The Malaysian Journal of Nursing (MJN)

Message from the Editor in Chief

2026-08-11T06:16:44+00:00

Education and Training Interventions to Improve Emergency Department Triage Accuracy and Decision-Making Among Nurses: A Systematic Review

2026-05-11T09:21:42+00:00

Background: Accurate triage is a critical component of timely emergency care, but there is considerable variation in acuity assignment and mis-triage across Emergency Department (ED) settings. Under-triage has important patient safety implications such as delayed care and unnecessary deterioration. Education and training are common methods for improving triage decision-making, but the most effective methods are unknown. Objectives: To synthesize evidence on education and training interventions used to improve triage accuracy and decision-making among emergency nurses across multiple five-level triage systems, using the Canadian Triage and Acuity Scale (CTAS) as the primary reference framework. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search was conducted in the databases Medline/PubMed, Scopus, and Google Scholar up to 16 March 2026. Studies included an assessed education, training, or decision-support intervention targeting triage for emergency nurses. Outcomes were measured as acuity assignment accuracy, under-/over-triage, inter-reliability and decision-making skills. Narrative synthesis was used for the findings because of the heterogeneity in study designs. Results: Seventeen studies met inclusion criteria, spanning CTAS, Emergency Severity Index (ESI), Korean Triage and Acuity Scale (KTAS), Australasian Triage Scale (ATS), and South African Triage Scale (SATS) contexts. Interventions comprised refresher education, mobile and gamified applications, e-learning, simulation, problem-based learning, and electronic decision support. Most studies reported positive findings regarding triage performance post-intervention, but effect sizes varied across systems and settings. Training effects may diminish over time without reinforcement, and barriers to implementation included workload, fatigue, and organizational factors. Conclusion: Structured, interactive, and reinforced methods, including technology-facilitated decision support where available, may contribute to triage competency maintenance and patient safety. However, effects are heterogeneous across triage systems and settings, and findings from non-CTAS systems should not be directly generalized to CTAS.

The Dual Role of Nurses in Adolescent Mental Health: A Systematic Review of Stigma, Policy Barriers, and Digital Health Challenges in Indonesia

2026-05-15T05:14:38+00:00

Background: Nurses in Indonesia are uniquely positioned to address adolescent mental health through digital tools while mitigating associated risks, yet no systematic review has synthesized evidence on this dual role. Objectives: This review aimed to map the scope of digital mental health resources for adolescents in Indonesia and assess digital risks impacting their care to clarify the nursing role. Methods: This systematic review followed the PRISMA framework. Four databases (PubMed, Scopus, Web of Science, and Google Scholar) were used in identifying 2,051 records. Inclusion criteria comprised peer-reviewed studies (2019-2024) focusing on mental health nursing within the Indonesian context. Exclusion criteria involved non-empirical articles, studies with non-Indonesian populations, and publications lacking full-text access or a DOI. After screening, 12 articles were selected. Methodological quality was appraised using CASP/JBI checklists by two independent reviewers, showing substantial agreement (κ = 0.71). Results: The synthesis identified three core themes: 1) pervasive systemic and socio-cultural barriers (e.g., stigma, low mental health literacy) that shape the care context; 2) notable absence of empirical research on nurses' use of digital resources or management of digital risks; and 3) consistent identified need for nursing capacity building and policy support. Quality appraisal revealed a mix of high, moderate, and low methodological rigors among the included studies, with substantial inter-rater agreement (κ = 0.71). Conclusion: This review reveals a critical socio-technical gap. Digital tools hold transformative potential, but nurses currently lack the competencies, guidelines, and systemic support needed to use them safely. To bridge this gap, the urgent development of a digital mental health competency framework for nursing education and the establishment of enabling policies are imperative.

