Belitung Nursing Journal最新文献

Background: End-of-life (EoL) care is a form of service provided to patients in the terminal phase and families to meet physical, psychological, social, and spiritual needs so that patients can face death peacefully and with dignity. EoL care can be facilitated by medical personnel, but it is not uncommon for nursing students to be involved as well. Several factors influence nursing students' ability to provide EoL care to patients.

Objective: This study aimed to explore the nursing students' perceptions and experiences regarding the provision of EoL care during clinical placements.

Methods: A qualitative descriptive study was conducted using purposive sampling and in-depth interviews with 10 professional nursing students who had experience providing EoL care. Data were collected with a four-question guide between February and May 2025 and analyzed inductively using thematic analysis, including familiarization, coding, theme development, and reporting. Strategies to enhance trustworthiness included credibility, transferability, dependability, and confirmability.

Results: Four main themes emerged: 1) Nursing Students' perspective of EoL Care, 2) Providing holistic Care to Patients and Families, 3) Challenges and Opportunities in Providing EoL Care, 4) Developing Heart of Caring. Participants conceptualized EoL as a holistic, person-centered process emphasizing comfort, dignity, and compassion rather than cure. They demonstrated developing competence in identifying clinical indicators of terminal decline and addressing patients' physical, psychosocial, and spiritual needs. Students described providing comfort through symptom management, active listening, emotional support, and the facilitation of spiritual practices aligned with patients' beliefs. Although communication difficulties, emotional strain, and insufficient preparation were significant barriers, they were also perceived as valuable learning opportunities that fostered personal growth, empathy, and professional confidence. Spiritual faith and viewing patients as family members further inspired compassionate, value-driven care.

Conclusion: Overall, the findings emphasize that experiential and reflective learning during clinical placements are essential in shaping nursing students' moral sensitivity, resilience, and humanistic orientation. Integrating Structured EoL care education that includes emotional and spiritual dimensions is crucial to preparing future nurses to deliver dignified, compassionate, and holistic care for patients and families at EoL.

Background: The Depression, Anxiety, and Stress Scale (DASS-21) is widely used to assess mental health symptoms; however, its dimensionality in working populations, particularly healthcare workers, remains under debate.

Objective: This study aimed to examine the dimensional structure of the DASS-21 among Chilean healthcare workers to evaluate its suitability as a screening measure of psychological distress in occupational contexts exposed to crises, emergencies, or disasters.

Methods: A cross-sectional survey was conducted in 2021 using a non-probabilistic convenience sample of 239 healthcare workers from a hospital in northern Chile. Confirmatory factor analyses were conducted to test four competing models (unidimensional, three correlated factors, second order, and bifactor) using structural equation modeling. Model fit was evaluated using RMSEA, CFI, and TLI, complemented by auxiliary bifactor indices (ECV, ωH, ωHS, PUC, ARPB).

Results: All models showed acceptable fit (RMSEA = 0.038-0.065; CFI = 0.974-0.992; TLI = 0.971-0.990). Although the bifactor model demonstrated the best global fit, auxiliary indices supported the dominance of a general factor (ECV = 0.87; ωH = 0.94), with limited reliable variance attributable to the specific factors (ωHS ≤ 0.16). Measurement invariance across sex was supported.

Conclusions: In this non-clinical sample characterized by low symptom severity, the DASS-21 operates primarily as an essentially unidimensional measure of psychological distress. From a nursing practice perspective, the total score may be used as a parsimonious screening indicator to support early detection, monitoring, and preventive mental health strategies among healthcare workers.

Background: In the evolving digital healthcare landscape, nurses are required to adapt to emerging technologies and demonstrate digital health literacy (DHL) to ensure high-quality patient care. DHL may enhance nurses' self-efficacy (SE) and foster innovative work behavior (IWB), both of which are essential for professional development and healthcare innovation.

Objective: This study aimed to explore the role of digital health literacy in shaping nurses' self-efficacy and innovative work behavior.

Methods: A cross-sectional correlational study was conducted among all available intensive care unit nurses (N = 406) at two university-affiliated hospitals in Egypt. Data were collected between November 2024 and January 2025 using three validated instruments: The Digital Health Literacy Instrument (DHLI), the General Self-Efficacy Scale (GSE), and the Innovative Work Behavior Scale (IWBS). Data analysis included descriptive statistics, Pearson correlation, and multivariate linear regressions. A mediation analysis was further conducted to evaluate the role of self-efficacy in the relationship between digital health literacy and innovative work behavior.

