The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review.

Background: Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered. Purpose: This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients. Methods: Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis. Conclusion: Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children. Systematic Review Registration: PROSPERO registration number was CRD42023456278.

A Systematic Review of Experimental Studies on the Impact of Empowerment-Based Interventions on Child and Parent Outcomes in the Pediatric Oncology Setting.

Background: Cancer has an impact not only on children but also on parents. Parents play the most crucial role in cancer's symptom control and management. However, as the primary caretakers, parents are frequently unprepared or engage in inappropriate behavior when caring for their children. Increasing parents' role through empowerment is critical in pediatric cancer care. Purpose: This systematic review aimed to identify the effect of empowerment interventions on parent and child outcomes in pediatric oncology. Methods: In this review, studies published between 2013 and 2023 in The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Medline, and Scopus databases were identified using a search strategy to identify relevant studies that determined empowerment-based intervention for parents in the pediatric oncology. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies. This systematic review followed the recommended reporting items for systematic reviews and meta-analysis (PRISMA) standards. Results: Seven studies met the inclusion criteria: four randomized and three non-randomized experimental studies. Children range in age from 1-14 years. The intervention is mostly delivered through face-to-face learning using booklets or modules as a learning tool. The intervention is delivered in 2-6 sessions over 1-8 weeks, lasting 20-45 minutes each. In most studies, the interventions positively affect parents' outcomes (knowledge, caring behavior, distress, care burden, quality of life) and children's outcomes (oral mucositis, gastrointestinal complications, quality of life). The intervention, however, has no significant effect on the coping style. Barriers to implementation include parent-nurse commitment, the retention of parent-nurse participation, and more time spent to provide interventions. Conclusion: Our study highlights that empowerment-based interventions positively impact parents and children. These findings suggest that an empowerment-based intervention should be developed to provide better cancer care for a parent and their children. Systematic Review Registration: PROSPERO registration number was CRD42023422834.

Uncertainty of parents due to having children with cancer: A concept analysis.

Background: Parents of newly diagnosed cancer children often experience significant concerns about the implications of the diagnosis. They find themselves in challenging decision-making situations, navigating through uncertain conditions following the disclosure. Uncertainty is a prevailing issue in healthcare, yet its interpretation and application within the context of health and nursing practice exhibit multiple meanings and variations. Objective: This study aimed to clarify the concept of parental uncertainty arising from having children with cancer. Methods: The concept analysis followed the steps outlined by Walker and Avant. A thorough literature search was conducted using the Embase, CINAHL, and MEDLINE databases to identify articles published between 1980 and 2022. Results: The literature search yielded 147 articles from various disciplines, including health, nursing, medicine, psycho-oncology, and management. After analysis, 20 articles were selected for inclusion. This study identified four key attributes of parental uncertainty associated with having a child with cancer: (1) emotional disturbance, (2) unpredictability, (3) insufficient information, and (4) problems with decision-making. The antecedents of parental uncertainty encompassed the complexity of the disease, the diagnostic and treatment processes, the hospital environment, communication, and support from credible authorities. The consequences of parental uncertainty included the pursuit of new information, parental adaptability to their role, and parental distress. Conclusion: Understanding the four attributes of parental uncertainty, along with their antecedents and consequences, can facilitate the future development and operational translation of the concept of uncertainty in nursing practice. This concept is valuable in the evidence-based provision of nursing care to parents of children with cancer, enabling comprehensive recognition and assessment of parental uncertainty and the implementation of appropriate interventions that are sensitive to parental experiences. Ultimately, this approach promotes the adaptation of both the child and the parent.

Unmet Supportive Care Needs Survey among Male Partners of Gynecological Cancer Survivors in Indonesia.

