researching the lived-world of children with advanced cancer
    by Barbara Lyn Galvez, Waraporn Kongsuwan, Savina O. Schoenhofer, Urai Hatthakit

    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.

  • Selected factors related to physical activity among persons with heart failure in a university-affiliated hospital, Bangkok, Thailand
    by Sittigorn Saiwutthikul, Apinya Siripitayakunkit, Sumolchat Duangbubpha

    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.

  • Assessing the financial burden of hemodialysis treatment in Malaysia
    by Nur Fatin Aqilah Mohd Fadzli, Ali Aminuddin Mohd Rasani, Soon Lean Keng

    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.

  • Transitional care programs to improve outcomes in patients with traumatic brain injury and their caregivers: A systematic review and meta-analysis
    by Amelia Ganefianty, Praneed Songwathana, Kittikorn Nilmanat

    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.

  • Resilience among nurses working in paediatric wards in Brunei Darussalam: A qualitative study
    by Nur Raihan Ramli, Hjh Siti Nor'ainah Hj Mohd Noor, Yusrita Zolkefli

    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.  

  • “I am afraid that others will feel scared and disgusted with me. So, I will keep it a secret until I die”: A qualitative study among patients with tuberculosis receiving DOTS regimen in Thailand
    by Apinya Koontalay, Wanich Suksatan, Kantapong Prabsangob

    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.

  • Nurses’ view of the nature of the support given to parents in the neonatal intensive care unit
    by Syazwana Mohd. Sidek, Sofiah Marup, Yusrita Zolkefli

    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.  

  • Relationship between quality of work-life, resilience and burnout among nursing professionals during COVID-19 pandemic in Iran: A cross-sectional study
    by Hosein Zahednezhad, Armin Zareiyan, Sanaz Zargar Balaye Jame

    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.

  • Validation of a Thai version of the Hope Scale among patients with acute myocardial infarction
    by Ampika Inyoo, Rapin Polsook

    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.

  • Development of a nursing assessment form for patients with diabetes mellitus in a hospital: A research and development study
    by Anita Joeliantina, Dwi Adji Norontoko, Hepta Nur Anugrahini

    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.

  • Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam
    by Van Thi Hai Nguyen, Aurawamon Sriyuktasuth, Warunee Phligbua

    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.

  • Establishing appropriate sample size for developing and validating a questionnaire in nursing research
    by Joko Gunawan, Colleen Marzilli, Yupin Aungsuroch

    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.

  • Understanding stigma and coping strategies among HIV-negative Muslim wives in serodiscordant relationships in a Javanese community, Indonesia
    by Yeni Lufiana Novita Agnes, Praneed Songwathana

    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.

  • Mental health nurses’ views of ward readmission: A focus group study in Brunei Darussalam
    by Karmayunika Khamsiah Haji Kassim, Mas Salina Haji Md Safar, Agong Lupat, Yusrita Zolkefli

    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.  

  • Nephrology nurses’ views in giving a dietary recommendation for dialysis patients: An interview study
    by Siti Norhayati Hj Emran, Yusrita Zolkefli

    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.  

  • The relationship between knowledge and self-efficacy of nurses regarding early initiation of cardiopulmonary resuscitation and automated defibrillation in Saudi Arabia
    by Zainah D Alaryani, Aisha Alhofaian, Mona Elhady

    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.  

  • Experiences of front-line nurses caring for patients with COVID-19 in Bangladesh: A qualitative study
    by Moustaq Karim Khan Rony, Shuvashish Das Bala, Md. Moshiur Rahman, Afrin Jahan Dola, Ibne Kayesh, Md. Tawhidul Islam, Israth Jahan Tama, Emdadul Haque Shafi, Shamima Rahman

    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.

  • Job satisfaction of foreign-educated nurses in Malaysia: A cross-sectional study
    by Su Yen Lee, Kim Lam Soh, Salimah Japar, Swee Leong Ong, Kim Geok Soh, Yuko Tsujita

    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.

  • The war on COVID-19 and vaccination mandates: Ethical code of conduct
  • The importance of providing palliative care for patients with severe COVID-19 in Indonesia
    by Christantie Effendy, Martina Sinta Kristanti

    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.

  • Self-management: A comprehensive approach to improve quality of life among people living with HIV in Indonesia
    by Achmad Fauzi, Nofa Anggraini, Novy Fatkhurohman

    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.

  • Psychosocial factors and burnout among oncology nurses in Brunei Darussalam: A pilot study
    by Fatin Afiqah Jais, Teo Yan Choo, Hasnan Kahan, Shanti Shahbudin, Khadizah H Abdul-Mumin, Hanif Abdul Rahman

    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.