Results: Nurses reported a mean digital health literacy score of 68.34 ± 10.61 (75.14% of the maximum possible score). The mean self-efficacy score was (32.36 ± 6.30). Approximately 66% of participants exhibited relatively high scores of innovative work behavior, particularly in the domains of idea generation and implementation. Statistically significant positive correlations were found between DHL and SE (r = 0.688, p < 0.001), DHL and IWB (r = 0.484, p < 0.001), and SE and IWB (r = 0.674, p < 0.001). An adjusted mediation analysis showed that DHL was positively associated with SE (B = 0.443, β = 0.688, p < 0.001, R² = 0.565) and with IWB in the total effect model (B = 0.453, p < 0.001). SE was also positively associated with IWB (B = 0.787, β = 0.604, p < 0.001). After inclusion of SE in the mediation model, the direct effect of DHL on innovative work behavior remained significant. The final mediation model explained 54.8% of the variance in innovative work behavior (R² = 0.548), after controlling for hospital type, age, and department. Mediation analysis indicated that SE partially mediated the association between DHL and IWB.

Conclusion: Digital health literacy was positively associated with nurses' self-efficacy and innovative work behavior, with self-efficacy partially mediating the association within the tested model. These findings suggest that integrating DHL into continuous professional development and nursing curricula may be beneficial to support digital transformation in healthcare.

Background: Appropriate self-management behaviors and good functional capacity are crucial to reduce complications in older persons with chronic heart failure. Health literacy and transformative learning can be used in health education to motivate health behavior change, but limited research has examined their effects on health literacy for self-management behaviors and functional capacity in older persons with chronic heart failure.

Objective: To investigate the effect of medagogy-based health literacy enhancement on self-management behaviors and functional capacity in older persons with chronic heart failure.

Methods: This assessor and statistician-blinded, randomized controlled trial involved 70 older persons with chronic heart failure attending a heart clinic at a hospital in central Thailand. Permuted block randomization with a block size of four was employed to assign the participants to either the experimental group (n = 35) receiving a 5-session medagogy-based health literacy enhancement program over three weeks, or the control group (n = 35) receiving standard care. Outcomes were measured at baseline, 1 month post-intervention (self-management behavior), and 2 months post-intervention (functional capacity). Data analysis followed the intention-to-treat principle, using split-plot ANOVA and Repeated-Measures ANCOVA to adjust for imbalances in baseline functional capacity.

Results: After the program, significant time and group interaction effects were found for self-management behavior (F _(1,68) = 91.322, p < 0.001; ƞp² = 0.573) and functional capacity (F _{(1, 67)} = 5.424, p < 0.05; ƞp² = 0.075). The experimental group demonstrated significantly higher mean scores for self-management behaviors than before the program (MD = 20.143, 95% CI = 17.561, 22.725; p < 0.001), and than the control group (MD = 18.686, 95% CI = 15.850, 21.521; p < 0.001). For functional capacity, the experimental group achieved a significant within-group improvement from baseline (p < 0.05) and a significantly higher adjusted mean capacity at post-intervention than the control group (M_adj = 20.887, 95% CI = 2.986, 38.787; p < 0.05).

Conclusion: The program led to improved short-term self-management behaviors and functional capacity. It can be used by nurses as a structured, patient-centered health education to promote older people's self-management and functional capacity. However, multi-site and longitudinal follow-ups are recommended for future studies.

Trial registry number: Thai Clinical Trials Registry (TCTR20250908004).

Background: Uncontrolled hypertension leads to a number of complications. To achieve effective self-management, adults with uncontrolled hypertension need health literacy to promote and maintain good health. Transformative learning is a key adult learning paradigm that supports perspective transformation, self-management, and blood pressure control.

Objective: This study aimed to evaluate the effects of a Transformative Learning Theory-Based Health Literacy Enhancement Program on self-management behaviors and blood pressure among adults with uncontrolled hypertension.

Methods: This cluster-randomized controlled trial was conducted at two sub-district health-promoting hospitals in northeastern Thailand. Hospitals were randomly allocated to either the experimental or control group to prevent treatment contamination. A total of 58 participants (n = 29 per group) were consecutively recruited. Data were collected between February and June 2025 using a validated Self-Management Behavior Scale and digital BP monitoring. Data were analyzed using independent- and dependent-samples t-tests and repeated-measures ANOVA, and ANCOVA was used to compare groups while controlling for baseline values.

