Pressure injury prevention: Knowledge and attitude and their predictors in Indonesian nurses working in hospital settings.

AIM: Nurses' knowledge and attitude are critical for pressure injury (PI) prevention. However, to date, there has been little research carried out on the knowledge and attitude of Indonesian nurses regarding PI prevention in hospital settings, and no study has investigated the predictors of knowledge and attitude of Indonesian nurses regarding PI prevention. This study therefore aims to investigate knowledge and attitude, and to identify the predictors of knowledge and attitude regarding PI prevention among Indonesian nurses in hospital settings. METHODS: A cross-sectional study was conducted between 1st November 2021 and 5th March 2022. A total of 563 nurses from three general hospitals in Central Java Province participated. The Pressure Ulcer Knowledge Assessment Tool 2.0 and the Attitude Pressure Ulcer Prevention questionnaires were used. A multiple linear regression analysis was used to determine the predictors of nurses' knowledge and attitude regarding PI prevention. RESULTS: The percentage of correct answers was 35.02%, indicating poor knowledge, while the percentage of nurses' attitudes was 75.46%, indicating a satisfactory attitude. The predictors of knowledge of PI prevention were found to be age (ß = -0.127, p = 0.025), level of education (ß = 0.153, p = 0.001) and income (ß = 0.107, p = 0.021), while the predictors of attitude toward PI prevention were level of education (ß = 0.101, p = 0.020) and professional position (ß = 0.093, p = 0.033). CONCLUSION: This is the first study to identify the predictors of attitude and knowledge regarding PI prevention in Indonesian nurses in a hospital setting. The results indicate a need for appropriate educational training based on the predictors to be given to Indonesian nurses working in hospital settings to increase their knowledge of PI prevention.

Nursing students' knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia.

Objective: The prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students' knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them. Methods: A cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis. Results: The results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96-20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19-0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40-5.41, P = 0.003). Conclusion: Findings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students' knowledge and attitudes based on the factors discovered in this study.

The cultural beliefs and practices of diabetes self-management in Javanese diabetic patients: An ethnographic study.

BACKGROUND: It is important to assess the cultural beliefs and practices of diabetic patients since such beliefs and practices greatly influence how patients self-manage the disease. However, how cultural beliefs and practices affect self-management in Javanese diabetic patients in Indonesia is still unclear since research about it is very limited. Therefore, the purpose of this study was to explore the cultural beliefs and practices of diabetes self-management in Javanese diabetic patients. METHODS: An ethnographic study was conducted between July 2020 and March 2021 in Banyumas Regency, Indonesia. Forty-seven participants were included, consisting of 36 type 2 diabetes mellitus (T2DM) patients as key informants and 11 family members and health providers as general informants. Purposive and snowball sampling methods were used, and data was collected through in-depth interviews, observations, and the writing of field notes. The data were analyzed by thematic analyses using NVivo 12 software. RESULTS: Four themes emerged from the data analysis: (1) misconception about diabetes and management, such as the belief of there being dry sugar and wet sugar types of diabetes; the belief that consuming a lot of cold rice does not increase blood glucose; the belief that insulin causes organ damage; the belief that diabetes can be completely cured; and the belief that walking barefoot is good for the body; (2) cultural beliefs and practices regarding treatment regimen, such as use of medicinal plants to lower blood glucose and home remedies to treat foot ulcers; (3) coping influenced by a blend of culture and religion, such as managing stress by submitting to God and being patients in dealing with their disease; (4) cultural influence on diet management, such as facing difficulties managing their diets at cultural events and difficulties managing the habit of eating sweet-tasting food. CONCLUSION: This is the first study to show that Javanese culture strongly influences how diabetic patients in Java self-manage their disease. Various aspects of Javanese culture were found to have either beneficial or detrimental effects on diabetic patients' health status. This study provides new insights for nurses in Indonesia and will help them design a culturally sensitive education program for their diabetic patients.

The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study.

AIM: To investigate the barriers and facilitators of foot care practice in diabetic patients in Indonesia. DESIGN: A qualitative content analysis with an inductive approach. METHOD: Semi-structured interviews were conducted on 34 type 2 diabetes mellitus (T2DM) patients, health providers and family members in Purwokerto, Indonesia, between July 2020 and December 2020. The interview transcripts were coded using NVivo 12. RESULTS: Four themes emerged from data analysis, including personal barriers (low susceptibility of developing foot ulcer, limited knowledge about foot care, fatalistic practices, financial problems, glucose control taking priority over foot care, lack of motivation, lack of confidence, fear of being labelled), environmental barriers (lack of knowledge and time of health providers, lack of family support and climate conditions), perceived foot health benefits (intention to feel better and desire to stay socially active) and religious practices (foot washing as part of religious practice and intention to feel clean before praying).

The knowledge, attitude, practice and predictors of complementary and alternative medicine use among type 2 diabetes mellitus patients in Indonesia.

OBJECTIVE: The prevalence of complementary and alternative medicine (CAM) usage among patients with type 2 diabetes mellitus (T2DM) in Indonesia is high. However, to date, little is known about why Indonesian T2DM patients choose CAM therapies, how their knowledge, attitude and practice (KAP) of CAM affects their choices, or how demographics correlate with patient choices. Therefore, this study aimed to investigate the KAP and predictors of CAM usage in T2DM patients in Indonesia. METHODS: This was an observational, cross-sectional study. Patients were interviewed using a questionnaire. Chi-square tests or Fisher's exact tests were used to compare demographic and clinical data, as well as KAP assessments, between T2DM patients who use and do not use CAM. Multivariate logistic regression analyses were used to investigate predictors of CAM usage. RESULTS: A total of 628 T2DM patients were enrolled in the study. CAM therapies were used by 341 patients (54.3%). The most common therapies were herbs and spiritual healing, used by 100.0% and 68.3% of CAM-using patients, respectively. CAM therapies were frequently recommended by family members (91.5%), and CAM users had significantly more knowledge and more positive attitudes toward CAM therapies than nonusers. Among users, 66% said they would not follow their healthcare providers' instructions to not use CAM therapies, and 69.5% said they would not disclose their plan to use CAM therapies with their healthcare provider. Neither demographic nor clinical characteristics were associated with CAM use. The factors that best predicted the use of CAM therapies were their availability and low cost (odds ratio [OR] = 4.59; 95% confidence interval [CI]: 3.01-7.01), the belief that CAM therapies were safe (OR = 2.04; 95% CI: 1.40-2.95), the belief that CAM therapies could help with diabetes control (OR = 1.75; 95% CI: 1.15-2.66), and the belief that CAM therapies could help maintain physical health (OR = 1.68; 95% CI: 1.13-2.49). CONCLUSION: CAM therapy users were more knowledgeable and had more positive attitudes toward CAM, but most of them chose not to disclose their CAM use to their healthcare providers. CAM use in Indonesia was associated with its accessibility, affordability, safety and effectivity, but not with any demographic or clinical characteristics. This study provided new evidence and insights for nurses and physicians in Indonesia that will help to design educational programs about the safety and efficacy of CAM therapies.

Foot self-care behavior and its predictors in diabetic patients in Indonesia.

OBJECTIVES: Previous studies have shown that diabetic foot ulcers are principally associated with improper foot self-care. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors. RESULTS: Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.