Experiences of Indonesian nurses in improving preterm oral feeding readiness in special care units: A qualitative descriptive study.

Background: Many preterm infants face feeding difficulties during the transition from enteral to oral feeding due to organ immaturity, resulting in aspiration, airway instability, and oral feeding intolerance. These challenges can increase morbidity and mortality among preterm infants. Nurses play a vital role in providing interventions to minimize negative impacts and enhance the safety of preterm oral feeding. Objective: This study aimed to explore the experiences of Indonesian nurses in improving preterm oral feeding readiness. Methods: A qualitative descriptive study was conducted involving ten nurses working in intensive care units as participants through purposive sampling. Data were collected through semi-structured, in-depth interviews conducted from January to March 2023. Thematic analysis was applied for data analysis. Results: Four key themes developed in this study: 1) comprehensive and holistic nursing assessment, 2) challenging and complex nursing issues, 3) the need for nutritional management skills, and 4) the necessity of collaborative support. Conclusion: Nurses play a pivotal role in enhancing oral feeding readiness among premature infants. Their responsibilities include assessing oral feeding readiness, addressing nursing challenges, and implementing multidisciplinary stimulation involving parents. This study provides a foundational framework for developing interventions to improve preterm oral feeding readiness.

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.

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.

Awareness, Attitudes, and Perceptions of Oral Healthcare among First Year Dental, Medical, and Nursing Students.

BACKGROUND: It has been reported that poor oral health can worsen general health conditions. Good collaboration between health professionals is important to provide proper oral healthcare. Thus, there is a need for oral healthcare interprofessional education (IPE). This study aimed to determine the baseline level of awareness, attitudes, and perceptions of oral healthcare among first-year students of dentistry, medicine, and nursing at Universitas Indonesia. METHOD AND PARTICIPANTS: A cross-sectional descriptive analytical study using a previously published questionnaire was conducted involving 442 students, consisting of dental students (DS), medical students (MS), and nursing students (NS) in Universitas Indonesia. RESULTS: Most students have shown good oral healthcare awareness, attitudes, and perception with no statistically significant difference between the groups (p < 0.05). The majority of the students did not perceive that (1) geriatric and nursing knowledge are required to practice oral care, (2) oral healthcare should be provided in cancer hospitals, and (3) oral healthcare can prevent cardiovascular disease and improve anorexia. CONCLUSIONS: This study showed that there were aspects of oral healthcare that should be improved in all student groups. Thus, oral healthcare IPE should be given to all students working in healthcare to develop knowledge and interprofessional collaboration in oral healthcare.

Effectiveness of pop-it therapeutic play on children's anxiety during inhalation therapy in children's wards.

Hospitalized children receive anxiety-triggering medical procedures, such as inhalation therapy. One non-pharmacological intervention that can be provided to reduce children's anxiety is pop-it therapeutic play. This study aimed to measure the effectiveness of pop-it therapeutic play on children's levels of anxiety during inhalation therapy in children's wards. This study used a randomized control trial involving 66 children aged 1-12 years who received inhalation therapy and were treated in the children's ward from three hospitals in North Sulawesi. The respondents were divided into intervention and control groups, with 33 respondents for each group. The samples were selected using simple random sampling. Anxiety level was assessed using the Visual Facial Anxiety Scale. The findings showed that playing pop-it effectively reduced children's anxiety levels during inhalation therapy, with a p value of 0.000 (α < 0.05). Therefore, playing pop-it is the right solution for children who receive inhalation therapy and is recommended as an alternative toy in hospitals. This finding can be applied in children who receive inhalation therapy because it is easy to do, efficient and effective controlling the children's anxiety.

Children's feelings in isolation rooms during COVID-19 hospitalization.