Results: At 8 and 12 weeks after the program, the experimental group had significantly higher self-management scores than the control group (t = 2.117, p = 0.039; t = 3.416, p = 0.001, respectively) and than their own baseline (F = 31.958, p < 0.001). Regarding clinical outcomes, ANCOVA revealed a significant main effect of the program on mean arterial pressure (MAP) at both 8 weeks (F _{(1, 55)} = 9.014, p = 0.004, η_p ² = 0.141) and 12 weeks (F _{(1, 55)} = 9.133, p = 0.004, η_p ² = 0.142). The adjusted mean MAP for the experimental group was significantly lower than the control group at the final follow-up (108.90 vs. 111.37 mmHg). A significant reduction was noted for systolic blood pressure (p = 0.028) but not diastolic blood pressure.

Conclusion: The study highlights the effectiveness of the program for improving self-management behaviors and systolic blood pressure. Nurses can integrate adult learning theories into health education to enhance outcomes for hypertensive patients in primary care.

Trial registry number: Thai Clinical Trial Registry (TCTR20250202009).

Background: Multidimensional frailty is highly prevalent among older adults residing in long-term care facilities (LTCFs). However, the structural interrelationships among physical, psychological, social, cognitive, and functional health domains remain insufficiently understood.

Objective: To characterize the network structure of multidimensional frailty domains and related health indicators among institutionalized older adults.

Methods: This cross-sectional study included 272 LTCF residents from Liaoning, China. Eleven theoretically selected health indicators were modeled using a Mixed Graphical Model with ℓ1-regularized neighborhood regression and model selection based on the Extended Bayesian Information Criterion (γ = 0.25). This approach estimates sparse conditional dependence structures among mixed data types. Strength centrality was used as the primary descriptive metric. Network accuracy and stability were evaluated using non-parametric and case-dropping bootstrap procedures.

Results: The strongest conditional association emerged between age and cognitive impairment (edge weight = 0.68). Substantial associations were also observed between physical frailty and ADL dependency (edge weight = 0.43), and between psychological frailty and depressive symptoms (edge weight = 0.45). Physical frailty, ADL dependency, and depression exhibited relatively high strength centrality values; however, bootstrap difference tests indicated that these nodes were not statistically more central than several other highly connected indicators. The correlation stability coefficient for strength centrality was 0.75, indicating good stability of strength centrality estimates within this sample.

Conclusion: The network revealed an interconnected pattern linking functional dependency, physical frailty, and psychosocial health among LTCF residents. Because the data were cross-sectional, the observed conditional associations should not be interpreted as causal or temporal pathways. These findings highlight the potential value of multidomain nursing assessment in long-term care settings and may inform hypothesis generation for future longitudinal or interventional nursing studies.

Background: Cholesterol, triglycerides, and low-density lipoprotein levels are key indicators of patients' self-care in coronary artery disease; although medications can improve lipid profiles, the results often remain above targets. Implementing mobile self-management programs is crucial for reducing the incidence of coronary artery disease, preventing cardiac events, and enhancing well-being.

Objective: This study aimed to evaluate the impact of a self-management program on cholesterol, triglycerides, and low-density lipoprotein levels in people with coronary artery disease.

Methods: A randomized controlled trial design was employed at a tertiary hospital in Thailand between June 2022 and June 2023. Forty-eight people were randomly assigned to one of two groups: control or experimental. The experimental group used applications and the telephone for four weeks to self-manage cholesterol, triglyceride, and low-density lipoprotein levels, while the control group received conventional care. Data were gathered about cholesterol, triglyceride, and low-density lipoprotein levels. Descriptive statistics, independent t-tests, and dependent t-tests were employed to analyze between-group and within-group differences. Effect sizes (Cohen's d) with 95% confidence intervals were calculated.

Results: Results showed that the experimental group had a statistically significant reduction in cholesterol (t = 2.121, df = 46, p = 0.039), triglyceride (t = 2.060, df = 46, p = 0.046), and low-density lipoprotein levels (t = 2.115, df = 46, p = 0.040) compared to the control group. This study demonstrates that a mobile application self-management program can lower lipid levels.

Conclusions: The findings indicate that a mobile application-based self-management program can significantly reduce cholesterol, triglyceride, and low-density lipoprotein levels in people with coronary artery disease in the short term. These findings highlight the crucial role of nurses applying these strategies to enhance patient care.

