Belitung Nursing Journal最新文献

Background: Designing an instrument to assess discharge readiness post-hip surgery is essential due to trends showing poor patient outcomes, such as pain management issues, mobility challenges, and insufficient home support. A structured assessment tool would help ensure patients are better prepared for recovery, reducing the risk of complications and readmission.

Objective: To develop and test the psychometric properties of the Readiness for Hospital Discharge Scale (RHD-HA-9) for hip arthroplasty.

Methods: Items were generated from a comprehensive literature review and individual, face-to-face interviews with experts and patients. A cross-sectional study was conducted across four tertiary governmental hospitals to evaluate the psychometric properties of the scale. Data were collected from a total of 200 older adults who had undergone hip arthroplasty between June 2020 and February 2021. Exploratory Factor Analysis (EFA) was performed on data from 100 older adults to identify the underlying factor structure, followed by Confirmatory Factor Analysis (CFA) on a separate 100-patient dataset to validate the model. The questionnaire's internal consistency, corrected item-total correlations, inter-rater reliability, construct, concurrent, and predictive validity were assessed.

Results: The RHD-HA-9 included nine items, categorized into two factors: the physical performance of hip function and barriers to physical activity. EFA and CFA confirmed these factors, explaining 62% of the total variance. Model fit indices were acceptable (CFI = 0.97, TLI = 0.96, SRMR = 0.04), though RMSEA was 0.12. Chi-square was significant (χ2 = 0.056, df = 24, p <0.001). The scale showed excellent internal consistency (Cronbach's α = 0.89) and stability (ICC = 0.94). ROC analysis identified a cutoff of 9.5, with a sensitivity of 90.7%, specificity of 70.6%, and AUC of 0.89.

Conclusion: The RHD-HA-9 demonstrated strong psychometric properties for assessing discharge readiness in older adults following hip arthroplasty. It identifies patients who need additional support during their transition home. Nurses can use this tool to accurately assess patient needs and implement effective post-discharge care, thereby enhancing patient outcomes.

Background: Early pregnancy ultrasound provides a more accurate estimate of the estimated delivery date (EDD) than the last menstrual period (LMP). However, LMP-based EDD calculation remains common in resource-limited settings. Inaccurate EDDs can contribute to adverse birth outcomes. However, research examining the accuracy of LMP-based EDDs and their association with delivery-related adverse events is limited.

Objective: This study aimed to evaluate the accuracy of self-reported LMP in predicting EDD and its association with adverse events during delivery.

Methods: Data were analyzed from 171 pregnant women participating in the Indonesian Birth Cohort Study based in Makassar, Indonesia. This study utilized a prospective cohort design, employing descriptive statistics and Poisson regression analysis in Stata. Adverse events were defined as any unexpected negative occurrence during delivery, including issues related to healthcare access, birth attendance, and the medical condition of the mother and newborn.

Results: Mode of delivery and categorized differences between actual delivery date and estimated delivery date (ADD-EDD) were significantly associated with adverse events during delivery. Cesarean delivery was associated with a higher risk of adverse events compared to vaginal birth (Adjusted Risk Ratio [ARR] 1.11, 95% CI: 1.02-1.22, p <0.001). Additionally, ADD-EDD differences of ≤-15 days (ARR 1.49, 95% CI: 1.35-1.65), -14 to -8 days (ARR 1.33, 95% CI: 1.19-1.49), and ≥15 days (ARR 1.37, 95% CI: 1.20-1.58) showed an increased risk (all p <0.001). An ADD-EDD difference of 8 to 14 days was marginally significant (ARR 1.20, 95% CI: 1.00-1.44, p = 0.046). The ADD-EDD distribution showed notable gaps, with ADD deviations occurring as early as 109 days before and as late as 45 days after the EDD. On average, the ADD occurred approximately one week earlier (-7.15 days) than the EDD.

Conclusion: Lower accuracy of LMP-based EDDs and delivery mode is associated with increased adverse events during delivery. Transitioning from LMP-based EDDs to more accurate methods is necessary to improve maternal and neonatal care outcomes. Integrating routine early ultrasound for EDD calculation can better equip healthcare providers and nurses to plan deliveries, reduce risks, and improve patient outcomes in resource-limited settings.

Background: In China, the incidence of hypertension rises significantly with age, resulting in a markedly reduced quality of life (QoL) among older patients compared to the general population. Therefore, it is essential for healthcare providers, particularly nurses, to identify the predictive factors that influence QoL in this demographic.

Objective: This study aimed to describe the QoL levels and investigate the predictive power of perceived health status, self-care behavior, and social support on QoL among older patients with hypertension in Wenzhou, China.

Methods: A cross-sectional study was conducted with 131 patients with hypertension aged 60 and above, visiting the Cardiovascular Outpatient Department of The Second Affiliated Hospital of Wenzhou Medical University. Data were collected using validated instruments between November and December 2022 and analyzed using descriptive statistics and stepwise multiple regression.

