Potential Methods to Improve Self-management in Those with Type 2 Diabetes: A Narrative Review.

Context: The ability of self-manage was important for type 2 diabetes mellitus (T2DM) patients and it was supported and depend on the method used. We aimed to summarize the potential method of self-management to improve self-empowerment. Evidence Acquisition: To obtain the related data, 5 databases, including Scopus, Science Direct, ProQuest, CINAHL, and SAGE, were comprehensively searched. The search was done in advance using the Boolean operator. The full texts of articles presenting data on self-management methods were screened and retrieved. Results: A total of 22 studies were included in this review. Various self-management techniques were covered with primary and secondary outcomes. Primary outcomes included blood pressure, fasting blood glucose (FBG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Secondary outcomes included knowledge, self-efficacy, lifestyle habits, physical activity, diet, smoking, medical treatment, support, and health behavior. A goal-setting-oriented approach was effective in setting targets and gaining support from family members. A family-centered approach was effective in taking care of and taking good care of patients with T2DM. Strength training exercises provide patients with a choice of physical activity that can help them manage their blood sugar and blood pressure. Acceptance and commitment therapy (ACT) is a stress-reduction technique. The patient's acceptance of the disease and treatment for diabetes is aided by education. Conclusions: A successful self-management method was one which balances and adapts to the patient's condition. Regardless of the age of the patients, the overall findings from the review suggest that self-management methods can help patients become healthier and improve their quality of life by controlling their hemoglobin A1c (HbA1c) level.

Andragogy learning and the associated factors among nursing students in online palliative class during the COVID-19 pandemic.

Objectives: To investigate the andragogy learning and determine the related factors among nursing students in online palliative class during the coronavirus disease-2019 pandemic. Method: The descriptive cross-sectional online survey-based study was conducted from September 1 to December 31, 2021, after approval from the ethics review committee of the Institute of Technology and Health Bali, Indonesia, and comprised 2nd year nursing students enrolled in the online palliative class. Data was collected using a questionnaire to measure socio-demographic characteristics of the respondents, teacher characteristics, and learning media. Andragogy education movement questionnaire was used to measure students' self-concept, learning motivation, readiness to learn, orientation to learn, and learning experience. Data was analysed using SPSS 25. RESULTS: Of the 189 subjects, 161(85.2%) were females, and 90(47.6%) were aged 20 years, followed by 87(46%) aged 21 years, 10(5.3%) aged 22 years and 2(1.1%) aged 23 years. Age was significantly correlated with self-concepts (p=0.04), while parents' occupation was significantly correlated with learning motivation (p=0.04). Professional ability, personal quality and interpersonal relationships of teachers and learning media, including class management and props, were correlated with andragogy learning (p<0.001). CONCLUSIONS: High levels in all domains of andragogy learning were found. Maintaining the factors that influence andragogy learning through online platforms is an important goal in today's virtual learning era.

Patients' readiness before undergoing gastrointestinal endoscopy: A descriptive study.

Objectives: To analyse patients' anxiety related to endoscopy. Method: The descriptive study was conducted from July 23 to September 14, 2020, at the Endoscopy Unit of Dr Abdoer Rahem Situbondo General Region Hospital, Dr Koesnadi Bondowoso General Region Hospital and Ibnu Sina Gresik General Region Hospital, East Java, Indonesia. The sample comprised endoscopy patients of either gender aged >20 years. Data was collected using the Endoscopy Confidence Questionnaire. RESULTS: Of the 50 patients, 28(56%) were males and 22(44%) were females. The largest age group was 41-50 years 17(34%), followed by 31-40 years 13(26%). Overall, 48(96%) subjects were married. Abdominal pain was most common indication for the procedure 10(20%). Esophagogastroduodenoscopy was the procedure in 29(58%) patients, 42(84%) had no history of endoscopy, and 41(82%) were reluctant to undergo the procedure. CONCLUSIONS: Patients' anxiety rises before endoscopy. Nurses need to provide complete and clear information related to the procedure, including the less pleasant elements.

Increasing self-care of patients with type-2 diabetes through implementation of nursing agency based on the health promotion model.

