Jurnal Keperawatan Padjadjaran

Posterior communicating artery aneurysm presenting as isolated oculomotor palsy: The role of rapid identification, intervention, and multidisciplinary care - A case study

Raden Andi Ario Tedjo — 2025-04-29

Background: Posterior communicating artery (PCOM) aneurysms are the prevalent type of aneurysm with high rupture risks. Isolated oculomotor nerve (CN III) palsy is a key symptom warranting heightened awareness in primary care. Given the need for advanced imaging, early referral is paramount. This study highlights the significance of prompt identification, targeted intervention, and comprehensive management in optimizing patient outcomes.

Case: A 58-year-old woman presented with isolated CN III palsy. The patient underwent rapid referral to tertiary care with magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), revealing an aneurysm in the PCOM. Subsequently, coiling was performed to achieve complete occlusion. The procedure resulted in significant neurological recovery, with restoration of CN III function. Post-coiling, the patient receives close nurse monitoring, incorporating fall management and comprehensive education before discharge. CN III palsy is one of the unique-noticeable presentations of PCOM aneurysms, though symptoms may include facial pain, occasional headaches, and migraines. Coiling was chosen due to its less invasiveness and was recommended for posterior circulation aneurysms. Blood pressure control is essential to prevent aneurysm formation, rupture, and recurrence. Regular imaging follow-ups were needed to ensure long-term outcomes.

Conclusion: PCOM aneurysm care involves a multidisciplinary approach. Rapid identification, early referral, immediate occlusion, and comprehensive rehabilitative programs were mandatory to improve patient outcomes.

Roles of agro-nursing in bringing health services in rural and remote areas of Indonesia

Tantut Susanto — 2025-04-25

Agro-nursing is an innovative approach to health care that integrates nursing science with a contextual understanding of agricultural conditions and rural life. Rural and remote areas in Indonesia often face challenges in accessing adequate health care. This article discusses the role of agro-nursing in addressing these challenges, highlighting how nurses can act as agents of change who provide health care and empower communities through approaches appropriate to local characteristics. By utilizing local potential, community culture, and agricultural systems as an integral part of rural life, agro-nursing strengthens health care promotive, preventive, curative, and rehabilitative efforts. This study also highlights the importance of specialized training, cross-sector collaboration, and policy support to optimize the role of agro-nursing in improving the health of communities in remote and disadvantaged areas. It is hoped that agro-nursing can be a sustainable strategy for narrowing the gap in health services between urban and rural areas in Indonesia.

Triage in disasters: A conceptual analysis

Asih Dewi Setyawati — 2025-04-29

Background: Disaster triage faces significant challenges due to definitional conflicts and ambiguities. Conducting a concept analysis of disaster triage is essential for clarifying its meaning, improving decision-making, ensuring effective training, and enhancing disaster preparedness for healthcare professionals. Thus, this study aims to define the concept of disaster triage and identify its attributes, antecedents, and consequences using Walker and Avant's framework.

Method: The methodology involved a comprehensive literature review from 2013 to 2024, focusing on nurse-related triage during emergencies and disasters. Articles were gathered from databases such as Web of Science, PubMed, Scopus, Cochrane Library, and Google Scholar. After screening the titles, abstracts, and full texts, 30 articles met the inclusion criteria.

Result: Following Walker and Avant's framework, the concept analysis revealed that disaster triage is influenced by various antecedents, attributes, and consequences. Antecedents such as education, working experience, and disaster training provide the foundation for effective triage practices, while attributes such as clinical judgment, assessment skills, and effective communication are crucial in the triage process itself. The consequences of effective disaster triage include enhanced patient safety and care delivery efficiency.

Conclusion: In conclusion, this study provides valuable insights that deepen the understanding of the concept of disaster triage and also provides valuable guidance for clinical practice and informs future research in the fields of disaster management and emergency nursing.

Caring behavior and its impact on patient safety activities: Investigating the role of safety competency

Lusianah Lusianah — 2025-04-25

Background: Patient safety is a critical component of healthcare. Caring behavior among nurses is hypothesized to enhance patient safety activities. However, the relationship between caring behavior and patient safety activities, particularly the moderating role of patient safety competency, remains underexplored.

Purpose: This study aims to examine the influence of caring behavior on patient safety activities, while assessing the moderating role of patient safety competency.

