e-ISSN 2477-3743 p-ISSN 2541-0024 Welcome Jurnal Pendidikan Keperawatan Indonesia (JPKI) is an open-access journal published by Universitas Pendidikan Indonesia. This Journal aims to improve nursing science development, especially in nursing education by publishing scientific papers from researchers, lecturers, and practitioners of nursing and health professionals both on a national and international. JPKI has regularly published twice a year in June and December. We accept manuscripts written in English. Articles must be the result of research-based, case studies, results of literature studies with scientific concepts, knowledge, innovative and latest technologies within the scope of nursing. The article will be reviewed by reviewers from various institutions. JPKI has been nationally accredited based on the Decree of Minister of Research, Technology and Higher Education Number 10/C/C3/DT.05.00/2025 with SINTA Score 2. 🗓️ 2️⃣8️⃣ Days to First Editorial Decision ✅ 5️⃣6️⃣ Days to Accept 📈 2️⃣0️⃣% Acceptance Rate ❌ 8️⃣0️⃣% Rejection Rate
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The Relationship Between Frailty Syndrome and Depression Among The Elderly in West Java
Introduction: Frailty is a geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors. Depression is also common in later life and may coexist with physical vulnerability, particularly when older adults experience restricted activity and social contact during the COVID-19 pandemic. Objective: This study aimed to examine the association between frailty and depression among community-dwelling older adults who visited a primary health centre in West Java, Indonesia Methods: A cross-sectional correlational study was conducted in 2022 during the COVID-19 pandemic. Sixty older adults aged 60 years and above were recruited using convenience sampling from an accessible population of 208 older adults. Data were collected using a demographic and health-characteristics questionnaire, the Indonesian version of the FRAIL Scale, and the 15-item Geriatric Depression Scale. Descriptive statistics and Spearman's rho correlation were used for data analysis. Results: Most participants were aged 60-74 years (88.3%). Pre-frailty was the most frequent frailty category (53.3%), followed by non-frail (25.0%) and frail (21.7%). Most participants had no depressive symptoms (70.0%), whereas 16.7% had mild depressive symptoms, 11.7% had moderate symptoms, and 1.7% had severe symptoms. Frailty score was moderately and positively correlated with depression score (Spearman's rho = 0.59; 95% CI: 0.39-0.73; p < .001). Conclusion: Frailty and depression were significantly associated among older adults in this primary healthcare sample. Because the cross-sectional design does not establish directionality, routine screening for both conditions and longitudinal research are recommended to clarify causal pathways and guide preventive gerontic nursing interventions.
Copyright (c) 2026 Citra Windani Mambang Sari, Desy Indra Yani, Rizka Andara Fauzi, Shigeaki Watanuki, Mazlinda Musa
Effectiveness of Brandt-Daroff Exercises in Improving Postural Balance Among Older Adults With Recurrent Vertigo: A Quasi-Experimental Pretest-Posttest Study
Introduction: Recurrent vertigo in older adults is frequently associated with impaired postural control, unsteadiness, fear of falling, and reduced independence in daily activities. Brandt-Daroff exercises are a simple home-based vestibular rehabilitation approach that may support balance recovery through repeated positional stimulation and vestibular habituation. However, evidence regarding their use in community-based older adult populations in Indonesia remains limited. Objective: This study aimed to examine the effectiveness of Brandt-Daroff exercises in improving postural balance among older adults with recurrent vertigo. Methods: A quasi-experimental study with a one-group pretest-posttest design was conducted at the Pangudi Luhur Integrated Center, Bekasi, Indonesia. Thirty-three older adults with recurrent vertigo and impaired balance were recruited using total sampling. Postural balance was assessed before and after the intervention using the Romberg Test observation sheet. Participants were taught Brandt-Daroff exercises and performed the exercises three times daily for two consecutive weeks. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Results: Before the intervention, all participants demonstrated impaired postural balance based on the Romberg Test. After two weeks of Brandt-Daroff exercises, 24 participants (72.7%) showed improvement, while 9 participants (27.3%) continued to experience balance impairment. The Wilcoxon signed-rank test indicated a statistically significant improvement in postural balance after the intervention (Z = -4.889, p < 0.001). Conclusion: Brandt-Daroff exercises significantly improved postural balance among older adults with recurrent vertigo. These exercises may serve as a safe, low-cost, and feasible home-based vestibular rehabilitation strategy that can be integrated into community nursing practice. Further studies with control groups, larger samples, validated vertigo-specific outcome measures, and longer follow-up periods are recommended.
