Nursing Sciences Journal (NSJ) is a peer-reviewed journal devoted to publish research papers in nursing areas and related healthcare issues. NSJ is published 2 issues per years (April and October). Nursing Sciences Journal (NSJ), is a peer-reviewed journal devoted to publish research papers in nursing areas such as fundamental and basic nursing, adult or medical surgical nursing, neonatal and pediatric nursing, maternity nursing, mental health and psychiatric nursing, family and community health nursing, geriatric nursing, nursing administration and management, oncology nursing, transcultural nursing, HIV/AIDS and tropical diseases - and related healthcare issues such as health professional, health policy or healthcare system, women's health and education with focus on national or regional trend and issues. ISSN : 2598-8212 EISSN : 2598-8220 Published By : Universitas KADIRI
ROOT CAUSE ANALYSIS OF INCONSISTENT BACTERIAL CULTURE MEDIA QUALITY USING THE FISHBONE (ISHIKAWA) DIAGRAM: A CASE STUDY
Inconsistent bacterial culture media quality can compromise diagnostic accuracy and laboratory reliability in clinical microbiology. This study aimed to identify the root causes of bacterial culture media quality inconsistency using a Fishbone (Ishikawa) Diagram approach. A descriptive qualitative case study was conducted at the Microbiology and Biotechnology Laboratory, Faculty of Health Sciences, Universitas Anwar Medika, Indonesia, based on three laboratory quality complaints involving poor bacterial growth, contamination of prepared media, and inconsistent antimicrobial susceptibility test results. Data were collected through direct observation of media preparation processes, review of standard operating procedures, equipment calibration records, and structured discussions with laboratory personnel. Root cause analysis was performed using the 6M framework, including man, method, material, machine, measurement, and environment. The analysis revealed that method-related and measurement-related factors were the most dominant contributors, particularly non-standardized media preparation procedures, absence of routine growth promotion and sterility testing, and instability of sterilization and incubation equipment. Human-related and environmental factors acted as secondary contributors. These findings indicate that culture media quality inconsistency is primarily driven by systemic process weaknesses rather than isolated individual errors. Implementation of standardized procedures, strengthened quality control systems, and regular equipment monitoring is essential to improve laboratory performance and diagnostic reliability.
Copyright (c) 2026 Yulianto Ade Prasetya, Putri Setyawati, Sri Indah Kusumawati, Muhajiriansyah, Budi Hartono https://creativecommons.org/licenses/by-sa/4.0
GROUP-BASED HEALTH EDUCATION IN IMPROVING HYPERTENSION CONTROL BEHAVIORS IN COMMUNITIES: A SYSTEMATIC REVIEW
Hypertension is a major risk factor for cardiovascular disease and remains one of the leading causes of death worldwide. Despite the availability of effective treatments, poor medication adherence and inadequate self-management continue to hinder optimal blood pressure control. These challenges highlight the need for innovative, community-based strategies to support patients in managing their condition. One such approach is group-based health education, which facilitates shared learning, peer support, and improved patient engagement. This study aimed to evaluate the effectiveness of group-based health education in improving hypertension control behaviors through a systematic review.This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICO framework included adults with hypertension as the population, group-based health education as the intervention, standard care as the comparison, and hypertension control behaviors as the outcomes. These outcomes included reductions in systolic and diastolic blood pressure (SBP and DBP), medication adherence, self-care practices, and overall blood pressure control. Relevant articles were identified through PubMed, Scopus, and Google Scholar using keywords related to hypertension, group education, and community-based interventions. Studies meeting the inclusion criteria were analyzed descriptively. A total of twelve studies, primarily randomized controlled trials from various regions, were included. The findings consistently demonstrated that group-based education significantly improved blood pressure outcomes, adherence, and self-care behaviors. Overall, group-based health education is an effective and sustainable strategy that can be integrated into primary healthcare to enhance long-term hypertension management and patient outcomes.
Copyright (c) 2026 Nara Dikna Aditya, Djazuly Chalidyanto, Rika Ramadhani Makatita https://creativecommons.org/licenses/by-sa/4.0
EFFECTIVENESS OF GUIDED IMAGERY AND VIRTUAL REALITY ON PSYCHOLOGICAL COMFORT IN HEMODIALYSIS PATIENTS: A SYSTEMATIC REVIEW
Background: Hemodialysis patients often experience anxiety, stress, depression, and pain due to invasive and repetitive procedures, resulting in reduced psychological comfort and quality of life. Guided imagery and virtual reality are non-pharmacological interventions that have the potential to reduce psychological distress during therapy. This study aims to evaluate the effectiveness of the two interventions through systematic review. Methods: A systematic search was conducted in PubMed, Scopus, Science Direct, and Google Scholar for studies published between 2018 and 2025. Study selection followed PRISMA guidelines, and data were synthesized using a narrative approach. A total of 198 records were identified, and 10 studies met the inclusion criteria. The PICO framework includes Population = patients’ hemodialysis; Intervention = guided imagery and/or virtual reality; Comparison = standard care or pre-intervention conditions; and Outcome = psychological comfort which includes anxiety, stress, depression, pain, sleep quality, and psychological well-being. Article searches were carried out systematically through PubMed, Scopus, and Google Scholar databases using keywords relevant to guided imagery, virtual reality, hemodialysis, and psychological outcomes. Results: A total of 10 studies met the inclusion criteria, with the study design dominated by randomized controlled trials (RCTs). The study came from Iran, Indonesia, Egypt, Australia, Spain, and Poland. The results showed that guided imagery- virtual reality significantly reduced anxiety, stress, depression, and pain perception compared to standard treatments or pre-intervention conditions. Some studies have also reported improvements in sleep quality, patient satisfaction, and psychological well-being during hemodialysis.Conclusion: Guided imagery and virtual reality are effective in reducing anxiety, stress, depression, and pain, as well as improving sleep quality and psychological well-being in hemodialysis patients.
