Breastfeeding a Premature Baby During the Covid-19 Pandemic in Perinatology: An Exploration of Mothers' Experiences.

This study was conducted to explore the meaning of mothers' experiences of breastfeeding premature babies while being treated in the perinatology room during the COVID-19 pandemic. A descriptive phenomenological design was used in this study to describe the meaning of mothers' experiences. In-depth interviews were conducted with 11 mothers. The analysis of transcribed data resulted in three themes: (1) The pandemic has made it difficult for me to meet my baby, (2) Breastfeeding is not easy, and (3) I am a breast milk pumper. The breastfeeding experience of having a premature baby and being cared for by perinatology during a pandemic is full of challenges and limited support. The results of this study suggest that a review of the current regulations be carried out, and the staff be given continuing lactation education to strengthen breastfeeding support to mothers with premature babies.

Patient and family-centered care for children: A concept analysis.

Background: Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. Objective: This study aimed to clarify the concept of patient and family-centered care for children. Methods: Walker and Avant's concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. Results: The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Conclusion: Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.

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.

Analysis of the infant's acute pain assessment using developed conductance skin electric instrument compared to the behavioural and faces pain scale in painful injected vaccine.

This study compared the scale of infant pain during vaccinated injection using conductance skin electric (Skin Conductance), the Wong-Baker Faces Scale (WBFS) instrument, and Face Leg Activity Cry and Consolability (FLACC) instruments. It was observational cohort study with pre-experimental design using vaccinated injection as pain stimuli. This study investigated 121 infants (59 boys, 62 girls), age/PNA 4.37 ± 2.97 months, and current body weight 6522 ± 1378.65 grams). Most infants had adequate birth weight 71 (89.9%) about 2985.74 ± 405.83 kg and mature infants as 67 (84.4%), about 38,52 ± 2,09 weeks. Pain measurement of all three instruments was do simultaneously using a developed Skin Conductance (SC) apparatus and video recording (to assess behaviour and face). WBFS, FLACC and SC have the same significance in measuring infants' pain scale during vaccination injection. Statistical analysis showed a significant difference in the three pain measurement instruments between before and during injection with a p value of <0.001. So that SC can be recommended for pain measurement.

The Role of Knowledge, Attitude, Confidence, and Sociodemographic Factors in COVID-19 Vaccination Adherence among Adolescents in Indonesia: A Nationwide Survey.

COVID-19 vaccination in adolescents is important because the adolescent population has the highest incidence of COVID-19. This study aimed to explore the factors associated with COVID-19 vaccination adherence among Indonesian adolescents. This cross-sectional study involved 7986 adolescents, polled through online and offline surveys conducted in six major islands of Indonesia. The online questionnaire was distributed through popular social messaging and social media platforms. Our team also contacted schools and public places to recruit participants from remote areas. In total, 7299 respondents completed the questionnaire. Binary logistic analysis revealed that higher levels of knowledge, positive attitudes, and confidence in the COVID-19 vaccine were significantly associated with higher COVID-19 vaccination adherence in adolescents. Sociodemographic factors were also significantly associated with higher adherence to vaccination programs. Meanwhile, younger age and habitation in private housing were related to lower adherence to the vaccination program. Parental factors related to adolescent compliance were education level, household income, history of infection of family or friends with COVID-19, and working status. The national authorities and stakeholders should take extensive measures to increase attitude, knowledge, confidence, and family support among adolescence through multiple channels.

Health education to improve low-birthweight infant care practices in Central Jakarta, Indonesia.

This study aimed to assess the impact of health education on the caring practices of low-birthweight (LBW) infant mothers in Central Jakarta, Indonesia. A quasi-experiment design with a pretest-post-test control group model was conducted on 159 mothers (78 in the intervention group and 81 in the control group) of LBW infants treated in the perinatology ward of three hospitals in Central Jakarta. Provision of health education to mothers of LBW infants consisted of counselling sessions and one-on-one visits provided by primary health centre nurses. Data were collected four times consecutively over 6 weeks. A generalized estimating equation model with a linear link function was employed to examine LBW infant practice score changes due to intervention and other influential factors at four time points. Results: The LBW infant care practice scores were higher in the intervention group than in the control group at each measurement point. After controlling for maternal attitudes, LBW infant health education increased mothers' infant care practices at 2, 6 and 12 weeks by 2.179, 2.803 and 2.981 points, respectively, and reduced infant morbidity. Six weeks of health education had an effective impact on mothers' home LBW infant care practices and infant health status.