Copyright (c) 2026 Mila Sartika, Riska Subhianti Putri, Risti Tamara Tahanora, Hana Priscilla Frudence Sohilait
Cyberbullying Exposure, Sleep Disturbance, and Heart Rate Variability Among Adolescents: A Cross-Sectional Study
Introduction: Cyberbullying has emerged as a major adolescent health concern in the digital era. Although its psychological consequences are well documented, less is known about how cyberbullying relates simultaneously to sleep disturbance and physiological stress responses. Understanding these interconnected effects is important for developing comprehensive adolescent health assessment and intervention strategies. Objective: This study aimed to analyze the association between cyberbullying exposure, sleep disturbance, perceived stress, and physiological stress responses among adolescents. Methods: : A cross-sectional analytical study was conducted among 150 adolescents aged 15–18 years enrolled in senior high schools in West Java, Indonesia. Participants were selected using multistage cluster sampling. Cyberbullying exposure was assessed using the Cyberbullying Victimization Scale, sleep quality using the Pittsburgh Sleep Quality Index, and perceived stress using the Perceived Stress Scale-10. Physiological stress response was measured using resting heart rate variability (HRV) obtained under standardized resting conditions. Data were analyzed using IBM SPSS Statistics version 26.0 and AMOS version 24.0 through descriptive statistics, Pearson correlation, multiple linear regression, and structural equation modeling. Results: Participants reported moderate cyberbullying exposure (mean = 24.36, SD = 7.12), poor sleep quality (mean PSQI = 7.48, SD = 3.05), moderate perceived stress (mean = 18.92, SD = 5.64), and reduced HRV (mean = 42.15, SD = 10.83). Cyberbullying was positively correlated with sleep disturbance (r = .46, p < .01) and perceived stress (r = .52, p < .01), and negatively correlated with HRV (r = −.41, p < .01). Structural modeling indicated that cyberbullying was associated with HRV both directly and through pathways involving sleep disturbance and perceived stress. Conclusion: Cyberbullying is significantly associated with behavioral, psychological, and physiological stress responses in adolescents. Early multidimensional assessment is needed to reduce its long-term health consequence
Copyright (c) 2026 nia aprilia, Alini Alini, Ayu Dekawaty
Wearable-Integrated Education and Its Association with Self-Management and Quality of Life Among Patients with Hypertension: A Quasi-Experimental Study
Introduction: Hypertension is a leading global health concern requiring sustained self-management to prevent complications and improve quality of life. While digital health interventions are increasingly adopted, evidence on the effectiveness of wearable-integrated education in hypertension management remains limited. Objective: This study aimed to evaluate the effectiveness of wearable-integrated education on self-management behaviors and quality of life in patients with hypertension. Methods: A quasi-experimental study was conducted with 200 hypertensive patients recruited from community health centers. Participants were allocated into an intervention group (n = 100), which received wearable-integrated educational modules providing personalized feedback and reminders, and a control group (n = 100), which received standard health education. Outcomes included self-management, measured using the Hypertension Self-Management Behavior Questionnaire (HSMBQ), and quality of life, assessed with the WHOQOL-BREF. Descriptive, correlation, and multivariate regression analyses were performed. Results: Participants had a mean age of 54.2 years (SD = 9.1), with no significant baseline differences between groups. Post-intervention, the intervention group reported significantly higher self-management scores (78.4 ± 8.6 vs. 70.2 ± 9.1; p < 0.001) and quality of life scores (82.6 ± 10.2 vs. 75.1 ± 11.0; p < 0.001) compared with controls. Correlation analyses indicated that higher education, shorter duration of hypertension, and intervention participation were positively associated with outcomes. Multivariate regression confirmed the intervention as an independent predictor of both self-management (β = 0.39, p < 0.001) and quality of life (β = 0.36, p < 0.001), with models explaining 29% and 26% of the variance, respectively. Conclusion: Wearable-integrated education significantly improves self-management behaviors and quality of life among hypertensive patients. These findings highlight the potential of integrating wearable technology with educational strategies as a scalable, community nursing–driven approach to hypertension management
Copyright (c) 2026 Sudarman Sudarman, Akbar Asfar, Wa Ode Sri Asnaniar, Brajakson Siokal, Wa Ode Ratniwati S
Self-Efficacy and Resilience as Mediators of the Relationship Between Social Support and Relapse Tendency Among Individuals with Substance Use Disorder in Indonesia
Introduction: Substance abuse has been a public health concern, and even after detoxification treatment, the relapse rate is still high. Objectives: To explore relationship between self-efficacy, resilience and social support with relapse tendency in substance use disorder in Indonesia. Methods: The study employed a cross-sectional design and was conducted at a rehabilitation hospital in Jakarta, Indonesia. In order to be eligible for the study, participants had to be at least 18 years old, have normal and stable cognitive states, and have been diagnosed with a substance use disorder in the last year by experienced psychiatrists. The study variables were measured using a psychological questionnaire of relapse tendency, a self-administered social support survey, a bidimensional resilience scale, and self-efficacy. Also, 5,000 bootstrap samples with 95% CIs were used to assess the significance of the potential moderating effects. Results: Of 200 sample, there were 120 males and 80 females, mean age was 37.56 (SD=5.89). Descriptive analysis showed social support (71.2 ± 23.45), self-efficacy (7.03 ± 3.49), resilience (55.5 ± 17.66), relapse tendency (39.7 ± 15.28). Social support was negatively associated with relapse tendency (r = −0.689, p < 0.001). Mediation analysis showed significant indirect associations through self-efficacy and resilience. The indirect pathway through self-efficacy accounted for 13.50% of the total effect, the pathway through resilience accounted for 12.69%, and the sequential pathway through self-efficacy and resilience accounted for 11.72%. Bootstrap confidence intervals for all indirect effects did not include zero, indicating statistical significance. Conclusions: Self-efficacy and resilience are the most important factors in the relationship between social support and the likelihood of relapse in patients with substance use disorders. Social support was associated with lower relapse tendency, and this association was partially explained by self-efficacy and resilience. Longitudinal studies are required to confirm the proposed mediation pathways.
