Jurnal Keperawatan Padjadjaran

The unmet needs of palliative care among patients with non-malignant chronic illness in Indonesia: A phenomenology study

Rona Cahyantari Merduaty — 2024-12-25

Background and Objectives: People with chronic illness tend to report multiple and complex symptoms that decrease their ability to meet their needs and quality of life (QoL). As an approach to address people with chronic illness, palliative care is still shortly focused on people with chronic malignancies in Indonesia. Eventually, that paradigm makes the spectrum of palliative care interpreted narrowly only for cancer or end-of-life (EOL) patients. This study explores the experience and needs of patients diagnosed with non-malignant chronic illness towards their illness to identify the need for palliative care. This study used a qualitative method with a phenomenological approach.

Material and Methods: A total of seven (7) participants were involved in semi-structured interviews that were previously selected based on screening using an adult palliative patient score developed by Cipto Mangunkusumo Hospital (RSCM), Jakarta. Only participants with a score above or equal to 4 (four) are selected to participate. All qualitative data is recorded, transcribed, and analyzed using Colaizzi's approach.

Results: There are seven major interrelated themes emerging from this qualitative study that uniquely match with the illness trajectory of non-malignant chronic patients. The themes are: (1) negative feelings that cannot be described at the time of diagnosis, (2) ignorance of the disease process, (3) late realization that illness cannot be cured, (4) helplessness during the medication/treatment process, (5) shame of being a burden to family and surroundings, (6) limited access, (7) family and God as motivation and hope reinforcement to recover at the end of illness stage.

Conclusions: People with non-malignant chronic complain of several challenges, which are not much different from those with cancer. Therefore, patients with non-malignant chronic illness (PWNMCI) also have a similar need for palliative care. A deeper and broader assessment of palliative care should also be implemented in patients with non-malignant chronic illness from the early diagnostic process.

Evaluation of the clinical nurse career path system in Indonesian Hospitals: Identifying areas for improvement and development

firman firman — 2024-12-25

Background: The clinical nurse career path system significantly impacts nurses' professional growth, job satisfaction, and service quality. Evaluating its effectiveness is vital for enhancing human resource management. Purpose: This study aimed to evaluate the nursing career path in Indonesia, identifying areas for improvement and development. Method: This study used a mixed-methods approach with nine participants and 339 samples. Surveys targeted clinical nurses, while interviews involved nursing management. Data was analyzed using descriptive statistics and thematic analysis. Results: Managerial experiences revealed three themes: (1) implementation of the nurse career path as a mandatory accreditation process, (2) challenges in the implementation of the nurse career path, and (3) expectations for career path implementation. The process evaluation pinpointed areas for improvement, including organizing, internship programs, Continuous Professional Development (CPD), and career advancement. In product evaluation, 80.8% of nurses had good perceptions, with a 77% job satisfaction rate. Analysis showed a positive correlation between perception and job satisfaction (P < 0.001).

Conclusion: The clinical nurse career path in hospitals requires more attention, especially in areas such as human resources, which are not yet full-time, and leadership policies regarding rewards, regulations, and nurse placement in the implementation of career paths related to organizing, internship programs, CPD, and career advancement. Enhancing these aspects is vital for boosting nurses' job satisfaction and improving service quality and patient care.

Family caregiver burden in schizophrenia: A structural equation model of caregiver, patient, environmental, and family function factors

Dya Sustrami — 2024-12-25

Introduction: Families play a critical role in the care and support of individuals with schizophrenia. However, this responsibility often leaves caregivers with significant physical and psychological burdens.

Objective: The study aimed to evaluate the family caregiver, patient, environmental factors, and family function as predictors of family caregiver burden in schizophrenia patients.

Methods: This study used a cross-sectional design. The population consisted of family caregivers of schizophrenia patients who had experienced at least one episode in the past year, lived in the same house, and had been caregivers for at least one year. We recruited 220 family caregivers of schizophrenia patients. The variables in this study were family caregiver, patient, environmental factors, family function, and caregiver burden. The data was collected using a self-report questionnaire and analyzed using partial least squares.