Effectiveness of a Learning Package in Reducing Pain and Improving Activities of Daily Living Among Patients with Knee Osteoarthritis

2026-06-04T07:17:45+00:00

Background: Knee osteoarthritis (KOA) is a highly prevalent musculoskeletal disorder and a leading cause of pain and functional disability worldwide. Effective management increasingly emphasizes patient education and self-management strategies to reduce pain and restore mobility and functional independence. Objectives: This study aimed to evaluate the effect of a learning package on pain intensity and activities of daily living (ADL) among patients with knee osteoarthritis. Methods: A quasi-experimental one-group pre–post design was conducted in the orthopedic departments and outpatient clinics of Mansoura University Hospital, Egypt. A purposive sample of 71 adult patients diagnosed with KOA was selected. Data were collected using a structured interview questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, with a focus on the pain and ADL subscales. Measurements were obtained at baseline, one month, and two months post-intervention. Results: The findings demonstrated a statistically significant improvement in both pain and ADL scores after the implementation of the learning package (p<0.001). Pain scores decreased progressively over time, while functional performance in daily activities improved. Conclusions: The structured learning package was effective in reducing pain and enhancing functional ability among patients with KOA. It is recommended that educational and in-service training programs be regularly implemented to enhance patients' knowledge and self-management practices regarding knee osteoarthritis.

Effectiveness of Awareness and Understanding of Patient Safety Training for Nursing Students: A Quasi-Experimental Study

2026-02-05T12:16:37+00:00

Introduction: Patient safety, according to the World Health Organization (WHO), is the avoidance of mistakes and negative consequences related to medical treatment. Concern among the general public and professionals has grown as a result of increased awareness of medical errors and their repercussions, especially as they have been brought to light by the media and social media. The Institute of Medicine (IOM) has placed a strong emphasis on patient safety, pointing out that adverse events play a major role in inpatient mortality. Objectives: 1. To assess nursing students’ knowledge regarding patient safety, 2. To evaluate the effectiveness of a patient safety awareness program and to assess its impact on nursing students' knowledge. 3. To determine the association between knowledge scores and selected demographic variables. Methods: Purposive sampling was used to choose 100 third-year General Nursing and Midwifery (GNM) nursing students for a quasi-experimental study with a pre-test post-test design. A structured knowledge questionnaire on patient safety was used to gather data. The pre-test was followed by an awareness program, and two days later, there was a post-test. Descriptive and inferential statistics (paired t-test, ANOVA, and independent t-test) were used to examine the data; p < 0.05 was deemed statistically significant. Results: The 100 nursing students were all female, and most were between the ages of 21 and 25. The majority of pre-test knowledge (49%) was ordinary, but post-test results showed a significant improvement, with 58% attaining excellent and 6% exceptional knowledge. The average score rose from 8.58 ± 2.79 to 30.26 ± 5.91 (p = 0.0001). Urban students scored much higher than rural pupils (p < 0.05), although there was no significant correlation between knowledge and age. Conclusion: The findings of this study demonstrate that a structured patient safety awareness program significantly improved the knowledge of patient safety among GNM nursing students. The results highlight the value of integrating patient safety education into the nursing curriculum to strengthen students' understanding of safe clinical practices and support the delivery of high-quality patient care. Although age was not associated with knowledge improvement, differences based on area of residence suggest that educational resources and learning opportunities may influence outcomes. Future research should include larger, more diverse samples, evaluate long-term knowledge retention, and compare the effectiveness of different educational approaches, such as simulation-based, case-based, and technology-assisted learning.

Sociodemographic Predictors of Emotion Regulation Among Nursing Home Residents in Central Java, Indonesia: A Cross-Sectional Study

2026-02-07T05:13:47+00:00

Background: Emotional challenges may compromise the well-being of older adults in nursing homes. However, research on factors influencing Emotion Regulation (ER) among institutionalized older adults remains limited, particularly in developing countries such as Indonesia. Identifying relevant sociodemographic predictors is important to support appropriate interventions and improve emotional outcomes among institutionalized older adults. Methods: This quantitative cross-sectional study involved 150 older adults recruited via total sampling from nursing homes in Central Java, Indonesia. The data was collected using structured questionnaires assessing participant characteristics and ER using the Emotion Regulation Questionnaire (ERQ). Participant characteristics were summarized using descriptive statistics. Bivariate analysis was conducted using the chi-square test or Fisher’s exact test when appropriate. Variables with p < 0.25 were included in multivariate logistic regression to identify independent predictors of ER. Results: Gender and marital status were significantly associated with ER among nursing home residents. Logistic regression analysis indicated that gender (OR = 0.27; 95% CI: 0.13–0.56; p < 0.001) and marital status (OR = 1.36; 95% CI: 1.02–1.81; p = 0.039) were significantly associated factors, while other variables were not significantly associated, suggesting that differences in social roles and support systems may contribute to ER variation. The model explained approximately 15.1% of the variance in ER. Conclusion: Gender and marital status were identified as significant predictors of ER among older adults living in nursing homes. This suggests that nurses should consider gender and marital status when designing and implementing interventions to improve ER among institutionalized older adults.

