Belitung Nursing Journal最新文献

Background: Modern communities increasingly rely on technology, influencing older adults' health and daily life. While technology can enhance quality of life and independence, various barriers limit digital adoption among older adults.

Objective: This study aimed to identify barriers to digital device use among community-dwelling older adults in Abha, Saudi Arabia.

Methods: This study used a cross-sectional survey of 400 adults aged 60 years and older. Data were collected from February to March 2025 on depression (Beck Depression Inventory-II), cognitive status (Saint Louis University Mental Status Examination), and technology-related barriers (Technology Usage Barriers Questionnaire). Data were analyzed using t-tests, one-way ANOVA, effect sizes (Cohen's d, η²), and 95% confidence intervals.

Results: Smartphone users reported significantly higher barriers than feature phone users in personal (8.07 ± 4.50 versus 5.70 ± 5.09; p <0.001; d = 0.50), technical (5.20 ± 4.60 versus 4.20 ± 3.02; p = 0.009; d = 0.25), and environmental domains (1.90 ± 1.30 versus 1.40 ± 1.50; p = 0.001; d = 0.36). Among smartphone users, the highest personal barriers were observed in adults aged 80 years and older (11.3 ± 4.3; η² = 0.075), females (d = 0.48), those with primary education (d = 0.84), low-income individuals (d = 0.44), unemployed participants (d = 1.23), and rural residents (d = 1.24). Education most strongly predicted technical barriers (d = 0.94), while income had the greatest impact on environmental barriers (d = 0.93).

Conclusion: Older adults, especially smartphone users, women, those with lower education, low income, unemployed individuals, and rural residents, face substantial barriers to digital adoption. Tailored digital literacy programs, affordable access, and senior-friendly device design are essential to reduce the digital divide and improve autonomy, inclusion, and quality of life. For nursing practice, these findings emphasize the importance of assessing older adults' digital skills, providing targeted education, and advocating for technology solutions that support engagement and health management.

Background: Low birth weight (LBW) is a persistent public health challenge globally, including in Indonesia, particularly in remote areas like Papua. While biological risks are well documented, the influence of sociocultural factors on LBW infant care remains underexplored. There is a critical gap in understanding how cultural beliefs and family dynamics act as barriers to effective caregiving in these settings.

Objective: This study aimed to explore cultural barriers to the care of LBW infants in Papua, Indonesia.

Methods: A qualitative descriptive design was employed. Data were collected through face-to-face, semi-structured interviews with ten mothers of LBW infants in Jayapura, Papua, from May to July 2024. Interviews were transcribed verbatim and analyzed using inductive thematic analysis.

Results: Inductive thematic analysis resulted in six themes: (1) Traditions and traditional practices during pregnancy and childrearing; (2) Perceptions of herbal remedies and traditional practices in managing infant health and growth; (3) Traditional care practices for LBW infants and their adaptation within community health efforts; (4) Challenges and obstacles for parents in caring for LBW infants; (5) Family support, roles, and hospital-based education in LBW care; and (6) Parental understanding, needs, and expectations regarding LBW care.

Conclusion: Despite improvements in health information and services, ongoing cultural negotiation is needed to achieve optimal family-based LBW care. Nurses and other health workers should enhance cultural competence and employ patient-centered, culturally sensitive nursing care that integrates local traditions with evidence-based practice, aiming to improve infant health and reduce complications.

Background: Older adults are increasingly vulnerable to health risks, particularly in home care environments with limited formal safety measures. In Indonesia, family caregivers play a central role in providing care; however, research on interventions to enhance the safety of older adults at home remains limited.

Objectives: This study aimed to evaluate the impact of a caregiver-focused safety model, the Aging Safe from the Risk (ASRi) model, on caregivers' perceptions of safety culture and assessed its indirect effects on older adults' quality of life (QoL) and incidence of adverse events.

Methods: A quasi-experimental study was conducted from July to November 2022, involving 135 older adult-caregiver pairs (intervention: n = 68; control: n = 67). Older adults' QoL was measured using the modified WHO-QOL BREF (Indonesian version) and WHO-QOL OLD instruments. Family caregivers completed a Home Safety Culture (HSC) questionnaire and reported adverse events. Data were analyzed using descriptive statistics, chi-square tests, independent t-tests, Mann-Whitney U tests, Fisher's exact tests, repeated-measures general linear models (GLM-RM), and exploratory ANCOVA within the intervention group.

Results: Baseline characteristics were largely similar for older adults (age, comorbidities, fall risk, medication use) and caregivers (gender, age, education, marital status), although some imbalances were noted. Significant between-group differences were observed in the spiritual dimension (baseline p = 0.019, r = 0.202; fourth month p = 0.018, r = 0.204) and environmental dimension of safety culture (all time points p <0.001, r = 0.347-0.431), with a transient difference in the personal dimension at month one (p = 0.013, r = 0.215). QoL scores were consistently higher in the control group (p <0.001, Cohen's d = 0.551-0.645), reflecting baseline imbalance. Adverse events decreased in the intervention group during follow-up (p <0.001, Cramér's V = 0.343-0.364); however, the higher baseline incidence suggests that regression to the mean may have contributed to this reduction.

Conclusion: The ASRi model was associated with modest improvements in caregivers' perceptions of safety culture. Differences in QoL and adverse events should be interpreted cautiously due to baseline imbalances and potential regression to the mean. While these findings provide preliminary indications that caregiver engagement through the ASRi model may support safer home care practices, causal conclusions cannot be drawn. Randomized studies with longer follow-up are needed to confirm these effects.

Trial registry: NCT05487482 [clinicaltrials.gov].

People strive to remain 'human,' even when facing biological traits they see as 'non-characteristic.' Oftentimes, this fundamental drive leads individuals to use technology for self-change and improvement, aiming to realize their authentic sense of self. In this paper, we undertake a discursive, concept-driven inquiry to explore how the pursuit of completeness through body modification influences what it means to 'remain human' and how this, in turn, shapes the future of nursing. Drawing from a posthumanist framework that integrates the philosophies of Braidotti, Deleuze, and Heidegger with the nursing theories of Parse, Locsin, and Boykin & Schoenhofer, we argue that this technological transformation is a profound process of 'becoming.' Our analysis, informed by a purposive review of relevant literature, suggests that in a technology-rich world, nursing faces new opportunities that demand refined practices. To remain relevant, the nursing profession must adapt to these ongoing human transformations by expanding its understanding of personhood and human care.

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.