Results: Most respondents were predominantly between the ages of 46 and 65. The model showed that caregiver burden was influenced by the patient factor (t= 4.259, path coefficient: 0.088), environment factor (t= 6.540, path coefficient: 0.288), and family function (t= 10.977, path coefficient: 0.497). These findings showed that family function was the dominant factor in caregiver burden.

Conclusion: Patient factors, environmental factors, and family function significantly affected the family caregiver burden, except for the family caregiver factor. This model can help family caregivers decrease their burden by managing family functioning.

Factors influencing children's dietary variety in Eastern Indonesia: A comprehensive national analysis

Yoyok Bekti Prasetyo — 2024-12-25

Background: Limited dietary diversity among children is a critical public health concern across Indonesia, with Eastern Indonesia facing the most severe nutritional challenges among children. Purpose: This study aims to identify factors influencing children's dietary diversity in Eastern Indonesia. Methods: A cross-sectional study design was employed, utilizing data from the 2017 Indonesia Demographic and Health Survey (n = 1,476). Dietary diversity was assessed using the dietary diversity score (DDS), categorized into adequate and inadequate levels. Results: Key sociodemographic factors associated with DDS included the number of children in the household, place of residence, economic status, breastfeeding practices, and vitamin A supplementation, with p-values of 0.007, <0.001, 0.001, <0.001, and <0.001, respectively. Children who were not breastfed were 0.5 times more likely to have inadequate DDS compared to those who were breastfed (95% CI: 0.36–0.67). Urban-dwelling families had a 0.7 times lower risk of inadequate DDS than rural counterparts (p = 0.026; 95% CI: 0.47–0.95). Additionally, children from low-income families were twice as likely to experience inadequate DDS compared to those from higher-income families (p = 0.012; 95% CI: 1.14–2.99). Conclusion: Rural residency, low income, lack of breastfeeding, and inadequate vitamin A supplementation significantly contribute to poor dietary diversity among children in Eastern Indonesia. These findings highlight the need for targeted government interventions to bridge gaps in maternal education, enhance healthcare access, and improve families' socioeconomic conditions, ultimately advancing child nutrition and health in the region.

“Plants brought back to life”: An exploration of female adolescent survivors’ experiences of sexual abuse, healing and resilience

Maria Lourdes Jarabe — 2024-12-25

Background: Sexual abuse is a significant issue for adolescent girls in the Philippines. This study explores the experiences of survivors, focusing on their journeys of healing and resilience.

Methods: This Interpretative Phenomenological Analysis study aimed to understand the lived experiences of Filipino adolescent girls who survived sexual abuse through four key questions, namely: 1) How did each participant perceive their experience? 2) What coping mechanisms did they employ to deal with the trauma? 3) How did the abuse impact their self-perception and purpose in life? 4) What symbols or meanings do they associate with their experiences?

Results: The analysis identified six superordinate and sixteen subordinate themes. These included: 1) sense of loss – participants described a deep sense of loss due to the abuse; 2) healing as a process – healing was perceived as a gradual and ongoing journey; 3) supportive environment – supportive relationships played a crucial role in coping; 4) growing faith in God – faith emerged as a significant source of strength; 5) reclaiming the sense of self – regaining a sense of self-worth was a central aspect of healing; and 6) altruism – the desire of helping others emerged as a meaningful way to cope.

Conclusions: The participants’ experiences can be likened to a resilient plant that, despite facing near-destruction, revives with renewed strength. Family dynamics played a crucial role in the girls’ experiences of abuse. A culture of silence and fear emerged as a significant theme in their narratives. Additionally, the ambiguity and conflicting emotions surrounding accountability for perpetrators within close families posed complex challenges.

