Journal of Applied Nursing and Health

Willingness, Knowledge, and Skills of Nurses in the Prevention and Management of Diabetic Foot Ulcers: A Cross-sectional Study in Indonesia

Maria Suryani — 2026-07-01

Background: Nurses play a crucial role in the prevention and management of diabetic foot ulcers (DFUs); therefore, they should possess adequate knowledge, skills, and a willingness to do so. However, limited evidence exists on Indonesian nurses’ willingness, knowledge, and skills in the prevention and management of DFU. The study aimed to evaluate willingness, knowledge, and skills in the prevention and management of DFU among Indonesian nurses and to identify factors associated with these.

Methods: A cross-sectional survey study was conducted. A total of 549 nurses working in medical-surgical inpatient units at four hospitals in Central Java, Indonesia, were selected using convenience sampling, given ease of online access and willingness to participate. Data on willingness, knowledge, and skill in the prevention and management of DFU were collected using an online survey. The Chi-square and logistic regression tests were used for data analysis. This study was reported in accordance with the STROBE guidelines.

Results: The majority of nurses had no DFU training (65,2%), but had a bachelor's education level (51.9%) and were involved in DFU patient care (92.7%). Approximately 45.9% of nurses have adequate willingness, while 33.2% and 32.2% have adequate knowledge and skill, respectively. Higher education was associated with an adequate willingness (aOR 1.91, 95%CI:1.26-2.90, p=0.002), knowledge (aOR 1.55, 95%CI:1.07-2.26, p=0.020), and skills (aOR 1.72, 95%CI:1.18-2.51, p=0.005), among nurses. The DFU training was associated with adequate knowledge (aOR 2.71, 95%CI:1.86-3.95, p<0.001), and skills (aOR 2.63, 95%CI:1.81-3.85, p<0.001) of nurses. The DFU caring experience was also associated with nurses' knowledge (aOR 3.61, 95%CI:1.06-12.62, p=0.039) and skills (aOR 3.41, 95%CI:1.01-11.57, p=0.049). Furthermore, adequate knowledge (aOR 1.35, 95%CI:1.47-7.65, p=0.004) and adequate skills (aOR 5.60, 95%CI:2.41-13.01, p<0.001) were associated with willingness.

Conclusion: Under half of nurses in hospital settings had adequate willingness, knowledge, and skill in the prevention and management of DFU. Higher education level, practical training, and caring experience were associated with the nurses’ willingness, knowledge, and skills. Adequate willingness was also associated with adequate knowledge and skill.

Application of Dorothea Orem's Self-Care Theory in Patients with Diabetic Ulcers: A Mixed-Methods Case Study

Fitri Suciana — 2026-07-01

Background: Diabetes Mellitus is a metabolic disease with an increase in blood sugar levels above normal, which can cause complications if not properly managed. One of the complications that can arise is diabetic ulcers, which require nursing interventions after debridement or post-amputation.

Methods: This study employed a mixed-methods approach, combining both quantitative data and a case study design. Following STROBE guidelines, the quantitative component included 19 individuals diagnosed with diabetes mellitus. Using purposive sampling, 7 participants were selected based on the inclusion criteria of having diabetic ulcers and being hospitalised for at least 3 days, and 5 nurses who cared for the patients. Data were collected using structured observation sheets and nursing care records. For the qualitative component, guided by COREQ criteria, in-depth interviews were conducted using semi-structured interview guides to explore patients' experiences and perceptions. Data analysis for the qualitative data used grounded theory methodology, while descriptive statistics were applied to the quantitative data. NVivo software was used for qualitative coding, while SPSS was employed for descriptive analysis.

Results: Orem's theory can be used in self-care efforts by carrying out wholly compensatory system nursing interventions, such as wound care, monitoring infections, and carrying out antibiotic treatment, while partially compensatory systems can be carried out by patients independently, such as insulin treatment at home, physical activity, and not smoking, while supportive educative systems by providing foot care education by assessing foot health status. Orem's theory can be used in self-care efforts by performing wholly compensatory system nursing interventions with education, and patients can perform self-care with partially compensatory systems, such as physical activity, not smoking, and insulin use.

Conclusion: Self-care nursing interventions for diabetic ulcers include partially compensatory and totally compensatory systems.

Nurse-Led Multidimensional Intervention Improves Symptom Burden and Quality of Life in Hemodialysis Patients: A Quasi-Experimental Study

Achmad Fauzi — 2026-07-01

Background: Patients undergoing hemodialysis (HD) experience a high symptom burden that adversely affects health-related quality of life (HRQoL). Evidence on integrated nursing interventions to address these challenges remains limited, particularly in lower- and middle-income country (LMIC) settings. This study evaluated the effectiveness of a 12-week Multidimensional Integrated Nursing Intervention (MINI) in reducing symptom burden and improving HRQoL among HD patients in Indonesia.

Methods: A multi-site quasi-experimental study with a non-equivalent pre-test/post-test control group design was conducted between November 2025 and March 2026 across three public hospitals in Indonesia. A total of 112 maintenance hemodialysis patients were allocated to either a 12-week Multidimensional Integrated Nursing Intervention (MINI; n=56) or a control group receiving usual care (n=56). The intervention integrated symptom management, psychosocial support, dietary coaching, intradialytic exercise, and self-management education. Symptom burden and health-related quality of life (HRQoL) were assessed using the MSAS-GDI and KDQOL-36, respectively, and analyzed using paired and independent t-tests, with effect sizes estimated by Cohen’s d.

Results: Following 12 weeks, the MINI group demonstrated significantly greater reductions in MSAS-GDI compared to controls (1.59±0.33 vs 2.33±0.41; p<0.001; Cohen’s d=1.87). Significant improvements were observed across all five KDQOL-36 domains in the MINI group (all p<0.001; Cohen’s d=1.94), with no significant changes in the control group. Large, consistent effect sizes were observed across all three study sites.

Conclusion: A 12-week nurse-led multidimensional intervention demonstrated promising reductions in symptom burden and improvements in HRQoL in HD patients across Indonesian public hospital settings. These findings suggest that MINI may be a feasible model for integration into HD nursing protocols in LMIC contexts. Confirmation through cluster-randomised or pragmatic multicenter trials with longer follow-up is warranted before routine implementation can be recommended.

Effectiveness of Guided Imagery Therapy in Reducing Pain Among Adult Post-Appendectomy Patients: A Quasi-Experimental Study

Eldessa Vava Rilla — 2026-07-01

Background: Pain is a common complaint among postoperative patients, including those undergoing appendectomy. Guided imagery therapy is a non-pharmacological intervention that can help reduce pain by diverting patients’ attention from discomfort with minimal side effects. However, evidence regarding its effectiveness in adult post-appendectomy patients remains limited. This study aimed to determine the effect of guided imagery therapy on reducing pain intensity in adult post-appendectomy patients.

Methods: This study used a quasi-experimental design with a pretest-posttest control group, conducted in accordance with the TREND reporting guidelines. This study received ethical approval from the Research Ethics Committee of the Karsa Husada Garut College of Health Sciences. The sample consisted of 50 patients, equally divided into intervention and control groups (25 per group), recruited according to the inclusion and exclusion criteria. The independent variable was guided imagery therapy administered twice a day for 15–20 minutes over three consecutive days by the researcher, while the dependent variable was pain intensity measured using the Numeric Rating Scale (NRS). The control group received routine care. Data were analyzed using the Mann-Whitney test for differences between groups, with a significance level of 0.05. All statistical analyses were performed using IBM SPSS Statistics version 29.

Results: The intervention group showed a significant reduction in pain intensity (p<0.05). The intervention group demonstrated a marked reduction in mean pain scores from 4.88 at pretest to 1.68 at posttest, representing a very large within-group effect. In contrast, the control group showed only a minimal change from 4.84 to 4.44. Between-group comparison indicated a significantly greater reduction in pain in the intervention group than in the control group. All main statistical results are presented with 95% confidence intervals to provide an estimate of precision and uncertainty around the observed effects.

Conclusion: Guided imagery therapy has been shown to significantly reduce pain intensity in adult patients after appendectomy compared to the control group. It is recommended that nurses teach and provide guided imagery therapy regularly to reduce pain intensity in adult post-appendectomy patients

The Influence of Water Quality Based on BOD (Biochemical Oxygen Demand), COD (Chemical Oxygen Demand), and DO (Dissolved Oxygen) Values on the Health Level

Hariyono Hariyono — 2026-07-01

Background: Poor water quality can have a significant impact on public health. BOD (Biochemical Oxygen Demand), COD (Chemical Oxygen Demand), and DO (Dissolved Oxygen) are important indicators of water quality. This study aims to analyze the effects of water quality, as measured by BOD, COD, and DO, on the health status of the Kediri City community.

Methods: This study uses an observational quantitative research design with a cross-sectional approach. The sample comprised 100 respondents, selected using a cluster random sampling technique across 3 sub-districts in Kediri City. The data analysis uses a linear regression statistical test to examine the correlation between BOD, COD, and DO values and the health status of the Kediri City community.

Results: The study showed that the average BOD value was ± 11.8 mg/L, the average COD value was ± 27.87 mg/L, and the average DO value was ± 4.81 mg/L. For the average health degree based on the water quality of the Kediri city community, the average was ± 30.3 (max. score 40). From statistical analysis, the influence of BOD, COD, and CO levels on the degree of health based on the water quality of the Kediri city community, the data obtained BOD p-value <0.01, COD p-value <0.07, and DO p-value <0.00 (sig. ≤ 0.05).

Conclusion: BOD and DO levels influence the degree of health based on water quality in the Kediri city community. At the same time, the COD value does not affect the degree of health based on the water quality of the Kediri city community. This study shows that water quality in the city, as measured by BOD and COD values, still does not meet the Quality Standards, which can have a significant impact on the health of Kediri City's residents.

Effectiveness of a Culturally Adapted Mindfulness-Based Intervention on Blood Pressure, Medication Adherence, and Self-Management: A Quasi-Experimental Study

Ady Irawan.AM — 2026-07-01

Background: Hypertension is a leading global health problem, with poor adherence to treatment remaining a major barrier to effective control. Mindfulness has emerged as a supportive strategy for improving adherence and self-care. However, the effectiveness in non-Western hypertensive populations remains unclear. This study aimed to evaluate the effectiveness of a culturally adapted mindfulness intervention on blood pressure, medication adherence, and self-care in patients with hypertension in Indonesia.

Methods: A nonrandomized quasi-experimental pretest-posttest control group design was employed. 40 adults aged 18-40 years with stage 1 hypertension were recruited through purposive sampling, and the minimum sample size was determined using power analysis (G*Power 3.1), resulting in a minimum of 15 participants per group. To account for attrition, 20 participants were recruited per group. We excluded adults with coronary heart disease, pregnancy, concurrent complementary therapies, or prior mindfulness experience. The study followed the TREND guideline for nonrandomized evaluations. Participants were allocated to an intervention group (n = 20) that received an eight-week culturally adapted mindfulness program delivered in group and individual sessions, or to a control group (n = 20) that received standard care. Data were collected at baseline, post-intervention, and one-month follow-up, using a validated digital sphygmomanometer (blood pressure), the Morisky Medication Adherence Scale-8 (medication adherence), and the Self-Care of Hypertension Inventory (self-care). Ethical clearance was obtained from the institutional review board (No. 109/VII/AUEC/2024), and data were analysed using repeated-measures ANOVA and independent t-tests.

Results: Participants in the intervention group experienced significant reductions in systolic and diastolic blood pressure and improved medication adherence compared with the control group, with effects sustained at follow-up (time x group interaction: SBP F = 8.33, p < 0.001, η² = 0.15; DBP F = 7.01, p = 0.002, η² = 0.13; MMAS-8 F = 15.27, p < 0.001, η² = 0.24). Self-care scores increased significantly post-intervention (p = 0.030) but declined at follow-up, with no significant group difference at T2 (p > 0.05). Baseline characteristics were comparable between groups, ensuring equivalence.

