Experiences and perceptions of nurses and air ambulance service providers in carrying out aeromedical evacuations in Indonesia: A qualitative research.

Background: Basic non-military flight nurse training is essential for enhancing nurses' competency in conducting aeromedical evacuations. Trained nurses possessing flight nurse proficiency are indispensable for ensuring stable patient conditions amidst the unique physical, physiological, and psychological challenges encountered during flights. Objective: This study aimed to describe the experiences and perceptions of nurses and air ambulance service providers regarding aeromedical evacuations. Methods: This study employed a qualitative descriptive design. Data were gathered from February to July 2023 through semi-structured online interviews with seven nurses and air ambulance service providers engaged in aeromedical evacuation. Content analysis was utilized to interpret the interview data. Results: Seven themes were generated: 1) Experiences in aeromedical evacuation experiences, 2) Challenges faced by nurses and air ambulance service providers during aeromedical evacuations, 3) Essential knowledge for nurses involved in aeromedical evacuations, 4) Efforts to improve nurses' knowledge and skills, 5) Leveling of flight nurse training, 6) Flight nurse training methods, and 7) Flight nurse training evaluation strategies. Conclusion: Nurses and air ambulance service providers acknowledge the significant influence of the flight environment on changes in patient conditions during aeromedical evacuations. To effectively manage alterations in patient conditions during flights, healthcare workers equipped with aviation health competency are imperative. One approach to enhancing the competency of healthcare workers is through flight nurse training. The findings from this study serve as a valuable resource for policymakers and health-related institutions endeavoring to formulate aeromedical evacuation strategies.

The effectiveness of play therapy in children with leukemia: A systematic review.

PROBLEM: Leukemia is the most common form of childhood cancer worldwide. Children living with leukemia experience various problems because of the disease's progression, harmful effects of treatment, and prolonged hospitalization process. To increase their well-being and alleviate their problems, these children require ongoing support. One solution that both parents and professionals can use is play therapy. This systematic review aimed to identify the type and effectiveness of play therapy in children living with leukemia. ELIGIBILITY CRITERIA: We searched PubMed, Scopus, ScienceDirect, and ProQuest databases. Additionally, we performed manual searches on Google Scholar, Google Web, and grey literature. Inclusion criteria comprised: 1) Studies that implemented play therapy on leukemia children, 2) Full-text articles available in English or Indonesian languages from January 2000 to December 2021 and updated until July 2023, and 3) Intervention studies employing quasi-experimental or randomized controlled trial (RCT) designs. SAMPLE: From 1099 articles, 16 studies were selected. Several forms of play therapy were found, including pretend, music, art, and sand play therapy. RESULTS: Of the sixteen studies in this systematic review, fifteen demonstrated beneficial effects on psychological issues, particularly anxiety, despair, stress, and physical problems (fatigue and pain). CONCLUSION: Play therapy effectively alleviates some physical and psychosocial problems in children living with leukemia. IMPLICATION: Nurses can utilize play therapy as an intervention for children living with leukemia. Additionally, comparative research is recommended with a similar research strategy concerning studies with the same design. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022318549.

Chemo assist for children mobile health application to manage chemotherapy-related symptoms in acute leukemia in Indonesia: a user-centered design approach.

BACKGROUND: A mobile health (mHealth) application can encourage parents and pediatric patients to be involved in caring for their child's health condition by providing the ability to identify and actively manage chemotherapy-related symptoms in their child. Several monitoring systems available today are diverse in features and system basis. This study aimed to develop and trial the Chemo Assist for Children (CAC) mHealth application for symptom management in children with acute lymphoblastic leukemia (ALL). METHODS: In this study, the development of the CAC application went through multiple phases and methods. Study phases included: (1) development of the application's feature based on the need assessment, (2) creation of content of application based on literature review, (3) develop prototyping of CAC, (4) expert review and feedback on the application content, (5) usability testing by targeted end-user. RESULTS: Based on need assessment, it was determined that parents with leukemia children were interested in symptom management of chemotherapy and preferred mobile applications. Therefore, a mHealth application was designed to include features to identify symptoms and provide recommendation strategies to manage the symptom. Usability evaluation by end-user revealed that mHealth is a valid, accessible, and appropriate application for users. CONCLUSIONS: The CAC mHealth application developed can meet the needs of technology users to identify symptoms and manage chemotherapy-related symptoms in children with ALL. The CAC mHealth application can accommodate data not recorded at out-of-hospital care, increase the independence of symptom management, and improve communication between parents of children with ALL and health workers.

