Caring: Indonesian Journal of Nursing Science

Adherence to Oral Antidiabetic Drugs among Outpatients with Type 2 Diabetes Mellitus

2025-05-27T14:59:41+07:00

Type 2 diabetes mellitus (T2DM) patients are often required to adhere to oral antidiabetic drugs (OADs) prescribed by healthcare professionals for maintaining optimal blood glucose levels. Therefore, this study aims to assess adherence to OADs among outpatients with T2DM. A descriptive cross-sectional design was used, involving 32 participants selected through convenience sampling at Adam Malik General Hospital in Medan, North Sumatra, Indonesia. Data collection was conducted in July 2024, and descriptive statistics were used to analyze adherence levels and sociodemographic characteristics. The results showed that the majority of participants were under 60 years of age (68.8%), male (65.6%), had completed high school education (59.4%), were employed (71.9%), and had a monthly household income below the regional minimum wage (65.6%). In addition, more than 50% had been living with diabetes for five years or longer (53.1%), were covered by national health insurance (90.6%), resided in urban areas (62.5%), and had no diabetes-related complications (81.3%). The mean adherence score to OADs was 6.66 (SD ±1.20), with moderate adherence being the most common (56.3%), followed by high (28.1%) and low levels (15.6%). The results also showed that only a limited number of T2DM patients exhibit optimal adherence to their treatment regimens. This shows the need for healthcare providers and relevant stakeholders to develop targeted interventions and support systems aimed at enhancing medication adherence among diabetic patients.

Factors Related to the Implementation of Developmental Care in the Neonatal Intensive Care Unit

2025-05-12T14:48:59+07:00

Environmental stressors in the Neonatal Intensive Care Unit (NICU), such as noise, lighting, and invasive treatments, can interfere with premature infants' physiological responses, behavior, development, sleep, and central nervous system organization. Therefore, this study aims to analyze the relationship between nurses' factors (age, work experience, education level, and training) and their implementation of developmental care in the NICU. This quantitative study used a correlational analysis method with a cross-sectional design. The sampling technique applied was consecutive sampling, involving 70 NICU nurses as respondents. The inclusion criteria required that participants be nurses who had worked in the NICU for a minimum of 6 months and expressed willingness to participate in the study. The exclusion criteria included nurses who were on medical leave or currently unwell. Data were collected through a nurse characteristics questionnaire and a developmental care application questionnaire. The data were then analyzed using bivariate analysis with the Pearson test and multivariate analysis through linear regression. The results showed a significant relationship between age (p = 0.04), length of work experience (p = 0.03), and training (p < 0.0001) with the implementation of developmental care. However, education level was not significantly related to developmental care implementation (p = 0.873). The factor most strongly associated with the implementation of developmental care was nurse training (highest correlation coefficient = 0.426). There is a significant relationship between age, work experience, and nurse training in the implementation of developmental care in NICU settings. Among these factors, training plays the most crucial role in boosting nurses' confidence in applying developmental care practices.

The Experience of Pediatric Nurses Caring for Tuberculosis Children from Different Ethnic Groups in the New Normal Life

2025-05-12T14:30:31+07:00

The cases of Tuberculosis (TB) children in Indonesia increased in 2023 due to the impact of the new normal life. This increase was attributed to delayed immunization, poor nutrition, restrictions on activities, and disruptions to treatment services. The new normal life also affected the increasing number of TB children, in addition to certain ethnic beliefs and culture, causing a significant rise in hospitalized patients and deaths. Therefore, this study aims to explore the experience of pediatric nurses in caring for TB children from various ethnic groups during the new normal life. This study used a phenomenological method, consisting of 12 nurses working in a pediatric ward who were interviewed in an isolated room. The purposive sampling method was used to collect data through semi-structured and in-depth interviews. Data analysis was carried out using the 7-step Colaizzi method. The results showed that a total of 5 themes were identified, namely 1) nurses challenged by patients condition, 2) focus on safety care, 3) the influence of local culture in TB treatment, 4) differences in perceptions of TB between nurses as well as parents, and 5) understanding the perceptions of ethnic beliefs and culture of parents towards the disease. There are still challenges that pediatric nurses must overcome in providing care to patients in hospitals. The results could serve as initial data for developing guidelines or protocols incorporating a cultural competency method, thereby minimizing differences in the provision of nursing care for children with TB.