Psychological Safety among Community Health Officers (CHOs) in Selected Districts of West Bengal and its Impact on the Profession

2026-01-08T03:34:11+00:00

Background: Psychological safety is particularly crucial, as it directly influences decision-making, error reporting, teamwork, and overall job performance. Community Health Officers (CHOs) play an essential role in India’s comprehensive primary healthcare system. Their ability to make decisions, minimize errors, and innovate is important to provide excellent patient care. The present study was adopted to assess psychological safety among CHOs and measure its impact on the profession. Methods: A community-based cross-sectional and quantitative study on 103 randomly selected female CHOs. Data pertaining to socio-demographics and attitude regarding psychological safety and its impact on profession were collected via interview using a validated, semi-structured questionnaire and tools. Results: The majority (77.67%) of participants were 24-34 years old, unmarried (65.05%), and passed the class-12th standard (85.44%). Two-thirds (66.99%) of the participants were GNM, and the rest were B.Sc. nurses, with 82.52% having 1–5 years of work experience. 15.53% of participants reported experiencing job-related stress. The majority (67.96%) of participants reported a moderate level of psychological safety, and 13.6% reported a high level of psychological safety. Most (64.08%) participants felt that psychological safety had an average positive impact on their profession. A strong (r = 0.93) positive correlation and significant (t = 25.44, p < 0.05) relationship was found between psychological safety and its impact on profession among CHOs. Age and experience of CHOs significantly associate with the level of impact of psychological safety on their profession. Conclusion: A significant association between psychological safety and its impact on the profession exists, and healthcare administrators should implement targeted strategies to strengthen psychological safety in primary healthcare settings.

Influence of Demographic Factors on Mental Health among College Students

2026-02-07T05:24:22+00:00

Background: Demographic factors often influence the rise in mental health issues among college students globally. Understanding these factors is essential for designing early, targeted interventions and strengthening mental health services in academic settings. Objectives: This study aimed to examine the influence of age, gender, faculty, family income, physical health problems, and psychological trauma on the mental health of college students. Methods: A cross-sectional design was used with a total of 557 Indonesian university students as participants. Data were collected using a questionnaire and the Self-Reporting Questionnaire (SRQ-20). Data were analyzed using Spearman’s Rho, Mann-Whitney, and Kruskal-Wallis tests, followed by multivariable logistic regression analysis. Results: Statistical analyses revealed significant associations between mental health status and variables including age, gender, family income, physical health problems, and psychological trauma (p < 0.05), while the faculty variable showed no significant correlation. Psychological trauma emerged as the strongest independent predictor, with students who had experienced psychological trauma being more than nine times more likely to experience mental health problems. Conclusion: Trauma-informed and demographically sensitive mental health support is crucial, especially for students who are identified as vulnerable. These insights may inform mental health nursing assessments and targeted interventions in academic settings.

Visualizing Reasoning: Concept Mapping to Elevate Critical Thinking Among Nursing Undergraduates of Sikkim, India

