The Malaysian Journal of Nursing (MJN)

Message from the Editor in Chief

Prof. Datuk Dr. Hjh. Bibi Florina Abdullah — 2025-06-19

Assessing Knowledge, Attitudes and Cessation Intentions among University Students Using e-Cigarettes (HiPak): A Basis for Education

Art Brian Escabarte — 2025-06-19

Background: E-cigarettes, also known as “HiPak”, have surged in popularity worldwide. This led to higher e-cigarette smoking rates, which pose significant health risks. In the Philippines, present research on university students' e-cigarette uses and risk factors is inadequate. Objectives: This study aimed to explore the knowledge, attitudes, and cessation intentions toward e-cigarette use of university students. Methods: A descriptive correlational research design was used with a modified questionnaire as an instrument. Purposive sampling was used. Frequency and percentage were used to describe the results. The Mann-Whitney U Test was used to determine the relationship between participants' attitudes towards e-cigarettes and knowledge of health risks and the Kruskal-Wallis H Test for knowledge of health risks and cessation intention. Results: Using the Mann-Whitney U test and Kruskal-Wallis H-Test with a p-value at 0.05, the results showed that there is no significant difference between the user’s knowledge when grouped according to their demographic profile except for the current living condition, which has a p-value of 0.016. On the other hand, there was a significant difference between the user’s knowledge and their perception that using e-cigarettes makes smokers look relaxed and more acceptable by society than conventional cigarettes, with a p-value of 0.033. Conclusion: Therefore, the reasons why university students smoke e-cigarettes are for socialisation, to relieve stress, and the different flavours. The students only have a moderate level of knowledge regarding the health risks of e-cigarettes. This means that there is a need to conduct health teachings regarding effective stress coping techniques and the health risks of using e-cigarettes. For future studies, it is recommended to consider other variables which may influence the use of e-cigarettes among students.

A Model for Fostering Self-Efficacy in Breastfeeding Mothers Through Self-Directed Learning in Nursing Care

Dewi Ariani — 2025-06-19

Background: The prevailing low coverage of exclusive breastfeeding in Indonesia has a profound impact on the health outcomes of both mothers and infants in the short and long term. Notably, the primary issue in this context pertains to maternal self-efficacy. No concurrent research has addressed a self-efficacy model grounded in self-directed learning among breastfeeding mothers. This study aims to develop a model to enhance breastfeeding confidence in mothers through self-directed learning, with significant implications for maternal and infant health. Methods: The research utilized cross-sectional methods to examine 200 mothers who were breastfeeding infants between the ages of 0 and 6 months. Data analysis was carried out using structural equation modelling (SEM). Results: The research findings indicate a significant relationship between breastfeeding self-efficacy and the autonomic process, as evidenced by a t-value of 9.414 and a beta coefficient of 0.492 (moderate correlation). An increase in breastfeeding self-efficacy positively correlates with the success of exclusive breastfeeding. This autonomous process is influenced by breastfeeding education design and personal attributes, all of which contribute to the enhancement of breastfeeding self-efficacy and, ultimately, the success of exclusive breastfeeding. The autonomous process is identified as a significant influencer of breastfeeding self-efficacy. Breastfeeding support significantly influences Personal Attributes (PA) but does not have a notable impact on the Autonomous Process. Conclusion: In conclusion, breastfeeding self-efficacy emerges as the principal determinant in bolstering the successful practice of exclusive breastfeeding, facilitated by self-directed learning capabilities. The capacity for self-regulation significantly impacts breastfeeding self-efficacy.

Nursing Students' Readiness to Apply Flipped Learning: A Cross-Sectional Study

Sameh Elhabashy — 2025-06-19

Background: Flipped learning (FL) is a contemporary teaching approach that offers numerous benefits, particularly in the complex nursing educational environments. Assessing students' readiness for FL is essential to ensure its successful and satisfactory adoption. Objectives: To assess the readiness for implementing FL pedagogy in Egypt, particularly among nursing students, and to identify the factors influencing its adoption. Methods: The current study employed a cross-sectional descriptive research design, recruiting 372 nursing students from three different universities in Egypt to improve the generalizability of the findings. These institutions included Cairo University, Helwan University, and Misr University for Science and Technology. Data were collected using a self-administered questionnaire titled 'Nursing Students' Readiness for FL. Results: 75.2% of student’s demonstrated moderate (above average) readiness, with an overall mean readiness score of 64.8%. Technical readiness was the highest (74%), while environmental readiness was the lowest (53.6%). There was a significant correlation between the readiness domains (p< 0.001). Academic level (B = 2.205, p<0.001) and GPA (B = 5.705, p< 0.001) were influencing factor of readiness, with higher academic levels and GPAs linked to increased readiness. Conversely, gender, age, and university affiliation were not significant influencing factors. Conclusion: Nursing students demonstrated above-average readiness for adopting FL. The implementation of FL shows great potential, particularly if more attention is given to improving access to e-learning resources, providing technical support for students, and raising awareness among freshmen and those with lower academic achievement regarding FL and its benefits.

Experience of Burden in Self-Care of Type 2 Diabetes Mellitus: A Qualitative Study in Indonesian Context

Anih Kurnia — 2025-06-19

Background: Effective management of Type 2 Diabetes Mellitus (T2DM) depends on self-care practices, including lifestyle modifications, dietary management, and medication adherence. However, in rural Indonesian populations, these practices are often hindered by limited healthcare access, low health literacy, and sociocultural barriers, resulting in diverse and complex patient experiences. Methods: This qualitative study used a phenomenological approach to explore the lived experiences of T2DM patients in rural Indonesia. Participants were recruited through snowball sampling, starting with initial referrals from local healthcare workers. A total of 25 participants (15 females and 10 males) were included. Semi-structured interviews were conducted to investigate self-care practices, challenges, and support systems. Data were analysed using the Colaizzi method to systematically identify key themes and subthemes. Results: Three main themes emerged: (1) Knowledge and Health Literacy, highlighting significant gaps in understanding and low literacy levels among participants; (2) Emotional Impact, encompassing anxiety, diabetes-related distress, and efforts to maintain well-being; and (3) Influencing Factors in Self-Care, such as adherence to treatment, barriers to healthcare access, cultural influences, and the role of family and social support. Participants faced substantial challenges managing their condition, underscoring the need for improved education and tailored support systems. Conclusion: This study highlights the need for culturally sensitive interventions and enhanced education to improve Type 2 Diabetes Mellitus (T2DM) management in rural Indonesia. Addressing emotional well-being, health literacy, and healthcare barriers is essential. Family involvement and community-based support can foster sustainable self-care practices and improve diabetes outcomes.