  • Willingness of university nursing students to volunteer during the COVID-19 pandemic in Brunei Darussalam
    by Amal Atiqah Hamizah Hj Abdul Aziz, Khadizah H. Abdul-Mumin, Hanif Abdul Rahman

    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.

  • Effect of care for child development training on cadres’ knowledge, attitude, and efficacy in Yogyakarta, Indonesia
    by Akhmadi Akhmadi, Sunartini Sunartini, Fitri Haryanti, Ema Madyaningrum, Mei Neni Sitaresmi

    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.

  • Using a mobile application (“PrimaKu”) to promote childhood immunization in Indonesia: A cross-sectional study
    by Nani Nurhaeni, Siti Chodidjah, Robiyatul Adawiyah, Astuti Astuti

    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.

  • Illness cognition and depression among patients with coronary heart disease
    by Aan Nuraeni, Anastasia Anna, Atlastieka Praptiwi, Donny Nurhamsyah

    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.

  • The experience of older persons with mental health conditions who interact with healthcare robots and nurse intermediaries: The qualitative case studies
    by Tetsuya Tanioka, Feni Betriana, Tomoya Yokotani, Kyoko Osaka, Rozzano C. Locsin, Beth King, Savina Schoenhofer

    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.

  • Senior nurses’ perceptions of essential soft skills for novice nurses in a private hospital in Jakarta, Indonesia: A phenomenological study
    by Ernawati Ernawati, Cicilia Nony Ayuningsih Bratajaya

    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.

  • Citizens’ health practices during the COVID -19 pandemic in Indonesia: Applying the health belief model
    by Eko Winarti, Chatarina Umbul Wahyuni, Yohanes Andy Rias, Yudied Agung Mirasa, Sondang Sidabutar, Desi Lusiana Wardhani

    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.

  • Nurse education today: Between teaching and publication focus
    by Joko Gunawan, Yupin Aungsuroch, Mary L Fisher

    “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.

  • Recovery from ‘schizophrenia’: Perspectives of mental health nurses in the Eastern island of Indonesia
    by Fandro Armando Tasijawa, Suryani Suryani, Titin Sutini, Sinthia Rosanti Maelissa

    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.

  • Social stigma towards nurses: Time to refocus on what matters most
  • Assessment of the quality of independent nursing practice in Indonesia based on total quality management indicators
    by Devi Sahputra, Paul Lumbantobing, Cyruz P. Tuppal

    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.

  • Coping style, anxiety level, organizational support, and work commitment of educators during the COVID-19 pandemic in the Philippines: A mixed-methods study
    by Norhidayah A. Aragasi, Hamdoni K. Pangandaman

    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.

  • DAHAGA: An Islamic spiritual mindfulness-based application to reduce depression among nursing students during the COVID-19 pandemic
    by Meidiana Dwidiyanti, Badrul Munif, Agus Santoso, Ashri Maulida Rahmawati, Rikhan Luhur Prasetya

    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.

  • Self-control in old age: A grounded theory study
    by Laarni A. Caorong

    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.

  • “Accessibility”: A new narrative of healthcare services for people living with HIV in the capital city of Indonesia
    by Mahathir Mahathir, Wiwin Wiarsih, Henny Permatasari

    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.

  • Influence of self-esteem, psychological empowerment, and empowering leader behaviors on assertive behaviors of staff nurses
    by Ryan Michael F Oducado

    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.

  • Lived experiences of Overseas Filipino Worker (OFW) nurses working in COVID-19 intensive care units
    by Jane Marnel Pogoy, Jezyl Cempron Cutamora

    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.

  • The effect of warm compresses on perineal tear and pain intensity during the second stage of labor: A randomized controlled trial
    by Soumaya Modoor, Howieda Fouly, Hawazen Rawas

    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.

  • Implementation of nursing case management to improve community access to care: A scoping review
    by Alenda Dwiadila Matra Putra, Ayyu Sandhi

    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 development of Spiritual Nursing Care Theory using deductive axiomatic approach
    by Ashley A. Bangcola

    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.

  • Common ethical dilemmas of family caregivers of palliative patients in Indonesia
    by Martina Sinta Kristanti, Kusmaryanto Kusmaryanto, Christantie Effendy

    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.

  • Developmental assessment and early intervention for children with developmental delays: A case study in South Australia
    by Mardiyanti Mardiyanti, Amanda Case

    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.

