Factors Influencing Excessive Daytime Sleepiness among Undergraduate Nursing Students: A Cross-Sectional Study from North Sulawesi, Indonesia

Background: Excessive daytime sleepiness (EDS) is a common yet underrecognized concern among nursing students, potentially impairing academic performance and clinical readiness. Identifying factors associated with EDS is essential to inform preventive strategies and promote optimal student functioning. Objective: This study aimed to identify the factors influencing EDS among undergraduate nursing students in North Sulawesi, Indonesia. Methods: A descriptive correlational, cross-sectional design was employed. This study involved 101 students from a university in North Sulawesi Province, Indonesia, selected through consecutive sampling. Data were collected using the Epworth Sleepiness Scale (ESS) and analyzed using descriptive statistics, the Mann–Whitney U test, Kruskal–Wallis H test, Spearman’s correlation, and multiple linear regression. Results: The mean ESS score was 12.98 (SD=4.07), with 71 respondents (70.3%) classified as experiencing EDS. Caffeine consumption (B=3.458, β=0.295, 95% CI [1.232, 5.684], p=0.003) significantly predicted EDS, accounting for 14.9% of the variance. Conclusion: These findings highlight the need to address modifiable lifestyle factors, particularly caffeine intake, to reduce EDS among nursing students. Nurse educators and academic institutions should implement sleep health education and promote healthy coping strategies to mitigate daytime sleepiness. Early intervention may enhance students’ academic performance and clinical competence, ultimately improving patient safety and quality of care in future nursing practice

The Effect of Contrast Therapy on Phlebitis Severity in Toddlers and Preschoolers: A Clinical Study at Cibabat Hospital, Cimahi

Background: Phlebitis remains a prevalent complication associated with intravenous therapy in pediatric populations, particularly among toddlers and preschool-aged children. Managing phlebitis effectively is essential to minimize discomfort and prevent further complications. Non-pharmacological interventions, such as contrast therapy which involves alternating applications of warm and cold compresses have shown potential in reducing local inflammation and improving patient outcomes. Objective: This study aimed to assess the effectiveness of contrast therapy in reducing phlebitis severity among young children receiving intravenous treatment at a public hospital in Indonesia. Methods: A quasi-experimental study was conducted using a non-equivalent control group design with pretest and posttest assessments. A total of 30 pediatric patients diagnosed with phlebitis were recruited and allocated to either the intervention group (contrast therapy) or the control group (cold compress only). Phlebitis severity was evaluated using the Visual Infusion Phlebitis (VIP) Scale. Statistical analyses included the Wilcoxon signed-rank test and Mann–Whitney U test for bivariate comparisons, and logistic regression for multivariate analysis. Results: The application of contrast therapy significantly reduced the phlebitis grading scale within the intervention group. However, when comparing the intervention and control groups, the difference in mean phlebitis score reduction was not statistically significant. Conclusion: Contrast therapy serves as an effective non-pharmacological approach to managing phlebitis in pediatric patients. Nonetheless, its clinical effectiveness in comparison to cold compress therapy alone appears comparable. Further research with larger sample sizes and randomized designs is recommended to validate these findings and optimize clinical practice

Effectiveness of Ginger Aromatherapy on Blood Pressure Among Hypertensive Patients in a Community Health Center in Indonesia: A Quasi-Experimental Study

