Belitung Nursing Journal最新文献

Background: Leprosy remains a persistent public health challenge, especially in endemic areas, where its historical association with stigma continues to harm social participation and psychosocial well-being. Understanding how stigma affects social participation across different life areas is crucial for developing effective care and public health strategies.

Objective: To examine the association between stigma and social participation across different domains among people affected by leprosy.

Methods: A cross-sectional, quantitative study was conducted in 2019 with 97 individuals affected by leprosy followed at eight municipal reference units in Recife, Pernambuco, Brazil. Sociodemographic, environmental, and clinical data were collected using structured instruments and medical records. Stigma was assessed using the Explanatory Model Interview Catalogue (EMIC), and social participation was evaluated using the Participation Scale (PS). Data were analyzed using descriptive statistics, Spearman's correlation, chi-square tests for linear trend, and effect size estimation using Cramér's V. Statistical significance was set at p <0.05.

Results: A total of 53.6% of participants presented some degree of restriction in social participation. The mean stigma score was 16.63 (SD = 8.53), and the mean participation score was 16.58 (SD = 13.62). A statistically significant, low-magnitude correlation was observed between stigma and participation restriction scores (Spearman's rho = 0.25; p = 0.016). Categorical analysis demonstrated a significant linear association between higher stigma tertiles and greater participation restriction (χ² for trend, p = 0.022), with a low overall effect size (Cramér's V = 0.20; 95% CI: 0.10-0.36). Moderate effect sizes were observed in specific participation domains, including religious and community activities (Cramér's V = 0.24; p = 0.02), visiting other people in the community (Cramér's V = 0.26; p = 0.01), and perceived respect within the community (Cramér's V = 0.29; p = 0.04).

Conclusion: Stigma was significantly associated with restricted social participation among people affected by leprosy. Although the overall association showed low magnitude, moderate and statistically significant associations were observed in key social domains. These findings support the inclusion of stigma and social participation assessments in routine leprosy care and highlight the need for integrated clinical, psychosocial, and community-based nursing and health interventions aimed at reducing stigma and promoting social inclusion.

Background: Chronic pain is a common and burdensome condition among older adults, significantly impacting their quality of life and increasing interest in complementary and alternative medicine (CAM) approaches to pain management.

Objectives: This study aimed to describe the prevalence of CAM use and attitudes toward CAM for self-managing chronic pain among older adults, and to examine the associations between chronic pain characteristics, CAM use, and attitudes toward CAM.

Methods: A cross-sectional study was conducted among 289 hospitalized patients aged ≥60 years with chronic pain at a general hospital in Da Nang, Vietnam, in 2025. Data were collected using a structured questionnaire that included the Pain Disability Index (PDI) and the Attitudes towards CAM scale. Statistical analyses included t-tests, ANOVA, chi-square tests, and Pearson's correlation.

Results: CAM use was reported by 92.7% of participants, with biologically based therapies (e.g., herbal remedies) being the most common (81.3%). The average attitude score toward CAM was 28.7 (SD = 3.2), indicating generally favorable views. CAM use was more frequently reported among participants experiencing pain in specific anatomical locations, including the arm/hand, neck, upper back, and lower back (all p <0.008 after Bonferroni correction). Attitudes toward CAM were modestly associated with perceived pain control ability (p = 0.031) and with the impact of chronic pain on daily life (r = 0.206; p <0.001), while other pain characteristics showed no significant associations.

Conclusion: CAM is widely used and positively perceived among older Vietnamese adults with chronic pain. Associations were observed between certain pain characteristics and CAM use, as well as between pain-related interference and attitudes toward CAM. These findings highlight the importance of routinely assessing CAM use in older adults and providing guidance on safe, evidence-based options within comprehensive pain management, while recognizing the observational nature of the data.

Background: The use of alternative health care among people with diabetes remains widespread, especially in rural areas of West Kalimantan, Indonesia. In the Malay ethnic community, alternative health care is not just an issue of access but also deeply rooted in cultural and spiritual practices. However, limited research has explored the symbolic meanings and socio-cultural dynamics that underlie the consistent use of alternative health care by people with diabetes.

Objective: This study aimed to explore the cultural recognition and socio-cultural meanings embedded in the use of AHC among Malays with diabetes in West Kalimantan, Indonesia.