The treatment given to children who have been confirmed positive for COVID-19 and are showing symptoms involves isolation, which consequently is an unpleasant experience for pediatric patients. In isolation rooms, children reported a "rollercoaster" of feelings due to being separated from their families and familiar surroundings. This study examines children's emotions while being hospitalized in isolation rooms due to COVID-19. The study follows a descriptive qualitative design. Online interviews were carried out and involved 10 children who had been confirmed positive for COVID-19 and were hospitalized in two big cities in Sumatra. Four themes emerged from the data: i) children's emotional conditions after finding out they had positive COVID-19 test results; ii) boredom and inconvenience during isolation; iii) support from the children's peer; and iv) happy responses to receiving negative swab results and being allowed to go home. These themes describe the children's adaptation process to isolation based on the feelings they expressed during the interviews. This study suggests that, in order to improve their facilities, hospitals should support children's activities during isolation and nurses should improve their therapeutic communication with pediatric patients.

The Role of Knowledge, Attitude, Confidence, and Sociodemographic Factors in COVID-19 Vaccination Adherence among Adolescents in Indonesia: A Nationwide Survey.

COVID-19 vaccination in adolescents is important because the adolescent population has the highest incidence of COVID-19. This study aimed to explore the factors associated with COVID-19 vaccination adherence among Indonesian adolescents. This cross-sectional study involved 7986 adolescents, polled through online and offline surveys conducted in six major islands of Indonesia. The online questionnaire was distributed through popular social messaging and social media platforms. Our team also contacted schools and public places to recruit participants from remote areas. In total, 7299 respondents completed the questionnaire. Binary logistic analysis revealed that higher levels of knowledge, positive attitudes, and confidence in the COVID-19 vaccine were significantly associated with higher COVID-19 vaccination adherence in adolescents. Sociodemographic factors were also significantly associated with higher adherence to vaccination programs. Meanwhile, younger age and habitation in private housing were related to lower adherence to the vaccination program. Parental factors related to adolescent compliance were education level, household income, history of infection of family or friends with COVID-19, and working status. The national authorities and stakeholders should take extensive measures to increase attitude, knowledge, confidence, and family support among adolescence through multiple channels.

Community lifestyle influences feeding practices among Indonesian infants and young children.

OBJECTIVE: To analyze the feeding practices of malnourished infants and young children aged 6-24 months old in Bogor, West Java, Indonesia. METHOD: Fourteen mothers or caregivers who had malnourished infants and young children aged 6-24 months were interviewed, focusing on their feeding practices. Informants came from sub-districts in Bogor Regency, Indonesia, which had a higher incidence of malnutrition. The interview process was recorded. Verbatim transcripts of recorded interviews were analyzed using thematic analysis. RESULTS: Five major themes were identified: (1) Inappropriate practice of early initiation of breastfeeding, (2) Challenges in decision making to maintain breastfeeding, (3) Lack of complementary feeding practices, (4) Failing to follow feeding recommendations, and (5) Infant and young child feeding constraints. CONCLUSION: The feeding practice for malnourished infants and young children is not entirely based on the recommended standards. This situation is caused by several factors such as economic conditions, culture, parental knowledge, family and community health workers' support. Health workers need to provide comprehensive intervention for mothers and families intensively by taking into account the culture and conditions of the related family.

Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review.

BACKGROUND: The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting. METHODS AND FINDINGS: The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning). CONCLUSION: Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

"I can live a normal life": Exploring adherence to antiretroviral therapy in Indonesian adolescents living with HIV.