Mitigation of Environmental Exposure, Pollutants, and Endocrine Disruptors to Reproductive Health: A Literature Review

2025-05-25T13:22:48+07:00

Women's reproductive health faces escalating threats from environmental pollutants, including airborne particulate matter (PM2.5 and PM10), endocrine-disrupting chemicals (EDCs), heavy metals, and microplastics. These pervasive agents, found in air, food, water, and consumer products, are associated with hormonal imbalances, menstrual irregularities, infertility, adverse pregnancy outcomes, and long-term reproductive dysfunction. This literature review synthesizes current evidence on environmental exposures, specifically focusing on pollutants and EDCs impacting reproductive health. Adhering to the PRISMA framework, articles published between 2020 and 2024 were systematically identified from databases such as PubMed, ScienceDirect, and Google Scholar. Manual selection based on predefined inclusion criteria ensured the relevance and recency of included studies. Findings consistently demonstrate that air pollutants (PM2.5 and PM10) correlate with reduced ovarian reserve and altered estradiol levels. EDCs, such as Bisphenol A (BPA) and phthalates, are linked to early puberty, endometriosis, and infertility. Heavy metals influence age at menarche and menopause, as well as critical pregnancy outcomes like birth weight. Furthermore, microplastics and nanoplastics have been shown to impair placental function and elevate oxidative stress. These cumulative findings underscore the urgent need for comprehensive risk mitigation strategies, encompassing environmental education, behavioral modifications, clinical screening, and policy reform. Nurses are uniquely positioned to play a critical role in promoting reproductive health through education, early detection of environmental risks, and advocacy for safer community environments.

The The Impact of Artificial Intelligence on Health Literacy of Surgical Patients: A Literature Review

2025-05-25T13:19:04+07:00

This literature review was conducted to evaluate studies assessing the impact of artificial intelligence on the health literacy of surgical patients. A systematic search of the PubMed, Science Direct, Taylor & Francis, and Google Scholar databases, as well as the National Academic Network and Information Center, was performed. The search was limited to articles published in English or Turkish in the last five years, using the following keywords such as "Artificial Intelligence," "General Surgery," "Health Literacy," and "Nursing." A total of twenty articles, conducted in Turkey and other countries, met the specified scope conditions for this review. The findings indicate that a considerable number of studies have addressed health literacy in the context of surgical operations. A key determination was that 95% (n=19) of the virtual chatbots examined within these studies were ChatGPT. It was observed that these chatbots generally delivered accurate information at a "medium and above" readability level. The positive correlation between enhanced patient health literacy and improved surgical outcomes is well documented in the literature. Moreover, the integration of technological advancements, particularly from the field of artificial intelligence, has been demonstrated to increase the effectiveness of nursing care. Consequently, addressing health inequalities requires urgent, twofold measures: firstly, implementing targeted efforts to improve the health literacy of disadvantaged groups, and secondly, adapting nursing education to reflect technological advancements.

Self Harm Behavior Among High School Students: A Descriptive Study

2025-05-30T10:49:46+07:00

Self-harm is a prevalent form of self-inflicted behavior not motivated by the desire to die. Previous reports have shown that the youngest age group is the most affected on a global scale. Therefore, this study aimed to investigate the most prevalent forms of self-harm and the associated psychosocial factors among high school students in Medan, Indonesia. The convenience sampling was implemented and data were obtained through questionnaire containing demographic information and Self-Harm Screening Inventory (SHSI), which comprised 10 yes or no questions. To investigate the association between demographic variables and particular behavior, descriptive statistics and bivariate cross-tabulations were implemented. The results showed that the most frequently reported behavior included head banging (23%), intense scratching (33.3%), and hitting oneself (37.9%). Several factors, such as female gender, history of abuse, suicide attempts, emotional dysregulation (frequent anger), eating disorders, and exposure to domestic violence, were found to have significant associations. Furthermore, self-harm behavior was prevalent among high school students and was related to various psychosocial risk factors. These results emphasize the need for school-based mental health interventions concentrating on the early identification of at-risk youth, emotional regulation, and trauma history.