OBJECTIVE: The number of gynecological cancer survivors is increasing in Indonesia, and these women often require physical and emotional support from their male partners as primary caregivers. However, the male caregiver's need for biological, psychological, and social support is often neglected. This study aims to assess the demographic and clinical determinants affecting the unmet supportive care needs of the gynecological cancer survivors' husbands in Indonesia. METHODS: This cross-sectional survey involved 152 husbands of survivors who were recruited by a consecutive sampling method in two national referral hospitals. A self-administered Cancer Survivors' Partners Unmet Needs Questionnaire was used for data collection. Multiple linear regression was performed to analyze the data. RESULTS: The majority of participants (97.4%) reported at least one unmet need. The primary unmet needs were legal services (71.1%), financial support (70.4%), cancer recurrence concerns (69.7%), and ongoing health support (66.4%). These needs were significantly associated with the wife's radio-chemotherapy and lower household income (P < 0.01) and also related to the husband's education level, duration of caregiving, and wife's cancer stage. CONCLUSIONS: Husbands of gynecological cancer survivors in Indonesia reported a need for legal, financial, and health-care information and assistance. Multidisciplinary professionals should be involved in developing policy and interventions which facilitate the social-economic protection of survivors and their husbands, as well as comprehensive care needs to enhance the women's survival rate.

The relationships of unmet needs with quality of life and characteristics of Indonesian gynecologic cancer survivors.

Gynecologic cancer survivors' complex needs are too often overlooked. This study aimed to identify the associations between unmet needs and quality of life, and selected characteristics of Indonesian gynecologic cancer survivors. This study was a cross-sectional, correlation study. A total of 298 participants completed the Cancer Survivor Unmet Needs (CaSUN), EORTC QLQ-C30, and demographic and clinical-related questionnaires. A higher level of unmet needs was linked to lower perceived quality of life. Higher levels of unmet needs were associated with younger age, lower income, higher educational background, shorter time since diagnosis, more advanced cancer stage, and having combination therapies (p < 0.05). The most frequently reported unmet need of the Indonesian gynecologic cancer survivors was financial support (70.5%). The gynecologic cancer survivors who had completed primary treatment need continuous comprehensive cancer care to help them cope with the lingering or emerging problems related to cancer and its treatment.

Liens entre les besoins non satisfaits, la qualité de vie et les caractéristiques des survivantes de cancers gynécologiques en Indonésie.

Les survivantes de cancers gynécologiques ont des besoins complexes très souvent négligés. La présente étude indonésienne vise à établir les liens entre les besoins non satisfaits, la qualité de vie et certaines caractéristiques particulières de ces survivantes. Au total, 298 participantes ont rempli le questionnaire sur les besoins non satisfaits des survivants au cancer (Cancer Survivor Unmet Needs ou CaSUN), le questionnaire sur la qualité de vie EORTC QLQ-C30 ainsi que les questionnaires démographiques et cliniques. L'étude, réalisée suivant un devis corrélationnel transversal, a établi un lien entre les besoins non satisfaits et la dégradation de la qualité de vie perçue. Plusieurs facteurs sont associés à l'augmentation des besoins insatisfaits: patients jeunes, revenu moindre, niveau d'éducation moyen, diagnostic récent, stade avancé de la maladie, et polythérapie (p < .05). Chez les survivantes indonésiennes d'un cancer gynécologique, le soutien financier (70,5 %) constitue le besoin le plus souvent insatisfait. À la fin des traitements primaires, elles ont besoin de soins globaux et continus pour gérer les problèmes, nouveaux comme anciens, causés par le cancer et le traitement.

Impacts of age and marital status on the elderly's quality of life in an elderly social institution.

BACKGROUND: Living a life of good quality is important for everyone. This research aimed to get an overview of the quality of life (QOL) of the elderly in an elderly social institution in Jakarta, Indonesia. DESIGN AND METHODS: This descriptive study with a cross-sectional design included 107 participants using simple random sampling technique. Data were collected using an abbreviated World Health Organization Quality of Life (WHOQOL-BREF) and analyzed using statistical software, Mann Whitney and Kruskal Wallis test. RESULTS: The mean quality of life of the elderly's was 66.09 (scale: 0-100), with a mean QOL of 67.58 in the physical domain, 66.26 in the psychological domain, 64.64 in the social relationships domain, and 65.88 in the environment domain. Regarding age and marital status, there was a significant difference in the mean QOL of the elderly living in the elderly social institution (p=0.017 and 0.001). In contrast, there was no significant difference in their mean QOL in terms of gender, level of education, and length of stay (p=0.323, 0.164, and 0.697). CONCLUSIONS: The low quality of life of the elderly is our concern. The staff in the elderly social institution could develop some activities for the elderly to increase the elderly's QOL, such as making daily activities plans and the evaluation of those activities.