Nurse Professional Commitment as a Mediator Between ProQOL, Resilience, and Retention Intentions among Filipino Nurses

Ejay H. Ignacio — 2025-06-19

Background: The current global nursing shortage is an important issue with significant implications for nursing practice. Increased nurse turnover will yield five percent of the total annual hospital operating costs, estimated to be around 5 trillion dollars annually due to the cost of hiring and training new nursing staff. In the United States, Filipino immigrant nurses play an integral part in the healthcare systems to patch the critical staffing gaps. The changing landscape of healthcare system delivery in the United States, threatens Filipino nurses to stay at their current jobs. This study aimed to explore the mediating effects of nurse professional commitment in the predicting effect of nurses’ professional quality of life and resilience on intention to stay at current work among Filipino registered nurses in the United States. Methods: Causal predictive with mediation analysis was used to determine the mediating effects of nurse professional commitment in the predicting effect of professional quality of life and resilience on intention to stay at current work among Filipino registered nurses in the US. The target population was chosen using the convenience sampling technique based on the inclusion criteria: (a) Filipino registered nurses (both US and Philippines) currently employed in a hospital for more than one year in Pennsylvania, United States, (b) >18 years old and above. The statistical tool was treated using partial least square- Structural Equation Modelling to test the mediating effect of nurse professional commitment in the predicting effect of professional quality of life and resilience on the intention to stay at current work among Filipino nurses in the United States. To test the mediation, the researcher adopted Baron and Kenny four step approach. Results: It was found that professional quality of life and resilience didn’t significantly predict one's intention to stay. This is further supported with the non-significance in terms of direct effect. The inability of professional quality of life and resilience to significantly predict intention to stay (regression and direct effect) indicates that there are other variables such as professional commitment mediates the predicting effect of professional quality of life and resilience to intention to stay. Conclusion: The mediating role of professional commitment in the predicting effects of professional quality of life and resilience on intention to stay reflected the significance in terms of indirect effect and total effect. This indicates that being committed to one's profession and being resilient alone would not influence one's decision to stay in one's job.

Patient Perspectives on Solution-Focused Brief Therapy: A Qualitative Study in Nursing Practice

Fandro Armando Tasijawa — 2025-06-19

Background: Patients with schizophrenia are often characterized for poor adherence to antipsychotic treatment, which leads to a high rate of relapse. Various psychological interventions have been implemented to improve treatment adherence in schizophrenia patients. However, these interventions are typically administered by psychiatrists or psychologists and may not be accessible to patients in the community. Solution-Focused Brief Therapy (SFBT), as a positive, solution-oriented psychological intervention, offers a suitable option due to its simplicity and brevity and can be administered by nurses and general healthcare workers. This study aims to explore the perspectives of schizophrenia patients regarding the implementation of SFBT. Methods: This qualitative study employed with a descriptive phenomenological approach using in-depth interviews with six schizophrenia patients who had experienced Solution-Focused Brief Therapy (SFBT). Data were evaluated using Colaizzi’s seven-step method to capture the participants’ lived experiences and ensure research rigor and credibility. Results: The findings of this study reveal four themes: (1) The therapy helps to rise again, (2) The therapy opens the heart and mind, (3) Motivation to move forward, (4) Feeling better. Conclusion: The findings of this study can serve as input for nurses to implementing SFBT with schizophrenia patients. SFBT encourages nurses to focus on strengths, appreciate patients’ perspectives, respond to their needs and expectations, and view them holistically. Additionally, these findings provide new insights into the concept of “rising again”, which instills hope in overcoming challenges and represents an important area of nursing care in Indonesia and beyond.

Nursing Teaching Scheme on Remedial Compliance and Symptoms among Patients with Gastro-oesophageal Reflux Disease: A Quasi-experimental Study

Asmaa Mahmoud Gomaa — 2025-06-19

Background: Gastroesophageal reflux disease is among the most common conditions affecting the digestive system. A nursing teaching scheme for gastroesophageal reflux disease patients is important as it provides comprehensive information and guidance to help patients manage their condition effectively. Objectives: This study's objective was to evaluate the effect of a nursing teaching scheme on patient compliance and symptoms of gastroesophageal reflux disease. Methods: The research design was Quasi-experimental (one group pretest-post-test). A total of 60 patients were chosen as a purposive sample from the AL-Rajhi Liver Hospital's medical outpatient clinics at Assiut University, Egypt. The data was gathered using a structured interview questionnaire, the Mediterranean Diet Adherence Screener, the Morisky Medication Adherence Scale, and the Gastro-oesophageal Reflux Disease Questionnaire. Results: The total mean score of medication adherence levels increased from 2.08± 2.09 pre-teaching scheme to 5.88± 1.77 and 7.40±1.09, respectively, at one- and three-months post-teaching scheme, with p-value < 0.001 and significant statistical differences. The overall mean score for Mediterranean diet adherence levels significantly improved, rising from 6.97±1.72 before the nursing teaching scheme to 11.15± 1.46 and 12.87± 1.27, respectively, one and three months after the nursing teaching scheme. There was a significant inverse correlation between patient medication compliance and GERD symptoms severity at the one- and three-month post-nursing teaching scheme. Conclusion: The study results showed the effectiveness of a nursing teaching scheme in improving patients’ compliance and symptoms of gastroesophageal reflux. Therefore, the study recommends the teaching scheme be incorporated as part of the medical management approach.

Correlation of Self-empowerment and Family Support with the Quality of Life of Diabetes Mellitus Patients

Miftahul Munir — 2025-06-19

Background: Diabetes mellitus can cause dangerous complications and affect the sufferer's quality of life. Objectives: This research aims to study the relationship between self-empowerment and family support and the quality of life of diabetes mellitus sufferers in Tuban Regency. Methods: This research used a cross-sectional method. The research population was all diabetes mellitus sufferers who participated in the chronic disease program in Tuban Regency in July 2023, as many as 192 people. The sample for this research was 130 people selected using simple random sampling. Data collection used a questionnaire that has been tested. Data analysis used descriptive statistics and the Spearman test. Results: The characteristics of Diabetes Mellitus sufferers are 8 people aged less than 45 years, 103 women, 75 people with high self-empowerment, and 107 people with good family support. The quality of life of sufferers was in the good category for as many as 105 people and in the bad category for as many as 25 people. The relationship between self-empowerment and the quality of life of sufferers is 0.754 (p=0.000), and family support and the quality of life of sufferers is 0.950 (p=0.000). The results of the analysis show that high self-empowerment and good family support are closely related to the quality of life of diabetes mellitus sufferers. Conclusion: So, if there is a family member in the family who suffers from diabetes mellitus, it is hoped that the family will empower the sufferer to meet their needs, and it is important for the family to provide support so that the sufferer is confident.

