Belitung Nursing Journal最新文献

Background: Bullying victimization among adolescents is a significant public health issue in Indonesia, with limited research on factors such as self-esteem and peer pressure within local cultural contexts.

Objective: This study aimed to identify the factors influencing bullying victimization among early adolescents in junior high schools.

Methods: A cross-sectional study was conducted with 401 junior high school students from March to May 2024. Participants were selected through stratified random sampling, and data were collected using validated instruments, including the Revised Olweus Bully/Victim Questionnaire, Rosenberg Self-Esteem Scale, Peer Pressure Inventory, Depression Anxiety Stress Scales for Youth, and Parent Authority Questionnaire. Descriptive statistics, chi-square tests, and ordinal logistic regression were employed for analysis.

Results: Among participants, 23.2% reported being victims of bullying. Multivariate analysis identified high peer pressure as the strongest predictor of bullying victimization (OR = 5.64, 95% CI = 2.12-15.03, p <0.001), while authoritarian parenting style emerged as potentially protective (OR = 0.34, 95% CI = 0.13-0.87, p = 0.024) compared to authoritative parenting. Self-esteem, depression, and social media use did not demonstrate significant independent associations with victimization in the final model, despite showing significant bivariate relationships.

Conclusion: Peer pressure emerged as the critical predictor of bullying victimization among early adolescents, with authoritarian parenting demonstrating an unexpected protective effect within this cultural context. School-based interventions should prioritize peer-focused strategies while considering culturally specific parenting dynamics. These findings highlight the importance of developing prevention approaches that account for Indonesia's collectivist social framework.

Background: Family caregivers play a crucial role in providing continuous support to individuals with chronic illnesses. Their responsibilities extend beyond the well-being of patients, influencing both patient health outcomes and their own. Caregiving entails significant responsibilities and sacrifices, requiring caregivers to navigate evolving roles and care needs over time. Existing literature highlights the emotional and psychological challenges faced by caregivers, including role transitions and stress. However, most studies focus on caregiving experiences rather than the specific transitional phases caregivers undergo after assuming their responsibilities.

Objective: This study aimed to explore the transitional phases experienced by caregivers of chronically ill patients using an inductive approach, specifically grounded theory methodology.

Methods: This study employed a grounded theory (GT) approach involving 33 participants, including 24 caregivers and nine professional helpers. Data collection and analysis were carried out between April 2022 and January 2024. Participants were recruited through snowball sampling based on predetermined criteria. Data were collected using semi-structured interviews and memos and analyzed using NVivo 12 software. Several measures were undertaken to ensure the validity and reliability of the data.

Results: Findings yielded five stages of life transition, namely, (1) confusion, (2) conflict, (3) consideration, (4) adjustment, and (5) acceptance.

Conclusion: This study contributes to the literature by providing new insight into the life transition phases experienced by family caregivers. It offers meaningful implications for nursing practice, particularly in providing holistic support to family caregivers of individuals with chronic illness. It helps nurses to design more targeted, phase-specific interventions that focus on caregivers' psychosocial needs at each phase. The final model provides a beneficial premise for the development of clinical guidelines and support frameworks that are more responsive to the real experiences of caregivers.

Background: Patients with advanced colorectal cancer (CRC) receiving chemotherapy experience multiple symptoms due to both disease progression and complications of treatment. These symptoms affect the physical, psychological, and social aspects of health-related quality of life (HRQoL). Additionally, contextual variables of patients may also impact HRQoL.

Objective: To test a structural equation model on symptom clusters, contextual variables, and HRQoL in patients with advanced CRC receiving chemotherapy.

Methods: In this cross-sectional study, data were collected from 300 patients with advanced CRC who had received chemotherapy at five hospitals in Bangkok, Thailand, between March 2023 and July 2023. Data collection instruments included a demographic data form, Memorial Symptom Assessment Scale, Multidimensional Scale of Perceived Social Support questionnaire, Palliative Care Outcome Scale, and Functional Assessment of Cancer Therapy-Colorectal questionnaire. Structural equation modeling (SEM) was used to test the model.

Results: SEM showed a good model fit, with χ²/df = 1.15, p = 0.20, CFI = 0.94, TLI = 0.94, RMSEA = 0.03, and SRMR = 0.02. The symptom severity cluster dimension, symptom distress cluster dimension, social support, and palliative care outcomes predicted effects on HRQoL with 78% accuracy. The findings showed that the symptom severity and symptom distress cluster dimensions showed significant negative direct and positive indirect effects on HRQoL. Palliative care outcomes had a significant negative influence on HRQoL. Moreover, social support had direct positive and indirect negative influences on HRQoL.

