The Malaysian Journal of Nursing (MJN)

Factors and Organisational Strategies Associated with Nurse Retention and Turnover Intention in Public Healthcare Settings: A Systematic Literature Review

2026-10-03T05:52:27+00:00

Background: Nurse retention is a critical workforce priority as public healthcare systems face staffing shortages, increasing service demands, and continuing workforce pressures. High turnover can disrupt continuity of care, increase workload among remaining staff, and impose additional recruitment and training costs. Objectives: This systematic literature review aimed to (1) synthesise evidence on factors and organisational strategies associated with nurse retention and turnover intention among nurses in public healthcare settings and (2) develop a thematic framework to inform workforce sustainability. Methods: A systematic literature review was conducted using Scopus and Web of Science following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Peer-reviewed English-language empirical studies published between 2021 and 2025 were screened using predefined eligibility criteria and an adapted six-item quality appraisal checklist. The protocol was registered with PROSPERO (CRD420251186033). Twenty studies meeting the predefined quality threshold were synthesised using descriptive and thematic approaches guided by the a priori Job Demands–Resources framework. Results: Fourteen studies (70%) were conducted in Asia. Five interconnected themes were identified: supportive organisational culture, workload management, career development, psychological well-being, and reward and recognition. The findings indicate that retention and turnover intention are associated with interacting organisational, occupational, and individual factors. Technology-based retention strategies were minimally represented. Conclusion: Nurse retention in public healthcare settings requires an integrated perspective addressing organisational resources, occupational demands, and individual well-being. Future research should strengthen longitudinal and intervention-based evidence across diverse public healthcare contexts.

Message from the Editor in Chief

2026-10-06T10:23:02+00:00

Developing and Implementing an Educational Program about Toxic Management for Nurse Managers

2026-05-25T07:03:30+00:00

Background: Toxic management is a management style characterized by behaviors and practices that are harmful to employees' well-being and organizational performance. Objective: To develop and implement an educational program about toxic management for nurse managers at Main Assuit University Hospital. Methods: The study included all nurse managers (N = 70) working at Main Assuit University Hospital using a total population sampling technique. A one-group quasi-experimental design was used. Knowledge regarding toxic management was assessed before the program, immediately after its completion, and three months later. Data were collected using a structured self-administered questionnaire consisting of three parts: demographic characteristics, a toxic management knowledge scale, and a participant's feedback form. Results: The findings revealed that 61.4% of nurse managers had unsatisfactory knowledge scores regarding toxic management during the pre-test phase, while 92.9% and 90.0% had satisfactory scores during the post-test and follow-up phases, respectively. Highly statistically significant differences were observed between the pre-test and post-test phases, as well as between the pre-test and follow-up phases (p < 0.001). Conclusion: Nurse managers showed improved knowledge regarding toxic management across the post-test and follow-up assessments, particularly in relation to assessment of toxic management at work and strategies for preventing and managing toxic behaviors. Furthermore, participants reported favorable evaluations. Recommendations: Healthcare organizations should integrate toxic management education into on-going professional development and training programs. Further research is recommended to examine the effectiveness and applicability of the program across different cultural and organizational contexts.

Developing a Culturally Based Family-Centered Nursing Model for Emergency Prevention and Management among Families of Patients with Non-Communicable Diseases