This research provides valuable insights into the experiences of sexually abused Filipino adolescent girls, informing nursing practice. The findings enable nurses to offer culturally sensitive, trauma-informed care and develop targeted support interventions. Incorporating these insights into nursing education will enhance students’ competencies in trauma response, cultural sensitivity, and therapeutic communication with abuse survivors, leading to improved assessment protocols and care strategies.

Spiritual mindfulness combination with self-regulation on the effect to vital sign and anxiety reduction among pneumonia survivors

Daviq Ayatulloh — 2024-12-29

Background: Pneumonia has become a scary disease since the emergence of the COVID-19 pandemic. The severity of pneumonia often causes sufferers to experience fear and causes the disease to worsen, resulting in the patient's hemodynamics becoming unstable, this condition need an intervention to make the condition better.

Purpose: The purpose of this study was to analyze the effect of spiritual mindfulness combined with self-regulation in dealing with anxiety and improving vital signs in pneumonia patients.

Methods: A experimental quantitative research using a quasi-experimental with pre and post-test control group design between August - October 2024 in the regional hospitals in Gresik Regency, East Java, Indonesia. Total 62 respondents recruited using consecutive sampling which were then divided into intervention and control groups. Spiritual mindfulness intervention combined with self-regulation was given with a frequency of 2 times a day for 7 full days. Vital signs measured included blood pressure, respiratory rate, pulse and SpO2 which were observed through the researcher's observation sheet and anxiety was measured using the Zung Self-Rating Anxiety Scale (SRAS). Data were analyzed using paired t-test and independent t-test, also Wilcoxon signed rank test and Mann Whitney test.

Results: Spiritual mindfulness combination with self-regulation has effect to vital sign included blood pressure, respiration rate, pulse, oxygen saturation and anxiety of patient with pneumonia (p=0.000). The measurement showed the best changes or decreases in the intervention group, while the control group did not show much difference.

Conclusions: Spiritual mindfulness combination with self-regulation is the effective intervention for vital sign and anxiety in pneumonia patients.

Older adults’ lived experiences with bamboo bed handicrafts in improving their quality of life

Nisachon Sangsuk — 2024-12-25

Background: Improving the quality of life for older adults is crucial in Northeast, Thailand, where most have low health literacy and live in substandard conditions. They are more likely to age alone or with a spouse with less support overall.

Purpose: This study aimed to explore how the older adults had lived experiences using local wisdom, knowledge, and skill of bamboo bed handicrafts to improve their quality of life and strengthen the community.

Method: This research study used a descriptive design based on Husserl’s qualitative phenomenological philosophy. Participants were purposively chosen. The semi-structured interview guide was created. The twelve key informants, aged 61 to 78 years, had knowledge and experience of making bamboo bed crafts and were interviewed face-to-face in their home environment by consent. Seniors with cognitive impairment met the exclusion criteria. Guba and Lincoln’s trustworthiness criteria were used. The content analysis used the Colaizzi method.

Result: This study found four main themes: 1) Meaningful life 2) Happy life 3) Happy society and 4) Coping with deteriorating physical health through resilience adaptation.

Conclusion: Nurses should enhance quality of life for older adults by supporting their psychological well-being through self-acceptance, coping, resilient adaptation, and continued activity.

The effect of 12-weeks foot exercise on blood glucose levels, ankle brachial index, and sensation of protection in diabetes mellitus patients: A quasi-experiment study

Rosliana Dewi — 2024-12-25

Background: Diabetes Mellitus (DM) is a global health issue causing nerve damage, blood vessel damage, and leg impairment. Foot exercises can improve risk factors for diabetic foot ulcers, neuropathy symptoms, pressure distribution, joint mobility, and strength in individuals with diabetes.

Purpose: This study aimed to determine the effect of 12-weeks foot exercise on blood glucose levels, ABI values, and sensation of protection in diabetes mellitus patients West Java, Indonesia.

