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Introduction Dialysis is a long-term treatment for chronic kidney failure. Family caregivers play a significant role in the care of patients undergoing dialysis. The quality of life (QoL) of family caregivers is related to the quality of care provided to patients undergoing dialysis. Objectives This recent literature review aimed to synthesize the QoL experienced by caregivers of family members undergoing dialysis. Method This literature review employed four online databases, including SCOPUS, PubMed, ScienceDirect, and Web of Science. The extracted articles were further screened on the basis of the PRISMA guidelines. In this review, articles were selected on the basis of the following eligibility criteria: double-blind peer-reviewed articles, articles written in English language and published between 1 January 2013 and January 2023. This review used thematic synthesis. Results Four analytical themes emerged, including physical capacity, social relations, psychological state, and environment. All of these themes correspond to the dimensions of QoL. Conclusion The QoL of family caregivers of patients undergoing dialysis must be considered . A good QoL of these caregivers will improve the balance of life and further increase the ability and quality of care they provide for family members undergoing dialysis.

Introduction: Circumcision is a minor surgical operation that cuts the foreskin at the tip of the penis. Pain and anxiety are problems that all children who undergo surgery experience. This study aimed to review virtual reality game interventions to reduce pain and anxiety from pre, intra, and post-circumcision in children. Methods: Literature study using four databases (Scopus, Science Direct, PubMed, and Google Scholar) using quantitative research with RCT and quasi-experimental designs, using virtual reality, audio-visual and game interventions which were limited from 2018 to 2022 according to combination of keywords and using English. The framework investigation using PICOT, guidance protocol with PRISMA, and accessing the eligibility of articles systematically by checking for duplicates, titles, and abstracts and determining the eligibility of the full text according to the study of the goals. Results: Thirteen articles met the inclusion criteria. Of the thirteen articles, 1074 children were circumcised. Circumcision causes pain and anxiety in children, so non-pharmacological interventions are needed to overcome it. Virtual reality games are a distraction technique to reduce circumcision pain by diverting the child’s attention and reducing anxiety by providing interventions that children like using audio-visual media and games, with virtual reality or not. Conclusions: Virtual reality games intervention is a distraction technique to reduce pain and anxiety in circumcised children. The combination of interventions using traditional games or the latest technology must be considered to improve service quality. Keywords: anxiety; children; circumcision; distraction technique; pain

Introduction: Philosophical viewpoints from the first-hand source regarded as the best inception of COVID-19 knowledge are not widely explored. Humanity’s understanding grounded on experiences becomes substantial only when stringent documentation of any events is performed carefully. COVID-19 as a phenomenon and as an ongoing struggle has myriad global impacts; hence the study aims to explore the understanding of nursing students’ stances regarding the COVID-19 pandemic in their daily life. Methods: The study used a qualitative study design with online survey. A total of 41 nursing students were recruited through total sampling technique. The study was conducted to students in a university in the Philippines. Interview guidelines used open questions and were spread online. The data were subjected to thematic analysis. Results: The thematic analysis revealed five organizing themes, such as communication, commitment, care, collaboration, and change. Those themes were found among nursing students’ stance regarding the COVID-19 phenomenon. Conclusions: The communication, commitment, care, collaboration, and change as development of a crisis-induced framework from study findings satisfies the essential finding that the pandemic is likewise giving rise to a new normal. Moreover, the results assist nursing students and other health-inspired domains to effectively maintain positivity amidst catastrophic climates.

Nurses are health professionals on the front lines during the COVID-19 pandemic, especially those in the ER, where nurses are the key to controlling virus transmission. This article aims to do a scooping review on how to manage stress in emergency room nurses during the COVID-19 pandemic. This Scooping review explores the literature from the point of view of relevance by assessing the quality of the research, then the data is mapped to identify the main themes found in the literature. We observed that stress on nurses is a burden of excess factors, having a family or children, lifestyle changes, lack of access to PPE, lack of self-confidence, nurses also have feelings and fatigue. We also observed how nurses managed stress, namely strengthening training, positive spiritual coping, social support, and access to mental health services.