Results: The overall QoL was moderate (Mean = 75.52, SD = 5.86). Self-care behavior (β = 0.421, p <0.001), social support (β = 0.416, p <0.001), and perceived health status (β = -0.170, p <0.001) were significant predictors of QoL, collectively explaining 82.7% of the variance.

Conclusions: The findings highlight the importance of self-care behavior, social support, and perceived health status as critical factors influencing QoL among older patients with hypertension. Nurses and other healthcare providers should focus on enhancing these areas through targeted education and support initiatives to improve the overall well-being of this vulnerable population.

Metaparadigms differentiate disciplines in terms of how each discipline develops its knowledge and its scholarship. Four domains comprise the nursing metaparadigm: environment, person, health, and nursing. Of these domains, the environment domain is the least identified. Relating this domain to the broader substantive meaning of the geographical-landscape setting of nursing encounters requires further explanation. Through a discursive process, the article positions "space and place" by referencing the nursing environment. The article aims to clarify and explain the expanding reach of the environment domain, extending its definition while recognizing its range of influence in nursing and healthcare. Distinguishing the nursing environment as a well-established domain of the nursing metaparadigm makes nursing practice more visible, valuable, and relevant. Characterized by its impact on discipline-related knowledge development guiding professional practice, the environment domain assumes an integral "space and place" in human healthcare practice.

Background: One of the contributing factors to the high maternal mortality rate is the failure of the referral system, which inhibits the management of obstetric emergencies. Health workers at primary healthcare facilities serve as the gatekeepers of this referral system, and they must be equipped to make referral decisions, prepare referrals, and transport women safely and quickly to the hospital.

Objective: This study aimed to explore the challenges faced by health workers in primary healthcare settings when implementing appropriate and rapid obstetric emergency referrals for women.

Methods: A descriptive qualitative study design was employed, utilizing in-depth interviews with open-ended questions directed at 12 midwives working in health centers and private clinics in urban and rural areas from January to March 2024. The collected data were analyzed manually using content analysis.

Results: Four themes were identified as challenges within the referral system: referral consent, pre-referral care ability, patient transfer to the hospital, and patient admission to the hospital. Factors that worsened the challenges for midwives in implementing obstetric emergency referrals were patients' perceptions of hospital care, the opinions of parents or family members, and levels of self-confidence. Additional factors included experience in emergency care, training, care guidelines, distance and travel time to the hospital, hospital refusals, patient handover mechanisms, and the attitudes of colleagues.

Conclusion: Midwives, as health workers in primary healthcare, are expected to be skilled in addressing various challenges due to their close relationships with women at the forefront of the referral system. Enhancing competence in basic obstetric emergency care, improving communication between health facilities, and encouraging community empowerment are essential. Therefore, effective referrals from these improvements would enable women to receive timely and comprehensive obstetric emergency care. This study provides a foundational framework for developing interventions in health facilities and the community to strengthen the referral system and reduce maternal mortality in Indonesia.

Background: Fatigue following a stroke, known as post-stroke fatigue (PSF), is a frequent complication experienced by individuals recovering from a stroke, with its incidence steadily increasing over time. The long-term presence of PSF significantly hinders the rehabilitation process and quality of life for these individuals. However, the most effective intervention strategies for PSF remain unclear. Therefore, it is crucial to implement appropriate intervention strategies at an early stage to prevent and manage PSF, thereby mitigating its negative impacts and promoting recovery in stroke survivors.

Objective: This scoping review aimed to explore and chart the interventions available for managing post-stroke fatigue in individuals recovering from stroke, providing healthcare professionals with evidence to guide the development of optimal treatments.

Design: A scoping review.

Data sources: This review conducted a systematic search across six databases⎯PubMed, Web of Science, Cochrane Library, Scopus and CINAHL (via EBSCO), and CNKI, for articles published from 10 January 2012 to early May 2024.

Review methods: This review followed the PRISMA-ScR reporting guidelines. Studies were selected based on the PCC framework, focusing on specific participants, concepts, and contexts. Exclusion criteria included ongoing studies without results, articles without full text, posters, reviews, and protocols. Tables and narrative descriptions were used to present relevant information on the interventions and their outcomes during the review process.

Results: Twenty-seven studies were included, categorizing interventions for post-stroke fatigue into ten types: pharmacological treatments, physical activity, physical therapy, cognitive behavioral therapy, respiratory training, music therapy, mindfulness-based stress reduction, health education management, Traditional Chinese Medicine, and environmental enrichment.

Conclusion: The interventions for post-stroke fatigue have demonstrated positive effects in alleviating fatigue symptoms among stroke survivors. However, some approaches have limitations, and the most effective treatment strategy remains unclear. The multidisciplinary collaboration between nurses and healthcare professionals plays a critical role in managing post-stroke fatigue by providing patients with education on fatigue prevention and treatment, along with personalized care plans, including one-on-one or group interventions. Future research should focus on increasing sample sizes and conducting multicenter trials to identify the most effective intervention strategies for managing post-stroke fatigue.