Copyright (c) 2026 Nurtati Anggraeni, Eko Winarto, M. Jamaluddin, Sabina Gero https://creativecommons.org/licenses/by-sa/4.0
BRISK WALKING EXERCISE ON ANXIETY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: AN EXPERIMENTAL STUDY
Anxiety is a psychological problem commonly experienced by patients with type 2 diabetes mellitus (T2DM) and can worsen glycemic control and increase the risk of complications. Brisk walking exercise, as a simple form of aerobic physical activity, is known to have potential metabolic and psychological benefits. However, empirical evidence regarding its implementation in primary healthcare settings is still limited. This study aimed to analyze the role of brisk walking exercise on anxiety levels in patients with T2DM. This study employed a quantitative method with a quasi-experimental pretest-posttest with control group design. The sample was selected using a purposive sampling technique, consisting of 40 respondents, divided into an intervention group (n=20) and a control group (n=20). The sample size was determined based on sample size calculation for experimental design. The intervention group received a brisk walking exercise program three times per week for eight weeks. Anxiety levels were measured using the Depression Anxiety Stress Scale-42 (DASS-42) questionnaire. Data were analyzed using paired t-test and independent t-test. The results showed that brisk walking exercise was associated with a reduction in anxiety levels in patients with T2DM compared to the control group. Brisk walking exercise can be considered as an effective nursing intervention to reduce anxiety in patients with T2DM.
Copyright (c) 2026 Naura Almaghfira Asy'ghotillah, Upik Rahmi, Sehabudin Salasa https://creativecommons.org/licenses/by-sa/4.0
HEALTH WORKER SUPPORT TO IMPROVE SELF-MANAGEMENT OF HYPERTENSION PATIENTS: A CROSS-SECTIONAL STUDY
Background: Poor self-management, characterized by medication non-adherence and unhealthy lifestyles, significantly contributes to uncontrolled hypertension. Low self-efficacy in managing blood pressure remains a critical challenge in community health. Objective: This study evaluated the correlation between Health Worker Support and self-management practices among hypertensive patients. Methods: A quantitative cross-sectional study was conducted in December 2023 with 112 respondents selected via purposive sampling. Inclusion criteria included patients aged 19–65, diagnosed with uncomplicated hypertension, possessing a Glasgow Coma Scale (GCS) of 15 (E4V5M6), and being literate. Data were collected using healthcare support and self-management questionnaires, then analyzed using the Spearman Rank correlation test (alpha < 0.05).Results: Statistical analysis revealed a significant positive correlation between healthcare provider support and patient self-management (p= 0.003).Conclusion: Professional Health worker support is pivotal in enhancing self-management among hypertensive individuals. To optimize patient quality of life and prevent complications, healthcare providers should intensify proactive monitoring and educational interventions to foster better self-care autonomy.
Copyright (c) 2026 Tata Mahyuvi, Siti Mar'atul Munawaroh https://creativecommons.org/licenses/by-sa/4.0
USABILITY ANALYSIS OF THE LASIRAH “LANCAR ASI SEHAT IBU RIANG ANAK DAN HAPPY“ APPLICATION WITH THE USE QUESTIONNAIRE
Introduction: The postpartum period is a crucial phase for mothers in maintaining exclusive breastfeeding. Low self-efficacy and postpartum depression are major barriers to breastfeeding success. Advances in digital technology offer opportunities to enhance maternal independence through innovations. Aims: This study aimed to analyze the usability level of the LASIRAH (Lancar ASI Sehat Ibu Riang Anak dan Happy). Method: The study used a quantitative descriptive design with a cross-sectional method. The subjects were 30 postpartum mothers who used the LASIRAH application for 7 days, selected using a purposive sampling technique. Usability was measured using the USE Questionnaire, which covers the dimensions of usefulness, ease of use, ease of learning, and satisfaction. Data were collected using a 1–4 Likert scale questionnaire and analyzed descriptively as part of a formative usability evaluation. Result: The overall usability score was 84.54%, categorized as very feasible. Specifically, the usefulness dimension scored 86%, ease of use 84.5%, ease of learning 83.5%, and satisfaction 84.15%. These results indicate that LASIRAH is highly useful, easy to use and learn, and provides high user satisfaction. Conclusions and Suggestions: LASIRAH shows strong potential for broader implementation to enhance breastfeeding self-efficacy and prevent postpartum depression through a user-centered digital health approach.
Copyright (c) 2026 Siti Rochana, Septi Tri Aksari https://creativecommons.org/licenses/by-sa/4.0
THE EFFECTIVENESS OF ISOMETRIC HANDGRIP AND WALKING EXERCISES ON BLOOD PRESSURE IN ELDERLY PATIENTS WITH HYPERTENSION
Hypertension in the elderly is one of the global health challenges with a high prevalence. This study aims to evaluate the effectiveness of isometric handgrip exercise and walking exercise in reducing blood pressure in the elderly with hypertension. The research method used a quasi-experimental design with three intervention groups: (1) isometric handgrip exercise, (2) walking exercise, and (3) a combination of both. A total of 36 elderly were randomly selected and equally divided into the three groups. The intervention was conducted for eight weeks with analysis using Shapiro Wilk test, One Way Anova and Wilcoxon Test The results showed that the isometric handgrip and combination exercise groups had a significant decrease in systolic and diastolic blood pressure (p<0.05). Meanwhile, walking exercise also had a positive effect, although not significant in all weeks of evaluation. The combination of both interventions showed the most optimal results, especially at weeks 5 and 8. This study concludes that isometric handgrip exercise and its combination with walking exercise are effective for lowering blood pressure in elderly with hypertension. It is recommended that this intervention be applied as a non-pharmacological therapy in elderly health services, with assistance by health workers to improve compliance and effectiveness of the program.