Background: Ventilator-Associated Pneumonia (VAP) is still a concern for individuals who are dependent on a ventilator. It is envisaged that the growth of technology-based innovations would lead to the creation of remedies for the prevention of VAP. Purpose: The purpose of this study was to learn more about ICU nurses’ perspectives on nursing innovations to avoid VAP in patients who are on ventilators. Methods: Throughout July and August of 2021, a descriptive qualitative research study was conducted. Through the use of the snowball sampling approach, a total of 30 critical care nurses were recruited. During the interview procedure, each participant had around 40 minutes of time for an in-depth interview using a semi-structured format. In order to analyse the findings of the interviews, the technique proposed by Colaizzi was used. Results: The following four themes emerged: 1) Development of tools to prevent infection, 2) Innovation to monitor cuff tension, 3) Improvement of nurses’ skills and knowledge in using technology, and 4) Nurses’ burden in using technology. Conclusion: Nurses may benefit from considering VAP management as a part of technology-based innovation strategy. Nurses have praised the invention for measuring and monitoring the ETT cuff as a source of optimism for future advancement.

Introduction: Online education during COVID 19 pandemic is witnessing significant growth, particularly in higher education. The aim of the study will explore the challenges that are being encountered related to online education for nursing students. Methods: A correlational study using cross-sectional approach was adopted among 150 participants selected through convenient sampling technique. Data was collected through electronic survey from undergraduate students participated voluntarily studying in College of Nursing, King Khalid University, Abha, Saudi Arabia. The survey forms (Rating Scales on satisfaction and barriers of online education) were used to collect the data. Descriptive and inferential statistics were used to analyze the data by using SPSS version 24.0. Results: The results revealed nearly 92% of participants were highly satisfied with online education. The mean scores and SD related to satisfaction of online education was (37.50+ 8.50). The global perceived barriers mean scores and SD were (35.19+11.19) which indicates that they were able to quickly adopt new strategies by overcoming the limitations. Conclusion: The researcher concludes with the fact that study findings support that, students had positive perception on benefits of online learning by overcoming the limitations. In conclusion, online teaching and learning can be effectively incorporated in future also using blended approach.

Background: COVID-19 considered as a global health crisis poses mental health problems among individual and specifics to students. Purpose: This study aimed to determine the depression, anxiety, and stress levels among students amidst COVID-19 pandemic in Philippines. Methods: A cross-sectional study was undertaken in Region 8, Eastern Visayas Philippines. A total of 311 tertiary respondents randomly selected both private and government owned higher education institutions. The data compilation was done using online questionnaires through Google Forms with validated version of the Stress, Anxiety and Depression Scales 21 (DASS21) is used to calculate students’ level of stress, anxiety and, depression with their socio-demographic features. Results: We revealed that depression, anxiety and stress are instituted in 18.6 %, 35.1 % and 2.85% of students, respectively, amidst the COVID - 19 pandemics. The symptoms of disorders were moderate to extremely severe in 6.1%, 23.5%, and 0.6% of the study sample, respectively. Age, gender, marital status and family history of illness are significantly different with age group 20 and below, females, singles, and families with no history of illness displaying high level of anxiety. Results also established an association between anxiety and family’s monthly income and history of illness. The higher the monthly income and no presence of illness of families, the more anxious the person. Conclusion: Finally, the variables used, explained only 1.5% depression, 3.4% anxiety and 1.4% stress in this time of COVID-19 outbreak. It is therefore recommended to essentially develop community-based mental health program for preventive purposes.

Background: Health education, using new approaches in the nursing area, is of great importance. The current study aimed to evaluate the effects of a health belief model-based education on maternal abilities to caring for children with Avoidant Restrictive Food Intake Disorder (ARFID). Methods: This was a quasi-experimental non-randomized controlled trial with pre-test, post-test and a control group design. In total, 30 families with children with ARFID in Malang regency, Indonesia were divided into experimental and control groups. The experimental group was trained based on the Health Belief Model (HBM); however, the control group received an education based on the routine nursing process model. The necessary data were collected by a researcher-made questionnaire constructed based on HBM constructs. The obtained data were analyzed in SPSS. Descriptive statistics, homogeneity test, and Paired-Samples t-test were used to outline the relationship between the dependent and independent variables. Results: HBM effectively improved maternal abilities to manage eating disorders (P=0.009), promoting behaviors (P=0.000), and paternal involvement (P=0.000). Conclusion: HBM-Based education is recommended to be used in the provision of training in the mothers of children with ARFID.