Students' Consideration of Choosing Nursing Career for the Future

2025-06-12T14:05:15+07:00

Nursing is a profession that demands responsibility, empathy, and sustained commitment. Despite its critical role in healthcare systems, the profession is currently facing significant global challenges, most notably a widespread shortage of nursing personnel. This shortage is further exacerbated by a declining interest among younger generations in selecting nursing as a career, raising concerns about the future sustainability of the healthcare workforce. Therefore, this study aims to explore students' considerations when choosing nursing as a future career in a private school in Batam. A qualitative phenomenological approach was used, and data were collected through semi-structured interviews recorded using a Digital Voice Recorder. A total of 15 participants were selected based on data saturation. Four key themes were identified, including Nursing as a Noble Profession, Nurses as Role Models, Support for Becoming a Nurse, and Challenges in Choosing a Nursing Career. Students often perceive the nursing profession as noble and dignified, largely due to its dedication to caring for and helping others. The experience of being cared for and seeing nurses doing their job became students' role models in the future. Another factor was that social support was found to encourage students to pursue nursing. On the other hand, barriers such as gender stigma, the high cost of nursing education, and family economic difficulties are significant challenges in choosing this career. In conclusion, students' decisions to choose nursing are influenced by both supportive and obstructive factors. This study suggests that further investigation should be conducted using nursing theory, focusing on how clinical experiences during nursing education impact students' career goals in the context of personal, interpersonal, and social systems. Understanding these dynamics could help improve the recruitment and retention of nursing students.

A Philosophical Perspective of Hermeneutics Study of Lived Experience of University Students with Self-Harm

2025-06-03T10:53:18+07:00

Self-harm is a phenomenon characterized by the intentional infliction of injury or pain on the body, often without suicidal intent. Despite its prevalence, studies on this phenomenon within the Indonesian context remains limited, particularly in terms of the role of peer support. Therefore, this study aims to investigate the lived experience of university students who engage in self-harm and the perspectives of their supportive peers using hermeneutics phenomenological approach, rooted in the philosophy of Hans-Georg Gadamer. The complexity, sensitivity, and profoundly personal nature of self-harm was also explored using ontological, epistemological, axiological, and methodological foundations of hermeneutics. The strength of hermeneutics inquiry to explain meaning and context was assessed by a review of pertinent studies. The results identified several obstacles associated with ethical considerations and participants engagement. This shows that future nursing studies must focus on the development of nursing theories specific to self-harm, the integration of spiritual and religious perspectives, and culturally sensitive interventions. In addition, the current study validates the significance of hermeneutics in the advancement of nursing knowledge and practice in the context of mental health issues among young adults.

Community Knowledge about Antibiotics and the Role of Inter Professionals in Providing Health Education

2025-05-25T13:20:40+07:00

Antibiotics are drugs to prevent or kill infections caused by bacteria. Antibiotics are not drugs that are freely available for consumption, therefore they should not be used carelessly. The use of antibiotics that is not in accordance with the rules can cause resistance to antibiotics. This study aims to identify the knowledge of the community in Kampung Mudik Village, Barus District and the role of health workers to prevent the effects of resistance to antibiotics. Methods: This study focused on the community in Kampung Mudik Village, Barus District. This study is a descriptive study. The sampling technique used a probabilistic technique with a margin of error of 5%. The number of respondents was 146 community. The result of study indicate that the level of community knowledge about antibiotics varies: most community (58.2%) have high knowledge, (28.8%) have sufficient knowledge, and (13%) have low knowledge. All community (100%) have used antibiotics, but the majority of community (79.5%) do not know the side effects of using antibiotics that are consumed carelessly. This study found that most community already have good knowledge about the use of antibiotics, but many community still do not know the side effects if they take antibiotics not according to instructions. Therefore, it is suggested that the community needs to be given proper education through inter-professional collaboration to avoid the effects of antibiotic resistance.