Copyright (c) 2026 Tuty Yanuarti, Rusmai Triaswati
Effects of Passiflora edulis Juice on Blood Pressure Among Patients with Hypertension: A Randomized Double-Blind Placebo-Controlled Trial
Introduction: Hypertension remains a major global public health challenge and a leading risk factor for cardiovascular morbidity and mortality. In addition to pharmacological therapy, dietary and natural product-based interventions have gained increasing attention as complementary strategies for blood pressure control. Passiflora edulis (passion fruit) contains bioactive compounds with potential antihypertensive properties; however, clinical evidence supporting its effectiveness remains limited. Objective: This study aimed to examine the effect of Passiflora edulis juice consumption on systolic and diastolic blood pressure among patients with hypertension. Methods: A randomized, double-blind, placebo-controlled trial was conducted among hypertensive patients attending an outpatient clinic in Indonesia. Participants were randomly assigned to receive either Passiflora edulis juice or a placebo beverage daily for a predefined intervention period. Systolic and diastolic blood pressure were measured at baseline and follow-up using standardized procedures. Data were analyzed using linear mixed-effects models to assess changes in blood pressure over time between groups, adjusting for relevant baseline covariates. All analyses followed the intention-to-treat principle. Results: Participants in the Passiflora edulis juice group demonstrated a significant reduction in both systolic and diastolic blood pressure compared with the placebo group over the intervention period. The group × time interaction effect was statistically significant (p < 0.05), indicating greater blood pressure reduction among participants who consumed Passiflora edulis juice. No serious adverse events related to the intervention were reported. Conclusion: Daily consumption of Passiflora edulis juice was effective in reducing systolic and diastolic blood pressure among hypertensive patients. These findings suggest that Passiflora edulis juice may serve as a safe and beneficial complementary dietary intervention for hypertension management. Further large-scale and long-term studies are recommended to confirm these findings and explore underlying mechanisms.
Copyright (c) 2026 Roihatul Zahro, Ita Rahmawati, Mono Pratiko Gustomi
Association of Empowerment-Oriented Self-Care Education with Quality of Life Among Hemodialysis Patients in a Resource-Limited Setting: A Quasi-Experimental Study
Introduction: Chronic kidney disease (CKD) is a major global health problem, and many patients with end-stage kidney disease require maintenance hemodialysis. Although life-sustaining, hemodialysis is associated with persistent symptoms, psychosocial distress, and lifestyle restrictions that reduce health-related quality of life (HRQoL), particularly in resource-limited settings. Empowerment-oriented self-care education may strengthen patients’ ability to manage dialysis-related demands and improve HRQoL, yet evidence from district-level services remains limited. Objective: To evaluate the effect of an empowerment-oriented self-care education program on HRQoL among patients receiving maintenance hemodialysis. Methods: A quasi-experimental, two-arm pretest–posttest study with a control group was conducted in 2022 in a public district hospital hemodialysis unit in Sukabumi, West Java, Indonesia. Eligible adults receiving maintenance hemodialysis were recruited using consecutive sampling and allocated to either an intervention group (empowerment-oriented self-care education) or a usual-care control group. The intervention consisted of structured nurse-led self-care education integrated into routine dialysis visits and focused on guided problem-solving, collaborative goal setting, self-management skills, and coping strategies related to dialysis care. Health-related quality of life (HRQoL) was assessed at baseline and after completion of the intervention using the Kidney Disease Quality of Life 36-item survey (KDQOL-36). Data were analyzed using descriptive statistics and multivariable linear mixed-effects models to estimate group, time, and group × time effects, adjusting for baseline covariates. Results: Of 68 screened patients, 62 were enrolled and 58 completed primary analyses. Compared with usual care, the intervention group showed greater improvements in Burden of Kidney Disease, Symptoms/Problems, Effects of Kidney Disease, and SF-12 physical and mental components. Conclusion: Empowerment-oriented self-care education was associated with meaningful improvements in HRQoL among hemodialysis patients in a resource-limited setting. Integrating structured empowerment-based self-care education into routine hemodialysis nursing practice may help reduce perceived disease burden and improve patient well-being
Copyright (c) 2026 Nunung Liawati, Ady Waluya
A Longitudinal Evaluation of a Mind–Body Slow Deep Breathing Intervention for Blood Pressure Control in Older Adults with Hypertension