Effectiveness of Motivational Enhancement Therapy on Coping Strategies and Life Satisfaction among Patients with Substance Abuse

SanthoshKumar Jayakumar — 2025-06-19

Background: Substance abuse is a complex issue influenced by historical, biological, geographic, cultural, social, and economic factors. It poses a serious problem among teenagers and young people, with estimates suggesting that by the ninth grade, more than half of Indian boys have experimented with at least one substance. Objectives: To evaluate the effectiveness of motivational enhancement therapy on coping strategies and life satisfaction among patients with substance abuse. Methods: The study used a pre-experimental design with a one-group pre-test and post-test. The Coping and Satisfaction with Life scale was used in this study. A substance abuse patient and a purposive sampling technique was applied. The collected data were coded and analysed by using descriptive and Inferential Statistics. Results: In the pre-test, over half of substance abuse patients (50.83%) showed poor coping, while post-test results revealed improvement, with 66.7% demonstrating adequate coping. Dissatisfaction was high before the intervention (58.3%), including 25% severely dissatisfied. After the intervention, 48.3% reported being satisfied, and 41.7% were somewhat satisfied. A significant positive correlation (r = 0.778, p = 0.001) was found between coping skills and life satisfaction. Conclusion: The study concludes that implementing a motivational enhancement therapy program improves coping skills and life satisfaction in substance abuse patients, allowing them to meet their motivational needs while also developing cognitive, emotional, social, and self-management skills for future life transitions.

The Role of Cognitive Behavioural Therapy in Enhancing Mental Health and Reducing Loneliness among Nursing Home Residents

Amzal Mortin Andas — 2025-06-19

Background: The increasing elderly population necessitates comprehensive healthcare, including palliative care. Elderly patients in palliative care often experience loneliness, decreased resilience, and mental health issues that affect their quality of life. Cognitive Behavioural Therapy (CBT) has been recognised as an effective intervention for addressing psychological issues, but its effectiveness in elderly palliative care patients remains limited. Objectives: This study aims to evaluate the impact of CBT intervention on levels of loneliness, resilience, and mental health in elderly patients undergoing palliative care. Methods: This quasi-experimental study involved 126 elderly participants aged 60-90 years undergoing palliative care at long term care Budi Mulia 1. Participants were divided into two groups: an intervention group receiving CBT sessions for four weeks and a control group receiving no intervention. Data were collected using the UCLA (University of California, Los Angeles Loneliness Scale) Loneliness Scale, Resilience Scale, and General Health Questionnaire (GHQ-12). Data analysis was performed using a paired t-test and linear regression. Results: The study results indicated that the intervention group experienced a significant reduction in loneliness scores from 65 ± 10 to 45 ± 8 (p = 0.000), a significant increase in resilience scores from 90 ± 12 to 130 ± 15 (p = 0.000), and a significant improvement in mental health scores from 25 ± 5 to 10 ± 3 (p = 0.000) compared to the control group. Conclusion: CBT intervention is effective in reducing loneliness, increasing resilience, and improving mental health in elderly patients under palliative care. These findings not only support the use of CBT as part of holistic care for the elderly but also highlight its potential to transform healthcare practices by addressing psychological needs alongside physical care, ultimately improving overall quality of life.

Prevalence of Obesity and Health-Promoting Lifestyle Profile among Malaysian and Indonesian Nurses

Siti Khuzaimah Ahmad Sharoni — 2025-06-19

Background: Harmful lifestyle behaviours trigger physiological changes that multiply the risk of non-communicable diseases in the population. Methods: A descriptive cross-sectional survey was used to compare the prevalence of obesity and Health-Promoting Lifestyle Profiles (HPLP) among Malaysian and Indonesian Nurses. A total of 417 and 406 nurses from Malaysia and Indonesia participated in the study, respectively. Purposive sampling was used to select facilities, while convenience sampling was used for respondents’ selection. Data was collected using an online Google form and analysis was done using SPSS version 25.0. Results: The result of the study shows a significant association between age (p = 0.001 vs. 0.001) and marital status (p = 0.001 vs. 0.03) with BMI for Malaysia and Indonesia, respectively. A high prevalence rate of obesity was observed in Malaysia (55.9%) and Indonesia (47%). The total HPLP II score of the respondents were Malaysia (142.46 ± 22.70) and Indonesia (129.77 ± 17.89). Spiritual growth and interpersonal relationships had the highest subscale scores for both countries. Physical activity was lowest at 19.45 ± 4.54 vs 18.04 ± 4.27 for Malaysia and Indonesia, respectively. Lastly, a statistically weak relationship was found when BMI was correlated with health responsibility (r = 0.129, p = 0.009) for Malaysia. Similarly, weak correlations were observed in Indonesia between BMI and physical activity (r = 0.106, p = 0.033) and between BMI and interpersonal relationships (r = 0.120, p = 0.015). Conclusion: The prevalence of obesity was high, while physical activity was lowest for both countries.