Oral feeding skills in premature infants: A concept analysis.

Background: The delay in developing oral feeding skills becomes a problem experienced by premature infants. One of the reasons for the delay may be related to inconsistent definitions of oral feeding skills, which can cause discrepancies in the provision of nursing care. Objective: This study aimed to clarify the concept of oral feeding skills in premature infants. Methods: The Walker and Avant concept analysis method was used. A literature search was also conducted from five databases: CINAHL, PubMed, ProQuest, EMBASE, and Google Scholar, to find articles between January 2020 and December 2022. Results: The literature search obtained 20 articles on oral feeding skills from various disciplines. Five attributes were developed from the concept analysis, including (1) coordination ability to suck, swallow, and breathe, (2) the ability to regulate oral-motor functions, (3) the ability to regulate sensory functions, (4) the ability to maintain the stability of physiology function, and (5) the ability to regulate feeding behavior. Antecedents to oral feeding skills include immaturity of the nervous system, gestational age, feeding intolerance, increased length of stay and cost of care, increased rehospitalization, stress on parents, and increased morbidity and mortality. Consequences include optimization of growth and development, reduction of length of stay and cost of hospitalization, increased bonding attachment, increased self-efficacy of parents in caring for premature infants, and improvement of the quality of life of premature infants. Conclusion: The concept analysis provides five comprehensive attributes and their antecedents and consequences. However, this concept can be used to provide nursing care to premature infants, assess the criteria for discharge, and optimize nutrition for the growth and development of premature infants.

Feasibility of Kangaroo Mother Care (KMC) Implementation in Depok City, Indonesia.

Background: The infant and neonatal mortality rate in Depok City is still high, with low birth weight (LBW) and premature births being one of the main causes. In 2018, 14 out of 41 cases of early neonatal death were due to LBW. Studies show that Kangaroo Mother Care (KMC) can prevent or reduce LBW deaths caused by hypothermia, but the implementation is still not evenly distributed. Objective: Describe KMC feasibility as a supporting material for a KMC policy umbrella at Depok City. Method: Qualitative research was conducted with a Rapid Assessment Procedure (RAP) design. A total of 56 informants were divided into 8 discussion groups, 7 in-depth interviews and 2 Focus Group Discussions (FGD). The types of informants were families and inter-sectoral officers. Thematic analysis was used to analyze the data. Results: KMC implementation feasibility in Depok City in terms of facilities and infrastructure was still limited and the quality was insufficient. The number of human resources was still limited, and the competency was still not evenly distributed. LBW family readiness can be maintained if provided with complete and accurate knowledge; therefore, a strong commitment may develop to continue KMC at home. The potential sources of KMC financing are found at health facilities and inter-sectoral; however, to use it, a legal umbrella at the city district level is necessary. Conclusions: The factors of potential financing sources need to be followed up into a priority. This is to overcome the constraints of KMC feasibility implementation.

Knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia: A qualitative study in an urban community in Indonesia.

Background: Childhood pneumonia is the leading cause of death. Family caregivers may have a poor understanding of pneumonia, especially related to prevention and treatment. It is crucial to understand country-specific knowledge and healthcare-seeking behaviors of caregivers of children with pneumonia before planning programmatic responses, particularly in an urban community where the culture-social economic status is diverse. Objective: This study aimed to describe the knowledge and healthcare-seeking behavior of family caregivers of children with pneumonia in Indonesia's urban community. Methods: A descriptive qualitative study was conducted at a public hospital in Jakarta, Indonesia, from 10 December 2019 to 28 January 2020. Ten family caregivers of children with pneumonia were included, and a semi-structured interview was conducted for data collection. The audio recording was transcribed verbatim, and the data were analyzed using content analysis. Results: The emerged data indicated low knowledge of the family caregivers, especially mothers, which considered pneumonia a common cold only, and they failed to understand the risk of its transmission. Using traditional medicines was the first stage of healthcare-seeking behavior. If the symptoms worsened, the caregivers brought their children to the nearest health center. If there was no change in the symptoms, they headed to the hospital. The health center's location, condition, services, and staff attitude were considered factors to choose the services. Conclusion: Living in an urban area does not guarantee the family caregivers have better knowledge and good healthcare-seeking behavior. Therefore, nurses should provide comprehensive education about pneumonia, its symptoms, and treatment management to improve family care and prevent pneumonia-related deaths. Integrated management of children with illness is recommended to help the family caregivers of children with pneumonia receive treatment as quickly as possible.