Factors affecting nurses' ability to provide effective care in a disaster response: a review.

Disasters cause death, trauma, and psychological distress. Comprising the largest number of healthcare workers, nurses play a crucial role in reducing the impact of a disaster. The objective of this review is to identify the factors that influence nurses' ability during a disaster emergency response to provide adequate care. This research was conducted by doing a literature search from the Pro-Quest and Science-Direct databases using the PRISMA-ScR to screen the articles. The final results included 13 articles. An analysis was performed to identify themes in line with the purpose of the review. All factors affecting nurses' ability to respond to a disaster situation were classified into three themes: 1) factors increasing nurses' ability, 2) barriers to delivering effective nursing care, and 3) support needed to maintain the nurses' ability. During an emergency situation due to a disaster, adequate knowledge and skill to save lives, treat injuries, manage stress and coordinate between teams are the basic competencies needed for optimal care. Nurses' clinical experience or previous disaster experience and training could increase nurses' adaptability in disaster conditions. Support from nurses' workplace and proper implementation of disaster management policy enhance nurses' services and prevent barrier under disaster condition. The results emphasize that future training should aim for improving nurses' knowledge and skills, including the knowledge of nurses' family to protect themselves and deal with disasters. Such knowledge increased family preparedness, which is an important factor to enhance nurses' willingness to work following a disaster.

Relationship between Wound Severity, Discomfort, and Psychological Problems in Patients with a Diabetic Foot Ulcer in Indonesia: A Cross-sectional Study / Relação entre gravidade da ferida, desconforto e problemas psicológicos em pacientes com úlcera diabética do pé na Indonésia: um estudo transversal / Relación entre la gravedad de la herida, la molestia y los problemas psicológicos en pacientes con úlcera del pie diabético en Indonesia: estudio transversal

ABSTRACT Objectives: The purpose of this study is to identify the relationship between wound severity, discomfort, and psychological problems in patients with a diabetic foot ulcer in Indonesia. Methods: A cross-sectional study is conducted in three general hospitals and one clinic in Indonesia. The Bates-Jensen wound assessment tool (BWAT), the discomfort evaluation of wound instrument (DEWI), and the depression, anxiety, and stress scale (DASS) are used to measure the variables of interest. Path analysis is performed to evaluate the association between wound severity, discomfort, and psychological problems. Results: Of 140 patients with diabetic foot ulcers who joined this study, the majority experienced immobilization (74.3 %), pain (69.3 %), and sleep disturbance (63.6 %). The means were as follows: discomfort (2.35 ± 0.33), depression (1.34 ± 0.41), stress (1.49 ± 0.48), anxiety (1.43 ± 0.40), and wound severity (31.35 ± 9.96). Discomfort partially mediated the relationship between wound severity and psychological problems, which indirect effect was 0.11. Conclusion: High prevalence of discomfort, both physical and psychological, was found in patients with a diabetic foot ulcer. Discomfort mediates the relationship between wound severity and psychological problems. Integrating comfort into wound care management may help to reduce the psychological burden.

RESUMEN Objetivos: el presente estudio tiene como objetivo identificar la relación entre la gravedad de la herida, la molestia y los problemas psicológicos en pacientes con úlcera del pie diabético en Indonesia. Métodos: se realizó un estudio transversal en tres hospitales generales y una clínica de Indonesia. La herramienta de evaluación de heridas Bates-Jensen (BWAT, por sus siglas en inglés), el instrumento de evaluación de molestia de la herida (DEWI, por sus siglas en inglés) y la escala de depresión, ansiedad y estrés (DASS, por sus siglas en inglés) se utilizaron para medir las variables de interés. Se realizó un análisis de ruta para evaluar la asociación entre la gravedad de la herida, la molestia y los problemas psicológicos. Resultados: de 140 pacientes con úlcera del pie diabético que participaron en este estudio, la mayoría experimentó inmovilización (74,3 %), dolor (69,3 %) y trastornos del sueño (63,6 %). Las medias fueron las siguientes: molestia (2,35 ± 0,33), depresión (1,34 ± 0,41), estrés (1,49 ± 0,48), ansiedad (1,43 ± 0,40) y gravedad de la herida (31,35 ± 9,96). La molestia medió en parte la relación entre la gravedad de la herida y los problemas psicológicos, cuyo efecto indirecto fue de 0,11. Conclusión: se encontró una alta prevalencia de molestias, tanto físicas como psicológicas, en pacientes con úlcera del pie diabético. Además, la molestia media la relación entre la gravedad de la herida y los problemas psicológicos. La integración de la comodidad en el manejo del cuidado de las heridas puede ayudar a reducir la carga psicológica.