Introduction: Antiretroviral therapy is an important factor in improving the quality of life of HIV sufferers, but a complex problem in HIV sufferers is a trigger factor for non-compliance in undergoing ARV therapy. The purpose of this study was to explore the experience of people living with HIV/AIDS (PLWHA) undergoing antiretroviral treatment. Methods: This study was a qualitative phenomenological study, with a sample of 13 HIV patients (10 men and 3 women) who were taking antiretroviral therapy for more than one year; they were recruited using purposive sampling techniques, and data were collected through in-depth semi-structured interviews, field notes and document reviews. Data were analyzed using the Colaizzi method which consists of nine stages. Results: There were six themes that emerged from the experience of PLWHA undergoing antiretroviral therapy and these became the subject of this study, namely knowledge of HIV disease and antiretroviral drugs, self-motivation, social support, and skills in undergoing treatment (self-management), adherence, and quality of life. Conclusion: Of the six themes that emerged, poor knowledge (understanding of the disease and its treatment), social support and self-management were the main factors that were obstacles to and causes of treatment failure; this was due to the unpreparedness for receiving information at the beginning of treatment, lack of motivation, and ignorance in behavior when people had problems with medication.

Introduction: An understanding of supportive care needs is essential to achieve good quality care for women with breast cancer. This concept defines the needs of cancer patients in relation to the physical, emotional, psychological, social, informational and spiritual domains since the start of their journey through diagnosis, treatment, survivorship, palliative care and the grief process. Methods: This study was conducted to explore the unmet supportive care needs of women with breast cancer. Databases were searched in the journals using pre-determined keywords such as ‘supportive care needs’, ‘breast cancer’ and ‘woman’. The databases used were Scopus, Pro Quest, Science Direct and EBSCO. The search was limited to journals published in the period 2014-2020. Out of the 189 nursing journals initially found, 16 journals were selected that met all of the eligibility criteria. Eight studies used a cross-sectional design. Results: Most of the breast cancer patients were in the post-diagnosis phase and had survived. More than 50% of the journals reported that the needs of breast cancer women were going unmet. The predictors of a higher level of need among the breast cancer patients are age, social support and information. The most prevalent unmet needs among the women with breast cancer were found to be in the health system and related to information. Conclusion: Future research should focus on improving the education and psychological support programs available to provide for the unmet supportive care needs of patients newly-diagnosed with breast cancer. This can provide high quality care for them.

Introduction: Caring is the core or focus in nursing as a form of professional nursing practice. The current caring instrument is an original instrument that measures the attitudes or behavior of nurses, has not paid attention to the administrative and environmental aspects of the hospital. The use of an instrument that does not yet contain certain characteristics gives rise to improper measurement results. The purpose of this study was to explain the importance of developing caring measurement instruments with an Indonesian perspective. Methods: Systematic reviews were carried out from database articles on ScienceDirect, Scopus, Google Scholar, SpringerLink, Wiley online, Proquest, and EBSCOhost. Criteria for articles were articles published in the last 10 years, national and international research locations, and in Indonesian and English. 15 references were obtained from 2100 references that met the predetermined criteria. The development of a caring behavior instrument based on an Indonesian perspective does not yet exist. Results: The results found that development on the basis of linguistics, cultural adjustment, and according to the prevalence of disease in a country because the epidemiology of the disease differs on the climate region. Conclusion: Specific caring instruments in an Indonesian perspective is expected that the research results will be more accurate.