  • Reflections on International Nurses Day: Current status, issues, and the future of nursing in Indonesia
  • Knowledge, attitude, and practice towards COVID-19 among student nurses in Manila, Philippines: A cross-sectional study
    by Earl Zedrick S Quisao, Raven Rose R Tayaba, Gil P Soriano

    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.

  • Psychometric properties of Quality-of-Life Index for Vietnamese women with breast cancer three weeks postmastectomy
    by Xuan Thi Nhu Ha, Sureeporn Thanasilp

    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.

  • Symptom experience of adverse drug reaction among male and female patients with newly diagnosed pulmonary tuberculosis in Thailand
    by Apichaya Thontham, Rapin Polsook

    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.

  • Barriers to exclusive breastfeeding: A cross-sectional study among mothers in Ho Chi Minh City, Vietnam
    by Nhan Thi Nguyen, Huong Thi Do, Nhu Thi Van Pham

    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.

  • Factors related to Internet and game addiction among adolescents: A scoping review
    by Siripattra Juthamanee, Joko Gunawan

    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.

  • The development of Need–Threat Internal Resiliency Theory in COVID-19 crisis utilizing deductive axiomatic approach
    by Jonaid Mustapha Sadang, Daisy R Palompon

    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.

  • Developing an android-based application for early detection of postpartum depression symptoms in Indonesia
    by Irma Nurbaeti, Moch Syafii, Kustati Budi Lestari

    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.

  • Social stigma towards nurses taking care of patients with COVID-19 in Indonesia: A mixed-methods study
    by Marisa Junianti Manik, Siska Natalia, Theresia Theresia

    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.

  • Violence against nurses: A serious issue in Indonesia
  • A Proposed Theory of Symptom Cluster Management
    by Jerick Batin Tabudlo

    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.

  • Health literacy and health-promoting behaviors among adults at risk for diabetes in a remote Filipino community
    by Christian Sandor B. Ydirin

    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.

  • Working alliance among mental health nurses in Indonesia: A comparative analysis of socio-demographic characteristics
    by Iyus Yosep, Henny Suzana Mediani, Linlin Lindayani

    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.

  • Knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia: A qualitative study in an urban community in Indonesia
    by Nyimas Heny Purwati, Yeni Rustina, Bambang Supriyatno

    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.

  • Relationships between symptom control, medication management, and health literacy of patients with asthma in Vietnam
    by Doan Thi Kim Cuc, Nonglak Methakanjanasak, Ho Thi Thuy Trang

    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.

  • A year later: Life after the Year of the Nurse
  • Nursing handover in the Indonesian hospital context: Structure, process, and barriers
    by Krisna Yetti, Nani Asna Dewi, Sri Herni Wigiarti, Dina Warashati

    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.

  • Nursing ethics education in Brunei Darussalam – Where are we today?
  • Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia
    by Hamdan Mohammad Albaqawi, Vincent Edward Butcon, Bander Saad Albagawi, Richard Dennis Dayrit, Petelyne Pangket

    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.

  • Experience of healthcare workers in combatting COVID-19 in Indonesia: A descriptive qualitative study
    by Ramadhan Tosepu, Joko Gunawan, Devi Savitri Effendy, Muhammad Rustam HN, Febriana Muchtar, Ambo Sakka, Diah Indriastuti

    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.

  • Nurses’ roles in palliative care: An Islamic perspective
    by Edy Suprayitno, Iwan Setiawan

    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.

  • Protective role of resilience on COVID-19 impact on the quality of life of nursing students in the Philippines
    by Jean Nunez Guillasper, Ryan Michael Flores Oducado, Gil Platon Soriano

    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.

  • Diploma in Nursing or Bachelor of Science in Nursing: Contradictory issues among nurses in Bangladesh
  • Media use and behavioral disorders among Saudi Arabian children
    by Salmah Alghamdi, Duaa Bawageeh, Hessa Alkhaibari, Amwaj Almutairi, Shoug Aljuhani

    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.

  • Stress, adversity quotient, and health behaviors of undergraduate students in a Thai university during COVID-19 outbreak
    by Bovornpot Choompunuch, Wanich Suksatan, Jiraporn Sonsroem, Siripong Kutawan, Atittiya In-udom

    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.

  • Relationship between hand hygiene behavior and Staphylococcus aureus colonization on cell phones of nurses in the intensive care unit
    by Meri Afridayani, Yohana Ika Prastiwi, Khudazi Aulawi, Ibrahim Rahmat, Hera Nirwati, Haryani Haryani

    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.