Conclusions: Symptom clusters, social support, and palliative care outcomes were identified as predictors of HRQoL in patients with advanced CRC receiving chemotherapy. Understanding the SEM of symptom clusters, social support, palliative care outcomes, and HRQoL may help nurses and other healthcare professionals develop effective interventions to better manage symptoms in patients with advanced CRC receiving chemotherapy.

Background: Dementia is a growing public health concern in Thailand, placing significant demands on families, communities, and the healthcare system. Despite national policies supporting integrated care, community-based dementia services face challenges related to resource limitations, caregiver burden, and access to training.

Objective: This study aimed to explore the delivery of dementia care for community-dwelling older adults in Thailand, focusing on care processes, challenges, and support systems from the perspectives of community health nurses (CHNs), village health volunteers (VHVs), and family caregivers.

Methods: A qualitative descriptive approach was used. Twenty-two participants, including CHNs, VHVs, and family caregivers, were purposively selected from a metropolitan district in Thailand. Data were collected through semi-structured interviews and focus group discussions, supplemented by contextual health assessments. Thematic analysis was conducted using Sandelowski's content analysis framework, with rigor ensured through member checking, audit trails, and peer debriefing.

Results: Six categories emerged: 1) Care processes involved integrated services across prevention, promotion, treatment, and rehabilitation, with family playing a central role; 2) Conditional factors included strong cultural values of filial responsibility and provider-community trust; 3) Care outcomes reflected partial independence in older adults, with caregivers experiencing varying levels of well-being and frequent stress due to lack of support and training; 4) Successes were attributed to supportive policies, family dedication, and healthcare providers' intrinsic motivation; 5) Barriers included staff shortages, caregiver health issues, limited training, and insufficient confidence in VHVs; 6) Model development emphasized the need for policy backing, multidisciplinary collaboration, caregiver capacity-building, and dementia-specific community services.

Conclusion: Community-based dementia care in Thailand is driven by cultural commitment and dedicated local health workers but hindered by systemic constraints. Strengthening caregiver education, expanding service networks, and enhancing integrated support systems are critical for improving care quality and reducing caregiver burden. Equipping CHNs and VHVs with dementia-specific training and supporting their role in caregiver education and interdisciplinary coordination can further enhance the effectiveness and sustainability of dementia care in community settings.

Background: For most patients with advanced cancer, an important prerequisite for quality of end-of-life care is understanding their preferences. Nurses reported the challenges in the care process, such as poor communication patterns of sensitive topics. Aesthetic experience values meaningful moments and is sensitive to the impact of different environments and situations. Aesthetic expression enables individuals to transform intuitive cognition into artistic behavior, ultimately expressing real needs through aesthetic cognition, enhanced sensibility, and reflection, thereby promoting improved care quality. However, there is still a lack of studies exploring aesthetic experiences in end-of-life care from the perspective of patients with advanced cancer.

Objective: To explore the aesthetic experiences in end-of-life care as perceived by patients with advanced cancer during hospitalization.

Methods: This study applied a hermeneutic phenomenological approach and was conducted in an oncology unit of a hospital in China. This hospital was the hospital promulgated by the local health department as a pilot hospice care program. The hospital mainly admitted patients with advanced cancer who have given up radiotherapy and chemotherapy after being treated in a higher-level hospital. Data collection spanned from August to December 2023. Ten participants were invited to engage in reflective experiences using the individual face-to-face interviews followed by the creative drawings. The data were analyzed and interpreted following van Manen's approach.

Results: The findings revealed four themes: 1) Dynamic understanding; 2) Cherished relationships; 3) Prioritizing being presentable; 4) Creating a peaceful atmosphere. Patients with advanced cancer present different states at each stage of their disease progression, which requires dynamic understanding to provide more precise care. In addition, their demands for cherished relationships, a presentable style, and a peaceful atmosphere will also increase during this process. We need to pay attention to these moments that are meaningful to them for improving the quality of end-of-life care.

Conclusion: This study explored the aesthetic experiences from the unique experiences of patients with advanced cancer in end-of-life care, thereby using aesthetic elements to create and cultivate a unique end-of-life care ideal, which will stimulate the creativity and respond to the special challenges of end-of-life care.

Background: The Saint Louis University Mental Status (SLUMS) Exam is a commonly used tool for screening cognitive function, particularly for detecting mild cognitive impairment (MCI) and early dementia. It was developed to overcome limitations in existing cognitive assessments by evaluating a broad range of domains, including language comprehension, executive function, memory, and attention. While effective in English-speaking populations, its use in non-English-speaking settings is limited by language and cultural differences. In Thailand, the lack of linguistically and culturally adapted cognitive screening tools can lead to inaccurate assessments. To ensure reliable and valid evaluations in older Thai adults, the SLUMS must be appropriately translated and culturally adapted.