Background: Hypertension is a disease caused by several factors including genetic factors, physical changes, unhealthy lifestyles, the presence of certain medical conditions. One way to manage hypertension in a non-pharmacological way is using aromatherapy. Objective: This research was conducted to determine the effect of ginger aromatherapy on blood pressure in hypertensive patients at the Ngemplak II Health Center, Sleman Regency. Methods: The research design used was quasy experimental design with a non-equivalent control pre-posttest design approach. The study population was all hypertensive patients who conducted examinations at the Ngemplak II Health Center, Sleman Regency. The number of samples in this study were 50 respondents who were divided into 2 groups, namely 25 intervention groups and 25 control groups taken by purposive sampling technique. The intervention group was given ginger aromatherapy with a duration of 30 minutes per day for 3 days using a diffuser, while the control group only measured blood pressure on the first day and the third day. Results: The results showed that a small proportion of hypertensive patients were elderly (38%), mostly female (64%), and mostly worked as farmers (52%). Data analysed using the Mann-Whitney test showed that there was a significant difference in mean systolic blood pressure between the intervention and control groups (p value <0.001), however, between the intervention group and the control group, there is no significant difference in diastolic blood pressure(p = 0.460). Conclusion: Ginger aromatherapy has been proven effective as a non-pharmacological therapy for controlling blood pressure in hypertensive patients. Further research with a more accurate design and stricter control of confounding factors is recommended to follow up on the results of this stud

Strengthening Palliative Care Systems in Indonesia: A Strategic Policy Brief to Address Health System Gaps

Background: Cancer is one of the most burdensome diseases in Indonesia, ranking as the second-highest cost contributor in the National Health Insurance (Jaminan Kesehatan Nasional) scheme, with expenditures reaching 3.2 trillion rupiahs (approximately 221 million USD). Palliative care is an essential component of cancer management, aimed at alleviating physical, emotional, and psychosocial suffering. However, access to palliative care in Indonesia is extremely limited, with services available in only seven hospitals across three major islands, leaving most regions underserved. Objective: This policy brief aimed to analyze existing challenges and propose strategic policy recommendations for strengthening palliative care services to address healthcare system pressures in Indonesia, particularly related to cancer. Methods: A narrative policy analysis was conducted using secondary data from national healthcare reports, cost analyses, and peer-reviewed literature on palliative care effectiveness. The review assessed service coverage, accessibility, financial burden, and policy frameworks to identify key gaps and opportunities. Results: The analysis highlighted critical disparities in access to palliative care across Indonesia’s geographically dispersed regions. Despite evidence supporting the cost-saving and quality-of-life benefits of palliative services, implementation remains centralized and fragmented. Lack of national integration, workforce capacity, and public awareness were identified as major barriers. Conclusion: Developing an integrated, nationwide palliative care strategy is urgently needed to mitigate healthcare costs and improve quality of life for patients with cancer and other life-limiting illnesses. Policy efforts should focus on decentralizing services, expanding training for health professionals, and incorporating palliative care into primary healthcare systems

Effectiveness of Diaphragmatic Breathing Exercises in Enhancing Pulmonary Recovery and Expediting Water Seal Drainage (WSD) Removal in Pleural Effusion Patients at Persahabatan Hospital

Aims: Pleural effusion, characterized by the abnormal accumulation of pleural fluid, poses significant health risks and often necessitates interventions such as water seal drainage (WSD) placement. Diaphragmatic breathing exercises (DBE) are non-invasive techniques that may enhance pulmonary recovery and expedite WSD removal by optimizing respiratory mechanics. Despite the potential benefits, limited research has explored their effectiveness in patients with pleural effusion. Objective: This study aimed to evaluate the effectiveness of diaphragmatic breathing exercises in enhancing pulmonary recovery and expediting WSD removal in pleural effusion patients at Persahabatan Hospital, Jakarta, Indonesia. Methods: A quasi-experimental, single-group pretest-posttest design was employed. Seventeen adult patients diagnosed with pleural effusion undergoing WSD placement were recruited through purposive sampling. Participants performed DBE twice daily for 15 minutes over seven days. Pulmonary recovery and WSD outcomes were assessed using a validated Pulmonary Recovery Assessment Questionnaire. Data were analyzed using paired t-tests, with statistical significance set at p < 0.05. Results: The mean age of participants was 51.71 years (±10.12), with 64.7% female. Peak current respiration significantly improved from 103.53 L/min (±36.22) pre-intervention to 165.52 L/min (±75.28) post-intervention (p = 0.000). DBE also reduced the duration of WSD placement, indicating enhanced pulmonary recovery. Participants reported high feasibility and acceptability of the intervention. Conclusion: Diaphragmatic breathing exercises significantly improve pulmonary recovery and expedite WSD removal in pleural effusion patients. These findings highlight the potential of DBE as a cost-effective, non-invasive adjunct in respiratory rehabilitation. Further research with larger sample sizes and long-term follow-up is recommended to validate these results