Background: In recent decades, the service sector has become a crucial driver of economic growth globally. However, research highlights the need for implementing a patient-centered design in hospital services and notes the limited literature on patient perceptions of healthcare service quality in Indonesia.

Objective: This study aimed to explore patients' perceptions of healthcare service quality in outpatient settings at a public hospital in Palembang, Indonesia.

Methods: The study employed a qualitative descriptive design, conducting face-to-face, in-depth interviews with 50 outpatients (ages ranging from 34 to 56 years) 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 patient perspectives on healthcare service quality: patients' perceived service quality, perceived value, satisfaction, and revisit intention. Factors influencing patient perceptions included the appearance of hospital staff, the quality of facilities and equipment, staff responsiveness, knowledge, courtesy, and empathy. Additionally, word-of-mouth significantly impacted patients' perceived value of care. Emotional factors, complaints, and trust were found to be crucial in shaping patient satisfaction, while the patient-provider relationship played a significant role in influencing revisit intention.

Conclusion: The research emphasizes the critical role of building strong patient-provider relationships to enhance overall service quality. It highlights the need for healthcare providers and nurses to focus on improving patient engagement and understanding how perceived service quality affects patient loyalty. Strengthening these areas is essential for advancing comfort, safety, and the overall quality of healthcare services.

Background: The craving for sexuality and closeness continues into old age, although the means of expressing it may change. Beyond direct sexual encounters, older adults can express their sexuality through gentle affection, warm embraces, holding hands, and other intimate gestures. However, aging can also impact their sexual experiences.

Objective: This study aimed to explore the lived experiences of sexuality among older adults living in the countryside of Cebu, Philippines, during their senior years.

Methods: A qualitative descriptive phenomenological design was employed. Purposive sampling was used to select ten participants. Data were collected from September to December 2023, and Colaizzi's method of data analysis was applied to ensure thorough interpretation.

Results: Three major themes emerged: 1) Being Centered: An actualized form of sexuality in later years; 2) Being Connected: A strong sense of intimacy in later years; and 3) Being Conveyed: Diversifying expressions of sexuality in later years.

Conclusion: Despite advancing age, older adults can remain active in their intimate relationships and achieve a healthy marital life characterized by life satisfaction. They express their love for their partners by being centered, connected, and attuned to each other's needs and feelings. These findings highlight the importance for geriatric nurses to recognize and support the sexual health and intimacy needs of older adults, facilitating discussions and providing resources that promote overall well-being and quality of life.

Background: Chronic kidney disease (CKD) is a leading cause of death, with a rising incidence worldwide. Effective disease management requires health literacy (HL) interventions to optimize patients' self-management. However, difficulties in communication between patients and healthcare providers often impede improvements in HL. While HL interventions should prioritize enhancing communication quality, current evidence supporting this approach remains limited.

Objective: This study aimed to investigate the effectiveness of a Health Literacy Enhancement (HLE) program on CKD knowledge, self-management behaviors, and clinical outcomes in people with CKD.

Methods: A quasi-experimental study using a two-group pretest-posttest design was conducted from December 2022 to March 2023. Fifty-two participants with stage 3 to 4 CKD, recruited from outpatient CKD clinics in two district hospitals in Central Thailand, were divided into two groups. Participants in the experimental group (n = 25) received the HLE Program based on Baker's HL concept, while the control group (n = 27) received usual care for 12 weeks. Data were collected twice before and after the 12-week program using a demographic form, CKD knowledge, CKD self-management behaviors (SMBs), and clinical outcomes, including blood pressure (BP), hemoglobin A1c (HbA1c), estimated glomerular rate (eGFR), body mass index (BMI), and waist circumference (WC). Data were analyzed using descriptive statistics, Chi-square, Paired t-test, and Independent t-test.

Results: Following the HLE Program, the experimental group had a significantly higher score in CKD knowledge (t = 8.79, p <0.001) and self-management behaviors (SMBs) (t = 7.70, p <0.001). They also achieved a better average estimated glomerular filtration rate (eGFR) (t = 3.14, p <0.01) and had lower systolic blood pressure (SBP) (t = -2.54, p <0.05) and diastolic blood pressure (DBP) (t = -2.05, p <0.05) compared to the control group and their baseline measures. The effect sizes (Cohen's d) were substantial, indicating large effects for CKD knowledge (2.44), self-management behaviors (2.14), and eGFR (0.87), while SBP (-0.71) and DBP (-0.55) indicated medium effects. However, no significant differences were observed in HbA1c, BMI, and WC.

Conclusion: The HLE program can enhance effective patient-provider communication using plain language, leading to significant improvements in CKD knowledge and SMBs, as well as clinical outcomes, including eGFR and BP. Nurses should implement this program to enhance HL in people with CKD, leading to effective self-management and helping slow the progression of the disease.

Trial registry number: Thai Clinical Trials Registry (TCTR20240920001).