Objective: This study aimed to translate the SLUMS into Thai (SLUMS-Thai) and validate its use among older adults in Thailand.

Methods: The translation process consisted of seven steps: establishing the expert team, synthesizing the translated version, forward translation, pilot testing to ensure clarity, cultural appropriateness testing, blind back-translation, and translation equivalence testing. The study involved 100 older adults. Validation was performed using descriptive statistics, Pearson's correlations, the Index of Item-Objective Congruence (IOC), and Cronbach's alpha coefficients.

Results: The findings showed that cultural appropriateness was assessed using expert evaluations on the relevance and sensitivity of the tool to Thai cultural norms and practices, with the rate of appropriateness at the highest level (Mean = 4.97, SD = 0.71), and translation equivalence was also rated highly (Mean = 4.76, SD = 0.27). The correlation between the original SLUMS and the SLUMS-Thai was strong (r = 0.84 - 0.91). The IOC values for the 11 questions ranged from 0.80 to 1.00, and the Cronbach's alpha coefficient was 0.83, indicating high internal consistency. The tool's ability to differentiate between different cognitive states was proven by the Discriminant Index, which ranged from 0.23 to 0.62.

Conclusion: The SLUMS-Thai demonstrated acceptable content validity and strong psychometric properties that were linguistically and culturally appropriate. As a consequence, the SLUMS-Thai can be used to screen older persons for dementia and mild cognitive impairment in Thailand and may be helpful for modifying interventions for accurate diagnosis and cognitive function assessment.

Background: Juvenile delinquency with a history of alcohol use is a growing concern with a significant impact on their holistic well-being. Life purpose (LP) has been recognized as essential for enhancing adolescent wellness. LP should therefore be useful in addressing juvenile delinquency.

Objective: This quasi-experimental study investigated the effect of the life purpose program on the wellness of juvenile delinquents with a history of alcohol use in Southern Thailand.

Methods: Sixty-seven delinquents, aged 15 to 19, from the Juvenile Detention Center were randomly assigned to either the intervention group (n = 35) or the control group (n = 32). The intervention group engaged in an eight-week purpose program, whereas the control group continued with routine care. Wellness outcomes were measured using the Wellness Scale (WS) and analyzed through multilevel mixed-effects modeling.

Results: At baseline, there were no significant differences in wellness scores between the control and intervention groups. Following the intervention, wellness scores at weeks 16 and 24 were significantly higher in the intervention group compared to the control group (t = -6.101, p <0.001; t = -2.856, p = 0.008, respectively). The multilevel mixed effects model confirmed a significant improvement in wellness scores over time in the intervention group (β = 3.746; 95% CI = 0.22-7.27; p = 0.037).

Conclusion: The program was successful in improving wellness among juvenile delinquents with a history of alcohol use and shows promise for broader application. It should be implemented by nurses and other professionals as part of efforts to promote a sense of life purpose in similar populations. However, further research is needed to evaluate its long-term impact and sustainability. Integrating the life purpose program into existing rehabilitation processes may enhance the overall well-being of juvenile detainees.

Trial registry number: Thai Clinical Trials Registry (TCTR20241217002).

Background: Patients with a history of traumatic life events who enter the healthcare system are especially vulnerable, often posing greater challenges to care delivery. However, little is known about the capacity of nursing staff, especially nursing students, to deliver trauma-informed care (TIC).

Objective: This study aimed to assess the knowledge, attitude, and practice of trauma-informed care among Chinese nursing students.

Methods: A cross-sectional study was employed to survey undergraduate nursing students from a medical college in eastern China. Data were collected using an established self-administered questionnaire on TIC knowledge, attitude, and practice (KAP) consisting of 21 items. The content validity scale-level CVI was 0.950, and the reliability with Cronbach's α coefficient was 0.963.

Results: A total of 118 undergraduate nursing students, ranging from first to fourth year, participated in the survey, and ultimately, 117 students were included in the study, yielding an effective response rate of 99.15%. The average scores for KAP were 70.83±14.58, 77.78±11.11, and 66.67±16.67; however, the good levels of KAP accounted for 16.2%, 45.3% and 6.0%, respectively. Additional analysis showed a weak positive correlation between knowledge and attitude (r_s = 0.211, p = 0.022), while there was a moderate positive correlation between knowledge and practice, attitude and practice (r_s = 0.309, p < 0.001; r_s = 0.310, p < 0.001). Univariate analysis indicated that year of study and experience in caring for trauma patients were significantly related to practice (p = 0.039, p = 0.002).