Copyright (c) 2025 Erni Rahmawati, Lily Herlinah, Nurhayati, Dhea Natashia, Syamsul Anwar https://creativecommons.org/licenses/by-sa/4.0
THE EFFECTIVENESS OF BOOKLET MEDIA IN EFFORTS IO IMPROVE KNOWLEDGE AND ATTITUDE TO PREVENT CHRONIC ENERGY DEFICIENCY IN PREGNANT WOMEN IN TULUNGAGUNG
The prevalence of Chronic Energy Deficiency (CED) among pregnant women globally reaches 35–75% (WHO, 2017), and around 40% of maternal deaths in developing countries are associated with this condition. In Indonesia, studies conducted in 2017–2018 reported a CED prevalence of 17.3% and anemia in 48.9% of pregnant women. The 2021 National Health Survey (Riskesdas) reported that the risk of CED in East Java was 29.8%, higher than the national rate of 28%. This study aimed to determine the knowledge and attitudes of pregnant women regarding CED before and after the intervention, as well as to analyze the effect of the “Prevent CED” booklet on first-trimester pregnant women at Kedungwaru Public Health Center in 2024. The study used a pre-experimental One Group Pre-Test Post-Test design with total sampling, involving 25 respondents—second-trimester pregnant women who were registered, received services at the health center, and provided informed consent. Data were analyzed using the Wilcoxon Signed Rank test. The results showed a p-value of 0.003 (<0.05), indicating a significant effect of the booklet on improving the knowledge and attitudes of pregnant women regarding CED prevention. It is recommended that first-trimester pregnant women read the booklet to enhance understanding and prevent CED during pregnancy.
Copyright (c) 2025 Indah D.K, Ely isnaeni, Dewi Rokhanawati, Farida Kartini https://creativecommons.org/licenses/by-sa/4.0
THE EXPERIENCE OF THE DAYAK PEOPLE IN HEALING ILLNESSES THROUGH THE TRADITIONAL RITUALS OF THE DAYAK NGAJU: A PHENOMENOLOGICAL STUDY
Background: The Dayak Ngaju community in Palangka Raya, continues to practice traditional healing rituals despite the availability of modern healthcare services. Preferences for rituals such as Sangiang, Nyadiri, and Balian reflect the community's strong cultural identity and belief in supernatural healing. Objective: This study aims to explore the subjective experiences of the Dayak Ngaju people in undergoing healing processes through traditional rituals. Methods: This research employed a qualitative approach with an phenomenological design. A total of 10 participants were selected using purposive sampling. Data were collected through in-depth interviews, observation, and field notes. Thematic analysis using Colaizzi’s method was applied, involving seven stages. Results: Thematic analysis revealed nine key themes: (1) cultural background and connection, (2) factors influencing the choice of ritual, (3) personal experiences with ritual healing, (4) traditional healing practices of Dayak Ngaju, (5) meaning and beliefs about rituals, (6) interaction with modern healthcare systems, (7) sociocultural influences, (8) hopes for the future of the tradition, and (9) expectations and utilization. The findings underscore the importance of integrating transcultural perspectives into nursing practice and highlight the need for culturally sensitive care, improved cultural competence among healthcare providers, and collaborative approaches between traditional healers and medical professionals within inclusive healthcare systems
Copyright (c) 2025 Erlina Cahayani, Achir Yani, Muhammad Syafwani https://creativecommons.org/licenses/by-sa/4.0
THE RELATIONSHIP BETWEEN ANXIETY AND SLEEP QUALITY IN MEDICAL STUDENTS WRITING THEIR THESIS AT THE FACULTY OF MEDICINE ISLAMIC UNIVERSITY OF MALANG
Kecemasan tidak hanya berasal dari tuntutan akademik yang besar, tetapi juga dari ekspektasi diri yang tinggi dan ketidakpastian tentang masa depan profesional. Akumulasi dari faktor-faktor ini dapat menyebabkan gangguan tidur yang signifikan, seperti kesulitan untuk tidur, sering terbangun di malam hari, dan merasa tidak segar setelah bangun tidur. Tujuan penelitian ini untuk menganalisa kecemasan dengan Kualitas Tidur terhadap Mahasiswa Kedokteran di Fakultas Kedokteran UNISMA yang sedang menyusun Skripsi”. Desain penelitian ini menggunakan pendekatan kuantitatif dengan jenis penelitian observasional analitik dan desain cross-sectional.. Populasi adalah mahasiswa kedokteran tingkat akhir yang sedang menyusun skripsi sebanyak 40 orang. Teknik sampling menggunakan probability sampling.Pengumpulan data dilakukan secara simultan dalam satu waktu tertentu untuk mengukur kedua variable, dengan menggunakan kuesioner. Analisa data diatas didapatkan nilai Spearman’s Rho sebesar 0,558 yang berarti hubungan moderat positif dengan Sig. (2-tailed) sebesar 0.000. Kecemasan yang semakin meningkat akan berdampak terhadap kualitas tidur pada mahasiswa kedokteran yang sedang menyusun skripsi di Fakultas Kedokteran Universitas Islam Malang.
Copyright (c) 2025 Lingga Kusuma Wardani, Nurkhanila Agustin, Hengky Kurniawan, Dhita Kurnia, Reni Nurhidayah, Nuryeny H https://creativecommons.org/licenses/by-sa/4.0
THE EFFECTIVENESS OF POSITIVE DEVIANCE (HEARTH) TO REDUCE MALNUTRITION IN UNDER FIVE CHILDREN
Positive deviance (pos gizi) merupakan program gizi yang berbasis keluarga dan masyrakat bagi balita yang mengalami gizi kurang. Tujuan penelitian yakni menganalisis keefektivan intervensi positive deviance (pos gizi) sebagai penatalaksanaan gizi kurang pada balita. Jenis penelitian yang digunakan yakni quasi experimental dengan menggunakan rancangan one group pre post test design. Intervensi positive deviance (pos gizi) diberikan selama 2 minggu (12 hari). Jumlah perhitungan subjek dengan G-power didapatkan minimal 10 responden, responden diambil secara total sampling, dan didapatkan 12 balita yang mengalami gizi kurang dengan BB/TB pada rentang Z score = -2 s/d =-3. Data pengetahuan, sikap, dan perilaku orang tua dikumpulkan dengan kuesioner dan dianalisis dengan uji T dependen. Sedangkan data berat badan dan tinggi badan diukur sebelum dan setelah intervensi dengan analisis GLM-RM. Hasil penelitian adalah terdapat peningkatan berat badan dan tinggi badan sebelum dan setelah intervensi positive deviance (pos gizi) karena makanan yang diberikan kandungan gizinya disesuaikan kebutuhan nutrisi balita. Selain itu terjadi peningkatan pengetahuan, sikap dan perilaku ibu sehingga praktik dalam memberikan makanan untuk balita menjadi lebih baik. Kesimpulannya bahwa positive deviance (pos gizi) sebagai salah satu intervensi komprehensif yang dapat diterapkan untuk mengatasi gizi kurang pada balita di masyarakat.