Development and Evaluation of Internet-based Health Technology in Pediatric Oncology: A Scoping Review.

OBJECTIVE: There is an increased awareness to identify symptomatic experiences in children undergoing chemotherapy. An Internet-based health technology accessible and friendly for children and parents to report health problems during chemotherapy has been well-developed in developed countries. The purpose of this scoping review is to provide a comprehensive view of relevant research related to the emergence of health applications in pediatric oncology so that it can provide information for design and evaluation in the future. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines support this scoping review. To investigate the evidence on the development of Internet-based health technology, Science Direct, Scopus, PubMed, EBSCOHOST Medline, IEEEXplore, ProQuest, and Nature databases were searched between 2015 and 2021. RESULTS: 14 articles met the inclusion criteria with nine Internet-based health technologies. Moreover, four of nine mobile health apps use a theoretical foundation (SPARK for children and family member, Empower Stars!, THRIVE, and Facebook-based "Healthy Teens for Soaam"), three apps apply four stages of development and testing, and all apps have met the category of the degree of attachment of patients to the application. CONCLUSION: The effect of Internet-based health technology through a scientific process by paying attention to the underlying theories, user needs, developer passion, application testing, and evaluation methods is the key to success.

Improving Nursing Students' Medication Safety Knowledge and Skills on Using the 4C/ID Learning Model.

INTRODUCTION: Learning medication-safety has become a focus in many countries to improve medication-safety competencies in nursing students. Research on instructional design for medication-safety is still limited, especially about the use of the Four Components Instructional Design (4C/ID) model. This study aimed to compare the knowledge and skills in medication safety of nursing students after the medication-safety training using four components of instructional design known as 4C/ID. METHODS: This was a posttest-only quasi-experimental study using an intervention and control group. The participants were the third-semester students of a nursing school at Yogyakarta, Indonesia (intervention: n=55, control: n=40). The intervention group was trained for five weeks using the 4C/ID approach with interactive lectures, small group discussions, reflections, and skills simulation sessions. An observational skills evaluation and Multiple-Choice Questionnaire were administered in the last week after the training completed. Independent sample t-test and Mann Whitney tests were used to analyze the mean differences of knowledge and skills in giving oral medicine and drug injections between the two groups. RESULTS: The majority of respondents were female (74.1%), aged 19-20 years (77.8%), with GPA >3 (87.37%) and, the majority had never received instruction about patient safety (69%). There were significant mean differences in overall knowledge (p<0.05) and also in the skills of oral drug and intramuscular drug administration (p<0.05) between the intervention and control groups. CONCLUSION: Training in medication-safety using the 4C/ID approach could improve the medication-safety knowledge and skills of the nursing students based on simple to complex learning.

Effect of care for child development training on cadres' knowledge, attitude, and efficacy in Yogyakarta, Indonesia.

Background: Stunting is a common malnutrition problem among children in the world. The Care for Children Development (CCD) intervention is a strategy to reduce stunting. Objective: This study aimed to identify the effect of culturally modified CCD training on the knowledge, attitude, and efficacy (KAE) of cadres about stunting in the community. Methods: We conducted a community-based study with a quasi-experimental research design using a comparison group. The study was conducted from March 2018 to February 2019 at three Public Health Centers in Yogyakarta, Indonesia. The total participants were 69 in the intervention group and 53 in the comparison group. Cadres in the intervention group received two days of training on a culturally modified CCD guideline. In contrast, cadres in the comparison group received a brief explanation (a one-day training) on that program. The nurses from three public health centers were facilitators in this training. Knowledge and self-efficacy were assessed using a modified Caregiver Knowledge of Child Development Inventory and General Self-efficacy Scale, respectively. Data were analyzed using Mann-Whitney U and Wilcoxon tests. Results: All 122 cadres completed the training. In the intervention group, CCD training significantly increased cadres' knowledge (median score 14 vs. 11), attitude (58 vs. 55), and efficacy (30 vs. 28), all with p <0.001. In the comparison group, the short explanation of CCD significantly improved cadres' knowledge (median score 12 vs. 10) and efficacy (29 vs. 27) but not their attitude. The delta or change in score before and after CCD training for cadres' attitude in the intervention group was significantly higher than that of the comparison group (3.78 vs. 0.72; p = 0.050). Conclusion: A culturally modified CCD training significantly improves cadres' KAE in the intervention group and cadres' knowledge in the comparison group. The learning delivery methods with demonstrations and role-plays significantly improved the cadres' attitudes as health educators for stunted mothers in the community. For sustainability, community health nurses should regularly collaborate with cadres to improve the nutritional status of children in their area.

