Lessons Learned from the Lived Experiences of COVID-19 ICU Survivors Who are Struggling Through Critical Conditions and Surviving to Champion Life: A Qualitative Study.

Background: Due to the coronavirus disease 2019 (COVID-19) pandemic, millions of lives were lost globally, including in Indonesia. Some patients with COVID-19 may experience severe symptoms of hypoxia, while some may be critically ill and admitted to the intensive care unit (ICU) for survival. Purpose: This study aimed to understand the lived experiences of COVID-19 ICU survivors who were in a critical condition. Methods: This phenomenological study used semistructured interviews with nine participants who were COVID-19 ICU survivors. Data analysis was performed using the Colaizzi approach. Results: The phenomenon of the lived experiences of COVID-19 ICU survivors was presented in seven subthemes and four main themes: struggling in a state of helplessness, fostering a positive spirit from within, amplifying the support from nurses and doctors, and strengthening the connection with family and the Almighty. These themes indicated the essential aspects of psychosocial support needed to boost strength and energy and elevate the body's immune system, which is crucial to champion life through critical conditions. Conclusion: The new insight resulting from the study is shown in the four main themes, which play a significant role in elevating the healing process and enabling patients to survive critical conditions. Therefore, this study recommends the importance of psychosocial support for patients with critical conditions, which involves family and their significant others, and facilitating the connection between the patient and God.

Factors Associated to Community Practices Toward the COVID-19 Pandemic: A Cross-Sectional Study in Indonesia.

Background: COVID-19 still continue to spread and affects most nations globally to date. In this context, community knowledge, attitudes, and practices (KAP) toward COVID-19 are the most important for controlling and preventing the infectious pandemic disease. Objective: This study aimed to investigate the factors associated with community practices related to COVID-19. Methods: Cross-sectional study was conducted on 330 residents of Sumedang District, Indonesia. Selection of the sample using stratified random sampling. KAP toward COVID-19 was measured using the WHO questionnaire which is valid and reliable. The data were analyzed using the Rasch model, Pearson correlation, and linear regression. Results: This study revealed that most respondents tend to answer correctly on the sociality and disease transmission knowledge (+2.08 logit; SE 1.63), incorrectly in conceptual knowledge (logit measure -2.05; SE 0.45), tended to have a positive attitude (+1.6 logit; 0.54) and practice (+1.63 logit; SE 0.61). Based on the results of the Wright map, the most challenging statement for respondents was to use masks. Knowledge and attitude were significantly associated with the practice of COVID-19 prevention (p<0.001). Attitude is the dominant factor influencing society practice towards COVID-19 (Stand. Estimate= 0.2737; 95% CI=0.1608-0.378; p<0.001) and knowledge play an important role in improving COVID-19 prevention behaviour. Conclusion: New insight from this research shows that even attitude is the most dominant factor, yet this study also indicated that knowledge is critical for positive attitudes of society to support COVID-19 prevention practices. Since, knowledge is the basis for positive attitudes in preventing the transmission of Covid 19. Therefore, health education that explicates concepts, sociality and disease transmission is important to boost attitudes of the society in the practice of Covid 19 prevention.

Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis.

Background: Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant. Purpose: This study aims to identify the safety of early discharge after PPCI in low-risk patients. Methods: The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI's and Cochrane's Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0. Results: Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD -0.01; 95% CI: -0.04 to 0.01; Z=1.20; p=0.23; I2=0%) and mortality (RD 0.00; 95% CI: -0.01 to 0.01; Z=0.01; p=0.99; I2=0%) and also significant in reducing LOS in hour (SMD -2.32; 95% CI: -3.13 to -1.51; Z=5.64; p<0.001; I2=93%) and day (SMD -0.58; 95% CI: - 1.00 to -0.17; Z=2.76; p=0.006; I2=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD -0.00; 95% CI: -0.01 to -0.00; Z =2.18; p=0.03; I2=0%) and mortality (RD -0.01; 95% CI: -0.02 to -0.00; Z=2.04; p=0.04; I2=94%). Conclusion: ED strategies in low-risk patients after PPCI can be completely safe. This is proven by the absence of significant differences in readmission and mortality rates as well as reduce the length of stay.