The Effect of Nurse Coaching Program in Preventing Diabetes Mellitus Complications Behaviours and Improving HbA1c in Patients with Type 2 DM: A Pilot Study

Dayan Hisni — 2025-06-19

Background: Prevention of DM complications must involve the patient as the centre of care. One of the strategies of a patient-centred approach is coaching. However, there are not many studies describing the construction of coaching from a combination of nursing theories between the Theory of Integrative Nurse Coaching (TINC) and interpersonal theory to prevent DM complications and improve HbA1c levels. The specific elements of TINC theory that were used in the study were nurse coaching content to change the behaviours, while the interpersonal theory phases of nurse coaching consisted of orientation, identification, exploration, and termination. The objectives of the study were to determine the feasibility and evaluation of nurse coaching programmes and their impact on preventing DM complication behaviours and reducing HbA1c levels. Methods: This study employed a quasi-experimental design. The nurse coaching programme was twelve weeks long with some steps and methods according to the interpersonal relationship theory. Fourteen patients with DM were allocated into either the experimental group or the control group, with 7 respondents per group. The behaviours of preventing DM complications were examined by a questionnaire of the Summary of Diabetes Self-care Activities (SDSCA), while HbA1c was measured by the HbA1c and ACR analyser. These examinations were performed and compared at baseline and 12 weeks after the end of the intervention. Results: The respondents receiving the nurse coaching programme revealed significant improvement in the Preventing Diabetes Mellitus Complications Behaviours (p < 0.05) and HbA1c level (p < 0.05) compared to those receiving the standard care. Conclusion: This study reported that nurse coaching is feasible for implementation. The integration of the Theory of Integrative Nurse Coaching (TINC) with interpersonal theory effectively supported behaviour change and improved glycaemic control.

Osteoporosis Patients’ Knowledge Concerning Prevention Measures Related to Fractures, Baghdad, Iraq

Shaymaa Mohammed Hussein — 2025-06-19

Background: The Osteoporosis-related fractures (ORF) are a result of an imbalance between osteoblasts and osteoclasts. Osteoporosis’s consequences can lead to fractures, disability, and poor life quality. It has been reported to increase and enhance knowledge and awareness about health education in terms of protection from ORF. Objectives: The study aimed to assess Osteoporosis patients’ knowledge towards prevention measures related to fractures. Methods: This is a descriptive cross-sectional study in a purposive sample of 60 patients attending the outpatient clinic of rheumatology in Baghdad teaching hospitals, Iraq, carried out from February 2024 to June 2024. The data on the questionnaire prepared with the support of literature were collected using a patients information form with 37 questions to investigate patients’ knowledge towards prevention measures related to osteoporosis fractures. Descriptive statistics were used to illustrate the frequencies of the study variables. A bivariate analysis was carried out using ANOVA and t-tests. P-values less than 0.05 were considered significant. The statistical analyses were conducted using SPSS, version 25. Results: It was revealed the mean age was (54.2) years old with an SD of (11.7) years, the females accounted for (83.3%), the obese represented (48.3%), and the primary educational attainment was (40%). A (76.7%) of them haven’t had a previous fracture, (93.3%) have back pain, and (40%) are complaining from Rheumatoid Arthritis. Conclusion: It’s concluded the importance of disseminating awareness about Osteoporosis and fracture prevention and performing continuous workshops to enhance knowledge and practices. Also, improving early detection and management of Osteoporosis, and implementing further interventional studies are essential.

Perception of Nursing Students on Clinical Teaching and Learning of Public Health Nurses: A Descriptive Qualitative Approach

Yoga Tri Wijayanti — 2025-06-19

Background: Clinical teaching and learning are fundamental to nursing education, particularly for public health nurses. However, bridging the persistent theory-practice gap remains a challenge. This study explores nursing students' perceptions of clinical teaching and learning for public health nurses in Indonesia. Methods: A qualitative approach was used, involving telephone-based interviews with 18 final-year nursing students. Data were analysed using thematic analysis, guided by in-depth individual interviews and semi structured guidelines. Results: Three key factors were identified as crucial for successful clinical learning: innovative teaching methods, effective supervision, and opportunities for autonomy. While students valued clinical experiences for enhancing their competencies, they also faced several challenges. These included negative attitudes from clinical staff, lack of essential equipment, low student motivation, limited learning opportunities, and a shortage of qualified clinical supervisors. Conclusion: Strengthening clinical teaching and learning is vital for developing public health nursing competencies. A collaborative effort between nursing education institutions and clinical stakeholders is necessary to create a supportive learning environment. Addressing these challenges through better supervision, resource allocation, and innovative teaching strategies will help bridge the theory-practice gap and enhance the preparedness of nursing graduates for professional practice.

Communication Accommodation between Nurses and Patients in a Medical Tourism Hospital in Malaysia

Aditya Karuthan — 2025-06-19

Background: As frontline healthcare providers, nurses must communicate effectively with patients. Miscommunication in nurse-patient interactions often leads to heightened stress, anxiety, and dissatisfaction for both parties. Miscommunication may lead to misdiagnosis, mistreatment, and medical errors. Communication errors are likely to increase when nurses and patients communicate in their weaker language (L2) or when even one of the speakers uses a weaker language (L2). This study uses the Communication Accommodation Theory (CAT) to understand the adjustments made by Malaysian ESL/EFL nurses and foreign L1/L2 English-speaking patients seeking treatment in Malaysia. This study investigates the English language challenges of Malaysian English as a Second Language/English as Foreign Language (ESL/EFL) nurses interacting with foreign L1/L2 English-speaking patients and how they would accommodate their communication in English. Methods: A total of 432 ESL/EFL nurses from a Medical Tourism-Oriented Hospital participated in an online questionnaire. This study employed a quantitative research design to examine English language challenges and communication accommodation strategies among Malaysian ESL/EFL nurses in a Medical Tourism-Oriented Hospital. Data were collected via an online questionnaire from March 1–7, 2019 and analysed using IBM SPSS Version 24. Results: The findings indicated that the nurse had problems communicating in English. The nurses needed help understanding the foreign English pronunciation voicing out in English and were unsure of the correct English words to use in the interaction. The nurses prefer to use Malay to express themselves when interacting with foreign L1/L2 English-speaking patients. Most nurses immediately use hand and non-verbal gestures when they face difficulties communicating in English. Conclusion: The nurses adapted their communication styles when interacting in English. Nevertheless, the nurses changed their communication behaviour to foster mutual understanding, demonstrating that individuals naturally find ways to communicate effectively.