Introduction: Job stress is a major barrier to the attainment of safety, health, and wellness among nurses. Understanding factors job stress among nurses is very important to provide alternatives solution to ease the stress in the future. However, there are limited studies with respect to factors related to stress in Intensive Care Unit (ICU) nurses particularly in Indonesian context. This study aimed to identify factors correlated to job stress among ICU nurse in three public hospitals. Methods: A correlational study was carried on ICU nurses who hands-on ICU nursing care. Data were collected using questionnaires. Descriptive statistic and Spearman correlation were used to analyze the correlation between perceived job burden, working condition, quality of nursing work life, perceived organizational support, and stress among ICU nurses. Results: A total of 91 respondents (32 male and 59 female) were involved to the study comprises of two different educational backgrounds (59 Diploma III and 32 Bachelor degree). The statistical analysis using Pearson correlation found that workload (0.003), working condition (0.000), quality of nursing work life (0.000), perceived organizational support (0.000) significantly correlated to job stress among ICU nurses. Conclusion: All studied factors correlated to job stress among ICU nurses. All factors had moderate correlation with nurses’ job stress and working condition has highest strong correlation compare to the other factors. Its implies from the result that management of the hospital may provide more attention to job stress among nurses to maintain optimum performance to provide nursing care for patients particularly critically ill patients in ICU.

Editorial: Research Utilization and Evidence-Based Practice in Education and Nursing Practice

Introduction: The number of patients with diabetes mellitus (DM) in year 2001 was 5.6 million. In the year 2020, it is expected to reach 8.2 million. The diet of DM patients in Pulorejo village comprised low calorie, sugar free, and low fiber diet. Fiber consumed by these patients was taken from vegetables and banana. Unfortunately, the use of such diet keep the patient's blood sugar level remains increasing. The content of water-soluble fiber (pectin) in apple is higher and is able to reduce blood sugar level. The objective of this study was to analyze the effect of apple consumption on blood sugar level. Method: This study was used a quasy-experimental pre-post test purposive sampling design. Samples who met to the inclusion criteria were 14 persons divided into treatment and control group. Data were analyzed by using Paired t-Test (α=0.05) and Independent t-Test (α=0.05). Result: The result showed that there was an effect of apple consumption on blood sugar level with Paired t-Test (p=0.000) for blood glucose level before and after intervention in treatment group, and (p=0.100) for blood glucose level before and after intervention in control group. The results of Independent t-Test revealed p=0.000 for blood glucose level after intervention in treatment and control groups. Discussion: It’s can be concluded that there was an effect of apple consumption on blood sugar level in DM patients. The apple should be given in the best dose that can reduce blood sugar level, which is 2 x 150 g. The result of this study can be considered in as a material for diet promotion for the patients. Further studies should be developed to measure the variables of stress and sex of the patients.

Introduction: Exposure to pathogens is a serious issue for nurses. The literature explains that standard precaution have not consistently done in nursing. The purpose of this study was to analyze the factors affecting the compliance of nurses in Myanmar in performing standard precautions. Methods: This study used a cross-sectional design. Samples included 34 nurses in Waibagi Specialist Hospital (SHW), Myanmar. The independent variables were the characteristics of nurses, knowledge of standard precaution, and exposure to blood / body fluids and needle puncture wounds. The dependent variable was the performance of standard prevention. Data analyzed using descriptive analysis and logistic regression. Results: The result showed that almost respondents (91.18%) had a good knowledge about prevention standards and 73.5% of respondents had good adherence in performing standard precaution. However, in practice nurses have not been consistent in closing the needles that have been used correctly. The results showed that nurse characteristics did not significantly affect adherence to standard precaution with statistical test results as follows: age (p = 0.97), gender (p = 1.00), religion (p = 0.72), education (p = 0.85), work experience at SHW (p = 0, 84), education training program (p = 0.71), knowledge (p = 0.76), and needle stick injury (p = 0,17). But, there was a significant influence between adherence to standard precaution on the incidence of injury due to puncture needle with p value = 0.01. Discussion: The barriers to applying standard precautions by Myanmar nurses can be reduced by providing basic training, supervision and improvement of operational standard procedures.

