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All Journal Nurse Media Journal of Nursing Jurnal Keperawatan Padjadjaran Jurnal Kesehatan Holistic Jurnal Ilmiah Ilmu Keperawatan Indonesia (Indonesian Nursing Scientific Journal) Jurnal Kreativitas PKM Human Care Journal Jurnal Ners Indonesian Journal of Global Health research Lentera Perawat Jurnal Kesehatan Kartika Indonesian Journal of Global Health Research
Rizki Nugraha Agung
Universitas Muhammadiyah Jakarta
Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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The Effect of Progressive Muscle Relaxation on Blood Sugar Levels in Patients with Type 2 Diabetes Mellitus Fakhrudin Nasrul Sani; Fitrian Rayasari; Dewi Anggraini; Rizki Nugraha Agung; Retno Dyah Wahyuningsih
Indonesian Journal of Global Health Research Vol 7 No 5 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i5.6969

Abstract

One of the most complex chronic diseases is diabetes, which requires ongoing medical care aimed at reducing multifactorial risks beyond glycaemic control. Diabetes and stress are interrelated, where stress results in increased cortisol production, cortisol itself inhibits the work of insulin, this triggers an increase in blood sugar levels. One of the ways to control blood sugar levels by providing non-pharmacological therapy is to provide music therapy, relaxation and guided imagery. Progressive Muscle Relaxation (PMR) is one of the relaxations that can be applied to patients with diabetes mellitus. This relaxation technique can speed up the body's metabolism by physiologically increasing blood flow. This study aims to determine the effect of progressive muscle relaxation on blood sugar levels in patients with type 2 diabetes mellitus. This research is a quasi-experimental. The research design used is nonrandomised pretest - posttest with control group design. The research sample was divided into two groups, the intervention group and the control group. Blood sugar level measurements were carried out in the intervention group twice, namely before (pretest) and after (posttest) being given progressive relaxation therapy, while the control group did not receive any actions. The population in this study were patients with type 2 diabetes mellitus at Dr Moewardi Surakarta Hospital. Data analysis using the parametric paired t-test because the data is normally distributed. The blood sugar level in the control group before the relaxation intervention was an average of 237.90 mg/dl and after the relaxation intervention was an average of 218.57 mg/dl. The average blood sugar level in the control group before relaxation was 238.10 mg/dl and after relaxation was 231.43 mg/dl. The p-value for the intervention group based on the paired sample t-test statistic is 0.000 (p < 0.05) with an average decrease in blood sugar level of 19.33 mg/dl. These results indicate that progressive muscle relaxation exercises have an effect on changes in blood sugar levels in patients with type 2 diabetes mellitus. Based on the above description, it can be concluded that progressive muscle relaxation has an effect on changes in blood sugar levels in patients with type 2 diabetes mellitus.
Penerapan Intradialytic Stretching Exercise pada Dewasa Muda yang Menjalani Hemodialisis dengan Kram Otot: Laporan Kasus Dhea Natashia; Erwan Setiyono; Rizki Nugraha Agung; Siti Nafisah; Laela Nur Adzmi; Siti Aisyah Afifah
Jurnal Kesehatan Holistic Vol. 10 No. 2 (2026): Jurnal Kesehatan Holistic Volume 10/Nomor 2/July/2026
Publisher : Sekolah Tinggi Ilmu Kesehatan RS Husada