Trial registry number: Thai Clinical Trials Registry (TCTR20250129001).

Background: Older adults with colorectal cancer who undergo chemotherapy are at high risk of functional status decline. Various demographic and physiological factors influence functional status. However, based on the Theory of Unpleasant Symptoms, few studies have examined the relationships among physiological, psychological, and situational factors, symptom experience, and functional status in older adults with colorectal cancer undergoing chemotherapy.

Objective: This study aimed to describe functional status and investigate its associated factors among older adults with colorectal cancer undergoing chemotherapy in Thailand.

Methods: A cross-sectional study was conducted among 128 older adults with colorectal cancer receiving chemotherapy. Participants were recruited from a cancer hospital in Northeastern Thailand using multi-stage sampling, followed by systematic random sampling with a random digit table. Data were collected between October 2024 and July 2025 using standardized instruments. Data were analyzed using descriptive statistics, Pearson's product-moment correlation coefficients, and multiple regression analysis.

Results: The findings revealed that participants' functional status was moderate. Pearson's correlation coefficient analysis showed that body mass index and social support were positively associated with functional status. Fatigue, depression, and the number of chemotherapy cycles were negatively associated with functional status. Multiple regression analysis showed that fatigue was the strongest factor negatively associated with functional status (β = -0.375, p < 0.001), followed by depression (β = -0.329, p < 0.001). On the other hand, body mass index (BMI) (β = 0.188, p < 0.05) was positively associated with functional status. The model was statistically significant (R² = 0.409, F _(3,124) = 28.590, p < 0.001), which explaining 40.90% of the variance in functional status.

Conclusion: These findings suggest that nurses should implement early screening and proactive nursing interventions to reduce fatigue and depression. Such interventions may include optimizing nutritional status at each chemotherapy cycle and providing family support to help this population preserve functional status.

Despite substantial theoretical advancement, nursing knowledge continues to be framed by epistemological classifications rather than ontological clarification. The question of what nursing knowledge is, as a mode of existence, remains unanswered, despite existing frameworks that emphasize patterns, types, or domains of knowing. This paper argues that nursing knowledge is best understood as a relational ontology, a performative enactment emerging through practice rather than a collection of categorized components. Nursing knowledge is conceptualized as a unitary process manifested through embodied presence, interpretive meaning-making, and technologically mediated action. This paper illuminates how these aspects do not function as distinct domains but as a single, inseparable mode of being in clinical judgment and caring practices within digitally mediated contexts.

Background: Cardiovascular diseases (CVDs) are becoming more prevalent worldwide each year, contributing to the leading cause of mortality in both men and women. Awareness of CVD is low, particularly in developing countries.

Objectives: This study aimed to identify key variables that determine CVD awareness among young adults.

Methods: This study used a cross-sectional, descriptive correlational design and was conducted in accordance with STROBE guidelines. Data were collected across Indonesia via social media from late November 2022 to February 2023. CVD awareness was assessed using the Attitude-Belief-About-Cardiovascular-Disease (ABCD) Risk Questionnaire. Data were analyzed using univariate, bivariate (Fisher's, Wilcoxon, Spearman, and Kruskal-Wallis), and regression (ordinary least squares and robust) analyses.

Results: 270 respondents participated in this study, with average age of 26.88 (SD = 5.55). The mean CVD awareness score was 55.27 (SD = 5.85). Gender, educational background, and body mass index (BMI) all played a role in CVD awareness. Female sex was associated with lower awareness (OLS: B = -1.99, p < 0.001; robust: B = -1.62, p < 0.01), while university attendance was associated with higher awareness (robust: B = 1.64, p = 0.03). Higher BMI was the strongest and most consistent predictor of CVD awareness across models (OLS: B = 0.19, p < 0.001; robust: B = 0.18, p < 0.001).

Conclusion: Young adults (aged ≥ 18-39) in Indonesia demonstrated adequate knowledge of CVD risk factors; however, females, those with lower educational attainment, and individuals with normal weight showed lower levels of CVD awareness. Targeted health education and CVD screening programs are needed for these groups. Nurses play a pivotal role in bridging these awareness gaps by implementing tailored health education initiatives and proactive, community-based screening programs that specifically address the needs of these high-risk subgroups to promote early detection and long-term cardiovascular health.