Introduction: Hypertension is highly prevalent among older adults and often remains inadequately controlled despite pharmacological treatment, particularly in community and primary care settings. Low-cost, non-pharmacological interventions that support long-term self-management are increasingly recommended. Slow deep breathing, a mind–body intervention targeting autonomic regulation, has shown potential to reduce blood pressure, but longitudinal evidence among older adults remains limited. Objective: This study aimed to examine the longitudinal association between a structured slow deep breathing intervention and changes in blood pressure and quality of life among older adults with hypertension. Methods: A longitudinal repeated-measures quasi-experimental study with a comparison group was conducted among community-dwelling adults aged ≥60 years with hypertension. Participants were allocated to either a slow deep breathing intervention group or a standard hypertension education group using a non-random allocation approach. The intervention consisted of guided slow deep breathing practiced daily for four weeks. Blood pressure and quality of life (WHOQOL-OLD) were assessed at baseline, week 4, and week 8. Linear mixed-effects models were used to evaluate group-by-time interactions while adjusting for baseline values and antihypertensive medication use. Results: Sixty-eight participants completed the study (intervention n = 34; comparison n = 34). Compared with the comparison group, the intervention group showed greater reductions in systolic (β = −6.82, 95% CI −10.23 to −3.41, p < .001) and diastolic blood pressure (β = −3.94, 95% CI −6.31 to −1.57, p = .002), along with greater improvements in quality of life (β = 3.26, 95% CI 1.54–4.98, p < .001).. Conclusion: Participation in structured slow deep breathing was associated with improved blood pressure control and quality of life. Further randomized studies are needed to confirm effectiveness and causal relationships.
Academic Stress, Digital Distraction, and Academic Procrastination in Generation Z Nursing Students: A Longitudinal Study of the Protective Role of Resilience
Introduction: Generation Z nursing students face substantial academic demands alongside continuous smartphone engagement, which may be associated with digital distraction and academic procrastination. Although associations between academic stress and procrastination have been reported, the longitudinal role of problematic smartphone use as an indicator of digital distraction and the buffering role of resilience remain underexplored. Objective: This study examined longitudinal associations among academic stress, digital distraction operationalized through problematic smartphone use, and academic procrastination in Generation Z nursing students and explored resilience as a protective factor. Methods: A three-wave longitudinal survey was conducted among undergraduate nursing students in West Java, Indonesia. Measures included PSS-10, Smartphone Application-Based Addiction Scale (SABAS), PASS, and CD-RISC-10 at baseline, 4 weeks, and 8 weeks. Of 368 participants, 342 completed all waves (retention 92.9%; mean age 20.34 ± 1.71 years; 79.5% female). Data were analyzed using structural equation modeling with cross-lagged panel and moderation analysis. Results: At baseline, academic stress was positively associated with digital distraction (r = .41, p < .001) and procrastination (r = .46, p < .001), while digital distraction was associated with procrastination (r = .49, p < .001). Resilience was negatively associated with stress (r = −.38, p < .001) and procrastination (r = −.34, p < .001). Model fit was acceptable (CFI = .93–.94, TLI = .92–.93, RMSEA = .047–.049, SRMR = .041–.043). Higher academic stress was associated with subsequent digital distraction (β = .32, p < .001) and procrastination (β = .21, p = .004). Indirect associations were significant (β = .12, 95% CI [.07, .18]). Resilience was associated with lower procrastination (β = −.24, p < .001) and moderated the stress–procrastination association (β = −.18, p = .002). Conclusion: Academic stress was longitudinally associated with academic procrastination, directly and through digital distraction operationalized as problematic smartphone use. Higher resilience was associated with lower procrastination and a weaker stress–procrastination association
Barriers and Facilitators to Inclusive Healthcare for Children with Developmental Disabilities: A Qualitative Study of Caregiver and Healthcare Provider Perspectives
Introduction: Children with developmental disabilities frequently require long-term, multidisciplinary, and family-centered healthcare services. However, caregivers often encounter structural, logistical, communication, and professional barriers when accessing healthcare services for their children. Understanding both barriers and facilitators from caregiver and healthcare provider perspectives is essential for improving inclusive healthcare. Objective: This study aimed to explore barriers and facilitators to inclusive healthcare for children with developmental disabilities from the perspectives of caregivers and healthcare providers. Methods: A qualitative descriptive study was conducted using individual semi-structured interviews with 36 participants, consisting of 20 caregivers and 16 healthcare providers. Participants were recruited purposively from hospitals, rehabilitation centers, and community health facilities. Interviews were conducted individually, audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Recruitment continued until thematic saturation was