2026-10-03T05:37:24+00:00

Introduction: Non-Communicable Diseases (NCDs) are a major cause of morbidity and mortality worldwide and may lead to emergencies requiring rapid family response. However, family preparedness for emergency prevention and management remains suboptimal and may be associated with family dynamics, individual capacity, and cultural values. Objectives: This study aimed to evaluate a proposed culturally based Family-Centered Nursing (FCN) structural model for Emergency Prevention and Management (EPM) among families of patients with NCDs. Methods: A cross-sectional analytical design was applied using Partial Least Squares Structural Equation Modelling (PLS-SEM). A total of 210 primary caregivers of patients with NCDs were selected using proportional stratified random sampling. Data were collected using a structured questionnaire measuring Family Assessment, Individual Family Members Assessment, Culture Care, and EPM. Model evaluation included measurement and structural models. Results: Family Assessment and Individual Family Members Assessments were significantly and positively associated with culture care and EPM. Culture care was also significantly and positively associated with EPM. Specific indirect effects through culture care were significant and consistent with partial mediation. The model explained 55.3% of the variance in Culture Care and 70.9% of the variance in EPM. Conclusion: The findings provide preliminary support for the proposed culturally based FCN predictive model linking family and individual factors with EPM among families of patients with NCDs. Culture Care showed significant indirect associations with EPM, consistent with a partial mediating role. These findings support culturally sensitive, family-centered approaches in nursing practice. Further longitudinal or intervention-based research is needed to validate the model and evaluate its implementation and effectiveness.

Association between Performance Appraisal System, Workplace Well-being, Career Plateau, and Job Satisfaction among Nurses

2026-08-31T12:18:16+00:00

Background: Performance appraisal systems are integral to nursing management because they facilitate the recognition of nurses' contributions, performance enhancement, and career advancement. However, evidence of their influence on nurses’ workplace well-being, job satisfaction, and career plateauing remains unclear. Objectives: This study aimed to investigate the relationship between performance appraisal systems, workplace well-being, career plateau, and job satisfaction among nurses in selected hospitals. Methods: A descriptive correlational cross-sectional design was employed, involving 340 nurses from three hospitals in Assiut Governorate (Main Assiut University Hospital, General Assiut Hospital, and El-Mabarah Hospital, Egypt). Data were collected using five structured questionnaires: personal and occupational characteristics, performance appraisal systems, workplace well-being, career plateau, and satisfaction with performance appraisal. Data collection spanned three months, from July 2025 to September 2025. Results: Approximately 40% of nurses perceived the performance appraisal system as poorly implemented in their hospitals. Moderate levels of workplace well-being and job satisfaction were reported by 37.1% and 61.2% of the nurses, respectively. More than half of the participants experienced low levels of career plateaus. Significant positive correlations were identified between performance appraisal systems and both workplace well-being and job satisfaction, while a significant negative correlation was observed with career plateau (p ≤0.001). In the multiple linear regression analysis, workplace well-being and satisfaction with performance appraisal were significant positive predictors of the performance appraisal system, whereas career plateau was not a significant predictor (p > 0.965). Conclusion: The effective implementation of performance appraisal systems is associated with enhanced workplace well-being and increased job satisfaction and is inversely correlated with career plateau among nurses.

Preliminary Diagnostic Accuracy and Usability of a Rule-Based mHealth Application for Differentiating Migraine and Tension-Type Headache: A Pilot Study

2026-01-28T11:19:14+00:00

Background: Headache disorders are common causes of disability, and differentiating migraine from Tension-Type Headache (TTH) can be challenging because of overlapping clinical features. Mobile Health (mHealth) applications may support structured symptom assessment, but diagnostic performance should be established before such tools are incorporated into clinical triage. Objectives: This pilot study evaluated the preliminary diagnostic accuracy and inter-method agreement of a rule-based mHealth application for differentiating migraine from TTH using International Classification of Headache Disorders, 3^rd edition (ICHD-3) criteria and assessed application usability. In this study, diagnostic accuracy was assessed against an independently established clinical reference diagnosis, while agreement between the application and the clinical reference diagnosis was assessed using Cohen's kappa. Methods: A quantitative, cross-sectional pilot study included 73 participants recruited at the University of Fujairah. The application used a deterministic, logic-based weighted algorithm derived from ICHD-3 symptom criteria. Diagnostic accuracy was evaluated in a subset of 25 participants. After completing the application assessment, these participants attended clinical assessments by physicians from neurology and medicine, who independently applied ICHD-3 criteria without access to the application classification. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), overall accuracy, and Cohen's kappa were calculated. Reliability in this pilot study refers to agreement with the independent clinical classification as quantified by Cohen's kappa; test-retest reproducibility was not assessed. Usability was assessed using the System Usability Scale (SUS). Results: In the validation subset, overall accuracy was 88.0% (95% CI: 68.8%-97.5%), sensitivity was 80.0% (95% CI: 44.4%-97.5%), specificity was 93.3% (95% CI: 68.1%-99.8%), PPV was 88.9% (95% CI: 51.8%-99.7%), and NPV was 87.5% (95% CI: 61.7%-98.4%). Agreement with the clinical reference diagnosis was substantial (Cohen's kappa = 0.74). The mean SUS score was 78.6 (SD = 12.3). The wide confidence intervals indicate limited precision because of the small validation subset. Conclusion: The application demonstrated promising preliminary diagnostic accuracy and inter-method agreement with an independently established clinical diagnosis, together with satisfactory usability in this pilot sample. Because the clinical validation subset was small and confidence intervals were wide, these findings should be interpreted cautiously and should not be generalized beyond similar populations. Larger studies are required to confirm diagnostic accuracy and to evaluate test-retest and other forms of reproducibility before routine clinical implementation.

