Belitung Nursing Journal最新文献

Background: Father involvement in newborn care is increasingly recognized as a key determinant of infant health and family well-being. In Indonesia, paternal roles in neonatal care are often overlooked, and father-specific educational support remains limited. Understanding fathers' lived experiences and learning needs is essential for developing effective, culturally appropriate interventions.

Objective: This study aimed to explore the experiences and educational needs of Indonesian fathers in newborn care.

Methods: A qualitative descriptive study was conducted using a thematic analysis approach. Sixteen fathers of infants aged 0-12 months were recruited through purposive sampling in Jakarta and the surrounding areas. Data were collected in 2024 through in-depth semi-structured interviews and analyzed using Braun and Clarke's six-step framework. Trustworthiness was ensured through audit trails, member checking, and peer debriefing.

Results: Three major themes emerged: (1) social media as the main source of information, (2) fathers' practical involvement and learning needs in baby care, and (3) preference for visual and practical learning media. Fathers expressed strong motivation to be involved but faced challenges accessing reliable, father-focused educational content. Their learning preferences were shaped by practicality, time constraints, and the need for culturally relevant materials.

Conclusion: Indonesian fathers are eager to participate in newborn care but lack structured educational support tailored to their needs. Pediatric nurses play a critical role in developing father-inclusive, digital, and culturally responsive interventions that enhance paternal self-efficacy and caregiving competence. Future programs should integrate father-focused digital interventions, such as video-based tutorials and podcasts, into pediatric nursing practice to effectively bridge the educational gap.

Background: The high incidence of Drug-Related Problems (DRPs), including medication adherence among patients with chronic diseases, especially during no direct monitoring by health workers, becomes a challenge to therapy success. Home Medication Review (HMR) is an alternative solution in primary healthcare services to avoid further complications.

Objective: This study aimed to analyze DRPs, their affecting factors, and DRP interventions for patients with chronic diseases in primary health centers (Puskesmas) through HMR.

Methods: A quantitative, cross-sectional observational study using purposive sampling was conducted in several Puskesmas in Yogyakarta from February to May 2023. The collaborative HMR involved healthcare providers at each Puskesmas. DRPs were assessed based on observations and semi-structured interviews. The DRP classification followed PCNE V9.1, and medication adherence was measured using both pill counts and self-report via the MARS-10 questionnaire. Data were analyzed using SPSS 25.0 to perform logistic regression with a 95% confidence level.

Results: A total of 544 patients, comprising 269 adults and 275 older patients, were involved. Older patients experienced more DRPs than the adults (94.2% vs 84.8%). The most DRP experienced by both age groups was ineffective therapies, with the two most frequent causes being related to patient factors. Among the adults, hypertension comorbidity, number of medications, and BMI factors were associated with DRPs (p < 0.05). In contrast, no factors correlated with DRPs in the older patients. There was fair agreement between pill count and MARS-10 regarding medication adherence for both adults and older patients (kappa coefficients of 0.298 and 0.355, respectively).

Conclusion: Patients in primary health facilities with hypertension and using at least three medications have over a three-fold increased risk of experiencing DRPs. Healthcare providers, including pharmacists, nurses, and physicians, should collaborate to identify medication-related issues and provide personalized advice and management plans to enhance medication adherence. This study highlights the need for a standardized, structured HMR program, not merely as a patient home visit but also to better control chronic diseases.

Background: Prison health is increasingly recognized as part of community health, especially as the population of incarcerated women grows and presents unique health needs. Yet, evidence on how Thailand's prison health system addresses gender sensitivity, particularly when viewed through the WHO's Six Building Blocks framework, remains limited. This system-level knowledge gap restricts efforts to improve equitable care for women prisoners.

Objective: This study explored health service delivery for women prisoners in Northeastern Thailand from September 2022 to August 2024 through the WHO's Six Building Blocks framework, identifying barriers, enablers, and policy implications for gender-sensitive prison healthcare.

Methods: A qualitative descriptive design was employed. Data were collected through participatory and non-participatory observations, in-depth interviews, and document reviews with 35 informants, and analyzed using the WHO Health System Framework. Trustworthiness was ensured by triangulation, member checking, and prolonged engagement.

Results: The healthcare system encompassed all six WHO building blocks: service delivery, health workforce, health information, access to medicines and technologies, financing, and governance. However, gaps persisted in gender-sensitive services such as gynecological and trauma-informed care, nurse workload, and budget allocation. Initiatives such as telemedicine and the Pansuk Project provided support but were insufficient to address women's specific vulnerabilities.

Conclusion: While structural improvements have been achieved, strengthening gender-sensitive care is necessary. Nurses should integrate trauma-informed and gynecological competencies, supported by better shift management and telemedicine systems. Policy measures, including gender-responsive budgeting and inter-ministerial collaboration, are crucial to the sustainable integration of prison health into national public health.

Background: Maintaining regular physical activity (PA) is a critical challenge for patients undergoing cardiac rehabilitation (CR), as inadequate adherence can lead to adverse outcomes, including disease recurrence. Enhancing motivation is key to improving PA adherence. Motivational interviewing (MI) has been shown to overcome psychological barriers by building intrinsic motivation. However, there is a need to explore how to integrate MI techniques with digital technology to enhance intervention accessibility and leverage the strengths of both approaches.

Objective: This study aimed to evaluate the effects of a hybrid intervention model integrating phone-based motivational interviewing with mobile phone-based management on motivation and physical activity in patients undergoing CR.

Methods: This pilot randomized controlled trial was conducted in China between January and June 2024, involving 52 patients undergoing cardiac rehabilitation. The intervention group (n = 25) received usual care plus a 4-week phone-based motivational interviewing intervention, which included a face-to-face session, weekly phone MI sessions (OARS technique), and personalized support via WeChat. The control group (n = 27) received only usual cardiac rehabilitation guidance. Outcomes measured were steps/day (using a smart band) and motivation, assessed using the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2). Two-way repeated-measures ANOVA was used for data analysis.

Results: Compared with the control group, the intervention group showed a significant interaction effect of Group*Time on both steps/day (p <0.001, ηp² = 0.706) and the BREQ-2 (RAI) (p <0.001, ηp² = 0.349). The intervention group's daily steps significantly increased from 3582.80 ± 649.59 to 9444.79 ± 1413.72 (p <0.001).

Conclusion: This study indicates that a phone-based motivational interviewing intervention delivered by trained researchers can effectively increase physical activity levels and enhance autonomous motivation for PA in CR patients. This approach provides a scalable model for the routine care of cardiac rehabilitation patients, especially in resource-limited settings. For nursing practice, the findings highlight the importance of incorporating MI as a core skill and utilizing a hybrid, technology-supported care model to extend continuous professional support into patients' homes.

Trial registry number: Chinese Clinical Trial Registry (ChiCTR2400079877).

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.