achieved, defined as the point at which no new codes, categories, or themes emerged across consecutive interviews. Results: Six themes were identified: structural constraints within healthcare systems, accessibility and logistical barriers, communication dynamics between caregivers and healthcare providers, professional competency and training gaps, caregiver resilience and advocacy, and collaborative community-based support systems. Key barriers included limited specialized services, long waiting times, transportation difficulties, complex referral pathways, and insufficient provider training. Facilitators included caregiver advocacy, interdisciplinary collaboration, peer support networks, and community-based support systems. Conclusion: Inclusive healthcare for children with developmental disabilities requires system-level improvements in healthcare infrastructure, referral coordination, provider training, family-centered communication, and community-based support. Strengthening these areas may improve equitable healthcare access, particularly in resource-constrained settings
A Structural Model of Stigma, Spiritual Coping, and Mental Health Literacy Influencing Postpartum Mothers’ Mental Health Help-Seeking
Introduction: Postpartum mental health problems remain common, yet many mothers do not seek professional support. Stigma, limited mental health literacy, and reliance on coping strategies, including spiritual coping may jointly shape help-seeking decisions, but these factors are rarely tested within a single explanatory model. Objective: To examine a triadic model linking stigma, spiritual coping, and mental health literacy with postpartum mothers’ help-seeking behavior, including the moderating role of spiritual coping. Methods: A cross-sectional analytical study was conducted among 100 postpartum mothers (≤12 months after delivery) recruited from maternal–child health clinics and online parenting communities in West Java, Indonesia. Validated questionnaires assessed stigma, spiritual coping, mental health literacy, and self-reported help-seeking behavior. Data were analyzed using Pearson correlations, hierarchical multiple regression, and structural equation modeling (SEM). Model fit was evaluated using χ²/df, RMSEA, CFI, and TLI. Results: Stigma correlated negatively with help-seeking (r = −0.42, p < .001) and mental health literacy (r = −0.34, p < .01), while mental health literacy correlated positively with help-seeking (r = 0.51, p < .001). In regression analysis, stigma, spiritual coping, and mental health literacy explained 42% of the variance in help-seeking (R² = 0.42, p < .001), with mental health literacy as the strongest predictor (β = 0.41, p < .001), followed by stigma (β = −0.33, p < .001) and positive spiritual coping (β = 0.25, p = .005). SEM showed good fit (χ²/df = 1.87; RMSEA = 0.052; CFI = 0.95; TLI = 0.93) and confirmed direct effects of stigma (β = −0.31, p < .001), mental health literacy (β = 0.44, p < .001), and spiritual coping (β = 0.22, p = .015) on help-seeking. Spiritual coping significantly moderated the stigma–help-seeking relationship (β = 0.18, p = .024), attenuating stigma’s negative effect. Conclusion: Postpartum help-seeking is shaped by the combined influence of stigma, mental health literacy, and spiritual coping, with spiritual coping buffering stigma’s harmful impact. Integrated interventions should reduce stigma, strengthen mental health literacy, and leverage adaptive spiritual resources.
Copyright (c) 2026 R. Noucie Septriliyana
Associations Among Dietary Patterns, Perceived Stress, and Hypertension: A Community-Based Path Analysis Study
Introduction: Hypertension is a leading modifiable contributor to cardiovascular morbidity and mortality. Dietary patterns and psychosocial stress are interrelated determinants of hypertension, yet they are rarely examined simultaneously within community settings. Objective: To examine direct and indirect pathways linking dietary patterns and perceived stress with hypertension among community-dwelling adults using path analysis. Methods: A cross-sectional study was conducted among adults aged 30–65 years selected through multistage cluster sampling from community health center areas. Dietary intake was assessed using a validated 95-item Food Frequency Questionnaire to identify Prudent, Western, and Traditional dietary patterns. Perceived stress was measured with the PSS-10. Blood pressure was measured using standardized procedures; hypertension was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg or antihypertensive use. Associations were examined using bivariate analysis and structural equation modeling. Results: Among 250 participants (mean age 49.6±8.7 years; 57.2% female), hypertension prevalence was 38.8%. The Prudent pattern was inversely associated with blood pressure and stress, whereas the Western pattern showed positive associations (all p≤0.01). Path analysis showed that the Western pattern was positively associated with perceived stress (β=0.24, p=0.002) and hypertension status (β=0.29, p<0.001), while the Prudent pattern was inversely associated with hypertension status (β=−0.18, p=0.004). Conclusion: Western dietary patterns were associated with higher hypertension risk both directly and indirectly through perceived stress, while Prudent patterns showed protective associations.