Methods: A focused ethnography was conducted from July to November 2024 using in-depth interviews, focus group discussions (FGDs), observations, and field notes. A total of 45 participants took part in interviews, including people with diabetes, healthcare providers, traditional healers (Tabib), family members, healthcare volunteers, and community leaders. FGDs comprised five groups, and observations included nine participants. Data were analyzed through content, typology, and matrix analysis. To ensure trustworthiness, triangulation and member checking were employed. The study was guided by three theoretical frameworks: Symbolic Interactionism, Cultural Theory, and Critical Social Theory.

Findings: Four main themes emerged: (1) cultural logic and illness meaning, in which illness was viewed as a spiritual and moral imbalance; (2) symbolic meanings in alternative health care practices, highlighting ritual healing and spiritual faith; (3) social structures as pillars of healing, where family and community roles legitimized alternative health care; and (4) social processes that created cultural recognition through intergenerational transmission and community validation.

Conclusion: Recognizing AHC culturally is essential for understanding the illness experiences of people with diabetes. For nursing practice, these findings emphasize the importance of providing culturally respectful care, fostering open communication between healthcare providers and people with diabetes, and incorporating alternative healthcare approaches into safe, evidence-based health education.

Background: Excessive gestational weight gain can adversely affect maternal and fetal health. Dietary behavior change can help control gestational weight gain and prevent adverse pregnancy outcomes.

Objective: This study aimed to examine the effect of the Capability-Opportunity-Motivation Behavior (COM-B) model of dietary behavior program on gestational weight gain.

Methods: This single-blind randomized controlled trial used a pre-posttest control group design and included 96 pregnant women from a northern province of Thailand. Participants were randomly assigned equally to the experimental and control groups (48 each) using permuted block randomization. The experimental group received a 14-session COM-B model of dietary behavior program, while the control group received usual care. Data were collected via questionnaires between November 2023 and October 2024, and were analyzed using SPSS version 26, employing descriptive and inferential statistical methods.

Results: At 36 weeks' gestation, pregnant women in the experimental group had a significantly lower mean difference in gestational weight gain based on the Institute of Medicine (IOM) recommendation compared with both their baseline at 20 weeks and the control group. After adjusting for maternal age and education, the experimental group continued to show significantly lower gestational weight gain than the control group. The adjusted intention-to-treat analysis indicated a mean difference of -2.227 kg (95% CI: -3.75 to -0.70; p = 0.005; partial η² = 0.084), while the adjusted per-protocol analysis showed a mean difference of -2.648 kg (95% CI: -4.31 to -0.99; p = 0.002; partial η² = 0.110). These results suggest that the COM-B model of dietary behavior program effectively limited gestational weight gain, independent of sociodemographic differences. Even modest reductions in gestational weight gain may contribute to lowering the risk of pregnancy complications such as gestational diabetes and preeclampsia. Dietary behavior change was monitored, but not a predefined secondary outcome.

Conclusion: The COM-B model of dietary behavior program led to minimal but potentially clinically relevant reductions in gestational weight gain. The findings highlight the clinical relevance of nurse-led interventions, underscoring the need for nurse training to implement the program in routine antenatal care.

Trial registry number: Thai Clinical Trials Registry (TCTR20230907001).

Background: Nursing students often experience high levels of stress during clinical training, particularly in maternal and child health (MCH) rotations, which may affect learning and well-being. Understanding stress levels, stressors, and coping strategies can inform the development of supportive and culturally appropriate educational approaches.

Objective: To assess perceived stress levels, identify clinical stressors, and examine coping strategies among nursing students during MCH clinical rotations in Saudi Arabia.

Methods: A cross-sectional study was conducted in 2024 among 187 female nursing students enrolled in MCH clinical rotations. Data were collected using validated Arabic versions of the Perceived Stress Scale (PSS-10), the Nursing Student Clinical Stressor Scale (NSCSS), and the Brief COPE Inventory. Descriptive statistics and Spearman's rho correlation analyses were performed using SPSS.

Results: Most students reported moderate perceived stress (75.4%), with a mean PSS-10 score of 20.5 ± 5.9. The highest stressor domains were MCH-specific challenges (9.13 ± 5.00), academic pressures (8.72 ± 3.95), and the clinical environment (7.65 ± 3.64). Religion (5.20 ± 2.06) and acceptance (4.79 ± 1.80) had the highest mean scores among coping strategies, while substance use was least reported (3.04 ± 1.40). Self-blame showed the strongest association with total clinical stressors (rho = 0.501, p <0.001).

Conclusion: Female nursing students experienced moderate stress during MCH clinical rotations, largely related to clinical and academic demands. Coping strategies were predominantly emotion-focused, with self-blame showing a strong association with higher stress levels. These findings highlight the importance of culturally sensitive support strategies in nursing education.