Risk Factors of Stunting among Children in Rural Area of Jember, Indonesia

Lailil Fatkuriyah — 2025-06-19

Background: The stunting prevalence in Jember has seen a mark escalation, reaching 34.9% by the year 2023. The impact of stunting can be significant as it may reduce the quality of human resources. It is important to know the risk factors of stunting in order to modify these factors through prevention efforts. Methods: This research employed a cross-sectional design involving 163 mothers of children aged 12-59 months residing in Sukowono Village, Jember, Indonesia, who were selected using consecutive sampling. Independent variables included sociodemographic characteristics of families and children, collected using a demographic questionnaire. The dependent variable is stunting, determined by plotting the children’s height on the WHO (World Health Organization) Z-score height-for-age growth curve in the mother and Child Health book. Data were analysed using Multiple Logistic Regression. Results: As many as 49 (30.1%) children were found to be stunted. Factors significantly associated with stunting were maternal height (p<0.001; OR = 8.495), father's education (p=0.012; OR=4.097), and family income (p<0.001; OR=6.144). Conclusion: Nurses have a crucial role in preventing stunting in rural areas by educating the community, ensuring that parents prioritise proper nutrition for women at every stage of life, from birth and adolescence to marriage, pregnancy, and breastfeeding. Providing adequate nutrition for women throughout their lives, especially during their productive years, should be a priority since maternal height is inherited by offspring. To reduce stunting in rural areas, the government should continue to promote 12-years compulsory education and establish various strategies to assist underprivileged families in rural areas in meeting their children’s nutritional needs.

Nursing Students’ Perception of Anxiety and Illegible Handwriting as Contributing Factors to Increased Medication Error Risks in Southern Philippines

Gloria Shiela E. Coyoca — 2025-06-19

Background: Nursing is a demanding profession, increasingly burdened by a global shortage of healthcare workers, particularly nurses. This shortage elevates the risk of medication errors, a leading cause of preventable harm in healthcare systems. Among nursing students, reported rates of medication errors vary significantly, underscoring the need for targeted educational interventions to address personal factors such as sleep deprivation and anxiety. Methods: This descriptive survey study assessed the perceived susceptibility to medication errors among nursing students at Mindanao State University - Iligan Institute of Technology (MSU-IIT), College of Health Sciences (CHS), focusing on students in Levels 2 to 4. The aim was to understand students' perceptions of their vulnerability to medication errors in clinical settings, informing the development of targeted interventions to enhance patient safety. A sample of 173 students was selected through stratified random sampling. An online questionnaire, adapted from the Medication Error Questionnaire, assessed susceptibility across technical, human, operator, and organisational factors. The questionnaire demonstrated face validity and reliability, with a Cronbach's Alpha of 0.842. Data analysis using ANOVA identified differences in susceptibility across academic year levels. Results: The findings indicate that nursing students demonstrate low susceptibility to medication errors, with scores of 3.39 for technical factors, 2.71 for knowledge-related human factors, 2.43 for personal-related human factors, 2.02 for environmental-related organizational factors, and 2.69 for administrative-related organizational factors. Most respondents positively acknowledged the statements but identified key risk factors, including sleep deprivation, anxiety, illegible handwriting, and excessive patient assignments. Notably, no significant differences in susceptibility were found across academic year levels, challenging the assumption that senior students possess greater competence. Conclusion: Targeted educational interventions are crucial to reduce medication error risks among nursing students. Recommendations include incorporating time management and self-care practices into the curriculum, enhancing simulation training, and fostering supportive environments. Addressing these issues may improve student well-being and patient safety, warranting further exploration of the effects of sleep and anxiety on clinical performance.

Determinants of Suicide Ideation among University Students in Indonesia: A Cross-Sectional Study

Wahyu Rochdiat Murdhiono — 2025-06-19

Background: Many risk factors have been proven to influence students' suicidal ideation, which can lead to suicide attempts during the COVID-19 pandemic. Objectives: This study aimed to find suicide ideation rates among students and the determinant factors that influence them. Methods: This study used a cross-sectional design with 236 respondents from 5 random private universities in July-August 2023. The Depression Anxiety Stress Scale 21, the Oslo Social Support Scale, the Rosenberg Self-Esteem Scale, and the Revised Suicide Ideation Scale were utilised in this study. Chi-square/Fisher's exact test and multiple logistic regression were used to identify factors associated with students' suicide ideation. Results: The high suicide ideation rate among students is 16.95%. Self-esteem and social support were also significantly related to suicide ideation, with p=0.035 and p=0.003, respectively. Stress, anxiety, and depression also showed a significant relationship with suicide ideation (all p<0.001). Further analysis showed that the factor predictors associated with suicide ideation were high anxiety (OR 15.960; 95% CI 7.201-35.374; p<0.001), high stress (OR 10.259; 95% CI 4.797-21.938; p<0.001), and depression (OR 18.455; 95% CI 8.220-41.430; p<0.001). Conclusion: The determining factors that influence suicide ideation are social support, anxiety, stress, and depression. Community mental health nurses should collaborate with academic institutions to create an early detection program for suicide ideation in students. The program would be observed by nurses, who would then provide the required nursing interventions to prevent suicide.

Knowledge of Catheter-Related Bloodstream Infections Prevention among Staff Nurses in Dialysis Centre

Jeanny John — 2025-06-19

Background: Patients with end-stage renal disease initially starting haemodialysis treatment require reliable arteriovenous access to perform the procedure. However, using a Central Venous Catheter (CVC) for haemodialysis poses risks, including the potential for life-threatening Catheter-Related Bloodstream Infections (CRBSIs). These infections raise mortality rates and treatment costs. Safer alternatives must be prioritised in order to improve patient outcomes and reduce expenses. Alarmingly, only 42% of nurses have an intermediate understanding of CRBSIs, highlighting the need for comprehensive training and adherence to updated practices among dialysis nurses and healthcare personnel. Objective: This study aimed to assess dialysis nurses' understanding of preventing catheter-related bloodstream infections (CRBSI) to pinpoint knowledge gaps and strengthen infection control measures. Addressing these gaps will improve training programmes, promote best practices, and ultimately reduce the risk of CRBSIs in dialysis settings. Methods: A cross-sectional study was conducted with 100 nurses in the dialysis centre. A purposive sampling method was used. The tool for data collection was a questionnaire consisting of participants' sociodemographic data and the level of knowledge of dialysis nurses regarding the prevention of CRBSI. The data were analysed using IBM Statistical Package for Social Science (SPSS) version 27. Results: The survey findings indicate the following percentages: 42.0% (n=42) of the participants had an intermediate level of knowledge, while 21.0% (n=21) had low knowledge, and only 37.0% (n=37) had a high level of knowledge. Conclusion: The study results suggest that the majority of dialysis nurses possess an intermediate level of knowledge regarding CRBSI prevention. Organisations can improve CVC care by using simulation training, competency workshops, and case-based learning. Bundle training, audits, e-learning, shadowing, and drills reinforce best practices, boost staff skills, and enhance patient safety.