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background: Intradialytic muscle cramps are common complications experienced by patients with Chronic Kidney Disease (CKD) undergoing hemodialysis and may interfere with patient comfort and dialysis effectiveness. Intradialytic stretching exercise is a non-pharmacological nursing intervention that may help reduce these symptoms. Case Presentation: Two young adult patients with CKD undergoing routine hemodialysis at Jakarta Islamic Hospital, Cempaka Putih, experienced recurrent lower-extremity muscle cramps during hemodialysis sessions, particularly during the final hours of treatment. The first patient was 21 years old with an initial pain score of 4, while the second patient was 22 years old with an initial pain score of 5 based on the Numeric Rating Scale (NRS). Intervention and Outcomes: Both patients received intradialytic stretching exercises during two hemodialysis sessions, including ankle dorsiflexion movements and stretching of the gastrocnemius, soleus, hamstring, and quadriceps muscles. Following the intervention, both patients demonstrated reduced pain intensity and fewer muscle cramp complaints. The patients also appeared more relaxed and comfortable during hemodialysis sessions. Conclusion: Intradialytic stretching exercise may serve as an effective non-pharmacological nursing intervention to help reduce muscle cramp pain in patients with CKD undergoing hemodialysis. This intervention is simple to implement and may be considered as part of routine nursing care in hemodialysis units. Keywords: Chronic Kidney Disease; Hemodialysis; Intradialytic Stretching Exercise; Muscle Cramps; Nursing Intervention
Implementation of Stretching Exercise Intradialytics in Improving Muscle Cramps Symptoms in Patients Undergoing Hemodialysis Asep Novi Taufiq Firdaus; Ari Yulistianingsih; Rizki Nugraha Agung; Iyar Siswandi
Indonesian Journal of Global Health Research Vol. 7 No. 6 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i6.384

Abstract

Hemodialysis is the most successful and most frequent therapy used as form therapy replacement kidney therapy hemodialysis own One of the impacts felt by patients is that is cramps muscle cramps is one of the symptom the most common physical problems experienced patient dialysis. This is contraction muscle sudden that is not deliberate and marked with painful great thing happened repeatedly in patients hemodialysis. The purpose of study This analyze influence implementation implementation stretching exercise intradialytic in repair symptom cramps muscles in patients undergoing hemodialysis at Al Ihsan Regional Hospital Bandung. Data collection uses questionnaire, observation and interviews. Research sample as many as 15 patients shared into 2 groups. Research conducted at Al Ihsan Regional Hospital Bandung, room intermittent hemodialysis May -August 2025. results testing use one-way ANOVA test sig. value < 0.05 so that can concluded that there is influence significant before and after given stretching exercise intervention on cramps. Multivariate test on week first and second p value 1,000 or > 0.05 then No There is influence, on week to three 0.106>0.05 no There is influence and on the week to four p values 0.015<0.05 exist influence. Implementation Intradialytic exercise range of motion (ROM) intervention according to SOP shows success in a way practical All participants who received intervention report feeling more comfortable, calm, relaxed, and not too focus to action will therapy hemodialysis.
ANALISIS KETERKAITAN KADAR GULA DARAH DENGAN RISIKO NEUROPATI DIABETIK PERIFER PADA PASIEN DM TIPE 2 DI RSIJ CEMPAKA PUTIH iyar siswandi; Rizki Nugraha Agung; Juwi Athia Rahmini
JURNAL KESEHATAN KARTIKA Vol. 21 No. 1 (2026): Jurnal Kesehatan Kartika
Publisher : Faculty of Health Science and Technology, University of Jenderal Achmad Yani