Methods: This study employed Structural Equation Modeling (SEM) to analyze the relationship between caring behavior and patient safety activities. A total of 154 nurses from a private hospital in Tangerang participated. The caring behavior inventory (CBI) was used to assess the nurses' caring behaviors across four subscales: respectful communication, ensuring human presence, communication with a positive disposition, and professional knowledge and skills. The safety nursing activities scale evaluated comprehensive patient safety activities across eight subcategories, such as communication, operations, and risk management. The Patient Safety in Nursing Education Questionnaire (PaSNEQ) was employed to assess patient safety competency, comprising three subdomains: basic patient safety competency, clinical analysis and action effectiveness, and error prevention strategies and additional training.

Results: The analysis showed that caring behaviour significantly influenced patient safety activities (T-value = 7.70, p < 0.05). Patient safety competency did not significantly moderate this relationship (T-value = 1.21).

Conclusions: Caring behavior significantly improves patient safety, although increased patient safety competency does not show significant moderation effects. Future research should explore alternative moderators and emphasize interventions that foster caring behaviour to strengthen patient safety outcomes.

The self–directed learning readiness and self–efficacy of nursing students in synchronous learning: A cross–sectional study

Totok Harjanto — 2025-04-25

Background: Beyond the pandemic, synchronous online learning was found to be a reliable approach in undergraduate nursing education. The students' self-directed learning readiness and online self-efficacy are key to the successful implementation of this approach. Readiness determines the learner’s needs based on contextual education, while efficacy refers to the students' confidence when completing online learning tasks.

Purpose: The current study aims to investigate the relationship between self-directed learning readiness and self-efficacy among undergraduate nursing students.

Methods: A descriptive correlational study was carried out to measure the undergraduate nursing students’ readiness and efficacy using the Self-Directed Learning Readiness (SDLR) Scale and the Online Learning Self-Efficacy Scale. Upon completing data collection using a web-based survey, univariate descriptive and bivariate analysis with Pearson correlation were conducted.

Results: A total of 188 undergraduate nursing students participated in this study with an average age of 20.12 years old. The majority of nursing students (72.9%) within the program had a moderate SDLR level, while the mean (SD) SDLR was 149.95 (±12.24). Similarly, moderate self-efficacy was reported by the present study participants. The self-efficacy subscale of strength was categorized as high, while moderate levels of generality and magnitude were interpreted from the findings. The bivariate statistical analysis indicated a significant correlation between SDLRS and online self-efficacy (r=0.298, p<0.001). SDLR had significant correlations with each online self-efficacy subscale, including strength (r=0.259, p<0.001), generality (r=0.259, p<0.001), and magnitude (r=0.259, p<0.001).

Conclusions: In synchronous learning, the undergraduate nursing student’s SDLR was found to have a positive relationship with self-efficacy. Provisioning the students’ individual learning skills is necessary to enhance their readiness and consequently improve their acquisition of the educational outcomes.

Effect of combined lateral and supine positioning on oxygen saturation in ICU patients during the mechanical ventilator weaning process: A randomized controlled trial

Iwan Purnawan — 2025-04-25

Milk-sharing experiences: Perspective among Malaysian donors and rexipient mothers

Nurul Akma Jamil — 2025-04-25

Background: Shared breastmilk has been a longstanding tradition in many cultures throughout history through wet nursing, cross nursing, and the donation of expressed breastmilk to a milk bank. However, social media has introduced some new dynamics to this practice, making it more visible and accessible; and it is known as milk-sharing. Research on milk sharing is still in its infancy and focused on western perspectives. Therefore, the sociocultural dimensions of milk sharing have not been adequately explored across different settings and cultures.

Purpose: This qualitative study aims at understanding the milk-sharing experiences among donor and recipient mothers in Malaysia.

Methods: We conducted a social media analysis on milk-sharing postings from four Facebook Groups Pages. This was followed by a detailed exploration of individual experiences throughout the milk-sharing journey using a semi-structured, online interview with thirty mothers. Thematic analysis was applied in the data analysis process using ATLAS.ti 9 software.

Results: A total of 252 postings were retrieved from four Facebook Groups Pages. Of these, 151 postings referred to donating milk, 70 referred to requesting milk, and 31 focused on issues related to milk-sharing. Thirty mothers with various milk-sharing experiences were involved in this study. Fifteen donors, six recipients, and nine fell into both categories. The mothers in the study had an average age of 32.9 years and the majority were Malay. In terms of their relationship with the infants, 93.3% were biological mothers with the majority having two to five children. Thematic analysis identified five themes: 1) point of reference, 2) communication platform, 3) altruism for mutual benefit, 4) faith and 5) challenges and problem-solving methods.