Copyright (c) 2025 Fresty Africia, Lily Herlinah, Nurhayati, Dhea Natashia, Syamsul Anwar https://creativecommons.org/licenses/by-sa/4.0
TEPID WATER SPONGE AND ALOE VERA COMPRESSES FOR REDUCING BODY TEMPERATURE IN TODDLERS: A COMPARATIVE STUDY
Infants often experience fever, which if left untreated can cause seizures. Febrile seizures can cause brain abnormalities. Non-pharmacological methods such as compresses are used to reduce fever, including tepid water sponges and aloe vera compresses, but further research is needed on which compress method is more effective in reducing fever. The purpose of this study was to analyze the effectiveness of tepid water sponges and aloe vera compresses in reducing body temperature in toddlers with febrile seizures. This study adopted a true experiment using a pretest-posttest design with two control groups, using purposive sampling. A sample of 30 people was taken from the population of toddlers treated at Dr. Doris Sylvanus Regional General Hospital. The instruments used were observation sheets, thermometers, aloe vera gel, SOP for tepid water sponges, and SOP for aloe vera compresses, which were analyzed using the Wilcoxon Rank and Mann Whitney tests. The results showed that there was a significant decrease in body temperature with the tepid water sponge intervention and the aloe vera compress intervention. Based on the mean rank for aloe vera compresses > than the mean rank for tepid water sponges, it means that aloe vera compresses are more effective than tepid water sponges, so they can be recommended as a safe and easy-to-apply non-pharmacological method. Healthcare workers and families are advised to use aloe vera compresses as a practical alternative for treating fever in toddlers at home and in healthcare facilities, and to integrate them into education and guidelines for caring for children with fever.
Copyright (c) 2025 Oktaviona, Hamzah, Muthmainnah https://creativecommons.org/licenses/by-sa/4.0
IMPROVING QUALITY OF LIFE WITH NON-PHARMACOLOGICAL APPROACH FOR ADULT WITH HEMOPHILIA: A SYSTEMATIC REVIEW
Factor VIII/IX deficiency in hemophilia make patients susceptible to joint bleeding (hemarthrosis), especially in the knee, elbow and ankle joint. Repeated bleeding episodes trigger chronic joint damage (arthropathy) and pain, thus disrupting functional status, limiting social life which ultimately reduces quality of life. In Indonesia, factor VIII/IX replacement concentrate is the main treatment for hemophilia which is given on-demand. Its is because the price is still relativelt expensive and the stock is unevenly distributed in all regions. This systematic review aims to explore various non-pharmacological approaches that are eddective in improving the quality of life of adult with hemophilia. The method used in this research is article searches. Data obtained from 8 databases such as PubMed, ScienceDirect, Scopus, Wiley, ClinicalKey Nursing, Taylor & Francis, Proquest and Springer Nature Link by filtering articles based on year of publication, title, abstract and full text. The result obtained 10 articles that match with inclusion and exclusion criteria. There were three aspects of quality of life in hemophilia, five articles focused on addressing problems in the physiological aspect, five anothers discussed problems in the psychological aspect, and only one study intervened social aspect. Intervensions were carried out with various method such as education, watching virtual reality videos, counseling, hypnosis, use of knee support and physical exercise. Non-pharmacological approaches have been shown to improve quality of life with various intervention, but all interventions were given when there was no acute bleeding episodes (hemarthrosis).
Copyright (c) 2025 Alfi Kurnia Adha, Sri Yona, Riri Maria https://creativecommons.org/licenses/by-sa/4.0
ANALYSIS OF THE LEVEL OF NICOTINE DEPENDENCE AMONG TEENAGE SMOKERS IN SERANG CITY BANTEN PROVINCE
Smoking is a serious public health problem with a high prevalence among adolescents, including in Serang City, where it reaches 18.17% among adolescents aged 15–24. The purpose of this study was to analyze the level of nicotine dependence among adolescent smokers and the factors influencing it in Serang City, Banten Province. This quantitative study used a cross-sectional study design to analyze the level of nicotine dependence and its influencing factors. The population was estimated at 3,698 active adolescent smokers in Serang City. The sample size was calculated using the Krejcie and Morgan method. The sample size was 351 individuals. The sampling technique used was consecutive sampling. The research instrument was the Fagerström Test for Nicotine Dependence (FTND). Analysis used the Chi-Square statistical test with a significance level of α = 5%. The results showed a significant relationship between age at smoking initiation, duration of smoking, and number of cigarettes consumed per day with the level of nicotine dependence. Early intervention through education, smoking cessation counseling, and restricting cigarette access for adolescents is essential to prevent long-term addiction. Keywords: Nicotine Dependence, Adolescents, Cigarettes
Copyright (c) 2025 Jajang Ganjar Waluya, Lisnawati Yupartini, Soleh, Belvana Ainul Fitriyani https://creativecommons.org/licenses/by-sa/4.0
THE RELATIONSHIP BETWEEN BURNOUT AND NURSES’ PERFORMANCE IN THE EMERGENCY DEPARTMENT OF PROF. DR. MARGONO SOEKARJO HOSPITAL