Conclusion: A culturally adapted mindfulness program effectively improved blood pressure control and medication adherence in Indonesian patients with hypertension, although self-care benefits diminished over time. These findings suggest that mindfulness-based interventions can be a feasible, low-cost complement to standard care, particularly in resource-limited settings. Future studies with larger samples, longer follow-up, and reinforcement strategies are recommended to sustain self-care behaviours.

Mapping Self-Care Interventions for Improving Quality of Life Among Patients with Hypertension: A Scoping Review

Citra Reza Pujikurniawati — 2026-07-01

Background: Hypertension is a leading cause of cardiovascular disease and premature death worldwide. Despite the growing use of multidisciplinary self-care interventions to support patient-centred hypertension management, evidence on their effectiveness in improving quality of life remains fragmented. This scoping review aims to map and synthesise the available evidence on the effectiveness of self-care–based interventions in improving the quality of life of patients with hypertension.

Methods: This scoping review followed PRISMA-ScR guidelines, the PCC framework, and the JBI-refined Arksey & O’Malley methodology. Literature searches were conducted in PubMed, ScienceDirect, Scopus, and EBSCOhost (2021–2026). Eligible studies included experimental studies and systematic reviews involving treated hypertensive patients. After independent PRISMA-based screening by four reviewers, 13 articles were included. Data were appraised using JBI tools and synthesised through thematic analysis to classify intervention models by lead professionals, delivery modes, and key self-care components.

Results: From 1,328 identified records, the literature spans a broad international scope; however, it remains dominated by studies originating in High-Income Countries (HICs) or those using advanced digital health infrastructures. In contrast, evidence on the specific impact of these interventions on quality of life in Low- and Middle-Income Countries (LMICs), including Indonesia, remains relatively limited. The synthesis results identified three main categories of self-care-based intervention models: (1) professional-led models (facilitated by nurses, pharmacists, physicians, or community health workers and multidisciplinary collaborative care models), (2) digital health delivery modes (including mHealth, tele-nursing, and hybrid models), and (3) structured self-care components (focusing on self-monitoring, medication management, lifestyle modification, and psychosocial support). Although these models have proven effective in significantly lowering systolic and diastolic blood pressure while enhancing patient self-efficacy and quality of life, a research gap remains regarding the lack of direct comparative analysis between models in resource-limited settings and the systematic evaluation of long-term psychosocial outcomes.

Conclusion: Nurse-led, multidisciplinary, and technology-supported interventions can improve blood pressure control and quality of life in hypertension. Future research should evaluate their effectiveness and efficiency across different settings, particularly in Indonesia.

Effectiveness of Code Stroke Activation Models on Clinical Decision-Making Quality: A Scoping Review

Purwandi Purwandi — 2026-07-01

Background: Traditional medicine is widely used worldwide, particularly in rural communities of developing countries. Cultural beliefs, cost, accessibility, and social factors influence its use. This study aims to identify factors associated with the use of traditional medicine for Ear, Nose, and Throat (ENT) conditions among patients in Kumasi.

Methods: This scoping review was conducted in accordance with PRISMA-ScR guidelines and used the PCC (Population, Concept, Context) framework and the Arksey & O’Malley approach. A systematic literature search was conducted in the PubMed, ScienceDirect, Scopus, and EBSCOhost databases for the period 2021–2026. Inclusion criteria included studies on the Code Stroke activation model in the prehospital and ED settings. In contrast, exclusion criteria included in-hospital activation in the ICU or wards without ED involvement. The screening phase was conducted independently by four reviewers using the PRISMA protocol. Data were mapped through a documentation process using the JBI critical appraisal tools, and data synthesis was performed via thematic analysis to group activation models.

Results: Of the 1,690 identified records, the literature was found to be dominated by single-center studies or those conducted in high-income countries with advanced technological infrastructure. In contrast, evidence regarding the effectiveness of these activation models in Low- and Middle-Income Countries (LMICs) and the specific context of Indonesia remains very limited. The synthesis results identified four main themes of activation models: (1) nurse-based activation, (2) AI-based models (such as automated LVO detection), (3) pre-hospital activation via ambulance notifications, and (4) workflow optimization through a “pit-crew” model that transforms sequential processes into simultaneous parallel ones. Although these models have proven effective at accelerating time metrics such as door-to-needle time, a research gap remains: a lack of direct comparative analysis between models in resource-limited settings.

Conclusion: The integration of nurse leadership, parallel task delegation, and advanced technological support is critical to minimizing permanent neurological damage. Practice and policy implications include the need to implement a “no-fault” activation system for triage nurses and standardize AI reporting. Future research should focus on validating these models in geographically challenging contexts, such as in Indonesia, and conducting multicenter comparative studies to determine the optimal balance between diagnostic accuracy and hospital resource availability.

Menopausal Symptom Severity, Family Support and Coffee Consumption as Determinants of Sleep Quality among Menopausal Women in Indonesia

Ida Ayu Ningrat Pangruating Diyu — 2026-07-01

Background: Menopause represents a critical transition in women’s lives during which poor sleep quality is commonly reported yet often overlooked. However, limited evidence exists regarding factors associated with sleep quality among menopausal women in Indonesia, particularly from a biopsychosocial perspective. Therefore, this study aimed to identify factors associated with sleep quality among menopausal women.

Methods: This cross-sectional study, reported in accordance with the STROBE guidelines, included 277 women aged ≥40 years recruited from the service areas of community health centres (Puskesmas) in Denpasar, Indonesia, using convenience sampling. Women receiving hormone replacement therapy, using medications for menopausal symptom relief, or with a history of hysterectomy or oophorectomy were excluded. Data were collected through self-administered questionnaires, including the Menopause Rating Scale (MRS), Family Support Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI), all of which demonstrated acceptable validity and reliability. Sleep quality was the dependent variable, while menopausal symptom severity, family support, coffee consumption, physical activity, employment status, menopausal status, and comorbid conditions were examined as independent variables. Data were analysed using descriptive statistics, chi-square tests, and multivariate logistic regression.

Results: Nearly half of the women reported poor sleep quality (49.5%). Multivariate logistic regression analysis identified menopausal symptom severity, family support and coffee consumption as significant factors associated with sleep quality. Women with moderate-to-severe menopausal symptom severity had 7.42 times higher odds of poor sleep quality than those with none-to-mild symptoms (OR=7.42; 95%CI: 3.95–14.70; p<0.001. Women with low family support had 5.98 times the odds of poor sleep quality than those with adequate family support (OR=5.98; 95% CI: 3.21–11.14; p<0.001). In addition, women who consumed coffee had 3.35 times higher odds of poor sleep quality compared with non-consumers (OR=3.35; 95%CI:1.90–6.56; p<0.001).

Conclusion: Menopausal symptom severity, family support and coffee consumption were significantly associated with sleep quality among menopausal women. These findings may underscore the importance of considering biological, behavioural, and social factors when assessing sleep-related concerns and developing supportive care strategies for menopausal women.

Academic Stress and Achievement Motivation as Associated Factors of Burnout Among Vocational High School Students: A Cross-Sectional Study

AV Sri Suhardiningsih — 2026-07-01

Background: Final-year vocational high school students are exposed to substantial academic and practical training demands that may be associated with burnout. Within the Job Demands–Resources (JD-R) framework, academic stress is an academic demand, whereas achievement motivation is a personal resource. However, limited studies have simultaneously examined the relationships among achievement motivation, academic stress, and Burnout among vocational high school students. Therefore, this study aimed to analyze these relationships using the JD-R framework.

Methods: A quantitative cross-sectional study was conducted among 115 twelfth-grade vocational high school students selected through simple random sampling. Data were collected using the AMI, ESSA, and MBI-SS questionnaires. Scores were categorized for descriptive purposes, and associations among variables were analyzed using Spearman’s rank correlation test. Ethical approval was obtained before data collection.

Results: Most participants reported moderate achievement motivation (73.9%) and moderate Burnout (62.6%), whereas 53.9% experienced high academic stress. Spearman’s correlation analysis revealed a significant negative association between achievement motivation and Burnout (r = −0.602, p < 0.001). In contrast, academic stress was significantly positively associated with Burnout (r = 0.275, p = 0.003).

Conclusion: Higher achievement motivation is linked to lower Burnout, while higher academic stress is linked to higher Burnout among final-year vocational students. Improving motivation and managing stress may help reduce Burnout.

Clinical Variables Associated with Quality of Life Among Women with Breast Cancer: A Cross-Sectional Study

Anastasia Anna — 2026-07-01

Background: Breast cancer is a major public health concern in Indonesia. Clinical factors such as disease duration, cancer stage, treatment type, and comorbidities may affect patients’ quality of life (QoL), but evidence in Indonesia remains limited. This study aimed to examine the correlation between clinical variables and QoL among breast cancer patients.

Methods: This cross-sectional study was conducted between November 2025 and January 2026 at a referral hospital in West Java, Indonesia, and followed the STROBE guidelines. A total of 53 breast cancer patients were recruited using convenience sampling. The independent variables included clinical characteristics such as duration of illness, cancer stage, treatment received, treatment frequency, comorbidities, body mass index (BMI), and family history of cancer, while the dependent variable was QoL. QoL was assessed using the Indonesian version of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a validated instrument for evaluating functional status, symptoms, and global health status among cancer patients. QoL is categorised into poor, moderate, and good. Bivariate analysis was performed using Fisher’s exact test and the chi-square test.

Results: Among the 53 breast cancer patients, the majority had been diagnosed for less than one year (45.3%), underwent surgery combined with chemotherapy (41.5%), and received treatment every three weeks (64.2%). Most patients reported moderate global health status (49.1%), while 35.8% had poor QoL. Significant associations were found between duration of illness (p < .001; Cramer’s V = 0.467), treatment received (p = .030; Cramer’s V = 0.434), and treatment frequency (p = .034; Cramer’s V = 0.396) and global health status. No significant associations were identified between cancer stage, comorbidities, BMI category, or family history of cancer and QoL.

Conclusion: Duration of illness and treatment-related factors were significantly associated with quality of life among breast cancer patients. These findings suggest that the illness trajectory and treatment burden may be substantially related to patients’ overall well-being, supporting the need for targeted supportive care and routine QoL monitoring to improve patient-centred outcomes.

Association Between Reproductive Health Knowledge, Attitudes, and Premarital Sexual Behavior Among Adolescents: A Cross-Sectional Study in West Java, Indonesia

Masluroh Masluroh — 2026-07-01

Background: Adolescence is a critical developmental stage associated with increased vulnerability to premarital sexual behavior (PSB). Limited reproductive health (RH) knowledge and negative attitudes are recognized risk factors, yet most Indonesian studies have been conducted in single-school settings. Therefore, this study aimed to examine the association between RH knowledge, attitudes, and PSB among adolescents across three senior high schools in West Java, Indonesia.

Methods: A cross-sectional descriptive-correlational study was conducted among 108 adolescents from three senior high schools in West Java in 2025 (total sampling, n=36 per school). Data on reproductive health (RH) knowledge, attitudes, and premarital sexual behaviour (PSB) were collected using validated questionnaires and analysed using Chi-square (χ²) tests in SPSS v.26, with statistical significance set at p<0.05.

Results: More than half of respondents demonstrated insufficient RH knowledge (55.5% at SMK Texmaco; 41.7% at SMAN 18; 44.5% at SMAN 2). Negative or insufficient attitudes toward RH were found in 38.9%, 44.5%, and 38.9% of adolescents at the three schools, respectively. High-risk PSB—defined as engagement in intimate contact beyond hand-holding, including hugging, kissing, or more advanced sexual contact, a classification grounded in Indonesian cultural and religious norms where any non-platonic physical contact outside marriage carries significant health and social risk—was prevalent across all sites (44.5%, 47.2%, and 38.9%). Chi-square analysis revealed statistically significant associations between RH knowledge and PSB at all three schools (χ²=8.43, df=2, p=0.015, V=0.28 at SMK Texmaco; χ²=7.21, df=2, p=0.027, V=0.25 at SMAN 18; χ²=6.89, df=2, p=0.032, V=0.24 at SMAN 2 Babelan), and between attitude and PSB at SMK Texmaco (χ²=9.67, df=4, p=0.008, V=0.29).