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26874/jkkes.v21i1.537

Abstract

Background: Diabetes mellitus (DM) is a chronic metabolic syndrome characterized by hyperglycemia resulting from impaired insulin secretion or function. Long-term uncontrolled blood glucose levels carry a risk of triggering microvascular complications such as diabetic peripheral neuropathy (DPN), which is characterized by nerve damage and reduced sensitivity. Objective: This study aims to analyze the relationship between hyperglycemia status and the prevalence of peripheral neuropathy in Type 2 DM patients at the outpatient unit of RSIJ Cempaka Putih. Methods: A descriptive correlational study design with a cross-sectional approach was used. The study population consisted of all Type 2 DM patients at the RSIJ Cempaka Putih Outpatient Unit, with a sample size of 94 respondents selected via purposive sampling. The research instruments included medical record review for blood glucose levels and the 10-g monofilament test for neuropathy detection. Results: The majority of respondents were male (51.1%), with an average age of 58.73 years, and had had DM for >5 years (56.4%). A total of 53.2% of respondents were in a state of hyperglycemia ( mg/dL) and 70.2% of respondents had peripheral neuropathy. Chi-square test results showed a statistically significant association between hyperglycemia status and the occurrence of peripheral neuropathy, with a p-value of 0.001 (p < 0.05). Conclusion: There is a significant association between hyperglycemia and the development of peripheral neuropathy. These findings suggest that unstable blood glucose levels are a major determinant of nerve damage in patients with diabetes, underscoring the need for improved glycemic management and foot care education to prevent further complications.
Effect of rubber ball gripping range-of-motion exercise on hand muscle strength in patients with non-hemorrhagic stroke Zainab Zainab; Ninik Yunitri; Rizki Nugraha Agung; Saharuddin Saharuddin
Lentera Perawat Vol. 7 No. 1 (2026): January - March
Publisher : School of Health Sciences Al-Ma'arif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52235/lp.v7i1.694

Abstract

Background: Stroke remains a major cause of disability worldwide, often resulting in impaired upper limb function and decreased hand muscle strength that limit independence in daily activities. Simple, structured rehabilitation strategies such as range-of-motion (ROM) exercises using a rubber ball may provide practical and cost-effective support for motor recovery, yet evidence regarding their specific impact on hand muscle strength in non-hemorrhagic stroke patients remains limited. Objective: This study aimed to examine the effect of rubber ball gripping range-of-motion exercise on hand muscle strength in patients with non-hemorrhagic stroke. Methods: This study employed a pre-experimental one-group pretest–posttest design conducted in the Stroke Center inpatient ward of RSUD Labuang Baji Makassar. A total of 21 patients with non-hemorrhagic stroke who experienced upper extremity weakness were recruited using consecutive sampling based on predefined inclusion criteria. Hand muscle strength was measured using the manual muscle testing scale before intervention and daily after implementation. The intervention consisted of rubber ball gripping ROM exercise performed twice daily for six consecutive days as part of evidence-based nursing practice. Data were analyzed using descriptive statistics and paired statistical testing with a significance level of α = 0.05. Results: The mean hand muscle strength score increased from 3.10 ± 0.301 before intervention to 4.10 ± 0.301 after six days of exercise. Progressive improvement was observed beginning on the third day of intervention, with statistically significant differences between pre- and post-intervention measurements (p < 0.05). These findings indicate that repetitive ROM rubber ball gripping exercise contributed to clinically meaningful improvement in upper limb muscle strength among non-hemorrhagic stroke patients. Conclusion: Rubber ball gripping range-of-motion exercise demonstrated significant effectiveness in improving hand muscle strength in patients with non-hemorrhagic stroke.
Synergistic Interaction between Older Age and an Abnormal Ankle-Brachial Index in Relation to Diabetic Peripheral Neuropathy Yani Sofiani; Rizki Nugraha Agung; Yana Adharani; Iyar Siswandi; Yohanes Andy Rias
Nurse Media Journal of Nursing Vol 16, No 2 (2026): (August 2026) [In Progress]
Publisher : Department of Nursing, Faculty of Medicine, Universitas Diponegoro