Sexual Risk Behaviors Among Men Who Have Sex with Men (MSM) Using Pre-Exposure Prophylaxis (PrEP): A Systematic Review

2025-06-23T09:20:25+07:00

According to 2023 global estimates, approximately 39.9 million individuals were living with HIV (Human Immunodeficiency Virus), with 1.3 million new infections reported. Men who have sex with men (MSM) continue to represent a key population at heightened risk. When used consistently, pre-exposure prophylaxis (PrEP) has been shown to reduce the risk of HIV transmission by more than 90%. Stigma, limited awareness, and concerns about reduced condom use hinder its effectiveness. This review examines whether PrEP increases or decreases sexual risk behaviors, such as unprotected anal intercourse, among MSM to inform better HIV prevention strategies. Search in PubMed and ScienceDirect identified 585 records, with 26 studies meeting the inclusion criteria after screening and quality assessment using the CASP checklist. Out of these, 14 high-quality articles, including cohort, cross-sectional, and randomized controlled trials, were analyzed. Studies focused on MSM aged 15 and older using PrEP, excluding non-MSM populations, qualitative reports, and reviews. Two reviewers independently screened and extracted the data, resolving the discrepancies through discussion. A narrative synthesis examined patterns of sexual risk behavior and PrEP impact. Subsequently, PrEP significantly reduces HIV transmission but is linked to risk compensation behaviors, such as decreased condom use and increased high-risk sexual activities. Social and cultural factors, including stigma and familism, influence adherence to safe practices. Comprehensive interventions integrating PrEP with education, Sexually Transmitted Infection (STI) screening, and psychosocial support are essential. Governments and health providers should prioritize expanding PrEP access, improving adherence support, and integrating condom promotion to achieve greater HIV prevention impact on MSM communities.

A Cross-Sectional Research on Improving Clinical Confidence and Decision-Making Through One Day One Clinical Question (ODOCQ) Program

2025-06-18T10:17:11+07:00

Nurses are using knowledge sources to enhance practice through the latest and most trusted evidence-based methods. In this context, the ability to search and select knowledge can increase clinical confidence. Low clinical confidence also leads to hesitation or doubt in decision-making. As an essential element in successfully promoting achievement, the level of confidence and decision-making of the healthcare workforce should be improved. Therefore, this research aimed to determine the frequency of article sharing in improving the level of clinical confidence and decision making after following One Day One Clinical Question (ODOCQ) program. The results showed that ODOCQ was developed for nurses to enhance the capacity of online resources and publications on issues encountered in day-to-day work. A cross-sectional research using random sampling and online questionnaires was also developed to measure clinical confidence and decision-making. Inclusion criteria included one year of minimum service at the hospital, and the research was completed by 118 nurses. In addition, the frequency of article sharing as part of the ODOCQ program improved clinical confidence (p<0.001) and decision-making (p<0.019) significantly. Academic routine habits, such as the ODOCQ program and article sharing frequency, improved clinical confidence and decision-making of nurses, as well as the readiness of evidence-based nursing practice implementation. The program could be used for additional professional development and evidence-based preparation. However, further research is needed to measure the level of clinical confidence and decision-making with non-self-report measurement

Successful Smoking Cessation by Moderate Smokers: A Case Series

2025-06-23T09:12:51+07:00

Indonesia is one of the countries with the largest smoking population worldwide, and remains the only ASEAN nation that has not ratified the Framework Convention on Tobacco Control (FCTC). This has led to the continuous increase in catastrophic diseases recorded every year. Meanwhile, the role of health workers, specifically nurses, is very crucial in reducing smoking behavior. Cessation is a surefire strategy to start improving public health and the environment, although the initial steps are very difficult for active smokers. Therefore, effective programs and strategies consistent with individual motivation and cultural contexts are needed to achieve optimal smoking cessation outcomes. Three active moderate smokers aged 20, 21, and 45 years followed the programs and strategies provided for 3-6 months. The results showed smoking cessation was successfully achieved. The strategies adopted, namely Self Awareness, Sounding, and Support Systems, have the potential to successfully achieve smoking cessation. The process requires a personal approach and knowledge about possible motivations, as well as smokers culture to function properly. Furthermore, strengthening is also needed as a support system to prevent a relapse.