2026-02-06T07:11:01+00:00

Background: Critical thinking is an essential competency for nurses working in increasingly complex healthcare environments. Traditional teaching approaches often emphasize rote memorization and may not adequately promote higher-order critical thinking skills. The concept mapping approach has proven to be an effective tool for fostering meaningful learning through linking theory with practice. Objectives: To determine the effectiveness of concept mapping in educational settings as a learning method for enhancing the development of critical thinking among third-year B.Sc. nursing students at Sikkim Manipal College of Nursing, India. Methods: A quantitative randomized controlled pretest–posttest study was conducted among third-year B.Sc. nursing students. Sixty students were selected using simple random sampling from a total population of 90 eligible students and randomly allocated to either the intervention group (n = 30) or the control group (n = 30) using a lottery method. The experimental group underwent a concept mapping intervention for 12 weeks, while the control group engaged in conventional nursing care plans. Assessment of critical thinking skills was done using a Critical Thinking Questionnaire (CThQ), which is linked to the six cognitive domains of Bloom’s. Analysis of data used both descriptive and inferential statistics such as t-tests, independent t-tests, chi-square, or Fisher’s exact test. Results: Critical thinking scores increased significantly in the experimental group following concept mapping (81.67 ± 9.01 vs. 99.97 ± 9.43; t = 8.722, p < 0.001), compared with a smaller improvement in the control group (77.73 ± 10.53 vs. 82.26 ± 10.23; t = 4.871, p < 0.001). Post-test scores were significantly higher in the experimental group across all cognitive domains (p < 0.05), with large within-group and between-group effect sizes. Conclusion: Students who received concept mapping demonstrated significantly higher critical thinking scores than those who received conventional nursing care planning. These findings suggest that concept mapping may be an effective learner-centered teaching strategy for strengthening critical thinking among undergraduate nursing students.

Diabetes Self-awareness and Self-care Practices among Indonesian Diabetics: A Cross-Sectional Study

2026-05-15T05:13:25+00:00

Background: Self-awareness plays an important role in successful diabetes self-care practices. However, some Diabetes Mellitus (DM) patients in Indonesia reported low self-awareness, which results in poor glycemic control and accelerates the occurrence of DM complications, which in turn leads to an increased mortality rate due to DM complications. Objectives: This study aimed to examine the levels of diabetes self-awareness and diabetes self-care practices as well as their correlation among Indonesian diabetics. Methods: This study employed a cross-sectional design. The samples involved 134 patients with type 2 DM from the community health center in South Jakarta, Indonesia, selected using a convenience sampling technique. The diabetes self-awareness and the summary of diabetes self-care practices questionnaires were used for data collection. The t-test, Analysis of Variance (ANOVA), Pearson correlation, and multiple linear regression were used to analyze the data. Results: A total of 134 patients completed the face-to-face survey. The mean score of diabetes self-awareness was 11.03 (SD=2.74), and the diabetes self-care practices were 78.60 (SD=12.55) in total. The result of diabetes self-care practices dimensions was 34.61(SD=8.01) for DM diet, 11.74 (SD=3.12) for physical activity, 5.53 (SD=1.74) for blood glucose monitoring, 5.48 (SD=1.79) for medication, and 21.25 (SD=6.56) for foot care. Furthermore, the analysis revealed that DM duration and DSA have a statistically significant correlation on diabetes self-care practices, with coefficient β= -0.372 (p < 0.001) and 0.400 (p < 0.001), respectively. Conclusion: The study found a significant correlated between duration of diabetes, diabetes self-awareness, and diabetes self-care practices in Indonesian diabetics. These findings suggest that DM patients are experiencing quite good self-awareness and self-care practices, especially in DM diet, followed by foot care, physical activity, medication, and blood glucose monitoring.

Effect of Adding Warm Compression to Exercise Therapy on Severity and Functional Status among Patients with Chronic Limb-Threatening Ischemia

2026-02-04T08:41:56+00:00

Background: Chronic Limb-Threatening Ischemia (CLTI) is a serious form of peripheral artery disease. Significantly influencing their quality of life and functional abilities and causing increased risk for limb amputation. Objectives: To evaluate the effect of adding warm compression to exercise therapy on limb ischemia severity and physical functional health status among patients with CLTI. Methods: A quasi-experimental study design was used. One hundred patients from the Vascular Surgery Department of Assiut University Hospital, Assiut University, Egypt, were selected as a purposive sample (50 in the control group and 50 in the study group). A patient assessment form, a standardized classification system for CLTI severity assessment, and a physical functional health status assessment form were used to collect the data. Results: Statistically significant differences were found between both groups at 1 and 6 months postoperatively regarding the stage of CLTI severity (p<0.001 and p<0.001, respectively). Also, there are statistically significant differences between the two times (1^stand 6^th month postoperative) between both studied groups regarding the mean physical functional health status (P<0.001**). Conclusion: The study findings indicated that the implementation of exercise and warm compression positively influenced postoperative patient outcomes. The study suggests that exercise and warm compression should be regarded as an essential component of the standard hospital therapy for patients with CLTI.

