The experiences of Indonesian parents receiving bad news about their children's diseases: A qualitative descriptive study.

PURPOSE: Breaking bad news about children's chronic diseases is challenging and is often not performed according to the needs of parents. The aim of the study was to explore the experiences of Indonesian parents receiving bad news about their chronically ill child. DESIGN AND METHOD: This is a qualitative descriptive study that used semi-structured interviews. Twenty one parents who met the inclusion criteria were face-to-face interviewed between August 2021 and September 2022. Interviews were audio-recorded and transcribed. The data were analyzed using content analysis. The trustworthiness of the study was established through member checking, triangulation, and detailed transcriptions. The COREQ checklist was followed in this study. FINDINGS: Findings revealed four categories: 1) reactions when receiving bad news; 2) expectations while receiving bad news; 3) conflicting feelings and situations; and 4) perceived roles of nurses in delivering the news. CONCLUSION: Parents reacted in different ways when receiving bad news about their children's disease, mostly experiencing negative thoughts and being unable to bear the news. Despite those reactions, parents highlighted their right to receive the news with an understandable explanation through the roles of nurses as educators, advocates, and empathizers. PRACTICE IMPLICATION: Nurses are encouraged to strengthen their roles in breaking bad news. Nurses and healthcare professionals are also suggested to use understandable language and explain medical terms that are used in delivering the information to parents.

Aesthetic Expression as a Means to Nurture "Self" in a Basic Nursing Care Practicum.

ABSTRACT: Nursing students develop their professional "self" through clinical placement experiences. Aesthetic expression can be used as a means to reflect students' personal knowing and to convey self as nurtured during their clinical journey. In a postconference session of the Basic Nursing Care Practicum course, six students were asked to draw pictures reflecting their clinical experience and then share their stories. It appeared that nursing students learned the meaning of nursing and caring, and through these meanings, their actual self as nurses was also developed.

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief.

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

"I Checked Her While She was Sleeping Just to make Sure She was Still Alive": A Qualitative Study of Parents and Caregivers of Children with Chronic Disease in Indonesia.

PURPOSE: Caring for children with chronic disease is a stressful and challenging experience for parents and caregivers. This study aimed to describe the experiences of parents and caregivers who cared for children with chronic disease. DESIGN AND METHODS: A descriptive qualitative study was conducted through face-to-face interview in West Sumatra, Indonesia. Sampling was continued until saturation was achieved, resulting in eleven parents and caregiver who met the inclusion criteria. Data were collected from March to May 2019 and were analyzed through content analysis. Trustworthiness of this study was established following the criteria of credibility, transferability, confirmability, and dependability. RESULTS: Findings revealed three categories, namely expressions of care, efforts of care, and ways of accepting the situations. Parents expressed their feeling through crying, denial, guilt, and fear of loss. Efforts of care were reflected from trying traditional healing, following health care workers recommendations, and striving to be good parents. Ways of accepting the situations were derived from motivating oneself, looking for support, and surrendering. CONCLUSIONS: Parents and caregivers of children with chronic disease expressed various feelings and expressions since the first time they knew the diagnoses until they continued to care for their children at home and started life adjustment. The main points of concern and psycho-emotional burden on the family-care provider were identified as anticipatory grief, which occurred when the parents and caregiver realized that death maybe close after they knew the diagnoses. Another concern was regarding the appropriate way to care for the children at home, which was mostly provided by the mother. PRACTICE IMPLICATIONS: Psychological and social support should be given to parents who have children with chronic disease, especially from peer groups with other parents of children with the same conditions. Health care providers are suggested to provide caregivers with information regarding continuing care for their children at home and involve the father in planning family-centered care.

Nurses' perception regarding patient safety climate and quality of health care in general hospitals in Japan.

AIM: To clarify perceptions of nurses towards patient safety climate and quality of health care in Japan. BACKGROUND: Nurses' perceptions of patient safety climate and quality of health care services are not well-known. METHOD: The survey was conducted at general hospitals with 200 beds or more using the Patient Safety Climate Scale and the Modified multiple-item scale for consumer perceptions of health care service quality. RESULTS: Significant positive correlations were found among nurses' perception towards patient safety and health care service quality. The experience of nurses as members of the committee on patient safety and their employment position did not show any significant difference in the perception towards patient safety and health care services quality. Perceptions of health care service quality were lower among those with 6- to 10-year experience than with over 21 years. CONCLUSION: In the perception of nurses and nurse managers' continuous improvement, perceptions towards patient safety were related to reliability, assurance, responsiveness and empathy in health care service quality. IMPLICATIONS FOR NURSING MANAGEMENT: Generalist nurses with 21 years or more experiences in multiple departments showed high perception towards health care service quality. Experienced nurses' perceptions of activities to improve patient safety and quality of health care services are important.