The related factors of phlebitis among low birth weight infants in perinatology ward.

Peripheral intravenous line placement might lead to some risks and complications in low birth weight (LBW) infants including phlebitis, which shows varying percentages. This study aimed to analyze the causative factors of phlebitis among LBW infants in a perinatology ward. A total of 106 LBW infants who selected using a consecutive sampling technique were analyzed with cross-sectional method. Data were collected when LBW infants started receiving infusions until the infusion was stopped under certain conditions, using the Infusion Nurses Society (INS) phlebitis scale and the Neonatal Infant Pain Scale (NIPS) as the instrument. The variables related to phlebitis under bivariate analysis included the clinical experience of intravenous insertion, infusion pumps, site of insertion, neonatal birth weight, and the administration of total parenteral nutrition. The most significant risk factor of phlebitis was the nurses' clinical experience of intravenous insertion (< 2 years). Therefore, the results of this study can be considered to improve the quality of nursing care in perinatology ward.

The use of breastfeeding pillow to reduce discomfort for breastfeeding mothers.

The process of breastfeeding for newborns in the special care room often experiences obstacles due to diverse factors, such as environmental factors, hospitalization impact, and maternal discomfort during breastfeeding. The aim of this study was to determine whether breastfeeding pillows decrease maternal discomfort during breastfeeding. This research employed a randomized control trial (RCT) design involving 70 participants who were divided into an intervention (n=35) and a control group (n=35) based on the inclusion criteria. The intervention group used a breastfeeding pillow while breastfeeding the baby, and the control group provided ASI (breast milk) as recommended in the treatment room. The data measurement instruments were an observation sheet and the body part discomfort scale (BPDS). The BPDS comprised 4 assessments: the initial assessment, day I assessment, day II assessment, and the final assessment. The results of the GLM-RM analysis showed a significant reduction in maternal discomfort among participants using breastfeeding pillows (P<0.05). Supporting facilities such as breastfeeding pillows are needed to improve maternal comfort to increase the breastfeeding period and ensure optimal nutrition.

Factors influencing anxiety in mothers of low birth weight infants.

Low birth weight (LBW) infants pose a challenge for developing countries. Mothers of LBW are thus at risk of psychological stress and postpartum depression. This study was to identify the correlation between mothers' characteristics and their anxiety about having hospitalized low birth weight infants. This study used a descriptive correlation design and involved 90 respondents who met the inclusion criteria. The result of this study indicated that most of the mothers were categorized in non-risk age, unemployed or housewife, and having secondary education. Overall, the respondents showed mild anxiety and no significant correlation between mothers' characteristics and their anxiety (P>0.05). However, there was a significant correlation between her income and mother's level of anxiety (P<0.05). The conclusion could be use as the basic data for developing the program related to health promotion in overcoming the anxiety in LBW infant's mothers.

The Effect of Sleep Hygiene Education on Sleep Quality in Children with Type 1 Diabetes Mellitus: A Preliminary Study.

To identify the effect of sleep hygiene education on sleep quality in children with Type 1 Diabetes Mellitus (T1DM), a quasi-experiment with control group and pretest-posttest design was conducted. Samples of 46 children with T1DM in IKADAR were assigned into intervention (n = 23) and control (n = 23). The intervention group received sleep hygiene education for 10 minutes via video, then applied for 3 days. Respondents completed the Pittsburgh Sleep Quality Index (PSQI) Indonesian version (pretest) and were evaluated on the third day (posttest). There was a significant difference in sleep quality score rate (p < 0.001) pre and post-intervention in the intervention group and no significant difference (p = 0.833) in the control group. There was a significant difference in sleep quality score rate between intervention and control group after intervention (p = 0.001). Sleep hygiene can improve sleep quality in children with T1DM; therefore, it can be implemented as a nursing intervention to overcome sleep disorder in children with T1DM.