  • Factors influencing readmission among Thais with myocardial infarction
    by Rapin Polsook, Yupin Aungsuroch

    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.

  • SCHOOL HEALTH PROMOTION: A QUASI-EXPERIMENTAL STUDY ON CLEAN AND HEALTHY LIVING BEHAVIOR AMONG ELEMENTARY STUDENTS IN JAYAPURA, PAPUA, INDONESIA
    by Ellen Rosawita Veronica Purba, Lely Lusmilasari, Janatin Hastuti

    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.

  • LIVED EXPERIENCES OF ELDERLY REMARRIED WIDOWS: ADJUSTMENT AND COPING TO NEW ROLES AS BI-PARENT
    by Abdullah Junior Serad Mangarun

    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.

  • KNOWLEDGE AND ATTITUDES TOWARD PEOPLE WITH DEMENTIA AMONG NURSING STUDENTS IN YOGYAKARTA, INDONESIA
    by Salsabilla Rohadatul ‘Aisy Sunaryo, Azam David Saifullah, Sri Mulyani

    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.

  • THE RELATIONSHIP BETWEEN THE COTININE LEVEL IN URINE AND VITAMIN D IN THE UNIVERSITY STUDENTS
    by Ayse Berivan Bakan, Naim Uzun, Senay Karadag Arli, Metin Yıldız

    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.

  • ASSESSING CARPAL TUNNEL SYNDROME AMONG ADMINISTRATIVE STAFF OF A HIGHER LEARNING INSTITUTION: A PRELIMINARY STUDY
    by Muhammad Kamil Che Hasan, Muhammad Shazwan Azman, Zulkhairul Naim Bin Sidek Ahmad, Farrah Ilyani Che Jamaludin, Mohd Khairul Zul Hasymi Firdaus

    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.

  • ONE YEAR OF THE COVID-19 PANDEMIC: NURSING RESEARCH PRIORITIES FOR THE NEW NORMAL ERA
  • APPRECIATING POSITIVITY OF COVID-19
    by Joel Rey Ugsang Acob

    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.

  • NURSES’ PERSPECTIVES ON THE DEGREE OF MISSED NURSING CARE IN THE PUBLIC HOSPITALS IN HAIL CITY, KINGDOM OF SAUDI ARABIA
    by Mohammed Hamdan Alshammari, Haidee Pacheco, Eddieson Pasay-an, Farhan Alshammari, Abdalkareem Alsharari, Ebaa Felemban, Richard Dennis Dayrit

    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.

  • “SU JOK” THERAPY AND SCLEROLOGY PROFILE MONITORING FOR MANAGING CHEST PAIN AT HOME WHILE AVOIDING HOSPITAL ADMISSION DURING THE COVID-19 PANDEMIC: A CASE STUDY
    by Intansari Nurjannah

    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.

  • IS TELENURSING A SOLUTION FOR MANAGING THE IMPACT OF COVID-19 ON THE MENTAL HEALTH OF SCHOOL-AGED CHILDREN?
  • THE MENTAL HEALTH CARE MODEL TO SUPPORT THE COMMUNITY DURING THE COVID-19 PANDEMIC IN THAILAND
    by Onpicha Ketphan, Siripattra Juthamanee, Sarah Jane Racal, Dussanee Bunpitaksakun

    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.

  • CONCEPT ANALYSIS OF MATERNAL-FETAL ATTACHMENT
    by Endang Koni Suryaningsih, Meei-Ling Gau, Wantonoro Wantonoro

    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.  

  • COVID-19: PRAISE IS WELCOME, BUT NURSES DESERVE A PAY RISE
  • THE ADVENT OF ANTHROPOMORPHIC INTELLIGENT MACHINES: A BOON TO NURSING OR ITS NEMESIS?
  • PSYCHOMETRIC PROPERTIES OF SPIRITUAL INDEX OF WELL-BEING AMONG FILIPINO WOMEN WITH BREAST CANCER
    by Gil P Soriano

    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.

  • ERRATUM TO: 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
    by Ismail Fahmi, Elly Nurachmah

    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

  • THE CORRELATION BETWEEN RELIGIOSITY AND SELF-EFFICACY IN PATIENTS WITH CORONARY ARTERY DISEASE
    by Wantiyah Wantiyah, Firda Romadhonia Putri Rivani, Mulia Hakam

    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.