Social Engagement and Partner Support as Associations of Stress Among the Elderly: Implications for Community Nursing Practice

2026-05-15T05:25:05+00:00

Background: Psychological stress is common among older adults because of declining social participation and reduced emotional support. Although social engagement and spousal support are recognized as important psychosocial resources, evidence regarding their combined influence on stress among community-dwelling older adults in rural settings remains limited. This study addresses this gap by examining these relationships in a rural Indonesian community. Objectives: To examine the associations of social engagement and spousal support with stress levels among the elderly in Sombano Village, Indonesia, and to determine their combined contribution to stress. Methods: A community-based cross-sectional study was conducted among 100 older adults aged ≥60 years selected using purposive sampling. Social engagement was assessed using the Social Engagement and Activities Questionnaire (SEAQ), perceived stress was measured using the Perceived Stress Scale (PSS-10), and spousal support was evaluated using the Spousal Support Scale among participants with a living spouse. Data were analyzed using Spearman's rho correlation and multiple linear regression. Statistical significance was set at p < 0.05. Results: Social engagement was negatively correlated with stress (rₛ = −0.642, p < 0.001), and spousal support also showed a significant negative correlation with stress (rₛ = −0.587, p < 0.001). Multiple linear regression demonstrated that the overall model was statistically significant (F(2,97) = 67.98, p < 0.001), explaining 58.4% of the variance in stress levels (R² = 0.584; adjusted R² = 0.575). Social engagement emerged as the stronger predictor of stress (β = −0.428, 95% CI: −0.66 to −0.19), followed by spousal support (β = −0.337, 95% CI: −0.56 to −0.11). Conclusion: Greater social engagement and stronger spousal support were independently associated with lower stress levels among community-dwelling older adults. These findings support the integration of psychosocial health promotion, particularly strategies that encourage social participation and strengthen family support, into community nursing practice to promote healthy aging and psychological well-being.

Perceived Stress and Quality of Life among Caregivers of Children with Behavioral Disorders Attending a Tertiary Care Hospital in Kolkata

2026-06-23T02:51:43+00:00

Background: Family caregivers of children with behavioral disorders often face significant psychological challenges, including stress, and compromised quality of life. Objectives: To assess perceived stress and quality of life and its association with selective sample characteristics of the caregivers of children with behavioral disorders. Methods: This cross sectional study was conducted among 110 caregivers attending child guidance clinic of the Psychiatric Outpatient Department (OPD) at hospitals, Kolkata. Participants were screened and enrolled considering inclusion and exclusion criteria using purposive sampling techniques. Recommendation from the institutional ethics committee and ethical guidelines were strictly followed. Outcome variables were measured by using standardized Perceived Stress Scale and PedsQL Family Impact Module. Results: The current study findings revealed that the majority (94.55%) of the caregivers were parents and 65.46% were aged between 31 and 40 years. Most of the caregivers were Hindu (71%), belonged to nuclear families (46.37%), and 85.46% had no financial support from other sources. The majority (51.82%) of the children were diagnosed with Attention- Deficit/Hyperactivity Disorder (ADHD) only, 56.36% belonged to the age group of 8–11 years, and 70% were male. Among the caregivers, 66.36% had a mean level of stress and 24.55% had high stress. The mean perceived stress score was 24.78 ± 4.89. The mean total quality of life score was 64.10 ± 4.35, whereas the mean emotional functioning score was 58.75 ± 4.33 and the mean worry score was 60.41 ± 6.20. A negative correlation existed between perceived stress and quality of life (p < 0.02). The association of quality of life with duration of caregiving, and perceived stress with marital status, family support, and family conflict were statistically significant at the 0.05 level. Conclusion: These findings suggest that caregiver support in tertiary care settings should include stress management counselling, psychoeducation, family-support strengthening, and referral support for caregivers experiencing high stress, alongside the child’s standard mental health care.