Coping Strategies and Quality of Life of Children with Type 1 Diabetes Mellitus: A Preliminary Study.

This study was conducted to identify the correlations between the coping strategies and the quality of life of children with type 1 diabetes mellitus (T1DM). This cross-sectional study involved 39 children from 13 to 18 years old with T1DM who were selected using the consecutive sampling technique. The Pediatric Quality of Life Inventory 3.2 and Coping with a Disease questionnaire were used for this research, and the statistical analysis was conducted using the Pearson and Spearman correlation tests. The average age of the participants was 15.23 years old (± 1.81), they had been diagnosed with T1DM for an average of 5.54 years (± 3.06), and 59% were females. The most commonly used coping method was wishful thinking, and the quality of life mean was 63.82. The emotional reaction (p = 0.009, r = -0.413) and acceptance (p = 0.049. r = 0.317) coping strategies were significantly correlated with the quality of life. However, the other four coping strategies had no significant correlations with the quality of life. These study findings suggest that nurses should help to prevent children with T1DM from adopting emotional reactions as long-term coping mechanisms. Moreover, they should promote the use of the acceptance coping mechanism when providing nursing care for children with T1DM.

The Correlation between Caregivers' Characteristics and Emotional Development of Pre-School Children in Depok, Indonesia.

This study aimed to identify the correlation between emotional developments in pre-school children and the caregivers' characteristics. This study employed cross sectional design with cluster sampling technique and involved 206 respondents. The inclusion criteria were mothers of a child aged 3-6 years old and willing to participate in the study. The result showed 42.7% children exhibited deviation in emotional development. There was a significant relationship of mother's education and emotional development in children (p = 0.024; α = 0.05). Children of unemployed mothers had higher percentage of emotional deviation compared to working mother, although it was not significantly different (p = 0.387; α = 0.05). There was no significant correlation between caregivers and emotional development in children (p = 0.102; α = 0.05), child's age and emotional development (p = 0.183; α = 0.05), and child's gender and emotional development (p = 0.206; α = 0.05). Based on these findings, the stimulation of emotional development should be integrated into the curriculum for pre-school children in order to optimize their development.

Peer Support Increases Maternal Confidence, Kangaroo Mother Care Implementation and Weight Gain in LBW Infants.

Weight gain in low birth weight infants can be improved by Kangaroo Mother Care (KMC). The sustainability of KMC implementation can be improved by increasing maternal confidence. Therefore, an appropriate method is needed in KMC education so that maternal confidence, KMC implementation, and weight gain in low birth weight infants can be increased. This study aimed to determine the effect of peer support on maternal self-confidence, KMC implementation, and infant's weight gain in four hospitals: one hospital in Jakarta, Bogor, Tangerang, and Bekasi. The study design was a randomized controlled trial with pre-post test equivalent group which involved 24 participants in both intervention and control group, respectively, based on selected criteria. The intervention provided was three sessions of education on KMC based on individual approach provided by peers. The KMC implementation and infant's weight gain were observed for five days. This study employed a maternal self-confidence questionnaire and KMC observation and weight gain form. The result showed significant differences in mother's confidence, KMC implementation, and infant's weight gain between the control group and intervention group (p = 0.001; 0.001; 0.032; 0.030). There was a significant correlation between infant's birth weight, maternal self-confidence and infant's weight gain, as well as between comorbidities and weight gain in infants. So, peer support effectively improved maternal self-confidence, KMC implementation, and weight gain in infants in hospital. Therefore, the implementation may be extended throughout home visits.

A Preliminary Study on "PRISMA" Education in Improving Self-Management and Level of Compliance in Children with Type-1 Diabetes Mellitus.