Conclusion: Reproductive health knowledge and attitudes were significantly associated with premarital sexual behaviour (PSB) among adolescents. Strengthening school-based reproductive health education may help promote healthier behaviours, while further longitudinal studies are needed to confirm these findings.

Comparative Outcomes of Ginger Decoction and Lavender Aromatherapy on Emesis Gravidarum Among First-Trimester Pregnant Women: A Quasi-Experimental Study

Omega DR Tahun — 2026-07-01

Background: Emesis gravidarum affects 60–80% of first-trimester pregnancies and can reduce maternal quality of life. Evidence comparing ginger decoction and lavender aromatherapy remains limited, particularly in Indonesian primary maternal healthcare settings. This study compared their effectiveness in reducing the severity of emesis gravidarum among first-trimester pregnant women.

Methods: A quasi-experimental design with two separate intervention groups was employed, adhering to Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. Forty-four first-trimester pregnant women (≤12 weeks' gestation) experiencing emesis gravidarum were recruited via purposive sampling from Independent Midwifery Clinics in East Jakarta and Bekasi, Indonesia (November–December 2025). Group 1 (n=22) received ginger decoction; Group 2 (n=22) received lavender aromatherapy. The independent variable was intervention type; the dependent variable was emesis gravidarum severity, measured by the Pregnancy Unique Quantification of Emesis/Nausea (PUQE) instrument. Data were analysed using the Independent T-test, the Wilcoxon signed-rank test, and Cohen's d for effect size.

Results: Post-intervention mean PUQE score was significantly lower in the ginger decoction group (Mean=5.50, SD=1.50) versus lavender aromatherapy (Mean=7.18, SD=1.62; p=0.001; Mean difference=1.68; 95% CI: 0.73–2.63; Cohen's d=0.76). Both interventions significantly reduced emesis severity from pre- (Mean=9.34, SD=1.72) to post-intervention (Mean=6.34, SD=1.75; p<0.001, Wilcoxon test).

Conclusion: In this quasi-experimental study, ginger decoction demonstrated superior outcomes, serving as a low-cost, culturally adaptable non-pharmacological option for emesis gravidarum in Indonesian primary maternal healthcare. Lavender aromatherapy provided meaningful complementary benefit, particularly for women with psychosocial contributors to nausea or those intolerant of ginger. Findings should be interpreted within the limitations of the quasi-experimental design and the limited geographic scope.

Factors Associated with Midwives' Knowledge Regarding Congenital Hypothyroidism Screening and Early Neonatal Management: A Cross-Sectional Study

Lili Anggraini — 2026-07-01

Background: Congenital hypothyroidism is a preventable cause of intellectual disability in neonates. Although neonatal screening programs have been implemented in Indonesia, gaps in midwives’ knowledge of screening and early management may hinder timely diagnosis and referral. Evidence on factors associated with midwives’ knowledge in primary healthcare settings remains limited. This study aimed to analyse factors associated with midwives’ knowledge regarding congenital hypothyroidism screening and early neonatal management.

Methods: A cross-sectional analytical study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines among 78 midwives registered with the Indonesian Midwives Association of Indonesia Kedungwaringin Branch, Bekasi Regency, West Java, Indonesia, in 2025. Total sampling was applied. The dependent variable was knowledge level (good/fair/poor), and independent variables included age, education level, years of work experience, training attendance, and professional journal-reading habits. Data were collected using a validated questionnaire (20 items across 5 domains; Cronbach’s α = 0.82; Content Validity Index = 0.87). Bivariate analysis was performed using Chi-Square tests, reporting χ² statistics, degrees of freedom, p-values, and 95% confidence intervals. Multivariable logistic regression was additionally conducted.

Results: Of 78 respondents, 44 (56.4%) had good knowledge, 25 (32.1%) fair, and 9 (11.5%) poor knowledge. The majority were aged ≥30 years (59.0%), held a Diploma III (D3) qualification (57.7%), had >5 years of work experience (62.8%), had not attended CH-related training (56.4%), and did not routinely read midwifery journals (61.5%). Statistically significant associations were found between knowledge level and age (p = 0.001, OR = 1.84, 95% CI: 1.12–3.02), education level (p = 0.002, OR = 3.76, 95% CI: 1.58–8.94), years of work experience (p = 0.001, OR = 0.27, 95% CI: 0.11–0.66), training attendance (p < 0.001, OR = 7.04, 95% CI: 2.68–18.49), and journal-reading literacy (p = 0.002, OR = 4.85, 95% CI: 1.82–12.92). Midwives with higher education and training demonstrated significantly greater odds of good knowledge.

Conclusion: Strengthening continuing professional education and evidence-based literacy programs may improve the quality of congenital hypothyroidism screening and support earlier neonatal diagnosis. Targeted CH screening training programs and promotion of professional reading habits are recommended as priority interventions for primary healthcare midwifery services in Indonesia. Multicenter longitudinal and intervention studies are warranted to establish causal relationships and evaluate training program effectiveness

Effectiveness of Hindmilk Feeding on Weight Gain Among Low-Birth-Weight Infants

Aries Abiyoga — 2026-07-01

Background: Low Birth Weight (LBW) infants are at high risk of morbidity and growth problems. Hindmilk, which is rich in fat and calories, is proposed to improve weight gain, but evidence remains limited. This study examined the effect of hindmilk feeding on weight gain in LBW infants.

Methods: This pre-experiment design and was reported in accordance with the TREND guideline. A total of 15 LBW infants admitted to the Perinatology Unit of Malinau Hospital were recruited using purposive sampling. The independent variable was hindmilk feeding, while the dependent variable was infant weight gain. Data were collected using the Standardised Human Observation Sheet (SHOS) and analysed using the paired sample t-test.

Results: The findings showed a significant increase in infant body weight after the hindmilk intervention compared with baseline measurements. The mean body weight after intervention was higher than before intervention, with a statistically significant difference (p = 0.001). These results indicate that hindmilk feeding contributed positively to weight gain among LBW infants.

Conclusion: Hindmilk feeding significantly improved weight gain among LBW infants at Malinau Hospital. Therefore, hindmilk feeding may be recommended as an effective nutritional intervention for the management of LBW infants, particularly in resource-limited and remote healthcare settings.

Association Between Nurses’ Demographic Characteristics and Knowledge of Healthcare-Associated Infection Prevention: A Cross-Sectional Study

Arlina Dhian Sulistyowati — 2026-07-01

Background: Healthcare-Associated Infections (HAIs) significantly impact patient safety and healthcare costs. While general knowledge is often reported, evidence regarding how nurses’ demographic characteristics influence HAI knowledge remains inconsistent, particularly in specialised psychiatric settings. This study aims to analyse the relationship between nurses’ characteristics and their knowledge of HAI prevention and control.

Methods: This cross-sectional study followed STROBE guidelines. Data were collected from 125 nurses using a total sampling approach. Independent variables included age, gender, education, and length of service, while the dependent variable was knowledge of HAI prevention, measured by a validated 15-item Guttman-scale questionnaire. Data were collected using a validated and reliable structured questionnaire (Cronbach’s alpha > 0.60). Data were analysed using the Contingency Coefficient.

Results: Most respondents were aged 30–50 years (84%), female (58.4%), held a Diploma in Nursing (71.2%), and had more than 5 years of service (86.4%). The majority demonstrated good knowledge (94.4%). There were significant relationships between age (p<0.001), education (p<0.001), and length of service (p<0.001) and knowledge of HAI prevention and control. However, no significant association was found between gender and knowledge (p > 0.001).

Conclusion: Nurses’ characteristics, specifically age, education, and length of service, are significantly associated with knowledge of HAIs prevention and control, while gender does not show a significant association. These findings emphasise the importance of infection prevention education strategies tailored to nurses’ professional profiles.

The Effectiveness of Digital-Based Preconception Education in Improving Adolescent Girls’ Reproductive Knowledge

Sri Rezeki — 2026-07-01

Background: Adolescent reproductive health literacy is an important determinant of future maternal and neonatal outcomes. However, limited reproductive health knowledge among adolescents remains a major public health concern, particularly in areas with restricted access to reproductive health information. Digital-based preconception education offers a promising strategy to enhance adolescents’ reproductive health knowledge through accessible and engaging learning media. This study aimed to evaluate the effectiveness of digital-based preconception education in improving reproductive health knowledge among adolescent girls.

Methods: This study employed pre pre-experiment one-group pretest–posttest design involving 70 adolescent girls aged 15–19 years in Bangun Rejo Village. Respondents were selected using purposive sampling based on inclusion criteria, including smartphone ownership and active social media use. The intervention consisted of structured digital-based preconception education delivered through educational videos for approximately 30–45 minutes. Data were collected using a validated reproductive health knowledge questionnaire administered before and after the intervention. Data analysis was performed using descriptive statistics and the Wilcoxon Signed-Rank Test at α < 0.05.

Results: Before the intervention, most respondents had a moderate level of knowledge (67.1%), whereas after the intervention, the majority demonstrated a good level of knowledge (90%). Statistical analysis revealed a significant improvement in reproductive health knowledge following the digital-based preconception education intervention (p < 0.001).

Conclusion: Digital-based preconception education is effective in improving reproductive health knowledge among adolescent girls and may serve as an accessible and practical strategy for strengthening adolescent reproductive health promotion.

Age and Sex Differences in the Association Between Online Gaming Duration and Adolescent Mental Health: A Cross-Sectional Study

Ida Erni Sipahutar — 2026-07-01

Background: Online gaming is common among adolescents and may be associated with emotional and behavioural problems. However, evidence from Indonesia remains limited, particularly regarding whether age and sex modify the relationship between gaming duration and adolescent mental health outcomes. To examine whether age and sex moderate the association between online gaming duration and Strengths and Difficulties Questionnaire (SDQ) domains among Indonesian adolescents.

Methods: This cross-sectional study followed the STROBE reporting guideline. Participants were students aged 15–18 years who reported playing online games at a public senior high school in Bali, Indonesia (n = 109; total sampling). Online gaming duration (independent variable) was categorized as <1 hour, 1–2 hours, 2–3 hours, 3–4 hours, and >4 hours per day. SDQ domains (dependent variables) included prosocial behavior, hyperactivity/inattention, emotional problems, conduct problems, and peer relationship problems. Moderators were age and sex. Data were analyzed with statistical significance set at p < 0.05. Moderation was tested using a two-way MANOVA with interaction terms.

Results: Online gaming duration showed a significant multivariate association with the combined SDQ domains (p < 0.001; partial η² = 0.277). Significant interaction effects were observed for Age × Gaming Duration (p < 0.001; partial η² = 0.433) and Sex × Gaming Duration (p < 0.001; partial η² = 0.376). SDQ total difficulties were classified as abnormal in 81.6% of participants, which was interpreted cautiously as a potential measurement/contextual issue.

Conclusion: Gaming duration was associated with adolescent mental health indicators, and the association varied by age and sex. School- and family-based guidance should emphasize balanced digital recreation alongside sleep, study, and offline social activities, with screening and referral pathways for adolescents reporting emotional or behavioral difficulties

Supportive Care Needs and Patient Preferences Among Hemodialysis Patients with Chronic Kidney Disease: A Scoping Review of Evidence for Patient-Centered Kidney Supportive Care

Meyla Sari Handayani — 2026-07-01

Background: Patients with Chronic Kidney Disease (CKD) undergoing maintenance Hemodialysis (HD) face physical, psychological, social, and spiritual challenges that reduce quality of life. This scoping review mapped and synthesised evidence on supportive care needs and patient preferences to inform the development of holistic, person-centred, and culturally responsive Kidney Supportive Care (KSC) models for adults receiving maintenance HD.

Methods: This scoping review followed the PRISMA-ScR guidelines and the Arksey and O'Malley methodological framework, guided by the Population–Concept–Context (PCC) approach. Literature searches were conducted on May 25, 2026, across PubMed, Scopus, ScienceDirect, and EBSCOhost. Eligible studies included English- and Indonesian-language publications from 2021–2026 involving adults with CKD receiving maintenance HD. Qualitative, quantitative, and mixed-methods studies, as well as systematic reviews, were included. Study selection, data charting, thematic synthesis, and methodological quality appraisal were conducted using predefined criteria and Joanna Briggs Institute (JBI) critical appraisal tools.