Treatise on the influence of theism, transhumanism, and posthumanism on nursing and rehabilitation healthcare practice.

Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article is to discuss theistic ontologies such as the Judeo-Christian, Shinto-Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare.

Relating Mori's Uncanny Valley in generating conversations with artificial affective communication and natural language processing.

Human beings express affinity (Shinwa-kan in Japanese language) in communicating transactive engagements among healthcare providers, patients and healthcare robots. The appearance of healthcare robots and their language capabilities often feature characteristic and appropriate compassionate dialogical functions in human-robot interactions. Elements of healthcare robot configurations comprising its physiognomy and communication properties are founded on the positivist philosophical perspective of being the summation of composite parts, thereby mimicking human persons. This article reviews Mori's theory of the Uncanny Valley and its consequent debates, and examines "Uncanny" relations with generating healthcare robot conversational content with artificial affective communication (AAC) using natural language processing. With healthcare robots provoking influential physical composition and sensory expressions, the relations in human-healthcare robot transactive engagements are argued as supportive of the design and development in natural language processing. This implies that maintaining human-healthcare robot interaction and assessing the eeriness situations explained in the Uncanny Valley theory are crucial positions for healthcare robot functioning as a valuable commodity in health care. As such, physical features, language capabilities and mobility of healthcare robots establish the primacy of the AAC with natural language processing as integral to healthcare robot-human healthcare practice.

Intelligent humanoid robots expressing artificial humanlike empathy in nursing situations.

Intelligent humanoid robots (IHRs) are becoming likely to be integrated into nursing practice. However, a proper integration of IHRs requires a detailed description and explanation of their essential capabilities, particularly regarding their competencies in replicating and portraying emotive functions such as empathy. Existing humanoid robots can exhibit rudimentary forms of empathy; as these machines slowly become commonplace in healthcare settings, they will be expected to express empathy as a natural function, rather than merely to portray artificial empathy as a replication of human empathy. This article works with a twofold purpose: firstly, to consider the impact of artificial empathy in nursing and, secondly, to describe the influence of Affective Developmental Robotics (ADR) in anticipation of the empathic behaviour presented by artificial humanoid robots. The ADR has demonstrated that it can be one means by which humanoid nurse robots can achieve expressions of more relatable artificial empathy. This will be one of the vital models for intelligent humanoid robots currently in nurse robot development for the healthcare industry. A discussion of IHRs demonstrating artificial empathy is critical to nursing practice today, particularly in healthcare settings dense with technology.

Grief reactions and coping strategies of Muslim nurses dealing with death.

BACKGROUND: An intensive care unit (ICU) features high mortality rates. Witnessing subsequent deaths may affect nurses psychologically and spiritually. Islam has an influence on Muslims' life and death. Nevertheless, little is known about Muslim intensive care nurses' experiences of grief in dealing with the deaths of patients. AIM AND OBJECTIVES: This study aimed to describe the grief reactions and coping strategies of Muslim nurses in dealing with the death of patients. DESIGN: This is a qualitative study with a phenomenological approach. METHODS: Semi-structured individual interviews were conducted. Fourteen participants from an ICU in an Indonesian tertiary public hospital participated in this study. Data were analysed by thematic analysis. Trustworthiness was established by Lincoln and Guba's criteria. RESULTS: The findings identified four reactions of grief, four factors influencing reactions of grief, and three coping strategies used in dealing with death in an ICU. The reactions of nurse's grief were crying, being sad, feeling disappointed, and feeling guilty. These reactions were related to several factors including the circumstances of the patient's death, nurse's expectation of patient's recovery, relationships with the patient, and the reactions of family. Coping management strategies used by nurses in dealing with their grief comprised: sharing with colleagues, avoiding dying and death situations, and engaging in spirituality. CONCLUSIONS: The Muslim ICU nurse participants experienced their grieving through a variety of psychological reactions influenced by several factors. Personal coping strategies were revealed in dealing with their grief. However, avoiding dying and death situations affected their duty. RELEVANCE TO CLINICAL PRACTICE: Attention to nurses' grief should be paid to maintain their psychological well-being and quality of end-of-life care. Providing formal support to enhance grief management is recommended.

Psychiatric Home-Visiting Nurses' Views on the Care Information Required of Psychiatric Hospital Nurses.