From Education to Impact: Nursing-Led Approaches a Transformative Force in Advanced Valvular Heart Diseases

2026-02-14T05:16:18+00:00

Background: Valvular heart diseases have a substantial impact on healthcare systems, contributing significantly to cardiovascular morbidity and mortality worldwide. Skilled nurses play a crucial role in improving and stabilizing patients’ health and functional status through basic management and follow-up. Objectives: This study aimed to evaluate the efficacy of a structured nursing-led health education program in improving heart failure–related clinical status, health-related quality of life, and medication adherence as well as reducing mortality among patients with advanced valvular heart disease at the Cardiovascular Medicine Departments, Assiut University Heart Hospital, Egypt. Methods: a quasi-experimental research design was used. A purposive sample of 210 patients with advanced valvular heart disease was selected from the cardiovascular medicine departments at Assiut University Heart Hospital, Assiut, Egypt (105 were assigned to the study group and 105 to the control group). Tools: Data were collected using three tools: (I) a patient assessment sheet, (II) a heart quality of life questionnaire, and (III) a Modified Six-Item Morisky Medication Adherence Scale. Results: reveals that 57.1% for the studied & 53.3% for the control groups were aged 50 ≤ 65 years, 50.5% & 62.9% were males, and also statistically significant differences were observed in heart failure assessment, total category of heart QoL, and medication adherence between the study and control groups at six months, which persisted throughout the one-year follow-up period after implementing the nursing-led health education approaches (p-value < 0.001), with moderate effect size. Conclusion: The study's findings demonstrated favorable outcomes, associated with the nursing-led health education approaches. Thus, integrating these approaches into the management of patients with advanced valvular heart disease is strongly recommended to achieve sustained improvements in patient outcomes.

Effectiveness of an Integrated Family Nursing Care Model for Children with Pneumonia (ASTANIA) on Caregiver Independence: A Quasi-Experimental Study

2026-06-29T08:46:41+00:00

Background: Caregivers of young children with pneumonia require preparation that extends from hospitalization into home care. The ASTANIA model integrates family-centered nursing, structured discharge planning, skills training, and community follow-up. Objectives: To evaluate whether ASTANIA was associated with greater family independence than routine nursing care. Methods: This quasi-experimental, non-equivalent control-group study enrolled 76 mothers of children aged 2-59 months with pneumonia (ASTANIA, n = 38; routine care, n = 38) from four public hospitals in Jakarta. Family independence was assessed at baseline and monthly for three months. Repeated binary outcomes were analyzed using generalized estimating equations (GEE). Results: All 76 participants completed Month 3. The proportion classified as independent increased from 15.8% to 71.1% in the ASTANIA group and from 21.1% to 44.7% in the routine-care group. In the final GEE model, ASTANIA was associated with higher odds of family independence than routine care (adjusted odds ratio [aOR] = 2.426, 95% CI 1.004-5.860; p = 0.049). At Month 3, the odds of independence were higher than at baseline (aOR = 7.141, 95% CI 3.733-13.633; p < 0.001). Conclusion: ASTANIA was associated with improved caregiver independence over three months. Because allocation was by site rather than random, the results support cautious effectiveness claims and require confirmation in multicenter randomized studies.