Objectives: To analyse the effect of nursing agency model on fasting and 2-hour postprandial glucose levels in type 2 diabetics. Method: The quasi-experimental study was conducted from October to December 2021 in Lamongan, East Java, Indonesia, after approval from the ethics review committee of the University of Muhammadiyah, Lamongan, Indonesia. The sample comprised of type 2 diabetics of either gender aged 19-65 years who were able to move independently. The sample was divided into experimental group A, which was given nursing agency model training for six weeks, and control group B, which was only given diabetes treatment without any training. Patient self-care level was assessed using the Summary of Diabetes Self-Care Activities tool, while other variables were measured through fasting and 2-hour postprandial glucose levels. Data were analysed using a one-way covariance analysis test. RESULTS: Of the 256 individuals assessed, 42(16.4%) met the inclusion criteria, and, of them, 30(71.4%) comprised the final sample; 10(33.3%) males and 20(66.6%) females. Overall, 19(63.3%) patients were aged >50 years, and duration of diabetes was 5-10 years in 23(76.7%) cases. There were 15(50%) patients in each of the two groups. There was significant difference in the mean scores of all dimensions of self-care behaviour between the groups, and it increased significantly in group A post-intervention (p=0.05). There was a significant decrease in fasting and 2-hour postprandial glucose levels in group A compared to group B post-intervention (p=0.001). CONCLUSIONS: The application of the nursing agency model was found to be effective in increasing self-care ability and in reducing fasting and 2-hour postprandial blood glucose levels.

Modelo de aprendizaje de cuidados paliativos basado en la teoría de aprendizaje transformacional de cuidados paliativos de los estudiantes de enfermería en Indonesia / Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia

Introducción: La competencia sobre cuidados paliativos es una de las aptitudes que deben poseer los enfermeros generales. Por este motivo, deben llevarse a cabo estrategias para desarrollar modelos de aprendizaje de cuidados paliativos a fin de garantizar que los estudiantes de enfermería posean competencias en dicha materia. Por tanto, este estudio fue estructurado para desarrollar un modelo de aprendizaje de cuidados paliativos basado en la teoría de la transformación, que priorice la participación activa de los estudiantes, de cara a tratar los cuidados paliativos en la práctica futura. Métodos: Estudio transversal que incluyó a 189 estudiantes de enfermería como participantes. El modelo propuesto incluye 6 variables: características de los estudiantes, características del educador, medios de aprendizaje, competencias sobre cuidados paliativos, formación en paliativos basada en la teoría de aprendizaje transformativo (TLT) y logro de competencias. Los datos fueron recopilados utilizando un cuestionario probado mediante la técnica SEM (Structural Equation Modeling [Modelo de ecuaciones estructurales]). Resultados: El análisis SEM mostró que el valor R2 del aprendizaje de cuidados paliativos basado en TLT fue de 0,707, o 70,7%. Dichos resultados indican que la diversidad de las variables del aprendizaje de cuidados paliativos basado en TLT pueden explicarse mediante las variables de estudiantes, educadores, competencias sobre paliativos, y medios de aprendizaje en un 70,7%. Cada constructo tuvo un valor de Q2>0, lo cual significa que el modelo es satisfactorio. El valor del coeficiente por pasos de 0,627 indica que las características de los educadores tienen la contribución más significativa al modelo de aprendizaje de cuidados paliativos basado en TLT. Conclusión: Puede concluirse que el proceso de aprendizaje-formación basado en TLT es una estrategia prometedora para respaldar...(AU)

Introduction: Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. Methods: This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. Results: SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2>0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. Conclusion: It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.(AU)

Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia.

INTRODUCTION: Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. METHODS: This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. RESULTS: SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. CONCLUSION: It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.

Investigation of discriminatory attitude toward people living with HIV in the family context using socio-economic factors and information sources: A nationwide study in Indonesia.

Background: The well-being of people living with HIV (PLHIV) remains a concern. In addition to facing discrimination in their communities, many PLHIV have family members who have a discriminatory attitude. This study analyzes the discriminatory attitude toward PLHIV in the family context using socio-economic factors and information sources in Indonesia. Methods: A cross-sectional study design was adopted using secondary data from the 2017 Indonesian Demographic Health Survey (IDHS). A total sample of 28,879 respondents was selected using two-stage stratified cluster sampling. The study variables are information sources, sex, age, education, residence, earnings, and familial discriminatory attitude. We used the STATA 16.1 software to analyze Chi-square and binary logistics with a 95% confident interval (CI) with a significance of 5% (p-value < 0.05). Results: In Indonesia, familial discriminatory attitude has a prevalence of 72.10%. In the survey, the respondents with access to some information about HIV (AOR: 0.794; 95% CI [0.722-0.873]), women (AOR: 0.768; 95% CI [0.718-0.820]), and those living in rural areas (AOR: 0.880; 95% CI [0.834-0.929]) were the least likely to have a familial discriminatory attitude. Meanwhile, the respondents aged 15-24 years (AOR: 1.329; 95% CI [1.118-1.581]) and those with a secondary level of education (AOR: 1.070; 95% CI [1.004-1.142]) were the most likely to have a familial discriminatory attitude. Conclusion: In the study, we found that, the younger the age and the lower the educational level of the respondent, the more likely they were to have a familial discriminatory attitude. The government may consider these factors when designing policies to tackle familial discrimination faced by PLHIV; in particular, education on HIV and AIDS should be promoted.