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/nmjn.v16i2.78381

Abstract

A Sequential Explanatory Mixed Methods Evaluation of a Clinical Nursing Practice Guideline for Intracranial Pressure Management  Background: Increased intracranial pressure (IICP) is a life-threatening complication of traumatic brain injury (TBI). Previous studies in Thailand have not evaluated the effectiveness of a structured clinical nursing practice guideline (CNPG) in improving nurses’ knowledge, skills, and confidence, highlighting the need for a rigorously developed and evaluated CNPG.Purpose: This study aimed to evaluate the effectiveness of a CNPG in improving nurses’ knowledge, skills, and confidence in managing IICP among patients with TBI and to explore nurses’ perceptions of its feasibility, optimality, and benefits.Methods: A sequential explanatory mixed methods design was employed. The quantitative phase used a pre–post design and was conducted from February to September 2024. The intervention involved implementing an IICP CNPG among 45 registered nurses in two neurological wards at a tertiary hospital in eastern Thailand. Data were collected using four validated instruments: the Nurses’ Knowledge on IICP Questionnaire, Clinical Skills Observation Checklist, Self-Confidence Scale for IICP Care, and Nurses’ Perception of CNPG Questionnaire. In the qualitative phase, 20 nurses participated in two focus group discussions, which were analyzed using conventional content analysis.Results: Nurses showed statistically significant improvements in knowledge, clinical skills, and self-confidence following CNPG implementation (all p < .001). Perceptions of the CNPG in terms of feasibility, optimality, and benefits significantly exceeded the standard benchmark (all p < .001). Eight qualitative themes were identified, highlighting the roles of evidence-based knowledge, repeated training, structured protocols, interprofessional collaboration, and refresher training in enhancing the consistency, confidence, and quality of IICP care.Conclusion: The CNPG was feasible, effective, and well accepted among nurses, leading to significant improvements in knowledge, clinical skills, and self-confidence in IICP management. Future research should examine its long-term impact and effectiveness across diverse clinical settings.     Background: Diabetic peripheral neuropathy (DPN) is associated with older age and an abnormal ankle-brachial index (ABI). However, no previous study has investigated the synergistic interaction between older age and an abnormal ABI in relation to DPN.Purpose: This study aimed to investigate the independent associations and synergistic interaction of older age and an abnormal ABI in relation to DPN.Methods: This analytical cross-sectional study included 416 individuals with type 2 diabetes mellitus in Jakarta, Indonesia. Older age was defined as age >64 years. DPN was assessed using a combination of sensory testing with a 10-g Semmes-Weinstein monofilament and vibration testing with a 128-Hz tuning fork, with the diagnosis validated by a physician. ABI was assessed using continuous-wave Doppler ultrasound. Chi-square tests, independent t-tests, and multivariable logistic regression were performed with a significance level of p < .05.Results: DPN was identified in 34.9% (n = 145) of participants. Older age (adjusted odds ratio [AOR] = 1.74) and an abnormal ABI (AOR = 2.04) were independently associated with DPN. Older participants with an abnormal ABI were 4.03 times more likely to have DPN than adult participants with a normal ABI (p < .001). A positive synergistic interaction between older age and an abnormal ABI in relation to DPN was identified (AOR = 4.03; relative excess risk due to interaction [RERI] = 2.20; attributable proportion [AP] = 0.55; synergy index [SI] = 3.65).Conclusion: Older age and an abnormal ABI were independently associated with DPN, with their co-occurrence showing a positive synergistic interaction in relation to DPN. Further longitudinal studies with larger samples and relevant clinical factors are needed to confirm these findings. 
Effectiveness of the Biothesiometer and the Comprehensive Diabetic Neuropathy Screening Algorithm (CDNSA) in Detecting Diabetic Neuropathy Saqiraz Miftahayatun Putryana; Yani Sofiani; Rizki Nugraha Agung
Indonesian Journal of Global Health Research Vol. 8 No. 5 (2026): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v8i5.2517