Clinical Predictors of Functional Disability in Knee Osteoarthritis: Risk Stratification Approach as Implications of Nursing Practice

2025-07-01T15:52:37+07:00

Osteoarthritis (OA) of the knee is one of the most common musculoskeletal disorders and a leading cause of disability in the elderly. The severity of osteoarthritis can be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which is a widely used tool to measure pain, stiffness, and physical dysfunction in patients with OA. This study aimed to analyze the relationship between the demographic and clinical characteristics of patients with knee osteoarthritis and their WOMAC scores. The study used a quantitative, cross-sectional observational design. The relationship between functional disability (measured by the WOMAC score) and various factors was analyzed. The independent variables included age, sex, occupation, body mass index (BMI), OA grade, and duration of OA to the WOMAC score. Significant correlations were found between the WOMAC score and both OA grade (p=0.049) and OA duration (p=0.030). Furthermore, the multiple linear regression analysis revealed that OA duration (p=0.038) and OA grade (p=0.036) were significant predictors of the WOMAC score, collectively explaining 13.0% of its variance (R² value = 0.130). The findings of this study indicate that OA grade and duration of illness are significant predictors of the level of disability as measured by the WOMAC scores. OA levels and disease duration were the primary predictors of functional disability, explaining 13.0% of the WOMAC score variance. Nursing interventions should focus on risk stratification based on these clinical markers, prioritizing early intervention for newly diagnosed patients, irrespective of their age or BMI.

Clinical Supervision with Nurses' Work Motivation in Hospital: A Survey Study

2025-07-01T14:53:45+07:00

Nursing care is a key component of quality healthcare services, ensuring patient satisfaction and meeting hospital needs. However, patient dissatisfaction could reduce the quality of nursing care, caused by low nurses' work motivation. Clinical supervision was a form of coaching that increased nurses' work motivation through formative, restorative, and normative functions. Therefore, this study aimed to identify clinical supervision and work motivation of nurses providing care in Regional General Hospital. A descriptive correlation design was adopted with a cross-sectional method. Data were collected through a survey of 98 impatient nurses selected using simple random sampling. The survey used questionnaires that measured clinical supervision and work motivation, and then bivariate test analysis was carried out with the Spearman rho test. The results showed a significant relationship between clinical supervision and nurses' work motivation (p < 0.05), with a strong relationship strength (r = 0.637). Furthermore, the highest clinical supervision and work motivation were formative and intrinsic, respectively. In conclusion, effective clinical supervision can increase nurses' work motivation during work and contribute to the quality of nursing care in the hospital. This study recommended the continuous implementation of clinical supervision by room managers on an ongoing basis. Strategies for developing clinical supervision for nurses are important to increase nurses' work motivation to have an effective impact on performance in hospital.

Nurses’ Satisfaction with a Web-Based Application for Calculating Nursing Staff Based on Patient Dependency Levels and Unit Workload in Hospitals

2025-06-27T15:09:00+07:00

Complaints from nurses are often received by nursing managers regarding staff shortages, which leads to increased workload. Determining the unquantifiable level of workload poses a challenge, as the head nurse cannot accurately assess the number of staff shortages in the hospital room. Therefore, this study aims to develop a web-based application for the calculation of nursing staff needs based on patient dependency levels and unit workload. The application is accessible through both mobile and web platforms. A pre-experimental one-shot case study design, including 25 nurses, was used at a hospital in West Java. Measurements were conducted only during the post-test phase. The results showed that the majority of respondents were female (80%), who held a Diploma degree (76%), and worked as managers (48%). The average age of respondents was 34.3 ± 7.27 years, with a median experience of 5.0 ± 728 years. Generally, nurses' satisfaction with the application was at a moderate satisfaction, with an average satisfaction rate of 72.4%. A more detailed breakdown showed satisfaction scores of 74%, 71.4%, 75%, 70%, and 70.8% for content, format, accuracy, timeliness, and ease of use, respectively. Satisfaction with the application needs to be improved, specifically for timeliness and ease of use. This application was developed as a potential method for efficiently assessing staffing needs. Providing adequate training for nurses is essential to enhance the effectiveness and usability of the application in hospital settings.