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.

Path analysis of COVID-19 vaccine adherence among adolescents across Indonesia, in the Maluku-Papua Islands (Eastern Indonesia), and on Java Island.

BACKGROUND: COVID-19 incidence in Indonesia was high among adolescents, but vaccine acceptance remains low. The unequal geographical distribution of the health workforce and health facilities in Indonesia, including a lower number of health workers and facilities in Maluku-Papua, resulted in a low rate of vaccine acceptance. Knowledge, attitude, belief in the vaccine, comorbidity, congenital status are related to vaccine adherence, but mediation analysis of factors remains lacking. We aimed to analyze path analysis of knowledge, congenital, comorbidity, belief, and attitude to COVID-19 vaccine adherence among adolescents in Indonesia, Maluku-Papua Island, and Java Island. METHOD: A nationwide cross-sectional study was undertaken among 7604 adolescents. A path analysis to investigate mediating effects between variables combined with bootstrapping was utilized to determine statistical significance. RESULT: Knowledge, congenital status, comorbidity, belief, and attitude were significantly positively associated with COVID-19 vaccine adherence among adolescents in Maluku-Papua Island (p < 0.01; n = 4761), Java Island (p < 0.01; n = 1573), and Indonesia (p < 0.05; n = 7604). Congenital status, belief, and attitude negatively mediated the relationship between knowledge of and adherence to COVID-19 vaccine (p < 0.01) in Indonesia and among the subgroup on Maluku-Papua Island (p < 0.01), but a positive mediation (p = 0.04) in our subgroup analysis of Java Island. Comorbidity status, belief, and attitude negatively mediated relationship between knowledge and adherence to COVID-19 vaccine in Indonesia (p ≤0.01) and Maluku-Papua (p = 0.00), but no mediation role was found in Java Island (p = 0.58). CONCLUSION: Comorbidity, congenital illness status, belief in and attitude to COVID-19 vaccine negatively mediated the relationship between knowledge of and adherence to COVID-19 vaccine among adolescents in Indonesia and our sub-group on Maluku-Papua Island but not on Java Island. PRACTICAL IMPLICATION: Massive improvement in healthcare facility equality plays an important role in Indonesia gaining COVID-19 vaccine adherence.

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.

Understanding the experiences of caregivers of HIV-exposed children under five: A phenomenological inquiry.

Background: Children born to mothers with HIV require special care from the womb to the postnatal period, and caregivers involved in their care face several challenges. Objective: This study aimed to explore caregivers' experiences providing care for HIV-exposed children under five. Methods: This study employed a phenomenological approach. Ten caregivers of HIV-exposed children living in Jakarta, Indonesia, were selected using snowball techniques. Online in-depth interviews were conducted to collect data from September 2021 to July 2022, and thematic analysis using Colaizzi's method was performed for data analysis. Results: The study involved ten caregivers (nine females and one male) aged between 23 and 42 years. Seven of them were mothers who tested HIV-positive, while one was an adoptive father, one was a mother's sister, and one was an aunt of HIV-exposed children. The majority of them were housewives and had a low educational background. Three themes were generated: (i) disease-transmission foreboding, (ii) prejudice against mothers and children exposed to HIV, and (iii) seeking support. Conclusion: Caring for HIV-exposed children poses emotional and physical challenges for caregivers, necessitating support from health professionals and peer groups. Nurses play essential roles in improving caregiver well-being and supporting optimal growth and development in HIV-exposed children under five by designing intervention programs. Furthermore, to enhance home-based HIV care in Indonesia, the government must implement social interventions that target families with limited resources.

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.

Improvement in maternal knowledge, attitudes, and children's weight with education on World Health Organization feeding recommendations.

Malnutrition is among the most common nutritional problems in children worldwide. Specifically, stunting as a malnutrition problem is a global priority, including in Indonesia. This study analyses the effect of nutrition education interventions on maternal feeding knowledge, maternal feeding attitudes and children's weight. A quasi-experimental design using a pre-and post-test was selected and with a total sample of 70 people were assigned to an experimental and control group. This study was conducted in Jember Regency on July 2022, and the instrument used in this research were knowledge, attitude, and practice (KAP) questionnaires from the Food and Agriculture Organization (FAO). A Bivariate analysis showed that the nutritional education intervention had a significant relationship with increased maternal feeding knowledge and attitude and children's weight in the control group and intervention group (p-value <0.05). However, a higher score was on the intervention group score compared to the control group. Meanwhile, the average weight of the children in the intervention group increased by about 331.42 grams, which higher compare to the control group's average weight gain. This study concluded that health education about eating, according to the World Health Organization (WHO) recommendations, through an action-oriented group approach can significantly increase maternal feeding knowledge, attitudes, and children's weight.