Rehabilitative Exercise Strategies for Urinary Incontinence After TURP: A Quasi-Experimental Evaluation of Kegel and Bridging Techniques

Background: Urinary incontinence (UI) is a common issue following Transurethral Resection of the Prostate (TURP). Pelvic Floor Muscle Training (PFMT), including Kegel and Bridging exercises, is a promising non-pharmacological intervention for managing UI. Objective: This study aimed to evaluate the effectiveness of Pelvic Floor Muscle Training, combining Kegel and Bridging exercises, in reducing urinary incontinence among post-TURP patients, and to identify factors associated with UI severity. Methods: A quasi-experimental pre-posttest design was employed involving 44 male patients who had undergone TURP. Participants were allocated into an intervention group (n = 22), which received six sessions of PFMT over three weeks, and a control group (n = 22), which received standard care. UI severity was measured using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after the intervention. Data were analyzed using paired t-tests and regression analysis. Results: The intervention group demonstrated a significant reduction in UI scores from 15.50 (SD = 2.50) to 7.41 (SD = 4.12) (p = 0.0001), whereas the control group exhibited only minor improvement. Regression analysis identified age and body mass index (BMI) as significant predictors of UI severity (p = 0.037 and p = 0.041, respectively). Conclusion: Pelvic Floor Muscle Training effectively decreases urinary incontinence severity following TURP surgery. Integrating PFMT into routine postoperative nursing care may enhance patient outcomes and facilitate recovery. Future research should explore long-term adherence and outcomes associated with PFMT in diverse patient populations

Factors Associated with Resilience Family Caregiver of Patients with Dementia

Aims: Dementia represents a critical public health issue. Family caregivers play a vital role in providing care due to limited healthcare resources, yet they face significant bio-psycho-social challenges that impact their resilience. Understanding the factors influencing caregiver resilience is crucial for developing targeted interventions. Objective: This study aimed to analyze factors associated with the resilience of family caregivers of PwD in Bekasi City, Indonesia. Methods: A cross-sectional study was conducted among 42 family caregivers of PwD. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC). Descriptive and bivariate analyses were performed to examine associations between demographic characteristics, caregiving duration, dementia knowledge, and resilience. Results: The majority of caregivers were female (71.4%), aged 18–59 years (83.3%), and unemployed (71.4%). Most caregivers had a moderate level of resilience (71.4%), while 28.6% demonstrated high resilience. Bivariate analysis showed no significant associations between resilience and demographic factors, including gender, age, education level, employment status, caregiving duration, and dementia-related knowledge (p > 0.05). Conclusion: Resilience among caregivers is not significantly influenced by demographic variables, highlighting the importance of focusing on psychosocial and environmental factors to strengthen resilience. Future efforts should prioritize community-based interventions, stress management programs, and social support systems to enhance the well-being of caregivers and the quality of care for PwD

Knowledge, Attitude, and Practice Toward Infection Prevention Strategies Pre- and Post-COVID-19 Among Nursing Students: A Systematic Review