Burnout is a condition of physical, emotional, and mental exhaustion caused by excessive work demands. Emergency Department (ED) nurses are at high risk of burnout due to heavy workloads and intense emotional pressure, which may affect their performance. This study aimed to determine the relationship between burnout and nurses’ performance in the Emergency Department of Prof. Dr. Margono Soekarjo Hospital. This research used a quantitative approach with a descriptive analytic design and a cross-sectional method. The sample consisted of 45 ED nurses selected using a total sampling technique. The instruments used were the Malach Burnout Syndrome (MBS) questionnaire for burnout and a performance assessment questionnaire for nurses’ performance. Data were analyzed using descriptive statistics and the Chi-Square test. The findings showed that most respondents experienced mild burnout (88.9%) and had high performance (88.9%). The Chi-Square test indicated a significant relationship between burnout and nurses’ performance (p = 0.01). Conclusion: Lower levels of burnout are associated with higher performance. These results emphasize the importance of preventing burnout to maintain the quality of nursing care in the Emergency Department. Keywords: burnout, nurses’ performance, emergency department, work fatigue
Copyright (c) 2025 Leny Desti Pratami, Nurul Fatwati Fitriana, Endiyono Endiyono, Ragil Setiyabudi https://creativecommons.org/licenses/by-sa/4.0
EFFECTIVENESS OF BASIC PRE-HOSPITAL LIFE SUPPORT TRAINING FOR AMBULANCE PERSONNEL: A LITERATURE REVIEW
Medical emergencies remain the leading cause of death worldwide, with most occurring in the pre-hospital phase. Ambulance personnel play a vital role in providing initial assistance, requiring basic skills through Basic Pre-Hospital Life Support (BPHLS) training. The purpose of this study was to review the effectiveness of BPHLS training in improving the competence of ambulance personnel through a literature review. This study is a a systematic literature review based on PRISMA guidelines. Searches were conducted in PubMed, ScienceDirect, and Google Scholar for articles published between 2018 and 2024. Of the 152 articles identified, 12 articles met the inclusion criteria and were analyzed narratively. The results of the study showed that most studies showed that BPHLS training improved the knowledge, skills, confidence, and behavior of ambulance personnel in handling emergencies. Simulation-based training methods were more effective than lectures. However, several studies reported a decline in skills within 6–12 months without refresher training, and the impact on patient clinical outcomes was still inconsistent. BPHLS training has been proven effective in improving the competence of ambulance personnel, but it needs to be conducted regularly, be standardized nationally, and be supported by quality facilities and instructors. It is recommended that there be periodic refresher training programs and integration of training into the education system and pre-hospital services.
Copyright (c) 2025 Muhammad Syukri, NLP Inca Buntari Agustini, Ni Made Dewi Wahyunadi, Yustina Ni Putu Yusniawati https://creativecommons.org/licenses/by-sa/4.0
THE EFFECT OF BED HEAD ELEVATION IN PREVENTING VENTILATOR-ASSOCIATED PNEMONIA (VAP) IN PATIENTS ON VENTILATION
Ventilator Associated Pneumonia (VAP) is a common nosocomial infection in patients using ventilators. One recommended prevention method is head elevation of bed (HoB) at a 30-45 degree angle. The purpose of this study was to analyze the effect of head elevation on VAP prevention in patients on ventilators in the ICU of Dr. Iskak Tulungagung Regional Hospital. This study used a pre-experimental design. The sample consisted of 20 patients selected by consecutive sampling. Data were collected through Clinical Pulmonary Infection (CPIS) observations before and after the intervention for three days. The results showed that of the 20 patients who received the HoB intervention, 75% did not experience VAP, while 25% continued to experience VAP. The CPIS value increased significantly on the second and third days, indicating that this period is a critical phase for VAP development. Elevating the HoB position has an effect on reducing the risk of VAP, but does not completely prevent infection. Effective VAP prevention requires a comprehensive approach that combines HoB with other measures such as oral hygiene, endotracheal cuff pressure monitoring, and optimal ventilation management. Keywords: Head elevation of bed (HoB), Pneumonia, Ventilator.
Copyright (c) 2025 Sutrisno, Dian Sari Maharani , Mayta Sari Dwianggimawati https://creativecommons.org/licenses/by-sa/4.0
DEVELOPMENT OF AN AI-BASED SYSTEM FOR IDENTIFYING VAGINAL DISCHARGE DISEASES IN WOMEN USING THE FORWARD CHAINING
Vaginal discharge is a common gynecological symptom that often indicates various diseases, but its diagnosis frequently requires specialized medical examinations. The limited access to healthcare professionals and the lack of awareness can lead to delayed diagnosis and ineffective treatment, potentially resulting in more severe health complications. This research aims to develop an artificial intelligence (AI) system capable of identifying common vaginal discharge diseases, such as Bacterial Vaginosis, Candidiasis, and Trichomoniasis, based on a series of user-provided symptoms. The study utilizes a rule-based expert system approach with the forward chaining method to process symptoms logically and arrive at a probable diagnosis. The system's knowledge base is constructed from established medical literature and expert physician consultations to ensure high accuracy and reliability. The developed system was tested using a set of clinical cases, achieving an accuracy rate of 92.5%, demonstrating its effectiven ss as a preliminary diagnostic tool. This AI-based system is expected to serve as a valuable early screening instrument, helping to increase access to gynecological health information and facilitating timely medical intervention for women, particularly in areas with limited medical resources.