Conventional versus High-Frequency Chest Wall Oscillation Care among Critically Ill Patients: A Comparative Nursing Evaluation of Respiratory Outcomes

2026-02-11T06:19:38+00:00

Background: The critical care nurse plays a significant role in applying airway clearance methods, including conventional chest wall physiotherapy as well as High-Frequency Chest Wall Oscillation (HFCWO), which became a therapeutic modality to mobilize mucus in different respiratory pathologies. Objectives: To evaluate respiratory outcomes following application of conventional versus high-frequency chest wall oscillation care among critically ill patients. Methods: A quasi-experimental research design was conducted at the respiratory Intensive Care Unit (ICU), Assiut University Hospital, Egypt, on a purposive sample of 60 adult critically ill patients. Patients were selected and assigned to two groups: 30 in the conventional group and 30 in the HFCWO group. Tools: Three tools were utilized in this study I. Clinical and Demographic Profile. II. Respiratory system assessment. III. Patients’ Outcomes. Results: As regards arterial blood gases, there were significant time effects for Partial Pressure of Oxygen in Arterial Blood (PaO₂) and Arterial Oxygen Saturation (SaO₂). Significant time × group interactions were observed for both variables, indicating greater improvement in the HFCWO group. There were significant differences in volume of secretion on the fourth (p=0.042*) and seventh (p=0.017*) days. Additionally, the HFCWO group's ICU stay was shorter than that of the conventional group, with a statistically significant difference (p=0.032*). Conclusion: HFCWO therapy was more effective in improving respiratory outcomes and decreasing the length of ICU stay than conventional chest physiotherapy. These results support replication of this study using a larger probability sample in several hospitals in Upper Egypt.

The Effect of Implementing Nursing Management and Leadership Concepts on Management and Leadership Competencies Among Nurse Managers at Pekanbaru Hospital

2026-06-04T09:11:00+00:00

Background: The increasing complexity of healthcare services requires nurses to possess strong leadership and management competencies. However, hospital nurses often have limited opportunities to develop these skills through conventional face-to-face training. Therefore, effective and structured training interventions are needed to enhance nurses’ leadership and management capabilities. Methods: This study employed a quasi-experimental design involving 300 nurses at Pekanbaru Hospital, Indonesia, selected using purposive sampling. Participants were assigned to an experimental group and a control group. Leadership and management competencies were measured using a structured questionnaire administered before and after the intervention. Data were analyzed using paired-samples t-tests and independent-samples t-tests. Results: The findings demonstrated a significant improvement in leadership and management competencies among nurses in the experimental group. The mean score increased from 65.40 before the intervention to 78.20 after the intervention (mean difference = 12.80, t = 18.29, p < 0.001). In contrast, the control group showed a smaller improvement, with mean scores increasing from 75.20 to 78.50 (mean difference = 3.30, t = 4.40, p < 0.001). Although post-test comparisons revealed no statistically significant difference between groups, the experimental group exhibited a substantially greater improvement from baseline. The intervention was especially good at helping people get better at planning, organizing, and managing resources. Conclusion: Structured leadership and management training effectively improved nurses’ competencies and accelerated skill development compared with conventional training approaches. The findings support the implementation of structured training programs as a practical strategy for strengthening nursing leadership and management competencies in hospital settings.

Effect of Educational Guidelines on Anxiety and Self-Esteem among Women Undergoing Hysterectomy

2026-02-07T05:20:24+00:00

Background: Women undergoing hysterectomy frequently experienced anxiety because they worry about the procedure itself and losing their ability to conceive. Another important factor that is influenced by hysterectomy is self-esteem. When educational guidelines are used well, they can result in superior psychological results, such as decreased anxiety and increased self-esteem. Objectives: To evaluate the effect of educational guidelines on anxiety and self-esteem among women undergoing hysterectomy. Methods: A quasi-experimental research (pre-posttest) was utilized in the study. A purposive sample of 80 women underwent hysterectomy was enrolled. The study conducted at the Women Health Hospital's gynecological department at Assiut University. Three tools were used; a structured interview questionnaire, Zung Self-Rating Anxiety Scale to measure anxiety levels and Rosenberg Self-Esteem Scale to assess self- esteem level. Results: The study findings clarified that the majority (85%) of the studied women experience mild to moderate anxiety, only (30%) had high self-esteem before intervention while after intervention, both anxiety and self-esteem was significantly improved (P < 0.01). Conclusion: Women having hysterectomy saw a considerable and positive improvement in their self-esteem and decreased anxiety when educational guidelines were implemented. For women having a hysterectomy, it is crucial to incorporate educational guidelines into their regular preoperative and postoperative treatment.