Telenursing versus Traditional Outpatient Care for Older Adults with Type 2 Diabetes: Patient Satisfaction, Medication Adherence, and Lifestyle Modification

2026-10-03T05:41:02+00:00

Background: Comparative evidence on routine telenursing versus traditional outpatient care for older adults with type 2 diabetes in Saudi Arabia remains limited. Objectives: To compare the two modalities on patient satisfaction, medication adherence and lifestyle modification. Methods: A cross-sectional comparative study, reported per STROBE, at Hafar Al-Batin Diabetes Center, Saudi Arabia. Stratified random sampling drew 743 older adults from the telenursing (n = 362) and traditional outpatient (n = 381) clinic populations; allocation followed routine service, not randomization. Outcomes were measured with the Telenursing Interaction and Satisfaction Scale (TISS), Adherence to Refills and Medications Scale (ARMS) and Perceived Adherence Lifestyle Modification Questionnaire (PALM-Q). Groups were compared with independent-samples t, Mann–Whitney U and chi-square tests, and care modality entered into multivariable linear regression adjusted for sociodemographic and clinical covariates. Results: Total satisfaction was marginally higher with telenursing (93.90 ± 3.50 vs. 93.28 ± 3.41; mean difference 0.61, 95% CI 0.12–1.11; d = 0.18), confined to the health information (p < 0.001) and decisional control (p = 0.013) domains. After adjustment it was attenuated and borderline (β = 0.52, 95% CI 0.01–1.04, p = 0.048), and not robust to specification. Medication adherence, lifestyle modification and HbA1c did not differ (HbA1c 8.22 ± 1.03% vs. 8.33 ± 1.10%, p = 0.189). Conclusion: Routine telenursing delivered patient experience and self-management outcomes comparable to traditional care, with no evidence of a clinically meaningful advantage in either direction, supporting it as a non-inferior alternative where in-person attendance is difficult rather than a superior model. The cross-sectional design precludes causal inference

Effect of a School-Based Nurse-Led Red Dragon Fruit Intervention as an Adjunct to Iron–Folic Acid Supplementation in Adolescent Girls: A Quasi-Experimental Study

2026-02-23T05:04:45+00:00

Background: Background: Anemia remains a nutritional concern among adolescent girls, and routine Iron–Folic Acid (IFA) supplementation may benefit from complementary food-based strategies. Objectives: To examine whether adding 100 g of fresh red dragon fruit (Hylocereus polyrhizus) daily to routine IFA supplementation was associated with an additional change in hemoglobin levels among adolescent girls. Methods: A quasi-experimental pretest–posttest study with a non-equivalent control group was conducted among 96 adolescent girls in a public senior high school in Yogyakarta, Indonesia. Participants received routine IFA plus 100 g of fresh red dragon fruit daily for 14 days (n = 48) or routine IFA alone (n = 48). Hemoglobin was measured before and after the intervention. ANCOVA compared post-intervention hemoglobin between groups after adjustment for baseline hemoglobin, age, and menstrual cycle characteristics. Results: Hemoglobin increased by 0.274 g/dL in the intervention group and 0.145 g/dL in the control group. The unadjusted between-group difference in change was 0.129 g/dL (95% CI −0.036 to 0.294; p = 0.123). After adjustment, the estimated marginal means were 12.98 and 12.80 g/dL, respectively, with an adjusted difference of 0.18 g/dL (95% CI 0.04–0.32; F (1,91) = 6.12; p = 0.015; partial η² = 0.06). Conclusion: Adding fresh red dragon fruit to routine IFA supplementation was associated with a statistically significant but small adjusted difference in hemoglobin after 14 days. The findings should be interpreted cautiously because of the non-randomized design, short follow-up, and potential measurement uncertainty.