Copyright (c) 2025 Devy Putri Nursanti, Bonifacius Vicky Indriyono https://creativecommons.org/licenses/by-sa/4.0
EXPLORING THE RELATIONSHIP BETWEEN LACTIC ACID LEVELS AND CLINICAL OUTCOMES OF SEPSIS PATIENTS IN INTENSIVE CARE UNITS: IMPLICATIONS FOR NURSING PRACTICE
Sepsis is a life-threatening condition frequently associated with clinical deterioration, including prolonged hospitalization and increased mortality risk. High lactate concentrations reflect tissue hypoxia and organ dysfunction, which may significantly worsen patient outcomes. However, previous studies on the association between lactate levels and clinical outcomes remain inconsistent. This study aimed to analyze the relationship between lactate levels, length of hospital stay, and mortality in sepsis patients in the intensive care unit. A retrospective observational cohort design was employed, with saturated sampling based on inclusion criteria (n=109). Data were collected from medical records with a total population of 134 patients. Results showed that the majority of sepsis patients were male, predominantly in the pre-elderly and elderly age groups. The most common comorbidities were pneumonia. Most patients had lactate levels >1.7 mmol/L, with prolonged hospitalization (≥3 days) observed and a mortality rate of 71.6%. Chi-square analysis revealed a significant association between lactate levels and both length of stay (p=0.039) and mortality (p=0.018). It can be concluded that elevated lactate levels were associated with prolonged hospitalization and increased mortality in sepsis patients. Lactate levels may serve as a prognostic marker, emphasizing the need for standardized sepsis management, including adherence to the “Hour-1 bundle” protocol, to improve patient outcomes.
Copyright (c) 2026 Rismawan Adi Yunanto, Wahyu Novia Fajriati, Ruris Haristiani https://creativecommons.org/licenses/by-sa/4.0
THE INFLUENCE OF INSTRUMENTAL MUSIC ON ANXIETY LEVELS IN PATIENTS UNDERGOING HEMODIALYSIS AT JOMBANG GENERAL HOSPITAL
Chronic Kidney Failure (CKF) with hemodialysis is a therapy used for patients with stage 5 chronic kidney failure (ESRD) to maintain kidney function. Hemodialysis is one of the therapies for patients with chronic kidney failure followed by electrolyte fluid imbalance disorders. Where the patient's blood containing toxins is diverted to the dialyzer to filter or clean through a semi-permeable membrane and then returned to the patient's body. The purpose of this study was to provide non-pharmacological therapy to reduce anxiety in patients with hemodialysis. This study is a true experiment study with a pre and post test approach with a population of 250 and a sample of 75 people was taken using random sampling techniques. Data were collected and analyzed using the Paired T Test. The results of the study showed that the results of the Paired T test for the instrumental music group obtained a sig value (2 tailed) in the pre and post test of 0.000 <0.05, which means that there is one group that has a very significant difference. The conclusion of this study is that there is anxiety and stress in patients undergoing hemodialysis, especially in new patients. Anxiety can be minimized by diverting attention using music, including instrumental music.
Copyright (c) 2025 Asri Putri Kisfandari, Yuly Peristiowati, Indasah, Dewi Retno Puspitosari, Achmad Wahdi https://creativecommons.org/licenses/by-sa/4.0
THE RELATIONSHIP BETWEEN SUBJECTIVE SLEEP QUALITY AND BLOOD PRESSURE AMONG UNIVERSITY STUDENTS
Poor sleep quality among university students is often associated with academic stress, lifestyle habits, and irregular routines, which may influence blood pressure (BP). This study aimed to examine the relationship between sleep quality and BP in Indonesian university students. A descriptive correlational study with a cross-sectional design was conducted among 207 students at a private university in North Sulawesi Province of Indonesia. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and BP was measured with an aneroid sphygmomanometer. Data analysis included descriptive statistics and Spearman correlation. The mean sleep quality score was 8.50 (SD=3.51) and 84.1% of participants were classified as having poor sleep quality. The mean systolic and diastolic BP were 107.76 mmHg (SD=13.61) and 75.91 mmHg (SD=11.91), respectively. A significant but weak negative correlation was observed between sleep quality and systolic BP (r=-0.191, p=0.006). While these findings differ from much of the global evidence linking poor sleep to higher BP, they highlight the complexity of sleep-BP interactions in young and healthy populations. These findings emphasize the importance of promoting better sleep hygiene, healthier lifestyle behaviors, and cardiovascular health strategies within university settings.
Copyright (c) 2025 Ferdy Lainsamputty, Mutiara Nala Aurelia Dotulung, Leroy Avron Justin Mononutu, Febi Ruth Alexandra Pikan, Maria Kristyani Lontaan, Metty Wuisang https://creativecommons.org/licenses/by-sa/4.0
THE RELATIONSHIP BETWEEN BULLYING EXPERIENCES AND SELF-ACCEPTANCE ADAPTATION ABILITY IN ADOLESCENTS
Incident bullying is an unwanted action that occurs in adolescents due to an imbalance of power, and bullying this has the potential to happen repeatedly and at any time. Experience bullying what the victim experiences directly will have an impact on their development and growth as a teenager, especially in terms of adaptability and social skills. Aggravating factors bullying namely lack of self- confidence, lack of self-acceptance, and lack of communication. This research aims to determine the relationship between experience bullying with the ability to adapt to self-acceptance. The design used in this research is correlation with the approach cross-sectional. The population of all students victims of bullying at Taruna Bakti Vocational School was 35 respondents. The sample in the research was 35 students obtained from engineering Total Sampling. Experience variable data bullying measured using a questionnaire The Olweus Bully and data on the variable ability to adapt to self-acceptance were measured using a questionnaire Berger’s Self Acceptance Scale, and data analysis with statistical tests Spearman rank. The research results stated that the majority of respondents 26 students (74.3%) experienced bullying lightweight with good acceptance criteria. The results of the analysis show that there is a relationship of experience bullying with the ability to adapt to self-acceptance (p-value 0.00<0.05). Good self-acceptance in individuals makes them able to develop themselves. able to interact with other people, and establish close relationships with other people without feeling disturbed by their weaknesses, because individuals who have high self-acceptance are aware of and accept all forms of shortcomings and weaknesses. the advantages that exist within him and realizing that other individuals also have these.