Motivation of male adolescents to become perpetrators of violence: a study of phenomenology.

BACKGROUND: Violence committed by adolescents is a serious public health problem. More than ten percent of youth violence have been subjected to violence and more than fifty percent attacks and serious violence. DESIGN AND METHODS: A qualitative study with a phenomenological study design in which semi-structured interviews were conducted with participants who were once challenged by violence and are now kept in LPKA Class II Jakarta. RESULTS: This qualitative study explores adolescent motivation to become violent perpetrators. This study discusses four major themes, namely, i) Unsafe environmental conditions; ii) Unpleasant past experiences; iii) Childhood trauma; and iv) Peer group solidarity or friendship. CONCLUSIONS: Adolescent motivational advice provides protection for students in Indonesia to participate in discussions about children related to challenges or assistance that can be given to adolescents so as not to offend again.

Perceptions of parents of under-5-year-old children with pneumonia on the effects of tobacco smoke: a phenomenology study in Manggarai, Eastern Indonesia.

BACKGROUND: In Eastern Indonesia, the incidence of pneumonia in under-5-year-old children is mostly predicted by environmental factors, such as exposure to household smoke and tobacco smoke. Sociocultural ideas shape the perception of parents on the effect of tobacco smoke thus influence their behaviour on reducing the smoke exposure on their child. The present study aimed to explore the perceptions of parents of under-5-year-old children with pneumonia about the effects of exposure to tobacco smoke. DESIGN AND METHODS: This qualitative study was conducted using a phenomenological approach. The study participants were 11 parents of under-5-year-old children with pneumonia in Manggarai, Eastern Indonesia. The data were collected through in-depth interviews and then analyzed using the Colaizzi method. RESULTS: The themes identified in the present study were i) "I know the risk of smoke, I can't help it" various perceptions on tobacco smoke effect; ii) tobacco causes shortness of breath on under-5-year-old children; and iii) tobacco smoke taking tolls on family's health and economy. CONCLUSIONS: The findings revealed that parent view tobacco smoke endanger children's health and hamper the socio-economic well-being of the family. It is necessary to improve parent's awareness about the effects of tobacco smoke through effective nursing communication that suits the family's needs and conditions.

The effect of storytelling on fear in school-age children during hospitalization.

Hospitalization places children in conditions that may nurture fears of new surroundings, strangers, and unknown actions. Storytelling can be administered as a distraction from the fears that a child experiences during treatment. This study aims to determine the effectiveness of storytelling against fear due to hospitalization in school-age children admitted to the hospital. This study used a quantitative approach with a pre-experimental design and the method used was nonequivalent control group pretest-posttest design. Subjects in this study consisted of two groups namely the intervention and the control groups. The total number of respondents was n=32 and located at the Maternity and Children Hospital in Indonesia. Bivariate analysis showed that storytelling intervention had a significant relationship with the fear of hospitalization among the hospitalized school-age children (p-value=0.001< 0.05). Also, there was a significant difference between the fear score in the intervention and the control groups (p-value=0.001<). Therefore, applying storytelling in the nursing intervention of pediatric patients in hospitals can be recommended to minimize the fear in children.

Blow pinwheels improve oxygen saturation of preschool children with post pneumonia in outpatient pediatric departement.

This study aimed to recognize the Pursed Lips Breathing (PLB) modification effect by blowing pinwheel to the oxygen saturation of preschool children with post pneumonia. Also, to analyze the oxygen saturation value of the preschool children with pneumonia on the intervention group and the control group and to recognize the differences. This study design was quasi experimental pre-posttest with control group design. The participants were 30 preschool children with post pneumonia (15 children were in the intervention group, 15 were in the control group) and were chosen by consecutive sampling. This study showed significant differences on oxygen saturation between the intervention group and control group (p=0.018<0.05). Blowing pinwheel affected the oxygen saturation of the preschool age with pneumonia on the intervention group but none on the control group. The results of this study can be used as the basis and reference for the hospital in making policies, as founded that blowing pinwheel affected the oxygen saturation escalation of the preschool children with pneumonia after several exercises. This activity was recommended to be implemented at the hospital as the treatment for the outpatient children with pneumonia and to be carried on at home for the preschool children who were able to perform independently. The recommendation for the further study was to use a true experiment with a larger sample and was not limited to PLB but also to measure the ability to blow.

Right lateral position can improving oxygen saturation and respiratory rate on under-five children with pneumonia.