Effect of Empowerment-Based Nursing Program on Knowledge and Self-Efficacy among Patients with Multiple Sclerosis

2026-10-03T05:43:55+00:00

Background: Multiple sclerosis is a long-term neurodegenerative disorder. Empowerment-based nursing interventions are considered an essential approach in chronic disease management, which effectively enhances patients’ knowledge and self-efficacy. Objectives: To evaluate the effect of an empowerment-based nursing program on knowledge and self-efficacy among patients with multiple sclerosis. Methods: A study-control quasi-experimental research design was used for conducting the study with a purposive sample of 102 patients obtained from the multiple sclerosis unit and neurological ward at Assiut University Hospitals, utilizing two tools: the patient's assessment sheet and the Multiple Sclerosis Self-Efficacy Scale. Results: Regarding age distribution, 51.0% of patients in the intervention group and 60.8% in the control group were aged between 30 and less than 40 years. The majority of patients in both groups presented with a relapsing–remitting disease pattern (82.4% in the intervention group and 94.1% in the control group). Following the implementation of the empowerment-based nursing program, 90.2% of patients in the study group demonstrated a satisfactory level of knowledge, while 31.4% exhibited a high level of self-efficacy. Conclusion: There were statistically significant differences in knowledge and self-efficacy between the study and control groups post application of the empowerment-based nursing program. Recommendation: Patients with multiple sclerosis should receive ongoing empowerment-based nursing programs, and healthcare institutions should integrate such programs into routine care.

Transcultural Self-Efficacy among Nurses Providing HIV/AIDS Care in Public Health Centers in Cimahi, Indonesia: A Comparative Cross-Sectional Study

2026-07-27T10:21:56+00:00

Background: Transcultural self-efficacy is relevant to HIV/AIDS nursing because culturally sensitive issues such as stigma, disclosure, sexuality, religion, family involvement, and treatment decisions are routinely encountered in care. Objectives: This study assessed transcultural self-efficacy among nurses providing HIV/AIDS services in Public Health Centers (PHCs) in Cimahi, Indonesia, and compared scores across demographic and professional characteristics. Methods: A comparative cross-sectional design used total sampling of the full accessible population of 61 eligible nurses from 13 PHCs. The bilingual 83-item Transcultural Self-Efficacy Tool (TSET) assessed cognitive, practical, and affective domains on a 1-10 scale. Domain and overall scores were analyzed as continuous variables. Because the overall score was non-normally distributed, Mann-Whitney U and Kruskal-Wallis tests were used, with Holm adjustment across eight profile comparisons. Results: Mean scores were 8.21 (SD=1.95) for cognitive, 7.86 (SD=2.28) for practical, 7.66 (SD=2.28) for affective, and 7.89 (SD=2.12) overall. The overall median was 8.57 (IQR 7.21-9.51; 95% CI for the mean 7.35-8.44). Corrected item-total correlations for the 83-item scale ranged from 0.820 to 0.976, and overall Cronbach's alpha was 0.998. After Holm adjustment, differences remained significant for education (Mann-Whitney U=211.5; adjusted p=0.0049) and work experience (H=14.48; adjusted p=0.041), but not for workplace or other demographic characteristics. Conclusion: Among this local census of PHC nurses, transcultural self-efficacy was highest in the cognitive domain and lowest in the affective domain. Education and work-experience groups differed, although the work-experience pattern was non-linear. Findings should be interpreted as local, exploratory group differences rather than causal or nationally representative effects.

Effect of Intermittent Pneumatic Compression Device on Reducing Deep Venous Thrombosis Occurrence among Trauma Patients