Diagnostic Accuracy of Clinical Examination, Ultrasonography, and Radiography for Developmental Dysplasia of the Hip in Infants: A Prospective Diagnostic-Accuracy Cohort Study

2026-04-21T12:55:38+00:00

Background: Developmental Dysplasia of the Hip (DDH) requires early recognition and appropriate age imaging to reduce delayed diagnosis and the need for more complex treatment. Nurses contribute to risk recognition, caregiver education, referral coordination, and follow-up, although nursing outcomes were not evaluated in this diagnostic study. Objectives: To compare the diagnostic performance of clinical examination, ultrasonography, and radiography for DDH in at-risk infants using a common composite reference standard. Methods: This prospective diagnostic-accuracy cohort study included 416 infants aged from birth to 12 months who had at least one stated risk factor for DDH. Participants underwent standardized clinical examination, Graf-method ultrasonography, and age-appropriate anteroposterior pelvic radiography. Final DDH classification was based on follow-up radiography at approximately 6 months of age and pediatric orthopedic adjudication. Sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), with 95% Confidence Intervals (CIs), were reported for each index test. Results: Ultrasonography had a reported sensitivity of 71.0% (95% CI, 65.5%-76.0%) and a specificity of 69.0% (95% CI, 60.7%-76.3%). Clinical examination had a sensitivity of 54.0% (95% CI, 48.2%-59.7%) and specificity of 64.0% (95% CI, 55.5%-71.7%), whereas radiography had a sensitivity of 71.0% (95% CI, 65.5%-76.0%) and specificity of 39.0% (95% CI, 31.1%-47.5%). Conclusion: Ultrasonography provided the most favorable reported balance of sensitivity and specificity in this selected high-risk cohort, while clinical examination remained an important first-line assessment and radiography provided age-dependent structural information. The findings support a coordinated, age-appropriate diagnostic pathway rather than reliance on a single modality. For nursing practice, the results emphasize standardized risk documentation, timely communication with pediatric and radiology teams, caregiver education, and closed-loop follow-up; however, direct nursing competencies, interventions, and outcomes should be evaluated in future studies.

A Pilot Intervention Study of Structured Art Therapy to Enhance Psychological Well-Being and Quality of Life in Older Adults

2026-02-07T05:21:47+00:00

Background: Aging leads to decreases in physical, mental, and social abilities, affecting the well-being of older people. Although art therapy is widely used, there is still little research on its specific methods and benefits for older adults. This study looked at the initial effects of organized art therapy on enhancing the Quality of Life (QoL) and Psychological Well-being (PWB) of older adults. Methods: This pilot study used a quasi-experimental design with pre- and post-tests without a control group. Art therapy, including drawing, coloring, making handicrafts, and collage activities, was conducted in one nursing home in Semarang, including 40 residents experiencing loneliness based on the University of California, Los Angeles (UCLA) loneliness scale. The World Health Organization Quality of Life - Bref (WHOQOL-BREF) questionnaire and the Ryff’s Psychological Well-Being Scale (RPWBS) were used. Since the data distributed normally, a paired t-test was used to examine the effects of art therapy; meanwhile, the QoL domains used the Wilcoxon signed rank test because the data did not distribute normally. Results: Post-intervention assessments indicated an improvement in both QoL and PWB scores, with the average QoL score increasing by 5.86 and the average PWB score rising by 4.35. Nevertheless, these results are preliminary and should not be construed as definitive evidence of effectiveness. Conclusion: Preliminary findings suggest that the intervention is feasible and may improve QoL and PWB. Nonetheless, the clinical utility of the intervention is not yet established, owing to the pilot study design, small sample size, and non-probability sampling. Consequently, larger controlled studies are necessary.