Effect of music therapy on cortisol as a stress biomarker in children undergoing IV-line insertion.

OBJECTIVE: An IV-line insertion can often provoke stress that can lead to an increase in cortisol levels. Complementary medication such as music therapy is needed to overcome the increase in cortisol levels. We conducted this study to determine the effect of music therapy on salivary cortisol levels in children with leukaemia undergoing IV-line insertion. METHOD: This was a pre-experimental study with a pre- and post-test design. We analysed the salivary cortisol levels in 30 children with leukaemia undergoing IV-Line insertion from January until February 2018. Music was played using earphones after the completion of the IV-line insertion procedure. The salivary cortisol levels were analysed by an enzyme-linked immunosorbent assay (ELISA) test. Changes in cortisol levels were considered clinically significant if the differences were ≥0.05 ng/ml. The Wilcoxon test was used to test the effect of music therapy on cortisol levels and a p-value of <0.05 was considered statistically significant. RESULT: Levels of cortisol before and after the music therapy had a median (min-max) of 4.14 (0.25-9.89) and 3.47 (0.16-15.31), respectively. The median difference of cortisol levels was 0.67 ng/ml. This change of ≥0.05 ng/ml indicates the clinical effect of music therapy on cortisol levels. Though the music therapy did not significantly affect salivary cortisol levels (p = 0.99), this study revealed the clinical effect of music therapy in reducing cortisol levels. CONCLUSIONS: This study did not indicate a statistically significant effect of music therapy on cortisol levels of children with leukaemia during an IV-line insertion. However, the study findings reflect the clinical effect of music therapy in reducing cortisol levels.

Training on modified model of programme for enhancement of emergency response flood preparedness based on the local wisdom of Jambi community.

The community's role during a disaster within the first 24-72 hours before having government's aid is crucial in making the condition under control in a timely manner. Disaster management institution, especially at local level, has not had any models for flood preparedness training through participative approach based on the local wisdom of Jambi community to reduce disaster risks. This study tries to evaluate the effectiveness of training programme for flood preparedness based on the local wisdom designed for Jambi community, Indonesia. This research is an experimental study with pre- and post-test control design, in-class training followed by field practice and evaluated using three components: pre-test and post-test evaluations (score scale: 0-100), skill observation during disaster training (score scale: 1-4). The participants consisted of 24 local people chosen from the disaster-prone area; all participated in the disaster training. The score of pre- and post-test evaluations indicates improved post-test result with 71.4 (p < 0.005). There was also a skill improvement in the final simulation with 75% excellent score using model modification of programme for enhancement of emergency responses based on the local wisdom. This study completely evaluates the effectiveness of training for flood preparedness based on the local wisdom to improve the knowledge, ability and skill of people in disaster-prone areas.

Why do nursing students make medication errors? A qualitative study in Indonesia.

OBJECTIVES: This study aimed to explore Indonesian nursing students' perceptions of the types and causes of medication errors in clinical rotations. METHODS: This descriptive qualitative study was conducted with 26 nursing students who had completed their final clinical rotations. Data were collected through four focus group discussions and analysed by Colaizzi's method. RESULTS: Three themes were obtained from the data analysis: important role played by nurses in medication safety, types of medication errors (near misses) committed by nursing students, and the causes of medication errors during clinical rotations. CONCLUSION: Nurses play a vital role in dispensing medication and ensuring patient safety, but near misses are still reported during clinical rotations. Lack of knowledge, skills, proper supervision, and appropriate role models during clinical rotations lead to medication errors by nursing students. Appropriate role models and adequate supervision in the clinical education stage are necessary to ensure the achievement of medication safety competencies.