2026-10-03T05:47:20+00:00

Background: Deep vein thrombosis remains a significant global disease burden and is the leading cause of inpatient mortality in injured patients. As such, measures to prevent Deep Vein Thrombosis (DVT) should be taken. Intermittent Pneumatic Compression Devices (IPCDs) are essential for preventing deep vein thrombosis by enhancing venous blood flow and reducing venous stasis. They provide a safe, non-invasive method of thromboprophylaxis. IPCDs help compensate for impaired muscle pump activity following injury or surgery. Their use contributes to improved circulation and reduced risk of thromboembolic complications in critically ill trauma patients. Objectives: The study aimed to evaluate the effect of intermittent pneumatic compression device on reducing deep venous thrombosis occurrence among trauma patients. Methods: The study was carried out at a trauma intensive care unit at Trauma Hospital of Assiut University, Egypt, using a quasi-experimental research design. A convenient sampling of 60 patients was used. Four tools were utilized to collect data- patient assessment tool, DVT risk factor assessment, DVT Incidence monitoring, and patients' outcomes tool. Results: The outcomes revealed that study populations were at high risk (0.0% and 43.3%), study versus control group for developing DVT, the difference between study populations was statistically significant (P-value=0.001*), There were significantly less thrombotic events in the patients that received intermittent pneumatic compression as compared to the control group, (3.3% and 26.7%), and Length of stay at Intensive Care Unit (ICU) was statistically significant, and on ventilation (P-value=0.029*), shorter in the intervention group. Recommendations: Implementation of Intermittent Pneumatic Compression device is effective and can decrease deep venous thrombosis incidence in trauma patients. Conclusion: The use of an intermittent pneumatic compression device significantly reduced the occurrence of deep venous thrombosis among trauma patients (3.3% versus 26.7%) and was associated with shorter durations of mechanical ventilation and ICU stay. As a safe, non-invasive method of thromboprophylaxis, the device offers a practical nursing intervention for lowering thromboembolic risk in critically ill trauma patients.

Feasibility of Nurse-Led Structured Education and Relaxation Techniques as an Add-on to Ayurvedic Management for Psoriasis in an Indian Ayurveda Hospital: A Randomized Controlled Pilot Study

2026-08-18T11:07:22+00:00

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease with substantial psychological burden. Ayurvedic inpatient management is widely used in India, but no structured nursing protocol has been described. Objectives: To assess the feasibility of a nurse-led structured education and relaxation intervention alongside standard Ayurvedic management and obtain a preliminary estimate of its effect on psoriasis severity. Methods: Two-arm randomized controlled pilot study at a tertiary-level Ayurveda hospital in New Delhi, India. Ten adults with a Psoriasis Area and Severity Index (PASI) of 10 or above were block randomized to experimental or control arms (n = 5 each). Both received standard Ayurvedic treatment; the experimental arm additionally received structured education, supervised relaxation and yoga to Day 14, and caregiver-supported home practice to Day 60. Seven feasibility domains were primary, and PASI was secondary. Results: Of 17 patients screened, 13 were eligible and 10 randomized, giving a consent rate of 76.9% against the pre-specified 80% threshold, the only criterion not met. Retention, session attendance, home practice, protocol fidelity, and acceptability reached 100%, with no attributable adverse events or missing PASI data. Baseline PASI was higher in the control arm (mean 27.28 versus 20.04). Median PASI reduction at Day 60 was 74.6% in the experimental arm versus 17.6% in the control arm; the between-group difference was 10.00 points (95% CI 5.30 to 15.40; exact p = 0.008). Conclusion: The protocol was feasible within routine Ayurvedic inpatient care, with consent the one criterion needing change. The PASI difference is a preliminary signal only, given the small sample and baseline imbalance.

Easing Heel Lance Pain: The Role of Nesting Position as Nursing Intervention in Preterm Neonates