Conclusions: Milk sharing is a personal and sociocultural-bounded practice where mothers negotiate their understanding of the need to breastfeed and the use of donated breastmilk. Despite its specific focus on the Malaysian context, this research offers a complementary understanding of milk sharing within a non-Western framework and transferable to similar sociocultural backgrounds. The findings are important for intercultural nursing and midwifery practice, where nurses can incorporate sociocultural perspectives into breastmilk donation initiatives to increase public acceptance.

The effect of awake prone position in non-intubated patients with COVID-19: A feasibility randomized controlled trial

Eli Indawati — 2025-04-25

Introduction: The duration of discomfort and clinical benefits of lying prone in Indonesian clinical settings remain unknown, with the accumulation of prone hours potentially impacting results. The study aimed to test the effect of awake prone position in non-intubated patients with covid-19.

Methods: This study used a feasibility randomized control trial. The research was conducted at two general hospitals in Jakarta, Indonesia. This study used a computerized random number generator was used to assign patients to intervention and control groups. The sample is adult patients who admitted to the hospital with hypoxic respiratory failure due to a positive COVID-19 test. A total of 70 patients were randomly assigned to each group, with 35 individuals being included in the analysis. The intervention involved bed-side nurses encouraging patients to lie prone for at least 6 hours daily, with additional pillows provided for comfort. Significant prone position sessions were recorded if they lasted more than 30 minutes in both arms, lasting for 7 days.

Results: The intervention group of patients achieved 65.7% adherence to the intervention protocol. After 2 hours, the P/F ratio was significantly different across the groups, but no significant different between intervention and control group, in term of respiratory escalation, length of stay, or mortality. However, 5.7% of patients in intervention group and 11.4% of patients in control group died due to respiratory failure.

Conclusions: Clinical trial conditions have shown that non-intubated patients can be placed in an awake prone position without harm, and this information could be used to help design protocols for future large randomized controlled trials.

Mental health and home life in the early phase of marriage: An evaluation of early married and non-early married women

Suhariyati Suhariyati — 2025-04-27

Estimating the 10-year fracture risk among persons with HIV and person without HIV: A comparative study

Iqbal Pramukti, S.Kp., MsC — 2025-04-28

Background:

The risk of osteoporotic fracture among persons with HIV was higher than the persons without HIV. Traditional factors are also found as the risk factor affecting fracture risk among persons with HIV and general population. Predicting the fracture risk among the high-risk group is important to develop a comprehensive fracture prevention program.

Purpose:

This study aimed to compare the estimation of the 10-year fracture risk between persons with HIV and persons without HIV using the FRAX™ algorithm.

Methods:

This study recruited 245 participants from August to November 2023, while 221 participants agreed to participate. The participants consist of 107 persons with HIV and 114 persons without HIV. The estimation of the ten-year probability of major osteoporotic and hip fractures was calculated using the FRAX™ algorithm. The participant's characteristics related to osteoporotic fracture risk was analyzed using a Chi-Square analysis.

Results:

The overall mean score of 10-year probability of major osteoporotic fracture (MOF) was 3.1% (SD 1.9) for the HIV group and 2.7% (SD 2.3) for non-HIV. For the 10-year probability, hip fracture (HF) risk was 0.5% (SD 0.5) for the HIV group and 0.6% (SD 0.9) for non-HIV. For MOF, HIV persons with fracture history showed a lower score (3.5%) compared to persons without HIV (5.3%). Smoker HIV persons showed the same MOF score (4.6% vs. 4.6%) but lower HF score (0.8% vs. 1.6%) when comparing to persons without HIV, respectively. HIV persons with glucocorticoid use showed a higher MOF probability score than persons without HIV (2.8% vs 2.7%).

Conclusions:

The 10-year fracture risk was higher among persons with HIV compared to persons without HIV. Fracture history, smoking behavior, and glucocorticoid use were identified as the potential factors associated with the risk. Further analysis using multivariate regression analysis may require to confirm the factors associated with high fracture risk.

The impact of interactive video-based exercise on quality of life among pregnant women in Indonesia: A pilot study

Dewi Marfuah — 2025-04-28

Background: Pregnant women experience lower quality of life compared to the general population and experience a decrease in their quality of life as their pregnancy progresses. Video interactive provides an interesting and interactive environment, so participants would be more likely to enjoy completing their physical activity regimen.

Objectives: This study aimed to determine the impact of video interactive-based exercise on quality of life among pregnant women in Indonesia.

