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.

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.

The promising performance of manganese gluconate as a liquid redox sulfur recovery agent against oxidative degradation.

This work studied the oxidative degradation performance of manganese gluconate as a liquid redox sulfur recovery (LRSR) agent. The degradation of gluconate in an aerated sulfide containing 0.1 M manganese/0.8 M gluconate/pH 13 solution was 11% in 47 h and 20% in 100 h of reaction time. With the total price of chelates being more or less comparable, these were superior to the degradation resistance of EDTA chelate in a solution of 0.1 M iron/0.2 M EDTA/pH 8 which degraded by about 30% in 47 h, and NTA in Fe-NTA (0.1 M metal/0.2 M chelate/pH 6.5), which was degraded by 40% in 100 h of reaction time. At pH of 13, 0.1 M Metal, and 0.8 M gluconate, manganese degraded gluconate more severely than iron and copper. At a lower chelate to metal molar ratio (RCM) of 2 and as well as at a lower pH of 10, the manganese gluconate degradation, expressed as relative concentration to its initial concentration, was faster than at RCM of 8 and pH of 13. All of these observations can be explained among others by the well-known Fenton reaction hydroxyl radicals mechanism as the main cause of the degradation process.

"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.

Manganese gluconate, A greener and more degradation resistant agent for H2S oxidation using liquid redox sulfur recovery process.

Iron chelate liquid redox sulfur recovery (LRSR) has been one of the most frequently recommended technologies for the oxidation of H2S in natural gas into elemental sulfur, particularly when the acid gas has a high CO2/H2S molar ratio. The process is however known to suffer from extensive oxidative ligand degradation that results in high operational costs. Moreover, poor biodegradability or toxicity of the existing ligand has become a concern. In this research, we demonstrated that gluconate, a naturally greener ligand, when coupled with manganese as the metal, has considerable potential to be a better redox agent. Manganese gluconate solution was more resistant against ligand degradation compared with iron NTA. As required, aerated solution was capable of converting dissolved NaHS into elemental sulfur. At sufficiently high pH, manganese gluconate solutions were stable enough from precipitation of manganese hydroxide, carbonate, or sulfides. An equilibrium calculation has been developed to understand the precipitation behavior.

Parents' Voice in Managing the Pain of Children with Cancer during Palliative Care.

CONTEXT: Pain experienced by children can adversely affect their growth and development. Pain is a major health problem for cancer patients and remains an unresolved problem. AIM: To know how the experiences of mothers managing their children's pain during palliative care following cancer diagnosis. BACKGROUND: Pain experienced by children can adversely affect their growth and development. SUBJECT AND METHODS: Using qualitative methods within a descriptive phenomenological approach, in-depth interviews were conducted with parents (mostly mothers) of eight children diagnosed with cancer. The data were collected using the snowball sampling method. RESULTS: Participants experienced in managing the pain of children with cancer. Analysis of the results identified 8 themes: the dimensions of pain experienced by children undergoing palliative care; mothers' physical and psychological responses; mothers' emotional responses; barriers encountered by mothers when taking care of their child at home; mothers' interventions to reduce their child's pain; mothers' efforts to distract their child from pain; giving encouragement when the child is in pain; and mothers' efforts and prayers to make their child comfort. CONCLUSION: It can be concluded that the child's pain is the main cause of mothers' stress and pressure and also affects the daily lives of mothers and children. Along with the most effective intervention, nurses need to provide mothers and children with adequate information about cancer pain.

Systematic metabolic engineering of Methylomicrobium alcaliphilum 20Z for 2,3-butanediol production from methane.

Methane is considered a next-generation feedstock, and methanotrophic cell-based biorefinery is attractive for production of a variety of high-value compounds from methane. In this work, we have metabolically engineered Methylomicrobium alcaliphilum 20Z for 2,3-butanediol (2,3-BDO) production from methane. The engineered strain 20Z/pBudK.p, harboring the 2,3-BDO synthesis gene cluster (budABC) from Klebsiella pneumoniae, accumulated 2,3-BDO in methane-fed shake flask cultures with a titer of 35.66 mg/L. Expression of the most efficient gene cluster was optimized using selection of promoters, translation initiation rates (TIR), and the combination of 2,3-BDO synthesis genes from different sources. A higher 2,3-BDO titer of 57.7 mg/L was measured in the 20Z/pNBM-Re strain with budA of K. pneumoniae and budB of Bacillus subtilis under the control of the Tac promoter. The genome-scale metabolic network reconstruction of M. alcaliphilum 20Z enabled in silico gene knockout predictions using an evolutionary programming method to couple growth and 2,3-BDO production. The ldh, ack, and mdh genes in M. alcaliphilum 20Z were identified as potential knockout targets. Pursuing these targets, a triple-mutant strain ∆ldh ∆ack ∆mdh was constructed, resulting in a further increase of the 2,3-BDO titer to 68.8 mg/L. The productivity of this optimized strain was then tested in a fed-batch stirred tank bioreactor, where final product concentrations of up to 86.2 mg/L with a yield of 0.0318 g-(2,3-BDO) /g-CH4 were obtained under O2-limited conditions. This study first demonstrates the strategy of in silico simulation-guided metabolic engineering and represents a proof-of-concept for the production of value-added compounds using systematic approaches from engineered methanotrophs.

Enzyme feeding strategies for better fed-batch enzymatic hydrolysis of empty fruit bunch.

Lignin inhibitory becomes a major obstacle for enzymatic hydrolysis of empty fruit bunch conducted in high solid loading. Since current technology required high enzyme loading, surfactant application could not effectively used since it is only efficient in low enzyme loading. In addition, it will increase final operation cost. Hence, another method namely "proportional enzyme feeding" was investigated in this paper. In this method, enzyme was added to reactor proportionally to substrate addition, different from conventional method ("whole enzyme feeding") where whole enzyme was added prior to hydrolysis process started. Proportional enzyme feeding could increase enzymatic digestibility and glucose concentration up to 26% and 12% respectively, compared to whole enzyme feeding for hydrolysis duration more than 40h. If enzymatic hydrolysis was run less than 40h (25% solid loading), whole enzyme feeding is preferable.