Results: Twelve studies met the inclusion criteria. Four overarching themes were identified: (1) multidimensional supportive care needs, including physical symptom management, psychological support, social and financial assistance, spiritual care, and informational needs; (2) patient preferences for patient-centered care, emphasizing effective communication, shared decision-making, family involvement, and respect for spiritual values; (3) barriers to KSC implementation, including workforce limitations, inadequate psychosocial resources, financial burdens, insufficient professional training, and organizational constraints; and (4) strategies to strengthen KSC through interdisciplinary collaboration, Patient-Reported Outcome Measures (PROMs), family engagement, and integrated palliative care approaches. The review also identified evidence gaps regarding culturally adapted supportive care models, caregiver-support interventions, and implementation strategies in resource-limited settings.

Conclusion: Cultural beliefs are crucial in shaping treatment choices for ENT conditions. Public awareness campaigns by the Ministry of Health and local health authorities are recommended to educate communities on the benefits and risks of traditional medicine while promoting evidence-based healthcare practices.

Effectiveness and Implementation Barriers of Preoperative Education on Surgical Patient Outcomes: A Scoping Review

Kartika Nurif Adeline Putri — 2026-07-01

Background: Preoperative education improves patients’ understanding and reduces anxiety before surgery. However, evidence regarding its effectiveness and contextual factors remains inconsistent and fragmented. Therefore, this scoping review aims to map the effectiveness and limitations of preoperative education on surgical patient outcomes.

Methods: This study used a scoping review design based on PRISMA-ScR, the PCC (Population, Concept, Context) framework, and the Arksey & O’Malley method. A systematic search was conducted in four databases (Scopus, SpringerLink, PubMed, ScienceDirect) for articles published between 2022 and 2026. The study selection process included duplicate removal, title and abstract screening, and full-text review based on predefined eligibility criteria. Data were extracted using a standardised charting form by independent reviewers, with discrepancies resolved through discussion. The extracted data were analysed using thematic synthesis to identify key themes related to effectiveness and implementation barriers.

Results: A total of 514 records were identified from four databases. After excluding articles that were not full-text, not open access, or not written in English (n=207), 307 articles remained for screening. During the screening stage, 263 records were excluded due to duplicate removal, irrelevant titles and abstracts, inappropriate population, intervention, or study type. A total of 44 full-text articles were assessed for eligibility, of which 24 were excluded for not explicitly addressing preoperative education as the primary focus. No studies were excluded based on quality assessment. Finally, 20 studies were included in the review. Three main themes emerged from the synthesis: (1) Cognitive and psychological effectiveness, where most studies reported improvements in patient knowledge and reduced anxiety, although some studies found limited or non-significant effects; (2) Clinical and health system outcomes, including pain reduction, reduced opioid use, postoperative recovery metrics, patient satisfaction, and healthcare service efficiency, although findings varied across contexts and populations; and (3) Implementation barriers and limitations, including variability in educational delivery, timing, digital technology effectiveness, patient characteristics, and methodological constraints. Overall, substantial heterogeneity in effectiveness was observed, along with gaps in integrating multidimensional outcomes and standardizing educational approaches.

Conclusion: Preoperative education is a beneficial intervention that can improve clinical outcomes and healthcare efficiency, although its effects vary across populations and settings. These findings support the need for standardized, context-adaptive educational protocols and further high-quality studies to evaluate their effectiveness

Mapping Telehealth Interventions Supporting Self-Management in Coronary Artery Disease: Characteristics, Outcomes, and Evidence Gaps—A Scoping Review

Desy Hendriyani — 2026-07-01

Background: Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide, requiring long-term self-management to prevent recurrent cardiovascular events. Telehealth has emerged as a promising approach to support self-management through remote monitoring, education, lifestyle modification, and patient–provider communication. This scoping review aimed to map and synthesise the available evidence on telehealth-supported self-management interventions and their outcomes among adults with CAD.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O’Malley framework refined by the Joanna Briggs Institute (JBI). Guided by the Population–Concept–Context (PCC) framework, literature searches were conducted in PubMed, ScienceDirect, Scopus, and EBSCOhost for studies published between 2016 and 2026. Four reviewers independently screened titles, abstracts, and full texts against predefined eligibility criteria. Data were charted using a structured extraction form, and methodological quality was appraised using JBI critical appraisal tools. Findings were synthesised using descriptive evidence mapping and narrative descriptive analysis.

Results: Following the screening and eligibility assessment, 17 studies met the inclusion criteria and were included in the final synthesis. The included studies described a wide range of telehealth-supported self-management interventions, including mobile health applications, web-based platforms, telemonitoring systems, wearable devices, text messaging programs, cardiac telerehabilitation, and artificial intelligence-assisted technologies. Narrative descriptive synthesis showed that interventions commonly incorporated self-management components, including physical activity promotion, medication adherence support, dietary modification, smoking cessation, symptom monitoring, and psychosocial support. Across studies, reported outcomes included improvements in self-efficacy, health literacy, physical activity, medication adherence, quality of life, cardiovascular risk-factor management, and selected clinical indicators. Common intervention characteristics included personalized feedback, remote monitoring, nurse-led support, and multidisciplinary collaboration. The evidence also highlighted gaps related to long-term sustainability, implementation in resource-limited settings, digital equity, and adaptation across diverse healthcare contexts.

Conclusion: This scoping review mapped the current evidence on telehealth-supported self-management for adults with CAD and demonstrated substantial diversity in intervention modalities, self-management strategies, and reported outcomes. The findings highlight important knowledge gaps related to implementation, sustainability, and equity, particularly in low-resource settings. Future research should prioritize implementation-focused studies, culturally adaptable telehealth models, and long-term evaluations to support the integration of telehealth into secondary prevention and CAD management

Effectiveness Of Non-Pharmacological Coping Strategies For Labor Pain Management In Women: A Systematic Review

Sri Rejeki — 2026-07-01

Background: Labor is a natural physiological process often accompanied by severe pain, which varies among mothers. Uncontrolled pain may increase catecholamine levels, inhibit uterine contractions, prolong labor, and affect fetal well-being. Non-pharmacological approaches offer an important alternative for pain management. This review aims to synthesize evidence on the effectiveness of non-pharmacological coping strategies in reducing labor pain intensity.

Methods: This study is a Systematic Literature Review referring to the PRISMA 2020 guidelines. Article searches were conducted in Google Scholar, Semantic Scholar, PubMed, ScienceDirect, and ProQuest databases for the 2021–2025 period using the keywords “coping,” “managing,” and “labor pain.” Inclusion criteria included RCTs, quasi-experimental studies, observational studies, and systematic reviews in English or Indonesian discussing non-pharmacological coping strategies. A total of 11 articles met the criteria and were analysed using the PICOT framework.

Results: Identification through database searching (n =150), articles screened based on title and abstract (n= 110). Remaining relevant articles: 70, Full-text articles reviewed (n =30), and Articles meeting inclusion criteria and synthesized in the final review (n = 11). The synthesis shows that various non-pharmacological coping strategies, such as breathing exercises, music therapy, back massage, use of a birth ball, aromatherapy, acupressure, and emotional support, are effective in reducing pain intensity and anxiety during labor.

Conclusion: Non-pharmacological coping strategies are proven effective, safe, and empowering for mothers. Implications for practice may consist of Multimodal coping strategies that improve maternal outcomes, Non-pharmacological methods that reduce reliance on analgesics, and Interventions feasible in low-resource settings

Implementation and Effectiveness of Gender-Responsive Occupational Health and Safety for Female Workers in Waste Processing Industries: A Systematic Review

Dewi Sartika Hutabarat — 2026-07-01

Background: Female workers in waste processing industries are highly vulnerable to occupational hazards, including biological, chemical, ergonomic, and reproductive risks. Despite the implementation of Occupational Health and Safety (OHS) programs, evidence regarding gender-responsive OHS practices for female workers remains limited, particularly in low- and middle-income countries (LMICs). This systematic review aimed to synthesise evidence on the implementation and effectiveness of gender-responsive Occupational Health and Safety (OHS) programs among female workers in waste processing industries

Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed in Scopus, PubMed, ScienceDirect, Web of Science, and CINAHL for studies published between 2014 and 2024. Two independent reviewers conducted study screening through title, abstract, and full-text assessment. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Eighteen studies met the eligibility criteria. Due to heterogeneity in study designs, outcomes, and measurement indicators, meta-analysis was not feasible; therefore, the data were synthesised using a thematic narrative analysis.

Results: The PRISMA process identified 1,246 records, of which 18 studies were included in the final synthesis. Studies were predominantly conducted in LMIC settings and involved cross-sectional, qualitative, and mixed-method designs. Three major themes emerged: (1) occupational hazard exposure among female waste workers, (2) implementation of OHS interventions and personal protective equipment (PPE), and (3) barriers to gender-responsive occupational health protection. Most studies reported inadequate PPE utilisation, limited reproductive health protection, and weak institutional OHS policies. The quality of evidence ranged from low to moderate due to methodological heterogeneity and limited longitudinal studies.

Conclusion: Gender-responsive OHS implementation in waste processing industries remains suboptimal, particularly in LMICs. Strengthening workplace policies, reproductive health protection, PPE compliance, and gender-sensitive occupational programs is essential to improve worker safety. Future studies should employ longitudinal and intervention-based designs to evaluate the effectiveness of OHS programs among female workers.

Diagnostic and Metastatic Predictive Value of Urinary Exosomal miR-26b-3p in Prostate Cancer: A Prospective Observational Study

Muhammad Sufriyudi — 2026-07-01

Background: Prostate cancer (PCa) remains challenging to diagnose due to the limited accuracy of PSA testing. Urinary exosomal miR-26b-3p is a promising non-invasive biomarker, but evidence across PCa metastatic stages is limited, particularly in LMICs. This study evaluated miR-26b-3p expression in BPH, non-metastatic PCa, and metastatic PCa (M1b and M1c), and assessed its diagnostic and metastatic discrimination potential.

Methods: This prospective, observational, single-center study was conducted at Dr Sardjito General Hospital, Yogyakarta, Indonesia, from January 2023 to December 2023, and reported in accordance with the STROBE guidelines. A total of 40 male participants (12 BPH and 28 PCa) were enrolled using consecutive sampling. Inclusion criteria were men aged ≥40 years with histopathologically confirmed BPH or PCa who provided written informed consent. Exclusion criteria were prior pelvic radiotherapy, urinary tract infection, hematuria, or incomplete urine specimens. The independent variable was the clinical diagnostic group; the dependent variable was relative urinary exosomal miR-26b-3p expression. Urinary exosomes were isolated, and miR-26b-3p was quantified by quantitative real-time PCR (qPCR). Group comparisons used one-way ANOVA with post-hoc analysis, and diagnostic performance was evaluated by Receiver Operating Characteristic (ROC) analysis with Area Under the Curve (AUC) and 95% confidence interval (CI).

Results: miR-26b-3p expression differed significantly among the four groups (p = 0.002). Mean ± SD expression was 6.6 ± 3.4 in BPH, 44.2 ± 25.4 in non-metastatic PCa, 46.7 ± 41.1 in M1b PCa, and 35.1 ± 21.3 in M1c PCa. ROC analysis demonstrated excellent diagnostic performance for differentiating BPH from PCa (AUC = 0.982; 95% CI: 0.943–1.000; p < 0.001).

Conclusion: Urinary exosomal miR-26b-3p shows strong diagnostic discrimination between BPH and PCa and is associated with metastatic status, supporting its potential as a non-invasive biomarker for prostate cancer screening and metastatic risk stratification. Multicenter validation in larger, ethnically diverse cohorts is needed before clinical implementation.

Psychosocial Education for Families in Caring for Patients with Schizophrenia: A Systematic Review

Alexandra Maria Pires — 2026-07-01

Background: Schizophrenia is a chronic mental disorder that significantly impacts both patients and their families. Psychosocial education for families plays a crucial role in improving caregivers’ knowledge, reducing burden, and enhancing patient outcomes. This systematic literature review examines studies on family psychoeducation interventions for schizophrenia, focusing on their effectiveness and implementation challenges.