Conclusion: The students' KAP on trauma-informed care was not at a good level, especially regarding practice and knowledge, and required further strengthening. The findings provide baseline information for further development of a KAP-TIC comprehensive course and exploration of practice ability-centered TIC education for nursing students. Assessing the effectiveness of the newly developed TIC course and learning outcomes in clinical practice is also recommended.

Background: The quality of life (QoL) of family caregivers supporting older persons with functional dependence due to Type 2 Diabetes Mellitus (T2DM) is a growing concern. Accurately assessing caregiver well-being requires culturally appropriate, valid, and reliable instruments. However, such tools remain limited in the Indonesian context.

Objective: This study aimed to translate the Quality of Life Index (QLI) into Indonesian and evaluate the psychometric properties of the Indonesian version (QLI-I) among family caregivers of dependent older persons with T2DM.

Methods: Brislin's back-translation method was used to ensure linguistic and conceptual equivalence in the translation process. Content validity was assessed by a panel of five experts. Psychometric evaluation was conducted on a purposive sample of 394 family caregivers recruited from eleven community health centers in Medan, Indonesia. Construct validity was examined using confirmatory factor analysis (CFA), while convergent validity and construct reliability (CR) were analyzed to assess measurement accuracy.

Results: The Indonesian version of the Quality of Life Index (QLI-I) demonstrated strong construct validity, with standardized factor loadings ranging from 0.707 to 0.870. CFA indicated an acceptable model fit based on the following indices: Root Mean Square Error of Approximation (RMSEA) = 0.067, ratio of chi-square to degrees of freedom (CMIN/df) = 2.779, Comparative Fit Index (CFI) = 0.906, Incremental Fit Index (IFI) = 0.906, Goodness of Fit Index (GFI) = 0.814, and Tucker-Lewis Index (TLI) = 0.898. Composite Reliability (CR) values were high across all domains: Health/Functioning (HF) = 0.957, Family (FA) = 0.876, Social/Economic (SE) = 0.924, and Psychological/Spiritual (PS) = 0.922. Average Variance Extracted (AVE) values met the recommended threshold for each domain: HF = 0.633, FA = 0.586, SE = 0.605, and PS = 0.627. All constructs demonstrated acceptable discriminant validity, confirming the distinctiveness of each domain.

Conclusion: The QLI-I is a valid and reliable instrument for assessing the QoL of family caregivers of dependent older persons with T2DM. Its use in clinical and community settings can support nurses and healthcare professionals in identifying caregiver needs and developing culturally appropriate, evidence-based interventions to enhance caregiver well-being.

Background: Metabolic syndrome (MetS) is a cluster of chronic conditions, including obesity, hyperglycemia, hypertension, and dyslipidemia, known to significantly increase the risk of cardiovascular diseases (CVDs). Effective interventions are needed to control the progression of MetS.

Objective: This study aimed to determine the effectiveness of the Self-Efficacy Enhancement (SEE) program on health behaviors and clinical outcomes in individuals with Metabolic Syndrome (MetS).

Methods: A quasi-experimental study with a two-group pretest-posttest design was conducted from September 2023 to January 2024. A purposive sample of 70 participants with MetS was recruited from two healthcare settings in Thailand. Participants were divided into two groups: an experimental group (n = 35) and a control group (n = 35). The experimental group received the SEE program based on Self-Efficacy Theory, while the control group received only routine nursing care for 12 weeks. Data were collected using a Personal Information questionnaire, a Health Behavior questionnaire, and clinical outcome assessments, including waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol), before and after the 12-week program. Data were analyzed using descriptive statistics, paired t-test, independent t-test, Wilcoxon signed-rank test, Mann-Whitney U-test, and ANCOVA.

Results: Following the SEE program, the experimental group exhibited significant improvements in health behaviors (t = -12.830, p <0.001), a reduction in WC (t = 3.809, p <0.001), decreased SBP (z = -4.554, p <0.001) and DBP (t = -5.178, p <0.001), and an increase in HDL cholesterol (z = -3.193, p <0.001) compared to baseline measures. Furthermore, compared to the control group, the experimental group demonstrated significantly improved health behaviors (F = 193.86, p <0.001), lower WC (F = 19.58, p <0.001), lower FPG (F = 12.39, p <0.001), lower SBP (F = 25.04, p <0.001), lower DBP (F = 19.49, p <0.001), and lower non-HDL cholesterol (F = 8.49, p <0.01). Partial eta-squared (η²) indicated large effects for health behaviors, WC, FPG, SBP, DBP, TC, and HDL cholesterol; non-HDL cholesterol showed a medium effect. TC and HDL cholesterol showed no significant change after completing the program.

Conclusion: The SEE program improved health behaviors and clinical outcomes, supporting its integration into standard MetS care in nursing practice. Through e-health, education, exercise guidance, role modeling, and support, the program can boost confidence in adopting he