Experiences and Perspectives of Indonesian Nurses on Barriers and Facilitators for Implementing Evidence-Based Nursing Practice: A Qualitative Study

Sari Narulita — 2025-06-19

Background: Nursing practices must be implemented effectively to transfer health-related research, information, and experience into improvements in healthcare quality. Many studies have been conducted in nursing on implementing evidence-based practice (EBP). The poor utilisation of EBP in healthcare is often attributed to nurses’ insufficient knowledge and abilities. Methods: This study adopted a qualitative research design. Thirty staff nurses participated in semi-structured interviews. Purposive sampling was employed in the selection of participants. The authors analysed the interview data using COSTA qualitative data analysis. Results: Four main themes were identified: (1) the experience of nurses on EBP implementation, (2) the benefits of EBP implementation, (3) barriers to EBP implementation, and (4) facilitators of EBP implementation. Conclusion: Although most nurses are supportive and have a positive attitude towards implementing EBP, their knowledge and skills could be improved. Nurses believed EBP should be applied when clinical issues arose. Nursing evidence is not widely available or valuable, which is one of the barriers. Some reasons for introducing EBP included the limited information available in Indonesia and nurses’ inadequate comprehension of EBP. Support from the leadership and the widespread availability of web-based social network platforms for quick information access were additional facilitators.

Promoting Sustainability Healthcare Practices: A Quasi-experimental Study on Nursing Education in Governmental Hospitals

Ikram Zeyad Hamid — 2025-06-19

Background: Climate change, driven mainly by human activities such as fossil fuel combustion, poses severe risks to global health and stability. As healthcare practices contribute to environmental degradation, there is a growing emphasis on sustainable healthcare. As crucial healthcare providers, nurses play a vital role in adopting sustainable practices, yet they often need more education on these topics. This study addresses this gap by evaluating an educational programme to enhance nurses' knowledge and attitudes toward sustainable practices in healthcare settings. Objectives: The study aimed to assess the effectiveness of an educational intervention in improving nurses' knowledge and attitudes toward sustainable healthcare practices, thereby promoting a more environmentally conscious approach to healthcare. Methods: A quasi-experimental one-group pre-test/post-test design was implemented with 30 nurses from Mosul's governmental hospitals. Data were collected through a structured questionnaire administered before and after the educational program, which consisted of eight sessions covering topics from energy conservation to sustainable procurement practices. Reliability was confirmed with a Cronbach’s alpha of 0.82. Statistical analyses included paired t-tests to compare pre- and post-intervention scores for knowledge and attitudes. Results: The intervention significantly improved participants' knowledge and attitudes toward sustainability. Average knowledge scores increased from 50 (SD = 8.2) pre-intervention to 75 (SD = 5.6) post-intervention, while attitude scores rose from 60 (SD = 7.3) to 82 (SD = 6.1). These findings suggest that structured educational programmes effectively elevate understanding and positive perceptions regarding sustainable healthcare practices. Conclusion: The educational programme enhanced nurses' knowledge and attitudes toward sustainability, indicating that similar interventions could benefit healthcare sectors. Integrating sustainability education into nursing curricula is essential for equipping nurses with the skills to address healthcare's environmental impacts.

Effectiveness of Pre-Clinical Delivery of Behaviour Modelling Training Method to Improve Caring of Nursing Students

Setiadi — 2025-06-19

Background: Caring behaviour is not only carried out by nurses but is also carried out by nursing students at the service practice stage in hospitals as the first place to learn about the values and nature of their profession. Objective: The aim of this research is to analyse the effectiveness of preclinical debriefing using a behaviour modelling training model for nursing students to find basic strategies that can improve Caring behaviour in carrying out clinical practice in health services. Methods: This research includes pre-experimental research with a One Group Pretest-Post-test approach. The research subjects 27 level 1 nursing students.The collected data was processed statistically using the T test, a related analysis technique. Results: The statistical tests show significant differences between pre-test and post-test scores. For self-efficacy, the pre-test average was 17.89, increasing to 25.26 in the post-test (an increase of 7.37), with a t value of 32.660 and a p-value of 0.000 for clinical knowledge. For emotional regulation, the pre-test average was 10.22, rising to 14.22 (an increase of 4.00), with a t value of 39.618 and a p-value of 0.000. Both results indicate significant differences (p < 0.05). Conclusion: The behaviour modelling training method has been proven to be applicable as a training model because it has a clear syntax for changing participant behaviour according to the expected goals.

Research Potential in Nursing Students: Competencies and Influencing Factors

Vania Yulisa Abanto Castro — 2025-06-19

Background: Nursing research expands scientific knowledge; advances practice and improves healthcare to enhance public well-being. It defines the scope of nursing and highlights its impact on individual health. Universities play a key role in conducting research, fostering student training, and translating knowledge into socioeconomic value. The objective is to determine the research competencies and associated factors in nursing students from a private university, 2024. Methods: Quantitative, descriptive and cross-sectional study. The population was 245 nursing students from the 7th, 8th, 9th and 10^th semesters of a private university in Lima, Peru. The technique was the survey, and the instrument was a questionnaire. The instrument was developed virtually through the Google Forms platform. After data collection, the database was established in Microsoft Excel which was later exported to the statistical program IBM SPSS version 27. Results: 245 students who met the inclusion criteria participated. According to the level of research competencies, 40% had a low level, 39.2% a medium level and only 20.8% obtained a high level. The factors significantly associated with the level of research competencies in nursing students were having received motivation from a teacher, research interest, belonging to a group or seedbed, studying a research course outside their curricular mesh and publishing articles (Significance<0.05). Conclusion: Most of the students have a low level of research competencies. Although most of the students received motivation from a teacher to carry out research work. The future scope of this study on research competencies in nursing students focuses on identifying and strengthening key areas of research training. Nursing schools are encouraged to develop research courses from the first academic semesters, and to encourage students to publish articles in conjunction with their respective health research centres.