  • ERRATUM TO: KNOWLEDGE, ATTITUDE, AND PRACTICE OF COUGH ETIQUETTE IN PATIENTS WITH TUBERCULOSIS IN THE COMMUNITY HEALTH CENTERS
    by Desy Indra Yani, Yayat Fajar Hidayat, Afif Amir Amrullah

    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

  • NURSES’ COMPLIANCE ON PATIENT HANDOVER PROCESS IN THE PRE-OPERATIVE ROOM OF THE HOSPITAL IN VIETNAM
    by Nhut Minh Nguyen, Xuan Thi Nhu Ha, Katrina Einhellig

    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.

  • SELF-MANAGEMENT BEHAVIOR AND ITS IMPACT TO GLYCATED HEMOGLOBIN AMONG CLIENTS MEDICALLY DIAGNOSED WITH DIABETES MELLITUS: A CORRELATIONAL STUDY
    by Somsak Thojampa, Joel Rey Ugsang Acob

    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.

  • MITIGATING THE PSYCHOLOGICAL AND MENTAL HEALTH IMPACT ON FRONTLINE WORKERS DURING COVID-19
  • A RANDOMIZED CONTROLLED TRIAL ON THE ISLAMIC-BASED PROGRAM USING FAMILY APPROACHES IN PREVENTING ADOLESCENTS’ SMOKING BEHAVIOR IN INDONESIA: A STUDY PROTOCOL
    by Fithria Fithria, Muhammad Adlim, Syarifah Rauzatul Jannah, Teuku Tahlil

    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

  • EFFECT OF CARDIAC ARREST MANAGEMENT TRAINING ON THE ABILITY OF ORDINARY PEOPLE TO PERFORM HIGH-QUALITY CARDIO PULMONARY RESUSCITATION
    by Meliana Nurvitasari, Janes Jainurakhma, Zulfikar Muhammad

    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.

  • FACTORS INFLUENCING COMPETENCY DEVELOPMENT OF NURSES AS PERCEIVED BY STAKEHOLDERS IN VIETNAM
    by Do Thi Ha, Khanitta Nuntaboot

    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.

  • EFFECT OF GROUP-BASED HOPE INTERVENTION ON DEPRESSION IN FEMALE INMATES
    by Mei Rianita Elfrida Sinaga, Megah Andriany, Artika Nurrahima

    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.

  • COVID-19: A BALINESE VIEWPOINT
  • ERRATUM TO: FACTORS RELATED TO DEPRESSION AMONG OLDER PEOPLE LIVING IN CIMAHI, WEST JAVA PROVINCE, INDONESIA
    by Kiki Gustryanti, Sunanta Thongpat, Sonthaya Maneerat

    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

  • ERRATUM TO: CAREGIVERS’ EXPERIENCE IN MEETING SELF-CARE NEEDS OF ADOLESCENTS WITH AUTISM SPECTRUM DISORDER: A QUALITATIVE STUDY
    by Lilis Lestari, Elisabeth S Herini, Indria Laksmi Gamayanti

    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.

  • KNOWLEDGE, ATTITUDE, AND HEALTHCARE-SEEKING BEHAVIOR AMONG FAMILIES OF CHILDREN WITH TUBERCULOSIS
    by Muhammad Reza Saputra, Windy Rakhmawati, Sri Hendrawati, Fanny Adistie

    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.

  • ARE INDONESIAN NURSES READY FOR HEALTHCARE ROBOTS DURING THE COVID-19 PANDEMIC?
    by Feni Betriana, Tetsuya Tanioka, Rozzano Locsin, Hema Malini, Devia Putri Lenggogeni

    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.

  • THE ROLE OF CHLOROQUINE AND PSYCHOSOCIAL SUPPORT IN A PATIENT WITH COVID-19: A CASE REPORT IN INDONESIA
    by Ade Dilaruri, Ira Rahmawati

    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.

  • THE EFFECTIVENESS OF LOCAL WISDOM-BASED COUNSELING TO PREVENT IRON DEFICIENCY ANEMIA AMONG PREGNANT WOMEN: A PROTOCOL OF A RANDOMIZED CONTROLLED TRIAL
    by Darmawati Darmawati, Tongku Nizwan Siregar, Hajjul Kamil, Teuku Tahlil

    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

  • VALIDATION OF ELDERLY ABUSE ASSESSMENT TOOL
    by Joel Rey Ugsang Acob

    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).

  • THE RELATIONSHIP OF EMOTIONAL INTELLIGENCE, WORKPLACE CULTURE, AND NURSE PERFORMANCE IN A PRIVATE HOSPITAL IN MEDAN INDONESIA
    by Fajar Amanah Ariga, Jenny Marlindawani Purba, Mahnum Lailan Nasution

    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.