Copyright (c) 2025 Lilik Setiawan, Eko Arik Susmiatin https://creativecommons.org/licenses/by-sa/4.0
MOTHERS' KNOWLEDGE AND PERCEPTION OF ADOLESCENT REPRODUCTIVE HEALTH BEHAVIOR: A LOCAL PERSPECTIVE ON ADOLESCENT FEMALES AGED 12-18 YEARS IN KEDIRI DISTRICT
The impact of negative reproductive health outcomes is greater for female adolescents than for males, so the role of parents in providing health education to female adolescents is an important thing that requires serious attention. Mothers are parents as primary caregivers who have an important role in the development of reproductive health in adolescents. Lack of knowledge and perception of mothers about reproductive health in parents can trigger reproductive health problems, such as unwanted pregnancies, abortions, early marriages, sexually transmitted diseases (STDs), and HIV/AIDS. The purpose of this study was to determine the relationship between knowledge and perception of mothers on adolescent reproductive health. The sample was adolescents aged 12-18 years in the working area of ​​the Ngasem Health Center, Kediri Regency, as many as 80 respondents who were obtained based on proportional random sampling techniques. The instrument used to measure the variables of knowledge, maternal perception and adolescent reproductive health used a questionnaire. Data analysis used the Spearman rank test with a significance level of 0.05. The results of the study showed that there was a relationship between maternal knowledge and adolescent reproductive health education with a fairly strong correlation value (r = 0.482), and there was a significant relationship between maternal knowledge and adolescent reproductive health education with a fairly strong correlation value (r = 0.482), there was also a significant relationship between maternal perception and reproductive health education in adolescents with a strong correlation value (r = 0.777). Efforts are needed to improve maternal knowledge and perception in order to provide reproductive education so that adolescents become more responsible for their reproductive health. Keywords: knowledge, perception, reproductive health, adolescent mother
Copyright (c) 2025 Indah Jayani, Susmiati Susmiati, Eko Winarti, Devangga Darma Karingga, Sri Haryuni, Idola Perdana Sulistyoning Suharto https://creativecommons.org/licenses/by-sa/4.0
TRANSFORMING THE HEALTH OF THE ELDERLY THROUGH THE COMBINATION OF HATHA YOGA AND CHAYOTE JUICE FOR MENTAL HEALTH AND BLOOD PRESSURE
Hypertension in the elderly is still a serious health problem, especially in the Surabaya area with the highest prevalence in East Java. This condition not only affects the physical, but also has an impact on the mental health of the elderly, such as anxiety and depression, which often go unnoticed and actually worsen blood pressure. This study aims to examine the effectiveness of the combination of Hatha Yoga therapy and chayote juice in lowering blood pressure and improving the psychological condition of the elderly. The research design used a quasi-experiment with a pre-post test approach in two groups. A total of 100 elderly hypertensive patients in RW 04, Sumber Rejo Village, Surabaya, were divided into treatment groups (n=50) and control groups (n=50) through purposive sampling techniques. The treatment group underwent Hatha Yoga and consumed chayote juice twice a week for four weeks. Meanwhile, the control group participated in routine elderly gymnastics. Data were collected through questionnaires and observations, then analyzed using Wilcoxon and Mann-Whitney tests. The results showed a significant improvement in the emotional aspects of the elderly and a marked decrease in blood pressure in the treatment group with significant difference results (p = 0.000). This combination therapy has been shown to be effective and can be recommended as a safe, easy-to-apply, and beneficial nursing intervention in treating hypertension and mild psychological disorders in the elderly. Keywords: Hypertension, Elderly, Mental Health, Hatha Yoga, Chayote.
Copyright (c) 2025 Nurul Imam, Shinta Wurdiana Rhomadona, Nasywa Benita Trismantoro, Savira Agustina https://creativecommons.org/licenses/by-sa/4.0
PATIENT COMPLIANCE IN CHRONIC DISEASE MANAGEMENT PROGRAMS BASED ON THE HEALTH BELIEF MODEL HOLISTIC NURSING APPROACH IN BANTUL
The Chronic Disease Management Program (Prolanis) is a systematic strategy aimed at improving the quality of life for patients with chronic illnesses such as hypertension and diabetes mellitus. However, patient adherence to this program remains relatively low, particularly in semi-rural areas such as the Dlingo II Primary Health Center, Bantul. Understanding the factors that influence adherence is crucial for designing more effective and contextually appropriate interventions. This study aims to analyze the determinants of patient adherence to Prolanis using the Health Belief Model (HBM) framework and interpret the findings through a holistic nursing perspective. A quantitative approach with a cross-sectional design was employed, involving 163 active Prolanis patients within the working area of Dlingo II Primary Health Center. The variables examined included perceived benefits, perceived barriers, social support, and cues to action, analyzed using bivariate chi-square tests and multivariate binary logistic regression. The results indicate that all variables within the HBM framework significantly influence patient adherence (p < 0.05), with cues to action being the most dominant factor (OR = 8.615), followed by perceived benefits (OR = 5.637), social support (OR = 5.026), and perceived barriers (OR = 2.878). These findings highlight the importance of contextual education, meaningful reminders, and supportive social environments as key factors for program success. Adherence to Prolanis is influenced not only by individual perceptions but also by social dynamics and local cultural values. Integrating the HBM approach with holistic nursing provides a more comprehensive understanding of patient behavior and supports the effectiveness of community-based interventions in semi rural settings.