Exploring the Psychoeducational Needs and Strategies for Nurses to Reduce Psychological Distress among Women with Breast Cancer Post Mastectomy

Dewi Mustikaningsih — 2025-06-19

Background: Post-mastectomy breast cancer patients often experience psychological distress, which nurses play a crucial role in addressing. This study aimed to explore nurses' perceptions of the psychoeducational needs of women following mastectomy to reduce psychological distress. Methods: This research uses a qualitative research design with focus group discussions carried out by twenty nurse informants from the Kariadi Hospital in Semarang, Indonesia, recruited through purposive sampling techniques. The Focus Group Discussion (FGD) guide created by the researcher with open questions is employed. FGDs were recorded, transcribed, and analysed thematically. Results: The themes that emerged were "psychoeducational goals", with one subtheme (reducing the level of psychological distress); "content of psychoeducational material", with five subthemes (patient adaptation regarding the impact of mastectomy, physical treatment, the impact of negative thoughts, the impact of negative emotions and psychological support); and "psychoeducation format", with six subthemes (form, method, media, tools, duration and frequency). Several strategies are applied to overcome the problem of psychological distress faced by women who have breast cancer after mastectomy. Conclusion: Psychoeducational competency is inherent in nurses because they demonstrate skills in dealing with patients' psychological distress, such as pain management, deep breathing techniques, progressive muscle relaxation, early ambulation, physical mobilisation, range of motion, self-talk, and psychological support. Therefore, hospital managers can implement a program to increase the competence of nurses in dealing with patients' psychological stress by providing psychoeducation so that nursing practice can improve.

Efficacy of Comprehensive Management Protocol for Improvement of Bone Health in Elderly Osteoporotic Individuals Attending a Tertiary Care Centre Hospital in Kolkata, India

Chhanda Pal — 2025-06-19

Background: Osteoporosis is a growing public health concern, especially among the elderly population in India. There is a dearth of studies evaluating the role of multimodal treatment for the improvement of bone health apart from pharmaceutical management in India. In this study, an attempt was made to improve bone health using comprehensive multimodal management, compared to conventional pharmaceutical management, specific nutrition, and diet. Methods: A total of 130 patients diagnosed with osteoporosis (T score –2.5 or below by Quantitative Ultrasound Scan, QUS), aged between 50 to 80 years, were selected for the study. All participants were receiving standard pharmaceutical treatment along with specific nutrition and diet prescribed by their treating physician. They were randomly divided into two groups of 65 each: the control group continued with standard treatment, while the experimental group received comprehensive management (including standard care, muscle-building exercises, and environmental/lifestyle modifications). Data were collected from 58 participants in each group. Bone Mineral Density (BMD) was measured via QUS at baseline on the 6^th months and 12^th months, with follow-up at 3 and 9 months via telephonic interview, mainly for supervision. Statistical analysis was performed using the Mann-Whitney U test. Results: At baseline, median BMD T score was –2.5 (control) vs –2.6 (experimental) (p=0.08), indicating homogeneity. At 6 months, it remained –2.6 (control) vs improved –2.5 (experimental) (p=0.02). At 12 months, the score was –2.6 (control) vs –2.5 (experimental) with p=0.001, suggesting significant improvement in the experimental group. Conclusion: A supervised, comprehensive multimodal management protocol offers a cost-effective and practical adjunct to conventional pharmacological treatment. It significantly enhances bone health and BMD outcomes in elderly patients with osteoporosis.

Self-Efficacy Towards Ability to Perform Nursing Care

Lina Indrawati — 2025-06-19

Background: The ability to perform nursing care is a determining factor in the success of patient care in hospitals. Many nurses are less aware of the importance of improving their ability to provide nursing care, even lack of self-confidence has an impact on the nursing process while patients are undergoing treatment. Objectives: This study aims to determine the relationship between nurses' self-efficacy and the ability to perform nursing care. Methods: This study is a correlation study using a cross-sectional approach. This study conducted from February to May 2023.The focus of this study was on nurses who works in hospital on West Jakarta, Indonesia. The sampling technique used random sampling with a sample size of 218 nurses in hospital. Data collection in this study used a Likert scale questionnaire to measure self-efficacy and the ability to apply nursing care where the questionnaire was developed by the researcher and has been tested for validity and reliability. This study used univariate and bivariate statistical analysis. The statistical analysis used was Chi Square. Results: Nurses with high self-efficacy have the capability to provide good nursing care was 67.4% or 147 participants. The results showed a p-value of 0.001 < 0.05, It’s mean there was significant relationship between self-efficacy and the ability of nurses to provide nursing care. Conclusion: Self-efficacy plays an important role in determining the ability to provide nursing care so that each nurse needs to increase self-efficacy in the nursing process carried out on patients. Further research is needed regarding factors that are more effective in increasing a person's self-efficacy.

Effect of Foot Reflexology on Pain and Fatigue Levels Regarding Insulin Injection among Diabetic Children

Marwa Mohamed Ouda — 2025-06-19

Background: Pain and fatigue are common side effects of insulin injections. Foot reflexology is a complementary therapy gaining popularity and acceptance since it seems to help with pain and weariness. Methods: This research aimed to evaluate the effect of foot reflexology on pain and fatigue levels regarding insulin injection among diabetic children. A quasi-experimental research design (Pre-test Post-test Design) used to conduct this study, and it was carried out at the Paediatric Medical Department at Sohag University Hospital. A convenient sample of 100 diabetic children who were receiving insulin injections will be recruited in this study; the studied children were randomly assigned into two groups, with 50 children in each group (the study and control groups). Three tools were used to collect data: Tool (1): A structured interviewing questionnaire. Tool (II): Numeric Pain Rating Scale (NPRS) and Tool (III): Fatigue Assessment Scale. Results: After receiving an insulin injection, over half of the diabetic children in the study group experienced minor pain, compared to just 8% in the control group, according to the current research. Additionally, the post-foot reflexology of the diabetic children under study showed a highly statistically significant difference in fatigue levels between the study and control groups. Also, the results demonstrated that following the foot reflexology intervention, the diabetic children under study had a very statistically significant (P < 0.001) decrease in their fatigue mean score in both the study and control groups and had very statistically significant variations in their pain scores after the foot reflexology intervention (P = < 0.001). Conclusion: Foot reflexology has an effect on pain and fatigue reduction regarding insulin injection among diabetic children. Foot reflexology could be used as a supplemental therapy and non-pharmacological approach to treat diabetic children's fatigue and pain from insulin injections.