Pediatric patients with pneumonia experience respiratory distress in the form of shortness of breath and rapid breathing, which affects oxygen saturation. Oxygen saturation and respiratory rate can be increased by providing the right lateral position. Fulfillment of oxygen will affect the healing of children and can reduce the length of stay in hospital. The purpose of this study was to identify the effect of right lateral positioning on oxygen saturation and respiratory rate in under-five children with pneumonia. The study design was a quasi-experimental pre-posttest with control group design. Respondents were 32 infants with pneumonia, (right lateral=16 and control group=16), selected by consecutive sampling. Univariate and bivariate analyzes were performed. There was a significant difference in oxygen saturation before and after right lateral position (p-value=0.000) and there was a significant difference in the respiratory rate before and after right lateral position (p-value=0.000). The results can be used to improve health services by promoting the right lateral position as a selftreatment intervention for increasing oxygen saturation and stabilizing respiratory rate in infants with pneumonia.

Using a mobile application ("PrimaKu") to promote childhood immunization in Indonesia: A cross-sectional study.

Background: Universal immunization coverage among children in Indonesia is low compared to the global target. Many children in Indonesia are not fully immunized as recommended by the government, which results in a high mortality rate. The government has developed a mobile application (PrimaKu) to provide information on vaccinations and reminder features. However, the successful use of the immunization features of the app has not been widely studied. Objective: This study aimed to evaluate the use of PrimaKu on maternal attitudes toward immunization and complete basic immunizations status among Indonesian children aged 12 to 24 months. Methods: A cross-sectional research was conducted at a public health center in West Java Province, Indonesia, from August to December 2020. Convenience sampling was used to select the respondents. Data were collected using validated questionnaires and analyzed using binomial logistic regression. Results: A total of 119 mothers were included. About 44.5% of children had a complete basic immunization status. Mothers who had a supportive attitude toward immunization were 3.58 times (95% CI 1.49-8.57, p 0.003) more likely to complete the basic immunization, and those who used the mobile app were 3.23 times (95% CI 1.18-8.87, p 0.034) more likely to complete the immunization. Conclusion: Using the PrimaKu mobile application could increase maternal attitudes toward immunization and complete basic immunization status. Therefore, public health nurses should provide comprehensive education and improve mothers' literacy to use the application.

Assessing effectiveness of regular repositioning in preventing pressure ulcers in children.

Pressure ulcers have adverse effects on health. Thus, early detection of damage to skin integrity is important for preventing the occurrence of pressure sores. Meanwhile, two-hourly repositioning is a nursing intervention performed to prevent pressure ulcers. This study aimed to evaluate the implementation of regular repositioning for preventing pressure sores. The Braden Q Scale is an instrument that predicts skin breakdown caused by pressure ulcers. The designs used quasi-experiment pretest and posttest nonequivalent control group; 93 participants were selected through a nonprobability sampling technique by consecutive sampling (43 for the intervention group and 50 for the control group). Respondents in the intervention group were repositioned every 2 hours, and the control group received pressure mattress, which is done for 14 days or until the child can go home. The findings suggest that there is a significant difference in the Braden Q scores from before and after repositioning of the intervention group and the control group using pressure mattress (P<0.001). Nurses are expected to be able to detect early damage to skin integrity and to implement regular repositioning by using the Braden Q Scale.

Testing of Braden QD Scale for predicting pressure ulcer risk in the Pediatric Intensive Care Unit.

Children admitted to the Pediatric Intensive Care Unit (PICU) are at risk for pressure injury due to immobility and the challenge of positioning medical devices. However, a comprehensive instrument to assess pressure injury risk is still finite. This study aimed to test the validity and reliability of the Braden QD Scale. The design used was a Pearson correlation coefficients and Cronbach's alpha (α). Fifty-one pediatric patients below age 18 who had been bedridden for at least 24 hours were engaged through a consecutive sampling method. The results showed assessments made by using the Braden QD Scale revealed that 88.2% of patients were at risk for a pressure injury. The validity test results of the Braden QD Scale ranged between 0.532 and 0.833. The reliability test results of the Braden QD Scale ranged between 0.756 and 0.834. The sensitivity value is 100%, specificity value is 40%. In general, the study finding suggests that the Braden QD Scale is a valid and reliable instrument for predicting pressure injury risk. Nurses may employ this tool to assess pressure injury risk in pediatric patients.

COMFORT Behavior Scale instrument: validity and reliability test for critically ill pediatric patients in Indonesia.

