Belitung Nursing Journal最新文献

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and progressive β-cell dysfunction, leading to long-term complications that negatively affect patients' quality of life (QoL). Various demographic, psychological, and clinical factors influence QoL. However, limited research has explored these associations within the sociocultural context of a rural regency in Indonesia, where variations in healthcare access, education, and economic conditions may uniquely affect QoL.

Objective: This study aimed to examine the relationships between clinical and demographic factors and QoL among patients with T2DM.

Methods: A cross-sectional study was conducted from June 2024 to February 2025 with 1,030 adult T2DM patients recruited via purposive sampling. QoL was assessed using the Diabetes Quality of Life Scale (DQOL), and anxiety was measured using the State-Trait Anxiety Inventory (STAI). Additional data on employment status, disease duration, age, and therapy type were collected via structured questionnaires. Data were analyzed using SPSS 27 with univariate, bivariate (chi-square), and multivariate logistic regression analyses. Statistical significance was set at p < 0.05.

Results: Descriptively, most participants were female (90.8%), aged 51-60 years (59.7%), and had completed senior high school (84%). Overall, 61.2% reported good QoL. Anxiety was mild in 73.3% and moderate in 26.7% of participants. Multivariate logistic regression indicated that moderate anxiety (OR = 2.78; 95% CI [1.48-5.25], p = 0.041), disease duration ≥5 years (OR = 10.24; 95% CI [2.13-12.40], p = 0.027), older age (≥50 years) (OR = 8.94; 95% CI [2.15-14.73], p = 0.032), unemployment (OR = 3.66; 95% CI [1.03-13.07], p = 0.030), and insulin therapy (OR = 11.3; 95% CI [2.80-12.60], p = 0.019) were significantly associated with poor QoL. The model showed good fit (Hosmer-Lemeshow χ² = 5.32, p = 0.72) and moderate explanatory power (Nagelkerke R² = 0.24).

Conclusion: Longer disease duration, older age (≥50 years), unemployment, moderate anxiety, and insulin therapy were significantly associated with lower QoL among T2DM patients. These findings emphasize the need for integrated care strategies combining educational, psychosocial, and socioeconomic interventions. Nursing practice should prioritize holistic, patient-centered approaches incorporating psychological support, individualized education, and social empowerment.

Background: Medication errors (MEs) are among the most prevalent healthcare-related incidents. However, many institutions do not report these incidents.

Objective: This study aimed to investigate the proportion of medication error reporting and the associated factors of medication error reporting among healthcare workers (HCWs) in the hospital settings.

Methods: This mixed-methods study used a sequential explanatory design. The quantitative phase involved 122 HCWs, including physicians, nurses, midwives, and pharmacists/pharmacist assistants, and the qualitative phase purposively included 15 of these participants. Data were collected from June to July 2024 at a public hospital in North Lampung, Indonesia, using a self-administered questionnaire and face-to-face in-depth interviews. Quantitative data were analyzed using logistic regression, and qualitative data were analyzed using thematic analysis.

Results: The proportion of medication error reporting among HCWs was found to be 64.7%. Lack of a readily available system for reporting medication errors and fear of being blamed were considered as two of the most common causes of HCWs being hindered from reporting MEs. The logistic regression analysis showed that having experienced any medication administration error and having discovered medication error cases that others committed were significantly associated with medication error reporting. From qualitative data, eight themes emerged: 1) monitoring and evaluation, 2) teamwork, 3) self-motivation, 4) organizational culture, 5) rewards and penalties, 6) lack of facilities, 7) lack of understanding about MEs, and 8) fears.

Conclusion: The study found a relatively high rate of medication error reporting, indicating that HCWs have an intrinsic motivation to report. However, systemic barriers, such as the lack of a supportive infrastructure and fear of retribution, remain major challenges. Developing a user-friendly, digital medication error reporting system with an anonymous option is recommended to mitigate fear and providing institution-wide training on patient safety culture and reporting procedures to address knowledge gaps.

Background: In Japan, patients receiving treatment in advanced acute care hospitals often cannot return home immediately and require ongoing hospitalization. Sequential support is crucial to facilitate long-term recovery and community reintegration. Therefore, functional assessments should extend beyond physical function to include daily activities and participation. However, how nurses across different hospital types in Japan evaluate patients' functional status using a standardized framework remains unclear.

Objective: This study examined how nurses in hospitals with varying care functions assess patients' functional status, focusing on the application of the International Classification of Functioning, Disability, and Health (ICF) framework.

Methods: A cross-sectional survey with a qualitative component was conducted in accordance with the STROBE guidelines. Participants were 200 registered nurses in Japan, each with at least three years of clinical experience. Data were collected from February to March 2025 through an online survey using a commercial research firm's verified panel of licensed nurses. Quantitative data were analyzed using descriptive statistics, chi-square tests, and one-way analysis of variance (ANOVA). In addition, open-ended responses were analyzed qualitatively to capture contextual perspectives on functional assessment.