  • AN INTERVENTION PROGRAM TO IMPROVE NURSES’ COMPETENCIES IN DISASTER RESPONSE: A MIXED-METHODS STUDY PROTOCOL
    by Cut Husna, Hajjul Kamil, Mustanir Yahya, Teuku Tahlil

    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

  • EXTENT OF HEMODIALYSIS NURSES’ PRESENCE AS PERCEIVED BY PATIENTS
    by Ma. Almira Pliego Nebres, Clarence Bien Ladion Nebres, Bienvisa Ladion Nebres

    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.

  • EFFECT OF PROGRESSIVE MUSCLE RELAXATION ON SLEEP QUALITY AMONG PATIENTS WITH CHRONIC DISEASES: A LITERATURE REVIEW
    by Syafa'atun Mirzanah, Sri Yona, Debie Dahlia

    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.

  • LIVED EXPERIENCE OF NURSES IN CARING FOR PERSONS WITH OUT-OF-HOSPITAL CARDIAC ARREST IN RURAL AREAS OF EAST JAVA INDONESIA: A PHENOMENOLOGICAL STUDY
    by Janes Jainurakhma, Mochamad Soleh, Ni Luh Dewi Ayu Sita, Ika Yuli Astuti

    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.

  • NURSING RESEARCH PRIORITIES IN INDONESIA AS PERCEIVED BY NURSES
    by Lely Lusmilasari, Yupin Aungsuroch, Widyawati Widyawati, Sunisa Sukratul, Joko Gunawan, Melyza Perdana

    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.

  • WHAT ROLES DO INDONESIAN NURSES PLAY IN THE EARLY IDENTIFICATION AND INTERVENTION OF CHILDREN WITH DEVELOPMENTAL DISABILITIES? A QUALITATIVE STUDY
    by Mardiyanti Mardiyanti, Lesley Cuthbertson, Paul Jewell

    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.

  • NURSING THE NURSED: ADDRESSING COVID-19 PANDEMIC CRISIS IN THE CUEN THEORY PERSPECTIVE
    by Joel Rey Ugsang Acob

    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.

  • ‘WASH YOUR HAND!’: THE OLD MESSAGE FROM FLORENCE NIGHTINGALE TO BATTLE COVID-19
  • QUALITY OF LIFE OF FAMILY CAREGIVERS OF CHILDREN WITH LEUKEMIA: A DESCRIPTIVE QUANTITATIVE STUDY
    by Ikeu Nurhidayah, Sri Hendrawati, Dewi Pratiwi Hasriyadhi

    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.

  • BONDING AND ATTACHMENT EXPERIENCE AMONG POSTNATAL MOTHERS WITH SPONTANEOUS CHILDBIRTH
    by Fauziah H Wada, Yayi Suryo Prabandari, Elsi Dwi Hapsari

    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.

  • THREE NOTICEABLE ISSUES ON NOVEL CORONAVIRUS: A QUICK LOOK FROM VIETNAM’S CIRCUMSTANCES
  • THE EFFECT OF ORAL CARE INTERVENTION ON ORAL HEALTH STATUS OF INTUBATED PATIENTS IN THE INTENSIVE CARE UNIT
    by Diah Tika Anggraeni, Ayu Trisna Hayati, Aan Nur'aeni

    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.  

  • EFFECTIVENESS OF DIABETIC FOOT EXERCISES USING SPONGES AND NEWSPAPERS ON FOOT SENSITIVITY IN PATIENTS WITH DIABETES MELLITUS - CORRIGENDUM
    by Siti Fadlilah, Adi Sucipto, Nazwar Hamdani Rahil

    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

  • EFFECT OF USING AN ANDROID-BASED MODULE ON KNOWLEDGE AND ATTITUDE OF NURSING STUDENTS ABOUT THE PROVISION OF TRANSCULTURAL NURSING
    by Apriani Susmita Sari, Elsi Dwi Hapsari, Widyawati Widyawati

    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.

  • COMPARISON OF THE EFFECTS OF REMINISCENCE THERAPY ALONE AND IN COMBINATION WITH PSYCHOEDUCATION THERAPY ON DEPRESSION LEVEL OF ELDERLY IN INDONESIA: A QUASI-EXPERIMENTAL STUDY
    by Sutinah Sutinah

    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.

  • EFFECTIVENESS OF DIABETIC FOOT EXERCISES USING SPONGES AND NEWSPAPERS ON FOOT SENSITIVITY IN PATIENTS WITH DIABETES MELLITUS
    by Siti Fadlilah, Adi Sucipto, Nazwar Hamdani Rahil

    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.