Methods: The sample in this study was individuals aged 18 or above with a confirmed diagnosis of diabetes mellitus. A 154 patients willingly volunteered to participate and were subsequently enrolled in the study (77 in intervention group and 77 in control group). The study encompassed participants who engaged in a twelve-week regimen of foot exercises utilizing teaching modules and video materials.The study employed several tools, namely a glucometer, a glucometer stick, Ankle Brachial Index value, and a questionnaire. A bivariate analysis using the paired t-test and ANCOVA was conducted using IBM SPSS Statistics version 22.0.

Results: In intervention group, random blood glucose was decreased significantly from 237.5 ± 9.56 at baseline to 188.0 ±6 9.19 after intervention (p=0.002). Sensation of protection as measure by the number of areas with loss sensation was improve from 5.21 ± 1.03 at baseline to 3.42 ± 1.21 after intervention (p=0.001). While, no significant improvement in ankle-brachial index after intervention (p=0.413). The ANCOVA test showed that between group, sensation of protection was significantly different in intervention group compare to control group (ß =0.413, p-value=0.038).

Conclusions: The study found that a 12-week foot exercise program significantly improves blood glucose and sensation protection, but not ankle-brachial index. Further research is needed with a more rigorous study design and larger sample size.

The effect of psychoeducation-based on transtheoretical model on depression in patients with coronary heart disease

Linlin Lindayani — 2024-12-25

Background: Depression is the most common psychological condition among patients with coronary heart disease (CHD). Although psychoeducational programs (PEPs) based on the Transtheoretical Model (TTM) have shown promise for psychiatric patients, their application among individuals with medical conditions, particularly cardiovascular disease, remains limited—especially in Indonesia.

Purpose: This study aimed to assess the effectiveness of a TTM-based PEP intervention in reducing depression among CHD patients.

Methods: A quasi-experimental design was employed, involving 80 CHD patients hospitalized in the coronary care unit (CCU) of a private hospital in West Java, Indonesia, in 2022. Participants in the intervention group attended seven sessions, each lasting 60 to 90 minutes. Depression symptoms were measured using the Hamilton Depression Rating Scale (HDRS). An ANOVA was performed to compare pre- and post-intervention mean HDRS scores and subscale scores between the two groups. After accounting for attrition, the final analysis included data from 76 patients.

Results: The participants had a mean age of 59.39 years (SD = 11.10) and a mean disease duration of 4.05 years (SD = 1.69). A paired t-test showed a significant reduction in the mean HDRS score of the intervention group, from 13.79 ± 2.84 pre-intervention to 10.16 ± 2.16 post-intervention (p < 0.0001). Most HDRS subscale scores also decreased significantly, except for insomnia, somatic/genital symptoms, and weight loss. ANCOVA confirmed significant differences between the two groups in overall HDRS scores.

Conclusions: The findings suggest that TTM-based PEP is effective in reducing depression among CHD patients. Incorporating such programs alongside standard treatments is recommended for enhanced patient outcomes.

Embracing innovation framework and transformative paradigm: A practical application in the ultralight project

Restuning Widiasih, Ph.D — 2024-12-25

Higher education, as a centre for research and innovation in the era of transformative learning, is encouraged to conduct research and innovation that can lead to innovation and impact in the areas of health, economy, and sustainability. Innovation requires a framework that functions as an essential guide for development. However, limited innovation frameworks can be applied in nursing, including maternity nursing. This study discusses the M-Motion framework as an alternative framework for developing maternity nursing innovation research. M-Motion comprises of three steps of: pre-innovation, innovation, and post-innovation and it is applied to the Ultralight Project. The project aims to improve pregnancy and fetal health by using the DetectMe device to integrate mothers’ self-monitoring data into online health systems so that the condition of pregnant women and their babies is promptly and accurately monitored. The application of the M-Motion framework to the Ultralight Project is a step in the right direction as it helps in illustrating the sequence between research and innovation, especially as it relates to the acceleration of reducing maternal and fetal mortality rates.