Results: No significant differences were observed in discharge planning practices among the four hospital types. The Functional Independence Measure was most frequently used in recovery-phase hospitals (p <0.001). Across all hospital types, assessments focused primarily on body functions and structures, while activities and participation domains received comparatively less attention. Qualitative analysis indicated that the focus of patient handovers varied by hospital function, reflecting institutional roles and priorities.

Conclusion: Although discharge planning practices were comparable across hospital types, functional assessments remained concentrated on physical aspects, with limited attention to broader domains critical for long-term recovery. These findings highlight the need for a more comprehensive and standardized use of the ICF framework to support patients' social reintegration and continuity of care across healthcare settings.

Background: Diabetic foot ulceration (DFU) is a common and serious complication in people with type 2 diabetes mellitus (T2DM), leading to morbidity, lower-extremity amputation, and reduced quality of life. Effective interventions focusing on glycemic control, foot care, and exercise are essential to prevent DFU.

Objective: This study aimed to evaluate the effectiveness of the 12-week Self-Efficacy Enhancement for Foot Care Program (SEFP) on HbA1c levels and foot status, including peripheral sensory loss and skin and peripheral vascular abnormalities, in people with T2DM in Thailand.

Methods: A quasi-experimental study with a two-group pretest-posttest design was conducted between October 2019 and January 2020 with 80 participants (40 per group) recruited from two public health centers in Bangkok. The experimental group received SEFP plus usual nursing care, while the control group received only usual nursing care. The SEFP included diabetes education, behavior modification, foot care, and 10-chair-pose foot exercises, with home visits, telephone follow-ups, and group discussions. Data collection included demographic questionnaires, HbA1c measurements, and foot status assessments using the Semmes-Weinstein Monofilament and clinical examination of skin and vascular abnormalities. Paired t-tests, independent t-tests, and ANCOVA were used to analyze within- and between-group differences.

Results: Baseline characteristics were comparable between groups. After the intervention, the experimental group showed significant reductions in HbA1c (t = 5.24, p <0.001) and significant improvements in overall foot status (t = -8.75, p <0.001), peripheral sensory loss (t = -2.97, p = 0.005), and skin and peripheral vascular abnormalities (t = -10.32, p <0.001). ANCOVA revealed significant between-group differences in post-intervention HbA1c (F = 30.56, p <0.001) and foot status measures (overall: F = 61.61, p <0.001; peripheral sensory loss: F = 11.76, p <0.001; skin and vascular abnormalities: F = 56.79, p <0.001).

Conclusion: The 12-week SEFP was associated with reductions in HbA1c and improvements in foot status in people with T2DM. This program is potentially recommended for nurses in primary healthcare settings to prevent DFU and enhance clinical outcomes. Long-term studies with objective vascular measures are warranted to confirm sustained effects.

Trial registry number: Thai Clinical Trials Registry (TCTR20250701002).

Background: The Ministry of Health in the Lao People's Democratic Republic (Laos) has developed a national nursing competency framework comprising five domains and 43 items, aligned with the Association of Southeast Asian Nations (ASEAN) core competencies. However, nurses' actual competencies in Laos have not been systematically evaluated.

Objective: This study aimed to develop and validate a measurement scale to assess the clinical competencies of nurses working in healthcare facilities and clinical settings in Laos.

Methods: A self-administered questionnaire was created based on the National Competency for Licensed Nurses in Laos (NCLN) and distributed to 359 nurses in Vientiane Capital and Champasak Province in October 2022. Responses from 355 nurses were analyzed. Construct validity was examined using exploratory factor analysis (EFA). Structural equation modeling (SEM) was then performed solely to evaluate the goodness of fit of the proposed model, rather than to confirm the factor structure. Content validity was verified by expert review, and reliability was assessed using the Spearman-Brown coefficient, Cronbach's alpha, and McDonald's omega (ω).

Results: The EFA identified five factors, comprising 26 items, which explained 73.2% of the variance. The SEM showed an acceptable model fit: χ²(289) = 698.2, p <0.001; GFI = 0.86; AGFI = 0.83; CFI = 0.94; RMSEA = 0.066. Expert review confirmed the content validity. Reliability was high (Spearman-Brown = 0.934; Cronbach's α = 0.880; McDonald's ω = 0.971).

Conclusion: The Lao Clinical Nurse Competency Scale (CAS) demonstrated satisfactory validity and reliability. SEM was used only to assess the model's goodness of fit, and future studies should conduct confirmatory factor analysis (CFA) using independent samples to verify construct validity.

Background: Nursing students frequently encounter education-related stress (ES) arising from demanding academic workloads, clinical responsibilities, and personal adjustments during their training. Persistent stress can negatively impact learning outcomes, clinical performance, and psychological well-being. Emotional intelligence (EI), which involves the ability to perceive, understand, and manage emotions in oneself and others, is recognized as a protective factor that helps individuals regulate stress and adapt to challenges. However, research exploring the relationship between EI and ES among nursing students in Indonesia remains limited.