The "construction of a community-based comprehensive care system for mental disorders" has been promoted in Japan. However, nurses in psychiatric hospitals do not intervene with community resources and support networks in Japan. This study aimed to determine the care information required by home visit nurses from psychiatric hospital nurses. A qualitative descriptive research design was employed. Semi-structured interviews were conducted with nine psychiatric home-visiting nurses, and content analysis was performed to analyze the data. Findings revealed 319 narratives about the information that psychiatric home-visiting nurses seek from psychiatric hospital nurses, which were classified into six main categories. Information needed for home-visiting nurses to provide care includes the following : 1) to build trust with home-visiting service users, 2) to help home-visiting service users live according to their wishes, 3) to help home-visiting service users continue treatment in the community, 4) to perform symptom management, 5) to provide family care, and 6) to protect the safety of home visiting nurses during home visits. Nurses in psychiatric hospitals should communicate this information to nurses who provide psychiatric home care. This will improve the quality of continuing care for home care users and support their recovery in community living. J. Med. Invest. 71 : 162-168, February, 2024.

The roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by Japan's public health nurses.

Background: Public Health Nurses (PHNs) collaborate with community volunteer welfare commissioners to support children with developmental disorders and their families lead a life without isolation. Objective: This study aims to clarify the roles and competencies that PHNs expect of welfare commissioners in supporting children with developmental disorders and their families. Methods: An online survey was administered through Survey Monkey© to 220 PHNs working in Japanese municipalities using an independently developed questionnaire regarding the roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by PHNs. Exploratory Factor Analysis (EFA) was performed to simplify the data structure and enhance understanding. The reliability of the scale was confirmed using Cronbach's α. Differences due to PHN attributes (e.g., experience collaborating with welfare commissioners) were analyzed using Welch's t-test. This study was conducted between April and September 2021. Results: The highest scoring items were, for the role, "a welfare commissioner's role is to pass on accurate information to their successor," and for competencies, "a necessary competency for a welfare commissioner is to protect the information about children with developmental disorders, and their families learned during one's work." The EFA results revealed a two-factor structure for role items: Factor 1, "Supporting children with developmental disorders and their families and preventing abuse," and Factor 2, "Connecting to social resources." Competency items were also found to have a two-factor structure: Factor 1, "Understanding the position of children with developmental disorders and their families and connecting with local residents," and Factor 2, "Understanding developmental disorders and supporting them based on assessment." A comparison of the attributes of PHNs showed no significant differences. Conclusion: PHNs feel welfare commissioners should pass on the information and protect confidentiality when supporting children with developmental disorders and their families. Furthermore, PHNs expect welfare commissioners to connect children with developmental disorders and their families to the community, prevent abuse, and provide support based on assessment. PHNs had the same expectations regarding the roles and competencies of welfare commissioners regardless of their own attributes.

Effects of Healthcare Technologies on the Promotion of Physical Activities in Older Persons: A Systematic Review.

This study aimed to explore the effects of health technologies on the promotion of health through physical activities of older persons. Following PRISMA guidelines, a systematic review of relevant articles published prior to 2020 was conducted from selected indices such as COCHRANE, PubMed, Science Direct, Proquest, including the use of hand search procedure. Twenty-seven articles were analyzed with significant findings influential to older people nursing: types of health technologies used for promoting physical activity; effects of technology use in promoting physical activity of older person care; and aspects that need to be considered in technology use among older persons. Characteristics of technologies were accuracy, usefulness, reliability, comfort, safety, and relevancy. Most technologies promoting physical activities for older people were wearable technologies that use artificial intelligence. Altogether, these technologies influenced overall healthcare behaviors of older persons. With healthcare technology efficiencies, proficiencies, and dependencies, technology-based healthcare have served older people well. Most technologies for older people care, such as wearables, reliably produce characteristics enhancing dependency and accuracy of bio-behavioral information influencing physical activities of older persons. Health technologies foster the values of physical activities among older persons thereby promoting healthy living.

Variations on a theme: Labeling patients as persons, the nursed, or client in nursing.

The debate regarding the variation of names used for labeling the patient in a nursing care situation has always existed in nursing. Names such as patient, client, person, and nursed have been used widely among healthcare disciplines, including nursing. However, does the use of any of these identifying terms establish the appropriate identification of the nurse and the persons being nursed in a nursing care situation participating in a mutual relationship? This editorial aims to address the varieties and rationales of identifying persons participating in or receiving nursing care. Among these terms, "person" describing human beings underscores personhood, allowing nurse-nursed relations to foster, support, celebrate, and affirm living the meaning of what matters most to one's life. Therefore, it will be advantageous to nursing practice if the term "person being nursed" is the relevant descriptor to be considered as the primary label.

Aesthetics in nursing practice as experienced by nurses in Indonesia: A phenomenological study.

