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.

Burnout dimension profiles among healthcare workers in Indonesia.

Background: Besides biological impact, COVID-19 also poses a threat to psychological wellbeing and the quality of life. Healthcare workers, especially those assuming a front-line post, are at a higher risk of being affected, both physically and psychologically. This study aims to analyse variables potentially associated with burnout and psychological distress among healthcare workers with various health center stratifications, where we commenced a nationwide survey to establish the baseline data. Method: An analytic observational study with a cross-sectional design was conducted on the 11th - September 18, 2020. Participants were enrolled from healthcare institutions represented by epicenter of the COVID-19 pandemic in Indonesia, which were Java, Sumatra, Bali, and were asked questionnaires, including the Depression, Anxiety and Stress Scale 21 (DASS-21), Maslach Burnout Inventory (MBI), Somatic Symptom Scale 8 (SSS-8), also Well-Being Index (WBI). A linear mixed effect model was used to analyse how three dimensions of burnout vary across occupations. Results: A total of 3629 healthcare workers were analysed in this study. Burnout syndrome was found in 37.5% of healthcare workers. The prevalence of burnout among medical personnel, nurses, and midwives was 44.6%, 33.5%, and 36.2%, respectively. The prevalence of burnout in healthcare workers was most common in Java (38.4%) and healthcare workers who work in the hospital (28.6%). Based on the burnout dimensions, 48.2% of healthcare workers experienced moderate to high emotional exhaustion, 51.8% moderate to high depersonalization, and 96.9% high personal accomplishment. The R 2 values was 0.33,0.28,0.27 for emotional exhaustion, depersonalization and personal accomplishment model. Calculated power of the emotional exhaustion and depersonalization model was 100% for both midwife and nurse variable. Meanwhile, the power of the personal accomplishment model was 100% for midwife and 94.7% for nurse variable. Conclusion: The extent of the three burnout dimensions is pervasive in all occupational levels and the place of work (hospital/community health center).

Researching nurses' adherence to patient safety guidelines in emergency departments.

BACKGROUND: One of the reasons why patient safety may be put at risk during healthcare interventions is a lack of staff adherence to patient safety guidelines. There could be a relationship between staff's adherence to patient safety guidelines and their perceived level of reward for their work and/or motivation. AIM: To examine the relationship between reward and adherence to patient safety guidelines, and between motivation and adherence to patient safety guidelines, among nurses working in emergency departments (EDs) in Indonesia. METHOD: This was a cross-sectional study of 101 nurses working in the EDs of four hospitals in Indonesia. Self-reported questionnaires were used to collect data on the level of reward participants felt they received for their work, the level of participants' motivation for their work, and participants' adherence to patient safety guidelines. Spearman's rank correlation testing was used to determine the relationships between variables. RESULTS: There was a statistically significant negative relationship between reward and adherence (P=0.019, r=-0.233), which meant that those who perceived their reward as low were more likely to adhere to patient safety guidelines than those who felt they were highly rewarded. There was a statistically significant positive relationship between motivation and adherence to patient safety guidelines (P=0.017, r=0.236), which meant that the higher the motivation, the higher participants' level of adherence to patient safety guidelines. CONCLUSION: Ensuring ED nurses are motivated for their work by offering rewards - such as a decent salary, a supportive workplace environment and career progression opportunities - is important to enhance their adherence to patient safety guidelines.

The effect of a smartphone-based perioperative nursing intervention: prayer, education, exercise therapy, hypnosis, and music toward pain, anxiety, and early mobilization on cardiac surgery.

BACKGROUND: Cardiac surgery can elicit both physical and psychological responses. Prayer, exercise therapy, education, hypnosis, and music are expected to be able to overcome pain, anxiety, and immobilization in the cardiac surgery. This study was to create a smartphone-based peri-operative nursing intervention model that was able to reduce pain, anxiety, and increase early mobilization cardiac surgery patients. DESIGN AND METHODS: This study consisted of three stages. The first stage was research and development, the second was true experimental design, and the third was cross sectional design. The samples size was 86 respondents. The intervention models for the treatment group comprised of a smartphone-based therapy of prayer, education, exercise, hypnosis, and music. The control group was given standard hospital intervention according to the clinical pathway. RESULTS: The majority of respondents were adults, male, high school graduate in the treatment group and bachelor graduate in the control group, CABG type of surgery, and having pain history. The intervention had a significant effect on reducing pain scale and anxiety level as well as increasing early mobilization (p<0.05). The intervention had a direct effect on pain and anxiety, but it had no direct effect on early mobilization. However, it gave indirect effect on early mobilization that was mediated by anxiety. CONCLUSION: The models can be used by nurses to reduce pain, anxiety and to increase early mobilization on cardiac surgery patients.