Children with Type-1 Diabetes Mellitus (TIDM) need long-term care that requires supervision. Without good management, there will be an increase in blood glucose, which can cause complications in organs and tissues. One way to improve self-management and level of compliance in blood glucose control is by providing education. This study aimed to determine the effect of PRISMA education on self-management and level of compliance in children with T1DM. This study used a quasi-experimental design with no control group. PRISMA education using animated videos was given to the respondents who filled out the questionnaire about self-management and level of compliance (pre-test) and were evaluated on the eighth day (post-test). The sample of this study consisted of 31 children in Jakarta, Bogor, Depok, and Tangerang. The results of this study indicate that PRISMA education had significant effects on self-management (p < 0.05) and level of compliance (p < 0.05). The delivery of self-management education in the form of animated videos could improve self-management and children's compliance in the management of diet, physical act, treatment, stress management and blood glucose control. Thus, this educational tool could be useful if it is integrated into nursing interventions, especially in the field of pediatric nursing.

Nesting with Fixation and Position to Facilitate Quiet Sleep and Oxygen Saturation on Low-Birth Weight Infants.

Low-birth weight (LBW) infants have a major problem of sleep-awake and instability on physiological function. The objective of this study was to identify the effect of nesting with fixation and position on sleep-awake status and physiological function. This study used a crossover design and was conducted in a general hospital in Jakarta, involving 19 LBW infants who met the inclusion criteria. The intervention consisted of: nesting with fixation combined with prone position (NFPP) (A), nesting with fixation combined with quarter prone position (NFQP) (B), nesting with quarter prone position (NQP) (C), and control group (D). The results of this study showed that there was a significant difference between NFPP and NFQP compared to the control group in regard to quiet sleep and oxygen saturation (p < .05). Nesting with fixation combined with prone position was the most effective method to facilitate quiet sleep and the stability of SaO2 followed by nesting with fixation combined with quarter prone position as alternative intervention for LBW infant. Therefore, the application of nesting with fixation is needed.

Increasing Confidence and Ability in Implementing Kangaroo Mother Care Method Among Young Mothers.

Mothers giving birth to low birth weight babies (LBWBs) have low confidence in caring for their babies because they are often still young and may lack the knowledge, experience, and ability to care for the baby. This research aims to determine the effect of education about kangaroo mother care (KMC) on the confidence and ability of young mothers to implement KMC. The research methodology used was a controlled-random experimental approach with pre- and post-test equivalent groups of 13 mothers and their LBWBs in the intervention group and 13 mothers and their LBWBs in the control group. Data were collected via an instrument measuring young mothers' confidence, the validity and reliability of which have been tested with a resulting r value of .941, and an observation sheet on KMC implementation. After conducting the education, the confidence score of young mothers and their ability to perform KMC increased meaningfully. The score of confidence of young mothers before education was 37 (p = .1555: and the ability score for KMC Implementation before education was 9 (p = .1555). The median score of confidence of young mothers after education in the intervention group was 87 and in the control group was 50 (p = .001, 95% CI 60.36-75.56), and ability median score for KMC implementation after education in the intervention group was 16 and in the control group was 12 (p = .001, 95% CI 1.50-1.88). KMC education should be conducted gradually, and it is necessary to involve the family, in order for KMC implementation to continue at home. A family visit can be done for LBWBs to evaluate the ability of the young mothers to implement KMC.

The Quarter Prone Position Increases Oxygen Saturation in Premature Infants Using Continuous Positive Airway Pressure.

A primary problem that occurs in premature infants is oxygenation disorders, thus requiring respiratory support, including continuous positive airway pressure (CPAP). The effectiveness of CPAP can be improved by adjusting the body's position, so the aim of this study was to examine the effect of the quarter prone position on the oxygenation status of preterm infants using CPAP. This study used a randomized controlled trial with a crossover design. A group of 15 preterm infants receiving CPAP was selected, and randomization of allocation was done to divide the respondents into the intervention group (quarter prone) or the control group (supine). Oxygenation status was measured using an observation form, and the result showed a significant difference in the oxygen saturation levels of premature infants using CPAP in the quarter prone group compared to that in the supine group (p = .045). The quarter prone position was effective for improving the oxygenation status of premature infants using CPAP. It is recommended that the quarter prone position be applied as part of nursing care in neonatal nursing.