Background: While aesthetics in nursing practice brings out the beauty in nursing, studies regarding how aesthetics are implemented in practice are lacking. Objective: To describe the meanings of aesthetics in nursing practice experienced by nurses in Indonesia. Methods: This qualitative study employed a hermeneutic phenomenological approach based on Gadamerian philosophy. Thirteen nurses were asked to reflect on their experiences of providing aesthetics in their practice through drawing, followed by individual face-to-face interviews. Data were collected in a public hospital in West Sumatra, Indonesia. The interview transcripts and the pictures were analysed following van Manen's approach. Results: Five thematic categories were revealed: 1) Engaging in caring for persons; 2) Full of compassion; 3) Sympathetic place of care; 4) A joyful time of care; and 5) Distracting the inconvenience in care. Conclusion: Aesthetics in nursing practice is understood and experienced by Indonesian nurses in various ways, not only limited to the visual beauty, cleanness or tidiness of nursing intervention, but are expressed in other ways within caring, including providing care with compassion, applying the art of communication, relieving the pain, and applying innovation in care. These findings can be used to inform nurses in practising aesthetic nursing for enhancing the quality of care.

Remote-Controlled Drone System through Eye Movements of Patients Who Need Long-Term Care: An Intermediary's Role.

The use of a remote-controlled drone system (RDS) by eye movements was studied to assist patients in psychiatric long-term care (PLTC) to allow them to view the environment outside the hospital, hoping that this will bring them some enjoyment. However, successfully applying this system requires human intermediaries in facilitating the interactions between patients and RDS operators. The aim of the study was to describe the role of nurses as intermediaries in the application of an RDS through eye movements of patients PLTC. This study employed the Intentional Observational Clinical Research Design. Data collection was performed in November 2021 at a psychiatric hospital with selected patients in PLTC. Seventeen patients took part in the indoor experiment, whereas 23 patients took part in the outdoor experiment. Fifteen of the 23 patients in the outdoor experiment were the same patients who took part in the indoor experiment. Most of the patients in the indoor and outdoor test arenas could successfully, delightfully, and safely fly the drone. This study demonstrated that RDS using just eye movements could increase the quality of life in older patients with psychiatric problems in PLTC. For the successful use of this drone system, nurse intermediaries assumed critically significant roles.

Investigation of Methods to Create Future Multimodal Emotional Data for Robot Interactions in Patients with Schizophrenia: A Case Study.

Rapid progress in humanoid robot investigations offers possibilities for improving the competencies of people with social disorders, although this improvement of humanoid robots remains unexplored for schizophrenic people. Methods for creating future multimodal emotional data for robot interactions were studied in this case study of a 40-year-old male patient with disorganized schizophrenia without comorbidities. The qualitative data included heart rate variability (HRV), video-audio recordings, and field notes. HRV, Haar cascade classifier (HCC), and Empath API© were evaluated during conversations between the patient and robot. Two expert nurses and one psychiatrist evaluated facial expressions. The research hypothesis questioned whether HRV, HCC, and Empath API© are useful for creating future multimodal emotional data about robot-patient interactions. The HRV analysis showed persistent sympathetic dominance, matching the human-robot conversational situation. The result of HCC was in agreement with that of human observation, in the case of rough consensus. In the case of observed results disagreed upon by experts, the HCC result was also different. However, emotional assessments by experts using Empath API© were also found to be inconsistent. We believe that with further investigation, a clearer identification of methods for multimodal emotional data for robot interactions can be achieved for patients with schizophrenia.

Characteristics of interactive communication between Pepper robot, patients with schizophrenia, and healthy persons.

Background: Expressing enjoyment when conversing with healthcare robots is an opportunity to enhance the value of human robots with interactive capabilities. In clinical practice, it is common to find verbal dysfunctions in patients with schizophrenia. Thus, interactive communication characteristics may vary between Pepper robot, persons with schizophrenia, and healthy persons. Objective: Two case studies aimed to describe the characteristics of interactive communications, 1) between Pepper as a healthcare robot and two patients with schizophrenia, and 2) between Pepper as a healthcare robot and two healthy persons. Case Report: The "Intentional Observational Clinical Research Design" was used to collect data. Using audio-video technology, the conversational interactions between the four participants with the Pepper healthcare robot were recorded. Their interactions were observed, with significant events noted. After their interactions, the four participants were interviewed regarding their experience and impressions of interacting with the Pepper healthcare robot. Audio-video recordings were analyzed following the analysis and interpretation protocol, and the interview data were transcribed, analyzed, and interpreted. Discussion: There were similarities and differences in the interactive communication characteristics between the Pepper robot and the two participants with schizophrenia and between Pepper and the two healthy participants. The similarities were experiences of human enjoyment while interacting with the Pepper robot. This enjoyment was enhanced with the expectancy of the Pepper robot as able to entertain, and possessing interactive capabilities, indicating two-way conversational abilities. However, different communicating characteristics were found between the healthy participants' impressions of the Pepper robot and the participants with schizophrenia. Healthy participants understood Pepper to be an automaton, with responses to questions often constrained and, on many occasions, displaying inaccurate gaze. Conclusion: Pepper robot showed capabilities for effective communication pertaining to expressing enjoyment. The accuracy and appropriateness of gaze remained a critical characteristic regardless of the situation or occasion with interactions between persons with schizophrenia, and between healthy persons. It is important to consider that in the future, for effective use of healthcare robots with multiple users, improvements in the areas of the appropriateness of gaze, response time during the conversation, and entertaining functions are critically observed.