A Scoping Review of Predictors Associated with Self-Efficacy Among Patients with Coronary Heart Disease.

Self-efficacy (SE) is the main predictor of self-care behaviour in patients with coronary heart disease (CHD). Several studies identified factors that influence SE in CHD patients. However, review studies have yet to synthesize these results systematically. This review aims to identify SE and the factors influencing SE in CHD patients. This scoping review is reported based on the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched using relevant keywords using five databases: CINAHL Plus with Full Text and Academic Search Complete, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar, which was accessed on June 23, 2023. Articles with an observational design were included without date restrictions. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist, and data synthesis used thematic analysis. We found 11 articles discussing SE and the factors influencing SE in CHD patients. In this review, most studies reported that the SE level of CHD patients tends to be low to moderate. Factors associated with SE in this population are classified into three categories (low, moderate, and high). Cardiac knowledge and patient activation are the most influential predictors of SE in CHD patients. Public health interventions such as raising awareness about heart disease, modifying health behaviours, early screening, diagnosis, and appropriate treatment are critical to improving SE and cardiac care outcomes.

Barriers to Participation in Cardiac Rehabilitation Among Patients with Coronary Heart Disease After Reperfusion Therapy: A Scoping Review.

Patients with coronary heart disease (CHD) experience many barriers to participate in cardiac rehabilitation (CR) programs. Several studies identify barriers that can affect participation in CR among patients with CHD after reperfusion therapy. However, there has yet to be a review specifically in this population. This review aims to identify the literature systematically that analyzes the barriers that affect the participation of CHD patients after reperfusion therapy in implementing the CR program. This study used the Preferred Reporting Item for PRISMA Extension for Scoping Reviews (PRISMA-ScR) with databases PubMed, ScienceDirect, EBSCO-hosted Academic Search Complete, Scopus, Taylor & Francis, and Sage Journals. The keywords used in English were "coronary artery disease OR myocardial infarction OR cardiovascular disease OR heart disease" AND "Barrier OR obstacle", AND "percutaneous coronary intervention OR PCI OR angioplasty OR coronary artery bypass graft surgery OR CABG" AND "cardiac rehabilitation OR rehabilitation OR recovery". The inclusion criteria in this review were full-text articles in English, articles with a descriptive, cross-sectional, and cohort design with a minimum of 100 participants that discussed barriers to participation in patients with CHD after undergoing reperfusion therapy, and the CR phases such as I, II, III, and IV have also been identified. Based on the initial search, there are 23 relevant studies out of 7400. The results of this study reported that most of the participants from the studies analyzed had a low level of participation in CR (≤50%). We classify the factors that affect the level of CR participation into five categories: individual factors, health history, environmental, logistical, and health system. The most reported barriers in each category were age, comorbidities, lack of support from friends, family and health workers, distance or travel time, and cost and economic status. Professional health workers, especially nurses, can identify various barriers that patients feel so that they can increase their participation in attending CR.

Self-Efficacy in Self-Care and Its Related Factors Among Patients with Coronary Heart Disease in Indonesia: A Rasch Analysis.