Methods: This systematic review followed PRISMA guidelines. We searched Google Scholar, Scopus, Web of Science, and Crossref for peer-reviewed English-language articles from 2003 to 2023, using Boolean operators and keywords such as “family psychoeducation,” “schizophrenia,” and “caregiver burden.” Two reviewers independently screened and extracted data to ensure accuracy and reduce bias.

Results: The review includes 15 studies published between 2003 and 2023 that analyse various psychoeducational approaches, study designs, and outcomes. Findings indicate that family psychoeducation significantly reduces caregiver burden, improves family cohesion, and enhances patients’ symptom management and relapse prevention. However, despite its proven effectiveness, the implementation of psychoeducation remains inconsistent due to barriers such as limited resources, lack of structured programs, and cultural variations.

Conclusion: The review emphasises the need to integrate psychoeducation into routine mental health services and to train healthcare providers to deliver structured, evidence-based interventions. Future research should explore digital-based psychoeducation to improve accessibility and sustainability. Strengthening family psychoeducation can lead to better patient care, reduced stigma, and improved quality of life for both patients and caregivers

Association Between Nurses' Workload and Compliance with Digital NEWS Documentation: A Cross-Sectional Study

Linda Widiastuti — 2026-07-01

Background: Deterioration in a patient's clinical condition can occur suddenly during hospitalization, making early detection essential to prevent delayed interventions and reduce mortality risk. Patient deterioration requires early detection using the National Early Warning Score (NEWS). However, its implementation is often reported to be associated with nurses' high workload. Furthermore, limited evidence exists on how workload influences digital NEWS documentation, particularly in resource-constrained settings. This study aimed to determine the relationship between workload and the implementation of digital NEWS documentation.

Methods: This quantitative, cross-sectional study followed the STROBE guidelines and involved 72 nurses selected via convenience sampling at a Type A private hospital in Indonesia. The independent variable was workload, and the dependent variable was digital NEWS documentation. Data were collected using a validated workload questionnaire and a digital NEWS documentation checklist based on Royal College of Physicians (2017) standards, and analyzed using Jamovi software via Chi-square tests.

Results: 76.4% of respondents experienced a non-heavy workload, and 65.3% implemented digital NEWS documentation. The analysis revealed a significant relationship between workload and the implementation of digital NEWS documentation (p = 0.003; OR = 0.186; CI95% = 0,058-0,597), indicating that a heavier workload was associated with a lower likelihood of completing NEWS documentation.

Conclusion: These findings highlight that workload is significantly associated with clinical documentation compliance. To enhance patient safety, hospital administrators must move beyond general evaluations and implement targeted interventions, including staffing adjustments to balance nurse-to-patient ratios, workflow redesign to minimize administrative burden, and digital optimization of the digital NEWS system to streamline data entry.

Association Between Cyberbullying Exposure and Suicide Risk Among Undergraduate Students: A Cross-Sectional Study

Laili Nur Hidayati — 2026-07-01

Background: The increasing use of the internet and social media among undergraduate students has contributed to the growing prevalence of cyberbullying. Exposure to cyberbullying may negatively affect students’ mental health and increase the risk of suicidal ideation and suicidal behavior. However, limited evidence exists regarding the relationship between cyberbullying and suicide risk among college students in low- and middle- income countries, including Indonesia. Therefore, this study aimed to examine the relationship between cyberbullying exposure and suicide risk among undergraduate students.

Methods: This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and involved 392 undergraduate students recruited via convenience sampling. Cyberbullying exposure was treated as the independent variable, while suicide risk was the dependent variable. Data were collected using the Cyberbullying Behavioral Scale and the Beck Scale for Suicide Ideation (BSS). Statistical analysis was performed using the Spearman rank correlation test.

Results: Most respondents reported low levels of cyberbullying exposure, 359 (91.6%), and low suicide risk (82.7%). Spearman rank analysis demonstrated a statistically significant positive relationship between cyberbullying exposure and suicide risk (r= 0.141, p = 0.005), indicating a weak positive correlation.

Conclusion: Cyberbullying exposure was associated with suicide risk among undergraduate students. However, this finding should be interpreted cautiously and not considered evidence of a causal relationship. These results highlight the importance of mental health screening, cyberbullying prevention, and suicide risk assessment programs within university settings.

Effectiveness of a Family Unit Empowerment Model in Improving Diabetes Management, Family Empowerment, and Family Support among Adults with Type 2 Diabetes Mellitus: A Quasi-Experimental Study

Ni Wayan Trisnadewi — 2026-07-01

Background: Diabetes mellitus (DM) remains a major public health challenge in Indonesia, with its prevalence continuing to increase. Although incurable, effective long-term management can maintain patients' quality of life. Family involvement is essential in supporting adherence to diabetes management, yet evidence on structured family-unit empowerment interventions, particularly in community settings, remains limited. Therefore, this study aimed to evaluate the effectiveness of the Family Unit Empowerment Model in improving diabetes management, family empowerment, and family support among patients with type 2 diabetes mellitus (T2DM).

Methods: This study employed a quasi-experimental one-group pre-test–post-test design and followed the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) reporting guideline. A total of 140 patients with T2DM registered at the Blahbatuh 2 Gianyar Community Health Center were recruited through purposive sampling between December 2022 and July 2023. Inclusion criteria included a confirmed T2DM diagnosis, residence with family, ability to communicate effectively, and provision of informed consent. The independent variable was the Family Unit Empowerment Model; dependent variables were diabetes management, family empowerment, and family support, measured using the Summary of Diabetes Self-Care Activities (SDSCA), the Family Empowerment Scale (FES), and the Diabetes Family Support Scale, respectively (all Cronbach’s α ≥ 0.70). The intervention consisted of four structured weekly family-based health education sessions delivered over one month. Data were analyzed using the Wilcoxon Signed-Rank Test, with a significance level of p < 0.05.

Results: Statistically significant improvements in median scores were observed for all three outcome variables following the intervention. The proportion of families in the good empowerment category increased from 37.1% to 55.7% (p < 0.001, r = 0.54). For family support, the proportion reporting high support increased from 44.3% to 49.3%, with a significant rise in median scores (p < 0.001, r = 0.49). Diabetes management improved, with poor-category cases decreasing from 40.7% to 27.9% (p < 0.001, r = 0.33).

Conclusion: Participation in the Family Unit Empowerment Model was associated with statistically significant improvements in diabetes self-management behaviors, family empowerment, and family support among patients with T2DM. Because the single-group design and reliance on self-reported outcomes preclude causal attribution, these findings should be interpreted as preliminary. They provide promising support for family-centered empowerment approaches in community-based diabetes care and a rationale for evaluation in adequately powered, controlled, multicenter trials that incorporate objective clinical outcomes before broad implementation is recommended.

The Role of Self-Esteem, Family Relationships, and Social Support With Mental Health Among High School Adolescents: A Cross-Sectional Study

Diana Arianti — 2026-07-01

Background: Adolescent mental health has become a major public health concern worldwide. Although self-esteem, family relationships, and social support are recognized as important psychosocial protective factors, evidence regarding their combined contribution to adolescent mental health in the Indonesian context remains limited. This study aimed to examine the associations of self-esteem, family relationships, and social support with mental health among high school adolescents.

Methods: This cross-sectional study was conducted among 146 high school students aged 15–18 years in Padang, West Sumatra, Indonesia, and reported in accordance with the STROBE guidelines. Participants were selected using simple random sampling. Self-esteem, family relationships, social support, and mental health were assessed using the Rosenberg Self-Esteem Scale (RSES), Family Adaptability and Cohesion Evaluation Scale IV (FACES-IV), Multidimensional Scale of Perceived Social Support (MSPSS), and General Health Questionnaire-12 (GHQ-12). Data were analyzed using descriptive statistics, chi-square tests, and multivariable ordinal logistic regression, with adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) reported to identify factors associated with adolescent mental health.

Results: Bivariate analysis indicated that gender, self-esteem, family dynamics, and social support were significantly correlated with adolescent mental health (all p < 0.05). In the multivariable ordinal logistic regression model, adolescents with low self-esteem had significantly lower odds of being in a higher mental health category compared to those with high self-esteem (AOR = 0.00004; 95% CI: 0.000001–0.002; p < 0.001). Similarly, adolescents with weak family ties had reduced chances of improved mental health compared to those with strong family ties (AOR = 0.0002; 95% CI: 0.000005–0.007; p < 0.001). Gender continued to show a significant association with adolescent mental health (AOR = 82.43; 95% CI: 3.63–1877.76; p = 0.006), while social support lost its significance after adjustment.

Conclusion: Self-esteem, family relationships, and social support were significantly associated with adolescent mental health. Although they were not independent predictors in the multivariate model, these factors remain important psychosocial resources. Mental health promotion programs should target multiple psychosocial domains simultaneously, particularly within school and family environments.

Community-Based SENORITA Gymnastics for Improving Menopausal Symptoms and Quality of Life Among Postmenopausal Women: A Quasi-Experimental Study

Ni Putu Karunia Ekayani — 2026-07-01

Background: Community-based, low-cost exercise programs are needed to support menopausal health in primary healthcare and resource-limited settings. SENORITA Gymnastics integrates low-impact aerobic exercise and breathing-focused Tera Gymnastics and may be feasible for delivery through community elderly health posts. This study aimed to evaluate SENORITA Gymnastics for its effects on menopausal symptoms and quality of life among postmenopausal women.

Methods: A quasi-experimental non-equivalent pretest-posttest control-group study was conducted among 60 postmenopausal women at Posyandu Lansia in the working area of the Gunungsari Primary Health Care Center, West Lombok, Indonesia. Participants were allocated to the SENORITA Gymnastics group (n = 30) or the routine elderly gymnastics/control group (n = 30). SENORITA Gymnastics was delivered in eight sessions, twice weekly for four weeks. Menopausal symptoms were measured using the Menopause Symptom Questionnaire, and quality of life was measured using the WHOQOL-BREF. Data were analyzed using descriptive statistics, between-group comparisons, and exploratory logistic regression.

Results: Menopausal symptom scores decreased descriptively in both groups, from 61.77 ± 16.26 to 53.93 ± 13.31 in the SENORITA Gymnastics group and from 67.03 ± 19.03 to 53.40 ± 13.87 in the control group. The numerically larger symptom reduction occurred in the control group. Post-test menopausal symptom scores differed significantly between groups (p = 0.035), with slightly lower scores in the control group. Quality-of-life scores increased descriptively in both groups, from 84.80 ± 10.23 to 88.70 ± 7.67 in the SENORITA Gymnastics group and from 78.93 ± 12.06 to 86.83 ± 8.43 in the control group. Post-test quality-of-life scores differed significantly between groups (p = 0.025). However, the SENORITA group already had higher baseline quality-of-life scores, and the descriptive improvement was larger in the control group. Age was the dominant factor associated with quality of life in the final logistic regression model (adjusted OR = 0.072; 95% CI: 0.019-0.273; p < 0.001).

Conclusion: SENORITA Gymnastics is feasible as a community-based health promotion activity for postmenopausal women. However, this study did not demonstrate the superiority of SENORITA Gymnastics over routine elderly gymnastics for reducing menopausal symptoms or improving quality of life. Future randomized or cluster-randomized studies with baseline-adjusted repeated-measures analysis, standardized control conditions, intervention fidelity assessment, and larger multicenter samples are needed.

Cultural Meanings, Spiritual Adaptation, and Communal Resilience Following Spousal Loss Among Older Adults: An Ethnographic Study

Sri Ariyanti — 2026-07-01

Background: Spousal loss represents a significant life transition in later life, often influencing psychological well-being, social functioning, and personal identity. In rural Indonesian communities, bereavement is embedded within sociocultural contexts where spiritual beliefs, family obligations, and communal caregiving traditions shape how older adults experience and respond to loss. Despite growing attention to bereavement among older populations, ethnographic evidence examining culturally grounded adaptation processes in rural Indonesian settings remains limited. This study aimed to explore the cultural meanings of spousal loss and the adaptation experiences of older adults residing in rural Indonesian communities.