Introduction: Haemodialysis (HD) is one of therapies to sustain life for people with End Stage Renal Disease (ESRD). HD and ESRD are the source of the stressor for the patients. The purpose of this study was to gain insight about the life experiences of patients suffering from ESRD and coping that they used in dealing with stressors. Method: This study employed hermeneutic phenomenological study as methodology. Samples were taken at RSU Dr. Soedono Madiun in December 2010–May 2011 using purposive sampling. Participants in this study amounted to 9 people who all male and had suffered kidney failure and undergoing HD for more than 2 years. Data were processed and analysed through the nine stages data interpretation according collaizi. Result: Client's life experiences with HD and coping strategies they used to cope with critical situations have been identified and grouped into several themes. The first theme was the reaction of participants when receiving the diagnosis should undergo HD including: sad, rejection, fear, shock and feelings of resignation and hope. The second theme was perceived to critical situations by clients include shortness of breath, weakness, body swelling, itching, diarrhea and could not urinate. Last theme was the meaning of life in hemodialysis derived from attitudinal values (the values to be) and experiential values (the values of appreciation). Discussion: Ways in which clients address critical situations were quite diverse. Emotional informational, instrumental supports from spouse or significant other were needed by participants to overcome the critical situation. This study suggests that nurse should perform therapeutic communication to HD patients so that patients may cope with the disease more positively.

Introduction: Nursing care is integral part of health care and having important role in management of patient with emergency condition. The purpose of this research was to develop nurse performance improvement model based on individual, organization and job characteristics association in Emergency Department of RSUD dr TC Hillers Maumere. Method: This was an explanative survey by cross sectional approach held on July -August 2012. Respondents in this study were 22 nurses and 44 patients were obtained by purposive sampling technique. Data were analyzed by partial least square test and signi fi cant t value > 1.64 (alpha 10%). Result: Results showed that individual characteristic had effect on nurse performance (t = 7.59), organization characteristic had effect on nurse performance (t = 2.03) and job characteristic didn’t have effect on nurse performance (t = 0.88). Nurse performance had effect on patient satisfaction (t = 6.54) but nurse satisfaction didn’t have effect on nurse performance (t = 1.31), and nurse satisfaction didn’t have effect either on patient satisfaction (t = 0.94). Discussion: This research concluded that individual characteristics which in fl uence nurse performance in nursing care were ability and skill, experience, age, sex, attitude and motivation. Organization characteristic that influence nurse performance was reward while job characteristic that include job design and feedback didn’t influence nurse performance in nursing care. Nurse performance influenced patient satisfaction but nurse satisfaction didn’t influence patient satisfaction and nurse performance.

Introduction: Assumption of leprosy that it is uncurable, hereditary, cursed, and impure disease causes the patients angry, disappointed even being introvert and leads them to a treatment adherence. The goal of this study was to explain the increasing of knowledge, self efficacy and the decreasing of stress in patient with leprosy by support group in Leprosy Hospital of Sumberglagah.Method: This study was a quasy experiment study using pre test and post test nonequivalent control. Total sample was 28 respondents in inpatient ward and outpatient. The instruments were questionnaire and cortisol level. Data were then analyzed descriptively and statistically using Wilcoxon test, Mann-whitney test, paired test and independent t test with α 0,05. Results: Results showed that mean of age was 40,92 years old. Almost all of respondents were in primary education. Knowledge pre and post was 57,14% good; 100% good (p = 0,041). Self effi cacy pre and post was 42,86% high; 28,57% high (p = 0,307). Stres level pre and post was 35,71% normal; 50% normal (p = 0,046). Mean of cortisol level pre and post was 66,35 ± 28,72; 71,80 ± 23,84 (p = 0,598). Discussion: It can be concluded that support group increases knowledge and decreases stress but doesn’t increase self effi cacy and decrease cortisol level in patient with leprosy in Leprosy Hospital of Sumberglagah. Keywords: support group, leprosy, knowledge, self effi cacy, stress, cortisol