Comparison of Subjective Facial Emotion Recognition and "Facial Emotion Recognition Based on Multi-Task Cascaded Convolutional Network Face Detection" between Patients with Schizophrenia and Healthy Participants.

Patients with schizophrenia may exhibit a flat affect and poor facial expressions. This study aimed to compare subjective facial emotion recognition (FER) and FER based on multi-task cascaded convolutional network (MTCNN) face detection in 31 patients with schizophrenia (patient group) and 40 healthy participants (healthy participant group). A Pepper Robot was used to converse with the 71 aforementioned participants; these conversations were recorded on video. Subjective FER (assigned by medical experts based on video recordings) and FER based on MTCNN face detection was used to understand facial expressions during conversations. This study confirmed the discriminant accuracy of the FER based on MTCNN face detection. The analysis of the smiles of healthy participants revealed that the kappa coefficients of subjective FER (by six examiners) and FER based on MTCNN face detection concurred (κ = 0.63). The perfect agreement rate between the subjective FER (by three medical experts) and FER based on MTCNN face detection in the patient, and healthy participant groups were analyzed using Fisher's exact probability test where no significant difference was observed (p = 0.72). The validity and reliability were assessed by comparing the subjective FER and FER based on MTCNN face detection. The reliability coefficient of FER based on MTCNN face detection was low for both the patient and healthy participant groups.

Intentional Observational Clinical Research Design: Innovative Design for Complex Clinical Research Using Advanced Technology.

The growing use of robots in nursing and healthcare facilities has prompted increasing research on human-robot interactions. However, specific research designs that can guide researchers to conduct rigorous investigations on human-robot interactions are limited. This paper aims to discuss the development and application of a new research design-the Intentional Observational Clinical Research Design (IOCRD). Data sources to develop the IOCRD were derived from surveyed literature of the past decade, focusing on clinical nursing research and theories relating robotics to nursing and healthcare practice. The distinction between IOCRD and other research design is the simultaneous data generation collected using advanced technological devices, for example, the wireless Bonaly-light electrocardiogram (ECG) to track heart rate variability of research subjects, robot application programs on the iPad mini to control robot speech and gestures, and Natural Language Processing programs. Even though IOCRD was developed for human-robot research, there remain vast opportunities for its use in nursing practice and healthcare. With the unique feature of simultaneous data generation and analysis, an interdisciplinary collaborative research team is strongly suggested. The IOCRD is expected to contribute guidance for researchers in conducting clinical research related to robotics in nursing and healthcare.

Balance of Autonomic Nervous Activity, Exercise, and Sleep Status in Older Adults: A Review of the Literature.

While older people are frequently known to experience sleep disturbances, there are also many older people who have a good quality of sleep. However, little is known about the balance of autonomic nervous activity, exercise habits, and sleep status in healthy older adults. This study reviews the literature regarding balance of the autonomic nervous activity, exercise, and sleep in healthy older adults. Relevant articles were searched from electronic databases using the combination of the following keywords: "Autonomic nervous activity", "sleep status", "sleep", "healthy older adults", "aging", "heart rate variability (HRV)" and "exercise". Articles were included if they met inclusion criteria: (1) Published in English, (2) Article types: research and review articles, (3) Main outcome was related to the autonomic nervous activity, lifestyle, sleep, and/or healthy aging, and (4) Fully accessed. From 877 articles that were identified, 16 articles were included for review. Results showed that the autonomic nervous activity changes with increasing age, particularly a constant decline in cardiac vagal modulation due to the significant decrease in the nocturnal parasympathetic activity. In addition, the autonomic nervous activity was also related to sleep status and lifestyle, particularly the capability to exercise. In preparing older people toward a healthy aging, maintaining good sleep quality and exercise is suggested.