  • EFFECT OF LAUGHTER THERAPY ON DEPRESSION LEVEL IN ELDERLY IN A NURSING HOME, NORTH SUMATRA, INDONESIA
    by Rinco Siregar, Rumondang Gultom

    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.

  • OPTIMIZING NURSING DOCUMENTATION AS AN EFFECTIVE METHOD TO EXPRESS NURSING
  • PSYCHOMETRIC EVALUATION OF FILIPINO VERSION OF PATIENT SATISFACTION INSTRUMENT
    by Gil P Soriano, Kathyrine A Calong Calong

    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.

  • APPLICATION OF HEALTH PROMOTION MODEL FOR BETTER SELF-CARE BEHAVIOR IN PATIENTS WITH DIABETES MELLITUS
    by Made Mahaguna Putra, Kusnanto Kusnanto, Candra Panji Asmoro, Tintin Sukartini

    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.

  • AN ELDERLY’S PERSPECTIVE ON THE IMPACT OF SPIRITUALITY TOWARDS DEATH ACCEPTANCE
    by Minnie Besin Mamauag

    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.

  • THE EXPERIENCES OF STAKEHOLDERS IN SUPPORTING THE IMPLEMENTATION OF THE MENTAL HEALTH COMMUNITY RECOVERY PROGRAM IN WEST JAVA PROVINCE INDONESIA
    by Gebi Elmi Nurhayati, Raden Bayu Kusumah, Bandu Murwasuminar

    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.

  • EFFECT OF A WORKBOOK IN HEALTH EDUCATION ON SELF-EFFICACY AND QUALITY OF LIFE OF PATIENTS WITH CORONARY HEART DISEASE
    by Aan Nuraeni, Ristina Mirwanti, Anastasia Anna

    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.

  • DIFFERENCE OF BOWEL SOUND RETURN TIME AMONG POST-LAPARATOMY SURGERY PATIENTS AFTER CHEWING GUM
    by Warisya Miftah Amanda, Chandra Isabella Hostanida Purba, Ristina Mirwanti

    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.

  • COMPARISON OF TWO TURNING REGIMENS (1 VERSUS EVERY 2 HOURS) IN THE PREVENTION OF CONSTIPATION IN PATIENTS WITH STROKE
    by Nur Hidayati, Tintin Sukartini, Padoli Padoli

    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.

  • COMPARATIVE ANALYSIS BETWEEN NURSING CORE COMPETENCY STANDARDS OF AUSTRALIA AND THE PHILIPPINES
    by Rainier C. Moreno-Lacalle

    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.

  • THE RISK OF SMARTPHONE ADDICTION TO EMOTIONAL MENTAL DISORDERS AMONG JUNIOR HIGH SCHOOL STUDENTS
    by Rizky Setiadi, Tini Tini, Edi Sukamto, Umi Kalsum

    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.

  • EFFECT OF NANDA-I, NIC, AND NOC DOCUMENTATION SYSTEM TRAINING ON QUALITY OF NURSING CARE DOCUMENTATION IN THE PERINATAL WARD OF YOGYAKARTA REGIONAL PUBLIC HOSPITAL
    by Enny Eko Setyaningrum, Intansari Nurjannah, Anik Rustiyaningsih

    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.

  • SOCIAL SUPPORT OF PARENTS OF CHILDREN WITH LEUKEMIA
    by Nursyamsiyah Nursyamsiyah

    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.

  • PERCEPTION OF NURSES IN DECISION-MAKING PROCESS IN PALLIATIVE CARE FOR PATIENTS WITH CANCER IN PUBLIC HEALTH CENTERS
    by Atsarina Fauzan, Sri Setiyarini, Christantie Effendy, Martina Sinta Kristanti

    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.

  • FACTORS ASSOCIATED WITH HEPATITIS B AND C CO-INFECTION AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN VIETNAM
    by Le Hieu Thuy Anh, Suchada Thaweesit

    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.

  • FACTORS RELATED TO THE SUCCESSFUL TREATMENT OF TUBERCULOSIS: A LITERATURE REVIEW
    by Kusuma Wijaya Ridi Putra, Chanandchidadussadee Toonsiri

    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.

  • KNOWLEDGE, PERCEPTION, AND BURDEN OF FAMILY IN TREATING PATIENTS WITH SCHIZOPHRENIA WHO EXPERIENCE RELAPSE
    by Suryani Suryani, Eka Wahyu Ningsih, Aan Nuraeni

    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.