Background: Emergency department nurses face substantial occupational stress due to frequent exposure to high-risk, unstable, and unpredictable clinical environments. However, research on nurses' professional quality of life (ProQOL) has largely focused on other specialties, leaving ED nurses underrepresented. Addressing this gap is essential to improving professional well-being and job satisfaction.

Objective: This study aimed to examine the associations between family care, organizational support, psychological resilience, and ProQOL among emergency department nurses.

Methods: A cross-sectional study was conducted from July 6 to July 31, 2024, involving 441 emergency department nurses from 18 tertiary hospitals in 16 cities in Anhui Province, China. Data were collected using anonymous paper-based questionnaires and analyzed using descriptive statistics, t-tests, one-way ANOVA, Kruskal-Wallis H tests, Pearson's correlation analysis, and multiple linear regression.

Results: Compassion satisfaction differed significantly by sex (Z = -2.677, |d| = 0.231, p = 0.007), professional level (H = 17.675, η² = 0.035, p < 0.001), and number of night shifts (H = 10.571, η² = 0.022, p = 0.005). Burnout scores varied significantly by professional level (H = 8.861, η² = 0.016, p = 0.012), number of night shifts (H = 8.357, η² = 0.021, p = 0.015), and presence of chronic illness (Z = -2.029, |d| = 0.437, p = 0.042). Secondary traumatic stress differed significantly according to chronic illness history (Z = -2.232, |d| = 0.341, p = 0.026). Family care, organizational support, and psychological resilience were positively correlated with compassion satisfaction (r = 0.382, 0.549, and 0.562, respectively; all p < 0.001) and negatively correlated with burnout (r = -0.333, -0.405, and -0.497, respectively; all p < 0.001). Regression analyses indicated that family care, organizational support, and psychological resilience significantly predicted compassion satisfaction (adjusted R² = 0.458), while burnout was significantly associated with intention to leave the ED, family care, organizational support, and psychological resilience (adjusted R² = 0.358).

Conclusion: The findings provide evidence that family care, organizational support, and psychological resilience are associated with the ProQOL of nurses working in emergency departments. In China, these results offer useful references for regions facing similar emergency care pressures (e.g., high workloads in tertiary hospitals, nurse shortages) to optimize nurse well-being interventions. They also provide a foundation for developing targeted strategies to enhance nurses' professional well-being and job satisfaction.

Background: Loneliness in later life is common and is strongly associated with poorer quality of life (QoL). However, evidence from rural Egypt remains limited, particularly community-based studies that concurrently examine loneliness and QoL and their health, social, religious, and leisure-related determinants. This gap limits the development of culturally appropriate nursing and community interventions for rural older adults.

Objective: To assess the levels of loneliness and QoL and to identify their determinants among community-dwelling older adults in a rural Egyptian setting.

Methods: A cross-sectional descriptive study was conducted between July and September 2023 in a randomly selected rural village in Sharkia Governorate, Egypt. Using multistage probability sampling, 143 community-dwelling adults aged 60 years and older were recruited. Data were collected using structured and validated questionnaires. Descriptive statistics, Pearson correlation coefficients, and multiple linear regression analyses were performed.

Results: Participants had a mean age of 70.87 ± 8.50 years, and 52.4 percent were women. High loneliness was reported by 43.4 percent of participants, while 73.4 percent had low overall quality of life. Loneliness was strongly and inversely correlated with quality of life and was positively correlated with age and disease burden, while quality of life was negatively associated with age and number of chronic diseases and positively associated with education, income, social support, religious rituals, and leisure activities in bivariate analyses (all p <0.001). In exploratory multivariable analyses, quality of life was independently associated with age, education, current employment, number of chronic diseases, social support, and loneliness (R² = 0.743), while loneliness was associated with age, number of visitors, religious rituals, and leisure activities (R² = 0.451).

Conclusion: Loneliness and low quality of life are highly prevalent among community dwelling older adults in rural Egypt and are closely linked to aging, chronic disease burden, social resources, and engagement in meaningful activities. For nursing practice, these findings support the routine screening of loneliness and quality of life in primary and chronic care settings, the integration of social support and activity-based interventions into care plans, and collaboration with community and faith-based organizations to deliver culturally appropriate strategies aimed at reducing loneliness and enhancing quality of life among rural older populations.

Background: Colostomy surgery is the most common method used for the radical treatment and prolongation of life in patients with intestinal diseases. However, patients who undergo a colostomy face various physiological, psychological, and social challenges after the procedure. This necessitates that nurses deliver targeted care tailored to the specific needs of different stages and individual patients.