Dietary and Plasma Carboxymethyl Lysine and Tumor Necrosis Factor-α as Mediators of Body Mass Index and Waist Circumference among Women in Indonesia.

Dietary and plasma carboxymethyl lysine (dCML, pCML) and plasma tumor necrosis factor-α (pTNF-α) may be associated with obesity in affluent society. However, evidence in women from low-middle income countries with predominantly traditional diets is lacking. We investigated the mediator effects of dCML, pCML and pTNF-α on body mass index (BMI) and waist circumference (WC) among Indonesian women. A cross-sectional study was conducted among 235 non-diabetic, non-anemic and non-smoking women aged 19-50 years from selected mountainous and coastal areas of West Sumatra and West Java. Dietary CML, pCML, pTNF-α were obtained from 2 × 24-h recalls, ultra-performance liquid chromatography-tandem mass spectrometry and enzyme-linked immunosorbent assay, respectively. Between-group differences were analyzed by the Chi-square or Mann-Whitney test and mediator effects by Structural Equation Modeling. The medians and interquartile-ranges of dCML, pCML and pTNF-α were 2.2 (1.7-3.0) mg/day, 22.2 (17.2-28.2) ng/mL and 0.68 (0.52-1.00) IU/mL, respectively, and significantly higher in the WC ≥ 80 cm than in the WC < 80 cm group, but not in BMI ≥ 25 kg/m2 compared to BMI < 25 kg/m2 group. Plasma CML and pTNF-α were positively and directly related to WC (ß = 0.21 [95% CI: 0.09, 0.33] and ß = 0.23 [95% CI: 0.11, 0.35], respectively). Dietary CML that correlated with dry-heat processing and cereals as the highest contributions was positively related to WC (ß = 0.33 [95% CI: 0.12, 0.83]). Ethnicity, level of education, intake of fat, and intake of energy contributed to dCML, pCML and pTNF-α, and subsequently affected WC, while only ethnicity contributed to BMI through dCML, pCML and pTNF-α (ß = 0.07 [95% CI: 0.01, 0.14]). A positive direct effect of dCML on pCML and of pCML and pTNF-α on WC was seen among Indonesian women. Dietary CML seems to have several paths that indirectly influence the increases in WC if compared to BMI. Thus, intake of CML-rich foods should be reduced, or the foods consumed in moderate amounts to avoid the risk of central obesity in this population.

Effectiveness in improving knowledge, practices, and intakes of "key problem nutrients" of a complementary feeding intervention developed by using linear programming: experience in Lombok, Indonesia.

BACKGROUND: Complementary feeding recommendations (CFRs) with the use of locally available foods can be developed by using linear programming (LP). Although its potential has been shown for planning phases of food-based interventions, the effectiveness in the community setting has not been tested to our knowledge. OBJECTIVE: We aimed to assess effectiveness of promoting optimized CFRs for improving maternal knowledge, feeding practices, and child intakes of key problem nutrients (calcium, iron, niacin, and zinc). DESIGN: A community-intervention trial with a quasi-experimental design was conducted in East Lombok, West Nusa Tenggara Province, Indonesia, on children aged 9-16 mo at baseline. A CFR group (n = 240) was compared with a non-CFR group (n = 215). The CFRs, which were developed using LP, were promoted in an intervention that included monthly cooking sessions and weekly home visits. The mother's nutrition knowledge and her child's feeding practices and the child's nutrient intakes were measured before and after the 6-mo intervention by using a structured interview, 24-h recall, and 1-wk food-frequency questionnaire. RESULTS: The CFR intervention improved mothers' knowledge and children's feeding practices and improved children's intakes of calcium, iron, and zinc. At the end line, median (IQR) nutrient densities were significantly higher in the CFR group than in the non-CFR group for iron [i.e., 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal) compared with 0.5 mg/100 kcal (0.4-0.7 mg/100 kcal)] and niacin [i.e., 0.8 mg/100 kcal (0.5-1.0 mg/100 kcal) compared with 0.6 mg/100 kcal (0.4-0.8 mg/100 kcal)]. However, median nutrient densities for calcium, iron, niacin, and zinc in the CFR group (23, 0.6, 0.7, and 0.5 mg/100 kcal, respectively) were still below desired densities (63, 1.0, 0.9, and 0.6 mg/100 kcal, respectively). CONCLUSIONS: The CFRs significantly increased intakes of calcium, iron, niacin, and zinc, but nutrient densities were still below desired nutrient densities. When the adoption of optimized CFRs is constrained by economic access for or acceptability of nutrient-dense foods, other strategies need to be incorporated into interventions to ensure adequate intakes of these nutrients.