Background: Adherence to antiretroviral therapy (ART) can be challenging since it needs to be continued for a lifetime. At their age, adolescents start to be responsible for their life, and this continued therapy might be a challenge for them. Objective: This study explored the experiences of adherence to ART in adolescents living with HIV in Jakarta, Indonesia. Methods: A qualitative study with an Appreciative Inquiry (AI) approach was employed to explore challenges adolescents face in ART adherence which focused more on positive aspects of the experience. In-depth interviews were conducted with ten adolescents who were selected purposively based on criteria including those aged 13-19 years, having been diagnosed with HIV infection and receiving ART for more than a year, and never having discontinued ART. All participants were registered in the outpatient clinic in one top referral hospital in Jakarta. The data were analyzed using thematic analysis. Results: Five themes were identified from the data: living a normal life, wanting to be healthy, taking medication on time, challenges in undergoing treatment, and there is hope. Conclusion: Adolescents with HIV want to live as normal and healthy as possible, like other adolescents. Even though adolescents face several challenges to comply with ART, they try to take the medication as prescribed. The findings of this study serve as input for nurses to maintain compliance with ARVs in adolescents who have HIV.

Oral feeding skills in premature infants: A concept analysis.

Background: The delay in developing oral feeding skills becomes a problem experienced by premature infants. One of the reasons for the delay may be related to inconsistent definitions of oral feeding skills, which can cause discrepancies in the provision of nursing care. Objective: This study aimed to clarify the concept of oral feeding skills in premature infants. Methods: The Walker and Avant concept analysis method was used. A literature search was also conducted from five databases: CINAHL, PubMed, ProQuest, EMBASE, and Google Scholar, to find articles between January 2020 and December 2022. Results: The literature search obtained 20 articles on oral feeding skills from various disciplines. Five attributes were developed from the concept analysis, including (1) coordination ability to suck, swallow, and breathe, (2) the ability to regulate oral-motor functions, (3) the ability to regulate sensory functions, (4) the ability to maintain the stability of physiology function, and (5) the ability to regulate feeding behavior. Antecedents to oral feeding skills include immaturity of the nervous system, gestational age, feeding intolerance, increased length of stay and cost of care, increased rehospitalization, stress on parents, and increased morbidity and mortality. Consequences include optimization of growth and development, reduction of length of stay and cost of hospitalization, increased bonding attachment, increased self-efficacy of parents in caring for premature infants, and improvement of the quality of life of premature infants. Conclusion: The concept analysis provides five comprehensive attributes and their antecedents and consequences. However, this concept can be used to provide nursing care to premature infants, assess the criteria for discharge, and optimize nutrition for the growth and development of premature infants.

The correlation between sleep quality and the prevalence of obesity in school-age children.

BACKGROUND: The prevalence of obesity increases year by year. Sleep quality is considered to be one of the obesity causes. The current average sleep range of children in Indonesia was 6-7 hours. This study aims to analyze whether sleep quality affects the prevalence of obesity in children. DESIGN AND METHODS: This study used a prospective cohort as the research method. The samples consisted of 37 primary school-age children (4th-6th grade) from West Java and Sumatra, which were selected using the snowball sampling technique. The data were collected by using PSQI and sleep logs (within a month). RESULT: The statistical results showed that most of the obese children, 12 out of 19, had poor sleep quality (63.2%), while most of the non-obese children (normal),15 out of 18, had good sleep quality (83.3%). Based on the chi-square statistic, the p-value =0.011

Sensitivity and specificity test of alarm malnutrition for hospital-acquired malnutrition among pediatric patients.

Detecting the risks for hospital-acquired malnutrition in children can be performed by using nutritional screening tools. One of the screening tools that has been created is Alarm Malnutrition. This study aimed to test the sensitivity and specificity of Alarm Malnutrition in detecting the risks for hospitalacquired malnutrition in comparison to Screening Tool for the Risk on Nutritional status and Growth (STRONGkids). This study employed cross sectional design and involved 168 hospitalized children (1 month to 18 years) at pediatric ward. The data were analyzed using diagnostic approach which resulted in sensitivity and specificity values. The statistical tests showed that the sensitivity and specificity values of Alarm Malnutrition and STRONGKids were 32,2% and 81,6% respectively. These results indicated that this screening tool was not better than STRONGkids which has been previously used in Indonesia. Alarm Malnutrition needs to be developed and improved in order to achieve better performance in detecting the risks for hospital-acquired malnutrition.