Copyright (c) 2026 supriadin supriadin, Imam Fajlrurrahman, Linda Putri Jumiati
Psychosocial, Behavioral, and Spiritual Determinants of Quality of Life in Chronic Kidney Disease: A Path Analysis Study
Introduction: Chronic Kidney Disease (CKD) is a progressive, irreversible condition that impairs physical, psychological, and social functioning, reducing patients’ quality of life (QoL). While factors like treatment adherence, social support, coping, and spirituality have been linked to QoL, few studies have explored their interrelationships in low- and middle-income countries. Objective: This study examined the direct and indirect associations among psychosocial, behavioral, and spiritual factors and quality of life among patients with chronic kidney disease undergoing maintenance hemodialysis in Indonesia using a hypothesized path model. Methods: A cross-sectional study was conducted with 300 adult CKD patients from three hemodialysis centers in Jakarta, selected via consecutive sampling. QoL (KDQOL-36™), social support, treatment adherence, self-efficacy, health literacy, coping strategies, and spiritual well-being were assessed using validated instruments. Path analysis was performed using AMOS version 24, with model fit evaluated using CFI, TLI, RMSEA, and SRMR. Significance was set at p < .05. Results: The model showed good fit (CFI = 0.945, TLI = 0.927, RMSEA = 0.057, SRMR = 0.048). Treatment adherence had the strongest direct effect on QoL (β = 0.31, p < .001), followed by coping strategies (β = 0.24) and spiritual well-being (β = 0.22). Social support, self-efficacy, and health literacy indirectly influenced QoL through treatment adherence. The highest total effect on QoL was from treatment adherence (β = 0.31), followed by coping (β = 0.24), spirituality (β = 0.22), and social support (β = 0.18). Conclusion: QoL in CKD patients is influenced by treatment adherence, coping, spirituality, and psychosocial support. Holistic, culturally sensitive interventions integrating education, psychological support, and spiritual care are essential to improve outcomes in resource-limited settings.
Maternal Sensitivity and Its Association with Cognitive and Socio-Emotional Development in Infants: A Cross-Sectional Study
Background: The first six months of life represent a critical period for brain development and emotional regulation in infants. Maternal sensitivity plays a vital role in shaping early cognitive and socio-emotional outcomes. However, empirical research examining this association in Southeast Asian populations, particularly during the early infancy stage, remains limited. Objective: This study aimed to examine the relationship between maternal sensitivity and both cognitive and socio-emotional development among infants aged 0 to 6 months in Bandung, Indonesia. Methods: A cross-sectional design was employed involving 120 mother-infant dyads recruited from urban and semi-urban maternal and child healthcare centers. Maternal sensitivity was assessed through structured observation using the Maternal Behavior Q-Sort (MBQS) – Short Version. Infant development was measured using the Ages and Stages Questionnaire, Third Edition (ASQ-3), focusing on the communication and personal-social domains. Data were analyzed using descriptive statistics, Pearson’s correlation, multiple linear regression, and path analysis. Model fit was evaluated using chi-square, RMSEA, CFI, and TLI indices. Results: Maternal sensitivity was positively correlated with infant cognitive (r = 0.42, p = 0.001) and socio-emotional (r = 0.38, p = 0.002) scores. Regression analysis confirmed that maternal sensitivity significantly predicted developmental outcomes even after adjusting for maternal education, infant age, and parity. Path analysis showed strong direct effects of maternal sensitivity on development and indirect effects via maternal education. The model demonstrated good fit (χ² = 2.45, RMSEA = 0.041, CFI = 0.981, TLI = 0.965). Conclusion: Maternal sensitivity is a key factor influencing early developmental outcomes in infants. These findings highlight the need for early identification and supportive interventions within pediatric and maternal health services to foster responsive caregiving and optimize developmental trajectories.