Introduction: Clinical Learning is a process of transformation of the student to become a professional nurse. Clinical Nurse Educator contributes to improve the quality of clinical learning because of variety of roles ranging from planning, implementing and evaluating learning clinical practice. Improving the quality of clinical practice learning, can be reached by improving the performance of Clinical Nurse Educator. The aim of this study was to know the effect of psychological variables and organizational variables to the competence and performance of Clinical Nurse Educators. Sample was Clinical Nurse Educators who work inpatient wards at Kediri Baptist Hospital inpatient wards. Method: This study was conducted in two stages. Phase I measure the competence and performance of Clinical Nurse Educator by Supervisor and students, as well as psychological variables and organizational variables by using questionnaires. Phase II was done by Focused Group Discussion to discuss about the variables that affect Clinical Nurse Educator performance. Data processed using Partial Least Square with α = 0.05, path coefficient = 0.5 and t table = 1.96. Result: The results of this research is showed that Performance Nurse Educator can be improved by increasing Individual Competence with path coefficient= 0.600 and t = 6.741. The individual competence will be increase by improving pscychological aspect nurse educator such as perception, personal aspect, motivation, learning skill and attitude with path coefficient = 0.518 and t = 2.715. Psycological Aspect can be increasing by improving Organization Variable such as Organization Resource, Salary, Organization Structure and Job Description with path coefficient = 0.825 and t = 19.658. Discussion: The conclusion of this result that increase of nurse educator competence and performance can be effort by improving psycological aspect and organizational variable Keywords: competence, performance, clinical nurse educator

Introduction: Acute complications are common in patients with Diabetes Mellitus (DM). To improve the behavior prevention of complications and control blood sugar levels, patients need to be equipped with knowledge about the disease process to built a positive attitude and good behavior. The aim of this study was to analyze the effect of patient empowerment based on experiential learning behavior on the prevention of complications and blood sugar levels. Methods: This study used a quasi-experimental design with pre-post test approach using control groups. Samples were 46 diabetic patients who take control in poly RS Mardi Waluyo Blitar taken by consecutive sampling. Data were collected using a questionnaire and checklist recall. Data were analyzed using paired t test, wilcoxon signed rank test and mann whitney. Results: The patient empowerment-based experiential learning have a significant impact on the behavior of prevention of complications. Discussion: Methods of experiential learning can be applied to improve the self-care of patients, especially those who have experienced an acute complications, so the patient is easier to implement behavioral prevention of complications and control blood sugar levels. Keywords: patient empowerment, experiential learning, behavioral prevention, blood glucose

Introduction: Patient safety is an important component of health services quality,and basic principles of patient care. Nursing students also have a great potential to make an action that could endanger the patient, because hospital is one of student practice area. The purpose of this study was to improve the nursing students competency in patient safety by using knowledge management SECI approached. Method: The study used exploratory survey, and quasy experiment. The samples were some of nursing students of STIKes Muhammadiyah Samarinda who were on internship programme that selected using simple random sampling technique, in total of 54 students. This research’s variables were the knowledge management SECI based-patient safety and nursing student’s competency. The data were collected by using questionnaires and observation. The data were analyze by using Partial Least Square (PLS). Result: The result showed that there were significant influence the implementation of a model patient safety based knowledge management seci on increased competence nursing students. Discussion: Improved student competency in patient safety using SECI knowledge management was carried out in four phases, that is Socialization, Externalization, Combination, and Internalization. The result was a new knowledge related to patient safety that able to improve the student’s competency.. Keywords: Patient safety, Knowledge management, SECI, competency

Introduction: Ventilator Associated Pneumonia (VAP) is a nosocomial infection in patients who use ventilator for more than 48 hours. The aimed of the study was to determine VAP incidence after VAP bundle application. Methods: This study used one-shot case study posttest only designed with samples of 6 individuals beginning on December 31, 2013 up to January 31, 2014. The totally score of CPIS assessment revealed that 4 of 6 patients was not diagnosed with VAP and 2 were diagnosed with VAP. Result: The results showed that the application of VAP bundle has infl uence in preventing VAP incidence. The totally score of CPIS assessment revealed that 4 of 6 patients was not diagnosed with VAP and 2 were diagnosed with VAP. Discussion: This study need to be backed up furthermore with a larger sample size and continuous CPIS assessment is needed to identify VAP caused by bacteria, especially the late-onset bacteria, in patients using mechanical ventilation in longer a time. Keywords: Ventilator Associated Pneumonia (VAP) Bundle, VAP incidence

The objective of this study was to analyze the relationship between working burden with time and motion study. The research’s design was used cross sectional studies with 56 samples of nurse which are taken by using purposive sampling technique. Data were collected for working burden by using observational with time and motion study, for nurses motivation and nursing care quality by using questioners with multiple choices. Data were analyzed by using Spearman’s Rho test with value level of p0.05.