Legal Protection for Adolescents Against Reproductive Health Rights in Minor Marriages

Fitriani Nur Damayanti — 2025-06-19

Background: Indonesia ranks seventh highest in the world in terms of early marriage, with many teenagers under the age of 19 years, entering early marriage in Demak City. To describe and analyse the implementation of legal protection for teenagers regarding reproductive health rights in underage marriages, in Mranggen District, Demak Regency. Methods: Descriptive analytic with a qualitative sociological juridical approach, as well as purposive sampling a sample of 11 informants. Primary data was obtained through interviews, documents from related in-situations, and direct observation, while secondary data was extracted from books, journals, and other literature. Data collection techniques include field and library studies, with data processing through examination, verification, classification and systematisation of data, which is then analysed qualitatively. Results: The findings of the study on Legal Protection of Adolescent Reproductive Health Rights in Underage Marriage in Mranggen Regency, Demak Regency, show that there is still a lack of knowledge regarding the rights of adolescent protection, especially regarding legal protection for women who marry underage. Conclusion: Adolescent knowledge of reproductive health rights in underage marriage shows the need for a comprehensive approach in addressing this challenge. Although there are regulations governing the age limit for marriage and dispensation procedures, their implementation is still closely related to social and cultural factors in society.

Psychosocial Responses of Drug User During Aftercare in Rehabilitation Center

Asmadi — 2025-06-19

Background: Drug abusers are victims who must be saved through rehabilitation. Rehabilitation nursing care restores normality to drug abusers, which is carried out medically and socially. The length of time and rehabilitation methods have implications for the client's psychosocial response. Objective: This research was conducted with the aim of identifying and exploring the psychosocial responses of drug abusers during aftercare process in rehabilitation centre. Methods: An exploratory descriptive design was used. The sampling technique was a total sample of 32 participants who during aftercare at two rehabilitation centres in West Java, Indonesia, during the period from June to August 2023.The study tool used questionnaire. The data were analyzed using descriptive statistics. Results: The emotional response that many drug addicts experience while undergoing rehabilitation is that 84.4% often feel bored, 68.8% often feel sad, 34.4% often feel no peace and 46.9% often have no enthusiasm for undergoing rehabilitation. The mental response experienced by many participants was that 43.8% often felt depressed, 28.1% felt confident that they would not relapse after completing rehabilitation. The behavioral response was 40.6% often felt that they were not strong enough to obey all the rules, 62.5% often felt embarrassed by their status as rehabilitation patients and 62.5% of participants believed that the rehabilitation they were undergoing didn’t make them aware of the need to undergo it live normally. Conclusion: More psychosocial responses are maladaptive. This is most likely an effect of the rehabilitation method used, and the length of time required to undergo rehabilitation.

Narratives from the Newly Appointed Deans of Selected Philippine Colleges of Nursing in Establishing Baccalaureate Nursing Program

Cyruz P. Tuppal — 2025-06-19

Background: The healthcare landscape is in constant flux, driven by evolving patient needs, technological advancements, and shifting health policies. This demands a nursing workforce with critical thinking, adaptability, and specialised skills to manage complex patient cases effectively. However, the current supply of nursing graduates in the Philippines falls short of meeting the growing healthcare demands. Establishing more Bachelor of Science (BSc) Nursing programs is crucial to bridge this gap and ensure high-quality patient care. Expanding these programs will increase the number of qualified nurses, addressing staffing shortages and improving patient outcomes. Methods: This research used a narrative inquiry approach, focusing on ten recently appointed deans of nursing programs who were tasked with establishing BS Nursing programs at private colleges or universities in the Philippines. This ensured participants had firsthand experience with the challenges and complexities involved in program development. Thematic analysis was employed to identify key themes. Results: Thematic analysis revealed several complexities in establishing a BS Nursing program, including securing qualified faculty, obtaining accreditation, securing clinical placements, managing financial investments, attracting students, and balancing theory and practice. The need to keep the curriculum current, manage student expectations, and balance faculty and student needs also emerged as significant challenges. Despite these obstacles, the importance of establishing additional BS Nursing programs is evident in addressing the nursing shortage and ensuring quality care. Conclusion: This research offers valuable insights into the complexities of establishing BS Nursing programs, providing guidance for future program developers and policymakers in the Philippines.

Strategies for Preventing and Reducing Psychological Problems and Mental Disorders among Deaf and Hearing-Impaired Communities

Yafi Sabila Rosyad — 2025-06-19

The majority of deaf people grew up in hearing environments, which have presented unique challenges and hazards to their socioemotional health. The aim of this study is to identify the mental health and psychological problems among individuals with hearing loss and to identify alternatives that can be done. This study is a narrative literature review employing the PRISMA framework. Journal articles were collected from Google Scholar, Crossref, and PubMed databases. The search results yielded 2000 research articles. After the selection process, 32 articles were eligible for review with Reports of included studies (11 articles). In this study, deaf people had experiences of psychological distress and mental health problems. Stress and anxiety are major issues for deaf psychological responses. Deaf mental health problems are body image and suicide. Deaf individuals had higher rates of depression, insomnia, anxiety, inferior quality of life, and emotional distress. It is essential to recognise the unique psychological challenges faced by individuals with hearing loss, such as stress, anxiety, and depression, to provide appropriate mental health support. Nurses can play a pivotal role in implementing interventions that address these mental health issues, improving the overall quality of life for deaf individuals. Strengthening interventions that can reduce psychological distress and mental health problems is needed to prevent long-term impacts on quality of life.

Self-Management of Patients with Early Chronic Kidney Disease: A Concept Analysis

Rita Dwi Hartanti — 2025-06-19

Background: Self-management is the management of care in patients with chronic diseases to prevent disease complications and slow the progression of CKD, especially in early CKD patients. Although self-management is critical, there is still a lack of clarity regarding the conceptualisation of self-management in early CKD patients. Concept analysis is needed to understand better the concept and meaning of self-management in early CKD patients. Objectives: The concept analysis aimed to clarify the concept of self-management in early CKD patients by identifying its antecedents, attributes, and consequences. Methods: The method used Walker and Avant’s concept approach through eight steps of analysis to explore the antecedents, attributes, and consequences of the concept of self-management analysis of early CKD patients. Results: Antecedents of self-management in early CKD patients include partnerships with healthcare professionals, problem-solving, self-care, and psychological management. Attributes of this concept include active participation in health care, the ability to manage and care for chronic diseases, and the development of health behaviour in CKD. Consequences of self-management in early CKD patients include caring ability, self-care, independence in carrying out care, and compliance in carrying out health care. Conclusion: This concept analysis can guide nurses in providing self-management interventions in early CKD patients. In addition, this concept can also be used as a guideline for developing self-management intervention programmes in kidney health nursing care.