2026-04-10T08:40:24+00:00

Background: The role of neonatal nurses is pivotal in the assessment and management of pain, as unmanaged pain in premature infants triggers hemodynamic volatility, leading to physiological instability and aberrant neurodevelopmental trajectories. Nesting positioning is a method for mitigating systemic pain responses. Objectives: To evaluate the effect of nesting position on procedural pain among preterm neonates undergoing heel lance procedures. Methods: A quasi-experimental research design was conducted at the Neonatal Intensive Care Unit (NICU) at Assiut University Children Hospital, Egypt, on a purposive sampling of 60 preterms whose gestational age ranged from 28-36 weeks. Data collection was conducted over an eight-month period, from October 2024 to May 2025. Preterm neonates were divided into two groups equally: 30 in the nesting group and 30 in the control group. Pain assessed by trained neonatal nurses blinded to group assignment to minimize observer bias Data quantification relied on structured questionnaire form, and Premature Infant Pain Profile-Revised (PIPP-Revised) scale. Results: The study found that 56.7% of preterm neonates in the nesting group were pain-free during the heel lance procedure, compared to 0% in the control group. Immediately after the procedure, 83.3% of preterm neonates in the nesting group were pain-free, compared to 10.0% in the control group. Conclusion: The study findings confirm that the implementation of nesting position as a nursing intervention significantly reduced pain severity during and immediately after the procedure. The study recommends institutionalizing this positioning strategy as a fundamental component of routine neonatal nursing practice is strongly advocated.

Perceived Social Support and Mental Well-being among Higher Vocational Nursing Students in Eastern China: A Single-Centre Cross-sectional Study

2026-10-03T05:51:30+00:00

Background: Nursing students may experience substantial academic and clinical demands, which may negatively affect their mental health. Previous studies have suggested that perceived social support (PSS) is associated with higher levels of Mental Well-Being (MWB) among nursing students. Understanding this association may inform the development of strategies to support nursing students’ MWB. Objectives: This study aimed to examine PSS and MWB levels among Chinese nursing students and the association between these two variables. Methods: A cross-sectional survey was conducted among 612 nursing students at a higher vocational college in Eastern China in March 2025. Data were collected using the Mental Health Continuum-Short Form (MHC-SF) and the Perceived Social Support Scale (PSSS). Results: The mean scores of PSS and MWB were 47.98±10.69 and 43.97±14.19, respectively. PSS was positively correlated with MWB (r = 0.347, p < 0.001). Simple linear regression analysis revealed a significant association between PSS and MWB (B = 0.461, 95% CI [0.362, 0.560], p < 0.001). After adjusting for demographic and health-related factors, PSS remained significantly positively associated with MWB (β = 0.317, p < 0.001), with the addition of PSS increasing the explained variance by 9.8%. Conclusion: PSS was independently associated with better MWB among Chinese nursing students. Longitudinal or experimental studies are needed to determine whether strengthening social support can improve mental well-being.

Development of Culturally Congruent Regional Food Recipes for Type 2 Diabetes Management: A Mixed-Methods Study in Phitsanulok, Thailand

2026-06-12T05:49:51+00:00

Background: Dietary non-adherence remains a global barrier to effective Type 2 Diabetes Mellitus (T2DM) management, often exacerbated by a "one-size-fits-all" nutritional approach. In Thailand, despite the implementation of the "Clinical Practice Guideline for Diabetes 2023" and the "Phuwadol Model" for diabetes remission, many patients struggle to sustain behavioral changes due to cultural disconnects. Objectives: To develop and assess the sensory acceptability of culturally congruent regional food recipes for T2DM patients in Phitsanulok, Thailand. Methods: A convergent parallel mixed-methods design was utilized. Qualitative data explored dietary behaviors via in-depth interviews (n=30; comprising 10 patients, 10 caregivers, and 10 healthcare providers). Quantitative assessment involved a satisfaction survey (n=30) of two developed regional recipes. Results: Six qualitative themes emerged: (1) Pre-diagnosis "Sugar Attachment," (2) Post-diagnosis fear-driven adaptation, (3) The nurse’s role in communal support, (4) Misconceptions in regional nutrition, (5) Demand for evidence-based local recipes, and (6) Accessibility of local raw materials. The developed recipes (Banana Blossom Salad and Sour Curry with Lotus Stem) utilized local, low-glycemic index (GI) ingredients. Quantitative results showed exceptionally high satisfaction in visual appearance and taste. Conclusions: Integrating local culinary wisdom into nursing practice through Leininger’s framework may enhance dietary adherence. This model bridges the "knowledge-to-action" gap by aligning clinical standards with the lived cultural experience of the patient. However, these findings are limited to sensory acceptability and lack empirical glycemic or biochemical validation.