Methods: A qualitative ethnographic design guided by Spradley’s ethnographic tradition was employed. Eighteen older adults who had experienced spousal loss were recruited through purposive sampling. Data were collected during six months of field engagement using in-depth interviews, participant observation, field notes, and focus group discussions. Data were analyzed through thematic ethnographic analysis to identify culturally embedded patterns of meaning and adaptation.

Results: Four interconnected themes emerged: spiritual acceptance of spousal loss, cultural values fostering resilience, communal caregiving practices, and loneliness after bereavement. Informants understood spousal loss not only as an emotional experience but also as a sociocultural and spiritual transition. Adaptation was facilitated through religious practices, family responsibilities, collective caregiving traditions, and community support, while loneliness and the loss of emotional companionship remained enduring challenges.

Conclusion: Adaptation to spousal loss among older adults is deeply influenced by cultural values, spirituality, and community relationships. These findings contribute to a deeper understanding of culturally embedded bereavement processes and provide a foundation for future cross-cultural and intervention-based research addressing grief and adaptation in later life.

Association Between Blood Glucose Levels and Leukocyte Counts in Patients with Diabetic Gangrene: A Cross-Sectional Study

Satria Eureka Nurseskasatmata — 2026-07-01

Background: Diabetic gangrene is a severe complication of diabetes mellitus (DM) that often leads to amputation. DM increases susceptibility to infection by impairing leukocyte function. Although hyperglycemia is known to weaken innate immunity, its association with leukocyte count remains unclear, particularly in low- and middle-income country (LMIC) settings. This study aimed to assess the association between admission blood glucose levels and leukocyte counts in patients with diabetic gangrene.

Methods: This study utilized a retrospective cross-sectional design and was prepared in accordance with the STROBE guidelines. Secondary data were extracted from the medical records and laboratory reports of patients hospitalized at Kertosono Regional General Hospital in East Java, Indonesia, from January to December 2022. A purposive total sampling approach was applied. Inclusion criteria required an inpatient diagnosis of diabetes mellitus with diabetic gangrene, alongside the availability of both random blood glucose and total leukocyte count results for the same admission. Exclusion criteria eliminated records with missing or illegible key laboratory values, duplicate records, and records lacking diagnostic confirmation in the discharge summary. The independent variable assessed was admission random blood glucose (mg/dL), and the dependent variable was the total leukocyte count (cells/µL).

Results: From an initial pool of 50 records, a final sample of 38 medical records was selected for analysis. Spearman’s rank correlation indicated that there was no significant association between random blood glucose levels and total leukocyte counts (r = -0.031; p = 0.853).

Conclusion: Admission blood glucose does not meaningfully track or correlate with total leukocyte count in patients presenting with diabetic gangrene. Clinically, this suggests that leukocyte count should not be used as a proxy or surrogate for acute glycemic status. Therefore, comprehensive infection severity assessments in these patients require integrating clinical evaluation with additional, more specific inflammatory indices.

Clinical Competence and Nursing Culture as Determinants of Standardized Pain-Sedation Assessment Compliance Among ICU Nurses: A Cross-Sectional Study

Ifa Hafifah — 2026-07-01

Background: Despite growing attention to ICU quality care, limited evidence has simultaneously examined the combined influence of nursing culture and clinical competence on compliance with standardized pain-sedation assessment among ICU nurses in developing healthcare settings. This study aimed to identify factors associated with ICU nurses’ compliance with standardized pain and sedation assessment using the COMFORT Scale and the Richmond Agitation-Sedation Scale (RASS), with a particular focus on the combined roles of nursing culture and clinical competence.

Methods: A quantitative descriptive survey design was employed. This cross-sectional study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study included 35 ICU nurses at a tertiary hospital in South Kalimantan, Indonesia, using a total population sampling method. All ICU nurses who met the inclusion criteria were eligible to participate. The dependent variable was ICU nurses' compliance with standardized pain and sedation assessment, measured using structured observation checklists based on the COMFORT Scale and the Richmond Agitation-Sedation Scale (RASS). The independent variables were nursing culture and clinical competence, measured using validated questionnaires. Observers were trained and standardized before data collection to ensure consistency of assessment. Data were analyzed using descriptive statistics, Spearman's rho correlation, and multiple linear regression after assessing model assumptions, including linearity, multicollinearity, normality of residuals, and homoscedasticity. Statistical significance was set at p < 0.05.

Results: Most participants were female nurses (65.7%) aged 30–39 years (51.4%) with ≤5 years of ICU experience (62.9%). Observed compliance with standardized pain and sedation assessment was moderate and inconsistent (Mean = 3.59 ± 0.505 on a 1–5 scale), with documentation and scheduled tracking intervals being the weakest domains. Bivariate analysis revealed that both a supportive nursing culture (r = -0.001, p = 0.002) and higher clinical competence (r = 0.912, p < 0.001) were significantly correlated with compliance. However, in the multiple linear regression model (R2 = 0.574, F(2,32) = 21.562, p < 0.001). Individual clinical competence emerged as the sole significant independent predictor of compliance with standardized pain and sedation assessment (β = 0.759, p < 0.001; 95% CI: 0.54 to 1.27). After multivariate adjustment, nursing culture was not significantly associated with compliance with standardized pain and sedation assessment (β = -0.001, p = 0.993; 95% CI: -0.29 to 0.29).

Conclusion: Clinical competence was the only independent predictor of compliance with standardized pain and sedation assessment among ICU nurses in multivariate model. Therefore, competency-based training and evaluation should be prioritized, while future longitudinal, multi-center studies should investigate the long-term effects of such interventions and other factors influencing compliance.

Effectiveness of Tafakur Prayer Spiritual Therapy on Psychological, Spiritual Well-Being, and Pain In Cancer Patients: A Randomized Trial

Priyanto Priyanto — 2026-07-01

Background: Despite growing evidence supporting spiritual interventions in cancer care, limited randomized controlled trials have examined the effectiveness of the culturally adapted Tafakur Prayer Spiritual Therapy (TPST). Therefore, this study aimed to evaluate its effectiveness on psychological well-being, spiritual well-being, and pain among hospitalized cancer patients.

Methods: A single-masked randomized controlled trial, strictly guided by the CONSORT framework, was conducted. Forty-two hospitalized cancer patients were successfully recruited via purposive sampling and randomly assigned to either a four-day TPST intervention group or a standard-care control group using block permutation. Allocation concealment was ensured. Baseline characteristics were homogeneous. The independent variable was the intervention, and the dependent variables were measured using the Psychological Well-Being Index, the Spiritual Well-Being Scale, and the Brief Pain Inventory. Data were analyzed using independent and paired t-tests with statistical software.

Results: Psychological well-being improved significantly in the intervention group compared with controls, demonstrating notable clinical significance for patients (Mean Difference=9.4, 95% CI=0.70; 18.10, Cohen's d=0.67, p=0.035). Spiritual well-being also showed a significant increase (Mean Difference=13.7, 95% CI=1.64; 25.76, Cohen's d=0.71, p=0.027). Furthermore, pain intensity decreased significantly, successfully shifting these patients to a lower pain category (Mean Difference = -9.3, 95% CI = -15.63 to -2.97, Cohen's d = 0.92, p = 0.005).

Conclusion: The culturally structured TPST significantly enhances holistic patient outcomes and alters the subjective pain experience. It should be routinely integrated into standard holistic oncology nursing protocols. Further multicenter randomized controlled trials with larger samples are needed to confirm the long-term effectiveness of this intervention across diverse hospital settings.

Routine Hematologic and Biochemical Profiles in Term Premature Rupture of Membranes: A Retrospective Case-Control Study

Septi Widiyanti — 2026-07-01

Background: Term premature rupture of membranes (PROM) is a common obstetric complication associated with increased risk of maternal and neonatal morbidity, primarily driven by inflammatory and infectious mechanisms. Although inflammatory pathways have been extensively studied, most evidence focuses on specific biomarkers such as C-reactive protein and cytokines. In contrast, routine hematologic and biochemical parameters—despite being widely available, inexpensive, and part of standard clinical practice—have not been consistently evaluated using PROM, particularly in low-resource settings such as Indonesia.

Methods: This retrospective case-control study, reported according to STROBE guidelines, included 90 women (30 term PROM cases and 60 normal delivery controls) selected using systematic random sampling from medical records at Ahmad Yani Regional General Hospital, Indonesia. Inclusion and exclusion criteria were applied to minimize confounding. Eleven complete blood count (CBC) parameters were analyzed, including leukocytes, erythrocytes, hemoglobin, hematocrit, MCV, MCH, MCHC, platelets, RDW, MPV, and blood glucose. Laboratory measurements were performed using the Sysmex XN-550 hematology analyzer and the Pentra C400 automated chemistry analyzer. Data were analyzed using SPSS version 25. Group comparisons were conducted using the Mann–Whitney U test, and effect sizes were calculated using rank-biserial correlation.

Results: Significant differences were observed in leukocyte count (p = 0.042), MCV (p = 0.016), MCH (p = 0.009), RDW (p = 0.023), and MPV (p = 0.036). Effect sizes ranged from small to moderate (r = 0.23–0.34), indicating limited clinical magnitude. Other parameters, including erythrocytes, hemoglobin, hematocrit, MCHC, platelets, and blood glucose, showed no significant differences (p > 0.05). Overall, the term PROM was associated with selective and subtle hematologic alterations.

Conclusion: Term PROM is associated with mild and selective changes in routine hematologic parameters, particularly those related to inflammatory and erythropoietic activity. Blood glucose, the only biochemical parameter evaluated, remained comparable between groups. These findings suggest limited standalone diagnostic value, and complete blood count (CBC) parameters should be interpreted as supportive indicators within comprehensive obstetric assessment rather than independent diagnostic tools.

Effect of Low-Cost CPR Pillow Training on Adolescents’ Willingness to Perform Bystander CPR: A Quasi-Experimental Study

Lukman Lukman — 2026-07-10

Background: Despite increasing CPR education initiatives, evidence regarding the effectiveness of low-cost CPR Pillow simulation in improving adolescents' willingness to perform bystander CPR remains limited. This study aimed to evaluate the effect of CPR Pillow training on scout members' willingness to perform CPR in Lubuklinggau City, South Sumatera, Indonesia.

Methods: This quantitative quasi-experimental study followed a non-equivalent control group pretest-posttest design in line with TREND principles. Seventy-two scout members aged 15–17 years who had never received CPR training were selected by random sampling and allocated to intervention and control groups. The intervention group received three sessions of classical teaching combined with CPR Pillow simulation over two months, while the control group received classical CPR training using leaflets only. Willingness to perform CPR was measured using a 30-item questionnaire with Cronbach's alpha of 0.85 and analyzed using paired and independent t-tests.

Results: The intervention group demonstrated a greater increase in willingness scores than the control group, with mean scores improving from 42.50 ± 7.00 to 86.90 ± 5.60. The control group also improved, from 42.30 ± 6.90 to 84.20 ± 5.90. The between-group difference in score change was statistically significant (t = 2.398, p < 0.001).

Conclusion: Low-cost CPR Pillow training significantly improved adolescents’ willingness to perform bystander CPR compared with leaflet-based training. This approach may be a practical and scalable strategy for school and scout CPR education in low-resource settings.

Association of Smoking, Obesity, and Psychological Stress with Asthma Severity Among Adult Patients: A Cross-Sectional Study

Lukman Harun — 2026-07-10

Background: Asthma is a chronic inflammatory airway disease that causes breathing difficulties and affects approximately 12 million people in Indonesia. Smoking status, obesity, and psychological stress have been associated with increased asthma severity and poor outcomes. However, few studies have simultaneously examined the relative influence of these factors on asthma severity among adult patients with asthma in primary healthcare settings. Therefore, this study aimed to analyze the association of smoking status, obesity, and psychological stress with asthma severity.

Methods: A quantitative cross-sectional study was conducted among 51 adult asthma patients who had experienced an asthma attack within the previous month and were recruited through purposive sampling. Smoking status was assessed using the Brinkman Index, obesity using Body Mass Index (BMI), psychological stress level using the Perceived Stress Scale (PSS), and asthma severity using clinical classification criteria. Data were analyzed using Spearman’s rank correlation and multivariable ordinal logistic regression, with p < 0.05 considered statistically significant.