Objective: This study aimed to understand the experiences of health needs of patients with colostomy in order to effectively improve their quality of life across different phases.

Methods: A longitudinal qualitative study was conducted. Data were collected between July 2022 and March 2023. A total of 15 patients with permanent colostomy were selected to participate in unstructured interviews, guided by the "Timing It Right" framework. Data analysis was conducted using NVivo 12 software following Colaizzi's methods.

Results: The findings were organized according to the five distinct phases of the "Timing It Right" framework. Three key themes were revealed from the analysis: (1) Meeting physiological needs is the basis for patients with colostomy to recover; (2) Satisfying psychological needs is a necessary condition for improving the quality of life of patients with colostomy; (3) Social adaptation needs are effective ways to improve the quality of life of patients with colostomy.

Conclusions: Based on the "Timing It Right" framework, the health status and needs of patients with colostomy differ across the following phases: diagnosis period, perioperative period, discharge preparation period, adjustment period, and adaptation period. This study not only provides a preliminary conceptual model for in-depth investigation of these patients' health needs at each phase but also offers directional guidance for the future development of phase-specific, patient-centered nursing intervention strategies to better address their dynamic health demands.

Background: Children with acute conditions that suddenly worsen need immediate care in the Emergency Room (ER). Family-Centered Care (FCC) is considered the best approach in pediatric nursing, but its implementation in the ER is still limited. This is due to various challenges that can increase child and family anxiety and decrease the quality of nursing care.

Objective: This study aimed to explore nurses' perspectives on the constraints of the health service system in implementing FCC in child care in the ER.

Methods: The study used a qualitative descriptive design. Eleven nurses working in the ER at Mokopido Tolitoli Regional Hospital participated in the study, which were chosen through purposive sampling. Data were collected using semi-structured interviews conducted from July 11 to July 23, 2023. Data were analyzed manually using a thematic approach.

Results: The thematic analysis revealed two main interrelated themes regarding barriers to FCC in the ER: human resource constraints and organizational constraints. Human resource constraints include limited nursing staff, varying educational levels, lack of training or outreach on FCC, lack of competency, and communication barriers. Meanwhile, organizational constraints include high ER workloads, limited nurse time, and a focus on emergency medical procedures rather than a holistic approach. These various barriers lead to suboptimal family involvement in the care of children in the ER.

Conclusion: The implementation of FCC in the ER still faces major challenges. These findings highlight the need for a strategic approach and supportive policies to improve nurse capacity and foster a collaborative and responsive hospital environment for patients' families.

Background: Uncontrolled type 2 diabetes results in major complications that threaten patients' life. Patients with uncontrolled type 2 diabetes often have inadequate health literacy, making them less motivated to perform self-management behaviors for glycemic control. Earlier health literacy interventions were effective in promoting self-management behaviors and reducing blood glucose, but evidence is lacking for those with uncontrolled type 2 diabetes.

Objective: This study aimed to investigate the effect of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes.

Methods: This two-group quasi-experimental study with pre-posttest design was done between September 2024 and June 2025. The participants were 64 patients with uncontrolled type 2 diabetes who lived in a community in a province in central Thailand selected using simple random sampling. The experimental group (n = 32) underwent the health literacy program with eight weekly sessions along with usual care while the control group (n = 32) was given usual care only. Data were collected using a Demographic Data Questionnaire, the Functional, Communicative and Critical Health Literacy Scale, the Self-Management Behavior Scale, and hemoglobin A1C (HbA1C) testing. Data analysis was performed with descriptive statistics, paired t-test and independent t-test.

Results: No significant between-group differences were noted in baseline data. At post-test, the experimental group had a significantly higher mean score of overall health literacy (t = 3.720, Cohen's d = 2.67), functional health literacy (t = 0.399, Cohen's d = 2.43), communicative health literacy (t = 7.90, Cohen's d = 1.76), and critical health literacy (t = 12.972, Cohen's d = 3.14), and self-management behavior (t = 21.862, Cohen's d = 2.84), and a significantly lower level of HbA1C (t = 3.436, Cohen's d = -0.82) than before receiving the program and than the control group (all p <0.01).

Conclusion: This study offers evidence for the program's efficacy in raising health literacy, which in turn improves self-management behavior and decreases HbA1C in patients with uncontrolled type 2 diabetes. Nurses can incorporate program activities in empowering patients for diabetes control by promoting their ability to seek and comprehend health information, communicate effectively during medical visits, and develop critical thinking abilities on diverse health determinants.

Trial registry number: Thai Clinical Trials Registry (TCTR20250624001).