RESUMO Objetivos: o objetivo deste estudo é identificar a relação entre a gravidade da ferida, o desconforto e os problemas psicológicos en pacientes com úlcera do pé diabético na Indonésia. Métodos: foi realizado um estudo transversal em três hospitais gerais e uma clínica da Indonésia. A ferramenta da avaliação de feridas Bates-Jensen (BWAT, por sua sigla em inglês), o instrumento de avaliação do desconforto da ferida (DEWI, por sua sigla em inglês) e a escala de depressão, ansiedade e estresse (DASS, por sua sigla em inglês) foram utilizados para medir as variáveis de interesse. Uma análise de rota foi realizada para avaliar a associação entre a gravidade da ferida, o desconforto e os problemas psicológicos. Resultados: de 140 pacientes com úlcera diabética do pé que participaram deste estudo, a maioria experimentou imobilização (74,3 %), dor (69,3 %) e transtornos do sono (63,6 %). As médias foram: desconforto (2,35 ± 0,33), depressão (1,34 ± 0,41), estresse (1,49 ± 0,48), ansiedade (1,43 ± 0,40) e gravidade da ferida (31,35 ± 9,96). O desconforto foi o mediador em parte da relação entre a gravidade da ferida e os problemas psicológicos, cujo efeito indireto foi de 0,11. Conclusões: verificou-se alta prevalência de desconforto, tanto físico quanto psicológico, em pacientes com úlcera diabética do pé. Além disso, o desconforto intermedeia a relação entre a gravidade da ferida e os problemas psicológicos. A integração do conforto na gestão do cuidado das feridas pode ajudar a reduzir a carga psicológica.

Improving the implementation of patient safety by nursing students using nursing instructors trained in the use of quality circles.

BACKGROUND: It is recognised worldwide that the skills of nursing students concerning patient safety is still not optimal. The role of clinical instructors is to instil in students the importance of patient safety. Therefore, it is important to have competent clinical instructors. Their experience can be enhanced through the application of quality circles. This study identifies the effect of quality circles on improving the safety of patients of nursing students. Patient safety is inseparable from the quality of nursing education. Existing research shows that patient safety should be emphasised at all levels of the healthcare education system. In hospitals, the ratio between nursing students and clinical instructors is disproportionately low. In Indonesia, incident data relating to patient safety involving students is not well documented, and the incidents often occur in the absence of a clinical instructor. METHODS: This study used a quasi-experimental research design with pre-test and post-test non-equivalent control groups. The aim of the project was to explore the implications of the quality circle on clinical instructors by comparing the students' knowledge, attitudes, and practices of control and intervention groups. A questionnaire will be conducted to evaluate the implementation of patient safety and the impact of the intervention. The data were statistically analysed using independent t tests. The intervention was the implementation of quality circles that focused on patient safety issues for the use of clinical instructors to assess and guide student nurse behaviour in regard to patient safety. The authors of this study trained the clinical instructors on how to use quality circle methods to solve nursing problems especially with relevance to the patient safety issues of students. RESULTS: The results showed a significant increase in the behaviour of nursing students towards patient safety issues (p < 0.001; α = 0.05). CONCLUSIONS: The implementation of quality circles has a significant effect on patient safety. Therefore, it is recommended to implement quality circles as a problem-solving technique to optimize patient safety.

Spirituality-Focused Palliative Care to Improve Indonesian Breast Cancer Patient Comfort.