A phenomenological study to explore patient experience of fluid and dietary restrictions imposed by hemodialysis.

BACKGROUND: Noncompliance with fluid restrictions and diet is a major problem among hemodialysis patients. This can lead to fluid overload in the interdialytic phase and the accumulation of metabolic waste. This study aims to explore the life experience of patients undergoing hemodialysis and their compliance with fluid restrictions and diet. METHOD: The design of this study was qualitative with a phenomenological approach. It involved 15 patients undergoing hemodialysis interviewed using semistructured interview guidelines. The data were collected and then transcribed and analyzed using the Van Mannen method. The coding analysis used Nvivo 12 software. RESULTS: Patients ranged from 24 to 64 years old. More than half of the patients were not compliant with the fluid restrictions based on the IDWG score (60%, n=15). Five themes emerged: fluid restrictions and understanding related to diet (health education, fluid and diet restriction, information provider, and experience), personal motivation (activity, side effects, need, and lack of motivation), social support (family), compliance (motivation and attitude), and disease management (management of fluid and diet restriction). CONCLUSION: Hemodialysis patients expressed a number of concerns that caused them not to comply with diet and fluid restrictions. Several issues identified were patient-related and potentially modifiable using the correct information or health education related to diet and fluid restriction. Nurses should be more aware of identifying these problems to address compliance issues. Future research should aim to understand nurses' perceptions and practices that may guide interventions to resolve this urgent compliance issue.

The determinants of willingness to care for people living with HIV-AIDS: A cross-sectional study in Indonesia.

Acceptance and willingness to care for people living with HIV-AIDS (PLHA) in society is still a concern. The purpose of this study is to analyse the determinants of willingness to care for PLHA in Indonesia. A cross-sectional study was conducted to process the secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. A total sample of 13,731 individuals was obtained by a two-stage stratified cluster sampling technique. The variables used were socioeconomic characteristics (age, sex, education, wealth quintile, residence, employment status and earnings), knowledge about HIV-AIDS, information about HIV-AIDS and willingness to care for PLHA. Binary logistic regressions were used to analyse the data. According to the data from IDHS 2017, 71.84% of total respondents in Indonesia are willing to care for PLHA. Female respondents, individuals in all wealth quintiles and those who have more information are more likely to care for PLHA. Respondents aged 35-49 years old and currently working are less likely to care for PLHA. However, level of education, level of knowledge, residence and earnings are not related willingness to care for PLHA. The dissemination of correct and accurate information about HIV-AIDS can help the community and society understand this condition. Thus, community members can accept PLHA and become more willing to provide care. The government can determine further policies for the appropriate dissemination of information, maximally and in accordance with recommendations. Collaborations among the government, health workers and the community are needed.

Factors Associated with National Health Insurance Coverage in Indonesia.

Background: The National Health Insurance (NHI) program is the Indonesian government's national health program. However, health insurance coverage has not been maximized. This study aims to analyze the factors associated with health insurance coverage in Indonesia.   Methods: Retrospective cross-sectional data were obtained from the Indonesian Demographic and Health Survey 2017. A total of 39,580 respondents were selected using two-stage stratified cluster sampling. The data come from the DHS Questionnaire Phase 7. In this study, we explored age, education level, wealth quintiles, residence, the number of children who are alive, marital status, current employment status, earnings, and health insurance status in relation to health insurance coverage. Then, we analyzed the data using chi-squared and binary logistic analyses.   Results: The prevalence of health insurance coverage in the Indonesian population is 62.3%. Respondent aged 15-24 years [AOR=0.88; 95% CI=0.77-1.00], secondary education level [AOR=0.44; 95% CI=0.41-0.47], poorer wealth index [AOR=0.76; 95% CI=0.71-0.82], live in rural area [AOR=0.78; 95% CI=0.75-0.82], divorced [AOR=0.72; 95% CI=0.63-0.83] were less likelihood to have health insurance. Conversely, the respondent who received earnings [AOR=1.25; 95% CI=1.18-1.32] was more likely to have health insurance.  Conclusion: This finding pointed to education level, economic status, and demographic area such as respondents who lived in rural areas should more pay attention to NHI. Intervention through the provision of appropriate information about NHI should be promoted.

Behaviour model for diabetic ulcer prevention.

PURPOSE: Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour. METHODS: An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square. RESULTS: Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891). CONCLUSION: Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.