Abstract

Diabetic neuropathy is a chronic complication of diabetes mellitus that often remains undetected in its early stages and may progress to foot ulcers and amputation. Early detection at the primary healthcare level is essential to prevent further complications. This study aimed to analyze the effectiveness of the Comprehensive Diabetic Neuropathy Screening Algorithm (CDNSA) compared with a biothesiometer as the reference standard in detecting diabetic neuropathy among patients with diabetes mellitus at Soromandi Primary Healthcare Center, Indonesia. This quantitative diagnostic test accuracy study used a cross-sectional approach. A total of 64 patients with diabetes mellitus who met the inclusion and exclusion criteria were recruited using consecutive sampling. Data were collected in 2025 through direct clinical assessments using both the CDNSA and a biothesiometer. The CDNSA assessed large-fiber function using a 10-g monofilament and a 128-Hz tuning fork and small-fiber function using pinprick and cold sensation tests, whereas the biothesiometer measured the Vibration Perception Threshold (VPT). Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and Receiver Operating Characteristic (ROC) curve analysis. CDNSA demonstrated a sensitivity of 94%, specificity of 100%, PPV of 100%, NPV of 80%, and overall diagnostic accuracy of 100%. The Area Under the Curve (AUC) was 97.1%, indicating excellent discriminatory ability in distinguishing patients with and without diabetic neuropathy. The CDNSA demonstrated excellent diagnostic performance and may serve as a practical and comprehensive screening method for the early detection of diabetic neuropathy in primary healthcare settings.
The Relationship Between Peripheral Oxygen Saturation (SpO₂), Ankle-Brachial Index (ABI), and HbA1c Levels with Diabetic Neuropathy Yeni Karlina; Yani Sofiani; Rizki Nugraha Agung; Wati Jumaiyah
Indonesian Journal of Global Health Research Vol. 8 No. 5 (2026): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v8i5.2553

Abstract

Diabetic neuropathy is one of the most common chronic complications in patients with type 2 diabetes mellitus and may lead to foot ulcers and amputation. Peripheral circulation disorders, tissue oxygenation impairment, and poor glycemic control are considered contributing factors. To determine the relationship between oxygen saturation (SpO₂), Ankle–Brachial Index (ABI), and HbA1c levels with diabetic neuropathy among patients with type 2 diabetes mellitus. A quantitative descriptive-analytic cross-sectional study was conducted among 60 patients with type 2 diabetes mellitus at Lantana Medika Clinic, South Jakarta. Participants were recruited using consecutive sampling based on predefined inclusion and exclusion criteria. Data were collected through face-to-face interviews, structured questionnaires, direct clinical assessments, and medical record review. SpO₂ was measured using a pulse oximeter, ABI was determined using a sphygmomanometer and handheld Doppler device, and HbA1c values were obtained from the participants' most recent laboratory results. Diabetic neuropathy was assessed using the Comprehensive Diabetic Neuropathy Screening Algorithm (CDNSA). Data were analyzed using descriptive statistics, Chi-square tests, and binary logistic regression. There was a significant relationship between duration of diabetes and HbA1c levels with diabetic neuropathy (p < 0.05). Multivariate analysis identified HbA1c as the most dominant factor associated with diabetic neuropathy. HbA1c and duration of diabetes are significantly associated with diabetic neuropathy. A comprehensive screening approach incorporating tissue oxygenation, peripheral circulation, and glycemic control assessment may enhance the early detection of diabetic neuropathy in primary healthcare settings.
Co-Authors Abdu Rahim Kamil Ari Yulistianingsih Asep Novi Taufiq Firdaus Dewi Anggraini Dhea Natashia Dian Noviati Kurniasih Dian Noviati Kurniasih Erwan Setiyono Fakhrudin Nasrul Sani Fenny Maryani Giri Widakdo Hadi, Muhammad Irma Puspita Arisanty Iyar Siswandi Jumaiyah, Wati Junaidin Junaidin Juwi Athia Rahmini Laela Nur Adzmi M. Khalid Fredy Saputra Melati Fajarini MG Enny Mulyatsih Muhammad Hadi Naryati Naryati Naryati Naryati Neneng Kurwiyah Nia Ayu Puspitasari Ninik Yunitri Ninik Yunitri Nuraeni Nuraeni Rayasari, Fitrian Retno Dyah Wahyuningsih Safruddin Safruddin Saharuddin Saharuddin Saqiraz Miftahayatun Putryana Siti Aisyah Afifah Siti Nafisah Suryani Suryani Wati Jumaiyah Yana Adharani Yani Sofiani Yani Sofiani Yeni Karlina Yohanes Andy Rias Yundari, Yundari Yunitri, Ninik Zainab Zainab