BACKGROUND: Palliative care is an approach that focuses on improving a patient's quality of life. This research aimed to develop a path model of the relationships between the variables of nursing care (information, emotional support, technical support, and palliative care), patient coping, family support, patient spirituality, and patient comfort expressed through physical and emotional mediators. METHOD: This cross-sectional study involved 308 breast cancer patients from 3 referral hospitals in Jakarta, Indonesia. A structural equation model with Kolcaba's theory was used to develop a theoretical model estimating the path or relationships between the key variables. RESULTS: The results showed that palliative care significantly improved breast cancer patient comfort by reducing anxiety and depression. Furthermore, the study demonstrated a significant positive relationship between spirituality and emotional well-being. CONCLUSION: Spirituality-focused palliative care is fundamentally importance for breast cancer patients. Nurses play an essential role in providing spirituality-focused palliative care to promote comfort in breast cancer patients in Indonesia.

Sensitivity, Specificity, and Accuracy of Kramer Examination of Neonatal Jaundice: Comparison with Total Bilirubin Serum.

Neonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations introduced by Kramer to assess the presence of neonatal jaundice. The purpose of this study was to determine the sensitivity, specificity, and accuracy of Kramer's visual assessment in the examination of neonatal jaundice. This study used cross-sectional design to examine 102 infants, with the sample selected by the convenience sampling method. A 2 × 2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment of neonatal jaundice obtained a sensitivity value of 76.92%, a specificity value of 89.47%, and an accuracy value of 86.27%. This research can contribute to the development of other non-invasive methods for assessing neonatal jaundice, and thereby contribute to a decrease in neonatal morbidity.

Medical-Device Related Pressure Injuries to Children in the Intensive Care Unit.

Medical devices that are attached to children put pressure on their skin or mucous membranes, and the devices can lead to injuries. The objective of this study was to determine the effectiveness of injury-prevention guidance about children who need to have medical devices attached to their bodies as part of their treatment. The research used a randomized controlled trial method, along with a cross-over design in 50 respondents with age ranges from 1 day to 18 years. The control group was treated in accordance to hospital routine, while the intervention group was given medical treatment based on Kiss and Heiler's guidelines. Skin assessment was conducted for 3 days. Incidence of Grade 1 pressure injuries on the respondent's skin or mucous membranes with a mean score of Neonatal Skin Risk Assessment Scale < 13 and average Braden Q score > 15 were observed. Health devices that caused pressure injuries on respondents were: ETT (13%), OGT (12%), NGT (11%), and SpO2 probe (6%). There were no significant differences between the control group and intervention group in terms of the number of pressure injury incidences. Skin trauma and pressure injuries caused by medical devices were within the low-risk category; therefore, nurses should not be complacent with the NSRAS and Braden Q scores in preventing pressure injuries. Further research is recommended to improve the power of related research and development in risk assessment of pressure injuries caused by medical devices in children.

Maternal Self-Efficacy of Pregnant Indonesian Teens: Development and Validation of an Indonesian Version of the Young Adult Maternal Confidence Scale and Measurement of Its Validity and Reliability.

Pregnant teens often feel uncertain in the last trimester about their ability to take care of their baby. At this time, maternal confidence in the ability to care for the baby is an important step in the preparation for becoming a mother. The purpose of this study was to examine the validity and reliability of an Indonesian version of the Young Adult Maternal Confidence Scale (YAMCS) as an instrument to measure maternal self-efficacy of pregnant teens in the last trimester. The study consisted of 90 pregnant teens, age of respondents less than 19 years and living in 1 of 3 sub-districts: Cilember, Sukamanah and Megamendung, Bogor Regency. West Java. All the participants completed a questionnaire based on the YAMCS to assess maternal self-efficacy. The YAMCS consists of 3 dimensions (perception of ability, uncertainty, and mothering behaviors) and 10 items. All items of the YAMCS had corrected item-total item correlation more than 0.3 and had 0.859 Cronbach's α scores. Based on the findings of this study, this questionnaire is a valid and reliable measure of maternal self-efficacy of pregnant teens in Indonesia. Health workers can use the questionnaire to assess the confidence of pregnant women, especially that of adolescents, in caring for their baby and being a good mother.