Background: Low self-efficacy (SE) can impact decreasing health status, poor self-care, and quality of life among patients with Coronary Heart Disease (CHD). Many factors can affect SE. However, studies on SE in CHD patients with Rasch Model analysis have not been carried out widely. Purpose: This study aims to identify the SE in self-care and its related factors that correlate SE among CHD patients. Patients and Methods: Cross-sectional study was conducted on 104 adult patients (≥18 years) diagnosed with CHD. Selection of the sample using convenience sampling technique with several predetermined criteria. SE was measured using the SEQ-CHDM questionnaire, with high validity and reliability results. Data were analyzed using the Rasch model and chi-square test. Results: The results showed that most respondents had a moderate SE (51.5%). Care units (p=0.003) and duration of illness (p=0.049) were significantly correlated to SE among patients with CHD. "Maintaining an ideal body weight" is the most challenging thing. On the other hand, stop smoking is the most confident thing to be performed by the respondents. Conclusion: We conclude that CHD patients in the acute care unit and patients with a duration of illness >6 months have a lower tendency for SE. Health interventions such as raising awareness about the disease, modifying health behavior, and immediately screening can improve patients' SE. Besides that, proper diagnosis and ongoing treatment are crucial to improving SE and CHD care outcomes.

Islamic Spiritual Care, Depression, and Quality of Life Among Patients With Heart Disease: A Systematic Review.

Objectives: This study sought to identify the potential effect of Islamic-Spiritual care and how it is delivered in treating depression and improving the quality of life (QoL) of patients with heart disease. Methods: This systematic review is reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched using relevant keywords through PubMed, CINAHL, Scopus, Springer Link, and Academic Search Complete. Articles with an experimental or cohort design were included, without date restrictions. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist, and data synthesis used thematic analysis. Results: The analysis included 6 of the 47 identified studies. All studies were conducted in Iran, and a small number had a low risk of bias. The intervention was given through an Islamic teaching strategy, indicating the potential to reduce depression and improve QoL. Moreover, the learning core consists of belief and surrender in God's providence, strengthened meaning and life's purposes, worship, and skills to overcome obstacles. Conclusions: The interventions had the potential to treat depression and improve the QoL. However, a further study considering the risks of bias and involving a larger patient population with other Muslim backgrounds is necessary.

Factors Associated with Increased Length of Stay in Post Primary Percutaneous Coronary Intervention Patients: A Scoping Review.

Several studies identify factors affecting increased length of stay (LOS) in patients with post-primary percutaneous coronary intervention (PCI). However, there has not been a review study that synthesizes these results. This study aimed to describe the duration of LOS and factors associated with increased LOS among patients with STEMI after PPCI. This study used scoping review using EBSCO-host Academic Search Complete, PubMed, Scopus, Taylor & Francis, and Google Scholar databases. The keywords used in English were "adults OR middle-aged" AND "length of stay OR hospital stay" AND "primary percutaneous coronary intervention OR PPCI" AND "myocardial infarction OR coronary infarction OR cardiovascular disease". The inclusion criteria for articles were: the article was a full-text in English; the sample was STEMI patients who had undergone a PPCI procedure; and the article discussed the LOS. We found 13 articles discussing the duration and factors affecting LOS in patients post-PPCI. The duration of LOS was the fastest 48 hours, and the longest of LOS was 10.2 days. Factors influencing LOS are categorized into three predictors: low, moderate, and high. Post-procedure complications after PPCI was the most influential factors in increasing the LOS duration. Professional health workers, especially nurses, can identify various factors that can be modified to prevent complications and worsen disease prognosis to increase LOS efficiency.

Emergency Nurses' Competency in the Emergency Department Context: A Qualitative Study.

Background: The availability of clear emergency nurses' competencies is critical for safe and effective emergency health care services. The study regarding emergency nurses' competencies remained virtually limited. Purpose: This study aimed to explore the emergency nurses' competencies in the clinical emergency department (ED) context as needed by society. Methods: This qualitative study involved focus group discussions in six groups of 54 participants from three EDs. The data were analysed using grounded theory approach including the constant comparative, interpretations, and coding procedures; initial coding, focused coding and categories. Results: This study revealed 8 core competencies of emergency nurses: Shifting the nursing practice, Caring for acute critical patients, Communicating and coordinating, Covering disaster nursing roles, Reflecting on the ethical and legal standards, Researching competency, Teaching competencies and Leadership competencies. The interconnection of the 8 core competencies has resulted in 2 concepts of extending the ED nursing practice and demanding the advanced ED nursing role. Conclusion: The finding reflected the community needs of nurses who work in ED settings and the need for competency development of emergency nurses.