Objective: This study examined the association between EI and ES among baccalaureate nursing students at a public university in Indonesia.

Methods: A cross-sectional correlational design was conducted from September to November 2024 with 225 participants selected through stratified random sampling. Data were collected using the Indonesian version of the Trait Emotional Intelligence Questionnaire-Short Form and the Indonesian-translated Arabic Higher Education Stress Inventory. Descriptive statistics summarized the levels of EI and ES, while Spearman's correlation, Mann-Whitney U, and Kruskal-Wallis tests were used to assess associations between variables.

Results: Most students demonstrated moderate levels of EI (73.8%) and ES (64%). The median (IQR) scores were 138.00 (29) for EI and 37.00 (8) for ES. A significant negative correlation was found between EI and ES (rₛ = -0.445, p <0.01), indicating that students with higher EI experienced lower stress levels. Among demographic variables, only gender was significantly associated with ES (p = 0.05), with men reporting higher mean ranks than women.

Conclusion: The findings highlight the importance of emotional intelligence in mitigating education-related stress among nursing students. Incorporating EI development into nursing curricula through emotional regulation training, reflective practices, and social-emotional learning strategies can build resilience, improve coping skills, and boost students' academic and clinical performance. Further long-term studies are recommended to investigate the causal relationships and effectiveness of EI-based interventions.

Background: Nurses demonstrate varying levels of self-directed learning competence, which is influenced by multiple individual and contextual factors. Identifying profiles with varying levels of self-directed learning is essential for providing targeted support and training. However, there is limited research exploring the potential profiles of self-directed learning competence among nurses.

Objectives: This study aimed to identify distinct latent profiles of self-directed learning competence among nurses and analyze the influencing factors.

Methods: A cross-sectional study design was used. Nurses were recruited using a convenience sampling from four tertiary hospitals in Guangzhou, China, between August 2024 and February 2025. The Self-Directed Learning Competence Scale for Nurses was used to assess the self-directed learning Competence of nurses. Latent profile analysis was performed to identify different potential profiles. Pearson's chi-square test and multinomial logistic regression were used to explore the factors influencing self-directed learning competence.

Results: A total of 740 nurses participated. Three latent profiles of self-directed learning competence were identified: low (n = 356, 48.1%), medium (n = 291, 39.3%), and high (n = 93, 12.5%). The self-directed learning competence of nurses was influenced by various factors, including Junior college and below (OR = 0.555, p= 0.043); Monthly number of night shifts = 3~4 (OR = 2.859, p = 0.029); Learning atmosphere = neutral (OR = 0.342, p = 0.018) and good (OR = 0.412, p = 0.038); Learning willingness (OR = 1.425, p <0.001), Difficulty of title promotion = difficult (OR = 2.628, p = 0.029) and Job stress (OR = 0.981, p <0.001).

Conclusion: The study revealed diverse profiles of self-directed learning competence among nurses. Nursing managers should design differentiated strategies based on these profiles. Enhancing organizational support and stimulating learning motivation can help improve nurses' self-directed learning competence, thereby promoting their professional development and improving the overall quality of clinical nursing care.

[This corrects the article DOI: 10.33546/bnj.3899.].

Background: Middle adolescents with conduct problems (CP) are at higher risk for aggression than their peers. However, factors contributing to this phenomenon remain insufficiently understood, particularly in Indonesia.

Objective: This study aimed to examine the direct and indirect relationships among parental monitoring, self-esteem, self-control, peer deviance, media violence exposure, academic self-concept, and aggression, using Problem Behavior Theory and supported literature review as a conceptual framework.

Methods: A cross-sectional correlational design was employed. Data were collected from May to June 2023 from students aged 14 to 16 years with CP across nine junior high schools in Aceh Province, Indonesia. Instruments included the Parental Monitoring Instrument, Rosenberg Self-Esteem Scale, Brief Self-Control Scale, Deviant Peer Scale, Extended Content-Based Media Exposure Scale, Academic Self-Concept Questionnaire, and Aggression Problem Behavior Frequency Scale Adolescent Rating. Data were analyzed using path analysis with LISREL 8.80 and the Sobel test.

Results: A total of 423 students participated in the study. Self-control and peer deviance were directly associated with aggression (z = -1.93, β = -0.19, and z = 2.41, β = 0.35, p <0.05, respectively). Self-esteem showed an indirect association with aggression, mediated by self-control (z = -1.783, β = -0.795, p = 0.038). Peer deviance mediated the effects of parental monitoring and media violence exposure on aggression (z = 2.126, β = 1.020, p = 0.017, and z = 2.14, β = 1.055, p = 0.017, respectively). The model explained 42 percent of the variance in aggression.

Conclusion: The findings highlight the importance of regular screening for conduct problems and aggression by community nurses and school-based counseling teachers, as well as the development of interventions focusing on peer deviance and self-control, which were identified as the most significant predictors of aggression.