  • UNDERSTANDING CLASSIC, STRAUSSIAN, AND CONSTRUCTIVIST GROUNDED THEORY APPROACHES
    by Windy Rakhmawati

    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.

  • PERCEPTIONS AND ATTITUDE ON USING SOCIAL MEDIA RESPONSIBLY: TOWARD SOCIAL MEDIA LITERACY IN NURSING EDUCATION
    by Ryan Michael Flores Oducado, Mhonica Reyes Sales, Aira Joy Piz Magarzo, Patricia Mae Arboleda Panes, Joreem Theus Paniza Lapastora

    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.

  • MASCULINITY, ILL HEALTH, HEALTH HELP-SEEKING BEHAVIOR AND HEALTH MAINTENANCE OF DIABETIC MALE PATIENTS: PRELIMINARY FINDINGS FROM BRUNEI DARUSSALAM
    by Deeni Rudita Idris, Nur Shazwana Hassan, Norashikin Sofian

    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.

  • “THIS IS 2019! BUT I STILL NEED TO WORK DOUBLE SHIFTS AND HAVE MULTIPLE JOBS TO KEEP ME ALIVE”: A PHENOMENON AMONG NURSES IN INDONESIA
  • VALIDATION OF NURSING OUTCOMES’ INDICATORS OF NURSING OUTCOMES CLASSIFICATION OF SELF-CARE FOR PATIENTS WITH STROKE
    by Sri Mulyani, Intansari Nurjannah

    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.

  • UTILIZATION OF A SOCIAL MEDIA PLATFORM TO DEVELOP CONTINUING EDUCATION PROGRAMMING FOR PROMOTING NURSING PRACTICE IN CAMBODIA
    by Karen Simon Reed

    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.

  • VALIDITY AND RELIABILITY OF NURSING INTERVENTION CLASSIFICATION: SELF-CARE ASSISTANCE ON PATIENTS WITH STROKE
    by Intansari Nurjannah

    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.

  • A NURSING REHABILITATION PROGRAM TO IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH MENINGIOMA: A NARRATIVE REVIEW
    by Amelia Ganefianty, Sri Yona

    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.

  • DEGREE OF SUSPICION OF PERIPHERAL ARTERY DISEASE AMONG GERIATRICS AND POLICEMEN IN ILIGAN CITY, PHILIPPINES
    by Jan Igor Temple Galinato

    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.

  • EMANCIPATION THROUGH NURSING WITHIN THE CONTEXT OF HEALTH DISPARITIES
    by Rainier C. Moreno-Lacalle, Rozzano C Locsin

    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.

  • PATIENTS’ AND NURSES’ PERCEPTIONS OF PALLIATIVE CARE OUTCOMES: A COMPARATIVE STUDY
    by Dewiyuliana Dewiyuliana, Sri Warsini, Christantie Effendy

    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.

  • BARRIERS TO ADHERENCE TO EXPANDED PROGRAM ON IMMUNIZATION AMONG PARENTS IN LANAO DEL NORTE, PHILIPPINES
    by Geraldine Sabate Ridad

    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.

  • VIEWPOINT: NURSES PREPARATION IN THE ERA OF THE FOURTH INDUSTRIAL REVOLUTION
  • MALAY CULTURAL PRACTICE AND CHILDBIRTH WITH TRADITIONAL BIRTH ATTENDANTS: A QUALITATIVE STUDY IN WOMEN OF PRODUCTIVE AGE IN WEST BORNEO INDONESIA
    by Lilis Lestari, Ramadhaniyati Ramadhaniyati

    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.

  • THE RELATIONSHIP BETWEEN NURSES' PERCEPTIONS AND SELF-EFFICACY IN IMPLEMENTING PALLIATIVE CARE IN THE INTENSIVE CARE UNIT
    by Theresia Avila Kurnia, Yanny Trisyani, Ayu Prawesti

    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.

  • A LITERATURE REVIEW IN TRIAGE DECISION MAKING: SUPPORTING NOVICE NURSES IN DEVELOPING THEIR EXPERTISE
    by Kurnia Putri Yuliandari

    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.

  • THE CORRELATION BETWEEN FAMILY FUNCTIONING AND QUALITY OF LIFE OF CAREGIVER OF CHILDREN WITH LEUKEMIA
    by Annisha Fadhilla, Ikeu Nurhidayah, Fanny Adistie

    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.

  • FACTORS ASSOCIATED WITH PARTICIPATION OF NURSES IN EARLY DETECTION OF CERVICAL CANCER<