Efficacy of Cognitive Behavior Therapy in Reducing Depression among Patients with Coronary Heart Disease: An Updated Systematic Review and Meta-Analysis of RCTs.

PURPOSE: The aim of this review is to identify the efficacy of cognitive behavior therapy (CBT) and the characteristics of CBT therapy that effectively improve depression among patients with coronary heart disease (CHD). METHODS: Studies that assessed CBT efficacy in decreasing depression among CHD patients with randomized controlled trials (RCTs) were searched through PsycINFO, PubMed, CINAHL, Academic Search Complete, Scopus, and Google Scholar. Two reviewers independently screened and critically appraised them using the Cochrane risk-of-bias tool. The fixed- and random-effect models were applied to pool standardized mean differences. RESULTS: Fourteen RCTs were included in the quantitative analysis. Depression was significantly lower in the CBT group (SMD -0.37; 95% CI: -0.44 to -0.31; p < 0.00001; I2 = 46%). Depression in the CBT group was significantly lower in the short-term follow-up (SMD -0.46; 95% CI: -0.69 to -0.23; p < 0.0001; I2 = 52%). Moreover, the subsequent therapy approaches were effective in reducing depression, including face-to-face and remote CBT, CBT alone or combination therapy (individual or mixed with a group), and frequent meetings. CONCLUSIONS: CBT therapy effectively reduces depression, particularly in short-term follow-up. The application of CBT therapy in CHD patients should consider these findings to increase the efficacy and efficiency of therapy. Future research is needed to address generalizability.

The Potential of Cardiac Telerehabilitation as Delivery Rehabilitation Care Model in Heart Failure during COVID-19 and Transmissible Disease Outbreak: A Systematic Scoping Review of the Latest RCTs.

Background and objective: Patients with heart failure are a high-risk group who may have a higher mortality rate if infected during the COVID-19 pandemic. The problem of a patient's non-adherence to cardiac rehabilitation programs is still a challenge, resulting in disappointing long-term benefits of cardiac rehabilitation. Telehealth, including telerehabilitation, has grown in popularity to improve access to quality healthcare. It is more valuable and safer compared to usual rehabilitation care, especially during the current COVID-19 pandemic, to cut down unnecessary hospital visits and reduce the risk of cluster infections. This study aims to identify the efficacy of relevant randomized control trials (RCTs) using telerehabilitation in managing heart failure. The model, delivery care, safety, and efficacy were assessed. Material and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The authors included relevant records published in the last ten years from three databases: PubMed/MEDLINE, ProQuest, and EBSCO. Each included study was further assessed using Cochrane's Risk of Bias (Rob 2) tool. Results: The telerehabilitation models consisted of cellphones, instant messaging, or online videoconferencing software. Some also included tool sets to monitor patients' vital signs regularly or during exercise. Most patients adhered to and completed all provided programs. Cardiac telerehabilitation successfully improved patients' physical fitness, quality of life, and mental health. No major adverse outcomes or significant complications were associated with the program. Conclusion: Cardiac telerehabilitation has the potential to deliver rehabilitation for heart failure patients, evidenced by its feasibility, efficacy, and safety. As a future perspective, this delivery care type can be applied throughout transmissible disease outbreaks or even globally.

Problems Facing Healthcare Providers When Caring for COVID-19 Patients: An Integrative Review.

The COVID-19 outbreak is a world health problem that affects millions of people. The pandemic is also causing burdens and challenges to health-care providers. Therefore, this study aimed to examine and help understand health-care providers' problems when caring for COVID-19 patients. An integrative review following Whittemore and Kanfl's approach was used along with a systematic search for emerging online databases and grey literature conducted from January to August 2021. The quality of papers was analyzed and a report was presented following PRISMA guidelines. A total of 18 articles that were predominantly descriptive with five themes, including mental health problems in the early stage of COVID-19 outbreak, working stress, physical and psychological impacts of disease, and the lack of support were analyzed. The results showed the pandemic's significant psychological impact on health-care providers directly caring for COVID-19 patients. Emotional, facilities and family support are needed to maintain the health-care providers' well-being.