Results: Among 51 participants, 45.1% had intermittent asthma. Smoking status (r = 0.377, p = 0.006), obesity (r = 0.264, p = 0.041), and psychological stress level (r = 0.375, p = 0.007) were significantly associated with asthma severity. Multivariable ordinal logistic regression revealed that smoking status (aOR = 5.23, 95% CI: 1.35–20.33, p = 0.017) and psychological stress level (aOR = 8.56, 95% CI: 1.64–44.79, p = 0.011) were independently associated with mild persistent asthma compared to those with intermittent asthma. Although obesity contributed significantly to the overall model, its adjusted effect estimates were imprecise and warrant cautious Interpretation.

Conclusion: Smoking status and psychological stress were independently associated with asthma severity. Conversely, the association between obesity and asthma severity should be interpreted cautiously because of the imprecise effect estimate and limited statistical power. Of all factors, psychological stress demonstrated the strongest adjusted association with asthma severity.

Rapid Shallow Breathing Index Measurement, Modifications, and Predictive Performance for Ventilator Weaning in Adult ICU Patients: A Scoping Review

Tatang Sopyan — 2026-07-10

Background: The Rapid Shallow Breathing Index (RSBI) is widely used to assess readiness for ventilator weaning in mechanically ventilated patients. However, variations in measurement methods, cut-off values, modifications, and predictive performance have resulted in heterogeneous evidence. This scoping review aimed to map the available evidence on RSBI measurement methods, modifications, and predictive performance for ventilator weaning outcomes in adult ICU patients.

Methods: This scoping review followed the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population–Concept–Context (PCC) framework guided the research question. Literature searches were conducted in PubMed, ScienceDirect, ProQuest, SAGE Journals, and EBSCOhost for English-language primary studies published between 2015 and 2026. Data were extracted using a structured charting process and analyzed through thematic synthesis.

Results: Of the 461 identified records, 18 primary studies met the inclusion criteria. Four main themes were identified: conventional RSBI performance, variability in measurement methods and cut-off values, serial RSBI monitoring during spontaneous breathing trials, and diaphragm ultrasound-based RSBI modifications. Conventional RSBI showed variable predictive performance across studies because of differences in patient characteristics, ventilator settings, SBT protocols, measurement techniques, and outcome definitions.

Conclusion: RSBI remains a simple and non-invasive bedside parameter for ventilator weaning assessment; however, conventional RSBI should not be used as a stand-alone predictor. Its interpretation should be integrated with comprehensive clinical assessment and patient characteristics. Future multicenter studies are needed to standardize RSBI measurement protocols and validate diaphragm ultrasound-based RSBI modifications across diverse ICU populations.

Comparative Experimental Study of Drying Temperatures (30°C vs 50°C) on Tannin and Mineral Retention in Moringa oleifera Leaves

Aris Fitriyani — 2026-07-10

Background: Moringa oleifera leaves are nutrient-rich plant materials containing minerals and bioactive compounds with potential food and health applications. Drying temperature may affect their composition through moisture reduction and concentration effects. However, evidence comparing moderate drying temperatures (30°C and 50°C) and their impact on tannin and mineral content remains limited. This study aimed to evaluate the effects of drying at 30°C and 50°C on tannin and selected mineral concentrations in moringa leaves.

Methods: A quantitative comparative laboratory experimental study was conducted using non-human plant samples. Fresh moringa leaves were dried at 30°C and 50°C under controlled conditions, with each treatment performed in triplicate. Tannin content was determined using UV–Visible spectrophotometry with calibration-based quantification, while mineral concentrations of calcium (Ca), magnesium (Mg), potassium (K), sodium (Na), and iron (Fe) were measured using Atomic Absorption Spectrophotometry (AAS) or ICP-OES. Inferential statistical analyses were conducted following assumption checks to compare measured concentrations between treatments.

Results: Drying at 50°C produced consistently higher measured concentrations of tannins and minerals compared with drying at 30°C, indicating a coherent temperature-associated pattern across all analyzed parameters. Iron exhibited the largest numerical difference between treatments. These findings suggest that drying temperature influenced the measured chemical composition of moringa leaf powder, most likely through enhanced moisture reduction and concentration-related analytical effects.

Conclusion: Moderate drying temperature (50°C) increased measured tannin and mineral concentrations relative to 30°C under laboratory conditions. However, these differences should be interpreted cautiously, as they likely reflect concentration effects rather than true nutrient retention or improved nutritional efficacy. Further studies incorporating moisture-normalized analysis, bioavailability assessment, and functional evaluation are required before translating these findings into clinical or public health recommendations

Association Between Spirituality and Cybersex Behavior Among Twelfth-Grade Adolescents: A Cross-Sectional Study in Surabaya Indonesia

Iis Fatimawati — 2026-07-12

Background: Despite increasing internet-related sexual activities among adolescents, evidence regarding the role of spirituality in preventing cybersex behavior remains limited, particularly in Surabaya Indonesia; therefore, this study examined the relationship between spirituality level and cybersex behavior among twelfth-grade adolescents.

Methods: A cross-sectional study following STROBE guidelines was conducted among 108 twelfth-grade students at ITP High School Surabaya, selected through simple random sampling from a population of 148. Inclusion criteria were active twelfth-grade students consenting to participate, while exclusion criteria were incomplete questionnaires or absence due to illness. The independent variable was spirituality level, and the dependent variable was cybersex behavior. Data were collected using the Daily Spiritual Experience Scale (DSES) and Internet Sex Screening Test (ISST). Ethical clearance was obtained from the Ethics Committee of Hang Tuah Health Sciences Institute (PE/90/VII/2024/KEP/SHT), and data were analyzed using Spearman’s rho correlation.

Results: Univariate analysis showed that 61.1% of respondents exhibited moderate spirituality and 66.7% were classified as at-risk cybersex users. Bivariate statistical analysis revealed a significant moderate negative correlation between spirituality level and cybersex behavior (Spearman’s rho ρ = 0.001, r = -0.310, 95% CI [-0.473, -0.128)..

Conclusion: Higher spirituality is significantly associated with lower cybersex behavior among adolescents, suggesting that internal spiritual experiences serve as an essential protective factor. It is recommended that school nurses and educators design spirituality-integrated digital literacy interventions.

Independent Determinants of Stunting Among Children Under Five Years: A Case-Control Study Using Multivariable Analysis

Islamiyati Islamiyati — 2026-07-12

Background: Stunting is a chronic growth disorder caused by long-term nutritional deficiencies and repeated infections during the first 1,000 days of life. This study aimed to identify independent determinants of stunting among children under five years in the Yosomulyo Community Health Center, Metro City, Lampung, Indonesia.

Methods: An analytical observational study with an unmatched retrospective case-control design was conducted from May 6 to May 30, 2025. A total of 76 children (38 cases and 38 controls) were selected using purposive sampling. Data were collected through structured interviews and verified using Maternal and Child Health (MCH) handbooks and health records to minimize recall bias. Statistical analysis was performed using IBM SPSS Statistics version 26. Bivariate analysis was conducted using the Chi-square test, and multivariate analysis was performed using multiple logistic regression with the backward likelihood ratio method.

Results: Showed that maternal anemia during pregnancy, exclusive breastfeeding, history of diarrhea, and low birth weight (LBW) were independent determinants of stunting. Maternal anemia during pregnancy was associated with stunting (AOR = 2.76; 95% CI: 1.25–6.10; p = 0.001), exclusive breastfeeding (AOR = 4.86; 95% CI: 1.80–13.10; p = 0.001), history of diarrhea (AOR = 3.42; 95% CI: 1.54–7.61; p = 0.003), and low birth weight (AOR = 2.01; 95% CI: 1.10–3.67; p = 0.010).

Conclusion: stunting is influenced by both prenatal and postnatal factors, particularly maternal nutrition during pregnancy, infant feeding practices, and early-life health conditions. Strengthening maternal nutrition programs, promoting exclusive breastfeeding, preventing low birth weight, and controlling childhood infections are essential strategies for stunting prevention. Future research using larger multi-center prospective designs is recommended to confirm these findings and strengthen causal inference.

Technology, Governance, and Workforce Management in Hospitals: A Scoping Review of Human Resource Management Evidence

Herlina Oktaviyanti — 2026-07-12

Background: Evidence on hospital human resource management (HRM) remains fragmented, particularly regarding technology integration, public–private differences, and the management of non-clinical staff. This scoping review mapped the available evidence to identify key themes and research gaps in these areas.

Methods: This scoping review was guided by the Arksey and O’Malley framework and reported in line with PRISMA-ScR. The review used the PCC framework (Population: hospital HRM stakeholders; Concept: technology integration, public-private HRM differences, and non-clinical workforce management; Context: hospitals and healthcare facilities). Searches were conducted in PubMed, Scopus, and Web of Science for English-language empirical studies published from 2020 to 2025. Eligible studies were qualitative, quantitative, or mixed-methods; non-empirical articles, non-English publications, studies before 2020, and studies outside healthcare-facility settings were excluded. After screening 487 records, removing 75 duplicates, assessing 57 full texts, and excluding 42 reports, 15 studies were included. Data were charted by author, year, country, design, focus, and key findings, then synthesized thematically.

Results: Five themes emerged from thematic synthesis: HRM as a strategic capability; technology-enabled HRM; motivation and retention of non-clinical staff; public-private differences in HRM practices; and the relationship between HRM, service quality, and patient satisfaction. The evidence suggested that digital tools can improve monitoring, coordination, and decision-making, but implementation depends on organizational readiness and available resources. Public hospitals were generally constrained by bureaucracy and limited flexibility, whereas private hospitals were more adaptable. Research on non-clinical staff remained limited, especially regarding career pathways, retention strategies, and unit-level HR practices.

Conclusion: Hospital HRM is shifting from an administrative function to a strategic, technology-supported system that influences service quality and organizational performance. This review contributes a consolidated map of evidence on digital HRM integration, public-private differences, and non-clinical workforce management, while showing that these areas remain underexplored. Future studies should prioritize comparative designs, stronger theoretical.

Internet Addiction and Depressive Symptoms Among High School Students: A Cross-Sectional Study

Yulia Ardiyanti — 2026-07-12

Background: Internet addiction has become an emerging public health concern among adolescents and has been associated with adverse mental health outcomes, including depressive symptoms. However, limited evidence is available regarding the association between internet addiction and depressive symptoms among Indonesian high school students. Therefore, this study examined the association between internet addiction and depressive symptoms among high school students.

Methods: This analytical cross-sectional study, reported according to the STROBE guidelines, was conducted among 81 Grade XI students at a State Senior High School 1, Kendal Regency, Indonesia, from June to August 2025. Internet addiction was assessed using the Internet Addiction Test (IAT) and depressive symptoms were assessed using the the Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using Spearman's rank correlation test.

Results: Most participants were female (56.8%) and aged 17 years (58.0%). The mean IAT score was 47.52 ± 15.43, while the mean PHQ-9 score was 8.96 ± 5.64, indicating predominantly mild internet addiction and mild depressive symptoms. Internet addiction showed a moderate positive correlation with depressive symptoms (r = 0.512, p < 0.001).

Conclusion: Internet addiction was positively associated with depressive symptoms among adolescents. These findings provide preliminary evidence that may inform future school-based digital wellness and adolescent mental health initiatives

Comparative Performance of TIMI and GRACE Scores for Predicting Mortality and MACE in Acute Coronary Syndrome

Fajar Prasetyo Winoto — 2026-07-12

Background: TIMI and GRACE scores are widely used for prognostic risk stratification in acute coronary syndrome (ACS), yet comparative evidence across ACS subtypes, settings, follow-up periods, and outcomes remains heterogeneous. This scoping review mapped evidence comparing TIMI and GRACE scores for predicting mortality and MACE in patients with ACS or suspected ACS.