Copyright (c) 2025 Widarto Widarto, Joko Prasetyo, Novita Anna Anggraeni https://creativecommons.org/licenses/by-sa/4.0
ARRIVAL TIME OF ACUTE CORONARY SYNDROME (ACS) PATIENTS AT THE EMERGENCY DEPARTMENT BY MODE OF TRANSPORTATION: A CORRELATION STUDY
In Acute Coronary Syndrome (ACS), the time elapsed between the onset of symptoms and the patient receiving treatment is an important determinant of survival and subsequent recovery. However, many patients do not receive treatment as quickly as recommended, largely due to substantial pre-hospital delays such as waiting to seek medical attention after the initial onset. Objective to determine the relationship between the mode of transportation used by patients and delays in their arrival at the Emergency Department (ED). This study used a cross-sectional design. The population in this study were SKA patients at Dr. Mohammad Zyn Sampang Regional General Hospital. The sampling technique used was simple random sampling, with a sample size of 35 people calculated using the Slovin formula. Based on data analysis and statistical tests, it was found that there was a relationship between the mode of transportation and the time of patient arrival at the ED. The arrival time of patients at the ED can be influenced by several factors, one of which is the mode of transportation used to go to the hospital. There is a need for education regarding the importance of arriving at the ED immediately for patients and families with Acute Coronary Syndrome
Copyright (c) 2025 Dessy Rindiyanti Harista, Andrean Dwi Ainur Rohman, Yunita Amilia, Satria Eureka Nurseskasatmata https://creativecommons.org/licenses/by-sa/4.0
NURSES’ KNOWLEDGE, BARRIERS, AND SOLUTIONS IN IMPLEMENTING HANDS-FREE INTRAMURAL INJECTION TECHNIQUE DURING CAESAREAN SECTION: A MIXED-METHODS STUDY
Sectio caesarea carries a high risk of sharp injuries that may endanger medical personnel. The Hands-Free Technique (HFT) is a method of passing sharp instruments through a neutral zone to reduce such risks. However, its understanding and application during intramural injections remain limited. Methods: A mixed-method approach with an explanatory sequential design was employed. Quantitative data were collected from 30 nurses using a questionnaire, and qualitative data were obtained through focus group discussions (FGDs) with 15 nurses. Descriptive, inferential, and thematic analyses were conducted. Results: Most respondents (53.3%) had a low level of knowledge about HFT. No significant differences were found by years of experience, prior training, or procedure frequency. The FGDs identified key barriers: limited knowledge, insufficient training and monitoring, and established routines perceived as more practical. Suggested solutions included regular practice-based training, visual aids in the workspace, supervisor accompaniment during procedures, and periodic monitoring with feedback and recognition. Discussion: These findings highlight the need for systematic interventions such as routine training, visual aids, and regular evaluations to support more consistent and safe implementation of HFT in operating rooms. Keywords: Barrier, Hands-Free Technique, nurse knowledge, sectio caesarea, solutions
Copyright (c) 2025 Gilny Rantung, Desmond Kristanto, Cori Epang https://creativecommons.org/licenses/by-sa/4.0
PSYCHOLOGICAL WELL-BEING OF CKD PATIENTS AND INFLUENTIAL FACTORS: A CORRELATION STUDY
Chronic Kidney Disease (CKD) is a major global health problem due to its irreversible nature due to the inability of the kidneys to function optimally in carrying out their regulation. CKD patients can experience psychological problems, requiring spiritual needs and family support that can affect psychological well-being. This study aims to determine the relationship between psychological well-being and influencing factors in CKD patients. This research method used a quantitative research type with a cross-sectional design. The population of this study was all CKD patients treated in the Hemodialysis Room at Dr. Adjidarmo Regional General Hospital with a sample size of 115 people using quota sampling in August 2025. Data analysis used univariate and bivariate using the chi-square test. The results showed a significant relationship between spirituality and psychological well-being (p-value 0.001 <0.05) and no relationship between family support and psychological well-being (p-value 0.08>0.05). High spirituality will have a 3.54 times greater chance of having good psychological well-being compared to low spirituality. In conclusion, nurses need to pay attention to the spiritual aspect of CKD patients in order to improve the psychological well-being of patients by implementing spiritual care for patients.
Copyright (c) 2025 Syafrina Arbaani Djuria, Epi Rustiawati https://creativecommons.org/licenses/by-sa/4.0
PARENTING PATTERNS AND DEPRESSION LEVELS IN ADOLESCENTS AGED 16-18 YEARS: A CORRELATION STUDY
Depression in adolescents is a growing mental health problem that can impact psychological, social, and academic aspects. Parenting styles significantly impact adolescent mental health. Inappropriate parenting styles have the potential to lead to emotional problems, including depression. This study aimed to determine the relationship between parenting styles and depression levels in adolescents aged 16–18 at SMAN 1 Widodaren, Ngawi Regency. This study used a descriptive correlational design with a cross-sectional approach. The population was 1,158 and the sample size was 92 respondents, selected using stratified random sampling. Data were collected using the Parental Authority Questionnaire (PAQ) to measure parenting styles and the Beck Depression Inventory (BDI-II) to measure depression levels. Statistical tests used the Spearman Rank Test. The analysis revealed a significant relationship between parenting styles and depression levels in adolescents aged 16–18 at SMAN 1 Widodaren. The findings confirm that implementing appropriate parenting styles is crucial for maintaining adolescent mental health and preventing depression. It is recommended that future research include other variables, such as social support or the school environment, to gain a more comprehensive understanding of the factors influencing adolescent depression. Keywords: Depression, Parenting Styles, & Adolescents Aged 16-18.
Copyright (c) 2025 Olliviyani Eka Dewanty, Sulistyo Andarmoyo, Siti Munawaroh https://creativecommons.org/licenses/by-sa/4.0
FACTOR ANALYSIS OF STRESS LEVELS AMONG PARENTS OF CHILDREN WITH DISABILITIES
Parenting stress among parents raising children with disabilities is a mental health concern that significantly impacts caregiving quality and family well-being. This study was conducted to identify factors associated with parenting stress levels among parents of children with disabilities in the Pekalongan Residency. The purpose of this study was to analyze the relationship between parental characteristics, social support, illness uncertainty, and the type of child’s disability with parenting stress. This research employed a descriptive analytic design with a cross-sectional approach and involved 39 parents as respondents. Data were collected using validated questionnaires and analyzed using the chi-square test. The results showed that the majority of parents experienced a moderate level of parenting stress (61.5%). There were significant associations between parenting stress and several factors, including the parent's gender, level of social support, illness uncertainty, and the type of the child’s disability (p<0.05). These findings highlight the importance of implementing family-based interventions and strengthening social support to reduce parenting stress among parents caring for children with disabilities.
Copyright (c) 2025 Ade Irma Nahdliyyah, Rahajeng Win Martani, Nur Baiti Nasution, Septiana Arifadhi, Endang Axtia https://creativecommons.org/licenses/by-sa/4.0