Determinants of Nurse Preparedness in Disaster Management: A Cross-Sectional Study Among the Community Health Nurses in Coastal Areas.

PURPOSE: Because Indonesia has a high risk of natural disasters, nurse preparedness is necessary to reduce and prevent deaths in the aftermath of such disasters. The aim of this study was to determine the factors associated with nurse preparedness in disaster management among a sample of community health nurses in coastal areas. PATIENTS AND METHODS: A cross-sectional study was undertaken from May to August 2020. The sample consisted of 142 nurses who worked at six Public Health Centers in Pangandaran, West Java, Indonesia. Participants were recruited using the total sampling technique. The data were collected using the Emergency Preparedness Information Questionnaire and analyzed using Chi-Square and binary logistic regression. RESULTS: Of the 142 respondents, 54.24% had a high level of preparedness. Multivariate analysis showed that nurses with higher levels of preparedness had worked between 6 and 10 years (adjusted odds ratio (AOR): 12.755, 95% confidence interval (CI): 2.653-61.314). Respondents who lacked disaster training were less likely to have a high level of disaster preparedness (AOR: 4.631, 95% CI: 1.604-13.367). Respondents who had never served as disaster volunteers were also less likely to have disaster preparedness (AOR: 0.18, 95% CI: 0.053-0.616). CONCLUSION: With nearly half of the respondents (45.77%) having a low level of disaster preparedness, this topic needs more attention from the government and healthcare workers. Several actions are needed to improve community nurses' disaster preparedness: providing them with routine disaster-related training, encouraging them to serve as volunteers in various disaster conditions, and offering them useful disaster-related information.

The relationship between nurses' knowledge and self-confidence in implementing palliative care in an intensive care unit.

BACKGROUND: This quantitative study aimed to analyse the relationship between knowledge and nurses' self-confidence (or self-efficacy) in applying palliative care (PC) in the intensive care unit (ICU). This study was a correlational study with a cross-sectional approach. The sampling technique used was total sampling, and the sample included all nurses who were actively working at the general hospital in Bandung, West Java, Indonesia, during the study. There were 127 people in total. Data were collected using questionnaires. The Pearson correlation test was used for bivariate analysis. The results of univariate analysis showed that the majority of respondents had high self-confidence but had less knowledge related to PC in the ICU. Based on the results of the bivariate analysis, there was a significant relationship between knowledge and self-confidence variables. The results showed that a high number of respondents had less knowledge in implementing PC in the ICU. Therefore, familiarisation sessions and training related to this are needed, focusing on nurses' beliefs in their abilities.

Expanding knowledge and roles for authority and practice boundaries of Emergency Department nurses: a grounded theory study.

PURPOSE: While emergency department nurses in Indonesia are critical to quality care, the role lacks recognition and standard practices and regulation of scope of practice are absent. This research explored the role of nurses in Indonesian EDs. METHOD: The conceptual lens applied in the research was grounded theory. The main data source was 51 semi- structured interviews with 43 ED nurses, three directors of nursing, three nurse leaders and two nurse educators. Data were also generated through observations and memos. RESULTS: Two key categories were constructed; shifting work boundaries and lack of authority. Shifting work boundaries was symbolic of a lack of professional authority and legitimized knowledge. Lack of authority reflected the dimension of professional autonomy through the nexus of power and knowledge. The interrelationship of these two concepts constructed a core category, securing legitimate power, which underpinned the positioning of nursing in Indonesia. CONCLUSIONS: The interconnection between political gains, tertiary knowledge, professional regulation and implementation of gender-sensitive policies was critical to the development of the ED role, the positioning of nursing within the health care system and improvement in quality of care.