Methods: A quasi-experimental study was carried out in Bandung, West Java, Indonesia from August 2023 to January 2024. The intervention and control groups involved healthy pregnant women aged above 18 years old, second trimester pregnant, advised by healthcare, literate, and willing to participate in physical activity. The study involved 264 pregnant women, with a response rate of 96%. Data was collected before (T0), immediately after (T1), and 2 weeks after the intervention (T2). The videos covered combination of exercise program for pregnant women, including warm-up, main phase (with an aerobic element, followed by strength and endurance exercises) and final stretching and relaxation. quality of life was measure using quality of life Gravidarum. The analysis was evaluated using repeated ANOVA test and difference-in-difference estimate.

Results: After a two-week follow-up, the intervention group showed a substantial increase in quality of life scores, with a moderate level of impact (effect size= 0.39). The difference-in-difference estimate showed a modest increase of 3.57 percentage points between groups.

Conclusion: The study demonstrated that video interactive exercise significantly improved the quality of life for pregnant women, indicating the potential for encouraging their participation in such activities.

Validating a mobile application for anemia prevention: Insights from expert feedback on AneMia_Prev®

Sri Rahayu — 2025-04-29

Background: Anemia remains a critical public health issue among adolescents, particularly in developing countries such as Indonesia. Poor nutritional knowledge and limited awareness of anemia-related symptoms, etiology, and prevention exacerbate this condition. Mobile health (mHealth) technologies have the potential to address these gaps through accessible, engaging, and scalable education tools. This study aimed to validate the content of AneMia_Prev®, a mobile application designed as an educational tool to enhance adolescent knowledge on the prevention of anemia.

Methods: A Delphi technique was employed involving two rounds of expert panel review. Twelve experts with clinical and academic backgrounds in nursing and public health evaluated the content of AneMia_Prev® based on relevance, clarity, layout, illustrations, language, and motivational features. The Content Validity Index (CVI) and modified kappa statistics were used to assess inter-rater agreement and content adequacy. Data were collected through an online survey using a 17-item validated questionnaire.

Results: In the first round, all 17 items achieved excellent content validity with I-CVI values ranging from 0.87 to 1.00 and kappa values above 0.87. Following minor expert recommendations, a revised version of the application was re-evaluated, resulting in unanimous ratings of excellence (I-CVI = 1.00; kappa > 0.92 for all items). Experts emphasized the application’s innovation, relevance, and potential to promote anemia awareness among adolescents.

Conclusion: AneMia_Prev® demonstrated excellent content validity and is considered suitable for educational interventions targeting anemia prevention among adolescents. Future research is recommended to assess semantic validation, cognitive impact, and learning outcomes among adolescent users to further refine the tool and evaluate its effectiveness in real-world settings.

Effect of warming gown use on shivering and body temperature in chronic kidney disease patients undergoing hemodialysis via catheter

Novita Anggraeni — 2025-04-29

Background: Haemodialysis is often accompanied by shivering, especially in patients with catheter access, which can reduce comfort, impair treatment efficacy, increase the risk of complications and contribute to inadequate dialysis. Addressing this issue through non-pharmacological means, such as a warming gown, offers a potentially effective, safe, and economical solution to improve patient outcomes.

Purpose: To develop a warming gown as an innovation to reduce the incidence of shivering in chronic kidney disease patients undergoing haemodialysis with a haemodialysis catheter.

Methods: This study employed a two-stage Research and Development design. In the first stage, a reusable, adaptive warming gown for HD catheter patients was developed and validated (S-CVI/Ave = 0.99). Second, a quasi-experiment was conducted with 60 patients recruited through total sampling. Subsequently, patients were randomly allocated to either the intervention group (warming gown) or the control group (blanket) using computer-generated randomisation based on their identification numbers. Shivering (Crossley and Mahajan scale) and body temperature (digital thermometer) were measured at 0, 15, 30, 60, and 120 minutes. Data were analysed using Wilcoxon, Friedman, and Bonferroni-corrected repeated Mann–Whitney tests.

Results: The intervention group showed a significant reduction in shivering levels from 2.63 ± 1.27 to 0.37 ± 0.49 (p < 0.001) and an increase in body temperature from 36.36 ± 0.52 to 36.84 ± 0.29 (p < 0.001). In contrast, the control group showed no significant changes (p > 0.05).

Conclusions: The warming gown was proven effective in reducing shivering and increasing body temperature in haemodialysis patients, offering advantages in comfort, safety, and cost efficiency.