The COMFORT Behavior Scale (CBS) is an instrument that has been validated in several languages to assess the levels of sedation in children. This project was implemented to identify the validity and reliability of CBS. The design used was an analytic descriptive cross-sectional approach. Fifty-one children aged 1 month to 18 years who received analgesic and/or sedation therapy were purposively selected and assessed for their sedation levels using CBS and the Nurse Interpretation of Sedation Score (NISS). The data were analyzed using the Mann-Whitney U test to measure the concurrent validity; each item was analyzed using Pearson correlation; inter-rater reliability was measured by the Kappa coefficient; and the internal consistency was measured by Cronbach's alpha. The results showed there was no significant correlation between the levels of sedation assessed using CBS and NISS (P= 0.118; α= 0.05). Six items in the CBS instrument were found to be valid (r= 0.348-0.813). The Cronbach's alpha for CBS was 0.873. Thus, the Indonesian version of CBS is valid and reliable in assessing sedation levels in children.

Squeezing a squishy object effectively controls pain in children during intravenous catheter insertion.

This study aimed to identify the effect of distraction technique involving squeezing a squishy object on pain in children during intravenous catheter insertion. In this work, the control group posttest-only quasiexperimental design was used. This study involved 50 participants aged 3-15 years and was assigned into either intervention or control group. The intervention group was provided with a squishy object to squeeze as a form of distraction during intravenous catheter insertion, whereas the control group received the standard intervention. The pain was measured by using the Wong- Baker Faces Scale for 3-8 years old and the Visual Analog Scale or Numeric Rating Scale for children older than 8 years. Mann-Whitney analysis reveals significant difference in pain level between the intervention and control groups (P<0,001; α=0.05). The distraction technique involving squeezing a squishy object effectively reduced pain in children during intravenous catheter insertion and is recommended for pain management in nursing care in the pediatric ward.

Family Support towards Resilience in Adolescents with Type I Diabetes: A Preliminary Study in Indonesia.

The prevalence of diabetes has increased in adolescents. Diabetic adolescents need ongoing support from their families, and the family plays an important role in the management of the disorder. This study aimed to identify the relationship between family support and resilience in adolescents with Type 1 Diabetes Mellitus (T1DM). Quantitative data analysis was conducted using simple logistic regression. Meanwhile, qualitative data were analyzed using content analysis. The results show that the median duration of a T1DM diagnosis was 4 years, which was dominated by early adolescents in the study group (41.9%); the mean resilience score was 67.95 (range 0-100) with 53.5% of the participants had low resilience, and 55.8% of the respondents received a high level of family support. Logistic regression test results indicate that significant family support is associated with resilience.

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.

Music Therapy and Story Telling: Nursing Interventions to Improve Sleep in Hospitalized Children.

Music therapy and story telling are examples of nursing interventions that facilitate the management of sleep disturbance in children. However, only a few studies have addressed the effectiveness of music therapy and storytelling on hospitalized children. This study aimed to examine the effect of music therapy and storytelling on sleep disturbance in hospitalized children for various medical conditions. This recent study was a preliminary study that included two intervention groups without a control group. This study involved 31 children with ages ranging from infancy to school age who were assigned to a 3-day music therapy or storytelling intervention group. Group 1 received music therapy (n = 16) and group 2 was provided with story telling (n = 15). Data collection was conducted from February through April 2018 in an infectious diseases ward of a hospital in Jakarta. Data related to sleep disturbance in children was collected using GATIA scale, an instrument measuring a sleep disturbance scale. Study results showed a significant change in the average of sleep disturbance scale score in both group 1 and group 2 (p < α; α = .05) which demonstrate that both music therapy and story telling improved scores on a sleep disturbance scale in hospitalized children. Music therapy and story telling were equally effective in managing sleep disturbance in children. Music therapy and story telling are safe, cheap, and convenient interventions that can improve the quality of sleep in children during hospitalization.

Is There Any Relationship between Feeding Practices for Children Under Two Years of Age (6-23 Months) and Stunting?

The aim of the paper is to examine the relationship between infant and young child feeding practices (aged 6-23 months) and stunting in East Jakarta. A cross-sectional study design is conducted with three main instruments: maternal and child characteristics, feeding practices, and health behaviors. Sampling is done by simple random sampling technique with a total of 143 respondent mothers in East Jakarta. The results of the analysis show no significant relation between infant and young child feeding practices and stunting (p = 0.147), and its relation with maternal and child characteristics, such as maternal age, maternal employment status, maternal educational level, low birthweight less than 2,500 g, sanitation and health behaviors, and household income (p > 0.05). Further longitudinal studies are required to identify risk factors associated with stunting among children.