Evidence-based nursing intervention to reduce skin integrity impairment in children with diaper dermatitis: A systematic review.

Diaper dermatitis often occurs in children. In Indonesia, the guidelines for managing this health problem are issued by each hospital in Indonesia, but there are no guidelines for formal prevention and management released by the Indonesian Health Ministry. This study aimed to propose the Air, Barrier, Cleansing, Diapering, Education (ABCDE) approach as an evidence-based independent nursing intervention to prevent and treat impaired skin integrity, particularly diaper dermatitis, in children by nurses. This systematic review was derived from multiple databases using the following keywords: "child," "diaper dermatitis," "diaper-free time," "air," "barrier," "cleansing," "diaper," and "education." From these keywords, 393 articles were collected and then filtered using inclusion and exclusion criteria to obtain the final articles to be analyzed. Thirty-one articles passed the criteria. The study found that the ABCDE approach was effective in preventing and treating diaper dermatitis in children. Its indicators of the approach were preventing or decreasing inflammation, repairing damage to the skin, and preventing reoccurrence. Based on the review and analysis of multiple aspects in Indonesia, the authors proposed a modification of the sequence to CBAD-E to implement the approach in Indonesian children. The intervention of the ABCDE approach matches Indonesian children's situation, and therefore it can be implemented in Indonesia. Accordingly, this recommendation may be useful and feasible to be implemented by nurses in preventing and treating diaper dermatitis in children, thus decreasing its prevalence.

"Becoming an independent feeder": infant's transition in solid food introduction through baby-led weaning.

BACKGROUND: Baby-led weaning (BLW), a method for introducing complementary foods, has become popular because it is considered beneficial for infants. METHODS: This study investigated the experiences of mothers when using BLW in Jakarta, Indonesia using a qualitative descriptive approach. Thirteen mothers participated who had introduced complementary feeding using BLW for a minimum of 6 months. Semi-structured interviews and thematic analysis was used to work with the data. RESULTS: Three themes were identified: avoiding being a 'picky' eater; infants gagging and choking; and becoming independent feeders. CONCLUSION: Further research related to the growth and development of baby-led weaning infants in Indonesia is recommended.

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.

Feeding practices for toddlers with stunting in Jakarta: A case study.

Stunting represents a child's failure to thrive. On the basis of the World Health Organization child growth standards, stunting is a height of <-2 SD of the z-score for the child's age. There are several major causes of stunting. One is the inability to optimize child feeding practices. The aim of this study was to explore the feeding practices that lead to stunting in toddlers in Jakarta. The participants in this study were 15 mothers. Content analysis was the method that was chosen for this study. The data analysis revealed four themes that describe the feeding practices for toddlers with stunting in Jakarta: i) mothers providing instant porridge and ready-to-serve steamed chicken rice; ii) a feeding frequency of small portions only 2-3 times per day; iii) a lack of diet diversity; and iv) the suboptimal intake of iron-rich foods. The provision of effective education about appropriate feeding practices to pregnant women and mothers with toddlers is expected to reduce the incidence of stunting in Indonesia.

Maternal feeding practice and its relationship with stunting in children.

The incidence of stunting in children is a crucial problem that remains challenging to tackle and is caused by multiple factors. This study aimed to determine the relationship between maternal feeding practice and the incidence of stunting in children in Depok, Indonesia. The study design was a correlation analysis with a cross-sectional approach including applied height-for-age z-score tables from the World Health Organization (WHO) and a feeding practices and structure questionnaire (FPSQ- 28). The study involved 262 participants who were selected using a cluster random sampling technique in 11 district health centers in Depok. The results suggest that there was no significant relationship between maternal feeding practice and the incidence of stunting in children in Depok (P>0.05). In addition, feeding practice performed by mothers was rather non-responsive. The study results are expected to provide benefits for nurses and health professionals in order to improve health education and promotion programs related to stunting and responsive feeding practice.

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.