Aims: COVID-19 (Coronavirus Disease 2019) has significantly impacted infection control, highlighting the vulnerabilities of the global healthcare system. This study evaluates measurable outcomes and barriers in nursing students' knowledge, attitudes, and practices, and barriers to infection prevention before and after COVID-19. Method: systematic review, with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) registered on PROSPERO: CRD42022322706. Using the PICO framework for article selection: Population (involving nursing students), Intervention/exposure (infection control or prevention), Compare and Outcome (knowledge, attitudes, and practice). We searched nine databases from March to June 2022, with inclusion criteria for full-text articles published in English from 2012 to 2022. The study quality used The Joanna Briggs Institute (JBI) Critical Appraisal tool and the National Institutes of Health (NIH). PICO synthesis for analysis. Results: Of 3,030 articles, only 15 met the criteria for inclusion: Cross-sectional (12/15, 80%), Descriptive study (2/12, 13%), and pre-post study (1/15, 6.67%). Infectious disease (4/15, 26.6%) and All disaster events (4/15, 26.6%), with the condition: pre-COVID-19 (11/15,73.3%), and during COVID-19 (4/15, 26.6%). The five themes were: (1) nursing students' knowledge level regarding infection control standards, (2) nursing students' attitudes towards infection control standards, (3) nursing students' practice on infection control standards, (4) factors affecting infection control in nursing students, (5) roles of nursing schools and hospitals in infection control. Conclusion: Nursing students showed increased knowledge, but gaps in attitudes and practice remain. Future efforts should develop standardized infection prevention curricula, integrate social media training, and strengthen academic-healthcare partnerships

Factors Associated with Spirituality in Patient Undergoing Hemodialysis

Aims: Chronic Kidney Disease (CKD) is a global health burden, with hemodialysis being a critical yet life-altering therapy. Spirituality has emerged as an essential dimension influencing the well-being of patients undergoing hemodialysis. However, there is limited understanding of the factors associated with spirituality among Indonesian patients, necessitating culturally sensitive research. Objective: This study aimed to identify factors associated with spirituality in patients undergoing hemodialysis in Indonesia. Methods: A cross-sectional study was conducted in Jakarta's hemodialysis unit in 2017, involving 148 participants selected through consecutive sampling. Data were collected using validated instruments, including the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT Sp12), the Beck Depression Inventory (BDI), the Medical Outcomes Study-Social Support Survey (MOS-SSS), and the Kidney Disease Quality of Life Short Form (KDQOL-SF36). Data were analyzed using univariate, bivariate, and multivariate logistic regression. Results: The majority of participants were female (52%), married (76.3%), and unemployed (75%), with an average age of 54.86 years. Half of the participants exhibited high spiritual levels (50.7%). Social support (OR = 1.052, p < 0.001) and depression (p < 0.05) were significantly associated with spirituality. Other variables, including HD frequency, duration of HD, and burden of kidney disease, were identified as confounders. Conclusion: Social support and depression significantly influence the spiritual well-being of hemodialysis patients, highlighting the need for comprehensive care approaches that address social and mental health alongside spiritual needs. Tailored interventions, including family-centered and spiritual counseling, can improve the quality of life for these patients

Prosocial Behavior and Psyhcological Difficulties as Predictors of Depressive Symptomps in Adolescents: A Cross-Sectional Study

Background: Adolescence is a crucial transitional period marked by significant changes and increased vulnerability to mental health problems, including depression. Objective: This study aimed to examine the relationship between prosocial behavior and psychological difficulties with depressive symptoms in adolescents. Methods: A quantitative correlational study with a cross-sectional approach was conducted among 155 adolescents aged 12–18 from a public senior high school in Surakarta, Indonesia. Data were collected using the Strengths and Difficulties Questionnaire (SDQ) and the Patient Health Questionnaire-9 (PHQ-9), and analyzed using Spearman’s correlation. Results: There was a strong positive correlation between psychological difficulties and depressive symptoms (r=0.656, p<0.001), while prosocial behavior was also significantly associated but with a weaker correlation (r=0.168, p=0.037). Conclusion: Psychological difficulties are more strongly associated with depressive symptoms than prosocial behavior. These findings highlight the importance of interventions that address both risk factors and strengths