Copyright (c) 2026 Dewi Srinatania, Tukimin Bin Sansuwito, Idris Adewale Ahmed
Nursing-LED and Nursing Supported Interventions to Enhance Resilience Among Vulnerable Populations in Post-Disaster Settings: A Scoping Review
Introduction: Increasing global disasters due to climate change have caused severe health crises, especially for vulnerable groups like older adults, people with disabilities, and those with chronic diseases. This study was conducted to map nursing interventions designed to enhance the resilience of vulnerable populations. Methods: This study used scoping review following Arksey and O’Malley and PRISMA-ScR guidelines. The eligibility were structured using the PCC (Population, Concept, Context) framework. A systematic search was executed for original English articles that published between 2016-2026 and written in english from databases including PubMed, Scopus, and EBSCOhost. Study selection was performed independently by two reviewer, and data extraction utilized a standardized charting form. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: A total of 275 articles were identified from three databases through the literature search. After screening, 15 final articles were included in the current review. The synthesis categorized interventions into two primary domains: (1) Physical Domain, comprising chronic disease management and self-management support, household emergency preparedness, and community healthcare outreach to navigate disaster-affected terrain; and (2) Psychological Domain, encompassing community-based psychosocial and trauma skills programs (e.g., SOLAR, CBDMHI), digital-based psychosocial interventions, and self-efficacy-focused education. Findings indicate that nurses function as critical care coordinators and community mobilizers. However, the synthesis reveals significant evidence gaps regarding the long-term sustainability of these interventions, the limited representation of populations with "layered vulnerabilities," and the need for standardized resilience metrics. Conclusion: Nursing-led interventions are paramount for sustainable resilience by integrating physical domain support with psychosocial and digital-based care. These strategies effectively leverage nursing roles as coordinators and community mobilizers, though future efforts must prioritize longitudinal implementation and policy integration to ensure long-term recovery for vulnerable populations
Copyright (c) 2026 Aliza Zulpa Putri, Firda Afriyani, Pujowati Pujowati, Yuni Fuji Fazriyyah, Puput Antika Sari, Wendi Sujana, Andi Mohamad Jalaludin, Baiq Dara Wulandari Saputri, Gumilar Supriyansah, Meriem Meyzabellah, Irpan Muhamad Nurdin, Wildan Akhmad Ihza Wardaya, Cecep Eli Kosasih, Yanny Trisyani, Vo Hoang Minh
Self-Management in Breast Cancer Survivorship: A Scoping Review of Patient Needs, Barriers, and Facilitators
Introduction: Breast cancer is a global health issue causing significant physical, emotional, and social burdens. Self-management is crucial in breast cancer care, but challenges such as healthcare access, emotional struggles, and financial difficulties could hinder its effectiveness. Objective: This scoping review aims to systematically explore the evidence about self-management in breast cancer care by identifying needs, barriers, and facilitators on its implementation. Materials and Methods: Using the Joanna Briggs Institute (JBI) framework, a comprehensive search was conducted across PubMed and Google Scholar for studies published between January 1st, 2019 and March 4th, 2025. The focus was on adult breast cancer patients, with studies addressing self-management needs, challenges, or supportive factors. Data were extracted and analysed using a critical interpretive synthesis approach. Results: The review included 14 studies, highlighting that breast cancer survivors face diverse needs, such as managing physical symptoms, accessing emotional support, finding reliable information, and building social connections. Key challenges included limited access to healthcare, emotional distress, and financial constraints. Supportive factors such as digital health tools, peer support networks, and personalized care strategies were found to improve self-management outcomes. Digital health innovations, such as mobile apps and online platforms, showed promise in enhancing patient engagement and treatment adherence. Conclusion: The review emphasizes the significance of personalized, technology-supported, and socially connected self-management strategies in breast cancer care, suggesting future research should focus on inclusive, culturally sensitive interventions.
Family-Based Digital Storytelling to Support Daily Diabetic Foot Self-Care: A Narrative Review
Introduction: Diabetic foot complications require sustained self-care behaviours and effective educational strategies within community and family nursing contexts. Objective: This review aimed to synthesise evidence on family-based digital storytelling as a nursing education strategy to support daily diabetic foot self-care Methods: : A narrative review was conducted using searches of PubMed, ScienceDirect, and Google Scholar. Relevant peer-reviewed articles published between 2020 and 2025 were analysed using narrative thematic synthesis guided by nursing theoretical perspectives. Results: Ten studies were included. .Five themes emerged: family co-regulation,, narrative meaning-making, emotional activation, procedural guidance, and behavioural continuity. Combined, family involvement and narrative learning consistently sustained daily self-care behaviours. Conclusion: Family-based digital storytelling ensures daily diabetic foot care continuity through emotional and relational engagement. Mechanistically, nursing curricula should integrate narrative digital competencies, while community nurses can adopt this scalable method as a standardized clinical protocol to replace traditional, low-adherence pamphlets
Copyright (c) 2026 Anih Kurnia, Faridah Mohd Said, Mahuya Karmakar, Lisna Anisa Fitriana
Web-Based ECG Learning Applications and Their Potential Contribution to Basic Trauma and Cardiac Life Support Competencies: A Scoping Review