Methods: This scooping review followed the PRISMA-ScR guidelines, the PCC framework, and the Arksey and O’Malley approach. Searches were conducted in ProQuest, Scopus, and CINAHL using Boolean search terms related to TIMI, GRACE, ACS, mortality, and MACE. Eligible studies were empirical quantitative studies comparing TIMI and GRACE for predicting mortality and MACE in adults with ACS. Records were screened, full texts were assessed, data were recorded using a standardized form, and findings were synthesized narratively based on outcomes and clinical settings.

Results: A total of 187 records were identified, 45 duplicates were removed, 142 records were screened, 44 full-text reports were assessed, and 12 studies were included. Studies were published between 2022 and 2025 and included at least 12,039 participants from China, Lithuania, India, Turkey, Spain, Pakistan, and Iran. For mortality, GRACE more consistently demonstrated stronger discrimination than TIMI, particularly in NSTEMI, broader AMI cohorts, and STEMI patients undergoing reperfusion or PCI. For MACE, findings were more heterogeneous; GRACE generally performed better in confirmed NSTE-ACS and STEMI PCI cohorts, whereas TIMI showed comparable or sometimes higher discrimination than GRACE in undifferentiated emergency chest pain populations.

Conclusion: The comparative performance of TIMI and GRACE depends on ACS phenotype, clinical context, and outcome definition. GRACE appears more robust for mortality prediction, while TIMI retains practical value as a simple bedside tool, especially in rapid triage contexts. Future studies should standardize MACE definitions, reporting metrics, and subgroup analyses across ACS populations.

Effectiveness, Benefits, Determinants, and Limitations of Early Mobilization After General Anesthesia: A Scoping Review

Candra Dermawan — 2026-07-12

Background: Early mobilization after general anesthesia is a key component of Enhanced Recovery After Surgery (ERAS) programs that improves postoperative recovery. However, evidence on its effectiveness, limitations, and implementation remains inconsistent across surgical settings. Therefore, this scoping review aimed to map and synthesize the available evidence on the effectiveness, benefits, limitations, and factors influencing the implementation of early mobilization after general anesthesia.

Methods: This scoping review followed the Arksey and O'Malley methodological framework and was reported in accordance with the PRISMA-ScR guidelines. Literature searches were conducted in Scopus, PubMed, ScienceDirect, and SpringerLink databases for studies published between 2022 and 2026. A total of 312 records were initially identified. Following duplicate removal, studies underwent title, abstract, and full-text screening based on predefined inclusion and exclusion criteria. Eligible studies included primary research articles involving adult patients undergoing general anesthesia and evaluating early mobilization in perioperative or postoperative settings, whereas review articles, editorials, case reports, and studies unrelated to early mobilization or general anesthesia were excluded. Data were systematically charted using a standardized extraction form, and findings were synthesized using thematic analysis to identify key themes related to effectiveness, benefits, determinants, and limitations of early mobilization.

Results: From 312 records initially identified, 250 studies remained after duplicate removal and underwent title and abstract screening. Following full-text assessment, 12 studies met the inclusion criteria and were included in the final synthesis. Thematic synthesis generated four major themes: (1) clinical effectiveness of early mobilization, including improvements in physical function, pain reduction, shortened length of stay, and decreased postoperative complications; (2) physiological and pharmacological determinants influencing mobilization readiness; (3) neurocognitive determinants affecting patients’ ability to participate safely in mobilization; and (4) organizational and healthcare system factors influencing implementation. The review also identified important literature gaps, including the lack of a standardized operational definition of early mobilization, substantial heterogeneity in intervention timing and outcome measures, and limited evidence regarding long-term recovery outcomes.

Conclusion: This scoping review suggests that early mobilization after general anesthesia improves postoperative outcomes, including ADL, pain, LOS, and complications. However, evidence remains limited by indirect findings and variability across studies. Future research should evaluate standardized interventions and long-term outcomes in diverse healthcare settings.

Effect of Spinach Extract Supplementation Combined with Iron Tablets on Hemoglobin Concentration among Pregnant Women: A Quasi-Experimental Study

Yeti Hernawati — 2026-07-12

Background: Anemia during pregnancy remains a significant maternal health problem, primarily associated with reduced hemoglobin concentration. Although iron tablet supplementation is a standard intervention in antenatal care, its effectiveness may be enhanced through complementary nutritional strategies. However, limited evidence exists regarding the effectiveness of spinach extract supplementation combined with iron tablets as an adjunct to routine iron supplementation among pregnant women. Therefore, this study aimed to evaluate the effect of spinach extract supplementation on hemoglobin concentration in pregnant women.

Methods: This quasi-experimental pretest–posttest two-group study with a control group was reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guideline. A total of 60 pregnant women were selected using purposive sampling and allocated to either the intervention or control group through nonrandom assignment based on existing antenatal care groupings. The intervention group received spinach extract supplementation combined with iron tablets combined with iron tablets, while the control group received iron tablets only for 14 days. Hemoglobin concentration was measured at baseline and after the intervention using an EasyTouch GCHb hemoglobin meter. Data were analyzed using paired-samples t-tests and independent-samples t-tests.

Results: Hemoglobin concentration increased significantly in both groups after the intervention. At baseline, there was no significant difference in mean hemoglobin concentration between the intervention and control groups. After the intervention, the intervention group had a significantly higher mean hemoglobin concentration than the control group. The mean hemoglobin change was 1.12 ± 0.32 g/dL in the intervention group and 0.76 ± 0.33 g/dL in the control group. The between-group difference in hemoglobin change was 0.36 g/dL (95% CI: 0.19–0.53; p < 0.001), with a large effect size (Cohen’s d = 1.11).

Conclusion: Spinach extract supplementation combined with iron tablets may provide an effective complementary strategy for improving hemoglobin concentration among pregnant women. However, further randomized studies with larger sample sizes and longer follow-up periods are recommended to confirm these findings.

Effectiveness Of HF-Care Educational Media on Self-Care Among Patients with Heart Failure: A Quasi-Experimental

Irma Nur Amalia — 2026-07-12

Background: Heart Failure (HF) remains a major cause of morbidity, mortality, and recurrent hospitalization, often associated with inadequate self-care. Although educational interventions can support HF self-management, evidence on HF-Care educational media in the Indonesian healthcare context remains limited. This study evaluated the effectiveness of HF-Care educational media on self-care among patients with heart failure.

Methods: A two-week quasi-experimental two-group pretest–posttest study following the TREND guideline was conducted at an Indonesian military teaching hospital in Bandung. Forty-six patients with HF were recruited using purposive sampling and allocated to an intervention group or control group, with 23 participants in each group. The intervention group received HF-Care educational media in addition to usual care, while the control group received usual care only. Self-care was measured using the Self-Care of HF Index Version 7.2. Data were analyzed using descriptive statistics, paired-samples t-tests, and independent-samples t-tests.

Results: Self-care improved in both groups, with greater improvement in the intervention group. The intervention group had significantly higher posttest self-care scores than the control group, with a mean difference of 27.00 points (95% CI: 21.80–32.20; p < 0.001) and a very large effect size (Cohen’s d = 3.14)..

Conclusion: HF-Care educational media may serve as an effective evidence-based nursing intervention to improve self-care among patients with heart failure. Future multicenter studies with larger samples, randomized designs, and longer follow-up are needed to confirm its sustainability and broader applicability.

Efficacy and Safety of Intralesional Hyaluronic Acid versus Control or Verapamil in Acute-Phase Peyronie’s Disease: A Systematic Review

Abdur Rahman Faqih Al Jundi — 2026-07-12

Background: Acute-phase Peyronie’s disease (PD) is challenging to treat because management is often delayed until the stable phase. Evidence for conservative therapies remains limited, and no previous systematic review has specifically evaluated intralesional hyaluronic acid (HA). This systematic review evaluates the efficacy and safety of intralesional HA compared with control or verapamil in acute-phase PD.

Methods: This review was conducted in accordance with the PRISMA 2020 guidelines and registered. Six databases (PubMed, ProQuest, SAGE Journals, EBSCOhost, EuropePMC, and Wiley Online Library) were searched from inception, and trial registries were screened for ongoing studies. Two reviewers independently screened titles, abstracts, and full texts against pre-specified PICOS eligibility criteria, with disagreements resolved by a third reviewer. Eligible prospective trials (randomised and non-randomised) reported on penile curvature, plaque size or volume, erectile function (International Index of Erectile Function, IIEF), penile pain (Visual Analogue Scale, VAS), or patient-reported outcomes. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool for randomised and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool for non-randomised studies, and the certainty of evidence was rated using GRADE.

Results: The search identified 287 records; after duplicate removal, 193 were screened and 23 full texts assessed, of which four prospective studies (two randomised controlled trials and two non-randomised prospective studies; 582 patients) met the inclusion criteria. The two RCTs were rated at low overall risk of bias (RoB 2.0) and the two non-randomised studies at moderate overall risk of bias (ROBINS-I), mainly owing to confounding and participant selection. Intralesional HA was associated with improvements in penile curvature (reductions of approximately 4.6–9.5° versus control or verapamil, including a 9.01° [46.1%] reduction versus an untreated control), plaque size or volume (up to a 93.7% reduction in plaque volume versus progressive growth in untreated patients), and erectile function (IIEF gains of approximately 1.0–3.8 points). HA showed a favourable safety profile with no major adverse events. However, several outcomes—including plaque-size reduction and IIEF change in some trials—did not reach statistical significance over verapamil, and the evidence base is small and clinically heterogeneous.

Conclusion: Intralesional HA is a potentially effective, non-surgical option for acute-phase PD, yielding improvements in curvature, plaque size, pain, and erectile function with an excellent safety profile. However, the overall certainty of evidence is limited by the small number of included studies, methodological heterogeneity, and short follow-up; findings should therefore be interpreted with caution. Large-scale, multicentre RCTs with standardised protocols, extended follow-up, and evaluation of combination therapies (e.g., with phosphodiesterase-5 inhibitors) are required before HA can be integrated into clinical guidelines.

Effectiveness of Digital Sound Therapy (DST) in Reducing Postoperative Pain Intensity Among Adult Surgical Patients

Sri Purwanti Ariani — 2026-07-12

Background: Postoperative pain remains one of the most common complications experienced by patients after surgery and may delay recovery, increase the risk of complications, and prolong hospitalization. Non-pharmacological interventions are increasingly recommended as complementary approaches to postoperative pain management. Despite growing evidence supporting audio-based interventions for pain management, evidence regarding the effectiveness and clinical implementation of Digital Sound Therapy (DST) among postoperative patients in Indonesian hospitals remains limited. Therefore, this study aimed to evaluate the effectiveness of Digital Sound Therapy (DST) in reducing postoperative pain intensity among adult surgical patients.

Methods: A quasi-experimental pretest–post-test control group study was conducted and reported according to the TREND guidelines. Sixty postoperative patients were selected through purposive sampling and assigned to an intervention group (n = 30) and a control group (n = 30). The independent variable was Digital Sound Therapy (DST), whereas the dependent variable was postoperative pain intensity. Pain intensity was measured using the Numeric Rating Scale (NRS) four hours after surgery (pretest) and immediately after a 20–30-minute Digital Sound Therapy (DST) intervention (post-test). The control group received standard postoperative nursing care without additional audio therapy. Data were analysed using the Wilcoxon Signed-Rank Test.

Results: Baseline demographic characteristics showed that most participants in the intervention group were aged 19–44 years (73.4%), female (63.3%), employed in the private sector (56.7%), and had completed senior high school education (46.6%). Before the intervention, 30.0% of patients reported mild pain, 53.3% moderate pain, and 16.7% severe pain. Following Digital Sound Therapy (DST), the proportion of patients reporting mild pain increased from 30.0% to 86.7%, while moderate pain decreased from 53.3% to 13.3%, and severe pain was eliminated. In contrast, most patients in the control group continued to experience moderate pain (70.0%) after the second assessment. The reduction in postoperative pain intensity following Digital Sound Therapy (DST) was statistically significant (p = 0.005).

Conclusion: Digital Sound Therapy (DST) effectively reduces postoperative pain intensity and should be considered as a complementary component of multimodal postoperative pain management in nursing practice. Further multicenter studies with larger sample sizes are recommended to confirm its effectiveness and support broader clinical implementation