Introduction: Electrocardiogram (ECG) interpretation is essential for recognising shockable rhythms, life-threatening arrhythmias, and ischemia in basic trauma and cardiac life support (BT&CLS). Although digital ECG learning tools are increasingly implemented, their contribution to BT&CLS-related competencies has not been comprehensively mapped, particularly in low- and middle-income countries (LMICs). Objective: To map and synthesise evidence on web-based ECG learning applications used to improve competencies relevant to BT&CLS, including knowledge, interpretation accuracy, confidence, usability, and resuscitation-related performance. Methods: This scoping review followed the PRISMA-ScR guideline. Searches were conducted in PubMed, ScienceDirect, and Google Scholar for peer-reviewed studies published in English or Indonesian between January 2019 and December 2024. Eligibility was guided by the Population–Concept–Context framework and included healthcare learners and professionals using web-based, mobile, or digital ECG learning tools in emergency, cardiovascular, or life-support education. Two reviewers independently performed study selection, data extraction, and quality appraisal using RoB 2 and Joanna Briggs Institute tools. Findings were synthesised narratively through thematic analysis. Results: Of 1,243 records identified, 18 studies were included. Study designs comprised randomised controlled trials, quasi-experimental, mixed-methods, observational, and usability studies across diverse settings. Web-based ECG applications consistently improved ECG knowledge and interpretation accuracy, with several interventions outperforming traditional lectures. Participants also reported increased confidence, engagement, and positive user experience. Methodological quality was generally moderate to good, although limited long-term follow-up and direct BT&CLS outcome assessment were noted. Conclusion: Web-based ECG learning applications enhance ECG-related competencies and are feasible across settings, including LMICs. Future studies should integrate ECG learning into BT&CLS simulations and evaluate effects on real-world resuscitation performance
Copyright (c) 2026 Nur Halimah, Inca Buntari Agustini, Ni Made Dewi Wahyunadi, I Wayan Edi Sanjana
Climate Change and Perinatal Mental Health: A Scoping Review of Environmental Exposures, Risk Factors, Protective Processes, and Potential Mechanisms
Introduction: Perinatal mental health disorders, including depression, anxiety, and trauma-related distress, are common conditions with potential long-term consequences for maternal functioning, infant development, and family well-being. Climate change is increasingly recognized as a health threat multiplier through environmental exposures and psychosocial stressors that may affect women during pregnancy and the postpartum period. Objective: This scoping review aimed to map and synthesize evidence on climate change–related exposures and perinatal mental health outcomes among pregnant and postpartum women, with attention to risk pathways, protective factors, and implications for nursing and maternal health services. Methods: This scoping review followed Joanna Briggs Institute guidance and was reported according to PRISMA-ScR. Searches were conducted in PubMed and Google Scholar for studies published between January 2010 and March 2025. Eligible studies included qualitative, quantitative, mixed-methods, and quasi-experimental. Human studies involving pregnant women or women up to 12 months postpartum formed the primary synthesis. Two reviewers independently screened studies and extracted data for descriptive and thematic synthesis. Results: Of 766 records identified, 14 studies met the inclusion criteria. Evidence was predominantly observational and focused on human populations; animal studies, where identified, provided contextual insight and were not included in the primary synthesis. Five domains emerged: extreme heat and weather events, heat-related psychiatric emergency encounters, wildfire exposure, air pollution, and climate anxiety with climate-related food insecurity. These exposures were generally associated with greater psychological distress, anxiety, depressive symptoms, and poorer maternal mental health, while social support appeared protective. Conclusions: Current evidence suggests that climate change–related exposures may be associated with adverse perinatal mental health outcomes through interconnected pathways. However, causal interpretation remains limited. Climate-informed screening, counseling, and social support integration may strengthen climate-resilient perinatal mental health services.
Copyright (c) 2026 Siti Nur Endah Hendayani
MMAS-8-Guided Nurse-Pharmacist Collaborative Education to Improve Medication Adherence and Blood Pressure Control in Patients with Hypertension: A Case Study
Introduction: Poor adherence to antihypertensive medication remains a major challenge in hypertension management and may contribute to uncontrolled blood pressure and preventable complications. Structured education guided by medication adherence assessment may help patients understand their treatment and improve medication-taking behavior. Objective: This case study aimed to describe the implementation of MMAS-8-guided nurse-pharmacist collaborative education to improve medication adherence and blood pressure control in patients with hypertension. Methods: This study used a descriptive case study design involving five patients with hypertension in the working area of Cimandala Primary Health Center, Bogor, Indonesia. The intervention consisted of structured education delivered collaboratively by nurses and pharmacists over 14 days. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), while blood pressure was measured before and after the intervention. Results: Before the intervention, four patients had medium medication adherence and one patient had low adherence. After the intervention, all patients achieved high adherence with MMAS-8 scores of 8. Mean systolic blood pressure decreased from 153 mmHg to 139 mmHg, and mean diastolic blood pressure decreased from 95 mmHg to 88 mmHg. Patients also reported improved understanding of hypertension management, increased motivation to take medication regularly, and stronger family support. Conclusion: MMAS-8-guided nurse-pharmacist collaborative education was associated with improved medication adherence and better blood pressure control among patients with hypertension. This approach may be considered a practical, patient-centered strategy to support hypertension management in primary healthcare settings